编者按：2013年5月14日，美国好莱坞著名女演员、慈善家、社会活动家、联合国儿童亲善大使、纽约大学校友安吉丽娜·朱莉在《纽约时报》撰文宣布，当得知她是乳腺癌易感基因1（BRCA1）突变携带者，乳腺癌和卵巢癌的风险高达87%和50%，为了预防乳腺癌和卵巢癌，她于2013年4月27日接受了减少风险双侧乳房切除手术。随后，乳腺癌遗传学及其咨询相关互联网搜索量大幅增加，《时代》杂志将此现象称为：安吉丽娜效应。
2018年5月28日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表美国安进、模拟统计、瑞士安进、英国曼彻斯特大学、圣玛丽医院的研究报告，调查了1997～2016年BRCA检测率和减少风险双侧乳房切除手术率，并且量化了安吉丽娜·朱莉发表文章前后的变化趋势。
该医疗保险索赔数据观察研究根据IBM旗下Truven医疗市场分析数据库，对美国商业医疗保险年龄≥18岁女性人群的BRCA检测率和减少风险双侧乳房切除手术率进行统计。截止事件为确诊乳腺癌或卵巢癌、末次随访日期2016年9月或死亡。通过中断时间序列分析，对安吉丽娜·朱莉发表文章前后的变化趋势进行量化。
结果发现，安吉丽娜·朱莉《纽约时报》文章引起美国人群：
既往无乳腺或卵巢癌女性的基因检测率和减少风险双侧乳房切除手术率显著增加（P<0.0001）
既往未接受BRCA检测女性的基因检测率和减少风险双侧乳房切除手术率显著增加（P<0.0001）
既往已接受BRCA检测女性的减少风险双侧乳房切除手术率无显著变化（P=0.70）
排除乳腺原位癌女性后，文章影响减小，表明对乳腺原位癌高风险女性影响最大。
因此，安吉丽娜效应代表了名人对公共卫生意识的长期影响，可观察到基因检测率和乳房切除手术率显著增加，并且随后持续多年。
相关阅读
Breast Cancer Res Treat. 2018 May 28.
Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect.
Alexander Liede, Mona Cai, Tamara Fidler Crouter, Daniela Niepel, Fiona Callaghan, D. Gareth Evans.
Amgen Inc., Thousand Oaks, USA; SimulStat Incorporated, Solana Beach, USA; Amgen GmbH, Zug, Switzerland; The University of Manchester, Manchester, UK; Saint Mary's Hospital, Manchester, UK.
PURPOSE: In 2013, Angelina Jolie disclosed in the New York Times (NYT) that she had undergone risk-reducing bilateral mastectomy (RRBM) after learning that she was a BRCA1 mutation carrier. We examined the rates of BRCA testing and RRBM from 1997 to 2016, and quantified trends before and after the Jolie op-ed.
METHODS: This observational study of insurance claims data representative of the commercially-insured US population (Truven MarketScan database) measured BRCA testing and RRBM rates among females≥18 years. Censoring events were breast cancer or ovarian cancer diagnosis, last follow-up date (September 2016), or death. Interrupted time series analyses were used to quantify trends before and after the op-ed.
RESULTS: Angelina Jolie's NYT op-ed led to a statistically significant increase in the uptake of genetic testing and in RRBM among women without previous diagnosis of breast or ovarian cancer in the US population, and in women who did not undergo testing for BRCA (P<0.0001 for both). The rate (slope) of RRBM among women who were previously tested for BRCA (P=0.70) was unchanged. After excluding women with in-situ tumors, the editorial's effect became less pronounced, suggesting that high-risk women with in-situ breast cancers were most influenced by Jolie's announcement.
CONCLUSION: The Angelina Effect (a term coined by Time magazine to describe the rise in internet searches related to breast cancer genetics and counseling) represents a long-lasting impact of celebrity on public health awareness as significant increases in genetic testing and mastectomy rates were observed and sustained in subsequent years.
KEYWORDS: Bilateral mastectomy; Genetic testing; BRCA mutation
DOI: 10.1007/s10549-018-4824-9
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