In the late 1990s, several studies including those from the National Institutes of Health (NIH) discovered that a particular alteration in the breast cancer gene called BRCA1 was present in 1 percent of the general Jewish population. Follow-up studies estimated the cancer risk associated with this alteration as well as two other alterations and that were reported to be present in the Ashkenazi Jewish population. The findings indicated that Ashkenazi Jewish women have a much greater risk of developing early onset hereditary breast cancer as a result of a defective BRCA2 or BRCA1 gene than women in the general population. The results of this report also suggest that these two common BRCA1 and BRCA2 mutations may account for over 25 percent of all early onset breast cancer cases in Ashkenazi Jewish women.
BRCA1 and BRCA2 are human genes that belong to a class of genes known as tumor suppressors. In normal cells, they help ensure the stability of the cell’s genetic material (DNA) and help prevent uncontrolled cell growth. Mutation of these genes has been linked to the development of hereditary breast and ovarian cancer; it has also been linked to the development of several types of cancer in men. While one of these is breast cancer and is rare in men, those men with a BRCA2 mutation carry a risk 80 times that of other men. The danger is much greater with prostate cancer. The average man’s chance of being diagnosed with prostate cancer during his lifetime is 1 in 6. But men with the BRCA2 mutation can have a risk as high as 1 in 3.
Melanoma is another cancer affected by BRCA gene mutations, which already occurs twice as often in male BRCA carriers as in other men. Other cancers that are found more often in men with BRCA mutations include pancreatic and stomach cancers. All these cancers tend to develop at a younger age than expected.
While the identification of these mutations was hailed as a tremendous breakthrough, it raised several concerns as well. Though the increased risk is great, these and other genetic mutations are detectable. Heightened awareness often leads to early detection of the cancers and significantly increases the effectiveness of the treatments. However, many people have been reluctant to test for these genetic mutations.
The fear of being denied coverage because of a genetic mutation has led many to ignore the possibility of taking action to reduce their risk and protect them should a diagnosis occur in their lifetime. Add to that that many people believe their major medical insurance will cover the costs associated with cancer.
However, even if the patient has health insurance, there will most likely be deductibles, co-pays, and annual or lifetime caps to pay. According to the American Cancer Society’s Cancer Facts and Figures, 2008, the total financial impact of cancer includes direct and indirect costs. The ACS estimates that one in five people who are diagnosed with cancer use all or most of their savings because of the financial cost of dealing with cancer.
Cancer insurance, a supplementary insurance program, can protect people from severe financial losses. Conceptually, it is very simple. Benefits are paid directly to policy holder regardless of any other insurance one may have. People can then use the benefits to help pay for all of the extra costs associated with the disease which includes both medical and non-medical expenses associated with a diagnosis of cancer.
“Most insurance policies only cover the medical costs of cancer treatment,” said Janet Lojeski of JRL Insurance Group who has been helping to insure families for more than 10 years. “Non-medical costs make up 66 percent of the costs associated with cancer that are not covered by Major Medical Insurance. These are costs patients and their families must pay for out of pocket.”
While medical expenses include physician and hospital charges, medications, surgery, and treatment costs, non-medical expenses include loss of income, transportation, lodging, child care, and increased living expenses.
“This is where cancer insurance can help,” said Lojeski. These supplemental policies may be purchased individually or, in some cases, through an employer’s benefits program. It is sold in three ways: individual, single parent with children, and a family plan that is defined as a couple with or without children up to age 19. If children are carrying 12 units in college, they are covered up to age 23.
Cancer insurance is guaranteed renewable for life, and only the policy holder can cancel coverage. Premiums do not increase due to age, and cancer benefits are never reduced. No one is ever singled out for a rate increase, and rates are not based on age.
“A medical exam is not required,” said Lojeski. “There are only five questions on the application, and there are few restrictions.” The policy must be in place before the individual is 65, and while someone with cancer won’t be able to buy a cancer policy, if a person has had cancer, and is five years cancer free, he or she is eligible for coverage. In addition, the consumer must have medical insurance since this is supplemental coverage.
If you are considering purchasing this insurance, it s suggested that you ask a few questions: What does the policy pay for? Does the policy offer increased benefits after an extended hospital stay? Are cancer-related illnesses covered? Will travel expenses be covered? Will your medical policy pay duplicate benefits? Is there a waiting period?
Genetic testing will determine whether you carry the gene and are at risk. With the recent passage of the GINA (the Genetic Information No-Discrimination Act), those who may have tested positive for specific genetic mutations and have not been diagnosed with cancer are protected. Premiums or contributions to a group health plan cannot be increased; insurers cannot require an individual or family member to undergo a genetic test; insurers cannot request, require, or purchase genetic information about an individual nor use genetic information as the only basis upon which to claim a pre-existing condition is present and, therefore, to deny coverage. GINA also affords consumers protections with regard to employment as well.
From that point on it is a matter of individual choice. Regular screening, prophylactic surgery and chemotherapy, and certainly vigilance are all options. However, it is important to acknowledge that other factors have been associated with increased or decreased risk of developing cancer in the general population: age, family and medical history, hormonal influences, obesity, physical activity levels, and alcohol consumption And while it is not yet known exactly how these factors influence risk in people with BRCA1 or BRCA2 mutations, awareness and behaviors that reduce one’s risk are always a good course of action, especially since a significant portion of hereditary cancers are not associated with BRCA1 or BRCA2 mutations.
Today, with GINA to protect individuals who may have a genetic mutation, and the option of purchasing cancer insurance to protect one’s financial assets, we all can exercise greater control over our health and the choices we may have to make.