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With Angelina Jolie's decision to go public with her BRCA1 diagnosis and prophylactic surgeries, many women have questions about genetic testing, preventive mastectomy, and preventive oophorectomy.

In light of Angelina Jolie's recent revelations concerning her efforts to minimize her increased risk of developing breast and ovarian cancer, many women are left wondering what steps we can take to reduce our own risk of developing the same diseases.

Jolie's choice to go public with her medical history and treatment options has stimulated both discussion and debate.

Genetic Testing

Jolie's journey began when she discovered she was positive for the BRCA1 genetic mutation.  According to Myriad Genetics, the patent holder for the genetic test to detect the mutation, women with either BRCA1 or BRCA2 have a highly increased risk for developing the diseases by age 70, up to 87% for breast cancer and up to 44% for ovarian cancer.  In contrast, women in the general population have only an 8% risk for breast cancer and less than 1% risk for ovarian cancer.

As Myriad is the sole patent holder, they are able to dictate the cost of the test. 

At $4000, it's beyond the budget of many women without insurance.

Fortunately, most insurance carriers cover the cost of genetic testing with the average patient paying only up to 10% of the test cost out of pocket. For any patient who will incur an expense of over $375 for testing, Myriad promises to contact that patient directly to arrange payment plans, including a $15 per month interest-free 25-month plan.

Patients who are covered by Medicare can qualify for coverage if they meet the Medicare criteria for genetic testing.

Their doctors should use the Medicare website to determine if coverage applies. Myriad also offers financial assistance for uninsured patients who meet certain medical and financial guidelines and are not covered by Medicare or Medicaid.

Genetic testing is a simple, relatively painless procedure.

BRACAnalysisis a very simple test.  The lab may draw a blood sample or an oral rinse sample may be obtained.  The samples are sent to Myriad for testing and results are returned to your doctor after a minimum of two weeks.

Mastectomy

After receiving a positive test result, Jolie opted for a preventive or prophylactic bilateral mastectomy, undergoing surgery to remove both breasts in order to decrease the risk of developing breast cancer later in life.

This option is rather controversial, but it is a choice for patients who test positive for the BRCA genetic mutations, or for patients who have a strong familial history of breast cancer regardless if they are negative for the mutation.

There are no federal requirements for insurance coverage of prophylactic mastectomy at this time, but some states have opted to mandate coverage.

To determine if your state has this mandate, you can research your state coverage laws with the State Cancer Legislative Database at http://www.scld-nci.net/.  While costs vary depending on the provider and individual complexities of the patient, a bilateral prophylactic mastectomy is estimated to run at least $15,000 and does not include breast reconstruction.

Some hospitals offer discount programs for uninsured patients and some states, such as Pennsylvania, provide free treatment for uninsured or underinsured women.

Despite the name, a simple mastectomy is no simple procedure.

The patient is placed under general anesthesia and the surgeon removes the breast tissue, pectoral fascia (the fibrous membrane covering the pectoral muscle), nipple, areola, and the axillary fat pad (under the arm).  At least a one night stay is required in order to monitor the patient for any complications.

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