Have you smoked? Lung cancer, smoking and associated stigma
Since smoking has become all stigmatized, so is the disease most often associated with it.
Stigma related to smoking and lung cancer may be an obstacle to patients seeking timely diagnosis and treatment.
Lung cancer is the fifth most commonly diagnosed cancer in Australia, and is the main cause of cancer death. And, with only 17%, it also has a far lower five-year survival rate than other types of cancer.
According to the Associate Professor Joel Rhea, president of the RACGP for specific cancer treatments and palliative care, one of the reasons for the relative mortality of lung cancer is that it is often not detected early enough for effective treatment.
"Often when people develop symptoms and start an investigation, [lung cancer] there is plenty of progress, "he told nevsGP.
Numerous factors can contribute to a delay in identifying lung cancer, but one barrier that can be particularly significant in some patients is a disease-related stigma, which largely stems from its association with smoking.
"Smoking is now becoming an almost moral question," said Associate Professor Rhee.
One of the most common questions about people diagnosed with lung cancer is "Did you smoke?" Meanwhile, a study published by the Lung Foundation last year revealed that 35% of respondents believe that people with lung cancer are "their worst enemy" who are "guilty of themselves", while almost a quarter of people diagnosed with illness felt shame, guilt or fear of discrimination.
Associate Professor Rhe believes that it is important to reduce the harmfulness of lung cancer to make patients feel free of these stigma when consulting with their doctors.
"The last thing we want to do is evaluate smokers, which will lead to more stigma, which can lead to a later presentation if there are any problems," he said.
It remains important, however, to recognize that smoking is a risk factor for lung cancer and to teach patients to be cautious about possible symptoms.
"Educate patients about what to look out for," said Associate Professor Rhee. For example, if they have cough for three weeks or more, they should go and see their GP for the X-ray. "
Such vigilance also applies to GPs.
"We need to look after smokers and if changes or symptoms develop, we organize chest x-rays and give them a diagnosis as soon as possible," said Associate Professor Rhee.
"This means understanding our local reference pathways for lung cancer because you have to arrive [these patients] which was seen by a specialist early. "
While smoking is a risk factor for lung cancer, this is not the only cause, which is difficult to explain to patients who develop a disease without smoking.
One of the things they often ask is: "I never smoked, why did I get it?" Said Associate Professor Rhee. "It's hard to answer that because we really do not know for sure.
"In the end, smoking is a risk factor, and just because someone smokes nothing guarantees nothing, it just makes [disease] Much more likely. But people can also become really unhappy and develop lung cancer even if they never smoke.
"So you're trying to talk about it that way, but it's never easy – I'm not sure how satisfied people are with this explanation."
Associate Professor Rhe believes that, as the smoking rate decreases, the demographic situation of smokers, and the number and type of people who develop tobacco-related illnesses.
"The pattern has changed in terms of smokers, many more women, especially younger women, are currently smoking, which is troubling," he said. But whether it will affect lung cancer in that population is difficult to know.
"It's also likely to become more common to see lung cancer in people who have never smoked or stopped working many years ago than the traditional paradigm of a patient with equal lung cancer."
But, regardless of how the patient may have developed the disease, associate professor Rhe again emphasizes the importance of solving the problem without a judgment.
"Smokers must feel comfortable in being truthful to their doctors, so that means they have an open mind and not be condemned," he said.
"I think it's really important: maintaining good relationships and creating patients who feel comfortable around us, allowing them to return to us if there is any concern."