Skip to main content

The effect of a celebrity health disclosure on demand for health care: trends in BRCA testing and subsequent health services use

Abstract

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.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  • Andersen M (1995) Revisiting the behavioral model and access to medical care: does it matter?. Journal of health and social behavior: 1–10

  • 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 144:397–406

    Article  PubMed  Google Scholar 

  • Armstrong K, Micco E, Carney A, Stopfer J, Putt M (2005) Racial differences in the use of BRCA1/2 testing among women with a family history of breast or ovarian cancer. JAMA 293:1729–1736. doi:10.1001/jama.293.14.1729

    CAS  Article  PubMed  Google 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):155–163

    Article  PubMed  Google 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.2013.181

    Article  Google 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.2006.09.1066

    Article  Google Scholar 

  • Cram P, Fendrick AM, Inadomi J, Cowen ME, Carpenter D, Vijan S (2003) The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect. Arch Intern Med 163:1601–1605. doi:10.1001/archinte.163.13.1601

    Article  PubMed  Google 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

  • Finlay E et al (2008) Factors determining dissemination of results and uptake of genetic testing in families with known BRCA1/2 mutations. Genet Test 12:81–91. doi:10.1089/gte.2007.0037

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.2005.04.5260

    Article  Google Scholar 

  • Jacobsen GD, Jacobsen KH (2011) Health awareness campaigns and diagnosis rates: evidence from National Breast Cancer Awareness Month. J Health Econ 30:55–61. doi:10.1016/j.jhealeco.2010.11.005

    Article  PubMed  Google 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.2014.58.5885

    Article  Google Scholar 

  • Jolie A (2013) My medical choice. The New York Times Company, New York

    Google 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.2014.141

    Article  Google Scholar 

  • Kesselheim AS, Cook-Deegan RM, Winickoff DE, Mello MM (2013) Gene patenting—the supreme court finally speaks. N Engl J Med 369:869–875. doi:10.1056/NEJMhle1308199

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • King MC, Marks JH, Mandell JB, New York Breast Cancer Study Group (2003) Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science 302:643–646. doi:10.1126/science.1088759

    CAS  Article  PubMed  Google Scholar 

  • Lacour RA et al (2008) What women with ovarian cancer think and know about genetic testing. Gynecol Oncol 111:132–136. doi:10.1016/j.ygyno.2008.06.016

    Article  PubMed  PubMed Central  Google Scholar 

  • Lebo PB, Quehenberger F, Kamolz LP, Lumenta DB (2015) The Angelina effect revisited: exploring a media-related impact on public awareness. Cancer 121:3959–3964. doi:10.1002/cncr.29461

    Article  PubMed  Google 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/M13-2747

    PubMed  Google 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:10.1177/0272989X14556130

    Article  Google 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

  • Truven Health Analytics (2015) Databases and online tools. http://truvenhealth.com/your-healthcare-focus/life-sciences/data-databases-and-online-tools. Accessed 11 Sep 2015

  • 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 27:299–309

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

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).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Megan C. Roberts.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Roberts, M.C., Dusetzina, S.B. The effect of a celebrity health disclosure on demand for health care: trends in BRCA testing and subsequent health services use. J Community Genet 8, 141–146 (2017). https://doi.org/10.1007/s12687-017-0295-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12687-017-0295-7

Keywords

  • Genetic testing
  • Breast cancer
  • Costs
  • Health services use