Associations Between News Coverage, Social Media Discussions, and Search Trends about Celebrity Deaths, Screening, and Other Colorectal Cancer-Related Events

Abstract

Objective.

Colorectal cancer (CRC) is the third leading cause of cancer death among both men and women in the United States. CRC-related events may increase media coverage and public attention, boosting awareness and prevention. This study examined associations between several types of CRC events (including unplanned celebrity cancer deaths and planned events like national CRC awareness months, celebrity screening behavior, and screening guideline changes) and news coverage, Twitter discussions, and Google search trends about CRC and CRC screening.

Methods.

We analyzed data from U.S. national news media outlets, posts scraped from Twitter, and Google Trends on CRC and CRC screening during a three-year period from 2020 to 2022. We used burst detection methods to identify temporal spikes in the volume of news, tweets, and search after each CRC-related event.

Results.

There is a high level of heterogeneity in the impact of celebrity CRC events. Celebrity CRC deaths were more likely to precede spikes in news and tweets about CRC overall than CRC screening. Celebrity screening preceded spikes in news and tweets about screening but not searches. Awareness months and screening guideline changes did precede spikes in news, tweets, and searches about screening, but these spikes were inconsistent, not simultaneous, and not as large as those events concerning most prominent public figures.

Conclusions.

CRC events provide opportunities to increase attention to CRC. Media and public health professionals should actively intervene during CRC events to increase emphasis on CRC screening and evidence-based recommendations.

Introduction

Colorectal cancer (CRC) ranks third for cancer-related deaths in the United States among both men and women.¹ CRC screening is an effective way to find precancerous polyps and tumors to reduce CRC incidence and mortality.² The current CRC screening guideline recommends that people aged between 45 and 75 screen for CRC.³

Promoting CRC prevention and early detection benefits from a public information environment that offers regular, evidence-based information about CRC and CRC screening. Past research shows that cancer related information seeking (i.e., actively looking for cancer information) and scanning (i.e., coming across related information in a less purposeful manner)^4,5 about CRC and CRC screening, could contribute to CRC screening behavior.⁶ As a result, finding opportunities to increase news and social media attention to CRC, and CRC screening in particular, should be a health communication priority in CRC prevention.

A wide range of cancer-related events have potential to increase media coverage and public attention to the corresponding cancer topics and boost related disease detection/prevention among the public. Prior research has tended to focus on specific cases of cancer events concerning public figures/celebrities.⁷ For example, Steve Jobs’ death from pancreatic cancer triggered information seeking and interpersonal discussions about cancer in general and pancreatic cancer specifically.⁸ Angelina Jolie’s announcement of her breast cancer gene mutation and prophylactic mastectomy led to more breast cancer referrals and genetic testing.^9,10 Chadwick Boseman’s death due to CRC increased searching about CRC on Google, CRC Wikipedia page views, and online traffic to the American Cancer Society website.^11,12 Katie Couric’s widely publicized colonoscopy during The Today Show increased CRC screening rates.¹³ While each of these studies focused on the impact of a single celebrity cancer event, accumulated evidence shows that such events have triggered seeking of cancer information,^11,12,14,15 interpersonal discussions,^16,17 and increased cancer screening-related referrals.^9,10,13 Moreover, a scoping review specified that increases in cancer related news coverage, information seeking, and interpersonal conversations are intermediate outcomes through which public figure cancer events exert influence on screening behavior.¹⁸

However, as these studies only examined highly selected cases of celebrity cancer events, the broader generalizability of these findings remains unknown. Prior research has suffered from a potential selection bias as specific cases were likely chosen for study due to their prominence (i.e., ability to draw researchers’ attention). Therefore, the effects observed may not be representative of celebrity cancer events as an overall category. Alternatively, the deaths of celebrities/public figures due to cancer may be systematically identified through news wire services and cancer related Wikipedia pages to reduce the potential for selection bias. Public figures identified by such a method may be of different levels of fame (the proportion of people who have heard about the person) and thus have different degrees of impact. Also, the influence of celebrity cancer events might depend upon a variety of psychological factors, such as parasocial relationship with or affinity for a public figure,^16,19–21 identification with the public figure,^17,19 or emotional reactions toward the specific event.^16,17,20,22 Thus, a more systematic study that includes CRC events concerning a wide variety of public figures is needed to remove post-hoc “selection” bias in research and allow comparisons between events.

Celebrity cancer deaths and celebrity screening events also differ in substance and scope, which might trigger distinct patterns of news coverage, social media discussions, and information seeking. Whereas celebrity cancer screening events may more naturally evoke screening related coverage and discussions, it remains an open question whether notable cancer deaths are consistently linked to messaging about the value of cancer screening. Moreover, apart from celebrity cancer events, there are a variety of other planned cancer campaigns such as annual national cancer awareness months (March of each year for CRC in the U.S.) and, more recently, the 2021 U.S. Preventive Services Task Force (USPSTF) change in the CRC screening guidelines which lowered the recommended starting age for routine CRC screening from 50 to 45.³ While it is generally assumed that national cancer awareness months are effective in raising attention and awareness about cancer, research so far offered mixed evidence.^23–25 More importantly, there is insufficient research regarding whether these structured strategic CRC advocacy events may trigger CRC screening-specific coverage, search, and discussions beyond CRC in general.

These concerns are exacerbated by the fact that only a small proportion of cancer related news stories focus on cancer detection or prevention relative to cancer risks and treatments.^26–28 A similar pattern has been observed for cancer-related social media discussions. While social media users reported that they were most likely to look for cancer prevention information,²⁹ social media discussions about national cancer campaigns tend to focus on fundraising rather than specific prevention.³⁰

Therefore, to provide a more comprehensive and up-to-date picture regarding the influence of CRC related events on media and public attention to CRC (and CRC screening in particular), this study systematically examined the effects of a variety of CRC events including celebrity deaths, celebrity screening events, national awareness months, and a screening guideline change during the three-year period from 2020 to 2022 on three outcomes: volume of (a) national U.S. news coverage, (b) Twitter discussions, and (c) Google search trends about both CRC and CRC screening. For the USPSTF CRC screening guideline change regarding the starting age, we also investigated whether news and social media platforms correctly identified age 45 as the newly recommended starting point for routine CRC screening. These findings stand to inform how public health infodemiology (analyzing information in mediated communication environments, especially online sources) can guide future public health interventions.³¹

Methods

This study used publicly available data, and it does not involve direct interactions with human subjects. Thus, it was exempt from institutional board review. We developed a systematic approach to identify celebrity cancer events from 2020 to 2022 by searching for CRC-related stories from news wires services, including The Associated Press and Reuters, and the CRC-focused Wikipedia page. We only included CRC events involving American public figures given that this study centered on U.S. media and public attention to CRC and CRC screening and to be consistent with our inclusion of only U.S.-based national CRC awareness months (March of each year) and screening guideline change. The final event dataset includes a total of 22 CRC events, consisting of 15 celebrity death events, three celebrity screening events, three national awareness months (in March each year), and the USPSTF screening guideline change. Table 1 shows detailed information about each event.

Table 1:

U.S. Based Colorectal Cancer Events, 2020–2022

	Date	Gender	Race	Occupation
Celebrity death
John Andretti	1/30/2020	Male	White	Athlete
Daniel Meggs	2/21/2020	Male	White	Athlete
Chadwick Boseman	8/28/2020	Male	Black	Actor
Natalie Desselle Reid	12/7/2020	Female	Black	Actress
Alto Reed	12/30/2020	Male	White	Musician
Joseph Siravo	4/11/2021	Male	White	Actor
Clarence Williams III	6/4/2021	Male	Black	Actor
Gregg Leakes	9/1/2021	Male	Black	Actor
Kangol Kid	12/18/2021	Male	Black	Musician
Jeff Dickerson	12/28/2021	Male	White	Reporter
Jim Corsi	1/4/2022	Male	White	Athlete
Billy Kametz	6/9/2022	Male	White	Actor
Kevin Conroy	11/10/2022	Male	White	Actor
Donald McEachin	11/29/2022	Male	Black	Politician
Kirstie Alley	12/5/2022	Female	White	Actress
Celebrity screening
Joe Biden	11/19/2021	Male	White	Politician
Heidi Klum	8/18/2022	Female	White	Model/TV Host
Ryan Reynolds & Rob McElhenney	9/13/2022	Male	White	Actors
Awareness month/Guideline change
Awareness month 2020	March 2020	-	-	-
Awareness month 2021	March 2021	-	-	-
Awareness month 2022	March 2022	-	-	-
Guideline change	5/18/2021	-	-	-

^aWe systematically identified celebrity cancer events in the U.S. from 2020 to 2022 by searching for CRC-related stories from news wires services, including The Associated Press and Reuters, and the CRC-focused Wikipedia page.

For news media data, we identified mainstream U.S. national news media across the ideological spectrum based on the Pew Research Center’s media report.³² We included those outlets where we were able to retrieve full text of news content from 2020 to 2022 through the Factiva database (https://www.dowjones.com/professional/factiva/). The final list consists of 15 major U.S. national news outlets (see Appendix Table 1). We used the following keywords to retrieve CRC related content: “colorectal cancer” and “colon cancer”. The keywords to retrieve CRC screening related content included “colorectal cancer screening”, “colon cancer screening”, “fecal test”, “stool test”, “colonoscopy”, “colonography”, and “cologuard”.

For Twitter data, we retrieved CRC related tweets during the same period using the queries: “coloncancer”, “colorectalcancer”, “colon cancer”, and “colorectal cancer”. We retrieved CRC screening related tweets with the queries: “colorectalscreening”, “colorectalscreeningtest”, “coloncancerscreening”, “coloncancerscreeningtest”, “crcscreening”, “crcscreeningtest”, “colonoscopy”, “virtual colonoscopy”, “colonography”, “CT colonography”, “cologuard”, “stool test”, “poop test”, “fecal test”, “stool sample”, “poop sample”, and “poo sample”. The keywords used were informed by previous research and went beyond those for news retrieval because social media discussions tend to be more colloquial and are thus less likely to use technical medical language.³³ We also added the parameters: lang = “en” and country = “US” to the search to restrict our Twitter data collection to English-language tweets and those that are identified as U.S.-based.

For Google Trends data, we retrieved search trends from 2020 to 2022 in the U.S. on the topics of “colorectal cancer” and “colon cancer screening”, respectively. Google Trends only provided weekly data in the form of relative search volume (RSV). RSV is calculated by dividing the volume of search on a keyword/topic by the total volume of search, and the results are rescaled where the search volume for the week with the highest RSV during the three-year period in focus is assigned the value of 100. Appendix Table 1 shows a summary of the data sources and search terms.

We plotted the time series for daily volume of news and tweets and weekly volume of search between 2020 and 2022 for CRC and CRC screening, respectively. We then tested the stationarity of each time series above to see if there are any trends over time or regular/seasonal fluctuations. Finally, we used the burst detection method³⁴ to identify significant temporal spikes in the volume of news, tweets, and search within the 3-day range and the 7-day range of each event. The burst detection method considered these temporal high volumes as “outliers” if their values are above Q3 (the third quartile) + 1.5*IQR (interquartile range).³⁴ To gauge media and public awareness of the starting age for CRC screening, we searched the full texts of news stories and tweets with the keywords “45”, “forty five”, “50”, and “fifty”. Two human coders counted the number of news stories and tweets indicating 45 or 50 as the appropriate starting age for routine CRC screening (overall or based on USPSTF if multiple sources are present) and compared the volume before and after the USPSTF guideline change.

Results

Time series data regarding the volume of news, tweets, and Google searches about CRC and CRC screening from 2020 to 2022 are shown in Appendix Figures 1 through 3. These Figures show no clear, apparent trend over time and no regular or seasonal changes. Augmented Dickey Fuller (ADF) tests were conducted to confirm stationarity: ADF test statistic = −18.76, p < .001 for CRC news; ADF = −8.40, p < .001 for screening news; ADF = −20.72, p < .001 for CRC tweets; ADF = −19.77, p < .001 for screening tweets; ADF = −5.30, p < .001 for CRC search; and ADF = −3.60, p = .006 for screening search. Thus, all the time series data were stationary based on the ADF tests. Given that there was no obvious trend over time or regular fluctuations in the time series, the temporal/irregular spikes in the data can be plausibly attributed to identified CRC events.

Using the burst detection method, we identified those significant temporal spikes (large “outliers”) if they exceeded the value: Q3 +1.5*IQR.³⁴ Returning to the time series data (see Appendix Figures 1 through 3), if a spike occurred within the 3-day range or the 7-day range after a CRC event, the event was deemed responsible for the spike. Given that there was no other CRC event identified during the March of each year other than the awareness month, spikes during March were attributed to the awareness month.

Results from burst detection are shown in Tables 2 and 3. Specifically, as the spikes in media and public attention identified within the 3-day range of the event (Table 2) and within the 7-day range of the event (Table 3) showed largely similar patterns, we only summarize results for the 3-day range of the event here. Celebrity deaths were more likely to lead to spikes in news and tweets about CRC in general than about screening. Out of the 15 celebrity CRC deaths, eight preceded spikes in CRC news (i.e., Chadwick Boseman, Kirstie Alley, Gregg Leakes, Kevin Conroy, Natalie Desselle Reid, Alto Reed, Donald McEachin, Billy Kametz), but only two preceded screening related news (i.e., Kirstie Alley, Donald McEachin). Five events preceded spikes in CRC tweets (i.e., Chadwick Boseman, Natalie Desselle Reid, Kirstie Alley, John Andretti, Gregg Leakes), but only three preceded spikes in screening related tweets (i.e., Chadwick Boseman, John Andretti, Jim Corsi). Three events increased searches about CRC (i.e., Chadwick Boseman, Kirstie Alley, Billy Kametz) and two increased searches about CRC screening (i.e., Chadwick Boseman, Kirstie Alley). Thus, there is a high level of heterogeneity in whether CRC deaths of public figures triggered spikes in the volume of news, tweets, and searches. Chadwick Boseman and Kirstie Alley’s CRC deaths were consistently associated with spikes in most outcomes.

Table 2:

Peak Volume of News Stories, Tweets, and Searches about Colorectal Cancer and Screening in the U.S. within Three Days of Each Colorectal Cancer Event, 2020–2022

	Colorectal cancer news (number of stories)	Screening news (number of stories)	Colorectal cancer tweets (number of posts)	Screening tweets (number of posts)	Colorectal cancer search (relative search volume)	Screening search (relative search volume)
Celebrity death
John Andretti	1	0	23 *	20 *	21	36
Daniel Meggs	0	0	9	11	19	33
Chadwick Boseman	38 *	2	1217 *	178 *	100 *	100 *
Natalie Desselle Reid	4 *	0	25 *	11	29	31
Alto Reed	4 *	1	5	11	20	29
Joseph Siravo	2	0	5	9	23	30
Clarence Williams III	1	1	12	7	22	37
Gregg Leakes	11 *	1	16 *	13	24	41
Kangol Kid	1	1	9	14	24	35
Jeff Dickerson	1	1	13	14	22	24
Jim Corsi	2	2	5	18 *	24	25
Billy Kametz	3 *	0	13	9	44 *	40
Kevin Conroy	5 *	0	6	15	23	38
Donald McEachin	4 *	3 *	13	14	25	40
Kirstie Alley	33 *	19 *	25 *	16	51 *	63 *
Celebrity screening
Joe Biden	4 *	35 *	13	205 *	23	47
Heidi Klum	1	1	9	11	25	39
Ryan Reynolds & Rob McElhenney	7 *	8 *	17 *	24 *	25	40
Awareness month/Guideline change
March 2020	3 *	2	72 *	19 *	19	38
March 2021	6 *	4 *	53 *	25 *	26	41
March 2022	3 *	2	33 *	12	30	57 *
Guideline change	13 *	7 *	20 *	11	27	75 *

^aThe values are the peak volume (represented by the number of stories/posts for news and tweets and relative search volume for searches) observed within three days of the event or the whole month for the awareness month.

Burst detection is used and significant bursts (values that are above the third quartile + 1.5*interquartile range) are bolded and marked with “*”.

Table 3:

Peak Volume of News Stories, Tweets, and Searches about Colorectal Cancer and Screening in the U.S. within Seven Days of Each Colorectal Cancer Event, 2020–2022

	Colorectal cancer news (number of stories)	Screening news (number of stories)	Colorectal cancer tweets (number of posts)	Screening tweets (number of posts)	Colorectal cancer search (relative search volume)	Screening search (relative search volume)
Celebrity death
John Andretti	8 *	0	23 *	20 *	21	36
Daniel Meggs	1	0	13	11	19	33
Chadwick Boseman	38 *	5 *	1217 *	178 *	100 *	100 *
Natalie Desselle Reid	4 *	1	25 *	15	29	31
Alto Reed	4 *	1	8	11	20	29
Joseph Siravo	2	0	9	11	23	30
Clarence Williams III	1	1	13	9	22	37
Gregg Leakes	11 *	1	16 *	13	24	41
Kangol Kid	4 *	3 *	11	14	24	35
Jeff Dickerson	1	1	13	14	24	25
Jim Corsi	2	2	8	21 *	24	38
Billy Kametz	6 *	0	16 *	9	44 *	40
Kevin Conroy	5 *	1	7	16	23	39
Donald McEachin	6 *	3 *	13	14	51 *	63 *
Kirstie Alley	33 *	19 *	25 *	16	51 *	63 *
Celebrity screening
Joe Biden	4 *	39 *	13	205 *	23	47
Heidi Klum	2	2	9	12	27	39
Ryan Reynolds & Rob McElhenney	7 *	8 *	17 *	24 *	25	40
Awareness month/Guideline change
March 2020	3 *	2	72 *	19 *	19	38
March 2021	6 *	4 *	53 *	25 *	26	41
March 2022	3 *	2	33 *	12	30	57 *
Guideline change	13 *	7 *	20 *	11	27	75 *

^aThe values are the peak volume (represented by the number of stories/posts for news and tweets and relative search volume for searches) observed within seven days of the event or the whole month for the awareness month.

Burst detection is used and significant bursts (values that are above the third quartile + 1.5*interquartile range) are bolded and marked with “*”.

Among the three celebrity CRC screening events, two of them preceded CRC screening news and tweets (i.e., Joe Biden, Ryan Reynolds/Rob McElhenney) but none of them significantly increased search (even within the 7-day range). For structured events, only one of the three national CRC awareness months (i.e., March 2021) led to increases in screening related news. Two increased screening related tweets (i.e., March 2020, March 2021), and one increased Google search about screening (i.e., March 2022). The USPSTF screening guideline change (May 18, 2021) led to spikes in screening-related news and search but not tweets.

Two specific celebrity CRC events preceded the highest volume spikes in screening related media and public attention relative to all other measured events. Joe Biden’s colonoscopy preceded the highest spike in screening-related news and tweets, and Chadwick Boseman’s death preceded the highest spike in screening-related searches.

Results related to awareness of guideline change regarding the starting age for routine screening are presented in Table 4. For CRC screening news, after to the guideline change, 15.8% of the news items specified 45 as the appropriate starting age for routine screening, compared to 3.8% before the change, z = 4.12, p < .001. By comparison, no news item identified 50 as the appropriate starting age after the guideline change, compared to 6.0% of news items before the change, z = −4.99, p < .001. Among CRC screening tweets, after the guideline change, about 3.0% of the tweets specified 45 as the appropriate starting age for routine screening, compared to 1.4% before the change, z = 4.92, p < .001. By comparison, about 1.3% of the tweets identified 50 as the appropriate starting age, compared to 2.8% before the guideline change, z = −5.03, p < .001.

Table 4:

Volume of News Stories and Tweets about Colorectal Cancer Screening in the U.S. Mentioning the Appropriate Starting Age for Routine Screening Before and After USPSTF Guideline Change, 2020–2022

Appropriate starting age for screening	Volume (%) of CRC screening news before the guideline change (n = 182)	Volume (%) of CRC screening news after the guideline change (n = 404)	Difference in proportions (after - before)	Volume (%) of CRC screening tweets before the guideline change(n = 3796)	Volume (%) of CRC screening tweets after the guideline change (n = 4598)	Difference in proportions (after - before)
Identifying 45 as the appropriate starting age	7 (3.8%)	64 (15.8%)	12.0%*	54 (1.4%)	140 (3.0%)	1.6%*
Identifying 50 as the appropriate starting age	11 (6.0%)	0 (0%)	−6.0%*	107 (2.8%)	59 (1.3%)	−1.5%*

^aCRC: colorectal cancer

^bUSPSTF: United States Preventive Services Taskforce

^c*p < .001

Discussion

Past research has typically focused on a highly selected single cancer event and its impact on a specific type of information behavior/communication.^{11,12,14–17} This study systematically identified a wide range of different CRC events during a three-year period to provide a more comprehensive picture about their impact on media and public attention. Moreover, the data is more up to date as it includes the time period after the outbreak of COVID-19 to see if CRC and COVID-19 competed for attention. Also, this study differentiated between CRC and CRC screening-related communication given that CRC screening specific information seeking/scanning may more directly promote the behavior.⁶

There is a high level of heterogeneity in the influence of celebrity CRC deaths on the volume of news coverage, tweets, and Google search about CRC. While the peak volume of CRC news stories after the death of Chadwick Boseman (38 stories) and Kirstie Alley (33 stories) accounted for about of 2.9% and 2.6% of all the CRC news stories during the three-year period, the peak volume of news stories associated with the deaths of other public figures only averaged three news stories (0.2% of the total volume) (Table 2). Similarly, the peak volume of CRC tweets after the death of Chadwick Boseman was 1217, accounting for 14.9% of the total volume of tweets during the three years whereas other celebrity deaths were associated with an average peak volume of 13 tweets (0.2% of the total volume) (Table 2). Chadwick Boseman’s death was associated with a peak relative search volume about CRC on Google of 100 (the highest during the three years), but other celebrity deaths averaged a peak relative search volume of 27. Past work on selected celebrity cancer events have shown large impacts, though this body of work suffers from a “selection” bias and runs the risk of overstating the impact of celebrity cancer events writ large.^{11,12,14–17} The current study finds that celebrity cancer event effects depend heavily on the specific public figures involved, such that only high-profile cases (e.g., Chadwick Boseman) may have large impacts across different attention measures. Specifically, Chadwick Boseman and Kirstie Alley are among the most famous actors/actresses in our study, according to the public opinion data from YouGov.^35,36 Their deaths also triggered the largest spikes in public attention to CRC (Table 2). However, while Kirstie Alley has a higher fame score than Chadwick Boseman based on YouGov, Chadwick Boseman triggered more public attention to CRC than Kirstie Alley. It might be because Chadwick Boseman died of CRC at a younger age (while CRC risk is higher among older people), making the case more tragic and attention-worthy. For some public figures that are less famous, their deaths due to CRC also triggered significant spikes in public attention. Taken together, findings showed that celebrity deaths can increase media and public attention, but this impact seems to depend less on the level of “celebrity” but rather a combination of newsworthiness, public connection to the celebrity, emotional reactions to the event, and other undertheorized and underexplored concepts.^19,21

Celebrity CRC deaths were more likely to precede CRC related attention in general than attention that was specific to CRC screening. For example, the deaths of Chadwick Boseman, Gregg Leakes, Kevin Conroy, Natalie Desselle Reid, Alto Reed, and Billy Kametz preceded spikes in the volume of CRC news but not screening related news. The deaths of Natalie Desselle Reid, Kirstie Alley, and Gregg Leakes preceded spikes in tweets about CRC but not about screening (Table 2). While we did not formally analyze stories for prevention and screening content, these findings echo past research work showing infrequent coverage of cancer prevention and detection information in news^26–28 and on social media.³⁰ This highlights the need for public health and media professionals to intervene to link CRC events to the importance of screening in CRC messaging to encourage the behavior.

Structured events such as national CRC awareness months and a screening guideline change showed effects on some attention measures, but not all of them simultaneously. The media environment is competitive where different health issues may compete for coverage and resources. For example, as COVID-19 began to impact the U.S. in early 2020 drawing significant media and public attention, the CRC awareness month of 2020 did not increase news about CRC screening or searches about CRC and screening (Table 2). Rather, there was even a slight decrease in CRC and screening related searches during the time, likely due to attention to COVID-19’s emergence (see Appendix Figure 3). However, it is also important to note that even when these structured events exhibit influence, the impact tends to be smaller when compared to those most prominent celebrity events (e.g., Chadwick Boseman, Joe Biden) (Table 2). For example, Joe Biden’s colonoscopy triggered the highest volume of 35 screening related news stories (6.0% of the total volume during the three years) and 205 tweets (2.5% of the total volume) while awareness months averaged 2.7 screening related news stories (0.5% of the total volume) and 18.7 tweets (0.2% of the total volume). Chadwick Boseman’s CRC death had a relative search volume of 100 (the highest during the three years) while the awareness months had an average search volume of 45.3. Moreover, while the screening guideline change increased media and public awareness of the updated starting age for screening (from 50 to 45), misperceptions among the public were still present (about 30% of CRC screening tweets mentioning the appropriate starting age for routine screening still specified it to be 50 after the guideline change). Therefore, beyond seizing the opportunities to increase media and public attention/awareness of CRC and CRC screening after celebrity cancer events, there is also space for public health and media professionals to further enhance the impact of those structured events/strategic campaigns.

This study has limitations. As it only focused on the U.S. context, CRC, and a three-year time period, it remains to be explored regarding the generalizability of the findings to other countries, cancer topics, and over a longer time span. Also, this study did not examine the impact of cancer events on different population segments while past research suggests that the effects may depend on education,³⁷ race,¹² gender,¹⁵ and media use patterns.^18,19 These differences may have subsequent implications on cancer information/prevention disparities.

Conclusions

In summary, there was a high level of variability in the effects of celebrity CRC deaths on media and public attention to CRC, and such events were less likely to lead to spikes in news stories and social media discussions about CRC screening than about CRC in general. Also, planned events such as awareness months and screening guideline change stimulated attention to CRC screening but not as powerful as those events concerning most prominent public figures. Thus, to enhance CRC prevention, public health and media professionals should seek to play a more active role in emphasizing the value of screening following celebrity cancer deaths, highlighting celebrity CRC screening behaviors, and devoting more resources to promote CRC screening-focused news coverage and social media discussions during CRC awareness months and screening guideline changes.

Highlights.

• This study examined colorectal cancer (CRC) public events and attention to CRC.

• Celebrity CRC deaths often preceded more media attention to CRC overall.

• However, celebrity CRC deaths did not always increase public attention to CRC.

• Celebrity CRC screening preceded spikes in news and tweets about screening.

• Most prominent public figures triggered more attention than CRC awareness months.

Appendix

Appendix Table 1:

Search Data and Collection Strategies Used by Data Source

Data type	Sources/keywords
News data	Factiva (NPR, The New York Times, PBS, The Washington Post, MSNBC, CNN, Business Insider, Newsweek, USA Today, NBC News, The Wall Street Journal, ABC News, CBS News, New York Post, Fox News)
CRC	“colorectal cancer”, “colon cancer”
CRC screening	“colorectal cancer screening”, “colon cancer screening”, “fecal test”, “stool test”, “colonoscopy”, “colonography”, “cologuard”
Social media data	Twitter
CRC	“coloncancer”, “colorectalcancer”, “colon cancer”, “colorectal cancer”
CRC screening	“colorectalscreening”, “colorectalscreeningtest”, “coloncancerscreening”, “coloncancerscreeningtest”, “crcscreening”, “crcscreeningtest”, “colonoscopy”, “virtual colonoscopy”, “colonography”, “CT colonography”, “cologuard”, “stool test”, “poop test”, “fecal test”, “stool sample”, “poop sample”, “poo sample”
Web search data	Google Trends
CRC	colorectal cancer (as a topic - genetic disorder)
CRC screening	colon cancer screening (as a topic)

^aCRC: colorectal cancer

Appendix Figure 1:

Volume of Stories Published Daily about Colorectal Cancer and Screening in U.S. News Coverage, 2020–2022

Appendix Figure 2:

Volume of Tweets Published Daily about Colorectal Cancer and Screening in the U.S., 2020–2022

Appendix Figure 3:

Relative Search Volume Weekly about Colorectal Cancer and Screening in the U.S., 2020–2022

Data availability:

Data will be made available on request