Abstract
Purpose
This study examines the representation of mammography on social media platforms, specifically, X (Twitter), Facebook, TikTok, and Instagram, from 2006 to 2023. X (Twitter) went public in 2006, Facebook in 2004, Instagram in 2012, and TikTok in 2018 (after merging with Musical.ly). The analysis starts from after the public launch years to analyze personal experiences shared online.
Methods
A retrospective content analysis was conducted on 1,771 posts using specific hashtags related to mammography. Posts were categorized into themes including emotional and psychological impacts, clinical and procedural details, and social and supportive interactions. The analysis involved summarizing the distribution of themes across different social media platforms, focusing on frequency counts and percentages.
Results
The analysis revealed that, among included posts, Instagram hosted the most discussions (621 posts), followed by TikTok (457 posts), X (Twitter) (403 posts), and Facebook (290 posts). Key themes identified included raising awareness (1,735 posts), spreading positivity (1,675 posts), and discussing clinical aspects, such as diagnosis (1,197 posts) and quality of life (1,011 posts). Posts often highlighted concerns about discomfort (701 posts) and anxiety (835 posts) related to mammography, while also emphasizing the importance of early detection and the support found within online communities.
Conclusions
Social media serves as a powerful tool for public health communication, offering a mix of positive narratives and highlighting concerns about mammography. The significant engagement from the general public reflects a diverse array of perspectives that can inform future health communication strategies.
Keywords: social media, mammography, health communication, breast cancer awareness, public health education
Patient-Friendly Recap
Detecting breast cancer early through mammography plays a crucial role in reducing death rates.
This study looked at the representation of mammography on X (Twitter), Facebook, TikTok, and Instagram, from 2006 to 2023.
Instagram had the most discussions, followed by TikTok, X (Twitter), and Facebook.
Social media posts revolved around raising awareness, spreading positivity, discussing diagnosis and quality of life, and highlighting discomfort and anxiety about mammography.
Balanced and accurate health messaging on social media from real experts is crucial to improve public awareness and make sure mammography guidelines are followed.
Breast cancer remains a significant global health issue, with early detection through mammography playing a crucial role in reducing mortality rates. Despite advancements in screening technologies, participation rates in screenings are hindered by factors such as fear, discomfort, and lack of awareness.1 Breast cancer is the second most common cancer affecting women in the United States, with an estimated 310,720 new cases of invasive breast cancer expected to be diagnosed in 2024, accounting for one-third of new female cancers each year. Additionally, approximately 42,350 women in the U.S. are expected to die from breast cancer in the same year.2
Currently, the American College of Radiology (ACR), a national organization responsible for clinical recommendations for care in the field of radiology, recommends that women start getting annual mammograms at age 40.3 Since 1990, there has been a nearly 30% decrease in breast cancer mortality, largely attributed to early detection via mammography screening.4
Mammography is an increasingly common procedure, with 75.9% of women aged 50–74 years in the United States having a mammogram within the past two years.5 However, adherence to these guidelines is variable, with studies indicating that factors such as socioeconomic status, access to healthcare, and cultural beliefs significantly influence whether women follow recommended screening intervals.6 For instance, a study by Smith et al7 found that only 67% of women adhered to the biennial screening recommendation, with lower adherence observed in minority populations. Another study highlighted that rural and underserved communities had markedly lower adherence rates due to limited access to mammography services.8 This underscores the need for increased public awareness and education, particularly in vulnerable populations, to improve screening adherence.
Before the widespread adoption of social media, patient engagement with breast cancer screening practices primarily relied on traditional healthcare settings and printed educational materials. However, with the rise of social media, there has been a significant shift in how patients access, share, and engage with health information. Studies have shown that social media has become a critical platform for patients to discuss their experiences, seek advice, and advocate for breast cancer awareness, leading to increased public engagement and potential changes in screening behaviors.9 The interactive nature of these platforms allows for real-time information sharing and community support, which can significantly influence patient perceptions and decisions regarding mammography.10 This evolution in patient behavior underscores the need to investigate how social media platforms shape public perceptions and experiences with mammography, providing insights that could enhance public health communication strategies and improve screening adherence.11 A study revealed that among social media discourse on breast cancer screening, 797,827 unique users tweeted 1,351,823 breast cancer-related tweets in a single month, demonstrating the extensive reach and potential impact of social media on public awareness and perceptions of mammography.12 A content analysis of discussions on X (Twitter) from posts on breast cancer screening guidelines through 2015 revealed notable engagement from non-healthcare users, who comprised 32.5% of the conversation. This study highlighted the disparities in guideline approval and confusion, with only 2.9% of posts showing approval for guidelines, underscoring the need for clearer communication and education on breast cancer screening practices.12
While X (Twitter) discussions collected through early 2019 revealed mixed perceptions of mammography, where positive and inspiring posts encouraging screening coexist with concerns about discomfort, there is a need to understand how these discussions span across other popular platforms like TikTok, Facebook, and Instagram.13 Each platform has unique user demographics and engagement styles, which can offer varied insights into public perceptions and experiences. For instance, TikTok’s younger user base and Instagram’s visual-centric approach may influence how information is shared and perceived, as compared to X (Twitter).
Previous studies have primarily examined social media discussions about mammography on platforms like X (Twitter) and Facebook. For example, Attai et al14 demonstrated how Facebook is used for patient education and support concerning breast cancer and mammography. Similarly, Rosenkrantz et al15 explored how X (Twitter) users share their experiences and concerns regarding mammography, focusing on both supportive and critical narratives. However, while these studies provided valuable insights into how mammography is discussed on these platforms, there is room for further understanding of how these discussions occur on newer platforms like TikTok and Instagram. These platforms, which cater to different demographics and feature unique content formats, have not been comprehensively studied in the context of mammography-related discussions.
This study aims to address this topic by examining how mammography is discussed across a broader range of social media platforms, including X (Twitter), Facebook, TikTok, and Instagram. Unlike previous studies that focused on single platforms or were rather limited in scope, this study provides a cross-sectional analysis of social media discussions about mammography from 2006 to 2023. By categorizing posts into themes, this study seeks to offer a more comprehensive snapshot of public perceptions and experiences with mammography across different social media environments. By analyzing a broader range of social media platforms over many years, this study aims to capture a more complete picture of the potential impact on patient engagement.16,17
METHODS
This descriptive observational study adhered to HIPAA regulations, negating the need for explicit participant consent. The study also followed ethical guidelines from the Association of Internet Researchers (AoIR), which state that research using publicly available social media data, with no direct participant interaction or sensitive information, generally does not require Institutional Review Board (IRB) approval. This is supported by the University of Pennsylvania IRB, which confirms that IRB approval is unnecessary for research involving non-private, publicly accessible social media data.18,19
The advanced search function on individual social media platforms (X [Twitter], Facebook, TikTok, and Instagram) was used to select 1,771 posts spanning from January 2006 to December 2022, covering a period of 16 years. The year 2006 was chosen as the start year because it coincided with the public launch of X (Twitter), the first platform included in the study. For Facebook, which launched in 2004 but did not become widely accessible until 2006, data collection also began in 2006 to ensure consistency and comparability across platforms. Instagram and TikTok data are included starting from their respective public launch dates in 2012 and 2018. This methodological choice ensures that the analysis reflects only the content publicly accessible during each platform's active years.
This broad time frame was chosen to capture a near-comprehensive overview of public perceptions and trends related to mammography, encompassing a wide range of voices across the lifespan of each platform. To ensure a near-comprehensive snapshot of discussions related to mammography on social media, specific hashtags were systematically selected based on their relevance, popularity, usage frequency, and social media trends. Indeed, the following hashtags were included in this study: #mammography, #mammogram, #breastcancerawareness, #mammogramsaveslives, #breastcancer, #earlydetectionsaveslives, and #breastcancerawarenessmonth. These hashtags were chosen for their direct association with mammography and breast cancer awareness, as well as their widespread use in public discourse on platforms like X (Twitter), Facebook, TikTok, and Instagram. The search query was performed in January 2023. This study aims to analyze how individuals share personal experiences with mammography on social media platforms between 2006 and 2022, focusing on key themes and public perceptions to better inform public health communication. Posts were collected in descending order based on the social media platform search algorithm results.
Figure 1 shows a simple flowchart from the initial search and subsequent removal of posts by exclusion criteria to provide a clear overview of the data selection process. Inclusion criteria for this study required that posts were authored by individuals sharing their personal experiences with mammography. Inclusion criteria for this study required that posts (1) were authored by individuals sharing their personal experiences with mammography, (2) were written in English, and (3) directly related to the poster’s personal mammography experience, including emotional, psychological, clinical, or procedural details. Posts meeting these criteria were included to ensure that the analysis focused on patient perspectives. Data collection did not exclude posts based on geographic origin.
Figure 1.
Data selection process flowchart.
Exclusion criteria were applied to posts that did not meet these conditions. Specifically, posts were excluded if they (1) originated from healthcare organizations, identified based on user handles, professional affiliations, or bio descriptions indicating a non-personal, institutional source; (2) discussed someone else’s experience, determined by the use of third-person language or narratives clearly about another individual's mammography experience; (3) were promotional or provided informational content unrelated to personal experiences; or (4) were not written in English. Indeed, this thorough approach ensured that the analysis reflected, as accurately as possible, individual patient experiences with mammography, while excluding institutional or third-party narratives and posts not in English.
The posts were reviewed by two medical students (authors TS and JG) trained in qualitative content analysis. Examples of this analysis can be found in the supplemental materials. This training included a comprehensive review of thematic analysis literature, practice coding sessions, and discussions. Both students independently coded each post using a predefined coding framework, and any discrepancies were resolved through consensus. The students reviewed works on thematic analysis, eg, from Braun and Clark,20 and engaged in practice coding sessions using a sample dataset to familiarize themselves with the process. To ensure consistency in coding, the students first independently coded a set of 200 posts. Their results were then compared to assess intercoder reliability, with Cohen's Kappa (κ=0.71) used to measure agreement.20
The thematic analysis process was carried out through a systematic and iterative approach to ensure that the themes identified were both representative and grounded in the data. The process began with an open coding phase where the two coders independently reviewed a subset of approximately 200 posts. During this phase, the coders did not use any pre-existing categories; instead, they allowed themes to emerge directly from the data reflexively by identifying recurring patterns, ideas, and topics. This inductive approach facilitated the identification of initial codes, which were then grouped into potential themes.
After the initial open coding, the coders engaged in a reflective discussion to compare their findings. This discussion involved reviewing the identified codes and clustering them into broader, more coherent themes. The continuous reflection and adjustment helped to ensure that the themes captured the nuances of the data accurately. The iterative process continued with further rounds of coding and theme refinement. The coders applied the preliminary themes to additional subsets of posts, continuously refining the themes based on the data. This process of constant comparison helped to ensure that the themes were robust and adequately captured the range of experiences and perceptions expressed by users.
The final coding framework was established after achieving thematic saturation, where no new themes were identified in the data. Posts were categorized based on specific inclusion criteria: “Emotional and Psychological Experiences” included posts describing personal emotions such as anxiety, fear, or relief related to mammography. “Clinical and Procedural Aspects” covered posts discussing technical details, diagnosis, or the experience of the procedure itself. “Social and Supportive Interactions” included posts that mentioned support from family, friends, or online communities. “Access and Awareness” captured posts discussing barriers to accessing mammography, the benefits of early detection, or advocacy for policy improvements. “Experience and Perception of Mammography” included personal narratives or opinions about the mammography experience, while “Education and Information Sharing” encompassed posts providing educational content, lifestyle tips, or updates on technological advances in mammography. Posts that did not meet these specific criteria or were made by healthcare organizations were excluded from the analysis.
Each post was coded based on the platform for thematic content using a Google Survey form to input the data. The standardized survey ensured consistent data entry and facilitated the subsequent analysis. Posts were categorized into Emotional and Psychological Experiences (Figure 5), Clinical and Procedural Aspects (Figure 6), Social and Supportive Interactions (Figure 7), Access and Awareness (Figure 8), Experience and Perception of Mammography (Figure 9), and Education and Information Sharing (Figure 10). Any associated multimedia was also included to ensure a thorough understanding of the patient's experience.
Figure 5.
Total number of comments related to emotional and psychological experiences.
Figure 6.
Frequency of clinical and procedural aspects mentioned in posts.
Figure 7.
Number of social and supportive interactions mentioned in posts.
Figure 8.
Count of posts discussing awareness and access to mammography.
Figure 9.
Number of mentions of experiences and perceptions of mammography.
Figure 10.
Quantity of education and information-sharing comments.
The data were analyzed by calculating frequencies and percentages for each category and theme, providing a general overview of how the themes were distributed across various social media platforms. This approach focused on highlighting the distribution of the themes rather than exploring relationships between them.
RESULTS
The initial phase of our study involved a thematic analysis of 1,771 posts across several social media platforms, focusing on specific predefined categories, such as whether individuals were advising others to get screened or sharing personal accounts of pain associated with mammography. Data collection began in the year each platform went public: 2006 for X (Twitter) and Facebook, 2012 for Instagram, and 2018 for TikTok. Initially collected were 3,500 posts, which were subsequently reduced to 1,771 posts that met the inclusion criteria for final analysis. Our findings, as shown in Figure 2, revealed that Instagram was the most prevalently used platform for these discussions. Of the included posts, Instagram hosted 621 posts (35.1%), while Facebook and X (Twitter) included 290 posts (16.4%) and 403 posts (22.8%), respectively. TikTok had a representation of 457 posts (25.8%). The theme distribution was examined by quantifying the presence of different themes across social media platforms, offering insights into the public discourse surrounding mammography.
Figure 2.
Distribution of social media platform usage for mammography discussions.
A detailed analysis of hashtag usage across the platforms is presented in Figure 3. The most commonly used hashtags, of included posts, across all platforms included #mammogram (720 posts, 40.7%), #mammogramsaveslives (538 posts, 30.4%), and #mammography (394 posts, 22.2%). Other hashtags such as #breastcancer (23 posts, 1.3%), #breastcancerawareness (65 posts, 3.7%), #breastcancerawarenessmonth (18 posts, 1.0%), and #earlydetectionsaveslives (13 posts, 0.7%) were less frequently used. This pattern illustrates the dominant use of a few key hashtags, with minor usage of others.
Figure 3.
Distribution of social media platform usage for mammography discussions.
Of included posts, on Facebook, the hashtag #mammogram appeared in 105 posts (36.2%), while #mammogramsaveslives was present in 146 posts (50.3%). Instagram users demonstrated a strong preference for #mammogram, which was featured in 269 posts (43.3%), surpassing the usage of #mammogramsaveslives at 41 posts (6.6%). On X (Twitter), #mammogramsaveslives was a part of 67 posts (16.6%), while #mammogram was included in 265 posts (65.8%). TikTok users most frequently used #mammogramsaveslives, with 284 instances (62.1%). This pattern illustrates the distinct hashtag strategies employed by users on different social media platforms to engage with and amplify the conversation surrounding mammography and breast cancer awareness. Further examination of Figure 4 reveals that the hashtag usage across platforms is not as diverse as initially anticipated. A small number of hashtags appear to dominate the coverage, with minor usage of many other hashtags. This underscores the need to consider platform-specific dynamics when analyzing social media data, as the context and audience engagement can vary significantly.
Figure 4.
Hashtag usage count by platform (of posts that met the inclusion criteria).
The analysis of emotional and psychological experiences reported by participants is summarized in Figure 4. The majority of respondents exhibited resilience (1,564 mentions), reflecting capacity to deal with health challenges. Raising awareness was a significant concern, seen in 1,735 mentions, indicating the importance of this theme among respondents. This high number likely overlaps with many other categories, such as spreading positivity (1,675 mentions) and maintaining self-esteem (1,405 mentions). Concerns about cancer (1,377 mentions) and mental health (835 mentions) were also prominent, highlighting the psychological impact of mammography experiences. Although less common, apprehension toward undergoing screening (317 mentions), relief regarding results (244 mentions), and reflections that the examination was not as bad as anticipated (282 mentions) were also noted. The use of humor (979 mentions) as a coping strategy was another significant finding.
Clinical and procedural aspects of mammography visits are detailed in Figure 6. A significant portion of participants discussed their diagnosis (1,197 mentions, 67.6% of the total posts), while concerns about quality of life were also prevalent (1,011 mentions). Suggestions for treatments (658 mentions) and issues regarding compression (701 mentions) were commonly discussed. Scientific explanations, such as mentions of BRCA gene mutations, were brought up in 540 cases. Other aspects like bedside manner (38 mentions) and staff quality (277 mentions) were less frequently mentioned but still notable. Concerns about radiation from mammography were mentioned in 506 instances, highlighting this as a significant area of focus for respondents.
Social and supportive interactions related to mammography are captured in Figure 7. Advising others to get screened was the most frequently reported behavior (1,065 mentions), reflecting the high level of community engagement and encouragement for preventive measures. Offering or seeking support online was also prevalent (880 mentions), showing a strong online community presence. Religious connotations (230 mentions) and discussions about family (162 mentions) were part of the conversation, indicating the personal and social dimensions of the mammography experience.
Figure 8 focuses on awareness and access to mammography. The majority of the discourse was centered on conveying the purpose of mammography (1,136 posts). Discussions about the benefits of early detection (170 posts) and barriers to accessing services (40 posts) were also present, although less frequent. Advocacy or calls for policy improvements were mentioned in 15 posts, while concerns about cost or insurance coverage were noted in only 12 posts.
Experiences and sentiments surrounding mammography are detailed in Figure 9. Follow-up mammograms were the most commonly discussed topic (735 mentions), followed by experiences shared after the mammogram (557 posts). Recognition of the importance of mammograms (473 posts) and first mammogram experiences (363 posts) were also significant themes. Personal narratives or stories about mammography experiences were included in 177 posts, while emotions like anxiety or fear were expressed in 111 posts.
Figure 10 provides insights into the role of education and information sharing in shaping engagement with mammography. Lifestyle tips or preventive measures related to breast health accounted for 799 instances, and discussions on follow-up care were noted in 750 posts. Seeking or offering support on social media was mentioned in 136 posts, illustrating the community's role in support and encouragement. Posts assessing the impact of social media on perceptions of mammography (74 mentions) and providing scientific explanations or educational content (39 mentions) were less frequent but still notable.
DISCUSSION
A growing number of studies have brought attention to how the Internet and social media play a role in disseminating medical information.21,22,23 Our study evaluates how social media engagement can reveal trends in breast cancer discourse, specifically mammography.9 The increased patient access to mammography information through social media platforms allows patients to take a more active role in their healthcare decisions and vocalize their feelings online.10 By broadening our study to mammography perceptions across multiple platforms over many years—from after the public launch dates of the platforms to 2022—we may better understand how users of social media access and convey information.
The diverse and multifaceted nature of social media discussions about mammography, as revealed in this study, underscores both the opportunities and challenges inherent in using digital platforms for public health communication. The study's systematic selection of relevant hashtags offers valuable insights into public engagement with mammography on social media, reflecting personal experiences and sentiments. However, the hashtag selection may have reduced the scope of our analysis, potentially missing some discussions due to the variability in hashtag use among social media users. Despite this, these findings can help bridge the gap between patient priorities and healthcare practices, thus enhancing patient care. While this study did not analyze trends over time or differences in comment types by platforms in detail, these aspects present valuable avenues for future research to further enhance our understanding of public engagement with mammography on social media.
Understanding platform-specific dynamics is essential for developing targeted public health communication strategies. Instagram emerged as the most frequently used platform among included posts, accounting for 35.1% of posts. This platform's visual-centric nature facilitates more personal and engaging content, enabling users to share detailed experiences through images and videos. TikTok, with its short-form video content, also had substantial engagement (25.8%). TikTok's younger user base and potential for viral content could significantly shape younger generations' perceptions and awareness of mammography. On X (Twitter) and Facebook, where posts are more text-centric, the conversations included detailed narratives and discussions, providing in-depth insights into individual experiences and concerns.10,11,12
These platform-specific findings can impact patient care. For instance, the high engagement on Instagram and TikTok suggests that these platforms may be more effective for visual and video content that can educate and reassure patients about mammography. Healthcare providers and organizations could leverage these platforms to disseminate accurate information, share positive stories, address common concerns, and incorporate the latest screening recommendations, thus potentially increasing screening rates and early detection.
In contrast, the detailed discussions on X (Twitter) and Facebook can be utilized for more comprehensive educational content and direct patient-provider interactions. These platforms facilitate discussions on screening guidelines, answer patient queries, and provide support, helping to mitigate misinformation and confusion about mammography.15,24
While patients may benefit from increased access to healthcare information, considerable drawbacks to social media include misinformation. Social media information is not routinely peer-reviewed or vetted.14 While physicians and other healthcare professionals can spread helpful information through social media engagement, there is a potential for patient confusion regarding screening guidelines and best practices.25 Therefore, healthcare professionals have an increased responsibility to engage on social media to provide a knowledgeable voice during online conversations.26,27
Utilizing social media content analysis, we uncover the varied experiences of individuals involving mammography. Such analysis serves as a practical, reproducible method to understand patient sentiments, often not captured by standard clinical questionnaires.28 Online discussions largely center on using the platform for advocacy about mammography experiences.29 Additionally, conversations predominantly aim to disseminate optimism.30 These social media insights could guide the enhancement of patient care by highlighting the differences between the priorities of patients and healthcare practitioners.31
CONCLUSION
Social media serves as a powerful tool for public health communication, offering a mix of positive narratives and highlighting concerns about mammography. The significant engagement from non-healthcare professionals reflects a diverse array of perspectives that can inform future health communication strategies. This study underscores the need for balanced and accurate health messaging on social media to improve public awareness, integrate the latest screening guidelines, and enhance adherence to these recommendations.
The strategic adoption of social media by radiology departments has the potential to significantly enhance patient education and care delivery. This approach not only fosters a more informed patient community but also streamlines communication, making it an invaluable asset in the modern healthcare landscape.31 The USPSTF recommends biennial screening mammography for women aged 40 to 74 years, acknowledging the moderate net benefit in reducing breast cancer mortality within this age group.32
Limitations
This research has several limitations based on the methodology. One limitation of this study is the reliance on specific hashtags to collect data from social media platforms. While hashtags were selected systematically based on their relevance and popularity, there is a possibility that not all relevant discussions were captured. The use of hashtags is influenced by user behavior, and some discussions about mammography may have taken place without the use of the selected hashtags or under different hashtags that were not included in this study. This could have resulted in a sampling bias, potentially overlooking important narratives and sentiments expressed by users who did not engage with the selected hashtags. Future research could benefit from a broader or more inclusive approach to hashtag selection, perhaps utilizing a combination of keyword searches and machine learning techniques to identify relevant content that may not be captured by popular hashtags alone.
The reliance on self-reported data from social media posts assumes honesty and accuracy from users, which may not always hold true. In general, social media research is susceptible to self-selection bias, which may make it difficult to generalize results, as posts could be concentrated from a particular group, such as those comfortable with sharing and posting their experiences online or from a certain geographic location. It is not possible to obtain a comprehensive cross-section of all women through this method. Public social media posts were the only data source, introducing potential bias, as private posts remain inaccessible for analysis. Determining demographic details like the age or treatment stage of patients was often challenging, raising questions about how these factors might influence the findings and thus were not included.
The analysis was restricted to English-language posts, which may have excluded relevant discussions in other languages, potentially limiting the generalizability of our findings across different linguistic and cultural contexts. Moreover, the study did not account for differences in social media usage patterns across various age groups and socioeconomic backgrounds, which could influence the representation of perspectives and experiences shared online. This limitation may affect the generalizability of our findings to populations that are less active on social media or have different levels of access to these platforms.
Geographic disparities in mammography experiences were not evaluated but could be significant. Future studies should investigate how different demographics and geographic locations affect patient experiences with mammography and how social media can be utilized to promptly disseminate the latest screening guidelines.
Another limitation of this study is the presence of misleading or inaccurate information in some posts, which was noted, and could affect the reliability of social media as a tool for healthcare communication. This issue highlights the potential for misinformation to skew public perceptions and underscores the need for cautious interpretation of data sourced from social media platforms. Additionally, while the focus was on the more common screening mammograms, other types of breast imaging were not explicitly excluded, possibly missing diverse patient experiences.
Supplementary Information
Acknowledgments
None.
Footnotes
Author Contributions: Study design: Stirrat, Umair, Akpolat. Data acquisition or analysis: Stirrat, Garner, Tailor. Manuscript drafting: Stirrat, Garner, Weitz. Critical revision: Garner, Weitz, Umair, Akpolat.
Conflicts of Interest: None.
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