Breast Cancer Awareness Content

Summary decisions examine cases in which Meta has reversed its original decision on a piece of content after the Board brought it to the company’s attention and include information about Meta’s acknowledged errors. They are approved by a Board Member panel, rather than the full Board, do not involve public comments and do not have precedential value for the Board. Summary decisions directly bring about changes to Meta’s decisions, providing transparency on these corrections, while identifying where Meta could improve its enforcement.

Summary

Fifteen users appealed Meta’s decisions to remove their Facebook and Instagram posts featuring different types of breast cancer awareness content. After the Board brought the appeals to Meta’s attention, the company reversed its original decisions and restored all 15 posts.

About the Cases

In October and November 2024, 15 users from various countries (Belgium, Canada, Czech Republic, France, Germany, Guyana, Italy, Japan, Portugal, United Kingdom and United States) posted content raising awareness around breast cancer in the context of “Pink October,” or Breast Cancer Awareness Month, an international campaign to raise awareness of the disease. They comprise:

• Six posts including illustrations depicting visible female nipples and breast cancer symptoms. The posts invite readers to perform self-exams for cancer detection and to consult with their doctor should they notice anything unusual.
• Five other posts including images depicting mastectomy scarring and visible nipple tattoos. The posts share positive messages about recovery and cosmetic surgery, and hashtags like #breastcancer, #mastectomy and #nippletattoo.
• Four other posts including images with visible female nipples, with accompanying captions sharing details of the depicted people’s experience with breast cancer along with hashtags referencing “Pink October.”

The users who appealed Meta’s removal decisions to the Board argued that their intention when posting was to share true stories about breast cancer, and relevant information about symptoms for prevention purposes and aesthetic services that help cancer survivors heal.

Under Meta’s Adult Nudity and Sexual Activity Community Standard, the company restricts “the display of nudity or sexual activity because some people in [Meta’s community] may be sensitive to this type of content, particularly due to cultural background or age.” This policy applies to “real photographs and videos of nudity and sexual activity, AI- or computer-generated images of nudity and sexual activity, and digital imagery, regardless of whether it looks ‘photorealistic.’” The company considers “uncovered female nipples” as “nudity” under this policy. Meta allows, however, visible female nipples when shared in “mastectomy,” “medical” or “health” contexts, which covers content seeking to “inform, discuss, or educate people about health-related issues ... or disease” or that “relates directly to the treatment of a disease,” like a “medical examination by oneself or a medical practitioner.”

After the Board brought these cases to Meta’s attention, the company determined that all 15 pieces of content did not violate the Adult Nudity and Sexual Activity policy and that its original decisions to remove the posts were incorrect. Meta considered that the breast cancer symptoms cases did not violate the policy because they depict female nipples in cartoon images that described and depicted breast cancer symptoms. Meta considered that mastectomy scarring and nipple tattoos cases also did not violate the policy because they depict visible female nipples in a mastectomy context, which is allowed under the Adult Nudity and Sexual Activity Community Standard. Finally, Meta also considered that people’s experiences cases did not violate the policy because they depict female nipples in real photographs that were shared in a medical, educational, and/or awareness-raising context. The company then restored all pieces of content to Facebook and Instagram.

Board Authority and Scope

The Board has authority to review Meta’s decision following an appeal from the user whose content was removed (Charter Article 2, Section 1; Bylaws Article 3, Section 1).

When Meta acknowledges it made an error and reverses its decision in a case under consideration for Board review, the Board may select that case for a summary decision (Bylaws Article 2, Section 2.1.3). The Board reviews the original decision to increase understanding of the content moderation process, reduce errors and increase fairness for Facebook, Instagram and Threads users.

Significance of Cases

These cases demonstrate that, despite Meta’s efforts to further improve accuracy in the enforcement of its exceptions to the Adult Nudity and Sexual Activity Community Standard, errors continue to hinder users’ ability to raise awareness about breast cancer. In one of the Board’s earliest decisions, the Breast Cancer Symptoms and Nudity decision, the Board emphasized that the removal of such content impacts not only users’ freedom of expression but also their right to health, given that access to health-related information is an important part of the right to health. The impact of similar errors was also addressed in the Board’s Education Posts About Ovulation, Breast Self-Exam and Testicular Cancer Self-Check Infographics summary decisions.

The Board has issued recommendations aimed at reducing Meta's enforcement errors specifically concerning exceptions to its Adult Nudity and Sexual Activity Community Standard. For example, the Board recommended that Meta “implement an internal audit procedure to continuously analyze a statistically representative sample of automated content removal decisions to reverse and learn from enforcement mistakes” ( Breast Cancer Symptoms and Nudity, recommendation no. 5). The Board considers that Meta did not address this recommendation, given that the company bundled it with recommendation no. 1, mentioned below, without engaging with the internal audit procedure outlined by the Board.

The Board also recommended that Meta “improve the automated detection of images with text-overlay to ensure that posts raising awareness of breast cancer symptoms are not wrongly flagged for review” ( Breast Cancer Symptoms and Nudity, recommendation no. 1). The Board considers this recommendation implemented as demonstrated through published information. Meta reported enhancements to text-overlay and the development of a new health content classifier with better capabilities to identify breast cancer context. The company reported that these enhancements have been in place since July 2021. To show the impact of the recommendation, Meta reported that its implementation has contributed to an additional 1,000 pieces of content being sent for human review that would have previously been removed between March 21 and April 18, 2023, alone. Even with the improvements reported by Meta, enforcement errors may still occur in at-scale content moderation. The Board encourages Meta to continue to improve its ability to accurately enforce its policies.

The Board additionally recommended that Meta “ensure users can appeal decisions taken by automated systems to human review when their content is found to have violated Facebook’s Community Standard on Adult Nudity and Sexual Activity” ( Breast Cancer Symptoms and Nudity, recommendation no. 4). Meta declined this recommendation because, according to the company, “the majority of appeals are reviewed by content reviewers.” “If users appeal a decision [Meta] make[s] to remove nudity, the appeal will be reviewed by a content reviewer, except in cases where [the company has] capacity constraints.” The fact that 15 pieces of content that clearly fall within the exceptions to the Adult Nudity and Sexual Activity policy were deemed violating by Meta until the cases were brought to the company’s attention shows that enforcement accuracy may improve if Meta implements this recommendation.

The Board encourages Meta to continue to improve its ability to accurately detect content that falls within exceptions to the Adult Nudity and Sexual Activity policy. While Meta’s commitment to the aforementioned recommendation no. 1 has been reportedly preventing enforcement errors, a commitment to recommendations nos. 4 and 5 seems necessary in light of the multiple enforcement errors identified by the Board. Implementing these recommendations would further strengthen the company’s ability to reverse errors.

Decision

The Board overturns Meta’s original decisions to remove the 15 pieces of content. The Board acknowledges Meta’s correction of its initial errors once the Board brought the cases to Meta’s attention.

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