Cancer Prevention Surgery: Right For Everyone?
DALLAS (CBSDFW.COM) - Angelina Jolie's decision to have a double mastectomy may prompt more women to look into cancer prevention surgery. At the same time, the film star's announcement is raising questions about what insurance companies cover in these situations, and what they do not.
According her op-ed piece in The New York Times, Jolie made the decision to have both of her breasts removed after genetic testing confirmed that she carries a mutation of the BRCA1 gene, which is linked to both breast and ovarian cancer. This kind of genetic testing is becoming more common. "There are a lot of different types of genetic tests that are available right now," said KRLD medical expert Dr. David Winter with Baylor University Medical Center. "Tests can also be done to look for heart disease and stroke risk."
Dr. Robin Skrine with Harris Methodist Hospital Fort Worth and the Lone Star Breast Center said that the tests do not require a blood draw. A cheek swab is sufficient. "We regularly test patients for the BRCA gene," said Dr. Skrine. "We would test someone like Angelina Jolie, who has a strong family history and whose relative who had cancer is no longer living."
Not all insurance companies cover genetic screening. Some will cover it only if there is evidence that a patient is at risk for a specific disease or disorder.
Laura Adams, a senior insurance analyst with InsuranceQuotes.com, said that health care providers can research what a patient's plan covers and what it will not. She said that women who believe they are at risk may be willing to pay for the test themselves, if it will bring them piece of mind. "I think for many women, having the test and getting some definitive answers early can be very helpful for their health going forward," Adams said.
If the test comes back positive for a mutation of the BRCA1 or BRCA2 genes, Dr. Skrine said that there are several options besides having both breasts and/or ovaries removed. "There are preventative medications that can be taken," said Dr. Skrine. "We use breast MRI to follow these patients, and we follow them clinically."
If a patient decides to have a mastectomy, and that procedure is covered by her health insurance plan, then federal law mandates that the insurance company must also cover reconstructive surgery. "You are entitled to rights under the Women's Health and Cancer Rights Act of 1998," said Adams. "What that does is, it makes sure that women who have had a mastectomy can also have the reconstruction. That reconstruction can take place at the time of the mastectomy or it could be over a series of months."
The Affordable Care Act does not specifically address genetic screening or preventative surgeries, and so coverage is not expected to change once the healthcare law goes into full effect. "There are many parts of the Affordable Care Act that will improve routine tests. This is beyond what's considered routine," said Adams. "I think what the Affordable Care Act will do is give more women access to healthcare in the first place. As more people become insured, they will come to know what their options are."
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