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Stigma Kills

Stigma Kills

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • JackeT
    2 months ago

    I couldn’t agree with you more Dusty! People don’t ask, “Do you have breast cancer because you have breasts or do you have colon cancer because of what you eat?” It doesn’t hurt my feelings as much as it makes me feel angry. When I began to smoke many many years ago, it was acceptable. I quit 20 years ago when I realized what I was doing to my body – needless to say, it was too late, but, I was extremely fortunate in that it was caught early and with surgery (1/3 of my left lung) I was cancer free for now. How do we go about making government realize that we can’t wait to decide this is a disease that needs to be fought against NOW?

    Thanks for listening.

  • vikkr
    6 months ago

    I would just like to add to how to respond when asked “did you smoke”?
    1) No, but I grew up in a home where everyone smoked before all the warnings and we know now what we did not know back then.
    2) I had radiation for breast cancer
    3) I was in the military, exposed to a lot of possible contributors.
    4) No but 20 30 40 years ago we did not know about certain carcinogens that we know about now…..
    AND so on. But the next time it comes up it’s like hey just because you have breast you deserve breast cancer, right? Or just because you have a brain you deserve brain cancer, right? Or my favorite so you drink alcohol so you deserve liver cancer, right? Usually one of these will shut people up..

    YES underfunding is HUGE due to the stigma. I hope and pray someday it will be different and maybe people will be more compassionate, like they are here. Judge nobody until you have been there.

  • Noel.Martin
    6 months ago

    Hi vikkr, I love these responses you have outlined. It is so sad that the stigma around lung cancer affects so many people. You are so right, NO ONE deserves cancer! Thank you for sharing your perspective with us. Best, Noel Team

  • vikkr
    8 months ago

    FABULOUS, I could not have said it better.

  • hedgiemom
    12 months ago

    Touche’! I had a similar experience in the ER. When the nurse asked me if I had any other medical problems, I told her I had stage 4 NSCLC -squamous. She said”did you smoke?”. I got really mad and asked her why do people automatically assume that? I said “ no, I had radiation to my chest in the 70’s, and my doctors were too stupid to recognize the warning signs, I had been having for over a year and a half! She said”oh, I’m sorry to hear that”.

  • Gladup
    5 months ago

    Yes, unfortunately, many even in the health field are ignorant of causative factors , and insensitive as well. We can only try to educate them and let them know their judgement is just that and has no place in the health care environment.

  • KarenAmy
    1 year ago

    All i can say is hallelujah to that! I do find myself feeling guilty for having smoked and everyone around me reminds me of it. I quit one month before being diagnosed. So thank you for easing the guilt a little.

  • katiek
    1 year ago

    thank you!

  • Trudyandme
    1 year ago

    I can relate to the feelings people get when asked if smoking is the result of their lung cancer. What I have thought about over the last 3 years is, “How did I get lung cancer.” Well, how about an answer like “Do you or have you smoked?” I lived in a house with heavy smokers, worked in offices with heavy smokers, ate in restaurants with smoking, and flew on planes before smoking was banned. Can it be that I didn’t smoke, but the secondhand smoke got me?
    Thank you, for your post, yes, we do need compassionate, equitable care.

  • jdpatraw
    1 year ago

    I had breast cancer 23 years ago and had all positive comments. Even though I never smoked I am getting tired of people asking me this question of dis you smoke. My next response is going. To be – does it matter? No one deserves king cancer whether they smoked or not. Just sounding off. Your take on this is very nice. Helps to get info on both sides.

  • jdpatraw
    1 year ago

    Sorry about my mistakes in this rant.

  • Dfredal
    1 year ago

    This hits home…
    No I have NEVER smoked…but I did grow up in a house with High Radon levels.
    Test your home, Ask me I can help guide you.

  • Susie
    2 years ago

    I think some ask because they smoke and their fearful. Some dont realize that it hurts. Then; there those who are thinking; “well there you go”. I have had many who dont even ask.

    Over the last two years and 5 oncologist they annoy me the most at this point. The first question is; “are smoking now”? If your not than its when did quit and how long did you smoke? How much did you smoke. Maybe for their statistics.

    I told the most recent one that I quit for 12 yrs and then picked it up again for 5 years but no one ever gives me credit for the 12 yrs. I quit. Does it really matter??? That is exactly what I will say to next person who ask me. In a nice way of course. (-:

  • Rosi
    2 years ago

    Never a smoker. Fortunately, my nodule discovered on r-ray due to bronchitis. Watched for three years with periodic scans and as soon as a change was noted, the adenocarcinoma was removed by a lobectomy. Surgeon follows the Sloan Kettering protocol where it is xrayed every 6 months and a scan now yearly. Now post 2.5 years cancer free. Yes, people look at me funny when I tell about my lung cancer but hey, I don’t care. I had my house treated for radon and it was expensive to do so particularly when radon is rare in my neck of the woods and no, it did not cause the cancer, as I have not lived in it long enough. No known reason as to what caused my cancer and there are many of us out there, being found to have cancer, without a known reason.

  • merpreb
    2 years ago

    I have just posted a post on my blog, about this very same thing.

    It’s hard not to resent questions that put us down. Some questions are actually demeaning and insulting. I’m glad that you started this conversation.

  • Margot moderator
    2 years ago

    Hi @merpreb,

    Thanks so much for sharing your blog on this topic; your discussions of guilt and shame were particularly powerful, as was in your last paragraph, “People like to have a say in how you live your life, how it can be better, should have been better, and can be better. Although they are trying to help it does just the opposite.” I know many in the community can unfortunately relate to the experiences you discuss. Hopefully as awareness about lung cancer increases, these instances will decrease in frequency. Thinking of you.

    Margot, Team Member

  • Gladup
    5 months ago

    Yes, I do think it’s getting better as awareness and education about lung cancer increases. Many people now know there are other causes and often no known cause for this disease, some as other cancers. No person deserves it.

  • cookie143
    2 years ago

    actually whether u smoked or not is no ones business and thats what i would say if people want to be rude i can also be rude no one wants this terrible disease im sure no one said oh let me smoke so i can get lung cancer so people be a little more compassionate if u cant say anything to support the person then dont say anything at all

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