Angelina Jolie – difficult decisions, no right answer

By now you’ve undoubtedly heard of Angelina Jolie’s decision to have a preventive bilateral mastectomy because of her predisposition to breast cancer as a result of a strong family history.

The news coverage has increased conversations and caused many women to wonder what they would do if they had the disease or were predisposed to getting it. One issue that looms large as they ponder these health issues is the cost of genetic tests, screening tests and treatment and the extent to which their health insurance will cover them.

Most insurance plans provide some degree of coverage for genetic counseling, especially if there is a family history of breast or ovarian cancer and coverage is increasing as a result of the Affordable Care Act. But just because counseling is covered it doesn’t mean testing is covered and the cost of genetic testing can be significant. The Affordable Care Act requires that most insurance plans provide for genetic counseling and testing without any patient cost sharing for women whose family history indicates a likely mutation. Medicare generally covers genetic testing only if a woman has received a diagnosis of breast cancer.

Even when the cost of counseling and testing is covered the decision to do so is difficult and should only be made after consultation with a primary care provider. It goes without saying that the decision to have a preventive surgery carries risk and the risk must be weighed against the risk of developing a disease and the decision is going to be unique to each person. Angelina Jolie made the decision that she felt was best for her and hopefully her decision will provide the best outcome. The decision to know or not know is difficult. My mother died from cancer and the specific type of cancer she had isn’t treatable so I don’t know that I want to know if I carry the genetic mutation (there’s no genetic testing available at this time for her specific type of cancer so this is all hypothetical). What’s the point of living each day with a black cloud over your head? Maybe its denial or maybe it’s an optimistic view of life, if the type of cancer she had were treatable and I was a carrier, I’d want to know.

You can see how the decision to know is difficult and if you do know the decision about what to do next is even more difficult. GVMH does offer genetic testing for the detection of certain mutations, if you’re interested in learning more, please speak with your primary care provider.

About Craig Thompson

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