Actress Angelina Jolie revealed recently that she chose to have a double mastectomy followed by reconstructive surgery with breast implants, to reduce her chances of dying of breast cancer.  Ms. Jolie, 37, says that she chose a double mastectomy because she tested positive for the mutated BRCA1 gene, which gave her nearly a 65% chance of developing breast cancer.   She explains her choice in an op-ed piece in the New York Times on May 14.  In the piece, Ms. Jolie says she wants other women to know they have choices.

Some readers hailed Ms. Jolie for her bravery and her willingness to speak so openly about such a personal decision.  A few readers, however, questioned the notion of choices.  For the average woman with a fear of cancer, a voluntary double mastectomy is probably not an option because of the cost.  Testing for the BRCA1 gene, genetic counseling, surgery, and breast reconstruction can cost tens of thousands of dollars.  Most insurance companies won’t pay for it if it’s done voluntarily, before the patient first develops any breast cancer.

Angelina Jolie says that for her it was a good choice, even though she had never been diagnosed with cancer.   On the positive side, her very public announcement may help other women make informed choices.   But practically speaking, it’s a choice that will remain out of reach of many women because of cost.   Even under Obamacare, testing for the BRCA gene (about $3,000) and genetic counseling will only be covered only “if appropriate”.  How that will be interpreted is anybody’s guess.

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