Effect of Nancy Reagan's mastectomy on choice of surgery for breast cancer by US women

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) 82 230 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) 80 057 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 overtime. 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 [Cl], 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.