• Rosemary Thackeray, Scott H Burton, Christophe Giraud-Carrier, Stephen Rollins, and Catherine R Draper.
• Department of Health Science, Brigham Young University, 221Richards Building, Provo, UT 84602, USA. rosemary_thackeray@byu.edu.
• Bmc Cancer. 2013 Jan 1;13:508.

BackgroundOne in eight women will develop breast cancer in her lifetime. The best-known awareness event is breast cancer awareness month (BCAM). BCAM month outreach efforts have been associated with increased media coverage, screening mammography and online information searching. Traditional mass media coverage has been enhanced by social media. However, there is a dearth of literature about how social media is used during awareness-related events. The purpose of this research was to understand how Twitter is being used during BCAM.MethodsThis was a cross-sectional, descriptive study. We collected breast cancer- related tweets from 26 September - 12 November 2012, using Twitter's application programming interface. We classified Twitter users into organizations, individuals, and celebrities; each tweet was classified as an original or a retweet, and inclusion of a mention, meaning a reference to another Twitter user with @username. Statistical methods included ANOVA and chi square. For content analysis, we used computational linguistics techniques, specifically the MALLET implementation of the unsupervised topic modeling algorithm Latent Dirichlet Allocation.ResultsThere were 1,351,823 tweets by 797,827 unique users. Tweets spiked dramatically the first few days then tapered off. There was an average of 1.69 tweets per user. The majority of users were individuals. Nearly all of the tweets were original. Organizations and celebrities posted more often than individuals. On average celebrities made far more impressions; they were also retweeted more often and their tweets were more likely to include mentions. Individuals were more likely to direct a tweet to a specific person. Organizations and celebrities emphasized fundraisers, early detection, and diagnoses while individuals tweeted about wearing pink.ConclusionsTweeting about breast cancer was a singular event. The majority of tweets did not promote any specific preventive behavior. Twitter is being used mostly as a one-way communication tool. To expand the reach of the message and maximize the potential for word-of-mouth marketing using Twitter, organizations need a strategic communications plan to ensure on-going social media conversations. Organizations may consider collaborating with individuals and celebrities in these conversations. Social media communication strategies that emphasize fundraising for breast cancer research seem particularly appropriate.

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