The Noga Clinic is a multi-disciplinary clinic for women who were diagnosed with a mutation in the BRCA (1 or 2) gene. The clinic opened in Shaare Zedek Medical Center in 2007 and was the first of its kind in Israel, and one of the first in the world, to offer comprehensive care for women at risk for breast cancer and ovarian cancer due to the BRCA gene mutation. This mutation is especially common in Israel - approx. 1 in every 40 women of Ashkenazi origin (2.5%) is a carrier. 
The uniqueness of the clinic is that it provides all necessary tests and counseling - gynecology, surgery, genetic and imaging - in one place in two concentrated examination days

Why Noga Clinic?
Carriers of the BRCA gene mutation face complex decisions about preventive surgeries (preventive mastectomy and preventive oophorectomy). These are accompanied by decisions about alternative hormonal treatment and about fertility management (going on the pill, IVF etc). The issue of the woman's self-image is also important and an integral part in the decision making process. 
At Noga Clinic, in addition to the routine follow-ups, the women receive answers to questions regarding treatment, can consult with the clinic's coordinator Dr. Mor and can have a counseling session with all the relevant experts before any difficult decision is made. 
Noga Clinic was founded as a national clinic and any carrier who wishes, may conduct her follow-up at the clinic regardless of her geographical origin. Over 400 women are monitored at the clinic. 
We are constantly adding new services according to medical developments and arising needs, such as PGD counseling and testing for carriers who wish to prevent the mutation's transfer to next generations, and the addition of a service for evaluation and treatment for menopausal problems resulting from an oophorectomy at a young age. 

Statistically, carriers are at a 70% risk for developing breast cancer and a 50% risk for developing ovarian cancer during their lifetime (compared with about 10% and 1/5% in the general female population). Therefore there is great importance in early detection of the mutation and routine monitoring. It has been proven that a proper monitoring and prevention program reduces the chances of illness and death among carriers by 90%.
The monitoring and prevention programs have been proven to be highly effective, but they are not simple. The monitoring for carriers over the age of 25 includes a manual breast exam twice a year, mammography scan once a year and a breast MRI once a year, half a year apart. The monitoring for ovarian cancer includes a gynecological exam, vaginal ultrasound and a blood test (CA-125) twice a year. During these sessions the women are also informed about surgeries that can reduce the risk of illness such as a mastectomy (with or without reconstruction) and an oophorectomy before the age of 40. These surgeries reduce the risk of breast cancer by about 90% and the risk of ovarian cancer by about 95%. An oophorectomy between the ages of 35-40also reduces the risk of breast cancer by about 50%.

The clinic was founded following Dr. Mor's PhD thesis. Her research focused on defining the needs and challenges facing carriers today. The participants described many difficulties in keeping up with the recommended monitoring program. Tests were done at different locations by different medical professionals and were time consuming. The different experts were often not coordinated and sometimes even gave conflicting advice. 
This situation required an immediate response. The purpose of the genetic screening is to enable an effective cancer prevention process for those at high risk. Our solution was a "one stop shop" - a clinic focused on carriers which will provide concentrated and coordinated, multi-disciplinary and up-to-date monitoring and treatment.

Following the founding of Noga Clinic, efforts are done to establish similar clinics in other hospitals across Israel. We see it as our mission to continue innovating and excelling in this field, including providing care for women whose HMO won't cover the cost of care in a designated clinic such as Noga.