Round 2 of the “Jolie Effect”
By Marija Ringwelski
Teenagers are not the only members of our society that are impressionable to the actions of celebrities. When Angelina Jolie announced 2 years ago that she had undergone a double mastectomy to significantly reduce her risk of developing breast cancer, a 40% increase in referrals by providers for the BRCA1 and BRCA2 genetic testing followed. Last week, Jolie announced she had her ovaries and fallopian tubes surgically removed (a surgical procedure called oophorectomy) to significantly reduce her risk of developing ovarian cancer. So, what are some of the key takeaways from her journey?
To test, or not to test — is that the question?
Like every medical test, this one costs money. Unless you have a personal or family history of breast or ovarian cancer, your health insurer will not pay for it and you are looking at $500 — $5,000 for the BRCA1 and BRCA2 genetic test.
A Practical Tip: You could fib and tell your provider that you have a family history of breast or ovarian cancer — no one will likely challenge you and your testing costs will be covered.
Let’s say you get tested and find out that your BRCA1 and BRCA2 genes are perfectly normal. Good news? Yes. However, only 5% of breast cancers and 10–15% of ovarian cancers are caused by BRCA1 and BRCA2 mutations; therefore, you are still at risk for developing both types of cancers.
In the US, about 12% of women will develop breast cancer and about 1.3% of women will develop ovarian cancer.
In general, your risk of developing breast cancer is much higher than ovarian cancer so you should continue getting regular early breast cancer screening tests (effective early ovarian cancer screening tests currently don’t exist). If you wish to take the same course of action as Jolie and undergo preventative surgeries, your insurer will not cover them so you are looking at up to $50,000 for a double mastectomy (not including reconstructive surgery costs) and up to $20,000 for oophorectomy.
Now, let’s say you get tested and you find out that you are BRCA1 and/or BRCA2 mutation positive. Bad news? Well, this means that you are at higher risk than the average woman in the population of developing breast and ovarian cancer. A BRCA1 positive test means you have 60% — 80% lifetime risk of breast cancer and a 30% — 45% lifetime risk of ovarian cancer. A positive BRCA2 test means you have a 50% — 70% lifetime risk of breast cancer and a 10% — 20% lifetime risk of ovarian cancer. If you wish to take the same course of action as Jolie and undergo preventative surgeries, your insurer will most likely cover it. Thanks to Obamacare, preventative services are inclusive of prophylactic double mastectomy (including reconstructive surgery) and oophorectomy so you should expect to pay little to nothing.
Alternatives to the knife
For breast cancer, in addition to continuing regular early detection screenings, you could also take risk-lowering drugs, such as tamoxifen or raloxifene.
For ovarian cancer, taking birth control pills and breast-feeding have shown to reduce the risk of cancer.
The genetic testing crystal ball
There is an entire world of gene mutations beyond BRCA1 and BRCA2 that are associated with increased risk of cancer and other diseases. In the past 2 years, more than 70 new gene mutations associated with an increased risk of breast, prostate and ovarian cancer, have been identified.
Who do you think will be the next celebrity to propel a genetic test into the spotlight?