Effect of Nancy Reagan's mastectomy on choice of surgery for breast cancer by US women.
BACKGROUND
While the actions of popular figures are believed to influence the behavior of the general public, including health care decisions, little research has examined such an effect.


OBJECTIVE
To determine whether a temporal association exists between use of breast-conserving surgery (BCS) for treatment of breast cancer and Nancy Reagan's mastectomy in October 1987.


METHODS
Population-based observational cohort study.


METHODS
Two sources of data: (1) 82 230 women aged 30 years and older who were included in the Surveillance, Epidemiology, and End Results tumor registry because of a diagnosis of local or regional breast cancer from 1983 to 1990; and (2) 80057 female Medicare beneficiaries aged 65 to 79 years who received inpatient surgery for local or regional breast cancer in 1987 or 1988.


METHODS
Percentage of use of BCS vs mastectomy over time.


RESULTS
Compared with women undergoing surgery for breast cancer in the third quarter of 1987 (just prior to Mrs Reagan's mastectomy), women were 25% less likely to undergo BCS in the fourth quarter of 1987 (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.66-0.85) and in the first quarter of 1988 (OR, 0.76; 95% CI, 0.67-0.86). In subsequent quarters, the rate returned to the baseline. In multivariate analyses, the decline was significant among white but not nonwhite women. It was most prominent among women aged 50 to 79 years in the central and southern regions of the country, and most sustained among women living in areas with lower levels of income and education.


CONCLUSIONS
Celebrity role models can influence decisions about medical care. The influence appears strongest among persons who demographically resemble the celebrity, and those of lower income and educational status.
Nattinger
A B
AB
Department of Medicine, Medical College of Wisconsin, Milwaukee, USA. anatting@mcw.edu
Hoffmann
R G
RG
Howell-Pelz
A
A
Goodwin
J S
JS
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D015331:Cohort Studies; D003657:Decision Making; D005197:Famous Persons; D005260:Female; D006126:Group Processes; D049673:History, 20th Century; D006801:Humans; D008408:Mastectomy / Q000523:psychology / Q000706:statistics & numerical data*; D015409:Mastectomy, Radical / Q000523:psychology / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000523:psychology / Q000706:statistics & numerical data; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology