title: Does lung cancer attract greater stigma than other cancer types?
abstract: OBJECTIVE
  Cancer stigma can have widespread effects, influencing the behaviour and wellbeing of patients as well as the community and even research funding. Patients with lung cancer report feeling particularly stigmatised because of the association with a behaviour (smoking) that is perceived to be personally controllable. However, there are other dimensions of cancer stigma, that might be more severe for other cancers. The present study therefore examined differences in attitudes towards lung cancer and four other cancer types, using a multidimensional measure of cancer stigma, to extend findings beyond personal responsibility attributions.
  
  
  METHODS
  Participants were a non-patient sample (n=1205) who were randomised to complete a survey online relating to one of five cancer types (lung, colorectal, skin, breast and cervical). Stigma was assessed using the Cancer Stigma Scale (CASS).
  
  
  RESULTS
  There were significant differences across the five cancer types on all CASS subscales: awkwardness (F(4, 1009)=5.16, p<0.001), severity (F(4, 984)=26.24, p<0.001), avoidance (F(4, 1008)=5.38, p<0.001), policy opposition (F(4, 1009)=8.38, p<0.001), personal responsibility (F(4, 995)=31.67, p<0.001) and financial discrimination (F(4, 957)=9.45, p<0.001). Lung cancer attracted higher stigma scores than breast and cervical cancer on all subscales. Lung cancer was similar to skin cancer on personal responsibility, avoidance, and policy opposition, but attracted higher stigma in the domains of awkwardness, severity and financial discrimination. Lung cancer was similar to colorectal cancer for awkwardness, but significantly higher on all other subscales.
  
  
  CONCLUSIONS
  Lung cancer stigma extends beyond personal responsibility attributions to other dimensions, particularly perceived severity of the disease and tolerance of financial discrimination against patients with the disease. Future work is needed to develop and evaluate interventions designed to limit cancer stigma for patients, health professionals and the community. Health policies should acknowledge the existence of lung cancer stigma and make a commitment to minimising this.
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK. Electronic address: l.marlow@ucl.ac.uk.
authors.forename: Laura A V
authors.initials: LA
authors.lastname: Marlow
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Waller
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology*; D008297:Male; D013240:Stereotyping; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Avoidance; Beliefs; Blame; Cancer; Discrimination; Stigma