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The American Cancer Society

A Moment Of Reflection As The Pink Of Breast Cancer In October Gives Way To The Reality of Lung Cancer In November

by Dr. Len November 05, 2012

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.

Comments

11/6/2012 2:04:36 PM #

Fran

Please put your money where your mouth is.  $12 million a year spent on lung cancer research out of $1 billion raised is a pittance for the deadliest cancer.

And please, do not insult us by waxing poetic over breast cancer and blaming the lung cancer patient while trying to say you sympathize with lung cancer patients having to deal with this inequity.  Did you even reread what you wrote before you posted it?  You had to link smokers and evil in the same sentence?  I suggest you spend some time reading the lung cancer forum on Inspire.com.  There you will find people who have had to band together to help each other in absence of support from "charitable" organizations such as yours.  (Maybe that is why we are one of the largest and most active forums on Inspire.)  Spend some time and read people's stories.  Maybe then you will find that lung cancer is also a "passionate and compassionate topic".


P.S. if you want to do something about the stigma in addition to admitting that lung cancer is worthy of ACS's funding, then move the Great American Smokeout out of November.  How can there not be a stigma when the ACS tells people there is.

Fran

11/6/2012 2:44:34 PM #

Amy

Dr. Len,

"They know they have received a virtual death sentence when they are diagnosed."

- This is not how my mom felt the first time she was diagnosed with lung cancer, nor the second time. Thank god she did not. Because of her hope, I had her with me for 5 years beyond her stage IV diagnosis.

"But not everyone had a hand in bringing the tragedy on themselves."
- I see. My mom "brought the tragedy" of lung cancer on herself. Thank you for perpetuating the stigma.

"There is no army of survivors."
- On the contrary, I know the army well. I may not be a lung cancer survivor, but I am part of that army. And it is thanks to organizations like yours that choose to ignore MY army and highlight other armies that this invisibility continues.

My army and I will keep marching forward regardless of the lack of hope, support, and respect you give us.

Thank you for reminding me why I do what I do.  

Amy

11/6/2012 7:18:38 PM #

K Latzka

Dear Dr. Lichtenfeld,

You say "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."

Who is "We"?  I've searched PubMed and don't find any research articles which include you as the author.  Is "We" the ACS?  Who at the ACS?  Can you please cite specifically how ACS took part in these advances?  If not, please rephrase this paragraph.  YOU should not be taking credit for the work of other scientists, who ARE committed to finding innovative lung cancer screening and treatment options.

K Latzka

K Latzka

11/6/2012 7:38:09 PM #

Gregory Pawelski

And the Reality of Lung Cancer is that November is Lung Cancer Awareness Month, and we have the opportunity to focus national attention on this disease, the leading cause of cancer.

Dr. Robert A. Nagourney has reminded us on this latest blog posting, with the advent of lung cancer awareness month, we have the opportunity to educate the public and expand awareness of the desperate need for advances in this disease.

The disparity in funding for lung cancer patients compared with ovarian or breast cancer patients is disturbing. For every lung cancer death, there are five to ten times more dollars expended on research to prevent breast and ovarian cancer deaths.

While he applauds the successes in breast and ovarian cancer treatment, he encourages lung cancer patients to call your congressperson to make lung cancer a front burner issue.

http://cancerfocus.org/forum/showthread.php?t=3796

Gregory Pawelski

11/7/2012 6:06:00 AM #

Brandy Bennett

null
Why is breast cancer 'worthy'? Why would the location that rogue, runaway cells choose to proliferate in the body make one cancer more 'worthy' than another? Why would an organization such as the American CANCER Society, fund breast cancer research above all other cancer research, when it is a proven fact that lung cancer kills more people than breast, ovarian, colon and prostate cancers combined?   I believe it is because of stigma.

All unhealthy lifestyle choices will lead to some type of consequences eventually.  Smoking seems to be the one that is demonized the most. We make look down on those that don't eat healthfully, or who have multiple sex partners, or who drink too many glasses of wine, or who do not exercise regulary.  But those that smoke, not only are they unhealthy, They DESERVE lung cancer???  Well not really.  Not in my mind. Never mind that so many of those that are diagnosed quit smoking decades ago.  And 10-15% NEVER smoked.

So, instead of blasting the media, facebook pages, Relay for Life events with pertinent education information, ACS has written this letter about how the victims probably smoked and could have prevented their disease.  Never mind that those with breast cancer could have led healthier lifestyles, abstaining from alcohol, eating low fat, not smoking, etc.  It is NEVER a breast cancer survivor's fault. IF ACS really cared about LUNG cancer, they would spend the whole month of November telling the world about early symptoms of lung cancer, early detections screening tools and educating the world that smokers and nonsmokers can get lung cancer.  Unfortunately, the world does not know this.  INCLUDING doctors.  SO they are not looking for this disease and often miss it, leading to a later diagnosis, which in turn leads to a poorer prognosis. PLEASE ACS, spread the word.  We will supply you with the education materials.

You are being bombarded with a wealth of information from an army of people.  I don't personally know them all. I know some of their names, some of their faces, some of their stories.  WE WILL NOT QUIT. WE WILL NOT QUIT. LUNG CANCER IS NOT SEXY. BLOOD TINGED PHLEGM IS UGLY. A COUGH THAT WILL NOT STOP IS EXHAUSTING. TUMORS ARE UGLY. CHEMO INDUCED STROKES ARE DEBILITATING. DRAGGING AROUND OXYGEN TANKS SUCKS. SILVER COLORED CASKETS ARE HEARTBREAKING. THIS IS REALITY.  

Brandy Bennett

11/7/2012 6:40:30 AM #

Stephanie

Just the headline......"the pink of breast cancer" "the reality of lung cancer" What's up with that?? I am so tired of this "people brought it upon themselves by smoking" Isn't drinking alcohol linked to breast cancer?? Why isn't  it mentioned that maybe the breast cancer victim should not have had that glass of wine?? I'll tell you why....it DOESN'T MATTER....the victim still has cancer!!! This article has just reinforced the stigma! We are building an army of survivors. As a former smoker I am not ashamed and I will not hide! I will bring my voice and join other lung cancer victims in protest. Stop with the pretend support.......we want real support...real money for awareness......and a real chance at survival.

Stephanie

11/7/2012 12:51:43 PM #

Kim Wieneke

"There is no army of survivors."  Actually, there is and I am part of that army.  It is not as well known as the ladies in pink but it does exist.  

Kim Wieneke

11/7/2012 5:28:59 PM #

thebyrdsfriend

I am part of that army too!  I am a stage 3A nsclc survivor.  Diagnosed 5-26-2010, lobectomy, chemo, and NED since 7-12-2010.  I am tired of all the pink.  I feel it's outlived it's color, and taken away monies that could be helping all kinds of cancer.  It's beyond me why the number one cancer killer in the nation is the least funded.  Sometimes we aren't smokers, sometimes quit smoking decades ago.  I myself worked my entire life in the service industry.  I waited tables at 16, where ashtrays were on the tables.  At 21, I began working where I could make the most money, being able to serve cocktails, and smoking was rampant.  I am affected by second hand smoke from working my entire life in the restaurant business.  Dang me.  This doctors attitude towards us lung cancer patients is un-acceptable.  NO ONE should ever take away hope!!  No one should ever say we have a death sentence!!  Mr. ~  You have taken on the wrong cancer survivors here.  We are STRONG, and we are ALIVE!

thebyrdsfriend

11/7/2012 9:45:05 PM #

JY

It's infuriating that you write "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."

My lung nodule was found by accident at the age of 38.  At the age of 40, I had it removed and it was staged at 1b.

I am not old, I do not have other chronic diseases and I never smoked.

Shame on you for scaring people by saying it is almost always a fatal disease.  And if you believe that, what are you and the ACS going to do about it?

Stop blaming the victims/survivors and start doing something positive with your resources.

JY

11/7/2012 10:26:02 PM #

Dinia

Talk is so CHEAP isn't it? Lung cancer death sentence, only due to lack of research. Talking and doing nothing for all Cancer, is nothing more than Criminal....Making money off of body parts such as the best seller, namely BOObs.There truly needs to be a Major Audit, and criminal charges for human traffician of body parts.Where is all this MONEY going?

Dinia

11/8/2012 2:36:07 PM #

Laurie

What a shame to read yet again an article blameing me for my lung cancer. I was a smoker and was diagnosed at age 44. The good news is that I am alive and well and quite active 6 years later. Stage 4.
My father-in-law smoked from age 10 to age 86 and did not get lung cancer.

In my local cancer support groups, there are people who did not smoke and are not here to tell about it because they were dx'd at a late stage and where not given much hope either.  Why are screenings only promoted to help people who have a history of smoking?  Why do you want me to believe it is an auto-matic death sentence?
Did you do ANY research before you penned this article?

In you're "professional" opinion are your stating smoking is only linked to lung cancer? That would be good news to the breast cancer victims that have or are still smoking. Well, everyone that has cancer. Do you shove this in their nose too?  I have not seen evidence warning the population about the links or spilled wine glasses promoting breast health.


And lastly, have YOU been sniffing glue?

God bless-Laurie

Laurie

11/9/2012 12:45:36 PM #

Becky

The reason we still have the stigma surrounding lung cancer is because of articles like this. All this article does is further the idea that there is a stigma, instead of trying to take it away. Way too much focus on the stigma and WAY too much focus on breast cancer in an article that should be focused on lung cancer and HOW we can change the statistics! So ashamed of ACS right now...

Becky

11/9/2012 11:16:09 PM #

Anna Lyon

Thank you. This article is a great first step toward showing the inequity in treatment and research for a cure of lung cancer and the horrific stigma it's victims must endure due to the ignorant notion that only smoking causes lung cancer. No, the ACS stance isn't yet perfect, but I see this as a hopeful step in the right direction.
The testing won't prove effective until researchers figure out that ANYONE might get it and test early and often, as they do with breast cancer and mammograms, colon cancer and colonoscopies, etc. You are correct that the politicization of cancers serves no one. Although I fight for the lung cancer victims, many of whom are no longer with us to fight for themselves because of the lack of research and early screening, I often wonder about those folks who have other non-trendy, outside-the-pink cancers, such as anal or some other body part no one wants to talk about. Again, a step in the right direction.
But please, it's November. Lung Cancer Awareness month. While ALL cancers need to be fought, it's time to look at this particular cancer and the compounded damage done to victims by this obsession with smoking.

Anna Lyon

1/17/2013 3:27:34 PM #

Danielle Greason

Removing heavy metals, toxins, neurotoxins, endocrine disruptors and hormone modulators from your body and from your environment is one of the keys to allowing your body to heal from cancer. Marcus Freudenmann explains many of the key holistic protocols in this video series here http://youcanhealcancer.com

Danielle Greason

About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.

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