Smoker's Guilt

Reviewed by: HU Medical Review Board | Last reviewed: January 2017.

Because of the well-known fact that smoking is the major cause of both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), many smokers or former smokers who develop lung cancer feel a sense of guilt or shame. The guilt is compounded by the stigma that is present in society, including the medical community. The stigma surrounding lung cancer is based on the belief that people get lung cancer because they made poor choices in life and that because of their poor choices, they deserve their disease.1,2

Guilt can be pervasive

While smoking is still the largest contributor to lung cancer, with an estimate that 90% of lung cancer cases are due to active smoking, many of the people who are now diagnosed with lung cancer are former smokers. Despite the powerful addiction of nicotine, these are people who have tackled their addiction and have achieved a tremendous accomplishment.

Unfortunately, the damage caused by smoking occurred many years before. While smoking cessation is critical to improving health and reducing the incidence of lung cancer, smoking that has occurred in the past may have already damaged the lung tissue and created the opportunity for cancer to develop. People with lung cancer who have smoked or who are current smokers often feel guilt for their smoking behavior causing their disease and this adds an additional emotional burden to an already stressful situation.1,3,4

The lung cancer community experiences more guilt than others

Many people with all types of cancer feel guilt, wondering what they could have done differently to prevent their cancer or detect it at an earlier, more treatable stage.

However, one study that assessed guilt and shame in patients with lung, breast, and prostate cancer found that people with lung cancer have higher levels of guilt and shame. Of the patients with NSCLC, 91.7% were smokers or former smokers and 29.5% of them felt their behaviors contributed to their cancer, compared with 10.5% of patients with other cancers who felt their behaviors contributed to their cancer.5

Most smokers start as teenagers

Most people who smoke start smoking as young teenagers, clearly not the best time to make informed adult decisions. Meanwhile, these young people are faced with billions of dollars of advertising of cigarettes and other tobacco products promoting their use. In addition, many of the people who are diagnosed with lung cancer today began smoking at a time when the risks and dangers of smoking were not fully understood. When these smokers become adults and are more informed and able to make a healthy decision, they are hooked on one of the most powerful addictive substances. Studies have shown that nicotine can be as addictive as cocaine and heroin.2-4

How cancer develops

While smoking can cause damage that leads to cancer, most people who get cancer have a combination of factors that contribute to the disease, including genetics, exposure to risk factors, and perhaps, bad luck. It is not fully understood why some people get cancer while others do not. Smoking greatly increases a person’s risk for lung cancer, but the majority of smokers do not develop lung cancer. In addition, approximately 20% of people who are diagnosed with lung cancer have never smoked.2,3

Coping with guilt

For people with lung cancer who are smokers or former smokers and who are dealing with feelings of guilt or shame, there are several strategies for coping with their emotional distress:

  • Educating themselves about the disease
  • Finding others who understand, such as a support group with other lung cancer patients
  • Getting support from a counselor or psychologist 2

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