Prevention vs. Risk Reduction in Lung Cancer

I wrote an article recently about how I was guilty of falling into the trap of blaming an acquaintance's smoking habit for her possible lung cancer (it had not yet been conclusively diagnosed). I was jumping the gun based on limited information and an ingrained bias -- a bias that I actively advocate against. At the end of the article, I wrote about the need to remove the stigma from discussions about treatment and how we need to also work on better ways to address smoking in the subject of prevention. It was brought to my attention, however, that what we really need to be talking about is not prevention, but risk reduction.

Not all cases of lung cancer can be prevented

Just by suggesting "prevention" could be achieved by quitting smoking or never starting, we are still leveling some range of victim blaming on the patient. The truth is, there is no absolute prevention for lung cancer. All we really can do is reduce the overall risk.

For years, the common dialogue on lung cancer has been all about prevention through not smoking. The relentless ad campaigns telling us that tobacco use is the primary cause of lung cancer may have created a sense of awareness about the dangers of smoking, but the result is a gross misunderstanding of the overall nature of lung cancer. It is viewed as a disease that patients bring upon themselves. It is viewed as a disease of the elderly, the infirm, the unhealthy; there is little drive to raise research dollars because the affected population is seen as somehow less deserving than other cancer demographics.

Prevention is an outdated term

Yet, smoking contributes to increased risk for other cancers that do not share the same stigma. A high percentage of bladder cancers are influenced by tobacco use. Mouth, throat, and even liver cancers may be caused by smoking. In fact, there are 12 different cancers heavily associated with smoking, but only lung cancer is saddled with the stigma¹. On the other hand, there is a growing population of never-smokers who have been diagnosed with lung cancer, and this group trends younger overall than those with a history of heavy tobacco use.

The take away is that "prevention" is an outdated term. It tends to be over-used by hucksters selling alternative "healing" programs or seminars, books claiming to offer the blueprint to perfect health, and services firmly rooted in pseudoscientific nonsense. Prevention is a promise that one will never get cancer -- as long as the proper protocol is followed precisely. But this is not only unrealistic and rife with victim-blaming, but it is an outright false way of viewing how and why cancer develops at all.

Cancer does not generally develop in a bubble; the formation of a tumor requires a fair amount of things to go wrong at the cellular level and exposure to a carcinogen is just one of those things. Removing or reducing carcinogen exposure will lower the risk of cancer forming, but it will not eliminate the risk entirely. Even the healthiest people, with the strictest diets and the cleanest lifestyles, may develop cancer -- and they may never know why, other than the very basic fact that some cells with damaged DNA managed to continue dividing and failed to die when they should have.

Because sometimes, cancer just happens

We can reduce our individual risk as much as possible, and removing habits that are known to greatly increase the risk of disease is a smart first step, but we should stop discussing lung cancer -- or any type of cancer -- as a disease that could have been prevented.

It is never the patient's fault. No one asks for this disease. No one deserves it. And if we are serious about educating the next generation, we need to start in no small part by restructuring the cancer narrative to show what the disease (in each varied incarnation) truly is. And rather than talk of prevention, we need to focus on the reality of reducing the risk of disease. If we can do that, we are one small step closer to breaking the stigma, encouraging better research funding, educating more people about early detection, and saving more lives.

Editor’s Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.