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Did you smoke? Lung cancer, smoking and badociated stigma
Smoking is increasingly stigmatized, as is the illness that is most often badociated with it.
The stigma badociated with smoking and lung cancer can be a barrier for patients seeking rapid diagnosis and treatment.
Lung cancer is the fifth most commonly diagnosed cancer in Australia and the leading cause of cancer deaths in the country. And, with only 17% of cases, its five-year survival rate is well below that of other cancers.
According to Associate Professor Joel Rhee, Chair of the RACGP Network on Cancer and Palliative Care, one of the reasons for the relative death of lung cancer is that it is often not detected early enough to allow treatment effective.
"Often, when people develop symptoms and start doing research, [lung cancer] is quite advanced, he said newsGP.
A number of factors may contribute to delaying the identification of lung cancer, but one of the barriers that may be particularly important for some patients is the stigma badociated with the disease, which stems largely from its badociation with smoking.
"Smoking has become almost a moral problem these days," said Associate Professor Rhee.
One of the most frequently asked questions to people with lung cancer is: "Have you smoked?" who had "only to blame themselves" when nearly a quarter of those diagnosed with the disease felt shame, guilt or fear of discrimination
Associate Professor Rhee believes that to reduce the harm of lung cancer, it is very important that patients feel safe from this type of stigma when they consult their general practitioner.
"The last thing we want to do is to judge smokers, it will lead to greater stigma, which can then lead to a later presentation if there are problems," he said.
It remains important, however, to recognize that smoking is a risk factor for lung cancer and to teach patients to be vigilant with regard to possible symptoms.
"Educate patients about what to watch for," said Associate Professor Rhee. "For example, if they have been coughing for at least three weeks, they should consult their GP for a chest x-ray."
This vigilance also applies to generalists.
"We need to pay attention to smokers and if they develop changes or symptoms, arrange chest x-rays and have them diagnosed as soon as possible," said Associate Professor Rhee.
"It means understanding our local reference pathways for lung cancer because it takes [these patients] seen by the specialist at the beginning. "
Although smoking is a risk factor for lung cancer, it is not the only cause that can be difficult to explain to patients who develop the disease without smoking.
"They often ask, among other things," I never smoked, why did I? Said Associate Professor Rhee. "It is difficult to answer this question because we do not really know it.
"In the end, smoking is a risk factor, so smoking does not guarantee anything, [disease] much more likely. But people can also become really unlucky and develop lung cancer even though they never smoke.
"So you try to talk that way, but it's never easy – I'm not sure how much people are happy with that explanation."
Associate Professor Rhee estimates that the number and type of people who develop a smoking-related disease is changing as smoking rates and the demographics of smokers go down.
"There has been a change of pattern in smokers; more and more women, especially younger ones, are starting to smoke, which is a concern, "he said. "But if it will have an impact on lung cancer in this population, it's hard to know.
"It will probably also be more common to see lung cancer among people who have never smoked or quit smoking for many years than the traditional paradigm type of lung cancer equals."
But no matter how a patient has developed the disease, Associate Professor Rhee again stresses the importance of treating the issue without judgment.
"Smokers should be comfortable telling the truth to their doctor, so it means being open-minded and non-judgmental," he said.
"I think it's really important, to have good relationships and to put patients at ease with us, which allows them to come back to us if there are problems."
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