It begins with a question. Virtually everyone diagnosed with lung cancer knows that question. Within one hour after receiving my own diagnosis, I returned to work and shared my diagnosis with a colleague. His response: “Did you smoke?”
It seemed so cavalier and callous at the time. Indeed, that question is cavalier and callous. Ironically, a year before my diagnosis, I was guilty of asking that question to a colleague whose husband was diagnosed with lung cancer. (I later asked and received her forgiveness for being so insensitive.) In the years since I have been asked that question countless times. However, I now understand that -- rather than cruelty -- it is asked out of ignorance and lack of understanding. People simply need to be enlightened.
Stigma hurts more than just feelings
Merriam-Webster defines stigma as follows: “A scar left by a hot iron: brand; A mark of shame or discredit: stain; An identifying mark or characteristic, specifically a diagnostic sign of a disease.”
Let me be clear. Smoking is the number one cause of lung cancer. Everyone knows that fact. Does everyone know the number two cause of lung cancer? Is it common knowledge that lung cancer among never smokers kills more Americans than AIDS, drunk driving, drownings or home fires? Even though many lifestyle factors contribute to other diseases, what kind of person would ask an AIDS patient “Are you gay?” At best, that would be insensitive. Then why do people think it is acceptable to ask lung cancer patients about their smoking history?
Actually, many are surprised to learn that half of new diagnoses are in former smokers, the majority of them quit smoking more than a decade before their diagnosis. Another 15 percent never smoked. The remaining 35 percent of people diagnosed with lung cancer are current smokers.
The stigma of lung cancer hurts everyone. It hurts the patients and their family members, who are also asked that question. It inflicts undue guilt and shame on patients who are facing a high probability of impending death. Each year, hundreds of thousands of Americans are diagnosed with lung cancer. These are not simply numbers. They are the people we love…our fathers, sons, mothers, sisters… our co-workers, friends, and neighbors. This stigma cuts more than feelings – it also has a deep impact on funding for research for new treatments and early detection. Lung cancer—the number one cancer killer—is the least funded of all major cancers, in terms of federal cancer research, in large part due to the idea that people with lung cancer have ‘done this to themselves.’
Enlightened and educational responses
Usually people do not realize they are being unkind by asking about smoking. As lung cancer survivors, we need to try to understand they intend no harm. Instead of allowing that question to act as an unintentional arrow, consider it an opportunity to enlighten others.
Here are a few suggestions that may help you and others:
- No, I never smoked. As a matter of fact, because I had asthma as a child, I have never even been around smokers. I later learned that asthma is a risk factor for developing lung cancer.
- No, I am not a smoker; however, after my diagnosis, I learned that radon is the number two cause of lung cancer. Radon is a radioactive gas that kills more than 20,000 Americans each year. I tested my home and discovered it had a high level of radon.
- Yes, I am a former smoker. I learned about lung cancer screening and—fortunately—they caught my cancer early. The screening was 100 percent covered by insurance. The screening program also included a smoking cessation component to help me quit.
- Yes, I am a former smoker. I quit 10 years ago. After I was diagnosed I learned that half of the people diagnosed are also former smokers.
- Yes, I am a smoker. I struggle to quit but it is very difficult, especially after being told that even if I quit, I probably only have a few months to live. I only recently learned about lung cancer screening for people at high risk. I wish someone had told me about screening sooner.
No one deserves lung cancer. And everyone with lung cancer deserves compassionate, equitable care.
Are you satisfied with your care team?