Choice and opportunity
MUTATIONS in the BRCA1 and BRCA2 genes are able to indicate risk of female breast and ovarian cancers. These genes produce tumour suppressor proteins, and mutation affects the ability of the proteins to repair damaged DNA. Thus, cells are more likely to develop additional genetic alterations that can lead to cancer.
These genetic mutations can be identified through a screening test – together, BRCA1 and BRCA2 account for about 20% to 25% of hereditary breast cancers and 5% to 10% of all breast cancers.
Stories such as Angelina Jolie’s play a great role in informing women not only to care for themselves, but to do so in the best possible way. In her New York Times article My Medical Choice, she made it clear that the double mastectomy she underwent was the best choice for her due to individual circumstances: mutation of the BRCA1 gene ( which put her at an 87% risk for developing breast cancer) and considerable family history of the disease.
Surprising liability
Dr Patricia Gomez, consultant breast surgeon at Pantai Hospital Kuala Lumpur, says preventive double mastectomies such as the one Jolie opted for are win- win for insurance providers and gene carriers.
“Jolie had a high chance of getting breast cancer by the time she turned 80 – if she had gotten cancer in her 50s or 60s, she would have spent much more on treatment than the cost of her preventive procedure,” Dr Gomez explains.
However, she reveals that this is far from the current understanding and practice of insurance providers. In fact, breast reconstruction post- mastectomy is considered cosmetic surgery and is therefore not covered by most insurance plans.
“Though insurance companies in Malaysia have a long list of diseases they cover, this list is about 30 years behind the rest of the industry and does not reflect the exponential advancement of medical technology,” says Dr Gomez.
“This is why although there are facilities for genetic screening in Malaysia, we don’t tell our patients to do it – once you have done the test, you must disclose this information to insurance companies and they can blacklist you and your family members as there is no legislation to stop them from refusing coverage.”
Exercising freedom
The old adage “prevention is better than cure” rings true in cases such as these – but if you were to opt for a preventive mastectomy like Jolie, the money would have to come out of your own pocket. The cost can be anything from RM50,000 to RM100,000 – which is still less than what one would spend on years of cancer treatment.
Although Malaysian women in the low- and middle- income bracket are not privy to the same opportunities as wealthy celebrities such as Jolie, the actress sends important messages of early detection, prevention and specific treatment in her article.
Explaining that her decision was one made with advice of medical experts, including doctors, surgeons and naturopaths, Jolie wrote, “There is more than one way to deal with any health issue. The most important thing is to learn about the options and choose what is right for you personally”.
Reconstruction of the breast postmastectomy is considered cosmetic surgery and is not covered by most insurance plans.