Liz Szabo, USA TODAY
Twitter, perhaps best known lately as a source of Big Bird jokes, might not seem like the first place to look for a breast cancer support group, a boot camp in medical research or the seeds of a social movement.
Yet a weekly Twitter chat on breast cancer, launched just over year ago, has blossomed into all those things and more, participants say.
The online chat, known as BCSM -- or breast cancer social media -- has a growing following of men and women looking to share war stories, empower patients and change the national conversation on breast cancer.
Folks who join the chats "are amazing. And they tell each other so," says co-founder and breast cancer survivor Jody Schoger, 58, of The Woodlands, Texas. "They find the best in each other and celebrate that quality."
Robert Miller, a medical oncologist at the Johns Hopkins Kimmel Cancer Center In Baltimore, is a frequent guest expert on BCSM. Miller says he understands how those unfamiliar with Twitter might be "skeptical that exchanging 140-character messages with a group of strangers for an hour every Monday night would be an effective tool. But it really is."
Psychologist Ann Becker-Schutte, a frequent guest expert on BCSM, says the support group take its positive tone from its leaders.
Schoger and her fellow organizers -- who became friends online months before ever meeting face to face -- each bring unique talents, says Becker-Schutte, who specializes in helping people with serious diseases.
Schoger is a writer with a background in public relations. Co-founder Alicia Staley, 41, is a three-time cancer survivor from Boston, as well as an information technology analyst and online community manager. The third member of the team, California breast surgeon Deanna Attai, joined BCSM during its second chat and quickly became a co-moderator.
A well of support
Each moderator works hard to keep conversations on track and avoid the pitfalls of traditional support groups, Becker-Schutte says. While other support groups may allow people to vent their frustration, she says, BCSM provides a way for people to transform those frustrations into action.
In most support groups, "one or two patients sort of take over, and it turns into a bitch session," Attai says. "That's not what you see with #BCSM. ... We have a common goal -- that's to educate, empower and support, and all that participate seem to embrace that."
Schoger says she's been pleased to see how BCSM helps women -- and the occasional man -- think through complex issues and become leaders.
"So many of these women are writing stronger blog pieces and are taking up the mantle in different breast cancer organizations," Schoger says. "I just love watching it."
Staley says the group's success has surprised her. There's no formal promotion. Instead, early participants often stumbled across the chats after searching for keywords -- known on Twitter as hashtags -- such as cancer.
"This is something incredible that has grown out of a hashtag," Staley says.
The virtual community has spent more than 600 hours in conversation since their first chat. Schoger alone devotes about 15 hours a week to BCSM, and another 10 more to her blog, Women With Cancer.
The key to forming a close-knit community, Schoger says, is listening. She notes that many organizations and companies use social media such as Twitter as a one-way broadcasting system to put out a message of the day. The most successful people in social media foster real conversations, she says.
Becker-Schutte notes that the women's fellowship doesn't end with their hour-long chats. BCSM leaders monitor the group's ongoing conversations. "If someone is having a hard time, it isn't long before someone responds." Becker-Schutte says.
Conversations such as BCSM fill a huge void, Attai says. She began chatting with breast cancer patients after noticing a 1 a.m. conversation between two women about Paget's disease of the breast, a rare form of cancer that Attai has treated.
"Patients just aren't getting the information they need," Attai says. "Two women shouldn't have to go online in the middle of the night."
And although individual tweets are brief, the group delves into deep subjects. BCSM has tackled issues such as parenting and maintaining a career through breast cancer treatment; emotions such as anger, anxiety about recurrence and survivor's guilt; and post-treatment complications such as "chemo brain" and lymphedema, which causes arm swelling.
Staley, who developed breast cancer twice after receiving radiation for Hodgkin lymphoma, says many patients feel alone. She divides her cancer experience into three phases: diagnosis, treatment and "after."
"The diagnosis comes at you fast and furious," says Staley, who blogs at awesomecancersurvivor.com. "You make your decision for treatment. You get to the end of the treatment plan, and you get a pat on the back and off you go into the world. I've been through this three times, and the 'after' part is the hardest. You are pushed back into the real world and you have to redevelop your framework for connecting. That's what this community has done, to prop me up post-treatment, to get me back into the real world."
The Internet is teeming with online support groups, of course, including dozens just for breast cancer, Schoger says. Hundreds of cancer survivors across the USA now blog about their experiences.
Online communities can be especially powerful for those with rare diseases, who often may not be able to find other people with their condition in their communities, says Terry Lynn Arnold, of Friendswood, Texas.
Arnold, who has a rare type of breast cancer called inflammatory breast cancer, says she has formed close bonds on Facebook with women she would likely never have met in person.
Doing their homework
BCSM stands out from most other support groups, however, because of its rigorous focus on medical evidence, Attai says.
Given that myths and misinformation can spread like wildfire online, Attai says it's crucial for BCSM to provide accurate information that's supported by strong science. The group regularly dissects the latest research and routinely recruits experts. Some of the more science-heavy topics have included clinical trials, hereditary breast cancers and how to avoid "voodoo medicine."
In addition to Miller and Becker-Schutte, guest experts have included Matthew Katz, director of radiation oncology at Lowell General Hospital in Massachusetts; Julie Gralow, director of breast medical oncology at the Seattle Cancer Care Alliance; and St. Louis breast surgeon Diane Radford.
Although the group has plenty of compassion for people with cancer, members have little patience for hecklers, self-promoters or spammers, Staley says.
"There are plenty of angry communities on Twitter, but we're not one of them," Attai says. "If someone wants to pick a fight, they will quickly learn that's not what we are about. If someone wants to come and promote broccoli extract (as a cure for cancer), we will call them out on that, and they will go elsewhere."
Connecting across platforms
Attai and other doctors say the chats have given them a better sense of what patients are going through, and "how much my patients were holding back from me."
And while the community may be virtual, the emotions expressed are palpable, especially when participants are in crisis, or grieving the loss of a loved one, Schoger says.
Last February, BCSM lost two of its members in one day. Organizers scrapped their planned chat and devoted the entire hour to remembering the two women. "We had what can only be called a virtual wake," Schoger says.
And while BCSM isn't political, the community has developed a strong voice on key issues in breast cancer. The group regularly criticizes "pinkwashing," or the commercialization of breast cancer, which is invoked throughout October to sell products. Breast cancer bloggers are taking up the issue, as well, so much that "pink-ribbon fatigue" is becoming a common phrase.
Members of BCSM are also "fearless friends" to women with metastatic disease, which has spread to other organs and is incurable. Such women often feel unwelcome and abandoned by other breast cancer groups, Attai says.
"It seems like the community as a whole have turned their backs on men and women with metastatic breast cancer," Attai says. "If you don't fit into this narrow window with pink, 'happy' cancer, then the community has no place for you."
Partly due to efforts like BCSM's, women with metastatic disease say their concerns are far more visible this year than just a year ago.
BCSM's founders say they would love to help other patients start or expand similar communities. Patients with very aggressive kinds of cancer, such as ovarian or brain tumors, often aren't healthy enough to form the sorts of advocacy groups that exist in breast cancer, Staley says. Often, these patients go immediately into aggressive treatments, which can make it difficult for them to organize support groups.
There are more than 2 million breast cancer survivors alive today, however, and many of them are relatively young and tech-savvy, she says.
Creating more communities like BCSM, however, would require finding moderators who are equally compassionate, dedicated and informed, Becker-Schutte says.
"They're pretty amazing," Becker-Schutte says. "They are doing for the community what they wish had been available for them in their initial diagnosis and treatment."
Coming up on Twitter
Join the discussion about breast cancer screenings #abcDrBchat at 1 p.m. Oct. 30.