By now, you’ve surely heard or read something about Angelina Jolie’s decision to go public with her elective double mastectomy to prevent breast cancer. Her decision – which she announced on May 14 – was based on the results of a blood test that had detected a genetic mutation. She has since announced that she will also undergo a preventative hysterectomy to prevent the chances of ovarian cancer.
The particular mutation is a gene known as BRCA (which stands for BReast CAncer Susceptibility Gene), a gene that is part of a class of genes known as tumor suppressors. According to the National Cancer Institute, there are 2 types of theses genes, BRCA 1 and BRCA 2. Both typically are genes that suppress tumors but when they mutate, they can lead to hereditary ovarian cancer and breast cancer. In their normal state, the BRCA genes help “prevent uncontrolled cell growth”. Once a woman – or a man for that matter – is diagnosed with having a BRCA gene mutation her chances of developing breast and/or ovarian cancer can increase significantly.
Because Angelina Jolie’s mother had died of breast cancer, she decided to have a blood test to see if she carried the gene mutation, which could indicate that she was susceptible to what is known as hereditary cancers – cancers that run in the family. The blood test, which was developed and patented by a company called Myriad Genetics (which also sets the $3,000 price for the test), is very reliable but is not generally covered by insurance companies.
Typically, insurance companies will pay for the medical bills associated with treating a mastectomy if the patient is diagnosed with breast cancer, including breast reconstruction surgery (which Ms. Jolie had). If a patient is in a high risk category – which Angelina Jolie was determined to be after taking the blood test – then it’s likely that an insurance company will pay for a preventative mastectomy like Ms. Jolie had.
But absent getting the test – which is an expensive out-of-pocket cost for most people – unless you already have cancer or have family history of cancer, what are you supposed to do? And that’s why we have a problem with health care in America as it is now. But wait – it’s about to get better.
When all of the provisions of the Affordable Care Act (also know as Obamacare) go into effect, the BRCA test is now going to be covered. Because of some ambiguous language in the original law (which seemed to indicate that only the genetic counseling for BRCA was covered and not the test itself), several federal agencies (including the Department of Health and Human Services) issued clarifying statements saying that the BRCA test would be covered for many private insurance plans when a woman without symptoms has a family history of cancer.
Because consider this. What is more cost-effective for the insurance company and beneficial for their patient customers in the long run? If an insurance company won’t pay for a test and their insured develops cancer, the costs will be far greater than if the insurer had paid for a test and the insured was able to take preventative measures (the way Angelina Jolie did) to prevent cancer. This is the kind of thing that seems incredibly logical to me but always seems to fall under the radar of the decision-makers at health care insurers.
In any event, that we all now are so much more aware of the BRCA gene and a test that can identify it means perhaps that many women (and men, too) may be spared the diagnosis of cancer. And for that, we owe Angelina Jolie a big thanks for sharing a very private experience in a very public way.