Prevention Preventive mastoid removal in cancer not at cash costs

Prevention Preventive mastoid removal in cancer not at cash costs / Health News
Social Court Karlsruhe: Only with gene mutation must pay cash
Breast cancer in a breast does not have to be a reason for a preventive mastectomy of the healthy breast. Only with an increased genetic breast cancer risk, a precautionary removal of the healthy mammary gland and a subsequent implantation with breast augmentation at cash costs are possible, the Karlsruhe Social Court ruled in a recent judgment of June 22, 2017 (Az .: S 14 KR 3991/16 ).

Women should scan their breasts while lying down for knots. This is advised by a young woman who has recently been diagnosed with breast cancer. While standing, the knot could not be felt with her. (Image: WavebreakMediaMicro / fotolia.com)

In this particular case, the applicant detected a malignant tumor in the right breast in 2015. The mammary gland was finally removed. The woman's breast was rebuilt with implants.

She also wanted to preventively remove the mammary gland in her healthy left breast. Subsequently, this breast should also be reconstructed with implants. Cancer can recur in her healthy breast, given her early onset. Your statutory health insurance should cover the costs of the procedure. It was unreasonable that she had to wait for the onset of the disease, according to the plaintiff.

But the health insurance company refused to pay. The woman does not have the gene mutations BRCA 1 or BRCA 2 associated with a higher risk of breast cancer. Only then should removal of the healthy mammary gland be indicated.

This was followed by the Social Court. Removal of the healthy mammary gland followed by breast reconstruction without an existing gene mutation should be considered a "new treatment method". In order for the health insurance in such a case to pay for the costs, a recommendation of the Joint Federal Committee must be present. The body, in which health insurance companies, doctors and insured persons are represented, have not yet given such a recommendation.

Nor is it in accordance with the current scientific state of affairs to undertake a prophylactic removal of the mammary gland at an increased risk of developing a young age of onset. A mere disease risk does not have a disease value and therefore is not life threatening. Therefore, the health insurance may not pay for a corresponding treatment. fle / mwo / fle