|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 640-641
Cancer stigma: Are we asking the right questions?
Soumya Swaroop Sahoo1, Udit Kumar Panda2, Pragyan Paramita Parija3
1 Department of Community and Family Medicine, AIIMS, Bathinda, Punjab, India
2 Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
3 Centre for Community Medicine, AIIMS, New Delhi, India
|Date of Submission||29-Jun-2020|
|Date of Decision||03-Jul-2020|
|Date of Acceptance||05-Jul-2020|
|Date of Web Publication||19-Sep-2020|
Soumya Swaroop Sahoo
Department of Community and Family Medicine, AIIMS, Bathinda - 151 001, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sahoo SS, Panda UK, Parija PP. Cancer stigma: Are we asking the right questions?. Cancer Res Stat Treat 2020;3:640-1
The recent article by Dr. Noronha titled, “Cancer stigma – Why don't we sit down and talk about it?” provides a deep insight into the present situation of the stigma associated with cancer in society. The author has rightly highlighted the stigma that an older male patient with breast cancer perceived, which resulted in a delay in seeking care. In India, cancer was considered a death sentence in the past. However, with the advances in medical science, cancer care has evolved immensely.
Stigma related to cancer is multifactorial. The author has listed three factors that are responsible for cancer stigma: different interpretations regarding cancer etiology, a form of punishment for past sins as viewed by the society, and the dubious presentation of different cancers adding to the stigma that is spread by societal elements such as rumors. Moreover, the stigma for a disease may be more prevalent and differentially presented in certain ethnic groups or geographical regions, which must be taken into account when assessing for the stigma. For instance, the cultural association of breasts with motherhood, nurturance, femininity, beauty, and beliefs regarding the etiology of breast diseases such as supernatural power, curses, and infidelity influence the stigma associated with breast diseases, including cancer.
The article describes a case of breast carcinoma in a male patient. In such cases, apart from the male gender, a young age of onset, attainment of higher education, and side effects of chemotherapy can be associated with higher perceived stigma. On the contrary, having a relative or friend who suffered from the same disease in the past can be associated with lower perceived stigma. Similarly, for other cancers, there will likely be multiple determinants of stigma. These need to be considered when deciding a strategy to fight the stigma that might hinder the treatment. Stigma has multiple domains, and different researchers have proposed different instruments to assess them. One example is the Cancer Stigma Scale, which assesses six subdomains of stigma, namely severity, personal responsibility, awkwardness, avoidance, policy opposition, and financial discrimination. It has been suggested that stigma in some domains might be higher than that in others, which needs to be evaluated systematically.
We also need to focus on the drivers and manifestations of stigma. For this, we need to improve the health literacy and to increase awareness regarding cancer detection and treatment during the early stages of the disease. There should be concerted efforts for educating the masses about the scientifically suggested preventive measures for cancer. Public awareness interventions should be careful not to propagate the message of blaming the victim, which is likely to occur in diseases such as oropharyngeal and lung cancers in patients with a history of tobacco use and the practice of societal taboos. Stigma perse affects the quality of life of a patient with cancer and the treatment seeking behavior of the affected individual. Patient–physician communication remains a vital step for mitigating cancer stigma. The diagnosis of cancer is often concealed from the patients due to the insistence of families, sociocultural norms, and the burden associated with it.,, This affects the decision-making process and the development of coping strategies of the patient. Therefore, routine screening programs initiated with effective linkages with cancer care centers can ameliorate the stigma. Our past experience with the human immunodeficiency virus and acquired immunodeficiency syndrome and tuberculosis suggests that interventions to reduce the stigma might bring the patients closer to the health-care system in their battle against cancer.
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Conflicts of interest
There are no conflicts of interest.
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