Breast Cancer & Prevention Guide

Last Updated on:

April 24, 2023

1 in 9 women are diagnosed with breast cancer. While the majority of breast cancer cases occur in women over the age of 50, it is important to note that about 25% of cases are diagnosed in women under 50 years old. Early detection has proven to be a crucial determinant in the success of treatments and overall outcomes. This guide will cover the routine screenings covered in Israel, and recommended by the Ministry of Health, as well as information on how to access the various tests, specialized breast cancer clinics, and more.

Breast Cancer Screenings

The Ministry of Health (MoH) recommends screening tests for the various age groups and risk groups:

‍Annual Breast Exam
‍Adult women should get annual breast exams. Some surgeons recommend starting at age 30, while others recommend starting at 25.
Women under 25 will need a referral from their family doctor.
The exam is done by a breast surgeon, or in some Kupot, by a general surgeon.
Wait times can be up to 6 months or more for some breast specialists. Appointments should be made well in advance, and women should set a reminder to schedule an appointment for an annual check.
If something feels suspicious in the physical exam, the doctor will refer the woman to either an ultrasound, mammogram or other relevant test. Many of these exams can be done within the Kupah system with a referral. Some may need to be done in a hospital or other external clinic. In that case, a hitchayvut will be required.
If other screenings come back positive, the doctor will refer the woman for a biopsy. In addition to the biopsy, the woman may have an MRI or CT done as well in order to get to a conclusive diagnosis. Hitchayvuyot are required in these cases as well.
For more information on Hafnayot & Hitchayvuyot, see here.
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BRCA Testing
Women of Ashkenazi descent can be tested for free, without needing to see a genetic counselor, and in most cases without a referral.
Non-Ashkenazi women can be tested if they have a family history of breast cancer, ovarian cancer, etc.
The test is a simple blood test, and in the case a referral is required for your Kupah, it can be easily obtained from your family doctor.
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High Risk
Women who are 50+, have a family history of breast or ovarian cancer, or are BRCA carriers [see below for information on BRCA gene testing & entitlements] are considered high risk by MoH (Ministry of Health), and are advised to have more extensive and regular screenings.
In addition to an annual breast exam, high-risk women should get mammograms or ultrasounds.
- Mammogram/US are covered by the Kupah and require a referral from a GP/gynecologist/surgeon.
- Frequency of testing is dependent on age/risk factor:
- All women between ages 50-74 (every 2 years).
- Women between 40-49 with a first degree relative who had breast cancer.
- If the doctor thinks there is a medical need. (Women with a first degree relative with breast cancer may be advised to start additional testing 10 years before the relative’s diagnosis.)‍

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Know your rights: Women with no risk factors, who are interested in annual mammograms should check with their supplemental plan to see if they subsidize private mammograms.‍‍

‍BRCA Gene Carrier

Women who are BRCA positive can join a clinic for BRCA carriers for more frequent follow-up in a specialized clinic. The following are some BRCA clinics in Israel:

Carriers of the BRCA gene are entitled to routine testing for early detection of breast and ovarian cancer, covered by the Kupah. Covered tests and treatments include:

Breast MRI (once a year).
Breast ultrasound or mammogram, (once a year).
Blood tests for cancer markers, (every 6 months).
Transvaginal ultrasound, (every 6 months).
Regular consultations with relevant physicians (oncologist, breast surgeon, gynecologist, etc.).
Preventative Mastectomy
- Including reconstruction surgery
Preventive oophorectomy
- Including egg freezing

Urgent Breast Exam or Appointment

Of course, if there are any suspicious findings, one should be assessed as soon as possible. Here are some suggestions to expedite the assessment process:
- Have a doctor write an urgent referral (דחוף).
- Consider traveling further to a clinic with an available appointment.
- Make use of supplemental benefits for partially subsidized private tests/scans.
- Continue to call for cancellations.

‍Breast Cancer Diagnosis

If biopsy results are positive for breast cancer, the woman will receive a referral from her doctor for an oncology clinic. She will need to contact the clinic for an appointment which will usually be very timely. A hitchayvut is required.

Treatment

In most cases, the treatment will include surgery and the woman will need to schedule an appointment with a breast surgeon. Supplemental insurance can be used both for second opinions, and to choose the surgeon who will perform the surgery.
Oncologist may recommend treatments using chemotherapy, radiation, hormones before and/or after surgery
Reconstruction: full reconstruction following a partial or complete mastectomy is covered by the Kupah.

‍Support within the Healthcare System

Social workers in the oncology department and throughout the Kupah can offer emotional and practical support during this time. Schedule an appointment to make sure you are receiving the various benefits to which you are entitled.
You will be assigned an oncological nurse. Nurses in the oncology department will be your point person for medical questions, as well as questions regarding hafnayot and hitchayvuyot. They will often give an email address, or even phone number.

Know Your Rights: Many patients will be entitled to disability from Bituach Leumi if they are under 62, and may be eligible for handicap parking permits or transportation discounts if receiving chemo/radiation. For more information on rights and benefits for cancer patients, see our Cancer Patient Guide.‍

Supplemental Insurance Benefits

Some supplemental insurance benefits include:

Partial subsidy of a private doctor to perform the breast exam or to review test results.
Partial coverage of private mammograms, and the ability to go for more frequent mammograms, regardless of medical indications.
Partial coverage for a private surgeon to perform biopsy, mastectomy, etc.
For more on supplemental insurance, click here.

Support Organizations

Contact The Yad L’Olim Healthcare Division in memory of Shira Pransky z”l for assistance.