The Angelina Jolie effect: Contralateral risk-reducing mastectomy trends in patients at increased risk of breast cancer
Open Access
- 2 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Scientific Reports
- Vol. 11 (1), 1-10
- https://doi.org/10.1038/s41598-021-82654-x
Abstract
Contralateral risk-reducing mastectomy (CRRM) rates have tripled over the last 2 decades. Reasons for this are multi-factorial, with those harbouring a pathogenic variant in the BRCA1/2 gene having the greatest survival benefit. On May 14th, 2013, Angelina Jolie shared the news of her bilateral risk-reducing mastectomy (BRRM), on the basis of her BRCA1 pathogenic variant status. We evaluated the impact of this news on rates of CRRM in women with increased risk for developing breast cancer after being diagnosed with unilateral breast cancer. The prospective cohort study included all women with at least a moderate lifetime risk of developing breast cancer who attended our family history clinic (1987–2019) and were subsequently diagnosed with unilateral breast cancer. Rates of CRRM were then compared between patients diagnosed with breast cancer before and after Angelina Jolie’s announcement (pre- vs. post-AJ). Of 386 breast cancer patients, with a mean age at diagnosis of 48 ± 8 years, 268 (69.4%) were diagnosed in the pre-AJ period, and 118 (30.6%) in the post-AJ period. Of these, 123 (31.9%) underwent CRRM, a median 42 (interquartile range: 11–54) days after the index cancer surgery. Rates of CRRM doubled following AJ’s news, from 23.9% pre-AJ to 50.0% post AJ (p < 0.001). Rates of CRRM were found to decrease with increasing age at breast cancer (p < 0.001) and tumour TNM stage (p = 0.040), and to increase with the estimated lifetime risk of breast cancer (p < 0.001) and tumour grade (p = 0.015) on univariable analysis. After adjusting for these factors, the step-change increase in CRRM rates post-AJ remained significant (odds ratio: 9.61, p < 0.001). The AJ effect appears to have been associated with higher rates of CRRM amongst breast cancer patients with increased cancer risk. CRRM rates were highest amongst younger women and those with the highest lifetime risk profile. Clinicians need to be aware of how media news can impact on the delivery of cancer related services. Communicating objective assessment of risk is important when counselling women on the merits of risk-reducing surgery.This publication has 39 references indexed in Scilit:
- Trends in the use of bilateral mastectomy in England from 2002 to 2011: retrospective analysis of hospital episode statisticsBMJ Open, 2013
- Increasing rates of contralateral prophylactic mastectomy – A trend made in USA?European Journal of Surgical Oncology, 2012
- Declining Incidence of Contralateral Breast Cancer in the United States From 1975 to 2006Journal of Clinical Oncology, 2011
- Patient and Surgeon Characteristics Associated with Increased Use of Contralateral Prophylactic Mastectomy in Patients with Breast CancerAnnals of Surgical Oncology, 2009
- Diagnostic Breast Magnetic Resonance Imaging and Contralateral Prophylactic MastectomyAnnals of Surgical Oncology, 2009
- Predictors of Contralateral Prophylactic Mastectomy in Women With a BRCA1 or BRCA2 Mutation: The Hereditary Breast Cancer Clinical Study GroupJournal of Clinical Oncology, 2008
- International variation in rates of uptake of preventive options in BRCA1 and BRCA2 mutation carriersInternational Journal of Cancer, 2008
- Increasing Use of Contralateral Prophylactic Mastectomy for Breast Cancer Patients: A Trend Toward More Aggressive Surgical TreatmentJournal of Clinical Oncology, 2007
- Evaluation of breast cancer risk assessment packages in the family history evaluation and screening programmeJournal of Medical Genetics, 2003
- A protocol for preventative mastectomy in women with an increased lifetime risk of breast cancerEuropean Journal of Surgical Oncology, 2000