Balancing a celebrity endorsement with evidence


Angelina Jolie
Image by Gage Skidmore via flickr.

“The ability to talk to a lot of people is freakish,” said Chris Rock in a conversation with Jerry Seinfeld for his new online show “Comedians in Cars Getting Coffee.”

“It’s more freakish than being able to run fast or dunk a basketball or any of those things.”

It’s freakish and powerful, maybe too powerful when it comes to celebrity endorsements of medical tests.

Dubbed “The Katie Couric Effect” for the 20 percent boost to colonoscopies after the popular anchor televised her own screening in March 2000, it’s also been demonstrated in cervical cancer and myriad other kinds of cancer screening tests.

No doubt it is happening again in the wake of Angelina Jolie’s May announcement of her BRCA testing for breast and ovarian cancer. The stock market has bet on it. And some doctors saw spikes in calls from patients after her New York Times op-ed was published.

The likely increase in demand comes at a time when prices for BRCA testing are dropping. Thanks to a June decision by the U.S. Supreme Court that invalidated patents on genes, companies have begun offering BRCA tests at a third of their original cost.

That’s great news for women who really should get the test but the truth is that the pool of women who might truly benefit from testing is much smaller than many people realize.  According to the National Cancer Institute, between 1 in 400 and 1 in 800 people in the general population carry a BRCA mutation.

That has experts in evidence-based medicine worried about the perils of overtesting, which can include overtreatment, especially if results fall into a gray area of risk, and perhaps a false sense of security if the test comes back negative.

“It’s no guarantee that you won’t get breast cancer because this particular gene is negative,” said Dr. Karen M. Schoelles, director of the ECRI Institute’s Evidence-Based Practice Center, in Plymouth Meeting, Penn.

ECRI is a nonprofit that specializes in helping professional partners like the U.S. Agency for Healthcare Research and Quality research medical questions. They look at all the evidence about a test or treatment to help guide recommendations about its use.

After Jolie’s announcement, ECRI self-commissioned a new consumer guide to help women make informed decisions about BRCA testing.

“We wanted to be sure that people had good information,” Schoelles said. “She did a very courageous thing by letting people know about her decision, and was altruistic, I think, in her desire to see it be available to women, but it didn’t provide all the context that an individual might want to make a decision about having this testing or not.”

The guide also talks about non-surgical options for managing genetic risk.  Evidence shows that frequently screening and tamoxifen are also good options for women who aren’t ready to lose their breasts or ovaries.

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