“My Medical Choice”, is a recent Opinion piece in the New York Times. It is an article written by Angelina Jolie in which she shares her story about choosing to have a preventative mastectomy.1 Also called a prophylactic mastectomy, she chose to have this surgery because she was diagnosed with the BRCA1 gene. She’s speaking out about this to spread her story in hopes that she may encourage other women be proactive.
“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.” -Angelina
Prophylactic mastectomy is a surgery that only women with a very high risk of breast cancer should consider. Contributing factors to being high risk are women with a family or personal history of breast cancer, and women who carry the abnormal genes known as BRCA1 or BRACA2.2 According to Angelina’s article, her risk was an 87% chance of developing breast cancer and a 50% chance of developing ovarian cancer.
People are calling her “brave” for speaking out. I assure you, she is brave; it’s tough to share personal information such as this, even if you aren’t a celebrity. Her message is one of great intention too, however I believe she has missed the mark. The cost of testing alone for BRCA1 and BRCA2, is more than $3,000 (in the US) while the cost of the surgery is over $15,000 and this does not include the reconstructive breast augmentation. And of course these costs “may or may not be covered by insurance”, most likely not since it would all be considered elective procedures from a “proactive” standpoint.3
I am glad Angelina is brave, and telling her story. The downside is that she is most likely only reminding the majority of American women that we don’t have the same means to pay for health care as someone of her income does. Her message will help a limited number of women who can afford to be proactive as she has. However, most of us can barely afford our health insurance premium let alone elective genetic testing. With our current health care system, the rest of us will have to sit and wait until we receive the cancer diagnosis to do anything about it. It would be great if Angelina could direct her message to the insurance companies and health care providers to advocate the preventative screenings for cancer, including genes such as this to be covered by insurance.
I may be out on a limb here, but what we need are people of Angelina’s status to speak out about the health care system’s need for reform. The Affordable Care Act is only the first step in a lengthy process of changing the system to catch up with the rest of the industrialized world’s health care systems. With more advocates for reform from well known people, we may be able to rise from our current rank as 37th in the world for health care (in case you don’t know, that’s a terrible rank4.) As CNN’s contributing writing Arthur Caplan says it best, “Jolie’s story reminds us that we need to adjust our health care system from one that pays for treatment to one that also covers prevention.”5
1. Jolie, A. (2013) My Medical Choice. New York Times Opinion. Retrieved from http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html?_r=3&
2. Mayo Clinic. (2011). Prophylactic mastectomy: Surgery to reduce breast cancer risk. Retrieved from http://www.mayoclinic.com/health/prophylactic-mastectomy/WO00060
3. BlueCross BlueShield of Tennessee, Inc. (1998-2013) PROPHYLACTIC MASTECTOMY. Retrieved from http://www.bcbst.com/learn/treatment-options/prophylactic-mastectomy.shtm
4. WHO (2013) World Health Organization Assesses the World’s Health Systems. Retrieved from http://www.who.int/whr/2000/media_centre/press_release/en/
5. Caplan, A. (2013) Angelina Jolie’s brave message. CNN Opinion. Retrieved from http://www.cnn.com/2013/05/14/opinion/caplan-angelina-jolie-mastectomy/index.html