Angelina Jolie turns heads—toward genetic information

see Celebrity disclosures and information seeking: the case of Angelina Jolie

It’s no secret that celebrities’ medical conditions draw attention. Interest in spinal injuries rose after actor Christopher Reeve fell off his horse and became paralyzed. Apple CEO Steve Jobs raised the profile of pancreatic cancer. Certainly actress Angelina Jolie’s public announcement of her genetic predisposition and decision to pursue risk-reducing bilateral mastectomy got lots of people talking about genetic testing for the BRCA1 and BRCA2 genes. Now, Juthe and colleagues document the impact of that increased public interest on Internet traffic to online cancer genetics resources available at the National Cancer Institute (NCI). The authors used digital media analytics to calculate page views for available fact sheets and Physician Data Query (PDQ) cancer genetics information summaries. On the date that Jolie’s announcement appeared in the New York Times, page views of the NCI’s preventive mastectomy fact sheet increased 795-fold compared with views one week previously. Use of other cancer genetics resources, including fact sheets for skin and prostate cancer, also had large increases in the days following Jolie’s announcement. In addition, resources intended for health professionals experienced a similar surge in Internet traffic. The authors suggest that the “Jolie effect” extended to health-care providers attempting to learn more about BRCA1 and BRCA2 by accessing PDQ information. Such instances offer genetics professionals an opportunity to educate patients about credible sources of online health information and highlight the opportunity for celebrity announcements to serve as teachable moments for both the public and medical professionals. —Karyn Hede, News Editor

Utility of gene-expression profiling in breast cancer still unproven

see Clinical utility of gene-expression profiling in women with early breast cancer: an overview of systematic reviews

Despite widespread use of gene-expression profiling to assist clinical decision making in women diagnosed with breast cancer, significant questions remain concerning its prognostic usefulness. In 2009, the Evaluation of Genomic Applications in Practice and Prevention Working Group (EWG) found evidence of an association between the prognostic ability of two gene-profiling systems—MammaPrint (Agendia) and Oncotype DX—and actual disease recurrence. Only MammaPrint is approved by the US Food and Drug Administration for determining the risk of distant recurrence in women less than 61 years old with stage I or II lymph node–negative early breast cancer. The two products measure gene expression in entirely separate sets of genes. Marrone et al. report that a new compilation of systematic reviews evaluating the clinical utility of the two products reveals no direct evidence that use of the tests improved outcomes of women with breast cancer. The reviews do show that use of the tests often led to a change in treatment. Six studies reported that 13–34% fewer patients received chemotherapy, and one study reported that 27% of patients changed their own treatment decisions after gene-expression testing. Two ongoing clinical trials, TAILORx and MINDACT, are currently evaluating whether using Oncotype DX and MammaPrint to guide treatment decisions for women with early-stage breast cancer changes patient outcomes. These findings are intended to provide input toward an updated recommendation from the EWG. —Karyn Hede, News Editor