title: Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery.
abstract: BACKGROUND
  The efficacy of prophylactic mastectomy and oophorectomy in reducing breast and ovarian carcinoma has recently been reported in high-risk women. Because cost has become central to medical decision-making, this study was designed to evaluate currently existing coverage policies for these procedures.
  
  
  METHODS
  A confidential detailed cross-sectional nationwide survey of 481 medical directors from the American Association of Health Plans, Medicare, and Medicaid was conducted.
  
  
  RESULTS
  Of the 150 respondents, 65% (n = 97) had 100,000 or more enrolled members and 35% (n = 53) had fewer than 100,000 enrolled members. Only 44% of private plans have specific policies for coverage of prophylactic mastectomy for a strong family history of breast cancer and 38% of plans for a BRCA mutation. Only 20% of total responding plans had a policy for coverage of prophylactic oophorectomy under any clinical circumstance. Governmental carriers were significantly less likely to have any policy for prophylactic surgery (range, 2%-12%) compared with nongovernmental plans (range, 24%-44%; P < .001). No significant regional differences for coverage policies were identified (P > .05).
  
  
  CONCLUSIONS
  Significant variations currently exist for health insurance coverage of prophylactic mastectomy and oophorectomy. As genetic testing becomes widespread, more uniform policies should be established to enable appropriate high-risk candidates equal access and coverage for these procedures.
authors.affiliation: Department of Surgery, University of California at San Francisco, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: E S
authors.initials: ES
authors.lastname: Hwang
authors.forename: J P
authors.initials: JP
authors.lastname: Anthony
authors.forename: R A
authors.initials: RA
authors.lastname: Dudley
authors.forename: B
authors.initials: B
authors.lastname: Crawford
authors.forename: W M
authors.initials: WM
authors.lastname: Aubry
authors.forename: L J
authors.initials: LJ
authors.lastname: Esserman
mesh_terms: D024682:BRCA2 Protein; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D019398:Genes, BRCA1; D005820:Genetic Testing; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006291:Health Policy / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D007348:Insurance, Health / Q000191:economics*; D008408:Mastectomy / Q000191:economics*; D009363:Neoplasm Proteins / Q000235:genetics; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery*; D010052:Ovariectomy / Q000191:economics*; D018579:Patient Selection; D012307:Risk Factors; D014157:Transcription Factors / Q000235:genetics
chemical_list: D024682:BRCA2 Protein; D009363:Neoplasm Proteins; D014157:Transcription Factors