In May 2013, an internationally renowned celebrity—Angelina Jolie—disclosed her receipt of BRCA1/BRCA2 (BRCA) testing and subsequent double mastectomy in a highly publicized editorial. Publicity surrounding celebrity health services use increases awareness of important health issues and demand for health services. We aimed to describe BRCA testing trends before and after Jolie’s disclosure, breast cancer-related services use following testing, and test reimbursement trends. MarketScan Commercial Claims data were used to compare trends in BRCA testing before and after Jolie’s health disclosure using an interrupted time series model among women aged 18–64. We used modified Poisson regression to estimate risks for health services use (surgical consult, mastectomy, mammography, magnetic resonance imaging, genetic counseling) following BRCA testing. BRCA testing rates increased from 12.5 to 19.0 tests/100,000 women between January 2013 and October 2014. Immediately following Jolie’s disclosure, testing increased by approximately 37% (p < 0.001). Although BRCA testing increased, use of post-testing follow-up services declined after Jolie’s disclosure. Mean insurance reimbursement and patient out-of-pocket spending on the test decreased by 3 and 36%, respectively. While genetic testing uptake increased following Jolie’s disclosure, subsequent health services use associated with BRCA mutations declined, suggesting that celebrity disclosures may be associated with potential genetic testing overuse.
Genetic testing Breast cancer Costs Health services use
This project was unfunded. Dr. Roberts was funded by the UNC Lineberger Cancer Control Education Program (CCEP) (R25 CA57726). Dr. Dusetzina receives salary support from the BIRCWH K12 Program and the North Carolina Translational and Clinical Sciences Institute (UL1TR001111).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animal rights
This article does not contain any studies with human or animal subjects performed by the any of the authors.
Andersen M (1995) Revisiting the behavioral model and access to medical care: does it matter?. Journal of health and social behavior: 1–10Google Scholar
Anderson K, Jacobson JS, Heitjan DF, Zivin JG, Hershman D, Neugut AI, Grann VR (2006) Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation. Ann Intern Med 144:397–406CrossRefPubMedGoogle Scholar
Armstrong J et al. (2015) Utilization and outcomes of BRCA genetic testing and counseling in a national commercially insured population: the ABOUT study JAMA oncology:1–10 doi:10.1001/jamaoncol.2015.3048
Berliner JL, Fay AM, Cummings SA, Burnett B, Tillmanns T (2013) NSGC practice guideline: risk assessment and genetic counseling for hereditary breast and ovarian cancer. J Genet Couns 22(2):155–163CrossRefPubMedGoogle Scholar
Borzekowski DL, Guan Y, Smith KC, Erby LH, Roter DL (2014) The Angelina effect: immediate reach, grasp, and impact of going public. Genetics in medicine : official journal of the American College of Medical Genetics 16:516–521. doi:10.1038/gim.2013.181CrossRefGoogle Scholar
Chen S, Parmigiani G (2007) Meta-analysis of BRCA1 and BRCA2 penetrance. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 25:1329–1333. doi:10.1200/JCO.2006.09.1066CrossRefGoogle Scholar
Desai S, Jena AB (2016) Do celebrity endorsements matter? Observational study of BRCA gene testing and mastectomy rates after Angelina Jolie’s New York Times editorial BMJ 355: i6357 doi.org/10.1136/bmj.i6357
Evans DG et al. (2014) The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services Breast Cancer Res 16:442 doi:10.1186/s13058–014–0442-6
Guillem JG et al (2006) ASCO/SSO review of current role of risk-reducing surgery in common hereditary cancer syndromes. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24:4642–4660. doi:10.1200/JCO.2005.04.5260CrossRefGoogle Scholar
Jagsi R et al (2015) Concerns about cancer risk and experiences with genetic testing in a diverse population of patients with breast cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33:1584–1591. doi:10.1200/JCO.2014.58.5885CrossRefGoogle Scholar
Jolie A (2013) My medical choice. The New York Times Company, New YorkGoogle Scholar
Juthe RH, Zaharchuk A, Wang C (2015) Celebrity disclosures and information seeking: the case of Angelina Jolie. Genetics in medicine : official journal of the American College of Medical Genetics 17:545–553. doi:10.1038/gim.2014.141CrossRefGoogle Scholar
Moyer VA, USPSTF (2014) Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: U.S. Preventive Services Task Force recommendation statement Annals of internal medicine 160:271–281. doi:10.7326/M13-2747PubMedGoogle Scholar
Noar SM, Althouse BM, Ayers JW, Francis DB, Ribisl KM (2015) Cancer information seeking in the digital age: effects of Angelina Jolie’s prophylactic mastectomy announcement. Medical decision making : an international journal of the Society for Medical Decision Making 35:16–21. doi:10.1177/0272989X14556130CrossRefGoogle Scholar
Thackeray R, Burton SH, Giraud-Carrier C, Rollins S, Draper CR (2013) Using Twitter for breast cancer prevention: an analysis of breast cancer awareness month Bmc Cancer 13 doi:Unsp 50810.1186/1471–2407–13-508
Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D (2002) Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 27:299–309CrossRefPubMedGoogle Scholar