Angelina Jolie, Genetic Testing, And The ACA

Dr. Otis Brawley, the chief medical officer of the American Cancer Society, is on the record with a quick post on Angelina Jolie’s startling announcement in a New York Times op-ed that she has had a prophylactic double mastectomy to cut her inherited risk of breast cancer. Jolie’s mother, actress Marcheline Bertrand, died of cancerĀ at age 56, and Jolie found through genetic testing that she carries the BRCA1 gene.

(Photo by Oli Scarff/Getty Images)

Brawley, who has been an outspoken critic of overtesting, answers many important questions that Jolie’s decision raises.

Should all women have the genetic test? No, says Brawley, but they should all have a conversation with their doctors.

This does not mean every woman needs a blood test to determine their genetic risk for breast and/or ovarian cancer. What it does mean is women should know their cancer family history and discuss it with their regular provider. If appropriate, they should be referred to and have the opportunity to discuss their risk and their options with a genetic specialist.

Are insurers required cover the genetic tests? What about the preventive surgery? Brawley says:

Insurance plans created before the passage of the Affordable Care Act are not required to cover the costs of genetic counseling, testing, and any surgery to reduce the risk of breast cancer. Under the Affordable Care Act, new plans are required to cover the costs of counseling and testing for breast cancer risk. There is no such mandate for the coverage of surgery.

Brawley points out that only a small number of breast cancers are linked to genetic risk factors, but women, like Jolie, who are at high risk should know it. He warns women to proceed cautiously and get a second opinion before deciding to have a preventive surgery. “Nonetheless, after careful consideration, this might be the right choice for some women,” Brawley writes.