The Health Burden Of The Survivors
Fri, 02/05/2010
Staff Writer

For Jews who escaped Europe during the Holocaust and settled in Israel, the Jewish state really was a kind of Promised Land. Yet from a health perspective, the young country couldn’t immunize them from the physical and mental burdens they carried with them.

In fact, Europeans who immigrated to Israel after the Holocaust were 2.4 times more likely to develop cancer than those who arrived before the war, according to a recent study published in Journal of the National Cancer Institute.

Researchers at the University of Haifa’s School of Public Health compiled a database of 315,544 Israeli Jews of European heritage born between 1920 and 1945. Lital Keinan-Boker, one of the authors of the study, explained that the data came from the Population Registry as well as the National Cancer Registry. Of the more than 300,000 immigrants studied, 57,496 were born in Europe and immigrated to Israel before or during World War II and did not endure the Holocaust; the remaining 258,048 moved to Israel after the war and had been caught up in the Shoah.

The scientists theorize that the biggest risk factors for these post-war immigrants were prolonged periods of both famine and severe mental stress at an early age. But funding is not yet available to test these hypotheses, wrote Keinan-Boker, who also works for the Israel Center of Disease Control.

“We cannot be sure that all of [the immigrants] were in the camps; some may have been hiding away, some in the resistance movements and some — in the USSR — running away from Poland eastwards,” she said in an e-mail interview with The Jewish Week. “The point is that our information is based on existing databases, not on individual data, and this is why we refrained from using the term ‘Holocaust survivors’; we could not be positive that all of the ‘exposed’ were indeed Holocaust survivors.”

In terms of incidence of cancer, the youngest cohort of subjects, those born between 1940 and 1945, seem to have been the most vulnerable. Men in this age group were 3.5 times more likely and women 2.33 times more likely to develop the disease in comparison to their peers. Among those subjects who developed cancer, incidence of breast and colorectal cancers were particularly high, for reasons that would require further inquiry, according to Keinan-Boker. The younger cohort had an increased likelihood of breast cancer in particular; the younger cohort were 2.44 more likely to develop breast cancer than those who did not live through the Holocaust. Colorectal cancer was also particularly common among a slightly older group of survivors — those born between 1935 and 1939; men in that group were 1.75 times more susceptible, and women were 1.93 times more susceptible.

“I cannot explain this based on the data we have, and I think this may deserve further research, based on individual data,” Keinan-Boker said.

The issue of Holocaust survivors succumbing to cancer came into public view in a significant way in 2008 when California Rep. Tom Lantos (D-Calif.), a Holocaust survivor who served 28 years in Congress, died of esophageal cancer.

To Rabbi Tzvi Tauby, a Chabad rabbi who pairs volunteers with New York Holocaust survivors in his iVolunteer program, the results of the recent study are not surprising.

“[The causes] could be many things that we don’t even know about,” Rabbi Tauby said, pointing to forced medical tests and malnutrition as potential causes. “If someone had rat poison a few times and lived through it, it could have permanently affected the body.”

What is much more shocking, he says, is that so many survivors have managed to stay alive and well.

“The thing that is surprising is the longevity of the survivors, the ones that didn’t get sick,” Rabbi Tauby added. “They’re living into their 90s and 100s.”

Cancer is by no means the only disease to affect Holocaust survivors. According to Keinan-Boker, survivors, as others in the elderly population, suffer from osteoporosis, cardiovascular diseases and chronic mental disorders.

Psychological ailments among survivors are a particular cause for concern among doctors and researchers, and many such conditions tend to overlap with physical illnesses like cancer, even extending into the second generation of Holocaust survivors.

“The past traumas could have a direct influence in the immunological system and, of course, in depression,” said Lea Baider, a professor of medical psychology at Hebrew University’s Medical School, who co-authored a journal article about Israeli Holocaust survivors coping with cancer in 1984. “All our extensive research shows that cancer patients of the first and second generation of Holocaust survivors have significantly more depression and more psychological distress than any other cancer group or healthy group.”

The University of Haifa study, which was actually completed in Israel in 2007, was published in the United States in November. Since the initial study, however, more research has been carried out on the link between survivors and cancer, though funds remain minimal, both Keinan-Boker and Baider agreed. Doctoral student Neomi Vin-Raviv, who worked on the initial study, is completing a study for a thesis project on female Holocaust survivors and breast cancer, Keinan-Boker said.

But researchers caution that both money and time are of the essence. “All these people are dying, because of their age and because of their illness,” Baider said.

Keinan-Boker agreed, adding, “If we are interested in learning more about cancer in Holocaust survivors, we need to carry on with our study now, because we may be unable to do that in a couple of years.”