October has long been associated with the color pink. October was officially designated National Breast Cancer Awareness Month in 1985, and the pink ribbon became its symbol in 1992. But what public health issue is recognized in November? Few know that November is National Lung Cancer Awareness Month, or that lung cancer’s ribbon is white.
While some organizations hold lung cancer awareness events, the central theme is usually smoking cessation. The reason is obvious: Most people think the only cause of lung cancer is smoking or exposure to secondhand tobacco smoke. The truth is, smoking is not the only cause of lung cancer. Never-smokers comprise 15–20 percent of lung cancer diagnoses. While smoking cessation is certainly a worthy cause, better lung cancer prevention, detection and treatment will only be achieved with increased research on all aspects of the disease. Sadly, the public perception that all lung cancers are caused by smoking—and thereby completely preventable—has curtailed advocates’ efforts to raise awareness and needed research funds. Advances in lung cancer research will not be made until we change public perception about lung cancer and its victims. Individuals suffering from lung cancer deserve that change.
At one point, I was clueless about lung cancer. That changed when my mom was diagnosed in July 2010. My ignorance made me completely unaware of the significance of her diagnosis. My family and I even laughed when her doctor said her life expectancy was three months; my mother appeared perfectly healthy. After experiencing neck pain and visiting her primary care physician, my mom saw three neurologists and was prepping for surgery to remove what was believed to be a benign tumor in her neck. Shockingly, a pre-operative x-ray revealed the lung cancer. My mom’s doctors explained that the diagnosis was slow because my mom was a life-long non-smoker. From the moment of the diagnosis to today, people who did not know my mom assume her lung cancer was caused by smoking. While I’m troubled by the impact that has had on me--feeling the need to establish that my mother never smoked--I am equally troubled by the impact this perception of lung cancer victims has on people’s willingness to donate to lung cancer awareness programs.
An acquaintance of mine lost her father to lung cancer, and the first question in response to how her father died is the same: “Did he smoke?” Is his death less tragic because he smoked a pipe? My mother’s death was certainly not more tragic because she never smoked, and smokers who are diagnosed should not be stigmatized as blameworthy. The impact of this stigma is clear: Lung cancer’s advocacy base is only a fraction of that of breast cancer.
My mom never smoked and my friend’s dad had smoked a pipe but stopped 10 years before his diagnosis. Their stories are not uncommon. While statistics indicate that more than 80 percent of lung cancers are caused by smoking, reality is that many who are diagnosed are former smokers, having quit smoking decades before diagnosis. According to the American Cancer Society, the risk of dying from lung cancer is cut in half 10 years after quitting.Because statistics show that smoking causes most lung cancers, it’s not surprising that lung cancer research has not been a priority. But while the percentage of smokers has declined, lung cancer’s mortality rate has not. The five year survival rate for lung cancer has barely improved in nearly 4 decades— currently around 15 percent, up from 13 percent in 1974. Lung cancer kills more people each year than breast, prostate and colorectal cancers combined. Yet, of the four major cancers, its research receives the least federal funding.
Public advocacy can change lung cancer’s stature. Take the breast cancer movement. In 1991, the Susan G. Komen Foundation distributed pink ribbons to runners in NYC’s Race for the Cure. In 1992, Self Magazine established the pink ribbon as the symbol of breast cancer and encouraged readers to sign petitions in exchange for a ribbon. These signatures were sent to the White House “as a reminder to the President that breast cancer research and treatment should remain a top priority.” In 1993, federal funding for breast cancer research had increased over 45 percent from the year before. Funding has increased annually ever since. Federal legislation has allocated funds for breast cancer research and encouraged states to cover preventative screenings. States, in turn, have adopted legislation mandating insurance coverage of mammograms. While public awareness, funding for research and legislative action were all on the rise, the morality rate for breast cancer began to fall, and has been falling ever since.
It’s time we do the same things for lung cancer victims.
This blog was prepared by Lauren Klemm, student attorney in the Public Health Law Clinic at the University of Maryland Carey School of Law, supervised by Kathleen Hoke Dachille, director of the Network for Public Health Law – Eastern Region.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
 Deborah Mitchell, A Brief History of Brest Cancer Awareness Month, EmaxHealth.com (Oct. 1, 2009), http://www.emaxhealth.com/1275/98/33967/brief-history-breast-cancer-awareness-month.html.
 Cf. Advocate, Lung Cancer Connection, http://www.lungcancerconnectioninc.org/advocate (last visited Nov. 17, 2011) (noting that November is “supposed” to be lung cancer awareness month).
 See Be Aware of Lung Cancer Awareness Month, HealthKicker Blog (Nov. 10, 2009), http://www.healthkicker.com/716209375/be-aware-of-lung-cancer-awareness-month (noting that white ribbons lack a public presence in November).
 See Biren Saraiya, M.D., Opinion: N.J. Should Devote More Funding to Help People Quit Smoking, NJ.com (Nov. 17, 2011, 6:07 AM0, http://www.nj.com/times-opinion/index.ssf/2011/11/opinion_nj_should_devote_more.html (encouraging New Jersey residents to urge representatives to fund more smoking cessation programs); see also Karen Vandersanden, Mercy Offers Nov. 17 ‘Save your Lungs’ event at Lindale Mall, The Gazette (IA), Nov. 8, 2011, http://thegazette.com/2011/11/08/mercy-offers-nov-17-save-your-lungs-event-at-lindale-mall/ (highlighting smoking cessation education as part of the lung cancer awareness events); Announcement, Univ. of Fla. News, Events on UF Campus Thursday will Offer Help to Quit Tobacco Use (Nov. 15, 2011), http://news.ufl.edu/2011/11/15/uf-smokeout/ (promoting the Great American Smokeout as part of Lung Cancer Awareness Month).
 Women’s Health Policy & Advocacy Program, Brigham & Women’s Hosp., Out of the Shadows: Women and Lung Cancer 20 (2010) [hereinafter Brigham & Women’s Hosp.].
 In addition to being related to cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix, smoking can also cause heart disease, stroke, aortic aneurysm, chronic obstructive pulmonary disease (COPD), asthma, hip fractures, and cataracts. Harms of Smoking and Health Benefits of Quitting, Nat’l Cancer Inst., http://www.cancer.gov/cancertopics/factsheet/Tobacco/cessation (last reviewed Jan. 12, 2011).
 Background, Dusty Joy Found., http://www.dustyjoy.org/about-us/background-of-djf.aspx (last visited Nov. 15, 2011) (noting that “the stigma of lung cancer has created a culture of research disparity”).
 After seeing the full impact of lung cancer, my family now considers it a triumph that my mother survived eleven months.
 Message From LCA President Laurie Fenton Ambrose for November – Lung Cancer Awareness Month – 2009, Lung Cancer Alliance, http://www.lungcanceralliance.org/MessageFromLCAPresidentLaurieFentonAmbrose-NovemberLungCancerAwarenessMonth.html (last visited Nov. 17, 2011).
 Free Help to Quit Smoking, Nat’l Cancer Inst., http://www.cancer.gov/cancertopics/tobacco/smoking (last visited Nov. 17, 2011).
 Lung Cancer Mortality Reduction Act of 2011, S. 752, 112th Cong. § 2(9) (2011).
 When Smokers Quit – What are the Benefits Over Time, Am. Cancer Soc’y
 S. 752 § 2(6).
 Trends in Current Cigarette Smoking Among High School Students and Adults, United States, 1965-2010, Ctrs. for Disease Control & Prevention, http://www.cdc.gov/tobacco/data_statistics/tables/trends/cig_smoking/index.htm (last updated Nov. 3, 2011).
 2011 Facts About Lung Cancer, Lung Cancer Alliance (2011), http://www.lungcanceralliance.org/news/documents/LCA%20Funding%20Fact%20Sheet%202011%20Final.pdf.
 About Lung Cancer, Lung Cancer Connection, http://www.lungcancerconnectioninc.org/about-lung-cancer (last visited Nov. 17, 2011).
 Nat’l Cancer Inst., FactSheet: Cancer Research Funding 2 (2011), available at http://www.cancer.gov/cantertopics/factsheet/NCI/Fs1_1.pdf. The four major cancers are: Lung, Prostate, Breast, and Colorectal. Id. NIH is not the only source of federal funding for cancer research, but it constitutes roughly 80% of federal funding. Federal Cancer Research Funding, Am. Ass’n for Cancer Research, http://www.aacr.org/home/public--media/science-policy--government-affairs/resources-for-policymakers/federal-cancer-research-funding.aspx (last visited Nov. 1, 2011).
 Sandy M. Fernandez, Pretty in Pink, Think Before You Pink, http://thinkbeforeyoupink.org/?page_id=26 (last visited Oct. 28, 2011).
 History, Pink Ribbon, http://www.pinkribbon.org/About/History/tabid/199/portalid/0/Default.aspx (last visited Oct. 28, 2011).
 Michael McGeary & Michael Burstein, Source of Cancer Research Funding in the United States 4 tbl.1 (1999).
 Id.; Nat’l Cancer Inst., supra note 21.
 See Women’s Health Research and Prevention Amendments of 1998, Pub. L. No. 105-340, 112 Stat. 3191 (1998) (repealed 2007) (extending allocations for breast cancer research through 2003); Women’s Health and Cancer Rights Act of 1998, Pub. L. No. 105-277, §§ 901–03, 112 Stat. 2681, 2681–436 to –438 (1998) (requiring insurance coverage of reconstructive surgery following mastectomies); Breast and Cervical Cancer Prevention and Treatment Act of 2000, Pub. L. No. 106-354, 114 Stat. 1381 (2000) (permitting states to use Medicaid funds for breast and cervical cancer screenings and treatment).
 See Marianne P. Bitler & Christopher Carpenter, Insurance Mandates and Mammography 6 (Nat’l Bureau of Econ. Research, Working Paper No. w16669) (stating that almost all states adopted mammography mandates between 1987 and 2000, most of which reflected current recommendations by the American Cancer Society (ACS)). from April 2009 version – most recent version is January 2011cannot be accessed without purchase.
 Am. Cancer Soc’y, Breast Cancer Facts & Figures 2009-2010, at 8 (2009). The mortality rate for breast cancer peaked in 1990 and then decreased at a rate of 1.8% annually until 1995. Id. For the time period 1995 through 1998, the mortality rate decreased by 3.3% annually. Id.