Bend doctor, insurer discuss double mastectomies

Actress Angelina Jolie 's decision prompts scrutiny

POSTED: 7:40 PM PDT May 16, 2013 
Doctor says need for double mastectomies is rare
BEND, Ore. -

Hollywood A-lister Angelina Jolie went public this week with her story of breast cancer -- she doesn't have it, but the odds are high that she would some day.

Jolie wrote an article published in the New York Times on Tuesday where she revealed she'd recently undergone a double mastectomy, removing both her breasts in a bid to prevent breast cancer. Jolie said she was genetically predispositioned to have the cancer her mother too also battled; and said her risk of getting it was 87 percent.

"A woman as attractive and high-profile as Angelina Jolie, I think it's a good thing that she's doing," St. Charles oncologist and cancer risk assessor Cora Calomeni said  Wednesday about Jolie's decision to go public.

"The risk of women to develop breast cancer over a lifetime who have the gene mutation is up to 87 percent," Calomeni said.

Calomeni said some men and women, including Jolie, have genetic predispositions to breast cancer, greatly increasing their chance of getting the disease.

Without the genetic mutation, the risk of developing the cancer is much less, ranging from 9 to 13 percent.

Calomeni said she discusses and often recommends double mastectomies for patients who screen positive for the mutation.

She said women who've already experienced breast cancer are more likely to opt for the surgery, and so are women who've seen the disease hit loved ones.

"Women who had never had breast cancer, but experienced what their mothers went through and didn't want to go through that, are more willing to have the surgery," Calomeni said.

Genetic testing and the surgery can cost thousands of dollars-- and it's not always covered by insurance.

Pacific Source Health Plans spokesman Tom Ewing said his company covers mastectomy costs, if the patient and physician agree it's necessary.

But he also said the company is more choosy about covering genetic testing, only accepting claims from patients who have seen a certified genetic counselor, and looking closely for proof of disease in family history.

"We do scrutinize those requests ahead of time, to make sure they are complying with the most current scientific evidence," Ewing said.

Calomeni said undergoing double mastectomies for preventative reasons is still rare. Just 5 percent of breast cancer cases are linked to genetic mutations.

She recommends woman and men who have a history of breast or ovarian cancer is the family, especially family members who had male breast cancers or early breast cancer before 50, get the genetic screening.

And getting a double mastectomy doesn't mean you won't get breast cancer -- it just reduces your odds to about 5 percent.

Calomeni said not every woman who has the genetic predisposition elects for the surgery. She said these woman need to be extra-careful to get mammograms and breast MRIs each year.

She said about one in 400 people have the genetic mutation, but Ashkenazi Jewish women have about a one in 40 chance of getting the disease.