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Broad Reach, But Not to Those at Risk

Angelina Jolie's op-ed on her decision to undergo BRCA testing and, because of her results, a preventive double mastectomy and, later, removal of her fallopian tubes and ovaries, led to increased BRCA testing rates, but might not have gotten to the more at-risk subpopulations, according to a new study appearing in the BMJ.

"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. "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."

Researchers from Harvard Medical School examined a database of insurance claims for women between the ages of 18 and 64 to gauge changes in BRCA testing before and after Jolie's 2013 op-ed appeared in the New York Times. Within about two weeks of its publication, the researchers noted a 64 percent relative increase in testing, or about an extra 4,500 BRCA tests and $13.5 million spent. They note that testing remained high for the rest of 2013.

However, they did not uncover an increase in mastectomies within 60 days of the op-ed's publication. "The fact that mastectomy rates dropped after Angelina Jolie's editorial suggests that that denominator of women who started getting the BRCA test became less appropriate for the BRCA test because they had a lower pre-test probability of having the mutation in the first place," Harvard's Sunita Desai tells the Guardian.

Desai and her co-author concluded in their paper that celebrity announcements like Jolie's can raise awareness and reach a broad audience, though "their ability to target subpopulations of interest may be limited."

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