Angelina Jolie revealed today that she had a preventive double mastectomy after discovering she carried a “faulty” gene that made her highly susceptible to breast cancer. Now, she’s encouraging other women to seek out information and consider testing for the same genes—namely, mutations on genes called BRCA1 and BRCA2, which have been linked to the development of breast cancer. But how necessary—not to mention affordable—is this?
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The 37-year-old Oscar-winning actress wrote an op-ed in today’s New York Times announcing her decision to undergo a double mastectomy after losing her mom to ovarian cancer and finding out that Jolie herself had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer due to a mutation of the BRCA1 gene, which predisposes her to both diseases.
There’s no denying that the numbers surrounding breast cancer are scary: More than 230,000 women are diagnosed in the U.S. alone each year and nearly 40,000 die as a result. Jolie, a devoted mother of six, made the difficult decision to undergo surgery in order to reduce her odds, which is now estimated to be just 5 percent. Rather than remaining private about her experience, Jolie is urging other women to learn about their own breast cancer risk and make informed choices along with their doctors.
“But I am writing about it now because I hope that other women can benefit from my experience,” she explains in her op-ed piece. “Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.”
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While the idea of a blood test to uncover your odds sounds like a good one, it comes with a hefty $3,000-plus price tag that is a financial impediment for many women. However, according to Marisa Weiss, M.D., founder of breastcancer.org, in certain instances insurance plans cover this type of genetic testing and elective double mastectomy surgery.
“If you have a family history that is consistent with this gene malformation, and your doctor and genetic counselor agree that you are at high risk, most insurance companies will cover the cost,” notes Dr. Weiss. But if you don’t have insurance or are not deemed at a high enough risk, these costly procedures would be out-of-pocket.
That said, Weiss points out that genetic testing isn’t for everyone.
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“The testing is only recommended if there is a significant family history of breast cancer,” she explains. “That includes having more than one close relative with the disease, their onset happening at a young age or a relative who has had it on both sides.” Genetic testing can also be recommended if a family member had ovarian cancer (which predisposes women to breast cancer), if a male in the family had breast cancer or if the woman is of Jewish descent from Eastern Europe (Ashkenazi) where these gene mutation rates are higher.
Even if you do test positive for the BRCA1 or BRCA1 gene mutation, keep in mind that a positive result only reveals a person’s risk of developing cancer—it can’t tell you whether you will actually go on to develop the disease. What’s more, testing positive for the genetic mutation doesn’t mean a double mastectomy is your only option, according to Weiss. “Everybody who has the gene malformation needs to be watched every six months with MRI and mammography,” she says. “There are also medications like Tamoxifen that can lower your risk and lifestyle changes like maintaining a healthy weight, not smoking, limiting alcohol and exercising regularly that can help.”
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Bottom line: Arm yourself with information. Talk to your primary care practitioner about your personal and family disease history to get a better picture of your breast cancer risk and whether genetic testing makes sense for you.