The costs of having a BRCA mutation are not only financial, there are also physical and emotional costs. At this time, there are basically three options for a woman who tests positive for a BRCA or other known HBOC (hereditary breast and ovarian cancer) mutation. The first option, is to do nothing. The second is to monitor their breasts and ovaries with increased medical surveillance via mammograms, breast MRI, and ultrasound. The third option is to have prophylactic surgery to remove the breasts and ovaries. It is nearly impossible to compare actual costs of the procedures involved due to the wide-ranging variables of insurance coverage, access to care, and geographic location, however from my own experience, I can say the overall costs financially and mentally are far less by choosing to have prophylactic surgeries.
Statistically, a BRCA+ woman has roughly a 60-80+% chance of developing breast cancer in her lifetime. If she goes with option one and does nothing, she very likely will have a cancer diagnosis. Without frequent monitoring the odds of catching the cancer at an early stage are slim. Which would most likely result in surgery on the breasts, either a lumpectomy or mastectomy and chemotherapy. Some may also require radiation treatment. Physically, these treatments take a huge toll on the body and can greatly affect how the body is able to heal from the subsequent surgeries. The mental costs of a cancer diagnosis are probably the most difficult to handle. The uncertainty and fear are unbearable at times.
The second option of increased surveillance may seem like the easier path, but it has many costs as well. A BRCA+ woman is recommended to have alternating mammograms and MRI testing every six months, starting at age 30, if possible. Many times, these tests will result in call backs and frequent biopsies. These tests are very expensive from a financial standpoint. I had one mammogram and one breast MRI prior to having prophylactic surgery and the costs were enough to meet my annual insurance deductible. These tests can also cause “scanxiety” which refers to the frequent and anxious waiting periods for results knowing you are at high risk for developing breast cancer. I also had concerns about the long-term health effects of being exposed to frequent testing, especially the MRI. The best-case scenario of the increased surveillance is early detection. Which means hopefully if cancer develops it will be caught in very early stages, but again, it may require chemo or radiation treatments in addition to surgery.
The option of prophylactic surgery may seem expensive at first, but in the long run I believe it ends up being the most cost effective, financially and emotionally. If the surgeries are timed right, most can get all the necessary stages of surgery within the year and only need to meet one annual deductible. This includes the mastectomy and any reconstructive procedures. Once a BRCA+ woman has had her breast tissue removed, she will no longer require the frequent testing, only a clinical breast exam from her physician every six months. The only time testing would be needed is if there was something suspicious, and best of all her high risk of developing breast cancer will go down to around 3-5%, which is less than the average population. The surgery alone will end up costing far less than cancer treatment. Also, it means going in to surgery with complete health, which can dramatically reduce the risk of complications and improve aesthetic outcomes when choosing to have breast reconstruction. While there may be some initial anxiety about having the surgery, the relief and peace that can be achieved afterwards, especially with quality breast reconstruction is priceless!
A recent article suggested the “Angelina effect” has cost the healthcare system $14 million in unnecessary tests.
The article stated, “In sum, this looks like a case of celebrity-induced over testing, the researchers wrote: “Celebrity announcements can reach a broad audience, but may not effectively target the population that would benefit most from the test.” According to the article, in the two weeks following Angelina Jolie’s famous piece in the New York Times, BRCA testing rates rose 65% costing about $3,000 per test. The researchers estimate this Jolie-inspired surge led to $14 million in health care spending in those two weeks alone.
It is very possible the attention Angelina Jolie brought to BRCA mutations and her decision to have prophylactic surgery may have led many women who were not necessarily in the high-risk category to request testing. However, it does not mean all of those women were actually tested. Women and men have to meet certain criteria to qualify for BRCA testing, especially for those with insurance coverage. A strong family history, early age of onset of cancer in other family members, type of cancers diagnosed, and other factors. Furthermore, if there is a known BRCA mutation, the testing would not be as costly, as a full panel test is not required and the individual could be tested only for the specific mutation their family member has.
The costs of a BRCA+ woman who chooses to have the testing and eventually prophylactic surgery, will very likely save the healthcare system a significant amount of money and more importantly, it will save lives.