Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Kuerer, HM; Hwang, ES; Anthony, JP; Dudley, RA; Crawford, B; Aubry, WM; Esserman, LJ

Published Date

  • June 2000

Published In

Volume / Issue

  • 7 / 5

Start / End Page

  • 325 - 332

PubMed ID

  • 10864338

International Standard Serial Number (ISSN)

  • 1068-9265

Digital Object Identifier (DOI)

  • 10.1007/s10434-000-0325-1


  • eng

Conference Location

  • United States