編者按：2013年5月14日，美國(guó)好萊塢著名女演員、慈善家、社會(huì)活動(dòng)家、聯(lián)合國(guó)兒童親善大使、紐約大學(xué)校友安吉麗娜·朱莉在《紐約時(shí)報(bào)》撰文宣布，當(dāng)?shù)弥侨橄侔┮赘谢?（BRCA1）突變攜帶者，乳腺癌和卵巢癌的風(fēng)險(xiǎn)高達(dá)87%和50%，為了預(yù)防乳腺癌和卵巢癌，她于2013年4月27日接受了減少風(fēng)險(xiǎn)雙側(cè)乳房切除手術(shù)。隨后，乳腺癌遺傳學(xué)及其咨詢相關(guān)互聯(lián)網(wǎng)搜索量大幅增加，《時(shí)代》雜志將此現(xiàn)象稱為：安吉麗娜效應(yīng)。

　　2018年5月28日，施普林格·自然旗下《乳腺癌研究與治療》在線發(fā)表美國(guó)安進(jìn)、模擬統(tǒng)計(jì)、瑞士安進(jìn)、英國(guó)曼徹斯特大學(xué)、圣瑪麗醫(yī)院的研究報(bào)告，調(diào)查了1997～2016年BRCA檢測(cè)率和減少風(fēng)險(xiǎn)雙側(cè)乳房切除手術(shù)率，并且量化了安吉麗娜·朱莉發(fā)表文章前后的變化趨勢(shì)。

　　該醫(yī)療保險(xiǎn)索賠數(shù)據(jù)觀察研究根據(jù)IBM旗下Truven醫(yī)療市場(chǎng)分析數(shù)據(jù)庫(kù)，對(duì)美國(guó)商業(yè)醫(yī)療保險(xiǎn)年齡≥18歲女性人群的BRCA檢測(cè)率和減少風(fēng)險(xiǎn)雙側(cè)乳房切除手術(shù)率進(jìn)行統(tǒng)計(jì)。截止事件為確診乳腺癌或卵巢癌、末次隨訪日期2016年9月或死亡。通過(guò)中斷時(shí)間序列分析，對(duì)安吉麗娜·朱莉發(fā)表文章前后的變化趨勢(shì)進(jìn)行量化。

　　結(jié)果發(fā)現(xiàn)，安吉麗娜·朱莉《紐約時(shí)報(bào)》文章引起美國(guó)人群：

• 既往無(wú)乳腺或卵巢癌女性的基因檢測(cè)率和減少風(fēng)險(xiǎn)雙側(cè)乳房切除手術(shù)率顯著增加（P<0.0001）

• 既往未接受BRCA檢測(cè)女性的基因檢測(cè)率和減少風(fēng)險(xiǎn)雙側(cè)乳房切除手術(shù)率顯著增加（P<0.0001）

• 既往已接受BRCA檢測(cè)女性的減少風(fēng)險(xiǎn)雙側(cè)乳房切除手術(shù)率無(wú)顯著變化（P=0.70）

　　排除乳腺原位癌女性后，文章影響減小，表明對(duì)乳腺原位癌高風(fēng)險(xiǎn)女性影響最大。

　　因此，安吉麗娜效應(yīng)代表了名人對(duì)公共衛(wèi)生意識(shí)的長(zhǎng)期影響，可觀察到基因檢測(cè)率和乳房切除手術(shù)率顯著增加，并且隨后持續(xù)多年。

相關(guān)閱讀

• 三年半后：安吉麗娜的抗癌勵(lì)志故事似乎發(fā)生了反轉(zhuǎn)

• 外科腫瘤學(xué)會(huì)乳腺疾病工作組預(yù)防性（降低風(fēng)險(xiǎn)）乳房切除術(shù)聲明

• 美國(guó)乳腺外科醫(yī)師學(xué)會(huì)共識(shí)聲明：預(yù)防性對(duì)側(cè)乳房切除術(shù)的結(jié)局與風(fēng)險(xiǎn)數(shù)據(jù)

• 美國(guó)乳腺外科醫(yī)師學(xué)會(huì)共識(shí)聲明：預(yù)防性對(duì)側(cè)乳房切除術(shù)的補(bǔ)充注意事項(xiàng)與共同決策框架

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