Will Angelina Jolie’s decision to undergo a double mastectomy influence the medical decisions of others? Research on a similar high-profile case, also featuring an influential public figure, suggests it very well might—at least in the short term.
In October 1987, first lady Nancy Reagan underwent a modified radical mastectomy after a cancerous lesion was discovered on one of her breasts. The operation generated massive news coverage and prompted a debate over whether, by opting for such a radical procedure, she was sending a message to American women: The best way to respond to breast cancer is total removal.
While that was presumably not her intention—breast removal was, and remains, a difficult decision made by a woman with her doctor, based on the specifics of her case—her choice resonated with the public. At least, that’s the finding of a 1998 study published in the Journal of the American Medical Association.
“Today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.”
A research team led by Dr. Ann Butler Nattinger examined data on two large groups of American women: 82,230 who were included in the Surveillance, Epidemiology, and End Results tumor registry following a breast cancer diagnosis between 1983 and 1990; and 80,057 Medicare beneficiaries ages 65 to 79 who received in-patient surgery for local or regional breast cancer in 1987 or 1988.
They found a 25 percent reduction in the use of breast-conserving surgery, as opposed to mastectomy, during the six months following Mrs. Reagan’s announcement. Those percentages began to rebound in the spring of 1988, and returned to roughly their previous level by the spring of 1989.
“The effect of Mrs. Reagan’s surgery was greatest among women who were demographically similar to her: White women aged 50 through 79,” the researchers report. “The effect was more prominent in the central and Southern regions of the country, and in countries with lower levels of education and income.”
Of course, Jolie’s situation differs from Reagan’s in many respects. The actress and director does not have breast cancer, but was told that, due to the fact that she carries a “faulty” gene (BRCA1), she had an 87 percent risk of eventually developing the disease. On average, women with this gene have about a 60 percent risk of developing breast cancer—five times higher than the general population.
That does not mean a radical mastectomy is the automatic way to go, however. As a 2011 editorial in the journal Cancer noted, some women who carry this gene or another known as BRCA2 “may opt for intensive screenings,” particularly if they are young and “have not completed their families.”
“Others may not want to wait,” the journal noted. (Jolie is 37.)
Mutations such as BRCA1 and BRCA2 are believed to cause about five to 10 percent of breast cancers among white women in the U.S. So her situation is relatively rare. And it’s important to note that in her statement, published in today’s New York Times, she acknowledges there are other options besides the one she chose. “I acknowledge there are many wonderful holistic doctors working on alternatives to surgery,” she writes.
Jolie’s central message, however, is that that “today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.” She did just that, and hopes other women will “benefit from my experience.”
Those hopes are very likely not in vain. Reagan’s case showed, in the words of the researchers, that “medical care can be influenced substantially by the behavior of celebrity role models.”
Whether that impact is positive or negative may depend upon the quality of media coverage. If the basic takeaway from her tale comes down to “Famous actress, facing cancer, has breasts removed,” it’s easy to imagine that lack of nuance producing a similar reaction to the Nancy Reagan disclosure.
On the other hand, if the message women take from her story is “get information early so you can make a smart, informed choice,” the effect could be positive indeed.
