People experiencing unexpected negative events tend to make sense of the situation through causal attributions. It seems that having some sort of answer to “why-me” makes the event less shattering and the world more controllable. We know for instance that the great majority of women with breast cancer tend to have clear ideas about its causes. Lung cancer, in contrast to breast cancer, has a well-known significant cause, as smoking explains about 80% of the incidence. This paper deals with the attribution process in lung cancer. It examines how lung cancer patients attribute the cause to their disease and how this relates to an understanding of how people deal with strain. Twenty-three patients with advanced non-small-cell lung cancer were consecutively followed by means of repeated interviews throughout the course of the disease. It emerged that among the smokers the most common attribution was “don’t know” – smoking was not seen as the prime cause to their cancer. This finding is discussed in relation to the few earlier somewhat contradictory studies that exist and it is argued that the finding is according well with the concept of ‘disavowal’ being the central process concerned in dealing with strain.