The Consequences of Lung Cancer Stigma

Stigma surrounding patients with lung cancer can have very real consequences. According to Lungevity.org:

• About 1 in 16 Americans will be diagnosed with lung cancer in their lifetime.

• About 60%–65% of all new lung cancer diagnoses are among people who have never smoked or are former smokers.

• More people die of lung cancer than breast cancer, colorectal cancer, and prostate cancer combined.

These surprising statistics raise questions:

• Why is lung cancer more common than we think?

• How do people get lung cancer if they don’t smoke?

• Why is it so deadly?

One contributing factor of these statistics is stigma. In honor of World Lung Cancer Day, we look at how the continuing stigma associated with lung cancer has consequences for awareness, early detection, research, treatment advances, and ultimately, survivorship.

What is Cancer-Related Stigma?

Stigma is a negative belief formed in ignorance and fear that can result in isolation and discrimination. Some may avoid people with cancer because:

• They wrongly or subconsciously fear they can “catch” cancer from them or be affected by toxic treatments, such as chemotherapy.

• They don’t want to be associated with the physical weakness and death that may result from cancer.

• They blame people with cancer because they “didn’t take care of themselves” or didn’t find their cancer early enough.

Stigma doesn’t always come from external sources. It can also come from within. People with cancer may blame themselves for their disease. Whether external or internal stigma, feelings of shame and guilt can lead to denial, secrecy, isolation, and lack of motivation to seek help for their disease.

Why is Reducing Cancer Stigma Important?

These days we tend not to discuss a cancer diagnosis in hushed tones or refer to cancer as “The Big C”. This is good news for cancer survivorship. With less fear and stigma around cancer, more people seek treatment earlier, rather than waiting in dread and isolation. With more cancer survivors coming forward to tell stories of hope, more funds are raised, more research is conducted, and more progress is made in treatments. This virtuous cycle has contributed to positive increases in cancer survivorship in the U.S., with 18 million cancer survivors in 2022 versus approximately three million in the 1970s.

How is Lung Cancer-Related Stigma Different?

Less progress has been made regarding lung cancer stigma. Most people with lung cancer report a similar experience when they tell others about their condition. The response to their life-threatening, life-changing news is often met with: Did you smoke?

“There’s an assumption that you smoked and that you deserve to have lung cancer,” said Jennifer Morrice, a lung cancer survivor and ambassador for the American Lung Association, who is engaged in promoting early screening for diverse populations at risk for lung cancer. “No one deserves lung cancer.”

It’s possible to see the effect of this stigma in the ability to raise money for research. “Funding disparity tells a discouraging story with lung cancer research receiving significantly less funding than other cancers,” said Tushar Desai, MD, professor of medicine (pulmonary, allergy, and critical care medicine) at Stanford University School of Medicine in Stanford, California. A comprehensive study of cancer research funding by Northwestern University in 2019 found that breast cancer received $460 million, whereas lung cancer, which has a much higher fatality rate, received less than $100 million. The same report found that cancers associated with stigmatized behavior, such as drinking, smoking, and sex, received lower funding across the board.

As recently as five years ago, lung cancer stigma was on the rise. A study based on a decade-long survey from 2008 to 2018 found that 60.3% of people agreed with the statement, “Lung cancer patients are at least partially to blame for their illness” compared with 55.7% in 2008.

What’s Driving the Stigma Around Lung Cancer?

As per the Centers for Disease Control and Prevention (CDC), people who smoke tobacco are 15–30 times more likely to get lung cancer than those who don’t. With the help of massive antismoking campaigns over the course of the past 50 plus years, cigarette smoking rates in the U.S. have gone from 42.6 percent in 1965 to 13.7 in 2018, according to the American Lung Association, and continue to drop, to 11.5 percent in 2021, as reported by the CDC.

Although there’s much to celebrate in these numbers, an unintended consequence of the antismoking campaigns in the past decades has been an increase in stigma related to smokers and people with lung cancer. Lung cancer advocates are changing communication about smoking away from fear and blame to a better understanding of nicotine addiction and the benefits of quitting.

Why is Reducing Lung Cancer Stigma Important?

“Stigma is a double hit for lung cancer,” Morrice said, “Not only does stigma make it hard for people who smoke to get treatment for a highly addictive substance, it makes people who smoked less inclined to talk to their doctors and get early screenings that could help save their lives.”

Dr. Tushar pointed out that although stigma continues to rise around lung cancer, lung cancer not associated with smoking is also on the rise. “More people, especially women, are being diagnosed with cancer who don’t have a history of smoking.”

Morrice believes it’s critical to change our single-minded attitude about the cause of lung cancer only being smoking. “Whether we’re smokers or not, we all need to be concerned about the environmental risk in lung cancer.”

Environmental hazards such as exhaust fumes, wood smoke, and radon – a naturally occurring odorless gas that can accumulate in buildings and homes – are important risk factors for lung cancer, as is exposure to chemicals such as asbestos.

What We Can Do About Lung Cancer Stigma?

Every step of progress helps undermine stigma. The U.S. lung cancer five-year survivor rate increased to 23.7 percent in 2021, thanks to early screenings, as well as more effective targeted therapies. And there are positive actions individuals can take to fight against stigma and increase positive outcomes.

Early screenings: Talk to your doctor about early screening for lung cancer if you currently smoke, have quit smoking, have a family history of lung cancer, or are experiencing symptoms such as coughing or wheezing, shortness of breath, or unexplained weight loss. Check out the American Lung Association screening resources.

Empathy: If you’re living with lung cancer, have empathy for yourself and remember that no one deserves lung cancer. Talk to your doctor about your feelings and ask for help.

Awareness: If you or a loved one is living with lung cancer, share your story with others. Learn more about what advocates such as Jennifer Morrice are doing and consider becoming an advocate yourself.