Intended for healthcare professionals

CCBYNC Open access
Research Christmas 2016: Famous Figures

Do celebrity endorsements matter? Observational study of BRCA gene testing and mastectomy rates after Angelina Jolie’s New York Times editorial

BMJ 2016; 355 doi: (Published 14 December 2016) Cite this as: BMJ 2016;355:i6357
  1. Sunita Desai, Marshall J Seidman fellow in health care policy1,
  2. Anupam B Jena, Ruth L Newhouse associate professor of health care policy and medicine1 2 3
  1. 1Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA
  2. 2Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
  3. 3National Bureau of Economic Research, Cambridge, MA, USA
  1. Correspondence to: A B Jena jena{at}
  • Accepted 16 November 2016


Objective To examine the effect on BRCA testing and mastectomy rates of a widely viewed 2013 New York Times editorial by public figure Angelina Jolie that endorsed BRCA testing and announced Jolie’s decision to undergo preventive mastectomy.

Design Observational study with difference-in-difference analysis.

Setting Commercially insured US population.

Participants Women aged 18-64 years with claims in the Truven MarketScan commercial claims database (n=9 532 836).

Main outcome measures Changes in BRCA testing rates in the 15 business days before versus after 14 May 2013 (editorial date) compared with the change in the same period in 2012; mastectomy rates in the months before and after publication, both overall and within 60 days of BRCA testing among women who were tested; national estimates of incremental tests and expenditures associated with Jolie’s article in the 15 days after publication.

Results Daily BRCA test rates increased immediately after the 2013 editorial, from 0.71 tests/100 000 women in the 15 business days before to 1.13 tests/100 000 women in the 15 business days after publication. In comparison, daily test rates were similar in the same period in 2012 (0.58/100 000 women in the 15 business days before 14 May versus 0.55/100 000 women in the 15 business days after), implying a difference-in-difference absolute daily increase of 0.45 tests/100 000 women or a 64% relative increase (P<0.001). The editorial was associated with an estimated increase of 4500 BRCA tests and $13.5m (£10.8m; €12.8) expenditure nationally among commercially insured adult women in those 15 days. Increased BRCA testing rates were sustained throughout 2013. Overall mastectomy rates remained unchanged in the months after publication, but 60 day mastectomy rates among women who had a BRCA test fell from 10% in the months before publication to 7% in the months after publication, suggesting that women who underwent tests as a result of to the editorial had a lower pre-test probability of having the BRCA mutation than women tested before the editorial.

Conclusions Celebrity endorsements can have a large and immediate effect on use of health services. Such announcements can be a low cost means of reaching a broad audience quickly, but they may not effectively target the subpopulations that are most at risk for the relevant underlying condition.


  • Contributors: Both authors contributed to the design and conduct of the study; data collection and management; analysis and interpretation of the data; and preparation, review, or approval of the manuscript. ABJ is the guarantor.

  • Funding: This research was supported by a grant from the Office of the Director, National Institutes of Health (ABJ: NIH early independence award; grant 1DP5OD017897-01) and the Marshall J Seidman fellowship at Harvard Medical School (SD). Study sponsors were not involved in study design, data interpretation, writing, or the decision to submit the article for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: support provided by grants from the Office of the Director, National Institutes of Health, and the Marshall J Seidman fellowship at Harvard Medical School; ABJ has received consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals, and Precision Health Economics, a company providing consulting services to the life sciences industry; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was exempted from review by the Institutional Review Board at Harvard Medical School.

  • Transparency statement: The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: no additional data available.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text