title: The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services.
abstract: BACKGROUND
  It is frequent for news items to lead to a short lived temporary increase in interest in a particular health related service, however it is rare for this to have a long lasting effect. In 2013, in the UK in particular, there has been unprecedented publicity in hereditary breast cancer, with Angelina Jolie's decision to have genetic testing for the BRCA1 gene and subsequently undergo risk reducing mastectomy (RRM), and a pre-release of the NICE guidelines on familial breast cancer in January and their final release on 26th June. The release of NICE guidelines created a lot of publicity over the potential for use of chemoprevention using tamoxifen or raloxifene. However, the longest lasting news story was the release of details of film actress Angelina Jolie's genetic test and surgery.
  
  
  METHODS
  To assess the potential effects of the 'Angelina Jolie' effect, referral data specific to breast cancer family history was obtained from around the UK for the years 2012 and 2013. A consortium of over 30 breast cancer family history clinics that have contributed to two research studies on early breast surveillance were asked to participate as well as 10 genetics centres. Monthly referrals to each service were collated and increases from 2012 to 2013 assessed.
  
  
  RESULTS
  Data from 12 family history clinics and 9 regional genetics services showed a rise in referrals from May 2013 onwards. Referrals were nearly 2.5 fold in June and July 2013 from 1,981 (2012) to 4,847 (2013) and remained at around two-fold to October 2013. Demand for BRCA1/2 testing almost doubled and there were also many more enquiries for risk reducing mastectomy. Internal review shows that there was no increase in inappropriate referrals.
  
  
  CONCLUSIONS
  The Angelina Jolie effect has been long lasting and global, and appears to have increased referrals to centres appropriately.
authors.forename: D Gareth
authors.initials: DG
authors.lastname: Evans
authors.forename: Julian
authors.initials: J
authors.lastname: Barwell
authors.forename: Diana M
authors.initials: DM
authors.lastname: Eccles
authors.forename: Amanda
authors.initials: A
authors.lastname: Collins
authors.forename: Louise
authors.initials: L
authors.lastname: Izatt
authors.forename: Chris
authors.initials: C
authors.lastname: Jacobs
authors.forename: Alan
authors.initials: A
authors.lastname: Donaldson
authors.forename: Angela F
authors.initials: AF
authors.lastname: Brady
authors.forename: Andrew
authors.initials: A
authors.lastname: Cuthbert
authors.forename: Rachel
authors.initials: R
authors.lastname: Harrison
authors.forename: Sue
authors.initials: S
authors.lastname: Thomas
authors.forename: Anthony
authors.initials: A
authors.lastname: Howell
authors.forename: Zosia
authors.initials: Z
authors.lastname: Miedzybrodzka
authors.forename: Alex
authors.initials: A
authors.lastname: Murray
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control; D005197:Famous Persons; D005260:Female; D019398:Genes, BRCA1; D020022:Genetic Predisposition to Disease; D006801:Humans; D008408:Mastectomy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior; D006113:United Kingdom