Experts discuss the nature of lung cancer and the evolving stigma surrounding the disease.
PUBLISHED March 29, 2019
Philippa J. Cheetham, M.D.: Hello and welcome to CURE Connections®. I’m your host, Dr. Philippa Cheetham, joined today in the studio by Dr. Edward Kim of the Levine Cancer Institute. We are here to talk about small cell lung cancer, an aggressive disease that accounts for 10 percent to 15 percent of all lung cancer. It remains a particularly challenging cancer to treat with historically unfavorable outcomes. However, every day the healthcare community is working toward improving therapy as well as patients’ quality of life. Dr. Kim and I will address important information surrounding the diagnosis and treatment of small cell lung cancer, as well as other matters tangential for patient care. Thank you all for tuning in to Cure Connections®.
Dr. Kim, welcome to the set. It’s fantastic to have you join us here today. I know that you’re an expert in managing all types of lung cancer, and we hear so much now in the media about lung cancer, and I think it’s fair to say that most people know about the association of lung cancer with smoking. And that, of course, brings a stigma to the diagnosis, correct?
Edward S. Kim, M.D., FACP: Yes. It’s interesting, when I first started my training and decided I wanted to be a lung cancer oncologist, there weren’t many people who wanted to do that. And in fact, they questioned my sanity of, “Why do you want to go into lung cancer?” And I said, well there’s a lot of work to do. I thought when we get to a point where we have awareness, like breast cancer, that pink is a cool color right now, can we make lung cancer one of those recognizable diagnoses and help a very large patient population, and I think we’ve actually gotten there. It’s very gratifying to see what’s happened over the last decade to 15 years in the treatment, the diagnosis and the survivals in lung cancer, so it’s been great.
Philippa J. Cheetham, M.D.: Now obviously years ago when cigarettes first came out and patients were smoking 20, 30, 40 cigarettes a day, we didn’t know the dangers of smoking. And obviously roll the clock on 50-plus years, we now know the strong correlation between smoking and lung cancer. And I think that many patients who were diagnosed with lung cancer probably feel that sense of stigma, particularly when doctors say, “Oh, you know, do you smoke? Have you smoked? Are you living with people who smoke?” There is still stigma despite the fact that we know there is this association between smoking and lung cancer. And what about patients who get lung cancer who’ve never smoked, who’ve never been exposed to cigarette smoke?
Edward S. Kim, M.D., FACP: Yes, part of my research previously was studying ways we could try to help people who had prior smoking-related cancers. There is this stigma out there, and it’s not their fault. Virginia Slims tennis tours. We used to give cigarettes out to our GIs [government issues], as standard issue. And so tobacco has really become a problem because of the way society accepted it, and now it’s less so. You’re almost cool if you vape now, but you’re uncool if you smoke. So we have to make some changes there as well.
Most people have done the right thing, they have stopped active smoking. So there are now more former smokers than there are current smokers. This is just the United States. We have issues going on in China, India, other parts of the world. But that stigma stays on, and one feels a little embarrassed almost, or guilty, that they get a diagnosis of lung cancer if they smoked in the past.
Philippa J. Cheetham, M.D.: Right. And we hear so much about other cancers — breast cancer, prostate cancer — about patients getting screened. And now we are starting to hear much more about screening for lung cancer, which hopefully is encouraging people to come forward and drop the stigma. You mentioned already that many patients are not smoking now, but obviously they still have that ongoing risk, particularly if they were a heavy smoker. Do you think that the patients who still do smoke, that there is that reluctance to come forward, or are we making improvements of breaking down that stigma?
Edward S. Kim, M.D., FACP: I think it’s tough. I think for those who smoke now, they’re not afraid of telling you, but they feel guilty telling you because they know they shouldn’t. And again, behavioral patterns, we know it’s tough to stop smoking. People have had a lot of trouble with it, whether it’s behavioral, pharmacological, etcetera. But I think it’s important because, just as you mentioned, we have a screening test now. We’ve finally shown that we can reduce mortality by 20 percent if we screen the appropriate person.
We need to get that message out. We cannot convince our family practitioners, our internal medicine doctors to do it in everybody because that would require them taking an accurate smoking and tobacco history. I think the patients really have to be advocates about this and realize that they need to ask their doctors about it.
Philippa J. Cheetham, M.D.: I’m sure there’s plenty of people watching this segment who probably tell their doctors, “Oh, I only have two or three a day,” when, really, they’re [having] two or three packs a day. But obviously we’re here to help patients and we know this is a big risk factor, so it’s important for us to know up front of course.