Nurse's Cancer Selfie Had Celebrity-Like Impact

Nick Mulcahy

December 19, 2017

On April 25, 2015, a 27-year-old nurse from Kentucky posted an arresting photo of herself on Facebook that depicted extensive facial scabbing and inflammation. "This is what skin cancer treatment can look like," she wrote in her social media post.


"Wear sunscreen and get a spray tan. You only get one skin and you should take care of it. Learn from other people's mistakes," the nurse urged in her post, under the name Tawny Dzierzek (she has since changed her surname to Willoughby).

She commented that she had previously tanned indoors four to five times a week and that she was first diagnosed with skin cancer at age 21. She noted that she has had basal cell carcinoma five times and squamous cell carcinoma once.

The skin cancer post and photo went viral, garnering 50,000 shares on Facebook. This led to coverage by major media, such as CNN, and an explosion of Google searches using the term, "skin cancer."

Now, a team of academics have scrutinized this story from 2015 as a case study in public health communications. Their findings were published online November 3 in Preventive Medicine.

The publicity about skin cancer that resulted can be likened to the interest sparked by disease-related announcements by celebrities, conclude the authors, led by Seth Noar, PhD, of the Lineberger Comprehensive Cancer Center and the School of Media and Journalism of the University of North Carolina, Chapel Hill.

"Tawny's skin cancer selfie appears to have engaged the public in ways only previously seen with celebrity disclosures," they write.

Tawny's skin cancer selfie appears to have engaged the public in ways only previously seen with celebrity disclosures. Dr Seth Noar and colleagues

Dr Noar and colleagues point out that Angelina Jolie's BRCA1 breast cancer surgery disclosure and Charlie Sheen's HIV acknowledgement both led to significant increases in testing for the respective conditions.

The study authors don't have post-selfie information about rates of skin cancer screening or tanning salon appointments, but they do have Google search data.

After the coverage of Willoughby's selfie in major news outlets in mid-May 2015, Google searches for the term "skin cancer" increased by 162% on May 13 and by 155% on May 14, when mainstream news coverage was at its peak.

These two days were also historically active, with near-record search levels for the term "skin cancer." Those days ranked sixth and eighth for the number of searches for that term since 2004, when Google began tracking search volumes.

Google searches for the terms "skin cancer prevention" and "tanning" were also "significantly higher than expected" with respect to volume, the researchers comment.

Internet searches are not trivial public health data, the authors assert: "Research has demonstrated that internet searches are a valid proxy for syndromic and behavioral surveillance, with information seeking often presaged by later behavioral changes."

In other words, healthy change can start on a keyboard.

The researchers make a prediction: "Given the participatory nature of social media, it is likely that more of these events will occur in the future."

But will they, to this extent? The team acknowledges that social media and tanning, which is a major skin cancer risk factor, were already intertwined in a powerful way. Social media use is associated both with "greater pro-tanning beliefs" and indoor tanning activity among young women, according to previous studies, the authors point out. Thus, a key initial audience was already primed to receive and react to the message.

Another instructive element for public health efforts from the Willoughby case is storytelling. "Stories can be more impactful than didactic communication," the authors write. Add a graphic image, which is known to augment skin cancer prevention messaging, and you have a "powerful combination," Dr Noar and colleagues assert.

"We conclude that an ordinary person's social media post caught the public's imagination and led to significant increases in public engagement with skin cancer prevention," they write.

The study was supported by the University Cancer Research Fund and the Lineberger Comprehensive Cancer Center. Two of the authors have equity in Directing Medicine, a company that provides public health consultation using methods described in the article. Another author has received consulting fees from the company.

Prev Med. Published online November 3, 2017. Abstract

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

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