Insurance Companies Must Cover Test for BRCA, the “Breast Cancer Gene”

mammogram_xray_cancer_270wBreast cancer and genetics has been in the news a lot lately. In mid-April, the Supreme Court heard arguments on whether the company that developed the so-called “breast cancer genetic test” should be able to patent the genes associated with breast cancer, BRCA1 and BRCA2. The case remains quite controversial, but another, albeit less buzzy, piece of news has the potential to make a huge difference for thousands of families: the genetic test itself must now be covered by insurance companies when a doctor recommends it.

In February, the Department of Health and Human Services released a new FAQ on the Affordable Care Act that makes it perfectly clear the genetic test for BRCA1 and BRCA2 is considered preventative care. When a doctor recommends the test for a woman with high risk for the mutation, her insurance company must cover it. The exceptions are for insurance plans that are “grandfathered,” or existed prior to the ACA’s enactment on March 23, 2010 (grandfathered plans account for less than half of Americans’ employer-paid insurance plans, and will continue to drop as time goes on).

BRCA1 and BRCA2 are known as tumor-suppressing genes, and regulate cell growth. When these genes carry a harmful mutation, a woman’s cells are more likely to engage in cancerous, unchecked growth. Not all breast cancers are caused by this mutation, but some statistics suggest that a woman with the mutation is five times more likely to develop breast cancer than a woman with normal BRCA1 and BRCA2 genes.

The Affordable Care Act provisions cover women who meet certain family history guidelines that imply a higher risk of mutation. Specifically, the mutation is linked to multiple family members who have seen development of breast cancer before menopause, incidences of a type of breast cancer known as triple negative, certain kinds of ovarian cancer, and even ethnic heritage (Ashkenazi Jewish women are much more likely to have the mutation than the general population).

Without insurance coverage, the genetic test can cost thousands of dollars. Only two percent of women will fall into the population of those who meet the guidelines, but it’s still important to recognize that this means the women at the highest risk won’t have to let financial reasons get in the way of being tested.

Having a BRCA1 or BRCA2 mutation is not a guarantee that you will get breast cancer, but it can be an important component of the best early detection practices for women who are at high risk. Women who do receive a positive test result can increase their frequency of clinical breast exams and mammograms, not to mention becoming especially cautious about lifestyle choices like smoking and nutrition.

The Maurer Foundation applauds the inclusion of genetic testing for BRCA1 and BRCA2 under the Affordable Care Act. When it comes to our health, knowledge truly is power, and we support any effort to empower women to take care of themselves and their health!