Since its release in 1998, the breast cancer stamp has raised over $50 million for breast cancer research. Perhaps one of the reasons the breast cancer stamp has been such a success is that it makes it so easy to do good: spend a few extra pennies on postage for mail that has to be sent anyhow, and you’ve done your part in supporting the cause.

The breast cancer stamp is the U.S. Postal Service’s first “semi-postal,” a stamp that is sold above its actual postage value. The stamp, which covers 37 cents worth of postage, costs 45 cents. Those pennies have added up, with more than 650 million stamps sold so far. Beth Brophy spoke to Ethel Kessler, the art director for the breast cancer stamp, who was diagnosed with breast cancer in 1994.

We’re seven years past the release of the breast cancer stamp. Are you surprised by its popularity?

I’m in shock and awe that we created something that resonates this much with so many people. The stamp was supposed to have a life of two years. But it continues to sell well, so Congress keeps renewing it.

You were a breast cancer patient, and the first assignment you get as an art director for the U.S. Postal Service is to design the breast cancer stamp. What was your reaction to the project?

The pressure that I felt was daunting. I had never designed a stamp before. Congress had passed a special law for the breast cancer stamp and the president had signed it. I was looking at a blank space. All I was told was the stamp can’t be of a mammogram machine and it can’t be of a breast. It had to appeal to people across many cultures. I was scared of falling flat on my face. I had an overwhelming horror of failure. All the negative emotions came up first.

But the stamp has turned into a huge success. How did you get from that state of fear to creating a powerful image?

Well, I soon moved on to what would make the stamp good. I had no idea yet of what the stamp should look like, but I knew what I wanted it to say, from my personal experience: The people who had died of breast cancer had tried hard to live. You can survive. Breast cancer is not a death sentence. I survived. It is possible. That’s a lot to get on a tiny stamp.