Benefits, risks seen in hype over Jolie’s disclosure
Celebrities drive average Americans to want what they have. That powerful impulse can even influence grave healthcare decisions and could prove complicated for women who fear they’re at high risk for breast cancer after Angelina Jolie’s disclosure that she underwent a preventive double mastectomy—a treatment option in response to a rare genetic mutation.
As is often the case when public figures choose or endorse a medical procedure, healthcare providers say they expect to see increased interest from patients who may seek testing for the BRCA1 and BRCA2 genes or consider a preventive mastectomy. And some providers will capitalize on Jolie’s celebrity to market testing for the BRCA gene mutations and related preventive treatments.
The Basser Research Center for BRCA, part of the University of Pennsylvania, placed an ad in the New York Times within days of Jolie’s disclosure, noting its appearance in the paper and advertising that the center is “focused on developing new prevention and treatment options, and on supporting BRCA affected families.”
“When famous people like Angelina Jolie have preventive surgery for breast cancer, it will generate interest because celebrities seem to be above it all, but in fact, they are human just like the rest of us,” Dr. Kathie-Ann Joseph, assistant professor in NYU Langone Medical Center’s department of surgery, said in an e-mail. “That has a powerful impact.”
However, these types of disclosures raise important questions about the impact of celebrity on how patients make decisions about their treatments for potentially fatal diseases or conditions.
Chris Christie, governor of New Jersey who may be considering a run for president in 2016, recently made his own health disclosure, confirming this month that he had received gastric banding to reduce his weight.
“There’s no question that stars influence clinical practice,” said Jeffrey Lerner, president and CEO of the ECRI Institute. “That’s why drug companies will use a celebrity in a direct-to-consumer ad.”
There are numerous examples of celebrities, politicians and other public figures who have publicly addressed, disclosed or advocated for types of treatments. Some have been lauded for raising awareness of a certain disease or condition, while others have been criticized for encouraging patients to undergo unnecessary or inappropriate treatments.
Notably, Oprah Winfrey came under fire almost a decade ago for recommending whole-body scans even as the Food and Drug Administration urged caution because there was no scientific evidence proving the benefits of the screening.
But in the cases of Jolie and Christie, the disclosures focused less on promotion and more on the role of proactively addressing personal health issues.
“I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer,” Jolie wrote May 14. “It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.”
Christie, likewise, described his procedure as a personal choice. “It’s not a career issue for me,” he said during a news conference. “It is a long-term health issue for me.”
Physicians say there are benefits and risks to the media hype surrounding celebrities and their healthcare choices, which can sharpen a patient’s understanding of a particular procedure as well as boost interest among patients who may not meet the clinical criteria.
“I think it’s very responsible and a good thing what people like Gov. Christie and Angelina Jolie did,” said Dr. Rumin Sorkhi, a bariatric surgeon who is affiliated with the Palomar Health system in San Diego County. “People look up to them and people learn from them.”
The numbers of prophylactic mastectomies and bariatric surgeries performed in the U.S. are rising.
A study released last year by the Pennsylvania Health Care Cost Containment Council found that the number of women who chose preventive mastectomies before a breast cancer diagnosis rose to 455 women in 2011, compared with 94 in 2002.
NYU Langone’s Joseph also attributed some of the growth in preventive mastectomies to women who have a family history of breast cancer, but are not carriers of the gene mutation.
Even for the patients who do carry the BRCA1 and BRCA2 genes, there are alternatives to surgery. Options include close monitoring or use of tamoxifen and raloxifene, which are hormone therapies that can reduce breast cancer risk.
While most insurers that cover mastectomies have been required by law since the late 1990s to cover breast reconstruction, a combination of increased awareness and bet-
ter reconstruction options has led more women to choose mastectomies to reduce their breast cancer risk, said Dr. John Kim, a plastic and reconstructive surgeon at Northwestern Memorial Hospital in Chicago.
“It makes it easier for patients to choose the more aggressive treatment,” he said.
Sorkhi said interest in bariatric surgery usually spikes following public announcements such as Christie’s and, in many cases, Palomar Health will report higher numbers of consultations or attendees at its free monthly bariatric seminars.
However, there are concerns that broad public endorsements of these surgeries can simplify what are still complex medical procedures. Ads and celebrity disclosures often do little to address the full benefits and risks.
“People assume … she’s famous, rich and powerful. She must have checked this out. This must be good,” ECRI’s Lerner said.
“When famous people like Angelina Jolie have preventive surgery for breast cancer, it will generate interest because celebrities seem to be above it all, but in fact, they are human just like the rest of us,” said Dr. Kathie-Ann Joseph of NYU Langone Medical Center.
New Jersey Gov. Chris Christie described his gastric banding procedure as a personal choice. “It is a long-term health issue for me,” he said.