Angelina Jolie had a "preventative double mastectomy" NY Times

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Angelina Jolie had a "preventative double mastecto... - 5/14/2013 3:51:48 PM

outlier

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Here is her statement in the NY Times:

My Medical Choice

"My doctors estimated that I had an 87 percent risk of breast cancer
and a 50 percent risk of ovarian cancer, although the risk is different in
the case of each woman.

Only a fraction of breast cancers result from an inherited gene mutation. Those
with a defect in BRCA1 have a 65 percent risk of getting it, on average. Once
I knew that this was my reality, I decided to be proactive and to minimize the risk
as much I could. I made a decision to have a preventive double mastectomy.
I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian
cancer, and the surgery is more complex.

On April 27, I finished the three months of medical procedures that the mastectomies
involved. During that time I have been able to keep this private and to carry on with my work"

< Message edited by outlier -- 5/14/2013 4:07:41 PM >

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RE: Angelina Jolie had a "preventative double mast... - 5/14/2013 4:03:15 PM

tj444

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I have been thinking about this a bit today.. that would be a tough call to do for those women with the gene.. I personally dislike implants, there are risks with them and they need to be replaced every 10 years or so too.. but I guess that in her case that is still better than the alternative..

I am guessing she is going to do ovarian surgery too, at some point?
I wonder if men get this gene/high risk also..
I wonder if any of her biological kids might have it too..
I wonder if Obamacare will cover the total costs for women with this gene that dont have Angelina's bucks...

I like that she has come forward to encourage women to get tested and consider their options..

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RE: Angelina Jolie had a "preventative double mast... - 5/14/2013 4:14:53 PM

searching4mysir

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quote:

ORIGINAL: tj444

I have been thinking about this a bit today.. that would be a tough call to do for those women with the gene.. I personally dislike implants, there are risks with them and they need to be replaced every 10 years or so too.. but I guess that in her case that is still better than the alternative..

I am guessing she is going to do ovarian surgery too, at some point?
I wonder if men get this gene/high risk also..
I wonder if any of her biological kids might have it too..
I wonder if Obamacare will cover the total costs for women with this gene that dont have Angelina's bucks...

I like that she has come forward to encourage women to get tested and consider their options..

My cousin's wife made this decision two years ago. She had the gene and both her mother and her sister had breast cancer (her mother died of it). They had their "miracle" baby, and when the child was weaned from the breast after about a year she had it done.

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RE: Angelina Jolie had a "preventative double mast... - 5/14/2013 4:18:44 PM

Kaliko

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quote:

ORIGINAL: tj444

I wonder if Obamacare will cover the total costs for women with this gene that dont have Angelina's bucks...

I like that she has come forward to encourage women to get tested and consider their options..

That's what I wonder about, as well. Angelina Jolie has the money to get the best of everything. How about your average woman? Is this truly a feasible option?

I do like, though, that she publicized that she's had it done. The talking about it, the awareness of choices, the knowledge that even those with seemingly charmed lives are forced to make difficult and painful decisions, is productive, I think.

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Post #: 4

RE: Angelina Jolie had a "preventative double mast... - 5/14/2013 4:28:00 PM

fucktoyprincess

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I think it's a personal decision on her part (and given her risk factors, a not surprising choice). I think having lost her own mother to breast cancer at age 56 (or thereabouts) after a 10-year battle, she remembers too well what it was like to see her mother wasting away in front of her. I can understand, after that experience, that she didn't want her children living though that pain, too. She is lucky to have a supportive spouse. I can imagine lots of men not being supportive of this choice when no cancer is yet present.

I am also glad she is publicizing her choice because it does several things. It reinforces the idea that women are not just breasts, that we are, in fact, more than our body parts, and that our lives can go on without this aspect of ourselves - an especially strong message from someone who has made her money from her looks. She also discussed the cost of the procedures in her op-ed and highlighted that she would like to see all women have access to the same tests and surgical options that she has had. Perhaps this will encourage others to both test themselves for the gene, but also to press for proper health care coverage for these various tests and surgeries.

There have been some naysayers (who feel this is too radical to do, or that it is all for publicity, etc). I am not one of them. I think to choose to remove one's breasts in this manner is a difficult choice for any woman. And playing her odds would have been a little too Russian Roulette....why do that when you have a loving family that you want to maximize your chances of growing old with?

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RE: Angelina Jolie had a "preventative double mast... - 5/14/2013 4:32:59 PM

sexyred1

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I applaud her brave decision. I personally know two women who had the same thing done for the same reasons. Neither of them are movie stars with movie star money.

They were able to get the medical services covered by insurance.

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Post #: 6

RE: Angelina Jolie had a "preventative double mast... - 5/14/2013 7:10:25 PM

njlauren

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It must have been so hard, given in many ways how breasts can be/are an important part of a woman's image of herself (before someone rakes me over the coals, that this is societal pressure on women, read accounts of women who have had mastectomy surgery and their feelings about it, and you read about how they feel like an important part is missing, and they don't necessarily talk about how others would perceive them). It sounds like she saw the odds and didn't want to take the chance, as I told my sweetie, she wants to grow old and be able to terrorize her kids when they grow up:).

Actually, I wonder how the course of treatment she did stacks up against waiting for cancer to occur. Leaving out the reconstruction (which would be done if she waited to get cancer, then had a mastectomy, so it is a wash). how much was the preventative surgery versus the radiation/chemo/mastectomy they do when you get it? How much would it cost over the long term, since cancer patients often have to go back later on if it re-occurs? I wouldn't be surprised if what she did , given the odds of her getting it, would be more cost effective then waiting to see if she got the disease then treating it there.

We are kind of in a brave new world with medicine as genetic factors are being better understood and the risk factors better known. The dark side of this may be that instead of doing a genetic scan on someone and thinking about prevention, that health care providers and employers a la the movie "Galactica" will use this to exclude people from care, so for example, if you are a woman and have this gene, exclude them from treating them for breast cancer, and given the greed of health insurers, the same people that when someone gets a major disease finds ways to drop them to save money, and the politicians who live in their Ayn Rand fantasy of survival of the fittest who would let them do this, I sadly suspect it is going to be more the latter than the former.

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RE: Angelina Jolie had a "preventative double mast... - 5/14/2013 7:18:16 PM

Kaliko

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quote:

ORIGINAL: sexyred1

I applaud her brave decision. I personally know two women who had the same thing done for the same reasons. Neither of them are movie stars with movie star money.

They were able to get the medical services covered by insurance.

That's kind of what I was wondering. I don't know anyone who has been through it (that I'm aware of, anyway) and I was wondering if insurance companies cover just the removal or reconstruction as well.

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RE: Angelina Jolie had a "preventative double mast... - 5/14/2013 7:23:10 PM

angelikaJ

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Given how very expensive most chemo-therapy drugs are, I can see how it might be less expensive (barring complications) for them to cover both, preemptively.

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RE: Angelina Jolie had a "preventative double mast... - 5/14/2013 7:32:40 PM

littlewonder

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My former boss had a double mastectomy. She did/does have breast cancer though. Insurance paid for her and are still paying for her reconstruction and all the upkeep that goes with it. She did however, take out an extra insurance that our work offered for those diseases that would cost a lot of money.

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RE: Angelina Jolie had a "preventative double mast... - 5/14/2013 8:26:13 PM

theshytype

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I'm surprised any insurance carrier would cover the charges and not label it as elective.
The article stated in the US, the tests alone cost around $3000 and I really doubt my carrier would cover it.
I'm curious now, though. I don't have a family history of these cancers but it just seems too wide spread for anyone to think they don't have to ever worry.
I lost a friend to breast cancer, someone who was told they were too young to have it.
I can't say for sure if I'd ever elect to take this preventative measure, but I certainly applaud anyone who chooses to be proactive.

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RE: Angelina Jolie had a "preventative double mast... - 5/15/2013 1:34:01 AM

FrostedFlake

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I was considering posting on this. I decided to let someone else bring it up. I didn't want to seem fixated. Too fixated, I mean.

There are certain things I think every woman should be aware of. I'm going to let Suzanne Somers tell you. Note carefully the doctors face in the first few seconds. He is interviewed in the second vid link.

Suzanne Somers' Stem Cell Breast Reconstruction Surgery

Suzanne Somers discusses her stem cell breast reconstruction on Dr. Oz

Cutting to the chase, Breast reconstruction using transplanted fat is not a good idea. Too much dies. But, fat contains about 1/2 a percent STEM CELLS. A centrifuge extracts the stem cells and they are mixed into an equal amount of unspun fat. Now, it can be transplanted with much better results. There are no anti rejection drugs, or the problems they cause, because all the fat comes from the patient herself.

This is an example of what I mean.

Obviously, there are applications other than reconstruction. But in terms of cancer, eventually the mastectomy and the reconstruction will both happen before the patient gets off the table.

Problem. FDA. Write your Congresswoman. Mention that Kotaro Yoshimura alone has done it 500 times. Enough caution, more dispatch.

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RE: Angelina Jolie had a "preventative double mast... - 5/15/2013 12:32:52 PM

fucktoyprincess

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quote:

ORIGINAL: theshytype

I'm surprised any insurance carrier would cover the charges and not label it as elective.
The article stated in the US, the tests alone cost around $3000 and I really doubt my carrier would cover it.
I'm curious now, though. I don't have a family history of these cancers but it just seems too wide spread for anyone to think they don't have to ever worry.
I lost a friend to breast cancer, someone who was told they were too young to have it.
I can't say for sure if I'd ever elect to take this preventative measure, but I certainly applaud anyone who chooses to be proactive.

Reconstructive surgery is required to be covered (by federal and state laws) if it is due to diagnosed breast cancer that was treated by tissue removal. So if you are diagnosed with cancer then it's covered.

But preventative removal and reconstruction is not always going to be covered (if it is even covered at all) by insurance.

What we consider cosmetic/reconstructive surgery is generally covered if it is due to a medical condition - in other words, for example, a burn victim, if they have insurance, in addition to covering the treatment, the insurance will generally cover reconstructive treatments for the skin. It isn't considered "elective" for purposes of coverage just because it is cosmetic. Another example, if you have a deviated septum and have surgery to correct it, the rhinoplasty to reconstruct the nose will generally be covered. Reconstructive procedures can be covered - it depends on why they are being done. Procedures that are done for purely cosmetic reasons with no underlying medical condition that would warrant it are generally not covered.

(I'm not arguing one way or the other about the distinction - I'm just saying this is how it works. So a woman who wants to enlarge her breasts with no underlying medical condition will likely not have insurance to cover this, but a woman who has been diagnosed with cancer and has a mastectomy would have the reconstruction covered).

I'm assuming preventative care like what Jolie did is not explicitly covered, although I think it is clearly more like a medical diagnosis than purely cosmetic. So there may be some laws that need to change.

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RE: Angelina Jolie had a "preventative double mast... - 5/15/2013 1:18:07 PM

MalcolmNathaniel

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She had a 1 in 6 chance of not contracting cancer. Assuming that the doctor she was talking to actually understands statistics. That is a huge assumption.

No doctor who cleaves to the Hippocratic Oath would have performed that surgery "First, do no harm."

And let's face it, he did alot of harm. She had a righteous pair of tits before listening to this quack.

My Aunt Diana died of breast cancer. She had two mastectomies when it was absolutely necessary. To say that I am angry is to say that the sky is kind of bluish.

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RE: Angelina Jolie had a "preventative double mast... - 5/15/2013 1:26:07 PM

mnottertail

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So, for every 12 tits that dont contract it, she loses 2.

I did not see where the 1/6 came from, and I had read somewhere it was an 87% chance she would contract it.

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RE: Angelina Jolie had a "preventative double mast... - 5/15/2013 2:25:57 PM

theshytype

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Yes, I know that reconstructive surgery is covered if due to cancer.
My comments were mostly pointed towards sexyred's and my surprise that those individuals she knew were covered under their insurance.
I would consider what Jolie did as elective. In my eyes, it was not medically necessary. I also don't consider carrying a gene, that may or may not cause something, to be a medical condition. I think it's great if carriers cover it, just surprised, that's all. It seems that insurance companies try to squirm their way out of anything they can.

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RE: Angelina Jolie had a "preventative double mast... - 5/15/2013 2:26:55 PM

TieMeInKnottss

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My mom suffered two different types of breast cancer and spent the last 3.5 of the last four years of her life in some type of chemo or radiation. It was horrible. Those 3 years she had constantly sick, problems with taste, lost her hair, her energy, her ability to enjoy life. She was 62 when she died so she was only 58 when she got the "garden variety easily cured" cancer in her left breast.... I am no scientist but I have noticed that cancer seems to, if eradicated, come back in a more vicious form. As soon as she finished the mastectomy, chemo & radiation about 6 months later she contracted a supremely rare form of cancer in her other breast...It was so rare, the National Cancer Institute had never heard of it and had to do research. Most doctors in the WORLD had never seen it (only .02% of known breast cancer cases are this type)

Anyway...one of her last "gifts" was to be tested for the gene to see if my sister and I could have possibly inherited the gene. Fortunately it turned out that it was not genetic.. I can honestly say I do NOT want to EVER know if I have cancer...after the hell she endured trying to fight it, doing everything to prevent it (my mom insisted on annual mammograms back when doctor's considered them experimental )... Finally after another year -year and a half of chemo, surgery, being used as a guinea pig because of the rarity...the doctors said "we have nothing else to try". She died almost exactly 6 weeks after they stopped chemo.... I may be a horrible daughter for saying this...I would have preferred to see her happy and alive for one year just waiting for it to spread then the 3.5 years of hell she bought as "extra time"

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RE: Angelina Jolie had a "preventative double mast... - 5/15/2013 5:54:44 PM

littlewonder

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I have heard that some insurances will pay for the gene test but will only pay for the masectomy if you actually get cancer. There are some insurances that where you can buy like a rider, an extra benefit to cover such things. Yeah, it costs more but it covers all kinds of things that normal insurance would not cover.

I think it just comes down to what insurance company you have. Read carefully over the plans.

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RE: Angelina Jolie had a "preventative double mast... - 5/15/2013 6:41:39 PM

Aswad

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quote:

ORIGINAL: theshytype

I would consider what Jolie did as elective. In my eyes, it was not medically necessary.

Nothing is medically necessary, other than reviving a patient in the ICU.

However, a number of things are a lot better to deal with right away, rather than waiting to end up in the ICU. There's only so long they can keep reviving you when your body isn't working properly anymore. And from a social perspective, when you're alive and healthy, you're contributing, which as a rule makes you worth the investment.

If the insurance companies could dump their clients once they turn ill, they would. So long as they can't, you can be sure any insurance company allowed to think with the bottom line in mind is going to want to cover this thing. 13% chance of an expense with no payoff. 87% chance of preventing a huge expense and securing continued insurance payments. That's a great deal for the insurance companies.

Of course, this also reminds me how great it is to live with universalized healthcare. It simply hadn't occured to me to consider that this might not be covered. Around these parts, the issue is how to do better, how to improve diagnosis (earlier, more accurate), how to get better reconstructions, etc., and the only thing the patients and doctors need to think about is whether or not preemptive surgery will be the best option for a given patient. Turns out to be more cost effecive for everyone, too, and the doctors treating the patients get more experience because they're not limited to gaining that from people that can afford treatment.

Which wasn't meant politically, but rather as a musing along the lines of "I empathize with what it must be like to worry, in the midst of something like that, about whether or not your insurance plan will cover it".

IWYW,
— Aswad.

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RE: Angelina Jolie had a "preventative double mast... - 5/15/2013 7:05:26 PM

littlewonder

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Yeah, it's sad here that the first thing that comes to our minds when we are ill or possibly become ill is "will my insurance cover this?" and if it doesn't we don't go for the care we need because we can't afford it. It just really makes one take things into account about our lives.

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