Abstract

This qualitative study explored the transformative potential of empowerment photography for individuals undergoing breast cancer treatment. Participants engaged in a multi-phase experience that included co-creating a personal theme related to their journey through treatment and recovery, participating in a beauty session, and taking part in a professional photo shoot. The process culminated in a public portrait exhibition, fostering both personal reflection, community engagement and improved patient well-being. To understand the impact of this experience, researchers employed brief statistical analysis primarily for demographic purposes and in-depth qualitative content analysis. Data included participants’ written reflections, the themes and captions they selected for their portraits, and their responses to open-ended survey questions. The analysis revealed that most participants reported a range of positive outcomes, including enhanced self-image, increased positive emotions, a stronger sense of connection to others, and a renewed sense of healing and purpose. Many also expressed a desire and perceived ability to inspire and support fellow cancer survivors. Findings suggest that empowerment photography—particularly when participants are actively involved as co-creators—can be a profoundly life-enhancing experience while undergoing breast cancer treatment. It not only fosters emotional well-being and self-worth but also contributes to a broader sense of empowerment and community among survivors. These results underscore the therapeutic potential of creative, participatory approaches in survivorship care and future breast cancer treatment and research.

Keywords

Patient Well-Being, Breast Cancer, Empowerment Photography, Resilience

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1. Introduction

Breast cancer is known to have a profound impact on an individual’s physical and emotional well-being. Over 300,000 women worldwide are diagnosed with breast cancer every year, and it is the most common occurring cancer affecting women in 157 countries (National Breast Cancer Foundation, 2025 [1]). Research demonstrates breast cancer creates a psychological and physical impact on the women who are diagnosed with the disease with a significant impact on quality of life and levels of emotional distress (Dauphin et al., 2020 [2]; Iancu et al., 2017 [3]). Physical symptoms that linger post-treatment include memory and concentration challenges, lingering pain, challenges with sexual pleasure and performance, and lymphedema (Lopes et al., 2018 [4]; Lovelace et al., 2019 ; Sun et al., 2018 [6]). Emotional side effects include difficulty dealing with feelings of isolation, depression, anxiety and sense of powerlessness about the illness, surgery, and possible disfigurement, social difficulties and uncertainty of life (Lovelace et al., 2019 , Khoury et al., 2024 [7]) and a significant impact on feelings of self-worth and self-image, (Chua et al., 2015 [8]; Qu et al., 2024 [9]).

Photography, within many breast cancer communities, is an established medium for highlighting the journey of being diagnosed with, and surviving treatment of the disease as well as the process of reclaiming and celebrating one’s changed body (Reghr, 2012 [10]). However, this has not always translated specifically to published research about the impact of these visually based programs. Cancer-related art making allows cancer patients to directly explore the physical and emotional parameters of the illness, particularly related to body trauma, losses, processing decisions and the role and influence of the medical establishment (Malchiodi, 1997) [11]. Visual research in health has been documented for at least the past two decades and has long been thought to serve as a vehicle for transformative potential (Pink, 2001 [12]). There are a number of different forms of photography that have been used with breast cancer patients which include autophotography (Banks, 2011 [13]), photoelicitation (Glaw et al., 2017 [14]), and Photovoice (Wang & Burris, 1997 [15]).

This project involved aspects of both Photovoice and empowerment photography. Empowerment work typically focuses on consciousness raising, group process in order to facilitate change (Freire, 1970 [16], 1973 [17], Malchiodi, 1997 [11]) and is grounded in the foundational belief that people are experts in their own lives. Empowerment photography can be defined as “a genre of photography that aims to celebrate individuals, particularly women, by capturing their strength, beauty and resilience. It goes beyond traditional beauty standards, focusing on self-expression and personal growth” (Hoffard, 2025, para. 1 [18]).

PhotoVoice has three primary components, feminism, empowerment and documentary photography (Wang & Burris, 1997 [15]). Traditionally, participants serve as co-researchers in documenting their concerns about community issues through photographs, with accompanying captions, which are then shared in a group environment in which these images are discussed and interpreted. Very little work has explored the intersection of photography and breast cancer from a scholarly approach (Silva, 2014 [19]), and there is little presented in qualitative health research about the impact that both posing in, and viewing one’s own participation in a breast cancer photography project as part of the psychosocial support and healing process.

2. The Study

While there was a significant participatory aspect of this project, it is important to note that unlike traditional PhotoVoice research one of the more common forms of qualitative health research, the participants did not take the pictures themselves. Participants served as the models for the project, had the opportunity to experience a “glamour session”, in which they were co-creators of their own physical presentation with the help of hair and makeup artists, and the photos were exhibited at multiple sites within their community. This study was framed by the principles of community-based participatory research (CPBR), in which a collaborative approach is applied to the development of knowledge by equitably valuing the input of community members and the research team in all aspects of the study (Israel et al. 1998 [20]; Minkler & Wallerstein, 2008 [21]). An important aspect of CBPR is the activism and advocacy aspect in which the quality of life of the participants is at the forefront of research benefits.

The research team referred to the modality of this project as empowerment photography, rather than PhotoVoice, because it was a professional photographer that captured the photos, rather than the participants taking the photos and as the modeling experience was designed to facilitate feelings of empowerment.

3. Methods

The photography project and mixed methods study took place in three phases. Funded by the Savannah Arts Council, the project included a glamour session for each participant and photography shoot for eight women in total. Participants were provided with written consent forms and had the opportunity to review and discuss these forms with the research team. Participants provided written informed consent to the research team prior to participation in the study.

One photographer worked with all the participants, and selected the hair and makeup team that would support the creation of the images with the participants. The photographer met individually with each participant, discussed the story wanting to be told by the participant and Co-created the theme. The participant, at a later date, participated in the photo shoot, in which multiple images related to the same theme were taken and later curated for a community gallery.

3.1. Participants

Purposive sampling was used to select participants chosen from various programs at a peer support organization in the southeastern part of the United States in order to have diverse ages, races, stages of breast cancer and breast cancer treatment. Recruitment criteria was an adult over the age of 21 who had been diagnosed with any form of breast cancer. Although those identified as male were not purposefully excluded, however, at the time, there were no males participating in any of the support programs. Descriptive characteristics of the participants are presented in Table 1. Three participants identified as White, two participants identified as Black, and two identified as Latino. Two participants identified as early in breast cancer treatment, three in long term treatment, one as post-treatment and one long term survivor. One participant from the gallery project declined to participate in the research study. Participants ranged in age from 30 years old to 70 years old, and all identified as female. The rationale for a small sample size was to focus on the individual healing nature of the photography experience for each individual participant and due to the intense participatory nature of the photography experience.

Table 1. Demographics.

All participants were informed of anonymity procedures, data protection, and the study scope. Participants were provided with a written copy of informed consent. This study was approved by Adelphi University Institutional Review Board [reference number #082123]. All data was encoded in an electronic database which was password protected. Participants were not compensated for participating in the study although they did receive the pre-photography session of hair and make-up free of charge.

3.2. Data Collection

Data was collected in two distinct phases, each designed to capture different dimensions of participant experience. The first phase occurred during the conceptualization of the photo shoot. In this stage, the participant-models collaboratively developed the thematic direction of their individual photo sessions in partnership with the photographer. This co-creative process involved detailed discussions about visual aesthetics, symbolism, and personal narratives. The themes that emerged from these planning sessions were systematically documented by the research team to serve as contextual data for subsequent analysis.

The second phase of data collection took place following the public exhibition of the photo gallery. During this phase, participants completed a post-gallery survey that included both quantitative and qualitative components. The survey featured multiple-choice items developed by the research team, informed by prior research on emotional responses that typically accompany breast cancer treatment (Counselman-Carpenter & Williams, 2023 [22]). These items assessed participants’ emotional and psychological reactions to their involvement in the project and their reflections on the final photographic outcomes (see Appendix). Additionally, open-ended prompts invited participants to describe their experiences in their own words, particularly in relation to the empowerment aspects of the session.

3.3. Data Analysis

This study employed content analysis as the primary analytic framework, following the methodological guidelines outlined by Neuendorf (2017 [23]). This approach was selected for its capacity to rigorously examine patterns in qualitative data, particularly in contexts where participants self-identify using open-ended and nuanced descriptors. Content analysis supports this approach, enabling the research team to remain grounded in participant narratives while also aligning findings with the limited established literature.

The analytic process unfolded in several stages including initial familiarization during which each member of the research team independently reviewed the dataset to gain a comprehensive understanding of the range and depth of participant responses and preliminary coding, during which team members generated initial codes based on emergent themes. Analysis of the open-ended survey responses was conducted in two stages. First, responses were coded in their entirety as long-block texts to preserve narrative coherence. Subsequently, these texts were segmented into shorter phrases for more granular thematic analysis.

A coding manual was collaboratively developed to ensure both consistency and transparency and which incorporated both inductive and deductive strategies. Codes were derived directly from participant language, with minimal interpretive translation and labels were not standardized unless clarification was necessary for categorization. New codes were added inductively as novel descriptors emerged and were integrated into the coding scheme through consensus by the research team. The coding framework was refined through ongoing team discussions to ensure conceptual clarity and inter-coder consistency. Intercoder reliability was assessed by having multiple researchers independently code a subset of the data, followed by comparative analysis to resolve discrepancies.

Throughout the analytic process, the team engaged in memoing and reflexive journaling to document interpretive decisions and critically examine potential biases. This practice enhanced the trustworthiness and transparency of the findings. Notably, the research team included both a breast cancer survivor and two non-survivors, which contributed to a more nuanced interpretive lens.

4. Findings

The themes that participants chose to caption their photograph in the gallery included: “ignite resilience”, “bloom where you are”, “strategic rest”, “choose to live life”, “focus on the finish line”, “be still”, “lit by legacy” and “hope in the deep waters”. The setting of each photo shoot, from the background to the costuming was designed by the photographer and the models together and visually reflected key components of the chosen theme.

Participants were asked to select from a list of fourteen feelings related to their diagnostic experience (Authors Redacted, 2023 [22]) any feelings that the experienced post-diagnosis (Table 2). In total, eleven feelings were selected by at least one participant, and all of them were reported as negative. Of the seven participants in the study, six answered this question and of the six participants, four reported body image concerns and four indicated symptoms of or a formal diagnosis PTSD. All six indicated either depression or anxiety.

Participants were also asked to share how they felt about their physical bodies during the photography session (Table 3). All seven participants who participated in the post-experience survey stated that the entire experience was transformative for them and all seven participants reported that they felt happy when they saw their final images for the gallery. Five stated they felt “amazing”, three stated they felt “encouraged”, six stated they felt “emotional in a positive way”, one stated they “felt beautiful” and one stated it was “hard for her to see herself” (Table 3).

Table 2. Participant identified feelings post breast cancer diagnosis.

Table 3. Feelings reported during the empowerment photography session.

Finally, when asked what else about the experience that they would like to share with the research team, six respondents chose to elaborate in longer text answers, which was then coded into themes. Overall, there were four themes shared by participants in response to their participation in the project: a sense of healing; other positive emotional reactions, wanting to influence others with their participation in the project and the importance of connecting with the team participating in the project.

4.1. A Sense of Healing

Two participants reported that participating in the empowerment photography project was both life-changing and healing in terms of coping with their cancer diagnosis and going through cancer treatment. One shared,

“This experience was life changing and I will never forget the feeling I had of hope, self love, pride, humbling gratitude and inner peace. This has stayed with me since and I will hold the relationships I have built during this short time together at high magnitude…”.

4.2. Other Positive Emotional Reactions

Five participants reported experiencing positive feelings related to their self-image and self concept including feeling a sense of self-love, gratitude towards their bodies, more peace towards their physical self, a sense of hope and feeling beautiful. One participant related the following:

“…the Empowerment session helped me to remember that it is important that I take care of me just like I take care of everyone else” while another stated, “I feel better knowing that I am still beautiful even with my scars. Beauty is feeling amazing in one’s own body.”

4.3. Interpersonal Connections with the Artists Involved

Three participants were expansive in sharing the impact that the team of people working with them during the empowerment session as transformative. The photographer, photography assistant, hair stylist and makeup artist were all identified as key members of influencing the positive aspects of their experience. One participant shared,

“K. [the makeup artist] and A. [photographer] are amazing at their craft. Thank you so much for connecting them with me. I was so beautiful and the experience was absolutely amazing! Another stated, “the care and attention that was given from the makeup artist to the photo session focused on what made me happy. I can actually say I was gorgeous for the shot and the pictures are breathtaking!”

4.4. Influencing Others

The final theme shared by three participants was how they hoped their experience with the photography project would influence the experience of others. One participant shared,

“…meeting new people like the photographer and the makeup artist was a blessing. I’m also hoping that this session will give hope to others”.

5. Discussion

The research indicates several important key findings, primarily that the experience of the empowerment photography project and subsequent community gallery exhibitions was reported by the participants to be overwhelmingly positive and life-enhancing for those who participated. Another key finding is how the empowerment photography experience allows participants to experience feeling beautiful, rediscover a sense of self, experience other positive emotions and to connect to others. Isolation has been identified as a significant risk factor during breast cancer treatment and specifically contributes to cancer-related mortality (Freedman & Nicolle, 2020 [24]; Sung et al., 2021 [25]), so there are important implications related to the feeling connected to others as part of participating in this project. In addition to feeling connected to others, participants also shared that they felt like their participation in the project could positively influence other women going through treatment for breast cancer which also led to experiencing positive emotions and connection of others.

These findings also support prior research (e.g. Tsaras et al., 2018 [26]; Khoury et al., 2024 ) that anxiety and depression are pervasive following the diagnosis of breast cancer and can strengthen between diagnosis and the completion of treatment. Another prior research finding that was supported by this study is that some of the most significant emotional damage that occurs as part of the breast cancer journey relates to negatively impacted body image (Chua et al., 2015 , Pikler et al., 2003 [27]), feelings of self-worth and connecting to one’s body. The outcomes of this study suggest that engaging in an empowerment photography journey may mitigate and provide healing from some of the impacts made on self-esteem, self-worth and body connection from the invasiveness of breast cancer treatment.

One of the most surprising findings was the specific role played by the hair and makeup artists and not just the photographer in this project. Four of the seven participants specifically commented on how amazing and supportive these different individuals were during the experience and how the hair and makeup artists enhanced the experience so profoundly, in addition to the impact of the photographer. Hair and make-up artists work in close physical proximity to their subjects, physically touching their faces, hair and scalp and help alter, even if temporarily, the physical appearance of the participants. The hair and make-up artists specifically serve in a responsive, design role to the participants, checking with them about the styles of the makeup application and hair whereas the photographer may take a more directive and distance approach, encouraging the participants to pose in a certain way, and standing at more of a distance. Further research on the role that the “glow-up” experience has as part of participatory based arts research should be conducted to understand the potential impact on factors of resilience and feelings of self-worth for those undergoing and post-breast cancer treatment. As so many of the participants reported finding the experience as healing and transformative, it is clear that further and more expansive work needs to be conducted in this area.

Finally, the findings from this project indicate the importance of the sense of feeling more in control of one’s body and appearance. Participants felt as if they were taking care of themselves by participating, rather than focusing on the care of others, particularly their immediate family members. They also reported, particularly in the written themes of their portraits, of choosing hope, and choosing to live life, despite being diagnosed with a life-threatening illness. Feeling a sense of control over one’s life, one’s body and one’s emotions has been shows to have a direct impact on quality of life and well-being in breast cancer patients. This answers the call of Qu et al., (2024 [9] ) and Geng et al. (2018 [28]) for not only identifying factors that can improve overall quality of life, but a sense of perceived control within daily life, decision-making and overall improved sense of self-efficacy and supports the findings of Rasidi et al. (2021) [29] and Park (2013) [30] about the “reconstructed self” that can accompany being a cancer survivor.

6. Implications

We offer the following implications for practice and future research related to photography-based interventions and support for those undergoing treatment for breast cancer. These findings demonstrate that participating in a glamour session, in which participants have control over using hairstyling and make-up in a way that makes them feel beautiful, and photography shoot in which the participant is a co-creator with the artists can have positive impacts on emotional well-being, quality of life, and create a sense of empowerment. Although there was only one outlier who commented on that the experience, along with the positive emotions that came from it that it was also hard to see oneself following their photoshoot, and despite the overwhelmingly positive nature of the glamour session and following photo shoot, it is critical to take into account the overall emotional toll that breast cancer treatment has on the patient and the continued complex relationship between a breast cancer patient and their body.

In addition to other forms of emotional support, when engaging in a project grounded in empowerment-based methods, the multiple emotional needs of the participants must remain at the forefront. These findings highlight the need for continued visual-based research related to breast cancer, positive emotions, reparative experiences and self-image. Further research with larger cohorts of breast cancer patients to have access to the glow-up and empowerment photography experience are warranted, with an active focus taken to include those who identify as male, non-binary or gender expansive.

7. Limitations

This study was limited by the fact that it is inherently subjective due to being both arts-based. It’s important to note that this photography project was not created in essence to bring attention to the lived experience of a post-mastectomy body as seen in the work by Jo Spence, Jen Rozenbaum and others, but as a healing experience for the participants and a community-based witnessing by their communities. The small sample size of participants may limit the generalizability to larger breast cancer populations. Another limitation may be due to bias social desirability due to the highly public nature of the intervention.

8. Conclusion

This study explored the experience of women who participated in an empowerment photography experience while being treated or having been treated for breast cancer. It is clear that further work exploring how research grounded in arts-based methodology, photography-based projects, visual research in health and qualitative health may facilitate factors of post-traumatic growth and/or resilience.

Appendix: Survey Questions

Participant Demographics

For Reporting Purposes Only

1) Gender

a) Male

b) Female

c) Non-binary/Genderqueer

d) Trans.

e) Would prefer not to answer

2) Current Age

a) 21 - 29

b) 30 - 39

c) 40 - 49

d) 50 - 59

e) 60 - 69

f) 70 years or older

3) Ethnic origin

a) White or Caucasian

b) Hispanic or Latino

c) Black or African American

d) Asian

e) Pacific Islander/Native Hawaiian

f) Native American/Indigenous/Alaskan Native

g) Other______________

h) Would prefer not to answer

4) Marital Status

a) Single, never married

b) Married or domestic partnership

c) Widowed

d) Divorced

e) Separated

f) Would rather not answer

5) What’s your total household income?

a) I’m a child or college student and have not yet entered the workforce

b) Less than $10,000

c) $10,000 to $19,999

d) $20,000 to $29,999

e) $30,000 to $39,999

f) $40,000 to $49,999

g) $50,000 to $59,999

h) $60,000 to $69,999

i) $70,000 to $79,999

j) $80,000 to $89,999

k) $90,000 to $99,999

l) $100,000 to $149,999

m) $150,000 or more

n) Would prefer not to answer

SECTION 4

Empowerment Session Participant Survey

Reframing Beauty Through Photography

6) Where were you in your journey when you participated in this program?

a) Newly diagnosed, haven’t undergone any treatment yet

b) In the initial treatment phase (surgery, radiation, chemo)

c) In the long-term treatment phase (endocrine therapy)

d) Post-treatment (no further treatment, including endocrine therapy)

e) Long-term survivor (5+ years)

f) Would prefer not to answer

7) How did having cancer and subsequent treatment affect your feelings about body image?

a) Cancer and treatment had a positive impact on my body image

b) Cancer and treatment had a negative impact on my body image

c) Cancer and treatment had no impact on my body image

d) Would prefer not to answer

e) Other: _______________

8) Would like to elaborate on my answer above? (optional) ________________

9) Please check all treatments that you underwent or are expected to undergo.

a) Unilateral mastectomy

b) Bilateral mastectomy

c) Lumpectomy

d) Chemotherapy

e) Radiation

f) Reconstruction

g) Hormone Blockers (such as Tamoxifen or Aromatase inhibitors)

h) Would prefer not to answer

10) Please check all of the following that you’ve experienced as a result of your cancer diagnosis, if any.

a) Body image concerns

b) Grief

c) Loss of Control

d) Fear

e) PTSD

f) Intimacy Concerns

g) Depression

h) Anxiety

i) Inability to connect with your “new” body

j) Anger

k) Loss of safety

l) Feelings that your body “betrayed you”

m) Gratitude

n) Optimism

o) Hope

p) Confidence

q) Would prefer not to answer

r) Other ______ fill in the answer

11) Did you enjoy the experience of your Empowerment photography session?

a) Yes

b) No

c) Neutral

12) How did you feel DURING your Empowerment. Session? Check all that apply.

a) Connected to your body

b) At ease with who you are

c) Empowered and strong

d) Hopeful

e) Love and acceptance of your body "as is"

f) Fearful

g) Anxious

h) Depressed/sad

i) Angry

j) Shame or Guilt

k) Would prefer not to answer

l) Other: ______________________________________

13) How did you feel when you viewed your images? Check all that apply.

a) Amazing

b) Happy

c) Encouraged

d) Depressed/Sad

e) Disappointed

f) Emotional–good

g) Emotional–bad

h) Would prefer not to answer

i) Other: _____________________________________

14) Was this a transformative experience for you?

a) Yes

b) No, not really

c) Would prefer not to answer

15) If you answered yes to it being a transformative experience for you, in what way was it transformative? ____________

16) In your own words, tell us what the Empowerment session has meant to you. Has the experience helped you emotionally? How so? How has the concept of beauty changed for you since participating in the Empowerment session?

17) Anything else you’d like to tell us about how this experience/program impacted you?

Conflicts of Interest

The authors declare that there is no conflict of interest.

References