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. 2018 Sep;171(2):435-442.
doi: 10.1007/s10549-018-4824-9. Epub 2018 May 28.

Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect

Alexander Liede  1 , Mona Cai  1 , Tamara Fidler Crouter  1   2 , Daniela Niepel  3 , Fiona Callaghan  1 , D Gareth Evans  4   5
Affiliations

Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect

Alexander Liede et al. Breast Cancer Res Treat. 2018 Sep.

Abstract

Purpose: In 2013, Angelina Jolie disclosed in the New York Times (NYT) that she had undergone risk-reducing bilateral mastectomy (RRBM) after learning that she was a BRCA1 mutation carrier. We examined the rates of BRCA testing and RRBM from 1997 to 2016, and quantified trends before and after the Jolie op-ed.

Methods: This observational study of insurance claims data representative of the commercially-insured US population (Truven MarketScan® database) measured BRCA testing and RRBM rates among females ≥ 18 years. Censoring events were breast cancer or ovarian cancer diagnosis, last follow-up date (September 2016), or death. Interrupted time series analyses were used to quantify trends before and after the op-ed.

Results: Angelina Jolie's NYT op-ed led to a statistically significant increase in the uptake of genetic testing and in RRBM among women without previous diagnosis of breast or ovarian cancer in the US population, and in women who did not undergo testing for BRCA (P < 0.0001 for both). The rate (slope) of RRBM among women who were previously tested for BRCA (P = 0.70) was unchanged. After excluding women with in-situ tumors, the editorial's effect became less pronounced, suggesting that high-risk women with in-situ breast cancers were most influenced by Jolie's announcement.

Conclusion: The Angelina Effect-a term coined by Time magazine to describe the rise in internet searches related to breast cancer genetics and counseling-represents a long-lasting impact of celebrity on public health awareness as significant increases in genetic testing and mastectomy rates were observed and sustained in subsequent years.

Keywords: BRCA mutation; Bilateral mastectomy; Genetic testing.

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Conflict of interest statement

This research was not supported by any specific funding. Statistical analysis and writing support provided by Amgen Inc.

Figures

Fig. 1
Fig. 1
Monthly incidence rates of BRCA genetic testing among adult female enrollees in MarketScan database (1997–2006)
Fig. 2
Fig. 2
Interrupted time series analyses of BRCA testing monthly incidence rates per 100,000 among adult female enrollees in MarketScan database (2007–2016) before and after Jolie op-ed on May 14, 2013 (shading depicts 95% CIs)
Fig. 3
Fig. 3
Monthly incidence rates of risk-reducing mastectomy procedures by BRCA testing among adult female enrollees in MarketScan database (2003–2016) (trend lines fitted using loess curves, and shading depicts 95% CIs)
Fig. 4
Fig. 4
Interrupted time series analyses of risk-reducing mastectomy monthly incidence rates before and after Jolie op-ed on May 14, 2013 (shading depicts 95% CIs). a Incidence rates of risk-reducing mastectomy procedures per 100,000. b Incidence rates of risk-reducing mastectomy procedures among never BRCA tested per 100,000. c Incidence rates of risk-reducing mastectomy procedures among BRCA tested per 100,000
See this image and copyright information in PMC

References

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