Breast Cancer Campaign Based on Lemons Goes Viral

Liam Davenport

January 19, 2017

A campaign using lemons to teach women to recognize breast cancer symptoms and to break the taboos of discussing the condition has gone viral and has been used to educate people all around the world.

The #KnowYourLemons campaign, from the charity Worldwide Breast Cancer, uses a set of easily understandable visuals, in which pictures of lemons have been altered to illustrate 12 key changes in the breasts that could indicate the presence of breast cancer.

Lemons used to depict breast changes that could be cancer. (Source: Worldwde CancerCampaign)

The campaign, which was the brainchild of a young designer who lost both her grandmothers to the disease, has now gone viral ― the image that illustrates the changes has been viewed more than 3 million times on Facebook and has been shared more than 40,000 times.

Moreover, the campaign has been featured by media outlets all over the world, including outlets in the United Kingdom, the United States, Canada, Australia, South Africa, the Netherlands, and Poland.

But what is the secret of the campaign's success in reaching so many people?

Corrine Ellsworth Beaumont, PhD, founder and director of Worldwide Breast Cancer, believes it's because the campaign uses visuals, rather than reams of text, to harness the power of modern design principles.

Speaking to Medscape Medical News, Dr Beaumont explained that a lot of research has shown that patients recall as little as 14% of what they are told during consultations, even for non-life-threatening conditions.

Furthermore, she said that a substantial proportion of patients have "low health literacy," and many feel uncomfortable talking about breasts and discussing the subject of cancer, even with their friends and family.

"This visual cuts through that because it's very friendly, it's approachable," said Dr Beaumont. "Patients can look at it, and they see lemons, but they interpret it as breasts."

"It's not overt, and I think that's why it's become so popular, because they understand in seconds without having to combat all of these hurdles of taboo and fear and large amounts of text."

Dr Beaumont did not expect the campaign to go viral in this way. She said she was simply "hoping that I could reach as many women as possible."

She continued: "Usually, the way these public health campaigns are designed is they target specific audiences and so they say: 'Okay, we're going to try and reach this group, so we'll create a campaign for them,' etc.

"I wanted to create a campaign that didn't segment the audience, so I wanted to find a way to present information that didn't appeal to only a certain age group or a certain literacy group or a certain ethic background."

Approached for comment, Emma Shields, health information officer at the leading charity Cancer Research UK, told Medscape Medical News: "It's great to see a campaign raising awareness about breast cancer and some of its symptoms, as diagnosing breast cancer at an early stage gives women the best chance of survival."

Although noting that breast cancer is more common in older people ― almost half of all breast cancer cases in the United Kingdom occurring in women older than 65 years ― she said: "However old you are, it's a good idea to get to know your breasts, so you know what's normal for you. But you don't need to check them in a set way or at a set time."

She also noted: "Thanks to research, better treatments and earlier diagnosis mean that more women than ever before are surviving the disease."

Carolyn Rogers is a clinical nurse specialist at the UK charity Breast Cancer Care, which offers information and support for people diagnosed with breast cancer, including a free helpline.

Approached for comment, she told Medscape Medical News that anything that jogs memories and "helps women remember to be aware of any changes in their breasts as they go through their lives" is welcome.

She emphasized that for healthcare professionals, the #KnowYourLemons campaign could have an effect with respect to the provision of services.

She pointed out: "Having these big campaigns is a good thing, but for healthcare professionals, it does then have an impact on who's coming to their clinics and who's going to their general practitioner."

She added: "While we could encourage all people to go along to their GP if they do have a change in appearance or feeling in their breast, the most important thing is that most women will not have breast cancer."

Campaign Was Years in the Making

Dr Beaumont began working on the #KnowYourLemons campaign more than 15 years ago, after the death of both of her grandmothers from breast cancer. Those deaths prompted a need to know more about the disease.

"I was in my early twenties, and I went to a cancer library and I asked them: 'What do I need to know about breast cancer?' And the person working there said: 'I don't really know what to tell you because no one your age comes in here,' " she recalled.

Dr Beaumont explained that in approaching the library, she had several questions: "Am I at risk? When do I need to start getting screened? And what does a lump feel like? What should I be looking for when it comes to breast cancer?"

After reading all the leaflets and websites that she could find, Dr Beaumont was left with more questions than she had when she started.

She said: "There wasn't one resource that simply said: 'Corrine, this is everything you need to know right now as a woman in her early 20s.' So I thought design could make a difference here."

Dr Beaumont initially began working on the visuals as part of her Masters Degree project and then for her PhD. Since then, the visuals have gone though many iterations. They have been tested on hundreds of patients and are being constantly refined.

She says that she always puts herself "in the shoes of the patient" to see the problem from their perspective, "and then I talk to healthcare practitioners and those involved, like caregivers, who really understand what the issues are, and then develop visual solutions based on their needs."

Although the visuals have been in development for the past 15 years, Dr Beaumont did not begin promoting the campaign until she left her job teaching design at Kingston University in London 2 years ago and formed the Worldwide Breast Cancer charity.

The visuals and accompanying leaflets have been translated into 16 languages, but Dr Beaumont is looking for donations to expand the campaign into more languages and to develop more materials to extend its reach.

She said: "I've been working on a project to help patients who have been diagnosed, because that's such a large information burden."

"They're trying to establish their subtype and what their treatment options are and why things are being recommended, as opposed to other things that their family and friends are saying worked for other patients online," she said.

Dr Beaumont has also been working on new materials for metastatic breast cancer patients, as "that's the hardest population to understand, because it's not a straightforward path"

She said: "We've done lots of testing. It's in clinical trials right now in Turkey, Mexico, and the US, and so far, the response has been very positive."

Worldwide Breast Cancer website.

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