The Angelina Jolie effect – Impact on breast and ovarian cancer prevention. A systematic review of effects after the public announcement in May 2013

Background: On 14 May 2013, Angelina Jolie (AJ), revealed herself to be the carrier of a BReast CAncer 1 (BRCA1) gene mutation and announced her decision to undergo a prophylactic mastectomy, followed by a laparoscopic bilateral salpingo-oophorectomy. This review explores the impact of the 'Angelina Jolie Effect' in order to reveal whether her announcement led to a change in the attitude of patients, and in decisions regarding healthcare options focusing especially on referrals, on genetic tests and on prophylactic mastectomies. Methods: Between January-February 2017, we performed a systematic search in PubMed using the key search term 'Angelina Jolie'. We searched for studies published between 2013 and 2017, reporting data on number of BRCA1/2 tests, number of referrals for breast or ovarian cancer and number of performed mastectomies, before and after AJ's disclosure. We considered eligible for inclusion all cross-sectional, retrospective, prospective studies written in English. Results: The literature search yielded 27 publications. After the analysis of title, abstracts and full text, we identified eight manuscripts for inclusion in the review. The studies were conducted from 2011 to 2015 in the USA, Austria, Australia, Canada and the UK. The announcement generated an increase of referrals for breast/ovarian cancer with peaks of +285%, an increase of BRCA tests with a peak of +80%, but did not lead to a significant increase of prophylactic mastectomies. Patients with a lower level of education asked for information about cancer, and most patients became more aware of breast reconstruction post-mastectomy. Conclusion: Celebrity disclosures, such as AJ's revelation of her BRCA status and her decision for a prophylactic mastectomy, can influence patients' behaviour leading to important effects on attitudes towards screening. Organisations should assist patients appropriately, but at the same time should consider the available resources, and should interface with journalists and the social media in order to guarantee the validity of the information. © Health Education Journal.