Angelina Jolie Effect: How One Op-Ed Shifted Testing

The Angelina Jolie effect is the measurable rise in genetic testing for breast cancer risk after Angelina Jolie's May 14, 2013 New York Times op-ed, "My Medical Choice." A UK study counted 4,847 referrals in June and July 2013, up from 1,981 a year earlier. A US study reported BRCA tests up 64 percent in the two weeks after the op-ed, without more detected mutations.

What was the Angelina Jolie effect?

The Angelina Jolie effect is the documented jump in BRCA testing and genetic referrals that followed her announcement that she had a preventive double mastectomy. The Associated Press reported that Jolie, then 37, wrote in the New York Times on Tuesday, May 14, 2013 that she had completed three months of surgical procedures after learning she carried a gene that made breast cancer extremely likely.

She wrote that her estimated chance of developing breast cancer had dropped from 87 percent to under 5 percent, and that her mother had died of cancer at 56. The op-ed gave readers a specific risk figure, a stated reason and a named decision, which is the material researchers later used to measure the response. This page covers the communications case, not medical advice.

EPR's wider case study on the actress is in the Jolie-Pitt PR team page, and other entries are in the celebrity PR case studies hub.

What did the UK study find?

The UK study found that referrals for breast cancer genetic testing rose about 2.5-fold in the two months after the op-ed. Researchers led by Gareth Evans of Genesis Breast Cancer Prevention and St Mary's Hospital in Manchester studied 21 clinics and regional genetics centers, and Reuters reported 4,847 referrals in June and July 2013 against 1,981 in the same months of 2012.

The BioMed Central summary of the study says the two-fold increase lasted until October 2013 and that there was no greater proportion of inappropriate referrals from general practitioners. A later commentary by the same group, published in Breast Cancer Research on PubMed Central, said the trend continued through 2014.

What did the US study find?

The US study found that BRCA testing rose 64 percent in the two weeks after the op-ed compared with the two weeks before. WBUR reported on the BMJ study by Sunita Desai of Harvard Medical School, which found testing rates still 37 percent higher at the end of 2013.

The same report said the increase did not appear to lead to more detected mutations, because the op-ed did not target women at higher risk. The study estimated about 4,500 additional tests in the 15 business days after the op-ed, at a cost of $13.5 million.

How do the two studies compare?

The two studies measured different things in different health systems, and the table sets out what each reported.

Experts not involved in the UK research warned that the effect could cut both ways. ABC News reported that only about 5 percent of breast cancer is BRCA positive, so a spike in testing does not by itself show that the right women were tested.

Why did one op-ed move so many people?

One op-ed moved so many people because it combined a specific personal decision with a famous name and a mainstream venue. Evans said Jolie's announcement was likely to have had a bigger impact than other celebrity announcements, possibly because of her image as a glamorous and strong woman, as quoted in the BioMed Central summary.

That explanation is the researchers' reading, not a proven mechanism. The data show reach and volume. They do not show which element of the op-ed caused the response.

What can health communicators take from the Jolie effect?

Health communicators can take four checks from the Jolie effect, each tied to a reported result.

1. State personal facts and risk figures precisely. The op-ed gave the 87 percent and under 5 percent figures, so readers could see what the decision changed.
2. Say who the message is for. The US study found more tests without more detected mutations, which suggests broad reach and not targeting.
3. Prepare services for demand. UK referrals rose from 1,981 to 4,847 in two months, so clinics needed capacity before a message like this lands.
4. Measure outcomes, not only volume. The US study counted extra tests and a $13.5 million cost, and found no clear gain in detection.

For the entertainment-side context, see EPR's entertainment media coverage and its healthcare communications section.