Effect of Nancy Reagan's Mastectomy on Choice of Surgery for Breast Cancer by US Women

• Published in: JAMA : the journal of the American Medical Association Vol. 279; no. 10; pp. 762 - 766
• Main Authors: Butler Nattinger, Ann, Hoffmann, Raymond G, Howell-Pelz, Alicia, Goodwin, James S
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 11-03-1998
• Subjects: Adult; Aged; Biological and medical sciences; Breast cancer; Breast Neoplasms - psychology; Breast Neoplasms - surgery; Cohort Studies; Decision Making; Famous Persons; Female; First ladies; Group Processes; History of medicine; History, 20th Century; Humans; Mastectomy; Mastectomy - psychology; Mastectomy - statistics & numerical data; Mastectomy, Radical - psychology; Mastectomy, Radical - statistics & numerical data; Mastectomy, Segmental - psychology; Mastectomy, Segmental - statistics & numerical data; Medical sciences; Medicare; Middle Aged; Multivariate Analysis; Patient Acceptance of Health Care - statistics & numerical data; Reagan; Reagan, Nancy; SEER Program; Socioeconomic Factors; Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; United States - epidemiology; Human; Carcinoma; Malignant tumor; Mammary gland diseases; Association; Conservative surgery; Surgery; Cohort study; Mastectomy; Female; Decision criterion; Mammary gland; Comparative study
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.279.10.762

CONTEXT.— While the actions of popular figures are believed to influence the behavior
of the general public, including health care decisions, little research has
examined such an effect. OBJECTIVE.— To determine whether a temporal association exists between use of breast-conserving
surgery (BCS) for treatment of breast cancer and Nancy Reagan's mastectomy
in October 1987. DESIGN/SETTING.— Population-based observational cohort study. PATIENTS.— Two sources of data: (1) 82230 women aged 30 years and older who were
included in the Surveillance, Epidemiology, and End Results tumor registry
because of a diagnosis of local or regional breast cancer from 1983 to 1990;
and (2) 80057 female Medicare beneficiaries aged 65 to 79 years who received
inpatient surgery for local or regional breast cancer in 1987 or 1988. MAIN OUTCOME MEASURE.— Percentage of use of BCS vs mastectomy over time. RESULTS.— Compared with women undergoing surgery for breast cancer in the third
quarter of 1987 (just prior to Mrs Reagan's mastectomy), women were 25% less
likely to undergo BCS in the fourth quarter of 1987 (odds ratio [OR], 0.75;
95% confidence interval [CI], 0.66-0.85) and in the first quarter of 1988
(OR, 0.76; 95% CI, 0.67-0.86). In subsequent quarters, the rate returned to
the baseline. In multivariate analyses, the decline was significant among
white but not nonwhite women. It was most prominent among women aged 50 to
79 years in the central and southern regions of the country, and most sustained
among women living in areas with lower levels of income and education. CONCLUSIONS.— Celebrity role models can influence decisions about medical care. The
influence appears strongest among persons who demographically resemble the
celebrity, and those of lower income and educational status.