Abstract
PurposeIn 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.MethodsThis 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.ResultsAngelina 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.ConclusionThe 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.
Highlights
On May 14, 2013, actress, filmmaker, and humanitarian Angelina Jolie disclosed in an open editorial to the New York Times entitled “My Medical Choice” that she had learned she was a BRCA1 mutation carrier and had undergone a risk-reducing bilateral mastectomy procedure with reconstruction [1]
We identified BRCA1 and BRCA2 genetic testing according to Current Procedural Terminology (CPT), Healthcare Common Procedural Coding System (HCPCS) codes 81211–81217 in outpatient claim
The estimates for the month-on-month Incidence rates (IR) remained similar to the previous analyses, some of the P values changed: This study describes that a large and immediate increase in BRCAtesting was observed among commercially insured women 18 years of age and older in the United States following Angelina Jolie’s New York Times editorial published on May 14, 2013
Summary
On May 14, 2013, actress, filmmaker, and humanitarian Angelina Jolie disclosed in an open editorial (op-ed) to the New York Times entitled “My Medical Choice” that she had learned she was a BRCA1 mutation carrier and had undergone a risk-reducing bilateral mastectomy procedure with reconstruction [1]. Women with inherited mutations in the BRCA1 or BRCA2 genes represent a population at greatest risk of developing early-onset breast cancer and ovarian cancer, and, face difficult decisions around whether to have risk-reducing surgery or opt for increased surveillance for early detection [2,3,4,5,6]. Angelina Jolie’s decision generated publicity worldwide, and led to increased awareness and interest in hereditary breast cancer and genetic testing, including publications in the medical domain evaluating this Angelina Jolie Effect [7, 8]. Using the identical MarketScan® data source, the objective of our study was to examine the rates of BRCAgenetic testing and rates of risk-reducing mastectomies from 1997 to 2016, applying methods that censor upon diagnosis of breast and ovarian cancer, and to measure changes in these trends upon the Jolie op-ed publication on May 14, 2013
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