








































This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2021 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Prostate cancer, awareness, Movember, 
Google Trends, breast cancer, Pinktober

None declared. Received on June 9, 2021 
Accepted on September 8, 2021

Soc Int Urol J.2021;2(6):362–369

DOI: https://doi:10.48083/UHSI5324

362 SIUJ  •  Volume 2, Number 6  •  November 2021 SIUJ.ORG

ORIGINAL RESEARCH

Is “Movember” an Effective Prostate Cancer 
Awareness Campaign Beyond the English  
Language? Insights From Google Trends  
Among Spanish Speakers
Daniel A. González-Padilla,1 Rodrigo España-Navarro,2 José Daniel Subiela,3 Raj Kumar,4  
Luis G. Medina,4 Júlia Aumatell,5 José Manuel De la Morena-Gallego,1 Giovanni E. Cacciamani4

1 Department of Urology, University Hospital Infanta Sofía, Madrid, Spain 2 Department of Urology, Regional University Hospital, Málaga, Spain 
3 Department of Urology, University Hospital Ramón y Cajal, Madrid, Spain 4 USC Institute of Urology and Catherine and Joseph Aresty Department of  
Urology, Keck School of Medicine, University of Southern California, Los Angeles, United States 5 Fundació Puigvert, Barcelona, Spain

Abstract

Objective To evaluate the impact of the “Movember” awareness campaign (men’s health campaign that takes 
place every November) on internet search trends for information online about prostate cancer and to compare the 
results with those for “Pinktober” (the breast cancer awareness campaign that takes place in October) in the Spanish 
language as an indirect measure of its effectiveness.

Methods Google Trends was used to evaluate the monthly relative search volumes (RSV) of the terms “cáncer de 
próstata” (prostate cancer), “cáncer de mama” (breast cancer), and “Movember” from January 2009 to December 
2019 both in Spain and worldwide (in the Spanish language). Breast cancer was used as a comparator of the campaign 
impact. Mean increase in RSV on-campaign and off-campaign was calculated and compared using the Mann-
Whitney U test and Joinpoint regression analysis to assess loss or gain of interest.

Results The term “cáncer de próstata” showed a statistically significant increase during the campaign months both 
in Spain (17.4%; P < 0.001) and worldwide (35.4%; P < 0.001). Both “cáncer de próstata” and Movember showed a 
decreasing trend worldwide and in Spain, while “cáncer de mama” showed an increasing trend.

Conclusion The Movember campaign generates a statistically significant increase in the search trends on “cancer de 
próstata” (prostate cancer) during the month of November (both in Spain and worldwide); when compared with the 
breast cancer campaign “Pinktober” these increases are of a lesser magnitude but still significant, suggesting that the 
campaign is effective beyond the English language, although the interest has been decreasing throughout the years.

Introduction

Prostate cancer is the second most frequently diagnosed neoplasm in men and causes 3.8% of all cancer deaths 
worldwide[1]. In Spain, 89.8% of patients are diagnosed in the localized stage, 6.4% in the locally advanced, and only 
3.8% in the metastatic stage[2].

The awareness campaign of men’s health that is celebrated every November with a blue ribbon as a symbol, also 
known as “Movember,” was started in Australia in 2003, aiming to increase awareness about prostate cancer, testicu-
lar cancer, mental health, and suicide prevention[3].



“Pinktober” is the breast cancer equivalent of 
Movember, held every October. Using a pink ribbon as 
a symbol, this campaign has been effective in encourag-
ing women to get informed about breast cancer and in 
becoming part of an early detection program[4].

Although these campaigns receive strong support 
from governments and non-governmental organiza-
tions, the true impact of the Movember campaign in 
terms of public health is not well-known. While positive 
results have been found in the English language[4,5], the 
campaign’s impact in non-English-speaking countries 
remains uncertain, even though the Movember website 
is available in 11 languages.

In 2019, more than 4.1 billion people worldwide had 
access to the internet[6]. The National Statistics Insti-
tute (INE) in Spain report that by 2019, 90.7% of the 
Spanish population between 16 and 74 years had used 
the internet. This value drops to 63.5% for those aged 
65 to 74 years[7], which is the age group in which most 
of the prostate cancer diagnoses occur, both in Spain 
and worldwide[2,8], which could limit the reach of the 
Movember campaign.

Google is the most popular search engine in the 
Western World, used for 93.39% of all searches carried 
out in Europe and 92.18% worldwide[9,10]. Google 
Trends is a free-access tool that allows users to analyze 
the frequency with which a term is registered in the 
Google search engine in relation to the total volume of 
searches carried out during a certain period of time and 
in predetermined geographical regions. These features 
have contributed to its use in health research as an epide-
miological tool with a methodology that is yet to be stan-
dardized[11].

The objective of this study is to identify the reach 
and impact of the Movember campaign on the search 
trends seeking information about prostate cancer in 
the Spanish language. As Spanish has the second most 
native speakers of all languages worldwide[12], Google 
Trends offers an indirect measure of the effectiveness of 
the campaign.

Material and Methods
We used Google Trends (https://trends.google.es), a 

publicly accessible and free tool designed by Google 
(Santa Clara, United States). Google Trends provides 
information on the volume of searches on Google, which 
has records from 2004 onwards available; this volume is 
represented by the metric “RSV” (relative search volume) 
which is represented by a number from 0 to 100, with 
100 being the maximum search activity for the term or 
terms entered in the specified time.

The search was carried out on October 4, 2020, using 
the terms “cáncer de próstata” (from now on, “prostate 
cancer”), “Movember,” and “cáncer de mama” (from now 
on “breast cancer”). Search trends from January 2009 
to December 2019 were analyzed. These criteria were 
filtered geographically into “worldwide” and “Spain.” 
“Pinktober” was used as a comparator as a widely recog-
nized successful awareness campaign and to allow direct 
comparison with prior publications.

Google Trends provides a monthly RSV value, from 
which we calculated the average overall RSV, analyz-
ing separately the months on-campaign (November 
for prostate cancer and October for breast cancer) and 
off-campaign (rest of the year).

The Joinpoint regression (JPR) model (National 
Cancer Institute) was used to identif y significant 
changes in mean annual RSV (ARSV) over time for each 
term. The JPR model is used to better describe trends 
that are not constant over time, and it enables evaluation 
of statistically significant changes (join-points) in trends 
as previously described[13–16].

Linear trends in RSV were summarized using the 
estimated ARSV and annual percentage in change 
(APC). APC was used to measure differences in ARSV 
between 2 join-points. Average annual percentage in 
change (AAPC) and the respective 95% confidence 
intervals were estimated to summarize linear trends in 
ARSV during the entire period.

The use of the natural log-linear model ([ln(y)=xb]) 
enables the analysis of AAPC in rate over time. A 
positive value of AAPC indicates an increasing RSV 
(increasing search volume or interest), while a negative 
rate refers to a decreased interest. When a dependent 
variable was “0” a log (x+1) transformation was applied 
to the entire dataset. A permutation test, allowing up to 
4 join-points, was used to evaluate any inflection points 
with a significant variation in the slope of the trend.  
A trend was defined as “non-constant” or “constant” if 
slopes were identified or not identified, respectively.

Mea n RSV va lues were compa red using t he 
Mann-Whitney U test and a P-value < 0.05 was consid-
ered statistically significant. The statistical analysis was 
performed using the statistical package SPSS v26.

Abbreviations 
AAPC average annual percentage in change
APC annual percentage in change
ARSV annual RSV
RSV relative search volume

363SIUJ.ORG SIUJ  •  Volume 2, Number 6  •  November 2021

Is “Movember” an Effective Prostate Cancer Awareness Campaign Beyond the English Language? 



Results
Analyzing the searches between 2009 and 2019, we 
observed that the term “cancer de próstata” (prostate 
cancer) filtered “worldwide” reached the maximum 
RSV (RSVmax - 100) in November 2017 and the 
minimum RSV (RSVmin) was 38, in January 2017, the 
mean annual RSV (RSVmean) was 50.9 off-campaign 
(all months of the year, excluding November) and 78.9 
on-campaign (all Novembers), observing a statistically 
significant increase of 35.4% (P < 0.001) during the 
campaign months. In Figure 1a (blue lines) we can see 
the blue spikes of searches carried out in the months of 
November, which are more evident from the year 2013 
onwards.

When analyzing the same strategy (“cancer de 
próstata,” 2009 to 2019) in Spain, RSVmax was also 
reached in November 2017 (100) and the RSVmin (28) in 
December 2009. The RSVmean was 42.3 off-campaign 
and 51.9 on-campaign, with a statistically significant 
increase of 17.4% (P < 0.001), these values are summa-
rized in Table 1 and represented in Figure 1a (orange 
lines), showing no clear spikes in search trends in the 
months of November, except for the year 2017.

Regarding the term “cancer de mama” (breast cancer), 
filtered “worldwide” the RSVmean off-campaign and 
on-campaign months were 21.3 and 69.8 respectively, 
with an increase of 69.4% in the months on-campaign 
for breast cancer.

Figure 1b shows how the trends in search for “breast 
cancer” have been increasing gradually each year during 
the campaign months, while trends for prostate cancer 

(Figure 1a) show a minimal increase relative to breast 
cancer. Analyzing breast cancer filtered by “Spain,” we 
observe an RSVmean for breast cancer of 14.5 off-cam-
paign, and 56.5 on-campaign, with an increase of 74.3% 
(P < 0.001) during the campaign months; these results 
are summarized in Table 2. Figure 1b shows increases 
of trends in searches for breast cancer in the months of 
October with the same trend as “worldwide,” while for 
prostate cancer such increases are imperceptible.

Prostate Cancer – Worldwide Prostate Cancer – Spain

FIGURE 1A. 

Search trends for the term “prostate cancer” 

TABLE 1. 

Cáncer de próstata (prostate cancer), trends from 
January 2009 to December 2019  

   Worldwide Spain

RSVmax, date
100, 

November 2017
100, 

November 2017

RSVmin, date
38, 

January 2017
28, 

December 2009

RSVmean off-
campaign

50.9 42.3

RSVmean on-
campaign

78.9 51.9

RSV increase during 
the campaign 

months
35.4% 17.4%

RSV: relative volume of searches; RSVmax: maximum RSV; RSVmin: 
minimum RSV; RSVmean: average RSV.

364 SIUJ  •  Volume 2, Number 6  •  November 2021 SIUJ.ORG

 ORIGINAL RESEARCH



Finally, for the term “Movember” filtered “world-
wide,” the RSVmax was reached in November 2012 
and the RSVmin (1) in multiple months over the years. 
RSVmean off-campaign was 3.0, while on-campaign 
was 43.7 with a statistically significant increase of 91.5%  
(P < 0.001). Figure 1c (blue lines) shows the spikes in 
search trends every November, and a virtual disappear-
ance of searches in the rest of the year. In turn, the trend 
in the months of November reached its maximum in 
November 2012 and gradually decreased from Novem-
ber 2013 to November 2019 worldwide.

When analyzing the same term filtered in “Spain” 
(Figure 1c, orange lines) the RSVmax was reached in 
November 2013 and the RSVmin (1) several months 
over the years. RSVmean was 2.4 off-campaign and 55.9 
on-campaign, with an increase of 99.2% (P < 0.001). 
These results are summarized in Table 3.

Join point regression analysis
For the geographical region category “world,” the 
web search for the term “cancer de próstata” (prostate 
cancer in English) showed a constant non-statistically 
significant decreasing trend (AAPC −0.5%, 95%CI −1.7 
to 0.7; P = 0.4) from 2009 to 2019. The web search for 
“cancer de mama” (breast cancer in English) showed a 
non-constant increasing statistical interest trend from 
2009 to 2019 (AAPC 3.8%, 95%CI 2 to 5.5; P < 0.0001). 
From 2009 to 2012 a non-statistically significant 
decreasing trend is seen (AAPC −0.5%, 95%CI −6.2 to 
5.5; P = 0.8). Interestingly, between 2012 and 2019, a 
statistically significant increasing interest trend is seen 
(AAPC 5.7%, 95%CI 4 to 7.3; P < 0.0001). The web search 
for the term “Movember” showed a non-constant and 

non-statistically significant decreasing trend (AAPC 
−5.4%, 95%CI −17.2 to 8; P = 0.4). A non-statistically 
significant increasing interest trend (AAPC 87.6%, 95%CI 
−12.1 to 300,4; P = 0.1) from 2009 to 2011. However, we 
found a statistically significant decreasing interest trend 
between 2011 and 2019 (AAPC −20.3%, 95%CI −26.6 to 
−13.5; P < 0.0001).

In the category for the geographical region “Spain,” 
the web searches for the term “cancer de próstata” 

Breast Cancer – Worldwide Breast Cancer – Spain

FIGURE 1B. 

Search trends for “breast cancer”

TABLE 2. 

Cáncer de mama (breast cancer), trends from  
January 2009 to December 2019 

  Worldwide Spain

RSVmax, date
100, 

October 2019
100, 

October 2013

RSVmin, date
12, 

December 2012
8,  

December 2009

RSVmean off- 
campaign

21.3 14.5

RSVmean on- 
campaign

69.8 56.5

RSV increase during 
the campaign 

months
69.4% 74.3%

RSV: relative volume of searches; RSVmax: maximum RSV; RSVmin: 
minimum RSV; RSVmean: mean RSV.

365SIUJ.ORG SIUJ  •  Volume 2, Number 6  •  November 2021

Is “Movember” an Effective Prostate Cancer Awareness Campaign Beyond the English Language? 



(prostate cancer in English) displayed a constant and 
non-statistically significant decreasing trend (AAPC 
1%, 95%CI −0.5 to 2.6; P = 0.2). The web searches for 
“cancer de mama” (breast cancer in English) showed a 
statistically significant increase interest trend from 2009 
to 2019 (AAPC 7.8%, 95%CI 5.3 to 10.5; P < 0.0001).
The web search for the term “Movember” showed a 
non-constant and statistically significant increasing 
trend (AAPC 24.6%, 95%CI 18.3 to 31.2; P < 0.0001). 
There is statistically significant increasing interest trend 
(AAPC 106.3%, 95%CI 81.8 to 132.2; P < 0.0001) from 
2009 to 2013. Nonetheless, there is evidence of a statisti-
cally significant decreasing trend between 2013 and 2019 
(AAPC −11%, 95%CI −16.8 to −4.8; P < 0.0001).

Discussion
This study is the first to indirectly evaluate the impact 
and extent of the prostate cancer awareness campaign 
known as Movember in a non-English language, using 
the Google Trends tool. Our results show a statistically 
significant increase in search trends for “prostate cancer” 
and “Movember” during the campaigning months from 
2009 to 2019, both in Spain and worldwide. Nonetheless, 
when directly compared with breast cancer awareness 
campaigns, the apparent impact is much more limited.

Further, the term “Movember” has sharp spikes in 
the months of November but practically disappears 
from search trends for the rest of the year, which makes 
us wonder if the Movember campaign achieves a long- 
lasting effect or remains only a cyclic event.

Additionally, this urological awareness campaign 
fails to reach a strong impact on search trends when 

compared with Pinktober, the breast cancer campaign. 
Interest in breast cancer not only remains in some 
form during the rest of the year but also increases year 
after year, both in Spain and in the rest of the world. 
These data are congruent with the findings of the study 
published by Patel et al. comparing the impact of the 
breast, prostate, and testicular cancer campaigns in the 
United States, which showed a strong increase of RSV in 

Movember – Worldwide Movember – Spain

FIGURE 1C. 

Search trends for the term “Movember” 

TABLE 3. 

Movember, trends from January 2009 to  
December 2019  

  Worldwide Spain

RSVmax, date
100, 

November 2012
100, 

November 2013

RSVmin, date
1, 

several months
1, 

several months

RSVmean  
off-campaign

3.0 2.4

RSVmean  
on-campaign

43.7 55.9

RSV increase during 
the campaign months

91.5% 99.2%

RSV: relative search volume; RSVmax: maximum RSV; RSVmin: 
minimum  
RSV; RSVmean: average RSV. 

366 SIUJ  •  Volume 2, Number 6  •  November 2021 SIUJ.ORG

 ORIGINAL RESEARCH



the month of October for breast cancer versus a minor 
increase in RSV in November for prostate cancer[17]. 
Similarly, Cacciamani et al. previously showed a correla-
tion between the campaign Pinktober in the month 
of October and an increase in search trends for breast 
cancer, mammograms, and pink ribbons during this 
period[4].

Another relevant point is the celebrity phenome-
non: a socially prominent person’s disclosure that they 
have cancer increases public interest in that cancer. This 
phenomenon can generate increases in search trends 
greater than those produced by awareness campaigns. 
This was demonstrated in the cases of Angelina Jolie 
and Steve Jobs[18,19], and it may account for the search 
trends peak observed in November 2017 in Spain and 
worldwide following media coverage of the diagnosis 
of prostate cancer at 48 years of age of Latin American 
ex-football player Eduardo Berizzo[20].

Meanwhile, the success of the Pinktober campaign 
on breast cancer can be explained by its having been 
promoted over a longer time. Awareness campaigns 
on breast cancer began in 1985 with the alliance of the 
American Cancer Society and Imperial Chemical Indus-
tries (now part of AstraZeneca)[21]. Additionally, the 
early detection programs for breast cancer started in the 
late 1970s[22], while the equivalent in prostate cancer 
started in the 1990s[23], and this screening program has 
suffered multiple setbacks, including the recommenda-
tion against it by the US Preventive Services Task Force 
(USPSTF) in 2012[24], which was maintained until the 
2018 update[25].

The use of Google Trends as a tool for the indirect 
analysis of urological and non-urological diseases from a 
public health perspective has been previously addressed. 
Schootman et al. couldn’t show a direct correlation 
between search trends and use of screening programs 
for colon, cervix, lung, breast, and prostate cancer in a 
state-level analysis in the United States[26]. Nonetheless, 
other authors have shown a positive correlation in the 
number of searches on cosmetic surgery modalities and 
the volume of procedures performed[27] or associations 
in search trends on sexually transmitted diseases in 
areas where the incidence of these is greater[28].

Our study has some limitations. First, the demo-
graphic characteristics of the population that carry 
out these searches are unknown. It must be considered 
that the campaigns intend to reach men whose age 
makes them candidates for programs for early detec-
tion of prostate cancer. This is recommended for the 
average male from the age of 50 according to the Euro-
pean Association of Urology[29] and from the age of 55 
according to the American Urology Association[30] and 
the USPSTF[31]. Another limitation is the impossibility 
of distinguishing those individuals seeking information 
on prevention and early detection strategies from those 
already diagnosed seeking information on available 
treatments.

Similarly, the tools provided by Google Trends do not 
allow a direct comparison of the interest between differ-
ent early detection strategies (mammography versus 
prostate-specific antigen) since the acronyms for these 
in English and Spanish are shared by other words from 
other sectors, and it is not possible to separate the results, 
while terms without acronyms do not yield useful results 
for comparison.

However, although the information derived from 
Google Trends does not replace formal epidemiological 
studies, it can be a complementary tool relevant to better 
understanding the scope, impact, and limitations of 
awareness campaigns on men’s health and other public 
health campaigns. Overall, we found increases in search 
trends every November, which correlate with a posi-
tive impact of the Movember campaign in the Spanish 
language worldwide.

Conclusion
The prostate cancer awareness campaign “Movember” 
correlates with a statistically significant increase in 
search trends for “cancer de próstata” (prostate cancer) 
in the Spanish language worldwide. When compared 
with the breast cancer campaign “Pinktober” these 
increases are of a lesser magnitude but still significant. 
Google Trends appears to be a useful tool for indirectly 
assessing the effectiveness of awareness campaigns; 
however, other epidemiological studies are necessary to 
directly confirm these findings.

367SIUJ.ORG SIUJ  •  Volume 2, Number 6  •  November 2021

Is “Movember” an Effective Prostate Cancer Awareness Campaign Beyond the English Language? 



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369SIUJ.ORG SIUJ  •  Volume 2, Number 6  •  November 2021

Is “Movember” an Effective Prostate Cancer Awareness Campaign Beyond the English Language? 


