Generic Latin America Report

Discussing advanced or metastatic breast cancer in Latin America
An analysis of online conversations relating to advanced breast cancer (ABC) or metastatic breast cancer (MBC) in Latin America April 2012
REVISED latin america breast cancer report in progress.indd 1
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Contents
Section 1: Section 2: Section 3: Executive Summary Introduction Focus questions 3 10 12 13 15 19 20 49 51
1. What are the website categories in which conversations are taking place? 2. What are the prominent websites for those seeking information on advanced breast cancer (ABC) or metastatic breast cancer (MBC)? 3. How are patients, caregivers and physicians interacting online? 4. What related topics are being discussed? 5. How does this community talk about the mainstream pink or Pink Ribbon movement? 6. What are the primary concerns, frustrations or unmet needs discussed among this community?
7. What brand treatment conversations are occurring, and what is the share of voice for 53 current competitors? 8. Who is participating in conversations about treatments? 9. Who are the leading influencers among target demographics? Section 4: Section 5: Campaigns and additional keyword searches Breast cancer compared to advanced and metastatic research 55 57
60 65
Section 6:
Conclusions
67
Appendix Methodologies Glossary
70 71 72
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Section 1
Executive Summary
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EXECUTIVE SUMMARY
Executive Summary
This report is designed to answer nine questions relating to online conversations regarding advanced or metastatic breast cancer (ABC/MBC). The questions were devised to inform the client of current themes or issues in Latin America based conversations, which may assist in refining public relations activities. The Latin America countries included in the research were: Argentina Brazil Chile Colombia Mexico Venezuela The world wide web was searched, based on agreed search terms (see appendix). The date ranges were dependent on the number of results obtained and also varied between each Latin American country. In order to capture the agreed relevant 2,000 online mentions for analysis, we had to go back as far as 2001. Analyzed data ranged from July 9th 2001 to March 31st 2012.
Country Argentina Brazil Chile Colombia Mexico Venezuela Start Date 18/01/2002 01/10/2001 26/11/2003 05/01/2006 09/07/2001 06/10/2001 End Date 31/03/2012 31/03/2012 31/03/2012 30/03/2012 31/03/2012 31/03/2012
The availability of results was heavily dependent on the use of the world wide web in each country, which varied greatly during the above search periods. This is one of many socioeconomic issues that, coupled with population size, education, healthcare access, and financial circumstances, can in part explain the differences in the proportions of results per country in this report and the broad date range. During the search the system returned a total of 4,900 results. From these results we extracted 2,195 that were relevant to this analysis. Those 2,195 results provided 4,053 separate pieces of data that have been used throughout this analysis. That is a ratio of 1.85 pieces of data per relevant result (please note an explanation of data and results terminology is contained in the introduction).
4,900
results
relevant results
2,195
pieces of data
4,053

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EXECUTIVE SUMMARY
Executive Summary Real-time data was supplemented with retrospective data to achieve robust sample size
Overall volume of results
1200 1000 800 600 400 200 0 Argentina Brazil Chile Colombia Mexico Venezuela Average
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
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EXECUTIVE SUMMARY
Executive Summary The map and table below provide a summary of the results returned for each of the Latin American countries analyzed in this report.
Country Argentina Brazil Chile Colombia Mexico Venezuela

n = 2,195
No. of relevant results 310 880 201 67 575 162
% of total relevant results 14.12% 40.09% 9.16% 3.05% 26.20% 7.38%
Total population of country *
42,192,494 205,716,890 17,067,369 45,239,079 114,975,406 28,047,938
% of combined total populations
9.31% 45.39% 3.77% 9.98% 25.37% 6.19%
Independent research suggests that there are just over 200 million Latin American users online, which represents 36.7% of the regions population, compared to 58.3% of Europe and 78.3% of the US.1 As a comparison of results to population indicates, the number of relevant results found for this analysis is generally in proportion to each countrys population. As such, the number of relevant results for each country represents a valid sample size. % of relevant results by country
26%
8%
3%
n = 2,195
40%
9% 14%
n = 2,195
* Population statistics taken from the CIA world fact book. (Retrieved 19 April 2012) 1 http://www.newmediatrendwatch.com/markets-by-country/11-long-haul/42-b

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EXECUTIVE SUMMARY
Executive Summary The following section addresses each question with a summary answer, drawn from the information that is presented in this report: 1. What are the website categories in which conversations are taking place? Four website categories were identified among results used in the analysis; with their percentage of total relevant results in brackets, they were: Medical news or journal sites (48.88%) Medical - related blogs or discussions (47.06%) Posts from individual and business accounts on social media sites such as Twitter and Facebook (3.14%) Financial news (0.91%)
2. What are the prominent websites for those looking for information on advanced breast cancer (ABC) or metastatic breast cancer (MBC)? Twitter was the highest yielding website, accounting for 3.05% of all relevant results. However, a total of 1,251 websites with conversations about advanced breast cancer were identified in the research, with no site other than Twitter generating more than 18 results. This fragmentation of conversations about ABC or MBC is indicative of a lack of online concentration for discussions on the disease. 3. How are patients, caregivers and physicians interacting online? Where commentators could be identified, 41.62% were the patients themselves, 28.65% were family member of patients, 16.76% were physicians and 12.97% were friends of patients. Notably, there was an absence of conversation among non-physician health care professionals, such as other members of oncology multi-disciplinary team involved in the management of ABC or MBC patients. In total 185 commentators were identified. 4. What related topics are being discussed? Education was the most frequently discussed topic of conversation regarding metastatic or advanced breast cancer, accounting for 15.72% of all discussions, which included sharing of disease facts and educating and increasing knowledge of the disease. Followed by risk factors and prevention and thirdly, discussions related to treatment.

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EXECUTIVE SUMMARY
Executive Summary 5. How does this community talk about the mainstream Pink Ribbon or pink movement? The Pink Ribbon campaign was the only context in which the pink movement was mentioned, accounting for just 0.52% of relevant results. Where sentiment was expressed towards the campaign, it was always positive. 6. What are the primary concerns, frustrations and unmet needs discussed amongst this community? The largest driver of conversations in Latin America regarding ABC or MBC were related to the psychological impact of advanced breast cancer, this accounted for 26.00% of unmet need results and focused on issues of femininity after mastectomy, depression, and fear of the unknown. 7. What brand treatment conversations are occurring, and what is the share of voice for current competitors? Herceptin (trastuzumab) was the most frequently mentioned brand treatment, accounting for 24.1% of all drug mentions. Roches Avastin (Bevacizumab) followed, accounting for 18.13% of brand mentions. Novartis Afinitor (everolimus) overall share of conversation was 1.39%. 8. Who is participating in conversations about treatments? Discussions regarding treatment of ABC and MBC constituted 13.19% of topic mentions. Of these, 99.00% were from medical discussions and news sites. The remaining 1.00% were from individual accounts such as Twitter or Facebook. 61 commentators were identified, 35 of whom were patients (57.38%), 13 were physicians (21.31%), 12 were family members (19.67%), and one friend (1.64%) The most frequent topics of discussions within treatments were chemotherapy, surgery and radiotherapy. 9. Who are the leading influencers among target demographics? Influencers were often mentioned in Latin America discussions and included notable people or groups. The most prominent influencers within Latin America on advanced breast cancer were Elizabeth Edwards (US - deceased) and Luciana Holtz (Brazil), followed by the National Cancer Institute (Brazil).

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EXECUTIVE SUMMARY
Executive Summary Key findings The following takeaways and insights are comprised in accordance with generic marketing and communications objectives; no definitive assumptions about the use of this analysis in a future communications campaign are made: The report findings support the assertion that the use of social networking sites and microblogs, such as Twitter and Facebook, have had a slower uptake in Latin America when compared to the US. There is some resistance among Latin American patients to present to physicians with healthcare issues, which increases the likelihood of presentation at late stage disease. Latin American conversations had a more emotional sentiment to them when compared to the US study. The prominence of education, risk factors and prevention and clinical trial conversations demonstrate the desire of people in Latin America to get information on ABC or MBC through sources other than physicians. Social media conversations in Latin America around this topic are very fragemented, particularly in the smaller markets. However, there has been a growth in these converstions recently, specifically in Brazil and to a lesser degree the other markets. This leads us to believe that the fragmentation is not a reason to avoid these channels. It is an opportunity to build a communication platform with these patients. The lack of involvement of medical or healthcare professionals in online discussion raises questions of credibility in relation to the information being shared.
Opportunities The absence of a prominent single online source of healthcare information, and the spread of sources found herein, suggest a client sponsored website may meet an unmet need. Client campaigns were not discussed during the timeframe based on search criteria.

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Section 2
Introduction
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INTRODUCTION
Introduction
Introduction The number of people seeking information and advice on social and digital media continues to increase significantly. The growth of social media beyond innovators and early adopters also increases the potential for campaigners to use it to influence behavior and change opinions. This presents considerable opportunities and threats for companies to engage with consumers. However, the growth of social media channels has also fragmented the audience, who are less likely to get information from a single source (such as a company website). And the wide variety of companies and charities that now use digital media means that consumers have a vast number of brands competing for their attention. By gleaning intelligence from consumers digital behavior companies can get deeper insights into attitudes and habits, identify trusted sources of information and devise compelling campaigns which reach the target audience and engage consumers. Definitions When this report refers to results, it is speaking about the raw material Trufflenet has generated when it scours the Internet. Data, on the other hand, refers to the output of a refined result a result that has been considered relevant, and topics and values applied to produce a piece, or pieces of data that are applicable to the analysis. The test for whether a result should be considered data (a relevant result) is that its value must be clear and completely unambiguous. No assumptions are made about data, for example, unless someone clearly states where they are located, or it appears in their biographical information a location value is not applied. Conditions This project is based on search terms that are designed to garner the best available results from the Internet. The list of search terms used for this project can be found in the appendix section of this document. In all graphs that appear in this analysis you will find an equation n=x. X is the number of pieces of data which combined have formed the basis of the information in the graph, unless otherwise stated. It is important to bear in mind when considering the information contained in this project the data is not linear. A single result may provide data to answer one or multiple questions, meaning that data sets throughout are not always directly comparable. It is important to consider the volume of data used to answer any question, depicted in the n values of graphs and in other varying locations particularly when drawing conclusions to inform next steps.

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Section 3
Questions
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WEBSITE CATEGORIES
1. What are the website categories in which conversations are taking place?
Total relevant results:
2,195
Number of websites that yielded relevant results:
1,251
The search for this analysis returned results from 1,251 different websites that generated 2,195 results deemed relevant to this project. To help understand and identify the most important websites to the interests of the client, those that yielded relevant data were divided into four categories: Social Media Platform Websites, such as social networking sites, that are dedicated to dissemination of user generated content including postings and videos from an individual or business user. Notably, the only websites found among results that conformed to this category were Twitter and Facebook Medical related blogs or discussions Websites that are forums, blogs, chat rooms or communities for medical discussion Medical news Websites that relate to medical news or medical journals
In solid tumors such as breast cancer cell proliferation in constant and rapid tumor may lead to an underdeveloped and dysfunctional vascular network around the tumor. The result is called hypoxia, a condition in which cancer cells are subject to reduced oxygen supply since they are not in proximity to blood vessels. These hypoxic regions within the tumor may increase the aggressiveness of the cancer and its potential to cause metastasis or recurrence of disease.
http://www.isaude.net/pt-BR/noticia/14439/ciencia-e-tecnologia/vitamina-b1-tiamina-pode-ser-prejudicial-para-pacientescom-cancer-de-mama

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WEBSITE CATEGORIES
What are the website categories in which conversations are taking place? Medical news and discussion sites accounted for 95.96% of all results, with social media platforms and financial news sites generating 3.14% and 0.91% respectively. The uptake of user-generated social media platforms such as Twitter and Facebook in the Latin American market is a comparatively recent phenomenon, which may account for the low volume of social media platform results. Likewise, the privacy settings of some popular Latin American social networking sites, most notably Orkut, are significantly more stringent than other English language communities, permitting very little, if any, public viewing of commentary. Volume of relevant results by website category
1200 1000 800 600 400 200
n = 2,195
69 1073 1033
20
Medical news
Medical discussion
Individual Social media platform
Financial news
Volume of websites that yielded results by category

700 700 600 600
657
582
500 500 400 400 300 300 200 200 100 100
n = 1,251
00
10
Medical Discussion Medical discussion Medical news MedicalNews Financial news Financial news
2
Individual Social media platform

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2. What are the prominent websites WEBSITES for those seeking information on advanced breast cancer (ABC) or metastatic breast cancer (MBC)?
PROMINENT
The table below identifies the top ten websites by volume of relevant results. The categories listed are, in order from left-to-right: The rank of the website (ranking) The websites domain name (website) The number of relevant results the website generated (no. of relevant results) Which of the four categories identified in question one the website subscribes to (category) The percentage of relevant results generated by that domain, as a percentage of the total relevant results used throughout the report (% of total relevant results)
The ten websites listed below generated 8.97% of the total 2,195 relevant results used in this analysis.
No. of relevant results 67 18 17 15 15 14 14 13 12 12 % of all results 3.05% 0.82% 0.77% 0.68% 0.68% 0.64% 0.64% 0.59% 0.55% 0.55%
Ranking
Website
Category
1 2 3 4 5 6 7 8 9 10
n = 2,195
www.twitter.com grupos.emagister.com www.isaude.net buscatextual.cnpq.br/buscatextual www.lasalud.com.mx www.ayudacancer.wordpress.com www.noticias.uol.com.br foro.enfemenino.com es.answers.yahoo.com www.zocalo.com.mx
SocialIndividual Media Platform
Medical Discussion Medical News Medical News Medical Discussion Medical News Medical News Medical Discussion Medical Discussion Financial News
What happened? She had overcome her breast cancer ... is it complicated by metastasis or something?
@Josselyn_Lugo
grupos.emagister.com
0.82%
3.05%
Twitter
www.isaude.net
0.77%
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PROMINENT WEBSITES
Top ten websites by volume of results, per category To assist in identifying websites of importance to the client, the following section provides a detailed breakdown of the websites listed in the previous table, by category (individual, medical discussion, medical news and financial news). Against each website you will see six descriptive categories: Name: Website: Volume: The name of the website. The website address that appeared in the results. The number of results the website or domain returned, relevant to the analysis. In brackets is the rank of the website against all relevant results, across all categories. A contact email address for the website owner or operator if available. Country in which the website owner is located, or the site is operated from. A brief description of the website and its content.
Contact: Country: Description:
Individual
Name: Website: Volume: Contact: Country: Twitter www.twitter.com 67 (1) partner@twitter.com US
Description: Twitter is the worlds largest microblogging site with approximately 200 million accounts. It connects users to the latest stories, ideas, opinions and news from around the globe.
Medical News
Name: Website: Volume: Contact: Country: Isade www.isade.net 17 (3) N/A Brazil
Description: Isade.net provides both regional and Brazil-specific medical news encompassing developments for healthcare professionals, public health stories and health science advances.
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PROMINENT WEBSITES
Top ten websites by volume of results, per category Name: Website: Volume: Contact: Country: Platforma Lattes buscatextual.cnpq.br/ buscatextual 15 (4) atendimento@cnpq.br Brazil
Description: Scientific research database created by CNPq that collates information on scientific research projects, institutions, and individuals involved in research. Name: Website: Volume: Contact: Country: Cancer: therapies and treatments www.ayudacancer. wordpress.com 14 (6) N/A Argentina
Description: Hosts recent cancer news, blog posts and discussions as well as general information about all cancer types. Name: Website: Volume: Contact: Country: UOL Noticas www.noticias.uol.com.br 14 (7) N/A Brazil
Description: UOL is the largest (by market share) online and Internet services provider in Brazil. Its news site, UOL Noticas, provides general news with a strong emphasis on science and health.
Medical Discussions
Name: Website: Volume: Contact: Country: emagister.com grupos.emagister.com 18 (2) N/A Global
Description: Emagister hosts discussion boards with a primary focus on higher education issues, for current and prospective students; and a variety of secondary themes including health.
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PROMINENT WEBSITES
Top ten websites by volume of results, per category
Name: Website: Volume: Contact: Country:
LaSalud www.lasalud.com.mx 15 (5) N/A Mexico
Description: Medical news and information site, with an array of health related discussion forums. Name: Website: Volume: Contact: Country: Enfemanino foro.enfemenino.com 13 (8) jorge.segado@enfemenino. com Mexico
Description: A womens lifestyle site that provides news and hosts discussions on female issues and interests including fashion, celebrities and health.
Name: Website: Volume: Contact: Country:
Yahoo Respuestas es.answers.yahoo.com 12 (9) N/A Global
Description: Yahoos spanish language general purpose question and answer forum. Participants can ask questions on topics of interest and receive answers from other site users.
Financial News
Name: Website: Volume: Contact: Country: Zocalo Staltillo www.zocalo.com.mx/ 12 (10) N/A Mexico
Description: Mexican national news site providing regular updates on a range of general interest issues, with a focus on finance and security news.
Discussing advanced or metastatic breast cancer in Latin America 18
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INTERACTING ONLINE
3. How are patients, caregivers and physicians interacting online?

Commentators were categorized by their interest in ABC or MBC, in 185 of the relevant results used in this analysis. The interest groups are defined as follows, along with the groups percentage as a proportion of the 185 identified: 41.62% of those identified were patients 28.65% were family members of patients 16.76% were physicians 12.97% were friends of patients
Notably, physicians were the only healthcare professionals identified among results, accounting for a total of 31 separate relevant results. The graph below reflects the website categories (defined in question one) that the above groups frequented to discuss ABC and MBC, by volume of relevant results: Volume of commentators identified in posts
end
ian Friend
2 5 1
17
Financial news Social media Individual platform Medical News Medical Discussion
mily Physician
7 1
23
Financial news Individual Medical News

40 60
ent Family 0 10 Patient 20
Medical Discuss 40 50
30
6
21 50
0
n = 185
10
20
30
40
50
60
As the graph demonstrates, all identifiable stakeholder groups used medical discussion websites to talk about advanced or metastatic breast cancer.

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FREQUENTLY DISCUSSED TOPICS
4. What are the topics that are being discussed?
Total volume of individual topic mentions:
3,638
Relevant results:
Topics of conversation identified:
2,195
11
Each of the 2,195 results used in this analysis were sorted by a trained analyst, and a topic (or multiple topic) values applied to each. This generated 3,638 separate topic mentions amongst relevant results. Those mentions were ascribed to one of eleven categories to provide an overview of the principal topics of conversation in the discussion, as defined in the table below:
Topic of conversation Education Risk factors and Prevention Treatment* Clinical trial Drug mention* Diagnosis and Symptoms Influencer* - notable people or groups Support New or media story Newsor media story (including Novartis) Unmet needs* Cost ribbon Pink Ribbon
n = 3,638
Volume of results 572 515 480 455 419 359 285 213 192 90 39 19
% Overall discussion 15.72% 14.16% 13.19% 12.51% 11.52% 9.87% 7.83% 5.85% 5.28% 2.47% 1.07% 0.52%
Each topic category is examined in detail henceforth, or, if denoted by an asterisk in the above table, as part of its own separate question later in this report.
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In-depth findings on each topic of discussion
Education
The graph overleaf is used (as a template) throughout the remainder of the analysis, and highlights multiple pieces of information. In all instances henceforth, the blue columns represent each countrys proportion of total relevant results used in this analysis (% of total relevant results), which was introduced in the executive summary. The red column (the color of which changes in each graph henceforth to highlight changes in topic) indicates the proportion of each countrys relevant results for the topic being analyzed (% of total education mentions), in this case education. The figure that appears under each country name is an indexed comparison of total relevant results for that country, to the topics relevant results (in this case education). In all cases, a result of 100 indicates an exact mirroring of the topic mentions for the country, to the proportion of total results that country generated for this study in other words, 100 reflects an anticipated outcome. However, most figures deviate from 100. Where a number is less than 100, discussion of the topic is less than would be anticipated. Where the number is higher than 100, discussion of the topic is higher than would be anticipated. The greater the difference between the result and 100, the greater the degree of emphasis that should be placed on that result. Thus, the graph overleaf tells us that conversations regarding education accounted for a greater than anticipated percentage of conversations in Mexico and Chile, and a less than anticipated percentage of conversations in Argentina, Columbia and Venezuela, though it should be noted that the sample sizes are small in the two latter countries, which increases the likelihood of large variations in the index score. In Brazil, the volume of conversations about education in the context of ABC or MBC were broadly in line with all conversations regarding ABC or MBC in that country.
Research indicates that rates of mortality from the disease remain high, most likely because it is still diagnosed in advanced stages. In the world population, the median survival after five years is 61%.
http://saudeweb.com.br/voce-informa/5-de-fevereiro-dia-nacional-da-mamografia/
Avon has launched a campaign against the Avon Breast Cancer. October is the month dedicated to the global debate on breast cancer and ways of early detection of disease. To mark the occasion, the Institute presented on Wednesday (29), the national study, entitled Avon Research Institute / Ipsos - Perceptions of breast cancer - myths and truths about the disease. The analysis was performed with a thousand Brazilian women to understand the myths and truths of them regarding the disease.
http://www.farolcomunitario.com.br/saude_000_0369instituto-avon-divulga-pesquisa-sobre-o-cancer-de-mama.
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Education
The majority of discussions included in education conversations consisted of factual information on breast cancer. These were divided between sharing and discussing facts of the disease and raising awareness. Proportion of total education mentions, by country
40% 35% 30% 25% 20% 15% 10% 5% 0%

Indexed comparison*
40%
38%
38%
26%
14% 9% 9%
12% 8% 3% 1% Mexico 146.15 2% Venezuela 25.00
While the majority of the findings in education are consistent with the overall distribution of results, Mexico and Chile did have a greater emphasis on education conversations, more than would be expected. Notably there was a national campaign in Chile to promote self-examination as a preventative strategy to assist early detection.
Argentina 64.29
Brazil 95.00
Chile 133.33
Colombia 33.33
n = 572 (education mentions) n = 2,195 (total relevant results)
% of total relevant results
% of total education mentions
Half of the cases of breast cancer are diagnosed each year in an advanced stage
@ Adrianogomes_
* Numbers lower than 100 indicated the discussion of the topic is less than what would be anticipated; number over 100 mean the discussion of the topic is more than what would be anticipated Discussing advanced or metastatic breast cancer in Latin America 22
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Education
Categories of websites hosting conversations about education
Medical discussion Medical news Social media platform
n = 572
Discussions regarding educational topics were most commonly generated on medical discussion or news sites, which accounted for 95.89% of the total relevant results used throughout this analysis.
What are the stages of cancer? The cancer has four stages or phases. Phase I is the starting when the tumour is localized and not compromised tissues. Phases II and III are considered intermediate, and occur when the tumour has spread to nearby structures. In stage IV, cancer has spread to other organs, characterizing metastasis.
http://grupomamacancer.wordpress.com/2007/05/06/perguntas-frequentes/

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Education
Raising awareness of breast cancer accounted for 45.00% of discussions within education, with all Latin American countries discussing: Month Against Breast Cancer - championed worldwide each October The critical need to raise awareness of breast cancer so that it can be detected earlier Specific country discussions included: Avon (the cosmetics company) in Colombia was very active at raising awareness Governments in Mexico and Chile initiated a national Program for prevention and control of breast cancer and to raise awareness In Brazil, Chile and Venezuela male breast cancer was discussed - For every 100 cases of breast cancer in women, one case is diagnosed in a male (Brazil and Venezuela) - Male breast cancer more likely to be detected in advanced stages (Chile)
Sentiment was rarely seen in Latin American education conversations, with only nine sentiment laden comments found among results. The graph below, which excludes instances of no sentiment (as do all other sentiment graphs found in this report), largely reflects negative sentiment that stemmed from discussions regarding late stage diagnosis.
Sentiment expressed within education discussions
n=9

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Risk factors and prevention

Combined, prevention and risk factor conversations accounted for 14.00% of all data used in this analysis. Of these, prevention conversations accounted for two-thirds of the discussions and commentators often listed more than one prevention strategy in their comments. Proportion of total prevention mentions, by country Venezuela, Argentina and Mexico had a lower level of prevention conversations than expected, highlighting the need to raise awareness of these strategies. Brazil and Chile were actively discussing prevention strategies at a higher level than expected. Colombia was at its anticipated level.
This disease kills one woman every two hours and is the leading cause of cancer death in Mexican women In Mexico, only 20% of cases are diagnosed early. Timely help some women to have a better prognosis for cure and treatment of breast cancer. It is therefore calls on all Mexican women for self-examination monthly and see a doctor at the slightest sign and especially scanning a mammogram annually after 35 of age
http://journalmex.wordpress. com/2009/10/25/%C2%A1no-masvictimas-por-cancer-de-mama/
Indexed comparison*
n = 289 (prevention mentions) n = 2,195 (total relevant results)
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Prevention Prevention conversations by category
Social media platform
Medical news Medical discussion
n = 289
As the graph demonstrates, prevention conversations were almost entirely generated by people using medical discussion and medical news websites. Where identified, physicians were seen to be using the sites to assist others in better understanding the disease.
According to research Breast Cancer - experiences and perceptions held by Pfizer, says most women informed about the disease, but they mistakenly suggest, for example, stress as a risk factor for this tumor type and do not do routine mammography
http://www.necessaire.com.br/cancer-de-mama-mulheres-se-deixam-influenciar-por-mitos/php
Already 81% of healthy women do self-examination without knowing that alone could hardly detect a tumor in the breast, especially in early stage. One fact that may indicate the habit of not female exams notes that in Brazil, less than 10% of women are diagnosed with ductal carcinoma, a type of breast cancer in early stage, this is the stage most likely to cure and more easily diagnosed by mammography - and often is not palpable
Sergio Simon, coordinator of research and clinical oncologist Albert Einstein Hospital in Sao Paulo

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Prevention The graph below represents the top five prevention strategies reported in the findings:
70 60 50 40 30 20 10 0
Venezuela 1 9 1 13 2 14 11 3 34 33 1 3 9 18 4 Self examination 2 Mammogram 3 Healthy Diet and exercise 1 2 2 4 Mexico Colombia Chile Brazil Argentina
3 8 Taking regular aspirin
Avoid excessive alcohol intake
n = 181
Among results it was found that people in all examined Latin American countries discussed: Self-examination being crucial for early detection of the disease Regular mammograms, annually once over the age of 40 Mentions of mammograms and self-examination accounted for 60.00% of the overall discussions on prevention Engaging in a healthy lifestyle with a good diet and regular exercise Keep alcohol intake to a minimum (not mentioned in Venezuela)
Specific country discussions included: Not smoking was discussed in Chile and Brazil Taking regular Aspirin was discussed in Brazil Breast feeding was discussed in Brazil, Chile and Mexico

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Risk factor conversations accounted for the remaining third of the prevention and risk factor total. As with prevention, commentators frequently listed more than one risk factor in their comments. Proportion of total risk factor mentions, by country
Overall risk factor conversations were consistent with their expected volume in Chile and Brazil. Mexico was a little lower than anticipated, with Venezuela and Argentina slightly greater. However, volumes in Colombia was twice the anticipated level, due to well reported risk factors, indicating that the level of knowledge in conversations was high.
Indexed comparison*
n = 226 (risk factor mentions) n = 2,195 (total relevant results)
According to a study published this month in the journal Radiology, patients with a history of breast cancer in the family, who are at high risk for the disease
http://www. panoramabrasil.com.br/
* Numbers lower than 100 indicated the discussion of the topic is less than what would be anticipated; number over 100 mean the discussion of the topic is more than what would be anticipated Discussing advanced or metastatic breast cancer in Latin America
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Risk factors
Risk factor conversations by category
The breakdown of website categories for risk factors was Medical discussion identical to those Medical news found for prevention, Social media platform with 99.00% of mentions occurring on medical discussion and news sites.
n = 226
Risk factors you cannot change include: Age and gender: the risk of breast cancer increases as you age. Most cases of advanced breast cancer is in women over 50 years. Women are 100 times more likely to develop breast cancer than men.
http://angieestherparedessanchez.blogspot.com/
Age and gender: as with most cancers, age is a very important factor. In fact, 77% of new cases and 84% of deaths from breast cancer occur in women 50 years or more. Over 80% of all cases occur in women over 50 years and less than 1% occur in men. The risk of breast cancer is clearly related to hormonal influences, but it is unclear how these affect the disease and particularly the types of disease. Genetic factors and family history of breast cancer: Some families seem to have a genetic tendency for metastatic breast cancer. We have found two genes that appear to be involved variants, BRCA1 and BRCA2
http://www.estudiagratis.com/cursos-gratis-online-Cancer-mama-curso-31118.html

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Risk factors
The graph below identifies the top five mentions of risk factors:
60 Venezuela 50 4 4 1 40 1 15 Mexico 3 1 6 3 30 36 20 13 2 2 13 1 Colombia Chile Brazil Argentina
5 10 6 0 Late detection of the disease

Aging women Ageing women
14
18
5 2 3
4 1 6 2 Having children later in life
Family history
Obesity
n = 171
All Latin American countries discussed: Late detection of the disease, which was noted as the biggest risk factor to the development of advanced or metastatic breast cancer (if not already at that stage) Aging women and family history
Specific country discussions included: Obesity was mentioned in all countries except Colombia and Venezuela Having children later in life was mentioned in Argentina, Chile, Mexico and Brazil Excessive alcohol intake was mentioned in all countries except Colombia and Venezuela
The reporting of the prevention and risk factors on medical news and discussion facts kept sentiment to a minimum as commentary was overwhelmingly fact based. When sentiment was expressed, it was negative (five mentions).

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Clinical trial
Clinical trial conversations generated 12.51% of the overall data identified in this report. As the graph below demonstrates, mentions of clinical trials were generally lower than would have been anticipated, with the exception of results for Argentina and Brazil. Proportion of total clinical trial mentions, by country
This chart signifies that clinical trial discussions in Latin America were lower than would be anticipated, with the exception of Brazil, where discussions on gene therapy were prominent.
Indexed comparison*
n = 455 (clinical trial mentions) n = 2,195 (total relevant results) * Numbers lower than 100 indicated the discussion of the topic is less than what would be anticipated; number over 100 mean the discussion of the topic is more than what would be anticipated Discussing advanced or metastatic breast cancer in Latin America 31
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Clinical trial
Category of website hosting clinical trial discussions
Medical news Medical discussion Social media platform
n = 455
As with prevention and risk factor discussions, information on clinical trials was most often shared on medical news and discussion sites. There was no sentiment conveyed in discussions about clinical trials. These discussions were entirely factual. The ten most frequently discussed type of clinical trials accounted for 33.64% of all clinical trial discussions.
Thus, from this trial, which aims to keep the disease under control as long as possible, patients with the disease continue their normal lives without the tumour progressing, as explained Cortes. Patients do not cure yet, but much longer maintain control of the disease, insists Cortes, who has said that approximately half of patients who previously lived with metastatic disease 12 to 14 months have gone to live 4 and even 5 years with this very aggressive tumour.
http://noticias.lainformacion.com/salud/cancer/avanza-la-supervivencia-de-las-mujeres-con-metastasis-en-cancer-de-mama_ ZvlzqpleVBnYu4s43PTUK3/

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This table presents the most frequently discussed topics among clinical trial discussions.
Clinical Trial Details Description ADAM33 gene is inactive. DCC gene COX2 EREG HB-EGF MMP1 MMP2 ST6GALNAC5 Cannabis could cure breast cancer active components of marijuana and its derivatives could reduce tumor growth of breast cancer and metastasis CLEOPATRA - A Study to evaluate Pertuzumab + Trastuzumab + Docetaxel vs. Placebo + Trastuzumab + Docetaxel in previously untreated HER2-positive metastatic breast cancerpatient ancer patient Prediction of response to treatments and genetics Discovery of protein Blocking a molecule that drives metastasis, Discovery of Peptide molecule. Research into ways to slow metastatis through molecules They discovered how cells of breast cancer using a particular type of molecule, called TGF beta, to promote metastasis, ie, expansion of cancer cells in the body, which process causes approximately 90% of deaths from the disease. Bolero 2 Researchers at the University of Texas MD Anderson Cancer Center, USA, found that the combination of the drug everolimus exemestane with hormone therapy dramatically improves survival of patients with breast cancer. Vaccines to improve prognosis Combination of lapatinib and trastuzumab Aspirin reduces chances of metastsis in BC patients and reduces risk of dying from tumor Country total n = 455 % Country share of discussion on top 10 clinical trials AR BR CH CO ME VE Total % total mentions of clinical trials
Various gene therapies
12
35
51
11.21%
Cannabis
10
13
35
7.69%
Cleopatra
12
22
4.84%
Various Biomarkers Trials and clinical research Protein based research/trials
13
2.86%
10
2.20%
Molecule research
1.32%
BOLERO2 Trial Belero
1.10%
Vaccinne Research lapatinib and trastuzumab
0 0
2 3
0 0
0 0
3 0
0 0
5 3
1.10% 0.66%
Aspirin
0.66%
22 14.38 %
85 55.56 %
13 8.50 %
2 1.31 %
23 15.03 %
8 5.23 %
153

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Diagnosis and symptoms

Diagnosis Diagnosis discussions included mentions of specific diagnostic techniques alongside discussions of what actually triggered the need to confirm the diagnosis, such as finding a lump or pain in a specific part of the body. Proportion of total diagnosis trial mentions, by country
As with results for clinical trials, conversations regarding diagnosis were largely lower than would be anticipated, with one marked exception Venezuela, which generated almost five times the volume of anticipated results. An explanation of this upturn in conversation volume is related to commentators reporting ultrasounds being ineffective as a diagnostic tool, specifically, being unable to detect inflammatory breast cancer.
Indexed comparison*
n = 243 (diagnosis mentions) n = 2,195 (total relevant results)
Breast cancer is a silent disease advanced and very aggressive, so the self is the main tool to diagnose it early
http://todo-en-salud.com/2010/12/dia-mundial-contra-el-cancer
18/05/2012 12:13

Diagnosis Diagnosis conversations, by website category
35.00% Medical discussion
65.00% Medical news
Results for diagnosis conversations by website category follow the previous trend of high yields from medical news and discussion sites; a trend which is itself likely the result of the high volume of results yielded from medical news and discussion sites throughout this report, and all relevant results used.
n = 243 There are basically two ways to detect breast cancer. One is when the disease results in symptoms , through one or any change in the characteristics of the breast. In an advanced stage of disease symptoms can be observed as nipple retraction, changes in skin color, itching or scaly lesions in the area. Moreover, it is possible to detect in its early asymptomatic when the lesion is still palpable, or is minimally palpable, and this is done through a mammogram
http://laprimeraplana.com.mx/2011/10/06/cancer-de-mama-%c2%bfque-es-y-como-detectarlo/#post-71985
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Diagnosis conversations by country The graph below lists the top 5 most mentioned diagnostic techniques: All six Latin American countries discussed the following points in relation to diagnosis:
80 70 60 50 40 30 20 10 0
4 10 4 8 10 42 18 2 18 12 Mammogram 4 Self examination 4 4 22 8 2 Biospy 8 2 Ultrasound
Venezuela Mexico Colombia Chile Brazil Argentina
Mammograms, the most frequently suggested technique to diagnose breast cancer Self-examination as a first step towards seeking help, and to confirm a diagnosis if a lump was found; diagnostic tests including MRI scan, biopsy and radiography were also mentioned
Specific country discussions included: Venezuelans had conversations regarding reports that ultrasounds are not an effective diagnostic tool, specifically because they were unable to detect Inflammatory Breast Cancer
3 MRI
Sentiment expressed within diagnosis conversations
n = 167
When sentiment was negative it was often referring to personal experiences of either the patient, family member or friends being diagnosed with advanced breast cancer.
n = 17
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Symptoms Symptom and diagnosis conversations accounted for 9.87% of all data used in this report. Proportion of total symptom mentions, by country As the graph demonstrates, comments in Brazil that related to symptoms were substantially lower than anticipated, while those in Colombia were significantly higher. Apart from there being a low level of discussions relevant in Colombia there was no clear rationale for this. The symptoms of advanced breast cancer may include: Bone painPain or discomfort in the breast skin ulcers, swelling of one arm (next to breast with cancer) and w eight loss. Men can develop breast cancer and symptoms include breast lump and pain and breast tenderness
http://www.videoblogs.com/visor_ youtube.php?in=lista&id=FXTKKP_
Indexed comparison*
n = 116 (symptoms mentions) n = 2,195 (total relevant results)
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Symptoms Symptoms conversations, by website category
Medical news 31.00%
n = 116
Medical discussion 69.00%
Again, the spread of results by website category reflects a division found in all relevant results.
The symptoms of advanced breast cancer may include: Bone Pain Pain or discomfort in the breasts Skin ulcers swelling one arm (next to breast cancer) Weight loss breast self-examination breast. Self-examination is a simple, albeit with a low degree of reliability, to detect breast cancer.
http://tomaateloapecho.blogspot.com/

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Symptoms conversations by country The graph below represents the top five symptom mentions: All six Latin American countries examined herein discussed the following symptoms:
35 1 Venezuela Mexico Colombia Chile 25 Brazil 19 Argentina
30
Bone and breast pain was the most frequently mentioned symptom in relation to advanced or metastatic breast cancer, particularly in Mexico Swelling, itching or color change including the swelling of arms next to affected breasts, redness and the itching of the skin Armpit or breast lumps
Specific country discussions included: No symptoms until disease reaches an advanced stage or that advanced breast cancer has no symptoms. This was discussed in Argentina, Brazil and Mexico Weight loss discussed in Mexico and Colombia Nipple changes retraction, discharge and skin irregularities were discussed in Argentina, Brazil Chile, and Mexico Sentiment expressed within discussions around symptoms
20
15 4 10 3 5 2 0 Bone and breast pain 3 2 1 1 3 1 Change in breast shape, colour 3 2 1 1 1 2 Breast or armpit lump 1 1 3 2 1 1 Swelling - arms, breasts 3 2 1 No symptoms
n = 70
Though low in total volume, in instances where sentiment was expressed in relation to symptoms it was largely negative, particularly due to the aggressive nature of symptoms in ABC or MBC patients. When late stage diagnosis was made, it was often with no symptoms recognized, therefore adding to the negative tone of the discussion.
n = 17
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Support
Proportion of total support mentions, by country
Supportive conversations identified in this research constituted 5.85% of all data, and as the graph opposite demonstrates, when compared to other results in this report, were not entirely dissimilar from anticipated volumes.
Indexed comparison*
n = 213 (support mentions) n = 2,195 (total relevant results) * Numbers lower than 100 indicated the discussion of the topic is less than what would be anticipated; number over 100 mean the discussion of the topic is more than what would be anticipated Discussing advanced or metastatic breast cancer in Latin America 40
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Support
Support conversations, by website category
Social media platform 16.00%
Medical news 23.00%
Medical discussions 61.00%
Notably, a substantial portion of support conversations were generated on social media platform websites, underlining the personal nature of these forums and the one-to-one relationships they can generate, would be conducive to support conversations.
n = 213
Support - related commentary also yielded the largest volume of identified commentators, accounting for 76.76% of 185 found throughout this report.

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Support
The following is a breakdown of commentators by category, found in support discussion results. Commentators identified during supportive conversations
Friend 11.30% Friend, 11% Physician Physician, 1% 0.70%
142 commentators were identified within support discussions.

Patient, 53%
Family, 35%
76 patients were identified (53.00%) 50 family members (35.00%) 15 friends (11.30%) 1 physician (0.70%)
Family 35.00% n = 142
Patient 53.00%
Supportive discussions in all countries included: Personal accounts of the disease, either by the patient or the person affected by breast cancer including: - Diagnosis, disease progression and death Many discussions were negative in nature as they were related to the disease being diagnosed at a late stage Medical discussions sites which shared encouraging conversations, such as: - Fundraising or charitable events - Living and coping with breast cancer - Sharing stories of hope Medical news stories were shared offering support and news of new treatments and ways of coping with cancer - Tributes to Daniela Romo, a public figure in Mexico suffering from advanced breast cancer
Sentiment expressed within support conversations
Sentiment was largely negative as there were many conversations relating to personal experiences of coping with diagnosis, living with the disease and death as a result of the disease.

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Support
Sentiment expressed within support conversations by country strongly positive Strongly positive Positive Balanced Negative Strongly negative
In another test soon after, they found that the cancer had metastasized into several parts in my bones. The diagnosis was that the cancer had developed to the fourth stage and they said they only had one or two years. After my discharge from the hospital, I continued to fight to not be defeated by my illness. At the same time, my husband and I continue to look for medicines and effective treatments for cancer while I was still receiving treatment in hospital.
http://www.cancertratamiento. com/2009/06/viviendo-en-pazcon-el-cancer.html
50 45 40 35 30 25 20 15 10 5 0
n = 110
1 2 3
3 3 6 8 Argentina 11
36
2 9 3 1 Colombia 5 Mexico
6 2 4 Venezuela
3 Brazil Chile
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News or media stories posted online

In total, news stories accounted for 5.28% of all topic data. News stories typically included mentions of pharmaceutical updates, clinical trial reports and governmental news relating to breast cancer. Proportion of total news story mentions, by country The table demonstrates a diversity of results in this section, with three countries (Argentina, Colombia and Mexico) recording higher than anticipated results, and the remaining three countries (Brazil, Chile and Venezuela) recording lower than anticipated results. Mexico, Argentina and Colombia mentions include interest in the US FDA withdrawal of Avastin for the treatment of advanced breast cancer. Spanish researchers have identified a gene, cyclin E, which is responsible for treatment resistance in breast cancer HER2-positive subtype, according to scientists announced. The study, led by Dr. Joseph Baselga of Vall dHebron hospital, Institute of Oncology in Barcelona, in collaboration with Massachusetts General Hospital Cancer Center (MGH-CC) of Boston, could lead to improved treatment can to prevent patients with this subtype of cancer develop resistance to current medical treatment
http://www.rosario3.com/salud/noticias. aspx?idNot=86570
Indexed comparison*
n = 192 (news story mentions) n = 2,195 (total relevant results)
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News or media story

News and media story mentions, by website category
Medical news Medical discussion Social media platform
n = 192
Mentions of breast cancer related news stories were generally confined to medical news and discussion websites.

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News or media story

All Latin American countries discussed: Current treatment options - 20.00% of discussions related to the US FDA withdrawal of the previously approved Avastin in the treatment of advanced breast cancer
Specific country discussions included: 11.00% mentioned clinical trial information on: - Gene therapies in Argentina, Brazil and Mexico - Biomarkers to predict response in Brazil and Mexico Treatments - 4.0% of the discussions related to Pertuzumab and its use in conjunction with Herceptin and docetaxel in Brazil and Mexico - 1.0% related to an oral treatment option for advanced breast cancer or metastatic from GlaxoSmithKline Oncology in Brazil - 1.0% commented on non-generic drugs being made in Chile - 1.0% AstraZeneca launch new drug Fulvestrant in Mexico An early detection campaign was discussed in Chile and Argentina
Avastin is not effective for breast cancer AFP | WASHINGTON | Posted on June 29, 2011 - 4:14 pm 1/1 Avastin is not effective against breast cancer COURTESY A reference group of independent experts convened by the U.S. Food Administration and Drug Administration (FDA) today endorsed the recommendation made months ago to ban the sale of anticancer Avastin.
http://m.eluniversal.com.co/cartagena/vida-sana/avastin-no-es-efectivo-para-el-cancer-de-mama-31645

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Cost
Only 1.07% of the overall results related to conversations around cost. Most of the discussions were categorized under financial news and were linked to stories about the economic and treatment costs of breast cancer. Costing discussions were only identified in Argentina, Brazil, Chile and Mexico . Proportion of total cost mentions, by country Conversations in Colombia and Venezuela did not make reference to cost. Argentina and Brazil were significantly lower than anticipated; while volumes in Mexico were double the expected level. Conversations in Mexico discussed the additional costs to the healthcare system of treating advanced or metastatic breast cancer. Patients with advanced-stage tumors have 80% chance of relapse In Mexico there is an upward trend in breast cancer, and according to the Programme of Action Breast Cancer of the Ministry of Health to sufferers and their families, as well as health services, this type of tumor has a significant impact due to the high emotional cost, social and economic involved in the care
http://journalmex.wordpress.com/2010/05/10/el-cancerde-mama-se-puede-curar-cuando-se-detecta-en-suinicio/
40%
Indexed comparison*
n = 39 (cost mentions) n = 2,195 (total relevant menions)
18/05/2012 12:13
Cost
Mentions of cost, by website category
Financial news Medical discussion Medical news
n = 39
90.90%
In a result that like support bucked the dominant trend of medical news and discussion sites generating the majority of results, conversations around the costs of ABC and MBC stemmed overwhelmingly from financial news websites. Discussions in these four countries included: 83% were related to the financial costs of treatment of advanced breast cancer including: - The financial burden on families - The cost of treatment
Country specific discussions included: Lack of a social security system in Argentina Herceptin was not covered by insurance in Chile due to its expense

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PINK RIBBON CAMPAIGN
5. How does this community talk about the mainstream pink or Pink Ribbon movement?
Pink Ribbon campaign Conversations relating to the Pink Ribbon movement accounted for 0.52% of the overall discussions. Proportion of total Pink Ribbon mentions, by country The table demonstrates a diversity of responses to the Pink Ribbon movement, with three countries (Argentina, Chile and Mexico) recording lower levels than anticipated results, and the remaining three countries (Brazil, Colombia and Venezuela) recording higher than anticipated results. Brazil, Colombia, and Venezuela all discussed awareness campaigns in their countries. Discussions in Colombia referred to the research collaboration between the University of Colombia and Avon Cosmetics.
Indexed comparison*
n = 19 (total Pink Ribbon mentions) n = 2,195 (total relevant results) * Numbers lower than 100 indicated the discussion of the topic is less than what would be anticipated; number over 100 mean the discussion of the topic is more than what would be anticipated Discussing advanced or metastatic breast cancer in Latin America 49
18/05/2012 12:13
PINK RIBBON CAMPAIGN
Pink Ribbon campaign Topics discussed in relation to the Pink Ribbon movement: 37.00% of discussions related to the raising awareness campaign that took place during the month of October. - The Brazilian airline Azuls use of a pink plane in its fleet was only mentioned in Brazil - The pink lighting of the Christ the Redeemer statue in Rio de Janeiro was discussed in Mexico only - Breast cancer research collaborations between Avon (the cosmetics company) and Colombia University
Sentiment was positive in Latin America when discussing the pink branding, however it was only apparent in five discussions.
Pink Ribbon conversations by category
Medical discussion Medical news
n = 19
Pink ribbon pins and other products of consciousness have become very popular in recent years. This is due in part to a growing trend of elements by a cause, proceeds donated often to research foundations or charitable organizations. Pink ribbon pins, pink purses and other items for breast cancer awareness are also popular because of the overwhelming amount of lives affected by the disease.
http://curarelcancerdemama.blogspot.com/2011_06_01_archive.html
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PRIMARY CONCERNS / FRUSTRATIONS
6. What are the primary concerns, frustrations or unmet needs discussed among this community?
Unmet needs 2.47% of topic mentions related to primary concerns, frustrations and unmet need conversations. Proportion of total unmet need mentions, by country
FranmenaG is a shame that the state of Chile denies choice to women with breast cancer just because they have metastasized.
@FranmenaG
This graph illustrates that Chile had a higher level of unmet needs, frustrations or concerns than would be expected. The governments decision to refuse access to Herceptin in Chile for advanced breast cancer patients has caused concern. Mexico also had marginally higher than anticipated levels of conversation about this topic, based on the number of patients presenting early in the disease cycle thus avoiding advanced or metastatic stage disease. Brazil, Colombia and Venezuela had lower levels of anticipated conversations, suggesting they have fewer unmet needs to share, or discuss it in other channels.
Clara_Bella_ This is disgraceful. NO Minsal drug delivery to women with breast cancer that has metastasized. @ Jmanalich
@Clara_Bella_
Indexed comparison*
n = 90 (total unmet need mentions) n = 2,195 (total relevant results)
18/05/2012 12:13
PRIMARY CONCERNS / FRUSTRATIONS
Unmet needs Unmet need conversations by category

Medical discussion Medical news Individual
In a result that near mirrors the outcomes in the support section of this analysis, individual category websites gained prominence among unmet needs mentions. Like conversations regarding support, this is possibly due to the personal nature of these forums and the one-to-one relationships they can generate.
n = 90
Discussions in the five countries that generated results included: Conversations that related to the psychological impact of breast cancer, which constituted 26.0% of the total unmet needs mentions, included discussion of: Losing the womanly feeling after a mastectomy Depression Fear of the unknown
Country specific discussions included: Commentary regarding the Chilean governments decision not to subsidise use of Herceptin, which constituted 24% of unmet need comments Brazil and Mexico jointly generated 19.0% of unmet need results, in discussions relating to raising awareness for early diagnosis Similarly, Brazil and Mexico generated a further 5% of unmet need topic results via discussion of women failing to seek healthcare advice due to embarrassment.
Sentiment expressed within unmet needs in conversations
Overall sentiment around unmet need discussions was negative, largely due to the psychological impact of the disease, and the Chilean governments decision regarding Herceptin.
n = 30

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7. What brand treatment conversations are occurring and what is the share of voice for current competitors?
This drug, known as T-DM1, combines the monoclonal antibody trastuzumab, marketed by the company as Herceptin, and DM antimicrotubule chemotherapeutic agent, has been shown to be as effective as the standard treatment with trastuzumab and chemotherapy but with fewer side effects. ...
http://pharma-jonpi.blogspot.com/2010/10/19octubre-dia-mundial-cancer-de-mama.html
BRAND TREATMENT CONVERSATIONS
The relevant search results used in this analysis contained 419 conversations mentioning at least one product, and a total of 502 mentions of drugs throughout. The table below is list of all brand mentions captured in this analysis:
Trade name Herceptin Avastin Nolvadex Tykerb Xeloda Halaven Taxotere Abraxane Aromasin Arimidex Aspirin Omnitarg Faslodex Femara Ixempra Afinitor Taxoterer Gemzar Premarin Taxol Navelbine Nexavar Prolia Zometa Doxil Paraplatin
n = 502
Volume 121 91 44 33 22 21 15 13 13 12 12 11 9 9 8 8 7 7 4 4 4 3 3 3 3 2 2
% of discussion 24.10% 18.13% 8.76% 6.57% 4.38% 4.18% 2.99% 2.59% 2.59% 2.39% 2.39% 2.19% 1.79% 1.79% 1.59% 1.59% 1.39% 1.39% 0.80% 0.80% 0.80% 0.60% 0.60% 0.60% 0.60% 0.40% 0.40%
Generic name Trastuzumab Bevacizumab Tamoxifen Lapatinib Capecitabine Eribulin Docetaxel Paclitaxel Exemestane Anastrozole Acetylsalicylic acid Pertuzamab Fulverstrant Letrozole Ixabepilone Anthracycline Everolimus Docetaxel Gemcitabine Conjugated estrogens Paclitaxel Vinorelbine Sorafenib Denosumab Zoledronic Acid (Zometa) Doxorubicin carboplatin
Pharmaceutical company Genentech/Roche Genentech/Roche AstraZeneca GSK Genentech/Roche Eisai Sanofi Celgene
Pfizer
AstraZeneca Bayer Genentech/Roche AstraZeneca Novartis
Bristol-Myers
Novartis Sanofi Eli Lily
Pfizer
Bristol-Myers Pierre Fabre Bayer Amgen Novartis Doxil patent Bristol-Myers
Table continued overleaf
Please note that cells left blank in the table indicate involvement in clinical trials.
18/05/2012 12:13
BRAND TREATMENT CONVERSATIONS
What brand treatment conversations are occurring?
Trade name Sutent Diamox Erubitux Gleevec Glucophage Lupron Neupoge Neuvenge Novantrone Tomtovok Xalkori Aredia
Volume 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
% of discussion 0.40% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20%
Generic name Sunitinib Acetazolamide Cetuximab Imatinib Metformin Leuprorelin Filgrastim Mitoxantrone Afatinib Crizotinib Pamidronic acid Docetaxel trihydrate Docetere CimaVax-EGF Antimicrotubule Aromatase inhibitor Flutamide
Pharmaceutical company Pfizer Barr Pharmaceuticals ImClone Novartis Bristol-Myers Abbott Amgen Dendreon Serono Boehringer Ingleheim Pfizer Novartis
Eulexin
Schering-Plough
n = 502
The table below specifically focuses on the breast cancer only products:
n = 240
Trade name Herceptin Tykerb Halaven Aromasin Abraxane Arimidex Omnitarg Femara Afinitor
Volume 121 33 21 13 13 12 11 9 7
% of Generic discussion name 50.42% Trastuzumab 13.75% Lapatinib 8.75% Eribulin 5.42% Exemestane 5.42% Paclitaxel 5.00% Anastrozole 4.58% Pertuzamab 3.75% Letrozole 2.92% Everolimus
Pharmaceutical company Genentech/Roche GSK Eisai

Pfizer
Celgene AstraZeneca Genentech/Roche Novartis Novartis
Please note that cells left blank in the table indicate involvement in clinical trials.
18/05/2012 12:13
WHO IS PARTICIPATING IN CONVERSATIONS
8. Who is participating in conversations about treatment?

Treatment discussions constituted 13.19% of the total topic mentions, and as the graph below highlights, most generated an anticipated volume of results when compared to their share of total relevant results used in this analysis. Proportion of total treatment mentions, by country
Blocking Snail-G9a-DNMT binding may pave way for novel therapeutic approaches targeting metastatic breast cancer http://bit.ly/yGuxjD
@bkmacy
Argentina and Venezuela both had a slightly lower level share of discussions on treatments than expected for no clear reason as both countries mentioned the top ten identified overall. Chile and Colombia presented slightly higher than average conversation volumes. Colombia frequently mentioned combination therapies including Trastuzumab, Bevacizumab and Xeloda. Chile mentions include higher levels of discussions on chemotherapy.
Indexed comparison*
n = 480 (total treatment mentions) n = 2,195 (total relevant results) * Numbers lower than 100 indicated the discussion of the topic is less than what would be anticipated; number over 100 mean the discussion of the topic is more than what would be anticipated Discussing advanced or metastatic breast cancer in Latin America 55
18/05/2012 12:13
WHO IS PARTICIPATING IN CONVERSATIONS
Treatment Mentions of treatment discussions, by website category

Social media platform 1.00% Medical news 49.00% Medical discussion 50.00%
Following the trend seen earlier in this report, nearly all treatment results were generated by medical news or discussion websites. The top ten discussion topics accounted for 65% of treatment results. The chart below represents these conversations:
n = 480
120
Top ten treatment mentions in all countries

118
100
80
74
60
40
32 26 19 15 12 12 11 9
20
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sy
er
ap
ap
ap
an
ap
as
rg
er
op
er
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iju
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se
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th
ar
th
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Discussions included: Treatment with chemotherapy, surgery, radiotherapy and combination therapies were most discussed in all countries. These accounted for 59% share of the discussions.
Sentiment expressed in discussions on treatment
When discussing treatment, 77.0% of commentary that expressed sentiment was negative; this largely stemmed from the fact that late stage disease treatment options are often seen as ineffective, or because in some Latin America countries desirable options are not available, such as Herceptin in Chile.
46.81%
n = 47

St a
n = 313
gi ng
om
of
Pa llia
ad
at iv
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he
th
tiv
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56
18/05/2012 12:13
LEADING INFLUENCERS
9. Who are the leading influencers among those discussing ABC and MBC?
For the purposes of this analysis influencers were categorized as healthcare professionals and organizations or notable public figures linked to the field of ABC/MBC who were regularly mentioned through conversations. However, over the extended period of time of the search, and due to the consequence of the severity of the disease, not all nominees were still surviving. In order to maximize Client opportunities with influencers (influential drivers and topics of social media conversations), they have been separated into three distinct categories: Twitter influencer - Based on an influencers volume of tweets or number of mentions during the search period Healthcare and professional organization influencer - These are physicians or medical centers who were mentioned frequently during the search period Medical discussion (blogger and forum) influencer - These sites were hosting conversations related to ABC/MBC and were deemed to be a credible and reliable source
Influencers in Latin America will need to be regularly evaluated over time to ensure a robust list can be developed due to the fact this is the early stage of social media activity.
Elizabeth Edwards, wife of former senator and twotime presidential hopeful U.S. John Edwards, died Tuesday at age 61, from cancer that shed been fighting against for years, U.S. media reported.
http://www.cooperativa.cl/fallecio-esposadel-ex-candidato-presidencial-de-ee-uu-john-edwards/prontus_nots/2010-1207/210926.html
The psycho-oncologist at the Institute Oncoguia, Luciana Holtz, estimates that in Brazil there is still a long way to go before women have increased access to early diagnosis. She said every year more than 50,000 new cases of breast cancer are diagnosed, half in an advanced stage.
http://ne10.uol.com.br/canal/cotidiano/ saude/noticia/2012/02/04/metade-doscasos-de-cancer-de-mama-diagnosticadospor-ano-esta-em-estagio-avancado-dizmedica-325056.php

57
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LEADING INFLUENCERS
Top influencers The following table lists the top ten influencers based on the categories and measures outlined above. However, this list is likely to change over time because the social media uptake is so low and fragmented. We have identified some emerging influencers in the table overleaf.
1
Influencer: Elizabeth Edwards
Location: United States
Volume of mentions: 10 Description: Wife of former Democratic Vice-Presidential candidate John Edwards who died from metastatic breast cancer. Although now deceased she was a big influencer during the time period of this report.
Influencer: Luciana Holtz

Location: Brazil
Volume of mentions: 6 Description: President of the Institute Oncoguia and manager of the Global Initiative Komen Brazil. Psycho-oncologist and social entrepreneur. She has made 1,912 Tweets, has 663 followers and is following 749 accounts. Volume of mentions: 6 Description: The National Cancer Institute (INCA) is a technical branch of the Federal Government, under the direct administration of the Ministry of Health. It plays multiple roles in all areas of cancer prevention and control in Brazil - prevention, epidemiological surveillance, treatment, information, education and research. Volume of mentions: 6 Description: Professor Eduardo Cortes is a leading oncologist at the Faculty of Medicine, Federal University of Rio de Janeiro UFRJ.
Influencer: National Cancer Institute (INCA)

Location: Brazil
Influencer: Professor Eduardo Cortes

Location: Brazil
Influencer: Institute Oncoguia

Location: Brazil
Volume of mentions: 6 Description: Organisation providing information about a range of cancer types, their treatments and methods of prevention. Also provides support and advice to cancer patients.
Influencer: Federal University of Rio de Janeiro UFRJ

Location: Brazil
Volume of mentions: 6 Description: Center for Research on Cancer (NPC) at the University Hospital Clementino Fraga Filho, part of the Federal University of Rio de Janeiro UFRJ
Influencer: Brazilian Society of Mastology

Location: Brazil
Volume of mentions: 5 Description: Brazilian Society of Mastology is an entity affiliated with the Brazilian Medical Association and the International Society Senologic Society and brings together about 1800 members, of which 1038 are Mastology experts. Volume of mentions: 4 Description: Professor, Faculty of Medicine of Ribeirao Preto, Sao Paulo University, member of the Brazilian Society of Mastology and active member of the American Association for Cancer Research.
Influencer: Daniel Guimares Tiezzi

Location: Brazil
Influencer: The Syrian Lebanese Hospital in Sao Paulo

Location: Brazil
Volume of mentions: 3 Description: The Hospital Srio-Libans (Syrian-Lebanese Hospital) is one of the leading hospitals in Brazil and South America. It is highly regarded for both its quality of care and treatment as well as its medical research. Volume of mentions: 3 Description: The American Cancer Society (ACS) is a United States based voluntary health organization dedicated to eliminating cancer. It operates solely in the US and Puerto Rico and its activities include providing grants to researchers, running public health advertising campaigns, and organizing projects.
10
Influencer: American Cancer Society

Location: United States

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LEADING INFLUENCERS
Top influencers In an environment where social media is just beginning to be a factor in healthcare decisionmaking, below is a list of potential influencers which may provide extensive information and opportunity for dialog. However, they are not yet robust influencers.
Website:
www.grupomamacancer. wordpress.com/ Description: Brazilian blog on health news with lots of cancer related posts, readers can leave comments reports a lot of international news on study results, drug approvals, etc.
Website:
www.ayudacancer.wordpress.com/ ensayos-clinicos/ Description: cancer therapies and treatment blog, people can and have left lots of comments and questions.
Website: www.isade.net Description: a Brazilian news portal with broad health/science focus and definitely including cancer, readers can actually make a comment or engage on individual articles.
Website: www.lasalud.mx Description: Mexican comprehensive health focused news site, option to comment at the end of each piece.
Website: www.journalmex.wordpress.com/ Description: while this is a news site for Mexico, there is a lot of health news.

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Section 4
Client campaigns and additional keyword searches
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CAMPAIGNS AND KEY WORD SEARCHES
Client campaigns and additional keyword searches

During the search period for this analysis, conversations discussing any breast cancer campaigns specific to the client were not identified. In determining this outcome, the relevant results used throughout this report were examined for mentions of the following websites, none of which were found: Campaigns and Programs Tumourescape.com Afinitor.com Targetmtor.com Compasssupportprogram.com
It is suggested that if mentions and analysis of the client campaigns is being sought, a campaign dedicated to the collection of data around that topic should be considered. Additional keyword searches Please note the additional keywords that were examined are denoted by bullet points. Estrogen receptor positive
This term was referred to infrequently, and HER2 was the more commonly used term for this type of breast cancer. HER2 - / HER2- negative HER2+ / HER2- positive
The HER2 gene term both positive and negative was mentioned 130 times. HER2 references were made in discussions about: 1. The Cleopatra trial 2. A Study of Trastuzumab Emtansine in Patients with HER2-Positive Metastatic Breast Cancer 3. The EMILIA study with Trastuzumab and Trastuzumab MCC-DM1 4. Treatment discussions i.e. with Herceptin

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Client Campaigns and additional key word searches Total mentions of HER2 among relevant results BOLERO-1 BOLERO-2 BOLERO-3
120 100 80 60 40 20 0
BOLERO-2 was mentioned five times in connection to its clinical trial. It was mentioned once in Argentina, Brazil, Venezuela but twice in Mexico. Mentions of BOLERO-1 and BOLERO-3 were not found.
HER2 - / HER2- negative
HER2+ / HER2- positive
n = 130
Competitor drugs and drugs in development Trastuzumab Discussions around Trastuzumab accounted for 24.1% of all brand mentions and 50.4% of the breast cancer only mentions; this was principally due to favorable reports emanating from clinical trials. When trastuzumab was discussed it was typically in a positive context. Sentiment towards Trastuzumab Mentions of Trastuzumad by country
n = 58
n = 58
Trastuzumab was discussed in all the countries.

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Client Campaigns and additional key word searches
Afinitor (everolimus) Afinitor was mentioned in Brazil, Mexico and Venezuela, and constituted 1.40% of drug mentions, where commentators shared details of the drugs involvement in a favorable clinical trial. pertuzumab
n = 11
Mentions of pertuzumab were identified in less than 2.2% of overall drug discussions and 4.6% of breast cancer specific drug mentions; and when mentioned they were typically linked with the clinical trials of Trastuzumab and Docetaxel, the results of which look promising. This drug was discussed in Argentina, Brazil and Mexico. Faslodex (Fulverstrant) Mentions of Faslodex by country
n=9
Faslodex was mentioned 9 times in the research, with no expressions of sentiment. Details of it being a new injectable hormonal therapy for the treatment of advanced breast cancer were shared.
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Client Campaigns and additional key word searches
Xeloda (Capecitabine) Xeloda was the focus of 4.3% of all drug mentions. It was discussed in all countries, most commonly in Brazil with 66% of discussion. Conversations shared information regarding its use in combination therapies and its US FDA approval. While negative comments were related to its side effect profile. Mentions of Xeloda by country
n = 22
Sentiment in Xeloda mentions

11% 33% 56% Strongly negative Negative Balanced Positive Strongly positive
n = 22
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Section 5
Breast cancer as a comparison to advanced or metastatic search results
18/05/2012 12:13
BREAST CANCER RESEARCH
Breast cancer compared to advanced and metastatic research

In parallel to the search used for this analysis, a concurrent search was run to quantify the volume of results in which breast cancer, in general, was mentioned. To decrease the likelihood of statistical anomalies, the parallel search was conducted over a three-year period for all countries; and to ensure a comparison of like - for - like the chart below compares results for the search terms used for this analysis (which are listed in the appendix) over the same three-year period. Therefore, the total number of relevant results in the table below will differ to the total number used in this analysis. The three-year period was March 1st 2009 to March 31st 2012 inclusive. The table also lists the total results (including both relevant and irrelevant) for both searches, again ensuring a like-for-like comparison. The general breast cancer search returned 45,178 results compared to the 4,384 advanced or metastatic breast cancer results from the same period, at a ratio of 10.31:1. Using the same relevant to irrelevant results ratio found in ABC and MBC results (1:2.24), we would have expected to yield approximately 20,169 relevant results from the 45,178 breast cancer results. It should be noted that the sum of these predicted yields do not add up to 20,169 in the table due to a recognized statistical methodological anomaly that exists within the equation method.
Total breast cancer search results
Total aBC and mBC search results
Total relevant (to this analysis) aBC and mBC results 269 804 162 60 519 141
Ratio of relevant to total aBC and mBC results
Predicted yield from total breast cancer results, based on aBC/mBC ratio 1061 5183 649 314 7437 6155
Argentina Brazil Chile Colombia Mexico Venezuela
2,469 12,119 1,306 655 16,450 12,179
626 1880 326 125 1148 279
2.33 2.34 2.01 2.08 2.21 1.98
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Section 6
Conclusions
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CONCLUSIONS
Conclusions
The following conclusions and actions are comprised in accordance with generic marketing and communications objectives; no definitive assumptions about the use of this analysis in a future communications campaign are made. Conclusions and recommendations 1. The use of social networking sites and microblogs, such as Twitter and Facebook, have had a slower uptake in Latin America when compared to the US. A parallel study examining ABC and MBC discussion in the US yielded a high volume of results from social networking and microblogging websites, with Twitter accounting for 55.00% of all results used in that study. However a recent study reported that traffic on social media websites in one of the countries in this study, Brazil, has increased markedly in the period of December 2010 to January 2011, with Facebook use growing by 192.00% and Twitter by 40.00%. With this increased update of social media activity in Latin America, there will be changes to the influencers identified in this research. A more robust, credible influencer list will be established in the future. 2. There is some resistance among patients to present to physicians with female healthcare issues in Latin American countries, which increases the likelihood of presentation at late stage disease. However the prominence of education, risk factors and prevention and clinical trial conversations within this research demonstrates the desire of people who are interested in advanced or metastatic breast cancer to gain information on it, or to seek assistance in relation to it. The absence of a prominent online healthcare information source in the analyzed markets, and the spread of online resources found in this report, suggests that the creation of the client sponsored healthcare focused website that serves as, amongst other things, a source of discussion and information may be welcomed. Such a website may help overcome the resistance of some women in Latin America to consult their physician on female healthcare issues; by removing any fears they hold regarding oneon-one consultations, through an anonymous, informative medium.

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CONCLUSIONS
Conclusions
3. There was a distinct lack of conversation and opinion generated by individuals employed in a medically related profession, or who are involved in the healthcare industry, which raises a question of credibility in relation to the information that is being shared online. The lack of involvement of medical or healthcare professionals in the discussion also suggests that if such influential voices were to be involved in the client sponsored medical information or community website, it would generate a level of credibility around such a site, whilst providing a service to the online community that appears to be currently unfulfilled. 4. This research has indicated that there is a lack of online discussion of any of the client targeted breast cancer awareness campaigns, though this could be a reflection of how people discuss campaigns online rather than a reflection of the success of the campaign. Client campaigns appeared to have little impact on breast cancer community in Latin America, with no mentions specific to these found in any of the social media discussions. In order to further understand the impact of these campaigns it may be useful to conduct an independent social media analysis focusing specifically on the campaigns.

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APPENDIX
Appendix
Search Terms Advanced Breast Cancer Metastatic Breast Cancer Stage IV (four) Cancer Late Stage Breast Cancer Locally advanced breast cancer
A complete list of websites is available upon request.

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METHODOLOGY
Methodology
Trufflenet combined powerful automated search with intelligent human analysis in order to produce the data contained in this report. By listening to, rather than directing respondents, we are able to produce a far more natural picture of what people are really thinking and saying. By capturing tone of voice directly from our audience, we help our clients to ensure their messaging is as consistent as possible with the voices and emotions of their audience, making their communications more authentic and hence more powerful and effective. Step one: Powerful automated search A series of spiders were deployed to search the web and identify the occurrence of key words and phrases. When the spiders identified a search result, Trufflenets system provided a time and date stamp to the search result and captured the headline of the article, post, video or forum thread. The spiders also captured the hyperlink to the source for future reference. Step two: Intelligent human analysis Analysts use an iterative approach in order to extract sentiment, topics and additional demographic information. An analyst reviews the search results each day for each search term in order to aggregate the data. This data analysis is then reviewed by a senior analyst to ensure that each category, theme or meaning is identified and the process iterated until every search result has been scrutinized. Step three: Developing insights Trufflenet and the client developed insights from the data, which then form the basis of a projects conclusions and recommendations. Step four: Conclusions and recommendations Conclusions and recommendations are mapped out during the final stage of work. A collaborative brainstorm identifies best practice and opportunities from other sectors that can be utilized to address the challenges identified in the research. Step five: Peer review Before the production of the final analysis the work is peer reviewed by a member of the team who did not play a part in the research. It is assessed to ensure that it meets the standards of quality, clarity and authority that are essential to all analytical work.

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GLOSSARY
Glossary
Support Supportive discussions included personal accounts from patients, family and friends on the disease and its impact. It included tributes to well-known public figures and information of fund raising activities. Treatment Treatment discussions included all conversations relating the treatment options for advanced or metastatic breast cancer such as chemotherapy, surgery, radiotherapy and therapeutic options etc. Clinical trial Clinical trial conversations were mentions of specific clinical trials related to advanced or metastatic breast cancer. Influencer Discussions which featured healthcare professionals, organizations or public figures who were mentioned in ABC/MBC conversations. Drug mention Conversations which featured mentions of drugs and more specifically those which treated only breast cancer. Education Education discussions featured raising awareness campaigns and sharing disease facts. News story / media Conversations which related to news and media stories which related to advanced or metastatic breast cancer, for instance, discussions around the withdrawal of the previously approved Avastin, gene therapy or news of biomarkers predicting response to treatment. Financial Conversations related to pricing and cost mentions for breast cancer, typically making reference to the financial burden on families and healthcare systems. Within this category discussions included investment or general news stories. Risk factors and prevention Discussions were separated between risk factors and prevention. Each was detailed separately in the report. Both included mentions of specific risk factors or prevention strategies. Diagnosis and symptoms Discussions were separated between diagnosis and symptoms. Each was detailed separately in the report. Both included mentions of specific diagnosis and symptoms. Pink Ribbon Discussions related to the Pink Ribbon campaign associated with breast cancer. Primary concerns, frustrations and unmet needs These included reference to quality of life issues and the psychological impact of ABC/MBC.

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Discussing advanced or metastatic breast cancer in Latin America

REVISED latin america breast cancer report in progress.indd 1

Appendix Methodologies Glossary

Discussing advanced or metastatic breast cancer in Latin America

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Discussing advanced or metastatic breast cancer in Latin America

Overall volume of results

Discussing advanced or metastatic breast cancer in Latin America

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Country Argentina Brazil Chile Colombia Mexico Venezuela

No. of relevant results 310 880 201 67 575 162

% of total relevant results 14.12% 40.09% 9.16% 3.05% 26.20% 7.38%

Total population of country *

42,192,494 205,716,890 17,067,369 45,239,079 114,975,406 28,047,938

% of combined total populations

9.31% 45.39% 3.77% 9.98% 25.37% 6.19%

Discussing advanced or metastatic breast cancer in Latin America

Discussing advanced or metastatic breast cancer in Latin America

Discussing advanced or metastatic breast cancer in Latin America

Discussing advanced or metastatic breast cancer in Latin America

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Discussing advanced or metastatic breast cancer in Latin America

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Total relevant results:

Number of websites that yielded relevant results:

Discussing advanced or metastatic breast cancer in Latin America

Individual Social media platform

Volume of websites that yielded results by category

Discussing advanced or metastatic breast cancer in Latin America

SocialIndividual Media Platform

Contact: Country: Description:

Top ten websites by volume of results, per category

Name: Website: Volume: Contact: Country:

LaSalud www.lasalud.com.mx 15 (5) N/A Mexico

Name: Website: Volume: Contact: Country:

Yahoo Respuestas es.answers.yahoo.com 12 (9) N/A Global

REVISED latin america breast cancer report in progress.indd 18

3. How are patients, caregivers and physicians interacting online?

Financial news Individual Medical News

ent Family 0 10 Patient 20

Discussing advanced or metastatic breast cancer in Latin America

FREQUENTLY DISCUSSED TOPICS

4. What are the topics that are being discussed?

Total volume of individual topic mentions:

Topics of conversation identified:

Discussing advanced or metastatic breast cancer in Latin America

REVISED latin america breast cancer report in progress.indd 20

FREQUENTLY DISCUSSED TOPICS

In-depth findings on each topic of discussion

Discussing advanced or metastatic breast cancer in Latin America

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FREQUENTLY DISCUSSED TOPICS

In-depth findings on each topic of discussion

40% 35% 30% 25% 20% 15% 10% 5% 0%

12% 8% 3% 1% Mexico 146.15 2% Venezuela 25.00

n = 572 (education mentions) n = 2,195 (total relevant results)

% of total relevant results

% of total education mentions

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FREQUENTLY DISCUSSED TOPICS

In-depth findings on each topic of discussion

Medical discussion Medical news Social media platform