Something In the Air

There are no pink ribbons for lung cancer on products at the mall and no special coffee blends that donate to the cause, and celebrities don't accept Oscars while supporting lung cancer research on their lapels.

Holland was most struck by that about 15 years ago, when a woman in her 50s with Stage IV lung cancer highlighted the inequities in a stark way. "Would you believe I'm sitting in this clinic and wishing I had breast cancer?" the woman asked Holland.

When you receive a diagnosis of colon cancer, breast cancer or brain cancer, nobody blames you. But society immediately makes that one-two connection between smoking and lung cancer that leaves little room for sympathy. And when the patient actually was or still is a smoker, there is an undeniable inner turmoil.

Holland likens the shame and judgment that shrouds lung cancer to the stigma that has dogged HIV/AIDS.

The statistics give credence to anyone wanting to wallow in blame. About 85 percent of lung cancer patients are current or former smokers, according to the Lung Cancer Alliance.

"The prominence of smoking in media reports on lung cancer may be contributing to the stigma that lung cancer patients say they feel, regardless of whether or not they have smoked," said Diane Blum, executive director of CancerCare, a New York advocacy group that released a study in October on media coverage of lung cancer. The report pointed out that although stories about breast cancer often feature inspiring accounts of survival, 44 percent of articles written about lung cancer over a one-year period mentioned smoking, and none of them was about a lung cancer survivor.

That is not encouraging. However, it makes sense statistically: Five years after people receive a diagnosis of lung cancer, only 16 percent of them are still alive.

Clinical studies have noted the self-flagellation of lung cancer patients. "A history of smoking correlated with increased levels of guilt and shame, regardless of tumor type. A personal identification of past behaviors as contributing to cancer correlated with higher levels of guilt, shame, anxiety, and depression," according to a study at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center.

But unless they are asked specifically about their feelings as part of a study, most lung cancer patients do not open up to their doctors.

"The majority of patients I see are former smokers. I can tell you from my perspective as a thoracic surgeon, there is an awful lot of guilt about being a smoker or a former smoker," said Blair Marshall, a thoracic surgeon at Georgetown University Hospital. "But I'm not sure it's really talked about. I think the guilt aspect of it is swept under the rug."

There is one place that the feelings are beginning to be expressed. Online forums such as the ones created by LUNGevity and the Lung Cancer Alliance allow lung cancer patients to talk honestly to one another about their disease, their smoking, their guilt and the way family members are treating them. They post photos, their frustrations, their fears and long timelines chronicling their screenings, PET scan results, the amount of Taxotere they're taking.

"I am coughing up little traces of blood. I smoke and inhale cigars. Really don't know if I can take the treatment all of you have endured. Got a million questions, I don't know where to begin."