- Angelina Jolie revealed that she has had a double mastectomy
- Arthur Caplan: For a woman whose career is tied to her looks, her decision is brave
- He says she has done a real service for women by talking about testing, counseling
- Caplan: Our health care system should find a way to cover costly preventive procedures
By making public her story about how she dealt with the high risk of getting breast cancer, Angelina Jolie has done a real service for women around the world.
By letting us all know about her decision to get genetic testing for susceptibility to breast cancer -- and then, when the results came back positive, to have a double mastectomy
-- she has bravely helped inform women with a history of breast cancer in their families about the need to seek out testing and counseling. For a woman whose career is tied to her appearance, her willingness to talk about her decision provides support to women and their partners who may face a similar difficult choice.
There are other lessons to be learned from her example. For one, reconstructive surgery is better than it was a few decades ago. For another, she chose not to have her ovaries removed, which some women do despite the resulting premature menopause and other hormonal changes.
Just as important is the issue of cost. Many insurance companies do not cover the cost of genetic testing for cancer and other conditions. The cost of the breast cancer test that Jolie had is prohibitive for many women. Some insurance companies won't pay for elective preventive mastectomy. And still others balk at the cost of reconstruction -- denying payment on the grounds that it is merely cosmetic or aesthetic.
Women with breast cancer and ovarian cancer in their families should talk to their doctors about the desirability of testing. If they are found to be at risk, not all will follow Jolie's decision, since even radical double mastectomy is not a 100% guarantee against getting cancer.
My preventive mastectomy: Staying alive for my kids
As the U.S. pushes forward into health reform, 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.
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