Angelina Jolie's Choice: Influences of genetic literacy and gender on public attitudes about prophylactic mastectomies

The scientific community has voiced concerns about the public’s likelihood of misunderstanding genomics and resulting negative consequences for health-related decision-making.  Angelina Jolie’s highly publicized choice to have a bilateral prophylactic mastectomy due to a rare BRCA genetic mutation offers a context for considering whether levels of genetic literacy influence attitudes towards prophylactic mastectomies. Data were collected from a relatively representative online panel of 1,028 adults using a one-time survey in the fall of 2013. In addition to testing genomic knowledge, we measured familiarity with genetic terms and ability to interpret information about BRCA mutations. These measures of genetic literacy were positively associated with confidence to evaluate whether Jolie’s choice was justified (R=0.396, P<0.001), with gender modifying this association (females R=0.438, males R=0.359; P=0.047). Women and those with higher genetic literacy were more likely to hold strong opinions regarding prophylactic mastectomies (OR=1.729, P<0.001 and OR=1.613, P<0.001). Increased genetic literacy was associated with favoring mastectomies; confidence to evaluate Jolie’s choice mediated this association. Respondents with above average confidence to evaluate Jolie’s choice were almost twice as likely to support prophylactic mastectomies, which objectively reduce cancer risk (OR=1.882, P<0.001). These results demonstrate how the ability to confidently apply genomic information in everyday situations may be important in facilitating informed health decisions.  Additionally, these findings suggest that rather than emphasizing genetic facts and terminology, genomics education programs might be more effective if they focused on improving understanding of risk information, while considering how other contextual factors may shape interpretations of genomic-based health risks.