Now that we are saying goodbye to the pink of October as we move onward from breast cancer awareness month, let us welcome the month of November, when we will shift our attention to lung cancer.
An article I read this past week posted on "Fair Warning" highlighted these issues, using breast cancer and lung cancer as a frame of reference. It carefully and in my personal opinion very professionally looked at the differences. Not casting blame, not failing to report both sides of the story, the author concisely pointed out how the way we relate to these two cancers is so fundamentally different.
In October we are awash in pink. Sometimes it seems the whole world is "pinked." Breast cancer is a passionate and compassionate topic, one that touches so many aspects of our sensitivities and sensibilities. It is a disease which frightens many women. It is a disease worthy of our efforts to find a preventive strategy that is acceptable and a treatment that will provide a cure. It is a disease which in our minds is almost always curable, if only we find it early. And-please keep this in mind-it is a disease where the perception is common that women (and the rare man) didn't do something specific to cause in the first place, other than occasionally to have the unfortunate fate of having been born to parents who carried a genetic trait that increased their risk.
Although lung cancer is a disease that merits our concern and our focused and committed efforts to reduce its incidence and impact on our lives, our families and our society, the reality is that how we talk and act about lung cancer is eons away from how we approach the topic of breast cancer. After all, lung cancer is in the minds of many a disease that people bring on themselves. If only they didn't give in to tobacco. If only they had stopped when they knew the real risks. If only, if only, if only...
Lung cancer is almost always a fatal disease. It is a disease that frequently strikes in the later years of life, when other diseases are also prevalent, and those other diseases (think heart disease, diabetes, and lung disease) can substantially impact the ability to treat lung cancer. It is a disease where screening has proven to be successful, but we forget that the vast majority of people screened for lung cancer still died and a significant number of folks who were screened but didn't have lung cancer died from the investigations needed to prove they didn't have lung cancer in the first place.
Breast cancer touches almost everyone, and the survivors (fortunately) are legion. They carry the flag to promote early detection, research into treatment, political attention to issues of interest (think mammography and more recently breast density), and fundraising for the cause.
Lung cancer is, in comparison, much more hidden, even perhaps shunned and shamed, since it is perceived as a disease of blame. There is no army of survivors. Much less is spent on lung cancer research compared to breast cancer. Lung cancer does not get a lot of political attention unless we are talking about laws to decrease smoking (which are not bad in and of themselves). But when you think about it, many of those laws are backed not by the smokers-who still want the right to expose themselves to second hand smoke in the last refuges available, such as bars frequented only by adults-but rather by the legions of people who understandably will no longer tolerate the true evils of second hand smoke where they work, where they play and even where they live (smoking in communal buildings such as apartments and condominiums is becoming a hot topic).
Last month I wrote a blog about breast cancer, and pointed out that the focus on youth, sexuality and curability left a lot of women out in the cold, waving their hands, asking "What about me?" Women who have recurrent disease, women whose disease was diagnosed in an advanced state even though they "did everything right" (whatever that means). These are women with breast cancer who may find the attention on fitness, youth and survival just a bit off-putting as they struggle for their lives against very long odds.
Imagine the person suffering from lung cancer.
They know they have received a virtual death sentence when they are diagnosed. There are treatments available, but they don't do much to prolong survival. There are no professional sports leagues espousing their cause. And they know that society blames them for the tragedy they have brought on themselves.
But not everyone had a hand in bringing the tragedy on themselves. 10-15% of lung cancer victims are never-smokers. If non-smoking lung cancer was a separate category of cancer death, it would be between the seventh and ninth most common cause of cancer death in this country, according to research reported several years ago by one of my colleagues.
And then there are the people who did heed the warnings, who did break the habit, who did overcome one of the most addicting substances we can expose ourselves to. They still get lung cancer years later, even though they thought they turned their ship around. You see, over time, once a smoker stops smoking, their relative risk of lung cancer declines substantially compared to what would have happened had they continued to smoke. But what many don't know is that their absolute risk of lung cancer continues based on the exposure they had up to that quit date. Not that it isn't a great thing to quit smoking-it is, whenever you are able to do it-but it is not an absolute guarantee that the ravages of smoking will dissipate from your body and your risk will fall to that of a non-smoker. It doesn't, unfortunately.
Where does this leave us?
Let's not forget there are considerable successes that can trace their roots to the month of November. Clearly the American Cancer Society takes great pride in its history of promoting the Great American Smokeout in the month of November. There are a lot of people who can attribute their decision to stop smoking to the efforts of the Society and others over the past years the program has been active to increase awareness of the harms of tobacco and the benefits of quitting smoking.
We do have some recent successes in the treatment of lung cancer, even though those successes may only apply to a small number of people. New targeted therapies do offer some hope, and genomic analyses hold the promise of being able to apply new treatments to more people. We are becoming more focused on how to manage patients diagnosed with lung cancer, and we have new forms of radiation therapy that may offer longer survival to those who cannot undergo surgery. Surgery itself is becoming less invasive. I am even aware of at least one institution where almost all the lung cancer surgery is now minimally invasive, and I am certain there are many others.
But the nagging inequality of attention, effort, and political "correctness" of lung cancer vs. breast and other cancers cannot be overlooked.
Which brings me to another thought: is there anyone out there besides me who is frustrated and perhaps dismayed at this increasing "politicization" of our efforts to provide research and attention to various cancers? Are we so focused on our particular cancer that we lose sight of the larger picture? Are we becoming so narrowly committed that we forget that as we delve more deeply into the secrets of the genome that we are in fact finally learning truths that will be applicable to many cancers, and not just one? Do we have to line up like soldiers in formation to choose our favorite cancer and forget about the rest?
I know that nothing I say or write can bridge the gap. However, in my everyday life, I am concerned about all patients with cancer, from those with the most common to those with the most rare, from the adults and the elderly to the children and youth, from quality of life to the effectiveness of communications. I cannot-and will not-allow myself to put one cancer above another. I will always commit to supporting fundamental research to identify the root causes of these scourges, and will also commit to do what I can to improve the availability and effectiveness of the treatments we offer all patients with cancer, no matter what identifying moniker they may carry from their disease.
So my plea for the month of November is that we recognize the impact and the sadness of lung cancer, the reality that we really need to get past the blame game, and we need to be balanced in what we do, what we say, and how we say it. Suffering is suffering, and we should never forget it. We should remember that stigmas for cancer patients are punishing, and not every prejudice we have about how someone contracted a cancer is always the truth. Even if it were, those afflicted deserve the thoughtfulness, care and consideration we should offer all who have a serious and potentially fatal disease.
Perhaps if we work to achieve that balance, we can offer hope, love and support to so many more people with cancer who truly deserve the benefits of our attention and efforts, no matter the diagnosis or the month of the year. Let us never forget or lose sight of the fact that we are all in this fight together. No one person and no one cancer should ever have to stand alone.