论安吉丽娜·朱莉对基因检测的影响,好与不好都在这里
2016/12/16
好莱坞明星安吉丽娜·朱莉接受基因检测后切除乳房和卵巢的举措,似乎推动了乳腺癌基因检测的热潮。近日,哈佛医学院的研究人员分析了了安吉丽娜·朱莉对乳腺癌基因检测带来的影响,结果发现朱莉专栏之后,乳腺癌风险基因检测的使用率大幅增加,但乳房切除术的使用率没有相应地上升,这表明基因检测并未增加乳腺癌的诊断率。


流行文化或者偶像可以影响我们对时尚、饮食习惯和品牌偏好的选择,但名人是否会影响我们的医疗决策?答案是肯定的。

哈佛医学院的研究者分析了2013年《纽约时报》发布安吉丽娜·朱莉专栏之后基因检测使用率发生的变化,相关结果于12月14日发表在BMJ(《英国医学杂志》)上。研究人员发现,继朱莉专栏之后,乳腺癌风险基因检测的使用率大幅增加,但乳房切除术的使用率没有相应地上升,这表明基因检测并未增加乳腺癌的诊断率。研究人员认为,明星代言可以促进医疗保健服务的使用率,但可能未有效地针对最需要这类服务的人群。

名人代言,助长了不必要的追捧

朱莉的母亲因乳腺癌和卵巢癌去世,她的祖母和姑姑也患有乳腺癌,因而她接受了BRCA1基因检测。检测结果也确定了朱莉携带乳腺癌致病基因突变,最后她选择了预防性双乳切除术和卵巢切除术。许多女性似乎成为了朱莉的“跟风者”。通过调查包含900万18至64岁女性的数据库,研究人员发现朱莉专栏发布之后2周,基因检测的使用率与上一年同时期相比上涨了64%。

此外,研究人员还发现,朱莉专栏发布之后,接受BRCA基因检测的女性对乳房切除术的使用率反而下降了3%,这表明那些接受基因检测的人携带突变的风险较低,也意味着基因检测并未带来额外的乳腺癌诊断率。

调查员之一Sunita Desai表示,“我们的研究结果强调了名人代言对健康行为有强大的影响力,但也表明这些影响并未针对那些真正有疾病风险的人。”换句话说,朱莉的举动加强了乳腺癌基因检测的知名度,也无意中助长了低风险人群对基因检测的追捧。

检测的费用为3000美元/次,这属于比较高的成本。研究人员估计,朱莉专栏后的短短两周内,与往年同时期相比,接受BRCA基因检测的人数多出了4500名,市场值增加了1350万美元。

避免基因检测泛滥,医生应该有些作为

本研究作者Anupam Jena表示,“从医生角度来看,当担心预防性筛查未得到充分利用时,名人公告会产生很大的推动作用,因为它能够让更多的患者愿意接受新技术。但是名人效应也可能会造成技术的过度使用。”

科学的迅速发展以及人们对突变的进一步理解,使得更多疾病基因检测的可用性增强。不同于简单的临床检查如结肠镜检查或艾滋病毒检测,基因检测充满了不确定性,因为检测结果揭示一个人患病的可能性,而非命运。

Desai表示,“虽然基因检测带来了明显的益处,但是阳性检测结果可能会给患者带来焦虑,甚至会带来进一步的检测,或者使患者过早地接受不必要的临床干预。”

为了使真正需要的人能够接受检测,避免不必要的检测发生,临床医生应该尝试着去理解人们为何要接受检测。如果是受名人代言的影响而去申请基因检测,医生应该对患者的医疗情况以及家族史进行详细评估,并阐明检测的优缺点。“个性化护理和个性化医疗的基础是以病人为分析中心。”Jena表示,“患者是否该接受基因检测,这没有正确或错误的答案。但重要的是,要在完全理解的情况下再做检测与否的决定。”

参考资料:

The Angelina Jolie effect on breast cancer genetic testing

Do celebrity endorsements matter? Observational study of BRCA gene testing and mastectomy rates after Angelina Jolie’s New York Times editorial

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  • Do celebrity endorsements matter? Observational study of BRCA gene testing and mastectomy rates after Angelina Jolie’s New York Times editorial

    Objective To examine the effect on BRCA testing and mastectomy rates of a widely viewed 2013 New York Times editorial by public figure Angelina Jolie that endorsed BRCA testing and announced Jolie’s decision to undergo preventive mastectomy. Design Observational study with difference-in-difference analysis. Setting Commercially insured US population. Participants Women aged 18-64 years with claims in the Truven MarketScan commercial claims database (n=9 532 836). Main outcome measures Changes in BRCA testing rates in the 15 business days before versus after 14 May 2013 (editorial date) compared with the change in the same period in 2012; mastectomy rates in the months before and after publication, both overall and within 60 days of BRCA testing among women who were tested; national estimates of incremental tests and expenditures associated with Jolie’s article in the 15 days after publication. Results Daily BRCA test rates increased immediately after the 2013 editorial, from 0.71 tests/100 000 women in the 15 business days before to 1.13 tests/100 000 women in the 15 business days after publication. In comparison, daily test rates were similar in the same period in 2012 (0.58/100 000 women in the 15 business days before 14 May versus 0.55/100 000 women in the 15 business days after), implying a difference-in-difference absolute daily increase of 0.45 tests/100 000 women or a 64% relative increase (P<0.001). The editorial was associated with an estimated increase of 4500 BRCA tests and $13.5m (£10.8m; €12.8) expenditure nationally among commercially insured adult women in those 15 days. Increased BRCA testing rates were sustained throughout 2013. Overall mastectomy rates remained unchanged in the months after publication, but 60 day mastectomy rates among women who had a BRCA test fell from 10% in the months before publication to 7% in the months after publication, suggesting that women who underwent tests as a result of to the editorial had a lower pre-test probability of having the BRCA mutation than women tested before the editorial. Conclusions Celebrity endorsements can have a large and immediate effect on use of health services. Such announcements can be a low cost means of reaching a broad audience quickly, but they may not effectively target the subpopulations that are most at risk for the relevant underlying condition.

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