Reasons Quitting Smoking Won't Eliminate Lung Cancer Deaths

Lung Cancer Awareness Month Isn't About Smoking

There are many reasons why quitting smoking won't eliminate lung cancer deaths, and this is an important point to make when some organizations focus "lung cancer awareness" efforts on smoking cessation. Information about smoking cessation is presented year-round, but does little for the vast majority of people living with the disease. Lung Cancer awareness should focus on support, education (as to symptoms and who should be screened), and to improve funding so that progress can be made—including not just better treatments, but research into the reasons why lung cancer is increasing in young women who have never smoked and haven't been exposed to secondhand smoke.

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Lung Cancer Awareness is About Lung Cancer Not Smoking

close-up of cigarettes
Why quitting smoking won't eliminate lung cancer deaths. Peter Dazeley/Photographer's Choice/Getty Images

Many people have been upset recently as well-meaning organizations have made smoking cessation the focus of lung cancer awareness month. Certainly, encouraging the public to never begin, and to quit if they smoke, is commendable. And for people living with lung cancer, quitting may improve survival. Yet lung cancer awareness month should have a different focus.

Spreading information on smoking cessation does little overall for those living with lung cancer today. The majority of people diagnosed with lung cancer today are non-smokers; they are either former smokers or never smoked.

To focus on smoking during lung cancer awareness month is analogous to making breast cancer awareness month all about informing women that they should have their first child before the age of 30 (to decrease the risk of breast cancer) and that everyone should breastfeed their children for year. Awareness month should be about supporting people with the disease, not about discussing the causes, as it is for women (and men) with breast cancer.

Awareness month should also be about funding to research better treatments. Those who smoked in the past won't benefit from a lecture about what they could have done differently 20 years or 30 years ago. Instead, people with lung cancer need treatments today. And for never smokers with the disease—not uncommon considering lung cancer in never smokers is the sixth leading cause of cancer deaths in the U.S.—this focus makes a month designed to celebrate their lives irrelevant. 

Some people may remain skeptical, but read on for further reasons why lung cancer awareness month should not have smoking cessation as the central focus.

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The Majority of People With Lung Cancer are Not Active Smokers

The majority of people with lung cancer are non-smokers. Istockphoto.com/Stock Photo©tai11

Lung cancer is the leading cause of cancer deaths in both men and women in the United States. Lung cancer kills twice as many women as breast cancer and three times as many men as prostate cancer. 

Smoking is important. It is the leading cause of small cell and non-small cell lung cancer and contributes to 80 percent and 90 percent of lung cancer deaths in women and men, respectively. Men who are smokers are 23 times more likely to develop lung cancer. Women who smoke are 13 times more likely, compared to never smokers.  Between 2005 and 2010, an average of 130,659 Americans (74,300 men and 56,359 women) died of smoking-attributable lung cancer each year. Exposure to secondhand smoke causes approximately 7,330 lung cancer deaths among nonsmokers every year. Nonsmokers have a 20 to 30 percent greater chance of developing lung cancer if they are exposed to secondhand smoke at home or work. 

Yet, even though smoking is a major cause, the majority of people who develop lung cancer today do not smoke. This includes people who smoked at some time in the past, as well as never smokers. In the United States, 20 percent of women with lung cancer are lifelong never smokers, with that number rising to 50 percent of women with lung cancer worldwide. And while around 30 percent of people smoke at the time of diagnosis, only 14 percent of people with lung cancer continue to smoke 4 months after the diagnosis is made.

In other words, the majority of patients who do not smoke at the time of the diagnosis of lung cancer are past smokers and they already quit smoking before being diagnosed. For this reason, the majority of people diagnosed with lung cancer today will not benefit from hearing about the hazards of smoking. Instead of being helpful, the focus on smoking serves to propagate the stigma of lung cancer as a smoker's disease, which in some cases is untrue. Unfortunately, even never smokers may have been subjected to this blame game. Have breast cancer? Nice. People act loving and ask how they can help you. Have lung cancer? People first ask you how long you smoked. And even if you say you didn't, they may raise their eyebrows and ask if you were a closet smoker. It's no surprise that many people diagnosed with lung cancer wish they had been diagnosed with breast cancer instead.

There are many reasons that living with lung cancer can be harder than living with breast cancer. Let's not add the stigma of smoking to this hardship.

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There are Other Causes of Lung Cancer

There are many causes of lung cancer. Istockphoto.com/Stock Photo©martin_33

Even if tobacco had never been introduced on the planet, we would still have lung cancer. Yes, smoking is the leading cause of lung cancer, but causes other than smoking are very important. Though the number seems small—20 percent of women who develop lung cancer being never smokers—this translates to a fifth of the 70,500 lung cancer deaths in women expected for 2018.

Radon exposure in the home is the second leading cause of lung cancer and the number one cause of lung cancer in non-smokers. Roughly 27,000 people die from radon-induced lung cancer each year, and this cause is entirely preventable. Picking up a radon test kit from the hardware store (usually $10 to $20), and having radon mitigation done if the test is abnormal, is all that's needed. During radon awareness month in January, many state health department even offer testing for free.

Putting these numbers in perspective may help. Around 40,920 women are expected to die from breast cancer in 2018. If we had a $10 test to check for a risk factor, and a procedure costing less than a thousand dollars that could completely prevent almost three-fourths of breast cancer deaths, do you think we would have heard? Why doesn't the public know about this? It goes back to the focus of this article; we are placing the emphasis of lung cancer awareness on smoking, and in doing so, are leaving the public with a false sense of assurance that all's well if you don't smoke.

There are other causes worth mentioning, from air pollution to indoor air pollution, to secondhand smoke, to occupational hazards (on-the job exposures are thought to contribute to up to 27 percent of lung cancers in men). Don't assume you are safe if you never smoked. Learn about the other causes of lung cancer in non-smokers and what you can do to reduce your risk.

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People Who Have Quit Smoking Are Still at Risk

People are at risk for lung cancer even after quitting smoking. Istockphoto.com/Stock Photo©imtmphoto

Quitting smoking certainly reduces the risk of lung cancer, but for most, some risk always remains. There are more former smokers who develop lung cancer each year than current smokers.

If you smoked in the past, don't fret yet. After 10 years of quitting, the risk of lung cancer decreases by 30 percent to 50 percent. There are also some ways of reducing your risk of dying from lung cancer.

One method is low-dose CT lung cancer screening. While screening doesn't lower the chance that you will get lung cancer, it does increase the chance that if you develop lung cancer, it will be found in the earlier, more curable stages of the disease. It's thought that screening people at risk could reduce the mortality rate from lung cancer by 20 percent in the United States. 

Screening is currently recommended for people between the ages of 55 and 80, who have a 30 pack-year history of smoking, and continue to smoke or quit within the past 15 years. In some cases, screening may be recommended for other people based on personal risk factors for lung cancer. Unfortunately, lung cancer screening is recommended far too infrequently, and efforts are in place to prompt more primary care physicians to recommend this testing. In other words, don't ask for your doctor to make the recommendation.

Unfortunately, we don't yet have a screening test for the majority of people who develop lung cancer today. Possible methods, such as testing for cell-free tumor DNA in a simple blood test, may change that in the near future.

In addition, studies looking at exercise and lung cancer as well as diet and lung cancer suggest there are some things that both people without and people with lung cancer can do to lessen risks. 

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The Stigma Interferes With Early Diagnosis

Stigma interferes with early diagnosis of lung cancer. Istockphoto.com/Stock Photo©lisafx

One of the highlights of lung cancer awareness events is when lung cancer survivors share their story, but rarely does misdiagnosis go unmentioned. Time and time again people share what eventually led to their diagnosis—often a series of visits, with several doctors, over a period of months, during which time they have been diagnosed with everything from asthma to Lyme disease.

Lung cancer flies below the radon screen for many health care professionals, especially lung cancer in never smokers and lung cancer in young adults. For this reason, many are diagnosed when lung cancer has already spread, and the chance of a cure with surgery has passed. In fact, young adults and never smokers are more likely to be diagnosed at an advanced stage of the disease.

Until we have a widespread screening tool for lung cancer, it's important for health professionals and patients alike, to realize that all you need to get lung cancer is lungs. The symptoms of lung cancer can be different in non-smokers than smokers, and those of lung cancer in women are often different than symptoms in men. Be your own advocate. If you have any symptoms that aren't adequately explained, ask for a better explanation or a second opinion. 

If we are to find lung cancer early, we need to dispel the myth that lung cancer is a smoker's disease. That's part of what lung cancer awareness month should be all about.

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The Stigma Interferes With Research for New Treatments

Stigma interferes with research for new treatments. Istockphoto.com/Stock Photo©AlexRaths

The stigma of lung cancer leads to less research. Private funding for breast cancer surpasses that of lung cancer by a great distance, as evidenced by Susan G. Komen being a household word and pink ribbons having a widely recognized significance. How many people can name the largest non-profits for lung cancer, and how many people even know the color of the lung cancer ribbon?

Public funding also lags far behind for lung cancer, and this is important because funding means dollars which in turn means research. In 2012, federal research spending added up to $26,398 per life lost to breast cancer, vs only $1,442 per life lost from lung cancer. It is heart-breaking to contemplate what the survival rate for lung cancer would be if the same amount of money and research had been invested as has been with breast cancer.

Why is the funding so low, and why are researchers less likely to devote themselves to lung cancer? The stigma. There is an unseen, unheard statement that says, "These people smoked so they deserve to have cancer." Nobody deserves to have lung cancer, whether a never smoker or a lifelong smoker. Making smoking cessation the focus of lung cancer awareness only increases this stigma and gap. 

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The Stigma Interferes With Research About Causes

The stigma of lung cancer interferes with research of the causes. Istockphoto.com/Stock Photo©tupungato

We noted the comparison between radon induced lung cancer deaths and breast cancer deaths earlier. One of the explanations for the difference is that breast cancer often affects women who could be someone's wife, mother, sister, or daughter, but almost twice as many wives, mothers, sisters, and daughters die from lung cancer as breast cancer.

Others point out that breast cancer often affects young women, and that lung cancer more often affects older people. Or they note that lung cancer has begun to decrease in incidence overall now that fewer people smoke. Yet there is an important fact that's being overlooked.

Lung cancer is increasing in young, never smoking women.

A 2018 study in The New England Journal of Medicine noted that the incidence of lung cancer in young women is now higher than in young men, and the discrepancy can't be attributed to smoking alone.

And we have no idea why.

It seems if we saw a similar increase in breast cancer incidence in young women it would be all over the news, with many theories as to why.

This changing epidemiology of lung cancer is not occurring in the United States alone. A 2017 study published in the Indian Journal of Cancer found that of women diagnosed with lung cancer, 76.1 percent to 84.9 percent were never smokers. The researchers concluded that we need to look beyond tobacco exposure when evaluating the causes of lung cancer.

The stigma of lung cancer, however, has led to much less research into the causes. Focusing on smoking cessation is not going to do anything for the increasing number of never smoking (and not exposed to secondhand smoke) young women who are being diagnosed with the disease.

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Lung Cancer is Increasing in Young, Never-Smoking Women

Lung cancer is increasing in young never-smoking women. Istockphoto.com/Stock Photo©nicomenijes

 Not only is focusing on smoking cessation not going to tell us anything about the causes of lung cancer in young people who don't smoke, but it leaves women without the support that organizations such as the American Cancer Society provide for women with breast cancer.

These women have to put up with constant questions about their smoking status, or another variant, "Did your parents smoke when you were growing up?" It's a double disservice to have non-profits who ordinarily support people with cancer to dismiss them as well.

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Focus of Lung Cancer Awareness Month

Lung cancer awareness month is for support and research for a cure. Istockphoto.com/Stock Photo©Zerbor

Okay. So smoking cessation shouldn't be the only focus of lung cancer awareness month. What should be at the center of awareness?

Support

The number one focus should be support. Every single person with lung cancer—regardless of smoking history and regardless of age—deserves our love, compassion, and the best care possible. Think of how women are treated during breast cancer awareness month—how they are celebrated, how they are reminded that research is being done to make a difference. 

If you just don't know what to say to someone who has lung cancer, check out these tips on things not to say to someone with lung cancer. How would you treat your friend or loved one with lung cancer differently, if she had breast cancer instead? These are honest questions that may be hard to ask.

Awareness/Education

The second focus should be about awareness. Not smoking cessation as this is done everywhere year round. Instead awareness that lung cancer occurs in non-smokers and having knowledge of the early symptoms could make a difference are messages that need to be shared widely. Those who are former smokers should have the opportunity to learn about screening options.

Funding

And just as breast cancer awareness month raises funds for research, lung cancer awareness month should also be a time to educate and encourage those with lung cancer about new advances, while providing funding for further advances.

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A Word About Smoking and Lung Cancer

For smokers with lung cancer, quitting is critical. Istockphoto.com/Stock Photo©quintanilla

To speak of separating lung cancer awareness month from smoking is not to dismiss smoking as a cause of lung cancer. It is. 

For the minority of people living with lung cancer who smoke, quitting is incredibly important, and likely the most important thing anyone can do to improve survival. There are at least 10 reasons to quit smoking after a diagnosis of cancer. Quitting smoking after a diagnosis of lung cancer improves the response to cancer treatments, improves quality of life, and improves survival.

For those without lung cancer, quitting not only reduces lung cancer risk, but improves survival in other ways. In addition to lung cancer, there are many cancers that are associated with smoking, and many other medical conditions associated with smoking.

The Quit Smoking Toolbox is a free resource to help you gather the tools you need to be successful in giving up the habit.

But remember that these tips on smoking and cancer were placed at the end for a reason. They apply to only a minority of people living with lung cancer today.

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