Commentary: I Will Survive: Preventative Care and Removing the Stigma of Lung Cancer
It came as a sad surprise when actress Kathryn Joosten lost her public battle with lung cancer early this month and when disco icon, Donna Summers, lost her private fight with lung cancer at the early age of 63 in May 2012. Unfortunately, the stigma attached to a lung cancer diagnosis comes with the obligatory next question, “Did she smoke?” If the answer is “yes,” next comes a too-common reaction: “Well, then she should never have started or should have quit.” This very stigma prompted Summers’ publicist to hastily announce that Summers “was a non-smoker.” Either way, she has a lot of company. A clear majority (nearly 78 percent) of new lung cancer cases are former or never smokers.
Lung cancer — the No. 1 cancer killer in our nation for men and women alike — carries a lot of baggage beyond what is often a devastating diagnosis for the patient and their loved ones. The scale of whether we expend the emotional, public health policy and financial capital to fight lung cancer in the way it deserves is wound very tightly around this complicated public reaction. Not unlike the early AIDS epidemic, our society’s view on lung cancer is screaming for a social norm change and until it gets one, hundreds of thousands of people will die – many of them needlessly.
An analysis recently released in the Journal of American Medical Association (JAMA) regarding new screening guidelines for the American College of Chest Physicians, the American Society of Clinical Oncology and the National Comprehensive Cancer Network coincided with Summers’ untimely passing. The good news is that the guidelines recommend low-dose computed tomography (CT) scans — screenings that have been found to be effective in saving lives through early detection of lung cancer more effectively than traditional chest X-Rays.
While a step forward, the guidelines could negatively impact all those above and below the age parameters, especially those with a family history of lung cancer. They are only being recommended for current and former smokers aged 55-74 who have smoked the equivalent of a pack a day for 30 years or more and either still smoke or have quit within the past 15 years because of the presumed risks associated with false positives. These include potential unnecessary biopsies, undue anxiety and in extreme cases, unnecessary surgeries. Someone who started smoking at 15 and has smoked for 35 years, who has a family history of lung cancer, would not be recommended for a CT scan until the age of 55.
Donna Summers would not have been recommended for this screening because she was reportedly a non-smoker. She was certainly exposed for decades to high levels of occupational secondhand smoke in the venues in which she performed, prior to the age of clean indoor air policies. Even now, only about half of the states have enacted these kinds of important public health initiatives. Before I ended my own three-pack a day cigarette addiction 20 years ago, I was once in an Atlantic City audience in the 1970s along with hundreds of other smokers when Summers performed under just such circumstances.
I am now one of the millions of Americans who comprise “the worried well,” those who smoked, quit and now live day to day hoping they quit early enough to avoid a lung cancer diagnosis. I am screened annually with a CT scan to make sure if I do develop lung cancer, it will be detected early when the odds of survival are so much higher. The fact is that in one year, nearly 208,000 Americans found out that they have lung cancer and almost 159,000 of them lost their lives to it. My insurance doesn’t cover it, but I personally believe $300 is a small price to pay annually to find out if I have a fighting chance to beat the most lethal cancer there is. However, if these new guidelines are accepted as written, the government agency that determines what is reimbursed by insurance companies will deny the claims of tens of millions of smokers who might have benefitted from these scans, who will be shut out due to lack of coverage or not being advised to get one due to their age.
Summers’ colleague Gloria Gaynor’s songbook included another disco era anthem – “I Will Survive.” Thanks to CT scans, I’m confident that I will survive and I hope the science soon allows smokers and non-smokers – especially those with high exposure to secondhand smoke at work or at home – all of whom are at risk for lung cancer to do the same.
Cheryl G. Healton, DrPH
President and CEO