From the Grace Archives | Originally Published November 13, 2014 | By Dr. Weiss 

Smoking is the most common cause of lung cancer – 85% of lung cancer patients have smoked at some point in their lives (or, stated another way, 15% of lung cancer patients have never smoked).  While quitting smoking certainly decreases the risk of getting lung cancer, more than half of lung cancer happens in people who have quit.  

Reason #3 to not blame the lung cancer patient:

Nicotine is really, really addictive.

After passing step one of my medical boards, my father decided to take me to Las Vegas to celebrate and for some father/son bonding. On our first night, he awoke in a cold sweat. As a burgeoning doctor, freshly woken from sleep, I was ready for action, “Dad, do you have chest pain?” “Can you breathe?” “What’s going on?” My father, almost 20 years after quitting smoking, had awoken with a dream of having a cigarette. Nicotine is that addictive. For a while, scientists had believed that it was the second most addictive chemical known to mankind, but many now rank it ahead of heroin. As anyone who has known addiction in their lives or the lives of someone they’ve cared about, addiction takes choices away.

While I’m sharing personal stories, I will admit that I smoked a cigarette in college. Some people, like me, smoked one cigarette, found nothing pleasing in the experience, and stopped. Other people have a very different experience—they find cigarettes pleasurable. Maybe they try a cigarette in their teens socially, perhaps after a few drinks. For a while they’re social smokers, never buying their own. Then, over time, they find that they’re craving the cigarettes. After a breakup or some other stressful experience, they smoke more. Pretty soon, they have a habit, and wake up one day, reach for a cigarette, and realize that they are an addicted smoker.

The tobacco industry has supported this process. Big Tobacco historically advertised to children. They promoted an image of smoking as cool. They misrepresented and even lied regarding the health effects of smoking cigarettes. The delivery of nicotine per cigarette and its speed of administration are more tightly controlled than many pharmaceutical products. Simply put, cigarettes are delivery devices for a harmful drug that, for reasons of American culture and law, are legal.  

Legally, you must be 18 years of age to purchase cigarettes in the US. But, in reality, teenagers find access to cigarettes fairly easily. Many teenagers are addicted to these harmful products long before they are smart enough to reject them; quitting later isn’t so easy. 

In America, we have a strong culture of personal responsibility, but the reality of nicotine addiction does not support this idea—personal choice, at best, is very incomplete when addictive substances are at play. I think that we can all agree that we should educate our children and teenagers about the harms of cigarettes and give them the coping skills to reject them. I think that we can all agree that smokers should be motivated to quit and that the medical system should give them all the counseling and medicines that can help. But, no matter how much we endorse empowerment of individuals to never start smoking or for smokers to quit, we cannot ignore the hard data that suggests that there are powerful forces at work other than personal choice.

Reason #4 to not blame the lung cancer patient:

Stigma hurts the patient (smoker or not) and it hurts efforts against lung cancer.

Stigma occurs when society views a person or group as inferior or disgraced because of some characteristic.  In other stigmatized diseases, stigma has been shown to negatively affect patients and health outcomes and some data demonstrates the same in lung cancer. Stigma also negatively affects public efforts to fight lung cancer. Although a nonsmoking woman has greater chance of dying of lung cancer than of breast cancer, lung cancer receives $1,337 in research funding per death while breast cancer receives $16,850 per death. More Americans will die this year of lung cancer than colon cancer, breast cancer and prostate cancer combined. America  (correctly) recognizes that breast cancer is a terrible disease — in October, the pink ribbon is everywhere. But where is the white ribbon in November?

And, if we want to talk about stigmatized and invisible smoking-associated cancers, dear reader, can you tell me what color the head and neck cancer ribbon is? Don’t feel bad if you don’t know; I didn’t know either until I started treating head and neck cancer patients — it’s red and white striped. Simply stated, efforts against breast cancer are popular; companies want to associate themselves with efforts against breast cancer because it improves their images. In contrast, fighting lung cancer, head and neck cancer, and other smoking related cancers is less popular, at least in part, because patients are blamed for their disease. A large survey of the general public found that 59 percent believed that lung cancer patients were at least partially to blame for their cancer. Despite the poor funding described above for efforts against lung cancer, only 12 percent of Americans choose it among cancers to deserve greater support.

A suggestion for refocussing our attention

I suggest that lung cancer patients should not be asked if they smoked—it is irrelevant because neither smokers nor nonsmokers deserve lung cancer or should be blamed for it. If you have been touched by lung cancer, consider doing something about it. Consider joining your local advocacy organization—in North Carolina I’m a big fan of the Lung Cancer Initiative and on a national level, there are many fine organizations to join. Better yet, if you think that we do good work here at GRACE, consider donating to us! 

Regardless, I’d like to spend less time on blame and more time on real action.