Annals of Surgical Oncology

, Volume 7, Issue 5, pp 325–332

Current National Health Insurance Coverage Policies for Breast and Ovarian Cancer Prophylactic Surgery

  • Henry M. Kuerer
  • E. Shelley Hwang
  • James P. Anthony
  • R. Adams Dudley
  • Beth Crawford
  • Wade M. Aubry
  • Laura J. Esserman
Original Article

DOI: 10.1007/s10434-000-0325-1

Cite this article as:
Kuerer, H.M., Hwang, E.S., Anthony, J.P. et al. Ann Surg Oncol (2000) 7: 325. doi:10.1007/s10434-000-0325-1

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 edical directors from the American Association of Health Plans, Medicare, and Medicaid was conducted.

Results: Of the 150 respondents, 65% (n 5 97) had 100,000 or more enrolled members and 35% (n 5 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.

Keywords

Prophylactic surgery BRCA1 BRCA2 Breast cancer Ovarian cancer Health insurance 

Copyright information

© The Society of Surgical Oncology, Inc. 2000

Authors and Affiliations

  • Henry M. Kuerer
    • 1
    • 4
  • E. Shelley Hwang
    • 1
  • James P. Anthony
    • 1
  • R. Adams Dudley
    • 2
  • Beth Crawford
    • 3
  • Wade M. Aubry
    • 2
  • Laura J. Esserman
    • 1
  1. 1.Department of SurgeryUniversity of California at San FranciscoSan Francisco
  2. 2.Institute for Health Policy StudiesUniversity of California at San FranciscoSan Francisco
  3. 3.Cancer Risk ProgramUniversity of California at San FranciscoSan Francisco
  4. 4.Department of Surgical OncologyThe University of Texas M. D. Anderson Cancer CenterHouston

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