🇮🇱 Cancer in Israel

In 2021 the Israel National Cancer Registry recorded 33,145 reportable tumours, 10.1 percent of them in Arabs; about 87 percent, 28,691, were invasive. Age-standardised incidence per 100,000 for all invasive cancers was 233.2 in Jewish and other men, 231.4 in Jewish and other women, 195.0 in Arab men and 175.4 in Arab women, and all four groups are falling. In the same year 11,582 Israeli residents died of cancer; age-standardised mortality was 95.0 in Arab men, 82.7 in Jewish and other men, 66.7 in Jewish and other women and 57.6 in Arab women, so the highest death rate and the lowest both belong to the Arab population, by sex. The registry's own report gives 64.7 rather than 66.7 for Jewish and other women in its trend paragraph, an internal inconsistency reported here rather than reconciled. Five-year relative survival for all invasive cancers rose between the 1996 to 2002 and 2010 to 2016 diagnosis periods from 57.5 to 67.4 percent in Jewish and other men, 64.1 to 72.6 percent in Jewish and other women, 48.3 to 55.5 percent in Arab men and 62.5 to 71.3 percent in Arab women. The registry's own summary of Israel's international position, citing the Global Cancer Observatory, is 40th of the world for incidence and 110th for mortality, which it suggests may reflect heavy use of early detection in common cancers and effective treatment.

Breast cancer, 2018 data: age-standardised incidence 88.7 per 100,000 in Jewish and other women against 65.9 in Arab women, but mortality 14.7 against 16.5, so incidence is about a quarter lower and death rate higher. Mean age at diagnosis was 62.2 against 55.1; 30.5 percent of Arab breast cancer deaths were in women under 50 against 11.7 percent of Jewish and other deaths; five-year relative survival for the 2008 to 2013 cohort was 89 against 84 percent. Incidence has been flat in Jewish and other women since 1996 and rising 1.7 percent a year in Arab women, while mortality fell 2.1 percent a year in Jewish and other women and did not move at all in Arab women. Colorectal cancer, 2020 data: Arab men have the highest rate of the four groups at 26.7 against 23.9 in Jewish and other men, and the disease arrives earlier, with 19 percent of Arab men and 25 percent of Arab women diagnosed before 50 against 11 and 12 percent, and mean age at death 66.7 and 59.0 against 75.1 and 77.2. Lung cancer, 2018 data: Arab men 41.7 per 100,000, far the highest of the four groups, against 26.7 in Jewish and other men; and the Health Minister's smoking report for 2025 puts current smoking at 46.2 percent in Arab men, 27.5 percent in Jewish men, 15.7 percent in Jewish women and 13.0 percent in Arab women, with ultra-Orthodox adults at 10.6 percent. Melanoma, 2019 data: 12.0 in Jewish and other men against 2.0 in Arab men, and the registry presents its remaining melanoma analyses for Jews and others alone because there are only single Arab cases a year.

In 2021 the registry recorded 304 invasive cervical cancers, an age-standardised rate of 5.8 per 100,000 in Jewish and other women and 4.3 in Arab women, and 79 deaths. It ranks Israel 159th of 185 populations for cervical cancer incidence in the Global Cancer Observatory. In the same year pre-cancerous lesions were 84.4 percent of all cervical tumour diagnoses: 1,648 CIN3 cases, with age-standardised rates of 43.5 in Jewish and other women against 7.7 in Arab women, and a steep recent rise in Jewish and other women of 14.1 percent a year since 2017. Screening is in the basket, and the entitlement has widened: women aged 25 to 54 every three years, where until 2021 it was 30 to 54 and before that 35 to 54, and all four health funds have in practice moved to HPV testing every five years. HPV vaccination has been in the school programme for eighth-graders of both sexes since September 2013. Two participation series exist and should not be merged: the registry, citing the national quality indicators programme for 2023, gives 68.7 percent of women aged 25 to 54 screened in the previous three years, while the programme's own 2024 publication gives 66.7 percent for the same age band on a definition that now admits five-yearly HPV testing and self-testing. Mean age at death in 2021 was 63.3 in Jewish and other women and 45.6 in Arab women, on small numbers the registry itself flags.

Mammography every two years for average-risk women aged 50 to 74 began nationally in 1995, after an Israel Cancer Association awareness campaign from 1990; annual faecal occult blood testing from 50 to 74 began in 2005 on the same initiative. In the 2024 quality indicators data, 72.3 percent of women aged 50 to 74 had had a mammogram, 73.8 percent in the general population, 68.6 percent in Arab society and 60.0 percent among the ultra-Orthodox, with 76.8 percent in the top socioeconomic deciles against 65.5 percent in the bottom. Bowel screening reached 65.0 percent nationally, 65.9, 64.1 and 53.7 percent by the same three groups. Cervical screening at the recommended frequency reached 66.7 percent of women aged 25 to 54, with the largest social gap of the four indicators: 82.6 percent in the top deciles against 46.0 percent in the bottom. The indicator that most affects whether screening saves a life is the follow-up: only 65.5 percent of people with a positive faecal occult blood test had a colonoscopy within 180 days, 75.9 percent in the top deciles against 50.1 percent in the bottom, a 25.8 point gap. The programme's own summary of the 2024 data is that screening rose and gaps narrowed. The outcome the bowel programme was built for is visible in the registry: 37 percent of new colorectal patients in 2020 were diagnosed at in-situ or stage 1, double the 19.9 percent of 2000, and the share metastatic at diagnosis fell from 14.6 to 8.2 percent.

The National Health Insurance Law of 1994 entitles every resident to a defined basket. The law says nothing about how new technologies enter it: the Knesset's own research paper notes that no statutory update mechanism was ever set. What the law does is make the basket zero-sum, because section 8(e) forbids adding a service without finding the money for it. So since 1998 the Health and Finance Ministers have appointed a public committee each year, and the procedure has been written down since February 2010, after the Israel Medical Association took the state to the High Court over the absence of published rules. The 2022 committee had four doctors, four economists, four health fund representatives, four public representatives, a chair and a coordinator. The Ministry publishes a call for proposals each January, open to anyone: patients, patient organisations, companies, professional bodies. Applications are worked up through the spring and summer to a uniform standard, deliberately anonymised so the committee cannot tell a company's submission from a doctor's. They are first graded high, medium or low priority on clinical value alone, with cost entering only at the later stages, and decisions are taken by consensus. For solid tumours the ranked list is produced by the Israel Society of Clinical Oncology and Radiation Therapy with the National Council for the Prevention, Detection and Treatment of Malignant Diseases, using the ESMO Magnitude of Clinical Benefit Scale; the Israeli authors of that account believe it is the only annual formal national ranking of new cancer drugs anywhere. Recommendations go to the Health Council, then the Health Minister with the Finance Minister's consent, then the government, and implementation normally follows within two weeks.

The supplement is fixed each year in budget talks between the Finance and Health Ministries, by no formula in law. It was 150 million shekels in 1998, 300 million a year from 2011 to 2013, 500 million from 2017 to 2021, 550 million in 2022 and 650 million in each of 2023, 2025 and 2026; the State Comptroller's own table gives 460 million for 2017 to 2019 where its headline text says 500 million, a discrepancy inside one report that is not resolved here. For 2026 the government's decision had been 550 million and the Ministry held the frame at 650 million, buying 107 technologies for 86,450 patients. Against it, the cost of the basket the funds are responsible for was 56,729 million shekels in 2020 and an estimated 75,474 million in 2024. The Tal Committee of 1999 recommended anchoring a technology coefficient of 2 percent of basket cost in law; the German Committee of 2014 proposed a floor of 0.8 percent; the Ministry itself recommended 1.5 to 2 percent in 2019. None was enacted. The State Comptroller's finding, read from its own report, is that in 21 of the 24 years from 1998 to 2021, about 90 percent of them, the supplement was below 1.5 percent of basket cost, and in four of them, about 15 percent, below 0.8 percent. The Ministry's own published figure is that the allocation varies between 0.8 and 1.7 percent and has stabilised around 0.9 percent. The Taub Center calculates that had the basket been updated since 1995 on the indices the professional committees recommended it would stand at 85 to 96 billion shekels rather than the 56.7 billion of 2020, a cumulative shortfall of about 26 percent, and argues the erosion is what built Israel's private health market. Demand is not the constraint: the Ministry estimates that drugs and technologies worth about 2 billion shekels a year reach the committee's final decision phase having already been judged to meet a clear medical need.

The Ministry of Health's own published account of its committee states that from 1998 to 2023 oncology, including haemato-oncology, comprised the largest number and proportion of approved technologies, a mean of 38 percent, ahead of cardiovascular at 10 percent, neurology at 7 percent and endocrinology at 6 percent. The State Comptroller puts the oncology drug budget at 37 percent of the average annual supplement across 2016 to 2021. Individual years diverge sharply. About half the 2019 budget went to cancer. In 2021 it was 8 percent, which the Israeli authors attribute to pandemic priorities and a large diabetes allocation. In 2025, 124 million shekels of 650 million, about 19 percent, went to oncology, beaten for the first time by infectious disease at about 160 million, of which an infant respiratory syncytial virus vaccine alone took 109 million. In 2026 oncology and haemato-oncology took 52 percent, about 340 million shekels, while infectious disease fell from 24 percent to 1 percent. The other pressure is price: the Ministry reports that the average yearly cost of an oncology drug approved by the committee rose, inflation-adjusted, from about 60,000 shekels per patient in 2009 to over 130,000 in 2018, which it converts in the same sentence to about 18,000 and 43,000 US dollars. The oncology share for 2020, 2023 and 2024 could not be sourced and is not guessed here.

Registration and funding are separate machines in Israel: a medicine can be fully registered and unfunded for years. The routes out, as the State Comptroller enumerates them, are the health fund's exceptions committee, private or commercial insurance, a clinical trial, compassionate supply from the manufacturer, the National Health Insurance Ombudsman, the labour court, personal or pharmacy import, and, rarely, treatment abroad under section 11. Two of these are measured. About 6,000 requests reached the four funds' exceptions committees in total over 2014 to 2017, roughly doubling across those years, with 60 to 65 percent approved, at a cost the funds put at about 200 million shekels a year. And an Israeli study of compassionate use counted 3,284 treatments between 2020 and 2024 using 596 distinct products across 1,361 conditions, 63 percent of them continuations of a study drug, the commonest being belantamab mafodotin at 9 percent and trametinib at 8.6 percent; 77 percent were given in large central hospitals and 49 percent in the Central district, with the Southern district lowest; and 60 percent of the commonest technologies, 13 of 22, later entered the basket, typically after more than two years of compassionate use. The widespread belief that Israel's supplementary plans cover off-basket cancer drugs is wrong: section 10(b)(4) of the law states that a supplementary plan shall not include life-saving or life-extending medicines, and those drugs were removed from the plans in three tranches up to 2010 in exchange for basket additions. That is the job of commercial insurance, which the Central Bureau of Statistics Social Survey of 2017 found 22 percent of the population held. What being left out costs is visible in the 2026 round: lecanemab for early Alzheimer's disease reached the final stage and was excluded at about 160,000 shekels per patient a year after a price reduction, and the ynet report notes those patients will go on paying from their own pockets or through private insurance. The Comptroller's own finding is the one worth repeating: the advantage goes to those with better access to information and services, who can pursue courts, the ombudsman or drug companies, and to those who hold private insurance.

The State Comptroller's May 2022 report is the sharpest published critique and was read here in the original. Contrary to the 2010 procedure, which requires an economic evaluation to accompany an application, economic evaluations are almost never submitted: in the three years 2018 to 2020 the technology assessment division received one, and told the auditors it is not functionally equipped to carry out economic evaluations, in staff, tools or methods. The Ministry's technology forum, all of whose members are Ministry staff, rejected 46 percent of non-drug and 9 percent of drug requests over 2018 to 2021 without those rejections or their reasons reaching the committee or the applicant. The sub-committee that prices submissions has no public representative, admits no journalists where the main committee does, and publishes no protocols; the main committee's protocols were published 109 to 160 working days late over 2018 to 2020. Costings rest on disease registries with no power to compel reporting, and the Comptroller singles out the National Cancer Registry for holding little information on disease stage, which matters because cancer drugs were up to 37 percent of the addition over 2016 to 2021. Ten technologies took 62 percent of the whole addition over those years, 1.7 billion of about 2.7 billion shekels, with the remaining 40 percent spread across about a hundred; 31 percent of technologies added in 2016 to 2021 came at no cost. Despite that concentration the Ministry ran no specific monitoring of how the top technologies were used or what benefit they produced. Israeli oncologists are not uniformly comfortable either: in a survey of 127 of them, 59 percent said they often face dilemmas about recommending unfunded treatments to patients in financial difficulty without private insurance, and 38 percent feel uncomfortable discussing cost with patients. The Ministry's defence is that the model is participatory, transparent, fast to implement and publicly accepted, and one of the longest-running national health technology assessment systems in the world.

The National Health Insurance Law names four funds. At November 2025 the National Insurance Institute's register counted 9,796,872 residents insured under the law: Clalit 4,954,452 (50.6 percent), Maccabi 2,710,338 (27.7 percent), Meuhedet 1,391,017 (14.2 percent) and Leumit 741,065 (7.6 percent). Clalit's share has drifted down from 52.3 percent in 2015 while Maccabi rose from 25.2 percent; the same publication gives Leumit as 7.5 percent in its abstract and 7.6 percent in its tables. Of the cost of the basket the funds are responsible for, the Institute's own table puts health insurance contributions at 44.5 percent in 2024 and the state budget at 49.0 percent, with the funds' own income from members fixed at 6.45 percent, a share legislated in 2008 and raised from the 5.4 percent that applied until 2007. The contribution itself is 3.23 percent of income on the lower band and 5.17 percent above it in 2026, with a minimum of 123 shekels a month. Money is divided between the funds by capitation, and the detail that matters for cancer is what the formula does not contain: the adjusters are age, sex and living in the periphery, and the Institute states that the cost per head excludes sums not divided by the formula, such as spending on severe illnesses. Cancer is not one of the five illnesses reimbursed by actual patient numbers, so a fund that treats more cancer than its capitation share implies carries the difference. Clalit holds about 55 percent of all insured aged 65 and over and 66.3 percent of residents of the periphery against 48.0 percent elsewhere, which is the same point from the other side.

The statutory severe illness list covers oncological disease alongside dialysis, HIV, cystic fibrosis, Gaucher disease, haemophilia, thalassaemia major and tuberculosis, and patients are flagged by a severe illness code granted on a current medical summary. Maccabi's entitlements page states that such patients are exempt from the quarterly co-payment and from co-payment on basket medicines designated for the disease, with a ceiling on other basket medicines and consumables that its own two documents give as 367 shekels a month in the January 2026 tariff and 379 on the April severe-illness page; both are reported here. Leumit's published schedule, current at 1 July 2026, exempts severe illness patients from co-payment for outpatient clinic and institute visits and from co-payment on their disease medicines. The figures differ by fund by more than a little and no single national figure should be quoted: a specialist visit is 33 shekels a quarter at Maccabi and 41 at Leumit; the family quarterly ceiling is 257 against 313.40; the accident and emergency charge, where no exemption applies, is 1,199 at Maccabi and a flat 600 at Leumit. Cancer patients are exempt at both where the attendance relates to their disease. Transport is confirmed at both: a taxi at the full one-way fare or half of both ways, an ambulance to the Magen David Adom tariff with a doctor's approval, a private car at a litre of fuel per 10 kilometres each way, and public transport in full. One thing this page states as an inference rather than a fact: neither fund's tariff contains any charge for inpatient care, day-hospital treatment, chemotherapy, radiotherapy or hospital-administered drugs, which together with the severe-illness exemption is why hospital cancer treatment is described as free at the point of use. That is an absence in two published tariffs, not a statement from the Ministry, whose pages could not be read.

Section 10 of the National Health Insurance Law sets conditions that make these plans unlike private insurance elsewhere: the fund must accept any applicant regardless of health or means, the price must be uniform within each age band, the plan must be self-financing, and it pays for services rather than cash, except for nursing and choice of operating surgeon. Section 10(b)(4) then forbids the plan from including life-saving or life-extending medicines. The common framing that supplementary plans cover off-basket drugs up to a monetary ceiling does not survive reading a rulebook: Leumit's, current at July 2026, handles off-basket medicines as a named-drug discount list of more than 600 medicines with per-drug indications and co-payment percentages, not an open ceiling; ceilings belong to commercial policies. What supplementary cover verifiably adds for a cancer patient is surgery in a private hospital or a public hospital's private service with choice of surgeon, a second opinion including on a pathology report, treatment abroad, genetic testing for colorectal, breast and ovarian predisposition, and a wig up to 1,866 shekels on the higher Leumit tier. Premiums were obtained for one fund only: Meuhedet Adif at July 2026 runs from 12.24 shekels a month per person under 18 to 92.46 at 70 and over. The Adva Center puts supplementary cover at roughly 80 percent of residents, and the Central Bureau of Statistics Social Survey of 2017, quoted by the State Comptroller, found 22 percent of the population holding insurance that covers medicines outside the basket. Household spending on private and supplementary insurance and on co-payments for medicines and treatments reached 15.3 billion shekels in 2020 against 9.6 billion in 2010 at 2020 prices.

From the OECD's own data, Israeli current health expenditure was 7.089 percent of GDP in 2024, 39th of 50 reporting economies, against Germany 12.2 percent, France 11.3, the United Kingdom 11.1 and Japan 10.3. The 2023 financing mix was government and compulsory schemes 65.24 percent, voluntary schemes 12.83 percent and household out-of-pocket 20.49 percent. Two cautions. This is current expenditure and excludes capital formation, so it is not the same series as the Israeli Central Bureau of Statistics national health expenditure figure, which uses a different definition and gives a higher share; the two must not be mixed, and the CBS series could not be retrieved. And no OECD average is published from that dataflow, so none is quoted here.

Section 47A of the Pharmacists Ordinance requires the Director to maintain a register of registered preparations and forbids anyone to manufacture, market or direct the use of a preparation unless it is registered and used in accordance with that registration. The Pharmacists Regulations (Preparations) of 1986 set the procedure. Two arms of the Ministry work in parallel on each dossier: the Drug Registration Department on safety and efficacy, and the Institute for Standardization and Control of Pharmaceuticals on quality. Clinical review goes to the Advisory Committee for Drug Registration, which takes at least two external expert opinions and can accept, accept with modifications, accept with post-approval requirements, reject, or hold for more data. The public drug registry is at israeldrugs.health.gov.il, with the Ministry's own caveat that some of its data may be incomplete or inaccurate. For scale, the advisory committee reviewed 620 new-drug and supplemental-indication applications between 2014 and 2019; in the 2014 to 2016 cohort oncology was the largest single field at 31 percent of applications, and oncology applications carried the highest risk of a major label variation after approval.

The recognised country list sits in regulation 1 of the Pharmacists Regulations: the United States, Canada, any European Union member state, Switzerland, Norway, Iceland, Australia, New Zealand, Japan, Israel and, added by amendment in April 2022, Britain. A narrower list, without Canada, Britain or Israel, governs clinical trials and should not be confused with it. Three routes use the recognition. Section 47A(a2) of the Ordinance provides that where a preparation is identical to a registered one in active substance, form, strength, route, activity and bioavailability and has been approved for marketing by the FDA or the competent European authority, proof of that approval suffices, and the Director must register it within 70 days or give a reasoned refusal. For new drugs the Ministry runs a non-statutory abridged assessment relying on the pre-clinical evaluation already done abroad. And import approval under regulations 5A and 5B requires certificates from a recognised country. The Ministry's own published analysis is blunt about the limit: approval by the FDA or the EMA does not pave the way to automatic approval in Israel, and in a substantial proportion of cases the same clinical data produced different safety and efficacy conclusions, requiring more data or a rejection. The general statutory deadline is 270 days from submission, with a stop-clock while the applicant completes the file. Those are statutory deadlines, not measured performance: no study of observed Israeli approval times, and no head-to-head duration comparison with the FDA or EMA, could be found.

Registration sits under section 47A of the Pharmacists Ordinance; funding sits under sections 8 and 9 of the National Health Insurance Law. The Israeli authors of the ESMO Open account put it plainly: coverage is universal, but not every licensed medicine or indication is reimbursed, and to be provided free a licensed cancer drug must also pass the Ministry's health technology assessment. The separation is visible in the regulator's own paperwork, which sets different forms depending on whether the preparation a hospital pharmacy is importing appears in the basket order for the requested indication. The only quantification that could be found is a proxy: of 3,284 compassionate treatments between 2020 and 2024, 60 percent of the commonest technologies, 13 of 22, were later included in the basket, typically after more than two years of compassionate use. No study of registration-to-reimbursement lag for Israeli oncology drugs was found.

The Public Health Regulations (Medical Experiments on Human Subjects) of 1980 forbid a medical trial on a human in a hospital without written approval, subject to the Declaration of Helsinki, which is annexed to them. Approval requires the hospital Helsinki committee to have notified its approval in writing. Who the approving Director is depends on the trial: for a special medical trial as defined in the Fourth Schedule it is the hospital's own medical director, and for any other trial it is the Ministry's Director-General. Regulation 3B requires the opinion of the Supreme Helsinki Committee, a ten-member national body including two public members and six professors, for any trial touching a person's genetic makeup, any trial involving non-natural fertilisation, and anything else the Director refers. The Ministry's Procedure 14, in force since May 2020, classifies a complete application as special or not within two working days, requires material 15 working days before a meeting and 30 where a quality dossier is assessed, and sets decisions at 60 working days through the central and Supreme Committee route, 45 through the expert-opinion route and 30 for professional handling within the clinical trials department, excluding time waiting for the applicant. Sponsors must carry at least three million US dollars of liability insurance. Registration on the Ministry's own trials register, MyTrial, is a precondition of institutional approval and must be updated quarterly; registration on ClinicalTrials.gov is explicitly not.

The defining feature is a shared haplotype: the markers flanking the variant travel with it down the generations, which is how a recurring variant is shown to be inherited from one ancestor rather than to have arisen repeatedly. Neuhausen and colleagues demonstrated this for BRCA1 in 1996 across 61 families; Laitman and colleagues dated BRCA1 c.68_69delAG to roughly 750 to 1,500 years ago, while Bar-Sade and colleagues had argued from its presence in Iraqi and Moroccan Jewish communities that it predates the diaspora. Both accounts are given here with their methods rather than one being chosen. The practical point is arithmetic: where three variants account for about 90 percent of the BRCA alterations found in a population, a three-variant panel does most of the work of full sequencing at a fraction of the cost. The limits are equally concrete. The same variant occurs on non-founder haplotypes, having arisen independently, and has been found on the Ashkenazi haplotype in families with no reported Jewish ancestry. BRCA1 c.5266dupC, one of the three, is not Ashkenazi-specific at all: it is a recurrent pan-Slavic allele. Carrier frequencies are estimates from particular cohorts that differ between them. And the ancestry categories used in these papers are the self-reported or study-assigned labels of the source publications, described here as such.

The three are BRCA1 c.68_69delAG (185delAG), identified by Struewing and colleagues in 1995 at 0.9 percent in 858 Ashkenazi people seeking testing for unrelated conditions; BRCA1 c.5266dupC (5382insC), at 0.13 percent in about 3,000 unselected Ashkenazi samples in Roa and colleagues' 1996 study; and BRCA2 c.5946delT (6174delT), at about 1 percent in 1,255 Jewish individuals in Oddoux and colleagues' work and 1.52 percent in Roa's 3,085. Struewing's 1997 New England Journal study of 5,318 Jewish volunteers in Washington found 120 carriers, 2.26 percent. The Israeli population cohort is the one that changed policy: Gabai-Kapara, Levy-Lahad, Mary-Claire King and colleagues genotyped 8,195 healthy Ashkenazi Israeli men recruited from health-screening centres between 2004 and 2010, found 2.17 percent carrying one of the three, then enrolled their female relatives. Cumulative risk of breast or ovarian cancer by age 80 was 0.83 for BRCA1 carriers and 0.76 for BRCA2 carriers, and age-specific risk was 3.8-fold higher for carriers born after 1958. The paper also states that in the Ashkenazi Jewish population of Israel 11 percent of breast cancer and 40 percent of ovarian cancer are due to these three variants. The number that settled the argument is that 51 percent of the 167 carrier families had little or no relevant cancer history, and only 35 percent of the high-burden families had ever been referred for genetic counselling, in a country with universal coverage. Compare the large clinic-ascertained prospective cohort of Kuchenbaecker and colleagues, 94 percent recruited through family clinics, which gives breast cancer risk to 80 of 72 percent for BRCA1 and 69 percent for BRCA2: the difference in ascertainment is the whole point.

The entitlement arrived through the ordinary basket mechanism, in Ministry of Health circular 3/2020 of 28 January 2020, the annual basket expansion circular. Its wording is precise and often misreported: the test shall be performed for every woman of Ashkenazi origin irrespective of disease or family history of cancer; Ashkenazi origin is defined by self-declaration; entitlement does not require prior genetic counselling; and entitlement is once in the patient's lifetime. There is no age floor and no grandparent rule, and the commonly quoted criterion of at least one Ashkenazi grandparent comes from clinical and research convention elsewhere, not from the Israeli circular. From mid-2021 through 2024 about 2,350 of 165,000 women tested through population screening, 1.42 percent, were carriers, roughly 650 a year. Clalit's own published evaluation of the first two years found 120 pathogenic variants in 13,502 Ashkenazi Jewish women screened between June 2020 and June 2022, 0.89 percent, with the three founder variants accounting for 96.6 percent of those found, and women who came forward younger and of higher socioeconomic status than eligible women who did not. Clalit has since run a population-scale experiment to raise uptake, randomly assigning members to one of five psychologically framed reminder messages and measuring the effect in its own records. A real-world comparison at Shaare Zedek of 352 newly identified unaffected carriers found that those coming through population screening more often carried BRCA2, 62.9 against 48.7 percent, and less often had a suggestive family history, 40.4 against 61 percent, and reported lower satisfaction with how the result was delivered, but testing route did not predict psychosocial outcomes on multivariate analysis and risk-reducing surgery rates at the recommended age were similar. Since the programme the nine high-risk clinics have agreed one national protocol: annual MRI from 25, mammography added from 30, risk-reducing salpingo-oophorectomy at 35 to 40 for BRCA1 carriers and 40 to 45 for BRCA2, and pancreatic surveillance from 50 for BRCA2. Not everyone is happy: in a survey of Israeli clinical geneticists and counsellors, most felt carriers did not fully understand the implications of a positive result when consenting, and 8 of 28 had initially opposed the programme. Which downstream services are basket-funded, and what the test costs a woman beyond being described in the literature as free, could not be sourced.

The Israeli survey of high-risk families found community-specific recurring variants: BRCA1 Tyr978X in 23 of 892 people of Iraqi and Iranian Jewish origin, 2.6 percent; BRCA1 c.981delAT in 7 of 264 of North African Jewish origin, 2.65 percent; BRCA1 A1708E in 8 of 282 and BRCA2 R2336P in 4 of 180 of Balkan Jewish origin. Among Ethiopian Jews, three recurrent BRCA2 variants were found in 11 breast cancer patients whose mean age at diagnosis was 35.7, with a combined carrier rate in controls of 1.8 percent, 5 of 280, an order comparable with the Ashkenazi figure; the authors called for a culturally adapted screening approach, and the Israel Cancer Association reports that on 1 September 2025 BRCA testing entered the basket for women of Ethiopian descent as well, putting about a million Israeli women in scope, of whom it estimates 42,000 to 47,000 are of Ethiopian descent. The Ministry circular making that change could not be read directly. In 188 consecutive Israeli Arab breast and ovarian cancer patients, 10 percent carried one of 12 pathogenic variants, with detection reaching 32 percent among the ovarian cancer patients; among 68 high-risk Druze, Muslim Arab and Christian Arab families, panel sequencing found only three pathogenic variants and 29 of uncertain significance. Mary-Claire King's Palestinian work found something different again: in 875 women with invasive breast cancer, TP53 p.R181C was the single most frequent variant, responsible for 15 percent of cancers among young-onset or familial patients, and the later risk estimate was 50 percent by age 50 and 81 percent by 80 with, importantly, no excess of paediatric cancer in relatives, so the phenotype is narrower than textbook Li-Fraumeni syndrome and testing children of these families is unwarranted. The decisive Israeli finding for policy is the negative one: across 250 ethnically diverse high-risk Israeli families screened after the common Jewish founders were excluded, 19 different pathogenic BRCA1/2 variants turned up and none recurred often enough to panel for. That argues for sequencing outside the Ashkenazi population, not for testing less. There is also a geographic gap: a survey of every Israeli public hospital found ten dedicated multidisciplinary carrier clinics following about 4,500 carriers, with none in the southern district or the northern half of the northern district.

Laken and colleagues identified APC c.3920T>A (p.Ile1307Lys) in 1997, finding it in 6 percent of Ashkenazi Jews and about 28 percent of those with a family history of colorectal cancer, and showed the mechanism: the change converts the sequence into an eight-adenine homopolymer tract prone to somatic truncating mutation. The InSiGHT position statement of 2023, from a systematic review of 65 papers, records a gnomAD minor allele frequency of 3.6 percent in Ashkenazi Jewish ancestry against under 0.15 percent in European, Asian, Latino or African populations, and about 2.5 percent in Sephardi Jewish individuals; it classifies the variant as pathogenic with low penetrance, a risk factor in people of Ashkenazi Jewish origin who should be tested and offered surveillance, with insufficient evidence in other populations. The commonly quoted odds ratio of 1.7 to 1.8 is now contested. A UK Biobank analysis of 466,315 people with 8,944 colorectal cancers found no significant association in Ashkenazi Jewish participants, odds ratio 0.71, and noted that the established estimate lies inside its own confidence interval, so the study was underpowered rather than contradictory. A large Israeli prospective screening cohort of 13,013 healthy subjects found the variant in 11.8 percent of cancer patients against 4.7 percent of healthy subjects, an adjusted odds ratio of 2.53. It is not in the national programme, whose 2020 circular covers BRCA1 and BRCA2 only; it is tested clinically on Israeli founder panels, where one study found that of 128 people carrying at least one panel variant, 84 carried a low-penetrance variant unrelated to the cancer they had been diagnosed with.

Talia Golan of Sheba Medical Center led POLO, a randomised placebo-controlled phase 3 of maintenance olaparib in metastatic pancreatic cancer with a germline BRCA1 or BRCA2 mutation whose disease had not progressed on first-line platinum. Median progression-free survival was 7.4 months against 3.8, hazard ratio 0.53. The final overall survival analysis found no significant difference in medians, 19.0 against 19.2 months, but the curves separated late, with estimated three-year survival of 33.9 percent against 17.8 percent. The screening ratio, 3,315 screened for 154 randomised, is the practical case for population-level knowledge of carrier status rather than testing at the point of need. Downstream of that, Israel runs pancreatic surveillance in BRCA carriers and has published outcomes: in a multicentre cohort of 180 asymptomatic carriers followed a median four years, four adenocarcinomas and four grade 1 neuroendocrine tumours were found, all in BRCA2 carriers, two of them with no family history of pancreatic cancer, and three of the four cancers were resectable; a second Israeli prospective cohort of 239 high-risk people found pancreatic cancer in 11, 73 percent at an early stage. Breast surveillance changes stage too: in a Sheba cohort of 298 carriers, 19.8 percent of those who knew their status and were under surveillance presented with carcinoma in situ, against 5 percent of those who learned their status only after diagnosis.

Counted against the ClinicalTrials.gov API on 25 September 2026, using a country filter rather than a free-text location search, Israel has 2,255 registered cancer studies of any status, 318 recruiting, and 82 recruiting at phase 1. That is 2.19 percent of the world's 3,741 recruiting phase 1 cancer studies and 1.69 percent of the 18,860 recruiting at all phases, from about 0.12 percent of world population. Per million people, using World Bank 2024 populations, phase 1 recruiting cancer trials run 13.42 in Australia, 11.04 in Denmark, 8.35 in Belgium, 8.20 in Israel, 7.45 in Singapore, 7.31 in Spain, 6.34 in the Netherlands and 5.92 in the United States. So: top five, not first. The caveat is worth printing because it is where most inflated Israeli trial figures come from: the loose location search returns 119 phase 1 recruiting cancer studies rather than 82, and 37 of those have no Israeli site at all, most of them at Beth Israel hospitals in the United States. Six centres do most of the work; of the 82 phase 1 studies, Sheba appears in 51, Rambam 45, Hadassah 37, Rabin and Davidoff 31, Tel Aviv Sourasky 25 and Shaare Zedek 12. Sixty-eight of the 82 are industry-sponsored, and eleven have sites only in Israel, which is domestic investigator-initiated early-phase work rather than site participation. One honest line about the trend: Israel's share of world phase 1 oncology starts fell from 2.59 percent in 2022 to 2.03 in 2023 and 1.60 in 2024 before recovering to 2.07 in 2025, while world starts stayed flat, so the dip is specific to Israel and coincides with the war from October 2023. The panel below shows the other half of the contrast, computed live from the corpus: on oncology publications per head Israel sits in the middle of the field.

Clalit's research institute describes an electronic health record database of comprehensive clinical and administrative data since 2000, with some records to the early 1990s, covering the 4.7 million patients the NEJM paper on its COVID vaccine cohort described as 53 percent of the population; its own public pages give the span variously as 20, 26 and 30 years, so the honest phrasing is decades rather than a number. Governance is unusually explicit: two independent ethics committees must approve any extraction, analysis is done on the institute's premises, and no identified or non-aggregated data leave them. Maccabi's KSM Research and Innovation Center, founded in 2016, reports 2.7 million members, a million biobank samples and 54 partners, with cancer a standing disease registry; its published oncology work includes a breast cancer short-term risk model built on 1,039,212 members and 18,959 diagnoses with an area under the curve of 0.85 for diagnosis within a year, and the external validation and routine deployment of prostate biopsy AI across 11,429 slides. Leumit's research institute works on about 730,000 members and two decades of data. The often-repeated claim that Pfizer bought Israel's individual patient records for vaccine data is wrong and worth correcting: the January 2021 agreement with the Ministry of Health provides for weekly aggregate national surveillance counts, and the famous individual-level study of 596,618 matched pairs was a separate Clalit analysis carrying no Pfizer funding statement. What sponsors were actually buying, in the published account, was an unusually strong capacity to show whether a rapid rollout works.

Hadassah's anti-BCMA product HBI0101, later licensed as NXC-201, was given without cryopreservation in a phase 1 dose escalation. The first 20 heavily pretreated patients had a 75 percent overall response rate with stringent or complete response in half, cytokine release syndrome at grade 1 or 2 only in 90 percent and no neurotoxicity of any grade; the phase 1b/2 report covers 50 patients at the top dose, with responses in 90 percent, 56 percent complete or stringent complete, 70 percent minimal residual disease negative, median progression-free survival 11.0 months, a median 25 days from enrolment to infusion, and the authors' own note that about half of those enrolled would have been ineligible for the pivotal industry trials. Michel Sadelain wrote the editorial on it. At Sheba the in-house CD19 CAR-T programme, started in 2016 with a CD28 costimulatory domain, produced non-cryopreserved cells within 9 to 10 days for 99 percent of 93 patients with relapsed or refractory leukaemia and lymphoma, with 100 percent of leukaemia patients receiving the target dose and response rates of 84 and 62 percent; it has also been used to rescue patients whose commercial product failed release specification. Sheba's Ella Lemelbaum Institute reported its full melanoma tumour-infiltrating lymphocyte series in 2020: 179 patients enrolled, 107 treated, 28 percent of the 103 evaluated responding, and at a median 7.2 years' follow-up half of the responders alive at six years. No reliable published figure exists for what any of this costs compared with a commercial product, and none is given here.

In 1989 Gross, Waks and Eshhar at the Weizmann Institute spliced the variable domains of an antibody onto the constant domains of the T-cell receptor and put the construct into a cytotoxic T-cell hybridoma. The cells killed their target without needing the major histocompatibility complex to present it, across strain and species barriers. Eshhar called it a T-body, and his group's 1993 single-chain design is what modern CARs descend from. Priority is genuinely contested and the page says so: Kuwana and colleagues in Japan built an antibody-variable and T-cell-receptor-constant chimera two years earlier, in 1987, but what they showed was a calcium flux, a signalling readout, not redirected killing. At the Technion, Avram Hershko and Aaron Ciechanover, with Irwin Rose, showed that cells tag proteins with ubiquitin for destruction, work that took the 2004 Nobel Prize in Chemistry. The debt modern drugs owe it is at the level of the pathway rather than the molecule: bortezomib inhibits the proteasome, the downstream protease, not the conjugation machinery the laureates characterised, and PROTACs and molecular glues were invented independently two decades later by exploiting the E1 to E3 cascade the Technion work defined. At the Hebrew University, Yechezkel Barenholz and the clinician Alberto Gabizon combined a polyethylene-glycol coat, remote loading down an ammonium sulfate gradient and a liquid-ordered bilayer to make pegylated liposomal doxorubicin, approved by the FDA in November 1995 as Doxil, the first nano-drug approved anywhere, and still standard in relapsed ovarian cancer; Gabizon's 1994 study measured the difference in patients, a plasma clearance of 0.1 litres an hour against 45 for free doxorubicin. Its review classification was standard, not accelerated, and the current application holder is Baxter. One more, from Yeda, the Weizmann transfer company: a 2007 settlement filed with the SEC names Michael Sela, Esther Hurwitz and Esther Aboud-Pirak as sole inventors of the United States patent on combining an EGFR antibody with chemotherapy, gives Yeda full ownership, and records a 60 million dollar settlement expense in a year when cetuximab sold over 1.3 billion dollars.

Investment in Israeli life sciences and health technology fell about 40 percent in 2025 to around 1.6 billion US dollars, with private investment about 1.45 billion across 165 deals, the lowest in five years, against about 1,800 active companies and 81,000 employees; the sector's own annual report has no count of oncology companies, so any such number is unsourced. Among the specific companies: Insightec in Tirat Carmel makes MR-guided focused ultrasound and its only oncology approval is a 2012 premarket approval for pain palliation of bone metastases, not tumour ablation. Alpha Tau in Jerusalem, built on physics from Tel Aviv University licensed through Ramot at a 2.5 percent royalty, has marketing authorisation in Israel from August 2020 and in Japan from February 2026, two FDA breakthrough device designations, and no FDA approval or clearance. IceCure in Caesarea won a De Novo authorisation on 3 October 2025 for cryoablation of low-risk breast cancer, but only in women aged 70 and over with tumours 1.5 cm or smaller on endocrine therapy, on single-arm evidence of 206 patients with a five-year recurrence of 8.7 percent overall and 2.3 percent in the matching subgroup; the company carries a going-concern warning. Nucleix's bladder EpiCheck was cleared in 2023 for monitoring recurrence alongside cystoscopy. P-Cure's upright proton system was cleared in May 2025 for head, neck and thorax tumours. Compugen in Holon predicts immune checkpoints computationally and validates them, which is how it found PVRIG; its anti-TIGIT antibody is the TIGIT arm of AstraZeneca's rilvegostomig. BioLineRx's motixafortide was approved by the FDA on 8 September 2023 for stem cell mobilisation in myeloma, and the rights now sit with Ayrmid, which also owns Gamida Cell after its 2024 insolvency wiped out shareholders. XACT Robotics shut down in September 2023 and its website still reads like a going concern; MobileODT was acquired by Liger Medical. Teva, the largest generic medicines company in the world, describes itself as maintaining a presence in oncology: its innovative oncology portfolio is mainly bendamustine, at 147 million dollars of US revenue in 2025 and falling.

The Israel Society of Clinical Oncology and Radiation Therapy, a union within the Israel Medical Association, describes itself as bringing together the doctors who treat cancer non-surgically in Israel, and publishes its membership as about 100 specialists and 80 juniors, which is society membership rather than a national headcount. Its chair is Ravit Geva; it holds an annual conference, in Eilat in January 2026, and works with the national cancer council. Its other role is the one that matters most here: with the National Council for the Prevention, Detection and Treatment of Malignant Diseases it produces the ranked list of new cancer drugs that goes to the basket committee. The Israel Cancer Association, founded in 1952, is a registered charity whose own report states that its work is made possible by public donations alone. Its FY2025 appropriations were 47.6 million shekels, of which 41.9 percent went to rehabilitation and support, 29.6 percent to public information, education and early detection and 10.4 percent, about 5.0 million shekels, to research and clinical protocols; it reports more than 55 million shekels awarded to Israeli researchers over the past decade. It initiated the national breast screening programme, which began nationally in 1995 after its 1990 awareness campaign, and the national colorectal programme in 2005, and it funds and assists the monitoring of the breast programme end to end; its mobile mammography units did about 22,600 examinations in 2025. It does not run the cancer registry, which is a Ministry of Health function.

Written into the 2021 report, in the registry's own words: the Global Cancer Observatory figures are estimated, not measured, and the data for Israel there do not separate Arabs from Jews and others, and therefore the rates on that site cannot be compared with the true rates the registry measures. The structural consequence is that there is no official Israeli age-standardised all-cancer rate at all, only four. Stage has been recorded since 2000 but only insofar as the information reaches the registry, and cannot be assigned when there was no surgery, when treatment preceded the first pathology, or when the report came from a death notification; published completeness runs from about 86 percent for cervix and 79 percent for melanoma to about 72 percent for breast and 56 to 77 percent for colorectum. The State Comptroller's finding that the registry holds little information on stage is the same fact seen from the basket committee's side, where it makes the costing of cancer technologies unreliable. The registry's reportable set is tumour registration, not treatment: it records tumour characteristics, and since 2016 oestrogen, progesterone and HER2 status for invasive breast cancer, complete for 67 percent of 2018 diagnoses, but no evidence was found that it records treatment given. It does record vital status, which is what lets it publish relative survival, and it publishes that survival separately by sex and population group, which is a strength rather than a gap. The most recent general incidence and mortality update covers diagnosis year 2021 and was published in August 2024, a lag of about two years and eight months, and the registry warns that a year's first publication is provisional: its 2020 report reflected only about 92 percent of expected cases. Basal and squamous cell skin carcinomas are not reportable at all.

Every Ministry of Health page in HTML form is served behind a challenge that refuses automated clients, so Ministry material was read only where the same document exists as a PDF. Specifically unsourced: whether the registry covers East Jerusalem and non-citizen residents, on which nothing was found either way; the terms on which researchers obtain registry microdata; Israel's quality indices in Cancer Incidence in Five Continents, and note that the volume publishes indices rather than letter grades; an official national HPV vaccination coverage rate by school year, as against health fund and survey estimates; whether Israel has adopted lung cancer screening nationally or moved the bowel screening start age to 45; a registry breakdown of stomach cancer by population group; the oncology share of the basket supplement for 2020, 2023 and 2024; observed rather than statutory drug registration times, and any head-to-head comparison with the FDA or EMA; any measured lag between Israeli registration and basket inclusion for cancer drugs; supplementary insurance premiums at three of the four funds and commercial insurance penetration; what the basket funds for a BRCA carrier once identified, as against the clinical protocol the consortium agreed; and charitable funding of unfunded cancer drugs, for which no scheme or figure could be found. Three conflicts in the sources are reported rather than reconciled: whether the one year with no basket supplement was 2003 or 2004; the State Comptroller's own report giving 460 million shekels in a table where its headline text says 500 million for 2017 to 2019; and the registry's own 2021 report giving Jewish and other women's mortality rate as 66.7 in one paragraph and 64.7 in another, and a 2021 prevalence total of 98,813 against components summing to 96,813.

Before this page the corpus held Sheba, Hadassah, Tel Aviv Sourasky, Rambam, Weizmann, Shaare Zedek, Rabin and Soroka; sixteen Israeli companies; and nine people, all of them chief executives or directors general. The institution pages described the science by name, but Zelig Eshhar, Aaron Ciechanover, Avram Hershko, Yosef Yarden, Moshe Oren, Yardena Samuels, Yechezkel Barenholz, Alberto Gabizon, Ephrat Levy-Lahad, Rachel Michaelson-Cohen, Eitan Friedman, Jacob Schachter, Michal Besser, Gal Markel and Polina Stepensky had no records of their own. Nor did the Technion, the Hebrew University, Tel Aviv University or the National Cancer Registry. Nor did Compugen. The CAR-T record did not say where the chimeric receptor came from, and the liposomal doxorubicin record did not say where the liposome came from. Two corrections to what the corpus did hold were made on the way: Gal Markel's melanoma centre is now at Davidoff rather than Sheba, and XACT Robotics, recorded as a startup, shut down in September 2023. That is a gap in our reading, not in the country, and it is why this round of country pages starts from national sources rather than from our own ranking.