The echoes of the bombshell Angelina Jolie dropped last week, when she told of her double mastectomy, have reached clinics in Israel. Her story has not only raised public awareness of the BRCA1 mutation, which increases the risk of developing breast cancer by roughly 80 percent, but also the wish by Israeli women to be tested for the mutation.
“When I went to a breast surgeon this morning, the first thing he said to me was ‘Let me guess — you came to ask for genetic testing,’” said A. from Ramat Gan. “I told him I hadn’t and asked why he was asking. He said, ‘That’s what everybody wants now. Since the report, women are coming every day asking for, demanding genetic testing.’”
Jolie wrote in her piece that the cost of the test, $4000, puts it out of reach for most American women (since President Obama’s health-care reform went into effect last February, the test is in the American health-services basket, but only for high-risk women). The test Jolie refers to is apparently not for identifying a specific gene, but rather a broader test of complete genetic sequencing, which makes it so costly.
Most carriers in Israel are Ashkenazi women
In Israel, accessibility to testing for the genetic mutations that cause breast and ovarian cancer (BRCA1 and BRCA2) for women at risk is high. Dr. Etti Samama, head of the Medical Technology Policy Division at the Health Ministry, says that like many other genetic tests, this test is among the services and technologies provided free of charge to women who meet the criteria. The vast majority of carriers in Israel are Ashkenazi women, of whom 2.5 percent carry one of the three mutations responsible for breast cancer, in comparison with 0.3 percent of the general population of women in Israel.
Q. Who is eligible for genetic testing in Israel?
Those eligible are anyone a geneticist recommends for testing. According to Samama, “Genetic tests are in the health-services basket. The question of which ones are included for a specific person and which are not is subject to genetic counseling. If the geneticist recommends the test for a specific woman, then for her the test is included in the health basket.”
Q. Is the genetic testing also included in the health basket?
Yes, on referral from the patient’s general practitioner.
Q. In what sorts of instances can the geneticist refer the patient for the test?
Geneticists have a great deal of latitude when it comes to recommending the test. They will recommend for any woman with a family history of breast cancer, such as women with a first- or second-degree relative who contracted the disease or carries the gene, or women who were young when they developed the disease.
Q. If a woman is simply anxious but has no family history of breast cancer, can she receive the test?
Yes, if she is in the high-risk age and population group (Ashkenazi women), there’s a good chance she will be found eligible for the test. According to the Health Ministry, women who are not Ashkenazi are not in the risk group. According to Samama, about 50,000 women in Israel carry the gene, but only 5,000 have been diagnosed.
There’s a whole generation of Ashkenazi women aged 40 to 50 who, because of the Holocaust, which cut off their family tree, have no idea that the gene is in their family, and they will be the first generation to develop the disease.
Q. If I’m turned down for testing because I don’t fit one of the criteria, how can I still be tested?
You can do the test privately. According to the Health Ministry price list, it costs about NIS 510 (that’s the maximum price; the actual cost may be lower).
Q. Let’s say my test results are positive, Heaven forbid, and I carry the gene. What happens next?
Women who decide to have a mastectomy, as Angelina Jolie did, are eligible for the operation, together with reconstructive surgery, as part of the health-services basket. Women deciding together with their physicians on close monitoring are eligible for annual MRI testing in place of a mammography. The MRI test is worth NIS 4,000, but through the HMO it costs about NIS 100. Women in that situation are eligible from age 25 or five years below the age of the relative who developed the disease, whichever is earliest. In addition, they will also receive a mammography and be examined by a physician.