Changing Breast Cancer Education One Lemon At A Time

A Conversation With Know Your Lemons Founder Dr. Corrine Ellsworth Beaumont

Although every breast cancer journey is entirely individual, a lack of comprehensive knowledge about all its symptoms is fairly universal. Dr. Corrine Ellsworth-Beaumont MFA, PhD realized this herself when she lost three loved ones — two grandmothers and a childhood friend. Between the death of three women in her life, and her own experience receiving little comprehensive information about how to recognize breast cancer symptoms, Dr. Ellsworth-Beaumont took matters into her own hands with the Know Your Lemons campaign.

The campaign, which went viral in 2017, is a global initiative dedicated to reducing the breast cancer mortality rate through uniquely visual and highly accessible education approach. Using her background in graphic design and passion for improving the breast cancer education space, Dr. Beaumont realized that a fruit whose anatomy is similar to that of a breast would be accessible on a global scale, no matter what language, cultural, or literacy barriers exist. Now, four short years later, the Know Your Lemons Foundation has reached over one billion people online, trained hundreds of Educators around the globe, and totally uprooted the traditional approach to breast cancer discourse.

We had the pleasure of speaking to Dr. Beaumont about her experiences, and what she did when life gave her lemons.

“Discover what you're passionate about, and then think about a group of people that you want to help and that you care about, and find a way to bring those two together.”

IJ: In your own words, what is the philosophy and vision behind Know Your Lemons?

CEB: The Know Your Lemons Foundation is really unique as a breast cancer charity in that we focus exclusively on early detection and we are global. Our materials are currently in 27 languages and we're used in over 99 countries. We also work equally well for women and men, multiple ages, multiple literacy backgrounds... We use universal design to make it really easy to understand basic breast health messages so people can find breast cancer as early as possible.

IJ: Alongside the role of your personal experiences, I'd love if you could talk a little bit more about why, strategically, a campaign like Know Your Lemons is successful? Your doctoral dissertation was on the psychological effects of healthcare communication design; how does Know Your Lemons in particular overcome that with its delivery and its strategy?

CEB: Design is used to improve so many things. But usually they're very commercially driven — let's make this car more beautiful, let's make this package of dog food more attractive to consumers — that sort of thing. And there's nothing wrong with making things beautiful or improving their design. But I didn't see this being applied very much to the field of health care. 

When my second grandmother passed away, I was in my early twenties and I thought, I need to know about breast cancer now. Am I at an increased risk? What does a lump feel like? Should I start getting mammograms now? Really basic questions. I went into an education center specifically for cancer and I asked them these questions and they said, “Well, here are some leaflets, books, and websites,” and everything kind of looked the same. None of it was engaging. It was a trifold leaflet with a lot of text, and women of different ethnicities, all in a group smiling at me. I thought, how do we better communicate this?

How I started with the project was by visualizing the myths about breast cancer. I thought there would be like 10 or 12 and I found 50. So, I thought, how am I going to illustrate all 50 myths about breast cancer when I can't show breasts? I used jugs and cones and melons and light switches and flashlights, and all kinds of things. Going through that process is how I stumbled on the lemons and realized what a good metaphor it was. 

I shadowed at a mammography center, [where] I talked to the radiologist and said, "What are you looking at when you're looking at the x-ray? What do you think holds women back from getting mammograms? What does a lump feel like?” That sort of thing. I asked if [a lump] could feel like a grape, and she said, “Yeah, it can be that size.” And I said, “No, like, is it hard? Or squishy?” And she said, “Oh, it's usually hard, like a nut.” And as soon as she said that, I thought... “Or a lemon seed.”

That's when the whole metaphor came together.

IJ: What was it like taking what started as a fairly personal project and turning it into a global initiative? 

CEB: A few years [after my master’s degree], I ended up moving to London to get my PhD where I explored how to best design for global audiences. After that, I was a professor in London for a while, teaching entrepreneurship and design thinking in the business school. Then, [when] my really good friend died, I just couldn’t let this project stay this little thing on the side. This needed to be out in front of everybody, because it could have helped my friend, it could have helped my grandmothers. So, I quit my job. I had just become a single mom, and I was leaving behind reliable source of income. But I just felt so strongly that this is what I was meant to do. 

About a year later is when the campaign went viral and we've been growing ever since. It was a real leap of faith to follow my passion and follow what I thought was an important cause. I'd say to anybody reading this: discover what you're passionate about, and then think about a group of people that you want to help [and] that you care about, and find a way to bring those two together. 

IJ: The visual nature of the campaign overcomes a lot of barriers, as does its global accessibility which you mentioned earlier. But in formulating these different approaches and materials, what have you found to be the biggest barrier in making this information comprehensible on a worldwide level?

CEB: That's a great question. There are three barriers that we tackle with how we design the campaign. 

One of the biggest barriers to education for breast health is taboo. If you show a breast, that really limits your audience. My showing lemons instead, it side-steps that completely. 

The second one is fear; no one likes to talk about cancer. When you talk about breast cancer, there’s an added level of difficulty because breasts are often associated with sex. Cancer is often associated with death. So, when you've got breast cancer, it's like “sex death”. The two biggest taboo things you can put together, right? Our materials are really friendly. They're yellow, they're bright, they're cheerful. That reduces the fear barrier. 

[insert KYL material w. lemons here]

The third barrier is literacy and time. I think the reason why the Know Your Lemons campaign has created so much attention and interest is because in 60 seconds you can learn the 12 symptoms of breast cancer with hardly any words. And it's a really unusual image. There's something unique and fun about it.

And in terms of getting the campaign out there, last year we launched our online global Educator course. We've gotten almost 200 Educators signed up by our first year, which we're pretty excited about. And anyone can be a volunteer Educator, including your readers! 

By partnering with our Educators, we find out what the local issues are, we give them these unique tools to be able to open up these conversations in the communities, and by opening up those conversations, that then empowers them to say, "How do we negotiate these cultural issues?”

One example of these cultural issues is the belief that a breast cancer diagnosis casts a dark shadow on a woman’s family. There's a story of a woman in the United Arab Emirates who had very clear symptoms of breast cancer. She was referred for a second appointment, but she never showed up. And the reason why she didn’t is because she said, “If I'm diagnosed with breast cancer, then who's going to want to marry my daughters? They'll think that my daughters have the same issue I do.” 

“The more we can educate, the more we can empower.”

IJ: I love that your Educators give Know Your Lemons better grasp of the cultural contexts you’re working with. 

CEB: It's all about education. We've had so many women come to us saying “I'm alive because I saw your campaign,” or “I'm alive because my friend shared this picture on social media, and that's what gave me confidence when my doctor said, ‘Oh, don't worry. It's probably nothing’ to say, ‘No, I'd like a mammogram or an ultrasound.’”

 The more we can educate, the more we can empower and we can change a lot of what's happening in breast cancer...for women’s lives and men’s as well.

IJ: Something also at play here is the unfortunate narrative of women's symptoms not being taken seriously. I saw that in the story about your friend who passed; at one point she was given a second chance at life because her nurse suggested she get a second opinion when the doctor ignored her symptoms the first time around. I wonder if this broader issue also contributes to the lack of substantive, breast cancer discourse, education, and awareness?

CEB: Yes. I think overall as women, we have a harder mountain to climb than our male counterparts [in healthcare] because the stereotypical view of men is if they're at the doctors, it’s because it's serious. The stereotypical view of women is they're always worried, you know, about something, or we like to nag. 

But, if the doctor says, “You're too young”, “You're just worried”, or “Let's just wait and see”, then I know I can ask for a mammogram. I know I can ask for an ultrasound. If they say no, then I know that doctors are imperfect and I can find someone else who will listen to me. 

Doing those steps to find out the answer can be really difficult. With our app, you can read through all the symptoms, read through all the descriptions, and say, “Yeah, this sounds like what I might have.” The app will say, "Do you think you have this symptom?” And if you tap on that button, it gives you three options: [one of them being] do you want to talk to the doctor? If they tap on that, there's a set of instructions on how the conversation should go.

“The stereotypical view of men is if they're at the doctors, it’s because it's serious. The stereotypical view of women is they're always worried, or we like to nag.”

I had a symptom a couple of years ago, and even with all the knowledge I had, there's still this moment where you freeze and you go, “Is this nothing? Do I have to call my doctor?” But it's just about having that information and knowing what makes sense for you.

[insert screenshot of KYL app here]

IJ: Among all the milestones we’ve talked about today, what was the one thing that made you realize how great of an impact Know Your Lemons was having?

CEB: We had one Kenyan Educator [who] taught a group of 40 female entrepreneurs, and three of them after the class said, “Hey, I have a few of the symptoms you’ve shown today.” [The Educator] was able to explain to them how to go to the local hospital to get the testing they needed, and they all came back as having breast cancer. So just that one class that she taught, because she had our materials and local knowledge, made it easier for them to ask her questions, just made all the difference. So, I’m really excited about expanding our global Educator program. 

IJ: What’s been the most fulfilling thing - the biggest take away from your work? 

CEB: I think being confident in your vision and having a good team around you can make all the difference. There can be those days where you feel discouraged and you think, “Are we doing any good here?” But, when you have a good team around you, then you share those burdens and find new ways to connect with people and expand and that’s been the big take-away. I’m just excited to see what happens next, now that we have this really clear vision of the future and are building our partnerships. We’re going to change the picture of breast cancer for good!

IJ: How can our readers help to grow the Know Your Lemons initiatives?

CEB: There are so many ways that people can get involved with what we’re doing, the simplest way being to follow us on social media and re-share our images. The second one is to make a donation; even a small donation can make a big difference. And if people are passionate—maybe this is a subject that’s personal to you—volunteer as a global Educator

We have an online course that takes between two and three hours to complete, and we give you teaching tools and everything you need to go out into the community and help make a difference in other women’s lives and move the cause of women’s health and women’s empowerment forward.

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