Angelina Jolie: Public-Health Hero?

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A 2013 editorial by Angelina Jolie increased testing for a gene associated with breast cancer. Whether that was a good thing is less clear, researchers report.

By Nathan Collins


Angelina Jolie. (Photo: Leon Neal/AFP/Getty Images)

Celebrities are not particularly well known for their scientific or medical acumen, but they have a built-in way to get a lot of attention for the issues they care about. More importantly, that attention can translate to action: According to a new study, screenings for a gene related to breast cancer went up 60 percent immediately after actress Angelina Jolie highlighted the test in a opinion piece.

Whether that was a good thing, Harvard University health-care policy researchers Sunita Desai and Anupam B. Jena write, is less obvious.

“Celebrity endorsements can have a large and immediate effect on use of health services,” Desai and Jena write. “Such announcements can be a low cost means of reaching a broad audience quickly, but they may not effectively target the subpopulations that are most at risk for the relevant underlying condition.”

To make those claims concrete, Desai and Jena looked at Jolie’s May 2013 editorial in the New York Times, in which she detailed her decision to have a double mastectomy after she tested positive for a harmful mutation in the gene BRCA1 that put her at greater risk for breast cancer.

To test the effects of Jolie’s editorial, the researchers turned to the Truven MarketScan Analytics Commercial Claims and Encounters database, which has anonymized data on the medical histories of 9,532,836 women between the ages of 18 and 64, including whether they’d been screened for BRCA and whether they subsequently had a mastectomy.

Screenings for a gene related to breast cancer went up 60 percent immediately after actress Angelina Jolie highlighted the test in a opinion piece.

Jolie’s editorial had a striking effect. In the 15 days prior to her op-ed’s publication, there were 0.71 BRCA screenings per 100,000 women per day, similar to testing rates throughout May of 2012. But in the 15 days after the editorial went to press, the rate jumped to 1.13 screenings per 100,000 women per day. What’s more, increased testing rates persisted through the end of 2013: Of the 32,945 women who underwent BRCA screening during 2012 and 2013, nearly half—15,233, or 46 percent—were tested in the seven-and-a-half months after Jolie’s story was published.

Now, that increase in testing did not have any effect on mastectomies, single or double, the rate of which hovered around eight per 100,000 women per month throughout 2012 and 2013. Meanwhile, the rate of mastectomy in the 60 days after BRCA screening dropped from 10 percent prior to Jolie’s editorial to 7 percent afterward, suggesting that many of the women who were screened did not have a harmful BRCA mutation.

That’s not to say BRCA screening is a bad idea—it could provide peace of mind for some and lead to increased vigilance for those at increased risk—but rather that the message may be too broad. “This … suggests that celebrities can reach a broad audience but may not effectively target the population that would benefit most from the test, in this case women with a family history of breast, ovarian, fallopian tube, or peritoneal cancer,” the researchers write.

The study is published in the BMJ’s Christmas Issue, an annual special devoted to serious science framed in rather less-than-serious ways.