22 September 2014

Jessica Ware By

Appeared in BioNews 772

The number of women in the UK being referred to breast cancer clinics doubled shortly after actress Angelina Jolie revealed she had a risk-reducing double mastectomy, a study has found.

Jolie went public in May last year about having both her breasts removed after testing positive for the BRCA1 gene mutation that increases the risk of cancer.

Her decision seems to have encouraged British women to seek out testing for risk-increasing genetic mutations; a study published in the journal Breast Cancer Research has reported a link between Jolie's revelation and a doubling of referrals for genetic testing.

Dubbed the 'Angelia Jolie Effect', clinics across the country felt the impact almost immediately. It lasted, the researchers said, until at least October of the same year, with referral rates twice as high as the same time period the year before. There were also more enquiries about risk reducing mastectomy and demand for BRCA1/2 testing almost doubled, the researchers observed.

Jolie's mother died of breast cancer, and just two weeks after the actress announced her mastectomy, her aunt also died of the disease. Having both breasts removed lowers the chance of developing breast cancer by up to 90 percent for those already at a genetic risk.

Led by Professor Gareth Evans of the charity Genesis Breast Cancer Prevention the research found that most women who had requested to be tested for the BRCA1/2 gene had a family history of breast cancer. In the UK, around one in every 1,000 women has the BRCA1 mutation.

The study also found that, from the 21 test centres monitored, there was 'no increase in inappropriate referrals'.

Professor Evans, also of St Mary's Hospital in Manchester, said: 'Angelina Jolie stating she has a BRCA1 mutation and going on to have a risk-reducing mastectomy is likely to have had a bigger impact than other celebrity announcements, possibly due to her image as a glamorous and strong woman'.

'This may have lessened patients' fears about a loss of sexual identity post-preventative surgery and encouraged those who had not previously engaged with health services to consider genetic testing'.

Although the 'Angelina Jolie Effect' had unprecedented results, this was not this first time that a celebrity had influenced public health behaviour. There was a considerable jump in women having cervical smear tests in 2008 and 2009, after Jade Goody died of cervical cancer.

Mr Lester Barr, chairman of Genesis Breast Cancer Prevention, stressed to the BBC that a double mastectomy was not the only answer: 'While a woman's risk of developing breast cancer and/or ovarian cancer is greatly increased if she carries the harmful mutation of the BRCA1 or BRCA2 gene, preventative surgery is by no means the answer for everyone.

'Of course, a preventative mastectomy is the most effective way to cut a woman's risk of breast cancer, however other options should also be considered. These include prevention drugs, such as tamoxifen, which has been approved by NICE'.

The researchers also observed that the increase in referrals followed the pre-release and final publication of NICE's guideline on familial breast cancer.

Earlier this month, a Canadian study reported on an increase in referrals to genetic counselling services at a cancer centre in Toronto after Jolie went public about with her decision (reported in BioNews 770).