Angelina Jolie’s revelation on The Times’s Op-Ed page that she had a double mastectomy to reduce her risk of breast cancer greatly raises public awareness of the genetic testing she used, as well as concerns about insurance coverage for this kind of testing. Ms. Jolie had a family history of cancer and tested positive for genetic flaws in the BRCA1 gene, which indicates an elevated risk for breast and ovarian cancer. Her doctor estimated that she had an 87 percent chance of developing breast cancer.
Very few women fall into such a high-risk category. But for those who do, the test may be lifesaving. Conducted by Myriad Genetics, the testing costs about $3,000, and surgery and breast reconstruction costs many thousands more for women choosing preventive mastectomies.
The health care reform law requires private insurers to cover genetic counseling and, if appropriate, BRCA testing, without a co-payment, in recently issued policies. Medicare and Medicaid coverage for BRCA tests for high-risk women may differ from state to state. Generally, neither private nor public insurance will cover the tests for women whose family history does not suggest increased risk, and that makes good sense. Test results can be unclear and may lead to unneeded surgery or treatments that have the potential for serious harm.
Even women who think their risk is high should take a cautious approach, said the United States Preventive Services Task Force, a group of independent experts who provide advice to the federal government on health screening measures. They should talk with their doctors to see if genetic counseling is needed, assess the pros and cons of BRCA testing, and consider options for treatment, which might include surgery, drugs that could reduce risk of breast cancer, and close monitoring with mammograms and M.R.I. scans. Women will need to check their policies to see what coverage is provided for preventive mastectomies and other preventive measures.
The New York Times