Just an idea

Competition Finalist

This entry has been selected as a finalist in the
Designing for Better Health competition.

To remind millions of women to complete their monthly breast self-examination, put a symbol in birth control pill packages on the optimal exam day.

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United States

Your idea

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Disease Prevention

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Name Your Project

Just an idea

Describe Your Idea

To remind millions of women to complete their monthly breast self-examination, put a symbol in birth control pill packages on the optimal exam day.


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What is your signature innovation, your new idea, in one sentence?

To remind millions of women to complete their monthly breast self-examination, put a symbol in birth control pill packages on the optimal exam day.

Describe what makes your idea unique--different from all others in the field.

It is an extremely low cost innovation, with the potential to catch cancers in their earliest stages, when breast cancer is most treatable.

Do you have any existing partnerships, and if so, how did you create them?


In which sector do these partners work? (Check all that apply)

Citizen sector (non profits, NGOs) .


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Provide one sentence describing your impact/intended impact.

This idea raises awareness of breast self-exam among women of all ages, particularly younger women, and catches more cancers in their earliest stages.

Please list any other measures of the impact of your innovation.

Catching cancers in their earliest stages could save lives. Cancer statistics show that early-onset breast cancer is more aggressive, so early detection is key to curing these women.

Is there a policy intervention element to your innovation?

No, but I note that the U.S.'s National Institute of Health has funded research to determine if breast cancer incidence is higher among birth control pill users. A study published in 2002 by the NIH revealed no link between breast cancer and birth control pills. In no way should this idea be interpreted as a warning--i.e. "Birth control pills may cause cancer, so check yourself for cancer." Rather, the risk is the same for all women, so let's remind the millions who use the pill about self exam.

How many people does your innovation serve or plan to serve? Exactly who will benefit from your innovation?

Women of childbearing age who use birth control pills to prevent pregnancy, treat ovarian cysts, or regulate their cycles. Millions of women around the world use these pills every month; in fact, birth control pills are the most popular method of family planning in most of the developed world. Indirectly, these women's families will be served, by helping their mothers and sisters remain healthy and live longer, more productive lives.

What is the key decision that you are trying to influence through your innovation/design?

I want to convince pharmaceutical firms to add this "nudge" about breast self exam to BCP packages. This might be difficult; the myth that The Pill contributes to breast cancer risk is pervasive, and pharmaceutical firms do not want to scare patients. But I feel this nudge could instead be promoted as demonstrating the firms' corporate social responsibility and care for the overall health and well-being of pill users. Women lead hectic lives; reminders like this can save lives.

What have you learned about how people respond to your innovation/design?

This innovation has never been tested. Though some research has shown that BSE doesn't necessarily save lives, other research demonstrates that women just do not regularly conduct BSE, because they forget. If we can remind millions more women to conduct BSE, using the birth control pill packages they see every single day, perhaps we can catch more cancers.

This Entry is about (Issues)


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How is your initiative financed (or how do you expect your initiative will be financed)?

Drug manufacturers would need to make a small, cosmetic change to the packaging of their birth control pills. These firms would also need to make changes to their package inserts, explaining the symbol and its meaning, and also explaining that research has not shown that BCP use causes cancer. It would also be advisable for these firms to print pamphlets to distribute to OB/GYN offices and their staffs. The costs would be nominal, but the results could be lives saved.

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What are the main financial barriers, and how do you plan to address them?

The barriers to the acceptance of this idea are not financial. The American Cancer Society has dropped its recommendation of BSE, because women just don't remember to do it, and research has failed to show a direct link between BSE and saving lives. Anecdotal evidence abounds, however, and it seems kind of like a chicken/egg problem: if BSE isn't done enough, it won't save lives, but if we can't prove that BSE saves lives, why promote it?

Aside from financial sustainability, how do you plan to grow and scale the initiative?

I would hope that, once one pharmaceutical firm elected to make this small change to the packaging of their birth control pills, all other firms would follow suit. Most women are well aware of breast cancer; we have friends, mothers, aunts, sisters, grandmothers who've suffered from or died from this disease. A simple reminder about BSE, in a package that millions of women look at every single day, could help prevent some of those cancers from being killers.

The Story

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What was the motivation or defining moment that led to the creation of this innovation? Tell the story.

I have always had trouble remembering to do my own self-exams. Shower cards distributed by gynecologists, reminders at my yearly exam--nothing worked. I take birth control pills for an ovarian cyst problem, and since I take them every day, it seems to be a simple and effective way to remind women to do that exam. What's even more beneficial? Research has shown that the best day of a woman's cycle for this exam is 7 to 10 days after the onset of menstruation. Since birth control pills regulate the cycle, it is easy to pinpoint the day or days in the pill schedule when this exam would be most likely to reveal a questionable lump in the breast. Millions of women use birth control every day. If we can remind those women to do breast self-exam, we can catch more of their cancers at their earliest stages.

Please name and provide a personal bio of the social innovator behind this initiative.

My name is Karla Robinson, and I'm just a mom with an idea.

My education is in the field of communication, and while I've never worked in medical marketing, I believe my understanding of media industries and the best way to communicate health messages could be beneficial in helping to promote this message to pharmaceutical firms and OB/GYNs.

At what stage is this initiative?

Innovative idea .

What resources would you need to take your initiative to the next stage?

What's needed is a method of communicating directly with the pharmaceutical companies, and some medical experts to testify to the benefits of breast self-exam. While some groups have ceased recommending BSE, with insurance companies failing to cover mammograms until ages 35 or 40 in some cases, it seems prudent to tell the younger women most likely to take these pills about BSE. Well designed pamphlets could be included in BC pill packages, as well as tampon packages.

How did you hear about this contest and what is your main incentive to participate? (Confidential)

I read about the contest on Freakonomics.com. I've had this idea in my head for some time, but never a good way to get the idea to the right people.

300 weeks ago Fran Holuba said: On May 11, 2009, the judges reviewed the entries for the Changemakers “Designing for Better Health” competition and would ... about this Competition Entry. - read more >
304 weeks ago Joseph Lurio said: A fabulous/simple/easy to implement idea. My question is: what evidence is there that self examination makes any difference in ... about this Competition Entry. - read more >
305 weeks ago Raphael Wanjaria Njararuhi said: Hi Karla, I like your idea.Its well defined and its simple anyone can understand it.You must be a very wise Mom! Best ... about this Competition Entry. - read more >
306 weeks ago Just an idea has been chosen as a finalist in Designing for Better Health.
312 weeks ago Karla Robinson said: I've recently expanded this entry; if you have other ideas on how to refine or expand this nudge, I'd welcome your comments or suggestions! about this Competition Entry. - read more >
312 weeks ago Amelia Forrest Kaye said: Karla, This is an excellent idea and a prime example of a low-cost and high-impact nudge that encourages people to change their ... about this Competition Entry. - read more >
315 weeks ago Wayne Smith said: This seems like a great idea with little effort to enact on the drug packaging side. Seems like it should have a lot of buy-in. Good luck! about this Competition Entry. - read more >
316 weeks ago Chloe de Roos Feinberg said: Hi Karla- I have to say this is a really great idea. It is so simple and it seems like the impact would be huge. Have you given any ... about this Competition Entry. - read more >