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  • Job insecurity may increase adult asthma risk

    “People fearful of losing their jobs are 60% more likely to develop asthma,” The Independent reports.

    Researchers have looked at whether perceived job insecurity (specifically, the likelihood that they would lose their jobs) affected people’s risk of developing asthma in Germany during the “Great Recession” (the global economic downturn that lasted from 2008 to 2012).

    They found that people who felt there was more than a 50:50 chance of them losing their jobs in the next two years were about 60% more likely to be diagnosed with asthma in this period.

    Despite finding a link between job insecurity and asthma, there are a number of things to bear in mind. Associations between mental health, genetic and environmental factors, and physical health can be complex, so it is often difficult to tease out precise causal relationships.

    For example, people who reported high levels of job insecurity in this study were also more likely to smoke and be in jobs that might increase their risk of asthma. The researchers tried to take this into account, but it is difficult to know whether factors such as these had an effect.

    It does seem plausible that job insecurity – a potentially stressful situation – could cause adult asthma attacks, given that stress can be a trigger. However, we cannot be certain, based on this study alone, whether job insecurity directly increases the risk of developing adult asthma.

     

    Where did the story come from?

    The study was carried out by researchers from the University of Düsseldorf in Germany, and other universities in the Netherlands and New Zealand. No funding for the study was reported, and the authors declared that they had no competing interests.

    The study was published in the peer-reviewed Journal of Epidemiology and Community Health.

    The Independent’s headline wrongly suggests that the study looked at workplace stress, which it did not – rather, it assessed just job insecurity. For the purpose of this study, high job insecurity was defined as a person perceiving that there was more than a 50:50 chance of them losing their job in the next two years. While the majority of us would find such as prospect stressful this may not be the case for everyone – for example, if you hate your job and have a good redundancy package you may even welcome redundancy. A person may also have a very secure job, but still have high levels of work stress.

    The Independent, however, does report both the actual risk of people developing asthma in the study as well as the relative increase in risk, which helps put the increase into a meaningful context.

     

    What kind of research was this?

    This was a cohort study looking at whether there was a link between job insecurity and new diagnoses of adult asthma. Studies have suggested that job insecurity may increase risk of poor health, and that job-related stress may be a risk factor for asthma, but have not looked at whether job insecurity might be linked with asthma. This latest study used data collected as part of the German Socio-Economic Panel (GSOEP) study, between 2009 and 2011 – during the European economic crisis, when job insecurity increased.

    This study design is the best way to look at the link between an exposure and outcome when it is not feasible or ethical to randomly assign people to have the exposure or not (in this case job insecurity). It allows researchers to establish that the exposure did in fact occur before the outcome, and could therefore potentially be contributing to it.

    The main limitation is that factors other than the exposure (called confounders) that differ between the exposed and unexposed groups could be causing any differences seen, rather than the exposure itself. Researchers can use statistical methods to try to remove their impact, but these methods are not 100% effective. They also can’t remove the effect of factors the researchers didn’t know about or measure.

     

    What did the research involve?

    The researchers analysed data on employed adults who did not have asthma when assessed in 2009. They measured how insecure the participants thought their jobs were at this point and then checked whether they had been diagnosed with asthma two years later, in 2011. They then assessed whether those who felt more job insecurity were more likely to develop asthma.

    The data used in this study was collected in face-to-face interviews. Asthma was assessed in both 2009 and 2011 by asking participants if they had ever been diagnosed with this condition by a doctor.

    Participants were asked in 2009 to rate on an 11-point scale, from 0% to 100%, how likely they thought they were to lose their job in the next two years. This allowed the researchers to classify and analyse their job insecurity as:

    • less than 50%, or 50% and higher
    • no insecurity (0%), low job insecurity (10% to up to 50%), high job insecurity (50% and over)
    • a continuous measure based on how many standard deviations they were from the average

    In their analyses, the researchers took into account confounders that could affect results, including:

    • demographic characteristics – such as age and gender
    • job factors – such as type of contract and working in a profession which could cause a high risk for asthma
    • health behaviours and conditions – such as smoking, overweight and obesity, and depression

    Of the approximately 20,000 participants in GSOEP, this latest study analysed the 7,031 who were employed and did not have asthma in 2009, and had answered questions on all the factors included in the analyses.

     

    What were the basic results?

    The researchers found that just under a quarter of participants (23%) reported high levels of job insecurity in 2009. These people tended, on average, to be slightly younger, have less education, lower income, and were more likely to be unmarried, be smokers, do less exercise, work in a high-risk asthma occupation, have a non-permanent contract, and to have been diagnosed with depression.

    In total, 105 people (1.5%) reported having been diagnosed with asthma during the study period. Among those reporting low or no job insecurity, 1.3% developed asthma, compared to 2.1% of those who reported high job insecurity.

    After taking into account the potential confounders, this equated to those with high job insecurity being at 61% higher risk of developing asthma (relative risk 1.61, 95% confidence interval 1.08 to 2.40). The researchers also found similar results if they analysed the effect of job insecurity in different ways.

     

    How did the researchers interpret the results?

    The researchers concluded that “perceived job insecurity may increase the risk of new-onset adult asthma”.

     

    Conclusion

    This latest study has found that people who reported feeling less secure about their job during the economic crisis were more likely to develop asthma.

    It collected data prospectively from a large sample representative of the German population, and excluded people who already reported having asthma at the start of the study. This meant the researchers could be sure that the job insecurity came before the asthma diagnosis.

    However, there are also some limitations that mean we should interpret its findings cautiously. Firstly, the researchers tried to take into account some factors that differed between those experiencing high levels of job insecurity and those who did not and might affect results. However, this may not remove their effect entirely. For example, they only had data on smoking at one point in time (in 2008), and did not assess how much a person smoked, or whether this changed over time. People who felt more insecure in their job may have been more likely to start smoking or smoke more, and this could contribute to the link seen.

    Secondly, the study only asked people whether they had been diagnosed with asthma by a doctor. It did not check their medical records to confirm this, or give all participants a medical to see if they did have asthma. Some people who already had the condition might not have been diagnosed at the start of the study.

    Thirdly, a lot of the participants in the overall study (more than 4,000) could not be analysed as they had missing data. These people differed from the ones who could be analysed in terms of their age, smoking habits and incomes, but not in their reported job insecurity or reported levels of asthma. If these people had been followed up, this could have altered the results.

    Finally, it is also worth noting that only a relatively small proportion of people in both groups developed asthma in the study – 2.1% of those reporting high job insecurity and 1.3% reporting low or no insecurity. So most people, regardless of job security, did not develop asthma

    The exact causes of asthma development are uncertain, though it is thought to be a combination of hereditary and environmental influences (such as being exposed to smoke as a child). In people who are susceptible to asthma, various things can then trigger an asthma attack – one of which is known to be emotions, which can include stress. For this reason, it is plausible that a stressful situation (job insecurity) could also be a trigger.

    Overall, although this study has found a link, there is no certainty that perceived job insecurity was directly causing the development of asthma in people previously without the condition.

    If you are worried that concerns about job insecurity are affecting your health, there are a number of steps you can take, such as:

    • not working longer hours than you need to just because you want to demonstrate your commitment; you have to have a good balance of work and leisure if you want to be resilient
    • being focused; it’s more effective to work in short, intense bursts and then take a break
    • if you’re feeling really insecure about your job, talk to your boss or to a trusted colleague and tell him or her how you’re feeling; rumours are often worse than the reality

    If you're still feeling anxious or low after a few weeks, see your GP. You may find that talking to a professional therapist helps, and your GP can advise you on talking therapy services in your area.

    Read more about coping better with job insecurity  

    Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

    Links To The Headlines

    Stress at work increases risk of developing asthma, according to major new research. The Independent, September 23 2014

    Links To Science

    Loerbroks A, Bosch JA, Douwes J, et al. Job insecurity is associated with adult asthma in Germany during Europe's recent economic crisis: a prospective cohort study. Journal of Epidemiology and Community Health. Published online September 22 2014



  • Late cancer diagnosis 'costing lives and money'

    "Almost half of cancer patients diagnosed too late," says The Guardian, citing a new report that explored both the financial and health impact of late cancer diagnosis.

    The late diagnosis of almost all types of cancer usually means the disease has already spread within the body, making it less treatable, reducing a patient's chances of survival, and potentially increasing the cost of effective treatments.

    This means an enduring aim of cancer treatment is to pick up the disease as soon as possible, so treatment is more likely to be effective.

    The report predicted around 52,000 cases of four common cancers (colon, rectallung and ovarian) may be spotted too late every year, costing the NHS around an extra £150 million to treat.

    Various theories have been put forward to explain why this is the case, including "patients put[ting] their heads in the sand when they feared cancer", and how "doctors are struggling to get patients seen quickly".

     

    Who produced this report on late cancer diagnoses?

    The report was produced by Incisive Health, a specialist health policy and communications consultancy, in collaboration with experts at Cancer Research UK, a leading cancer charity. It was funded by Cancer Research UK.

    The report – titled "Saving lives, averting costs: an analysis of the financial implications of achieving earlier diagnosis of colorectal, lung and ovarian cancer" – presumed that early diagnosis is crucial, and aimed to uncover the financial implications of achieving earlier diagnosis for colon, rectal, non-small cell lung (the most common type of lung cancer) and ovarian cancers.

    The report estimated the number of people currently diagnosed with cancer using national guidance and data sources. This included data on the stage of the cancer when it was diagnosed (where available), and the authors calculated the cost of treatment. They then modelled what would happen if the cancers had been diagnosed earlier.

     

    Links To The Headlines

    Almost half of cancer patients diagnosed too late. The Guardian, September 22 2014

    50,000 lives cut short by cancer diagnosis failings. The Daily Telegraph, September 22 2014

    52,000 cancer cases a year are spotted too late: Delays blamed on 'stiff upper lip' mentality and pressure on GPs not to refer patents for costly tests. Mail Online, September 22 2014

    Almost half of cancers 'caught too late'. ITV News, September 22 2014

    Links To Science

     

     



  • Dry-roasted peanuts may be worst for nut allergies

    “Dry-roasted peanuts 'worst for allergies',” the Mail Online reports. New research involving mice suggests that the roasting process increases the "allergic power" of peanuts.

    Researchers exposed mice to small amounts of proteins derived from either "raw" peanuts or dry-roasted peanuts, to “prime” their immune systems for an allergic reaction. They later gave them larger doses of the proteins and found that the intensity of the allergic reaction was much larger after priming with the dry-roasted protein, compared with the raw.

    The researchers speculated that the roasting process may change the chemical composition of nuts, making them more likely to provoke an allergic reaction.

    The research team thought this might partially explain why there is a much higher prevalence of peanut allergies in Western countries – where dry roasting is more common – compared with Eastern countries.

    Importantly, the findings were based on mice, so are not directly applicable to humans. Studies involving humans would be needed to better explore these issues. There may be ethical considerations, however, due to the possible risk of anaphylaxis – a severe allergic reaction.

    This research alone does not warrant the avoidance of dry-roasted peanuts out of fear of developing a nut allergy. Similarly, if you have a history of nut allergies, you shouldn’t assume that raw, boiled or fried nuts will be safe to eat. Those with an existing allergy should continue to take their normal action to prevent triggering their own allergy, which will vary from person to person.

     

    Where did the story come from?

    The study was carried out by researchers from Universities in Oxford (UK) and Philadelphia (US), and was funded by the National Institute for Health Research Oxford Biomedical Research Centre (UK), the National Institutes of Health (US) and the Swiss National Science Foundation Prospective and Advanced Research Fellowships.

    The study was published in The Journal of Allergy and Clinical Immunology, a peer-reviewed science journal. 

    The UK media’s reporting was generally accurate, with some warning against over-extrapolating the results to humans, and that new treatments or allergy-prevention strategies may take a long time to develop, if at all.

     

    What kind of research was this?

    This was an animal study, using mice to research allergic reactions to peanuts.

    Peanut allergies are relatively common and can be serious, sometimes fatal. The researchers highlight how, despite similar peanut consumption, the Western world has a much higher prevalence of peanut allergy than the Eastern world. The research team suggested that this might be due to the way nuts are prepared. Eastern countries tend to eat their nuts raw, boiled or fried, whereas Western countries consume more dry-roasted nuts.

    Researchers often use mice for research purposes because, as mammals, they are biologically similar to humans. Hence, conducting research on mice can tell us what might happen to humans without directly experimenting on them. The caveat is that there is no guarantee the results seen in mice will be applicable to humans; while similar, the biology of the two organisms is not identical, and the differences can sometimes be crucial.

     

    What did the research involve?

    The researchers studied the immune response of mice to various peanut products: peanut protein extracted from raw nuts; peanut protein extracted from dry-roasted nuts; raw peanut kernels (grain or seed); and dry-roasted peanut kernels. 

    The team studied how immune cells reacted to the peanut products and the biochemistry involved in the response.

    They studied three main routes of exposure to the peanut products:

    • peanut protein extracts were injected into the mice under the skin (subcutaneous route)
    • peanut kernels were fed to the mice for them to eat as they normally would (gastrointestinal route)
    • extracts were applied to sores in the skin (epicutaneous route)

    The main analysis looked at the immune reactions of the mice, comparing raw with dry-roasted peanuts and peanut proteins.

     

    What were the basic results?

    The main finding was that the dry-roasted peanut protein extracts and whole peanut kernel elicited a much stronger immune response in the mice than the equivalent raw peanuts and extracts. This occurred consistently across all three exposure routes – on skin, in the stomach and under the skin.

    Interestingly, when the mice were “primed” with low levels of dry-roasted peanut proteins to give a low-level reaction, they gave a much larger subsequent reaction to both raw and dry-roasted products. This suggested that exposure to dry-roasted nuts influenced subsequent reaction to raw nuts, possibly sensitising an individual for a strong reaction in the future.

     

    How did the researchers interpret the results?

    The researchers indicated that this is the first experiment to show a larger immune response elicited by dry-roasted peanuts compared with raw peanuts in a living mammal.

    They suggest that: “A better understanding of how high-temperature antigen modification, such as peanut dry roasting, leads to allergic sensitisation should inform future preventive strategies, including those concerning early-age exposure, and therapeutic measures, such as the choice and route of antigen delivery in desensitisation strategies.”

     

    Conclusion

    This small animal study indicates that dry-roasted nuts and nut proteins cause a larger immune reaction than raw nuts. The team hypothesise that this might explain the difference between the prevalence of nut allergies in Western countries – where dry roasting is more common – and Eastern countries – where raw nuts are more typically consumed. While this study lends some weight to this idea, it does not directly prove it.

    The study was consistent in its findings, giving them some validity, but we should consider that this was a small study involving mice. The findings are not directly applicable to humans, so we cannot say for sure that dry-roasted peanuts cause more allergic reactions or are the cause of the higher prevalence in the West – studies involving people would be needed to better explore this.

    As the researchers acknowledge, further research confirming the findings of this study are required, which could include exploring ways to prevent allergies to nuts through desensitisation (immunotherapy). After these methods are developed in mice models, they might be investigated in humans. The path to a treatment or preventative strategy from this very early-stage research might be long and complex, so readers should not expect any immediate or short-term impact. 

    This research alone does not warrant the avoidance of dry-roasted nuts out of fear of developing a nut allergy. Similarly, if you have a history of nut allergies, you shouldn’t assume that raw, boiled or fried nuts will be safe to eat.

    Those with an existing allergy should continue to take their normal action to prevent triggering their own allergy. Allergies can be very different in different people, so this might vary between individuals.

    Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

    Links To The Headlines

    Dry-roasted peanuts 'worst for allergies': Findings will help scientists develop nuts that prevent reactions. Mail Online, September 22 2014

    Peanut allergies: 'Roasted worse than raw nuts'. BBC News, September 22 2014

    Peanut allergy: Roasted worse than raw for sufferers. The Independent, September 22 2014

    Links To Science

    Moghaddam AE, Hilson WR, Noti M, et al. Dry roasting enhances peanut-induced allergic sensitization across mucosal and cutaneous routes in mice. The Journal of Allergy and Clinical Immunology. Published online September 22 2014



  • Mums 'feel shame' about how they feed their babies

    "Mothers are made to feel 'marginalised and ashamed' when they breastfeed in public, according to an international study," the Mail Online reports. But the same study found mothers who bottlefeed also feel subject to criticism.

    The study used discussion groups and interviews to explore the thoughts, feelings and experiences – as well as perceived barriers and facilitators – of feeding infants among a small sample of mothers in north-west England.

    A common theme was the shame felt by both mothers who breastfeed and bottlefeed their babies. For example, some breastfeeding mothers discussed concerns about how they are viewed by others when exposing their bodies in public, while conversely women who bottlefeed their baby often feel frowned upon for not breastfeeding.

    This was a small study involving just 63 women in one region of England, so we cannot assume its findings are representative of other, larger populations. But it does provide a useful insight into how, for some women, breastfeeding has become an emotional minefield. It suggests there is an important psychological, not just physical, aspect to breastfeeding.

    The researchers conclude that health professionals need to find effective methods of providing support to combat feelings of shame in mothers who either breast or bottlefeed.

     

    Where did the story come from?

    The study was carried out by researchers from the University of Central Lancashire in England, the Georg Eckert Institute for International Textbook Research in Germany, and Dalarna University in Sweden.

    Funding was provided by the North Lancashire Primary Care Trust.

    It was published in the peer-reviewed medical journal Maternal and Child Nutrition on an open-access basis, so it can be read online for free.

    The Mail Online is generally representative of this research, making it clear these findings are from only 63 women.

    However, the headline and general tone of its article mainly focuses on the shame that may be felt on breastfeeding in public. The experience of women who do not breastfeed is largely ignored.

     

    What kind of research was this?

    This was a qualitative study that aimed to review women's experiences, thoughts and feelings related to feeding their baby. Qualitative research uses methods such as interviews, observations and discussion groups to understand people's views and feelings, and what motivates them.

    The researchers state that emotions such as guilt and blame are often reported among mothers who do not breastfeed, while those who do breastfeed can sometimes feel fear and humiliation when feeding in public places.

    In this study, a sample of breastfeeding women and those who did not breastfeed (taken from two primary care trusts in north-west England) took part in discussion groups and individual interviews to explore their experiences, opinions and perceptions of feeding their baby.

     

    What did the research involve?

    This study reflects information as part of a wider UNICEF UK Baby Friendly Initiative community project in two community health facilities in north-west England.

    A total of 63 women were recruited from various mother and baby groups or clinics (such as baby massage, mother and baby groups, and breastfeeding groups). The researchers report they took care to include women representative of low to high socioeconomic status by recruiting them from a range of different backgrounds.

    The mothers' average age was 30 years, most were white British, and most were married or cohabiting and had one or two children. Their infants were mostly aged between 4 and 24 weeks, though 11 infants were aged 6 to 12 months, and 10 were over the age of 1.

    Of the women recruited, 28 were breastfeeding, 11 were formula feeding, 7 were mixed feeding through breast and formula, and the remainder were feeding a combination of complementary foods with either breast or formula.

    Thirty-three of the women took part in 7 discussion groups (focus groups), and 30 women received individual interviews in their homes, though 2 sets of women were interviewed in pairs.

    In both settings, women were asked a range of questions designed to explore the women's current infant feeding status, intentions and motivations behind the feeding pattern, and barriers and facilitators to support. For example, among other questions, the researchers asked:

    • Why did you choose to breastfeed or formula feed your baby?
    • What information did you receive in regard to infant feeding (antenatally and postnatally)?
    • Did any professionals discuss (or provide demonstrations) on infant feeding (breastfeeding or formula feeding)?

    The interviews and focus groups took between 25 and 80 minutes to complete, and were digitally recorded and transcribed in full.

     

    What were the basic results?

    The researchers explain how many of the women's discussions about their infant feeding experience involved feelings of shame, frequently indicating a sense of feeling out of control and a dependence on others because of insufficient information and a lack of appropriate infant feeding support.

    They also say that when a mother's infant feeding method was not as she (or others) intended, this could lead to further feelings of incompetence, inadequacy and inferiority.

    The researchers discuss the concept of how both bottle and breastfeeding can both be a source of "offence" to others in different ways.

    They also discuss how some of the discussions revealed how women sometimes held ideals and expectations of being a "good" mother. Some women felt anxious, fearful and dependent as a result of various influences: the experience of birth, being overwhelmed by new motherhood and not feeling prepared, cultural influences, and infant feeding.

    These feelings were particularly common among first-time mothers, who often weren't aware of what support they would need until faced with the realities of motherhood. Many referred to how they felt expected or under pressure to breastfeed, a pressure transmitted by cultural messages as well as health professionals. Women were said to often experience this as an additional burden of the already bewildering state of new motherhood.

    When exploring the social context of any feelings of shame that were experienced by breastfeeding women, a common theme that emerged was related to exposing their breasts in public and concerns about what people thought, or being stared at or frowned upon.

    Similar feelings of shame and judgement were reported by women who don't breastfeed their babies, such as people judging them for not breastfeeding. Some women also reported feeling a lack of confidence or difficulties in asking professionals for support about feeding.   

     

    How did the researchers interpret the results?

    The researchers say how their paper "highlights how breastfeeding and non-breastfeeding women may experience judgement and condemnation in interactions with health professionals as well as within community contexts, leading to feelings of failure, inadequacy and isolation".

    They say there is a "need for strategies and support that address personal, cultural, ideological and structural constraints of infant feeding".

     

    Conclusion

    This informative study explores the attitudes and experiences surrounding infant feeding, as well as the perceived barriers and ways this could be changed, looking at a sample of mothers in north-west England.

    A common theme revealed by mothers related to public and professional perceptions and expectations around infant feeding practices. Both breastfeeding and non-breastfeeding women discussed a sense of shame around their feeding practice for different reasons.

    For example, some breastfeeding women discussed concerns about how they are viewed by others when exposing their bodies in public, while conversely women who bottlefeed their baby can feel frowned upon for not breastfeeding. Another common theme discussed by mothers related to feelings of difficulties in accessing support.

    This study has provided new insights into the factors that may induce shame in new mothers. Qualitative research of this nature aims to give a detailed exploration of people's views and experiences, and all data and quotes were carefully collected and analysed.

    But because of the depth of the analysis, the sample size in these studies tends to be quite small. This study therefore reflects the experiences of only 63 women in one region of England. With only four mothers from minority ethnic groups, it is not known how representative these experiences are of other cultural groups.

    Women should never feel ashamed of breastfeeding in public. If other people take issue with it, it is their problem, not yours.

    On the other hand, women who find it just too difficult to breastfeed, or can't for other reasons, should also not feel ashamed or guilty.

    While breastfeeding does bring proven health benefits to a baby, having a happy and confident mother is probably as, if not more, important. 

    Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

    Links To The Headlines

    Breastfeeding in public 'still frowned upon': Mothers made to feel 'marginalised and ashamed', study finds. Mail Online, September 18 2014

    Links To Science

    Thomson G, Ebisch-Burton K, Flacking R. Shame if you do – shame if you don't: women's experiences of infant feeding. Maternal and Child Nutrition. Published online August 19 2014



  • 'Angelina Jolie effect' doubled breast gene tests

    “Referrals to breast cancer clinics more than doubled in the UK after Angelina Jolie announced she had had a double mastectomy,” BBC News reports. NHS services saw a sharp rise in referrals from women worried about their family history of breast cancer.

    In May 2013, actress Angelina Jolie announced that she had decided to undergo a double mastectomy followed by breast reconstruction surgery, as gene testing estimated she had an 87% chance of developing breast cancer.

    Examination of trends in genetic testing clinics in the UK showed that there was a peak in referral rates in June and July, with numbers standing at around two-and-half times higher than the previous year. There was almost a doubling in requests for predictive genetic tests for cancer risk genes, and many more enquiries about preventative mastectomy. Researchers were also encouraged by finding that all referrals to genetic or family history clinics were appropriate (that the so-called “worried well” weren’t diverting resources from where they were needed).

    This study can’t prove a direct cause and effect, but the evidence seems compelling.

    The researchers also speculate that, as Angelina Jolie is seen as a glamorous icon, her decision may have reassured women who fear that preventative surgery would make a woman less attractive.

    The actress would have been well within her rights to keep her health confidential, particularly knowing the media interest it would create. Her decision to speak out and help destigmatise mastectomies should be congratulated.

     

    Where did the story come from?

    The study was carried out by researchers from the University Hospital of South Manchester NHS Trust, and the Manchester Centre for Genomic Medicine at St. Mary’s Hospital. Financial support was provided by the Genesis Breast Cancer Prevention Appeal and Breast Cancer Campaign.

    The study was published in the peer-reviewed medical journal Breast Cancer Research on an open-access basis, so it is free to read online.

    The UK media’s reporting was generally accurate, though the Daily Mirror got a little confused with its headline "'Angelina Jolie effect' credited for huge rise in double mastectomies to reduce breast cancer risk”.

    The effect did cause a rise in the number of women being tested to see if a double mastectomy was required. However, the research didn't look at the number of operations carried out. As most of the tests would have actually proved negative, the impact on the number of operations is unlikely to have been a “huge rise”.

     

    What kind of research was this?

    This was a review of breast cancer-related referrals to family history clinics and genetics services within the UK for 2012 and 2013, to see how the trends changed between the two years.

    As the researchers discuss, it is common for news items related to a particular health service to lead to a short-term temporary increase in interest. There is rarely a long-lasting effect once the media attention has died down. For example, the 2009 death of reality TV star Jade Goody from cervical cancer led to a shortlived increase in the number of young women attending cervical cancer screening appointments.

    In 2013, there was said to be “unprecedented publicity of hereditary breast cancer” in the UK. This was associated with two things. First came the release of draft guidance from the National Institute of Health and Care Excellence (NICE) on familial (hereditary) breast cancer in January, followed by the final publication in June 2013. Second, and seemingly more significant, was the high-profile news reports that broke in May 2013 of actress Angelina Jolie’s decision to undergo a double mastectomy when finding that she had inherited the BRCA1 gene – putting her at high risk of developing breast cancer.

    Studies suggested that the news stories were associated with increases in attendance at hereditary breast cancer clinics and genetics services in the US, Canada, Australia, New Zealand and the UK. This study assessed the potential effects of the “Angelina Jolie effect” by looking at UK referrals due to breast cancer family history in the UK for the year 2012 compared to 2013.

     

    What did the research involve?

    This research looked at referrals specific to breast cancer for 21 centres in the UK. This included 12 of 34 family history clinics invited to participate, and nine of 19 regional genetics centres. Centres that did not supply data were reported to either not have this available, or were unable to collate the data. Monthly referrals to each centre for 2012 and 2013 were assessed, and the trends analysed. 

     

    What were the basic results?

    The results show that overall referral rates were 17% higher in the period January to April 2013 than they had been in the previous year (the draft NICE guidance on familial breast cancer hit the media in January 2013, prior to final publication in June). However, there was nearly a 50% rise in May 2013, which was too early to have been associated with the final publication of NICE guidance, and coincided with the media reports about Angelina Jolie.

    In June and July 2013, referral rates to the clinics were 4,847 – two-and-a-half times as many as in the same period the previous year (1,981 in 2012). From August to October, they were around twice as high as they had been in the same period the previous year. The referral rates then settled down again to being 32% higher in November and December 2013 than in November and December 2012.

    In total, referrals rose from 12,142 in 2012 to 19,751 in 2013. There was almost a doubling in requests for BRCA1/2 testing, and many more enquiries about preventative mastectomies.

    Encouragingly, internal reviews from specific centres show that there was no increase in inappropriate referrals.

     

    How did the researchers interpret the results?

    The researchers conclude that, “the Angelina Jolie effect has been long-lasting and global, and appears to have increased referrals to centres appropriately”.

     

    Conclusion

    This is an interesting study that reviewed how the trends in breast cancer-related referrals to breast cancer family history clinics and genetics centres in the UK changed between 2012 and 2013. The overall results show an increase in 2013, with particular peaks following high-profile media events – most notably, news of Angelina Jolie’s decision to have a double mastectomy in May of that year.

    However, there are a couple of points to bear in mind when interpreting these results.

    Firstly, the study did not have data available from all family history clinics and genetics centres in the UK, and the results are only representative of 40% of those who would have been eligible to participate. Therefore, it is not known whether the trends would be the same were data available from all services. However, this is a good representation, so is likely to give a good indicator.

    Studies such as this can assess trends, but it is still not possible to know the direct cause of any changes. As this study says, there were two related events that received media attention in 2013: the publication of NICE guidance on familial breast cancer (pre-publication in January and final publication in June); and the higher-profile news reports in May of Angelina Jolie’s decision to have a double mastectomy due to her high risk of developing familial breast cancer.

    While it may be plausible that the rises in referral rates to family history and genetics clinics were associated with this increased media attention, particularly the “Angelina effect”, it still cannot be proven that this is the only cause. Alternatively, the increase in trend could also be related to a gradual year-on-year increase in people’s health awareness.       

    It would be interesting to see how trends changed in years prior to 2012. It would also be interesting to know what has happened to the trend in referral rates through 2014. 

    Overall, the particular peaks in referral rates in June and July 2013 suggest that the news related to Angelina Jolie, perhaps combined with the publication of NICE guidance on familial breast cancer testing around this time, have a high chance of being associated with the increased referral rates.

    This is not surprising given the thought-provoking influence that the media is known to have.

    It is also encouraging to know that all referrals to genetic or family history clinics were appropriate, suggesting that the media attention is likely to have had a positive effect in increasing health awareness.

    Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

    Links To The Headlines

    Breast cancer test 'Angelina Jolie effect' found. BBC News, September 19 2014

    The Angelina effect: Surge in women going for breast cancer checks after actress speaks out about her mastectomy. Daily Mail, September 19 2014

    The 'Angelina Jolie effect': Her mastectomy revelation doubled NHS breast cancer testing referrals. The Independent, September 19 2014

    Angelina Jolie's breast cancer announcement doubled number of women being tested: study. The Daily Telegraph, September 19 2014

    'Angelina Jolie effect' credited for huge rise in double mastectomies to reduce breast cancer risk. Daily Mirror, September 19 2014

    Angelina Jolie's op sparks huge surge in the number of cancer tests. Daily Express, September 19 2014

    Links To Science

    Evans DGR, Barwell J, Eccles DM, et al. The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services. Breast Cancer Research. Published online September 19 2014