Talk:Lung cancer/Archive 2

Archive 1

Archive 2

Archive 3

Archive 4

More info to stages and picture

By looking at the stages section for lung cancer it seems kind of short and not very informative. There should be an explaination and included with a list of the stages. For example, it should mention if the stages are predictable or not. Also there should measurments on how large or small the tumor may be. Another change that needs to be made is by removing the disgusting picture. Moolietran(talk) 04:43, 16 June 2011 (UTC)

Which picture? We have a whole article on staging. --Doc James (talk · contribs · email) 06:15, 16 June 2011 (UTC)

Help me find direct source for 20 year lag time for cigarettes graph, please

Hello fellow wikipedians.

I wrote a motivational speech to help myself quit smoking. I showed it to some other smokers and they denied that smoking significantly increases the chances of getting cancer. The graph which shows more risk of cancer with more cigarettes says the source is NIH. I searched the NIH page and didn't find the chart or information. Can anyone please point me to the source or information on NIH used to make that graph?

Thank you, —Preceding unsigned comment added by 75.55.117.160(talk) 05:38, 29 November 2007 (UTC)

The original source is no longer available on-line, nor is the so-called archive. In any case, look atthis review. Axl (talk) 11:22, 29 November 2007 (UTC)

In Google Scholar, search "20 year time lag" +lung +cancer, you'll find plenty of interesting stuff. Its all copyrighted, so you'll need to go to the dead tree library for details. Emmanuelm 19:25, 30 November 2007 (UTC)

The classic study is the U.S. Surgeon General's report, Smoking and Health, 1964 [1] It has one graph in particular that made a strong impression on me, the comparison over several decades of veterans who smoked and veterans who did't smoke. The death rate of veterans who smoked was much higher, starting around age 50. It's a dramatic graph, although I've since learned that the evidence for the increased mortality of cigarettes is based on the combined weight of many consistent studies, not just that one study. Nbauman (talk) 05:32, 14 January 2008 (UTC)

Passive smoking

We just had a discussion at the Wikipedia:Meetup/NYC about how to deal with pseudoscience and fringe theories on WP.

This idea that passive smoking is not harmful seems to fit in that category. And I know that many (if not all) of the skeptics are paid by the cigarette industry.

The idea that passive smoking is harmful has been proven by strong evidence. It's challenged and has survived. That's how we know it's true. That's the scientific process.

There are a lot of readers who will come to WP who have heard the skeptics on passive smoking. Those who have enough science literacy to understand the evidence deserve a good answer.

I can't dismiss a peer-reviewed BMJ article out of hand. It's one study that goes against the consensus, but they played by the rules and they passed the peer reviewers. I think we need a good statement of what Enstrom was saying and why passive smoke is harmful anyway.

Enstrom couldn't support a causal relation with mortality. That's one study. Many other studies do support a causal relationship. That's medical science. We have conflicting studies, and we'll often have contrary studies, but when they overwhelmingly point in a certain direction, we go with the consensus.

I don't like to airbrush science. Science is untidy. Out of thousands of studies, some of them will have false leads. The public education of science has to acknowledge that.

I can see deleting Enstrom from this article. But the Environmental tobacco smoke article that we link to doesn't really explain his BMJ article either.

Can you give me a statement of why we shouldn't mention the Enstrom article in this entry? Maybe we shouldn't, but what's your thinking?Nbauman (talk) 06:16, 14 January 2008 (UTC)

Is this the (in)famous Enstrom & Kabat BMJ study (Enstrom JE, Kabat GC (2003). "Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98". BMJ 326 (7398): 1057. PMID 12750205) you're talking about? If so, can I recommend reading therelevant subsection of the passive smoking article?

If so, I think the question we should be asking fundamentally is whether this particular paper is relevant. One paper, wherever it was published, is only noteworthy when there aren't any others on the subject - when there are hundreds of other papers from equally prestigious journals which find pretty much the exact opposite of E&K's findings, I feel it's reasonable to discard theirs as statistical anomaly even before you take into account the controversy surrounding the paper's funding and methodology, and all the hubbub which arose or was deliberately provoked about it by the industry... Nmg20 (talk) 12:41, 14 January 2008 (UTC)

I don't think Enstrom and Kabat should be in this article, for the same reasons as Nmg20. Readers who come here, interested in passive smoking can follow the link and find a reasonably full account of the article and the issues it raised, with links to more. That way we cover the educational mission, without promoting fringe researchers with an axe to grind by making theirs one of a handful of articles on passive smoking in this bigger article.JQ (talk) 13:53, 14 January 2008 (UTC)

Secondhand smoke really brings the (professional) contrarians out of the woodwork. It's probably best to confine the discussion to thepassive smoking article rather than dealing with it separately across several articles - otherwise we'll end up with POV forks, which is what was happening here. We could add a {{see also}} template to link to the passive smoking article more clearly from here. As to Enstrom, the problem is that the Enstrom article is one article, cherry-picked out of the entire literature on passive smoking, which happens to reach a convenient conclusion. Its methodological flaws have been pointed up extensively, Enstrom's relationship with the tobacco industry formed the basis of another peer-reviewed article (PMID 15791022), and the Enstrom/Kabat BMJ paper was specifically cited in a U.S. District Court racketeering decision against the tobacco industry as an example of how the tobacco industry and its paid consultants published biased research (see [2], pp. 1380-1383). That's just for starters in terms of context.

We've gone back and forth on whether to base the explication of this issue on reliable secondary sources, or whether to get our hands dirty sorting the primary literature. The passive smoking article is a bit of a compromise, but if we're going to briefly cover or reference the issue here, then we should use reliable secondary sources. A (by no means complete) list of major medical organizations confirming the link between passive smoking and lung cancer includes the World Health Organization, the U.S National Institutes of Health and National Cancer Institute, the U.S. Surgeon General, the Centers for Disease Control, the U.S. Environmental Protection Agency, the American Heart Association, American Lung Association, and American Cancer Association, the American Medical Association, the Australian National Health and Medical Research Council, the U.K. Scientific Committee on Tobacco and Health, and the governments of the 151 nations which have ratified the World Health Organization Framework Convention on Tobacco Control. Sources for all of these are atPassive_smoking#Current_state_of_scientific_opinion. The number of medical/scientific bodies questioning the link between passive smoking and lung cancer is, so far as I know, zero. If we're going to touch on the "debate" here, we ought to reference some of these expert summaries of the data rather than a cherry-picked and largely discredited single study, per WP:WEIGHT. MastCell^Talk 17:17, 14 January 2008 (UTC)

Yes, that's the kind of answer I was looking for. I still haven't figured it all out in my own mind. I posted my notes ofUser:ScienceApologist's talk on the Meetup project page Nbauman(talk) 21:45, 14 January 2008 (UTC)

There is no ecact proof that even smoking causes lung cancer. When a first world general dies at the age of 113 and smoked regular it shows that smoking at most can only increase the risk. All these cause claims are based on studies where factors are unreliable. I notice this page claims that nearly 90% of all deaths from lung cancer are caused by smoking. Thats a ridiculous stat that cant be proved. Given that 13% of deaths are non smokers show this cant be the case. The stat seems to assume that any person that dies from lunger that smoked died because they smoked but it could have been for the same reasons that non smokers died. And what is defined as a smoker and a non smoker anyway? If you smoked 3 times in your life and die from lung cancer does that make you a smoker who died due to smoking? —Preceding unsigned comment added by81.99.238.215 (talk) 16:21, 18 July 2009 (UTC)

Since June 2009 up to date i had five friends who died from lung cancer, all of them smoked or still smoking. Another friend is still alive with a stage four lung cancer. He smoked also. The almost direct proportionality of the graph says it all. On the other hand the first death that whose wake i attended did not smoke. Both his siblings though smoked a lot and died via lung cancer. Per his daughter who is an officemate, the two siblings would always smoke beside the middle sibling, litteraly in the middle to convince him to smoke too. —Preceding unsigned comment added by169.128.252.99 (talk) 02:22, 24 February 2010 (UTC)

Thrombosis

Large cohort study in California: 3.4% of patients with lung cancer get DVT/PE/both. Most (3.0%) do this in the first year after their diagnosis. It is associated with a poorer prognosis. doi:10.1111/j.1538-7836.2008.02908.xJFW | T@lk 10:45, 18 January 2008 (UTC)

Any cancer is a risk factor for DVT/PE. Lung cancer is not a special case. Do you think this needs to be in the "Lung cancer" article?Axl (talk) 11:28, 18 January 2008 (UTC)

Not necessarily, but the study was in lung cancer patients and may be of prognostic relevance.JFW | T@lk 22:20, 26 May 2008 (UTC)

Gross photo

The photo should not be there at the top of the article as not everyone wants to see the cancerous lung of a corpse close up. The photo should be moved further down the article and a disclaimer should be posted above it. This is an encyclopedial, not Faces of Death. —Preceding unsigned comment added by 67.124.149.222 (talk) 19:20, 26 February 2008 (UTC)

Adjuvant chemotherapy

The adjuvant chemotherapy section in this article is incorrect and misleading to patients. It needs to be changed immediately:

1) CALGB 9633 trial found an extremely significant improved 4 year survival (59 to 71 %) with adjuvant chemotherapy for stage Ib disease (N=344)

2) NCIC Br.10 also found excellent 5 year survival benefit (54 to 69%) with adjuvant chemo for pIB and pIIA and B disease.

Adjuvant chemo for these stages is standard of care, i am not good with text and font and will not attempt to change it, but it is clearly incorrect.

"CALGB 9633 ... focused exclusively on patients with stage IB disease. Initial results, reported in 2004, showed a significant survival advantage with the addition of chemotherapy, but the 2006 updated results are no longer statistically significant." Axl (talk) 19:11, 13 April 2008 (UTC)

I can't find the appropriate reference for NCIC CTG JBR.10. However it looked at a mixture of stages, not just IB. The case for stage II is clear. IB remains controversial, exactly as the article states. Axl (talk) 19:24, 13 April 2008 (UTC)

FANCD2 suppression links tobacco smoke to oncogenesis

A team has shown an in-vitro demonstration of how tobacco smoke suppresses the expression of FANCD2, which codes for part of the Fanconi anemia protein complex, a DNA damage "caretaker" or repair mechanism.

• Hays Laura; et al. (2008-05-12). "Cigarette smoke induces genetic instability in airway epithelial cells by suppressing FANCD2 expression". British Journal of Cancer. {{cite journal}}: Explicit use of et al. in: |author= (help) cited in
• "OHSU Cancer Institute researchers pinpoint how smoking causes cancer". Eurekalert. 2008-05-13.

Deficits in the complex have been associated with other cancers involving the BRCA1 and RAD51 pathways.

• Nakanishi K, Taniguchi T, Ranganathan V; et al. (2003). "Interaction of FANCD2 and NBS1 in the DNA damage response". Nat. Cell Biol. 4 (12): 913–920. doi:10.1038/ncb879. PMID 12447395. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

LeadSongDog (talk) 21:39, 13 May 2008 (UTC)

No scientific link between smoking and lung cancer

Why doesn't the entry mention this? There is plenty of data and research supporting this. It's a fact, and it belongs in this entry. This article is bias and needs to be corrected. My rationale is that there is no scientific link between smoking and lung cancer. It's a fact, look it up. Stop undoing my changes please. Why are anti-smoking people introducing bias into the article? Not cool, people, Wikipedia articles are supposed to be neutral and present all the truthful facts, no? Just because you don't agree with the facts doesn't mean it isn't true.—Preceding unsigned comment added by Sudsak (talk •contribs) 21:34, 26 May 2008 (UTC)

Your rationale is contradicted by the preponderance of medical evidence ever since the British doctors study in the 1950s. You are entitled to an opinion, but it is rather poor form to accuse the other side of bias or a political agenda.

Now if you could be so kind as to show us your data, we can have a rational scientific discussion rather than a "my opinion vs your opinion" kind of debate. JFW | T@lk 22:23, 26 May 2008 (UTC)

I've had a quick look at the source you did provide in your edit summary -http://www.journaloftheoretics.com/Editorials/Vol-1/e1-4.htm.

Firstly the publication. This is not a health journal. It does not pretend to be peer reviewed. It also strongly supports unreservedly the work of a certainLauren Colby.

Secondly, causation in medicine is (out of necessity) not always Popperian in terms of falsification. Obviously if you think smoking causes cancer then to conduct a randomised controlled trial is completely unethical. Well-conducted observational studies have provided a strong relationship between smoking and lung cancer. The author of your paper is just mangling terminology. Then there's plausible experimental evidence, such as tobacco smoke compounds failing the Ames test time and time again. Your demands on causality are rather strict. According to this definition, there is no evidence that the assassination of Archduke Franz Ferdinand of Austria caused the start of World War I. JFW | T@lk 22:36, 26 May 2008 (UTC)

Studies can be distorted. lcolby refers to various flaws in those studues you refer to. Also a great point he makes is the anomaly that Japan and China have very low lung cancer rates yet very high smoking rates. I would like to know how the anti-smoking brigade explains that?http://www.lcolby.com/b-chap3.htm

Lung cancer is now common in China, due to the fact that many Chinese smoke. Most lung cancer cases are caused by the sufferer having smoked for decades, so it didn't become common there until smoking had been commonplace for a few decades. Gerhard Gruber(talk) 16:38, 26 September 2010 (UTC)

Jfdwolff - defining causation for historical events is completely different from trying to discuss it in the context of a disease. I think we can agree that being infected with the influenza virus causes flu - but there is no such clear link for smoking and cancer. Of course if you smoke, you greatly increase your chance of developing various cancers, but it is simply that - an increased risk. You cannot point to any one patient and tell me for sure that that patient developed lung cancer because they smoked. As such - as I have posted below, I think we should be considering rewording the article in terms of 'risk' instead of 'cause'. I have not checked into the other cancer articles yet, but this will likely extend to some of them also. Xeodus (talk) 00:48, 11 December 2011 (UTC)

Missing word added Xeodus (talk) 00:49, 11 December 2011 (UTC)

Dude...you're replying to a year old discussion. If you want to restart this thread, open a new section at the bottom, and just state your points. We've heard it all, so I don't think we'd need much info to figure out what you're saying. And you're wrong anyways. The data is.....overwhelming. OrangeMarlin ^{Talk• Contributions} 01:24, 11 December 2011 (UTC)

Thanks - will do! And it's not about the data ;) 82.45.234.129 (talk) 02:22, 11 December 2011 (UTC)

"Scientific evidence"

Sudsak (talk · contribs) continues to insert the incorrect claim that there is no scientific evidence linking smoking to lung cancer ([3]). I've asked for talk page discussion to no avail, but I'll leave this note anyhow. This is a featured article, and I think this is borderline vandalism, but I'll ask again for reasoning here.MastCell ^Talk 22:24, 26 May 2008 (UTC)

See the previous section. JFW | T@lk 22:29, 26 May 2008 (UTC)

Darn, that wasn't there when I posted. Edit conflict. I'll strike this. MastCell ^Talk 22:35, 26 May 2008 (UTC)

No scientific evidence smoking causes lung cancer

Seems some people here are telling to me "discuss this issue" on the talk page, yet they keep deleting what I write here? Odd. I have posted this here for discussion as I have been asked to.

There is *no* scientific link that smoking causes lung cancer. Scientists have never found a link between the two. Of course smokers have a higher incidence of lung cancer, no one is saying they don't. But a scientific, provable link between the two has never been found. There is so much anti-smoking bias out there that this fact gets lost. The article should be updated to reflect this. Also to say specifically that second-hand smoke "causes cancer" is just plain wrong. Second-hand smoke is "believed to cause cancer" is the correct wording.Sudsak (talk) 01:18, 27 May 2008 (UTC)

Your discussion was not removed, its there above. You might also like to check out[4] and this search gives you lots of papers on not only the statistical evidence linking smoking to lung cancer, but also medical causation including [5],[6] and many, many others. While you are welcome to believe that there is no medical evidence linking tobacco use with lung cancer, you may not introduce this point of view into this article since it isn't scientifically correct. Gwernol 01:44, 27 May 2008 (UTC)

Further, please review WP:Fringe and Fringe science.LeadSongDog (talk) 03:14, 29 May 2008 (UTC)

Also, please review reliable sources and verifiability. Denying the science that second-hand smoke causes cancer is definitely fringe. OrangeMarlin^{Talk• Contributions} 04:57, 29 May 2008 (UTC)

(sigh) another page to add to the watchlist...Cheers, Casliber (talk ·contribs) 05:03, 29 May 2008 (UTC)

Maybe homeopathic potion promoters can cure the non-existent cancer from harmless second hand smoke. Just a thought. OrangeMarlin ^{Talk• Contributions} 05:37, 29 May 2008 (UTC)

Nah, I'll just sit me under a pyramid....Cheers, Casliber (talk ·contribs) 10:21, 29 May 2008 (UTC)

Actually, this makes perfect sense. I am on my way to update Wikipedia to read that the Earth is widely beleived to be spherical and that the general consensus of the conventional mathematical community is that 2+2 = 4 (though, of course, a handful of brave dissidents fight the censorship imposed by Big Math)... MastCell ^Talk 18:06, 29 May 2008 (UTC)

Nah, Big Math is happy with 2+2=2 where "+" is used to indicate the bitwise logical OR operation. Also with 2+2=11 for base 3 addition. Why don't people state these simple assumptions every time, I wonder? LeadSongDog (talk) 20:05, 29 May 2008 (UTC)

See, that's the problem - I fell victim to Wikipedia's systemic bias toward base-10.MastCell ^Talk 20:36, 29 May 2008 (UTC)

Wow - geekiest discussion thread here to date. Congratulations! Nmg20 (talk) 06:59, 30 May 2008 (UTC)

This would be a good place for people who believe the tobacco industry to start reading. Tim Vickers (talk) 19:44, 30 May 2008 (UTC)

You are assuming too much Tim. Big Tobacco can't read, unless it's their Income Statement and Balance Sheet. OrangeMarlin ^{Talk• Contributions} 20:44, 30 May 2008 (UTC)

Looking at the stats for smoking in a survey of over 59,600 NHS doctors between 1951 and 1961 (and followed them till death), the results showed that compared with non-smokers (0.1 per 1000) the rate of lung-cancer in those doctors who smoked 25 cigarettes or more (2.2 per 1000) which is tiny increase. I think it would be fair to assume that smoking may cause a slight increase in the risk in cancer (0.0021%), there must be other factors at workers. (Similar results were found for coronary heart disease) It is probably fair to assume those who smoked lived a more unhealthy life - live a sedetary life, maybe ate less heathily, possibly drank more, which would explain the slight increase in cancer risk. It surprised, maybe as much as you. A greater explanation of the rising of risk of cancer is the increase length of life over the last 50-100 years. Cancer - after all - is disease that increases with risk the longer a person lives. —Preceding unsigned comment added by 217.42.21.75 (talk) 08:33, 17 August 2009 (UTC)

The vast majority of lung cancer sufferers have smoked for decades. There is no doubt that smoking causes most cases. Tobacco companies have tried for decades to cover up that fact, but the statistics and scientific studies have proved it. Whilst smokers tend to be more reckless about their health and lead more unhealthy lives than non-smokers, it is smoking that is the main cause of lung cancer. A sedentary lifestyle, high alcohol consumption and poor diet do not cause lung cancer, although they do cause some other types of cancer. Gerhard Gruber (talk) 16:38, 26 September 2010 (UTC)

Just wrong, the frequency of histological subtypes

From given source: Conclusions. In recent years, adenocarcinoma has replaced squamous cell carcinoma as the most frequent histologic subtype for all sexes and races combined. These shifts in histologic types by sex and race may be related to differences in exposure to tobacco products, dietary factors, environmental or occupational carcinogens, and host characteristics. Increased use of trans-bronchial and needle biopsy may have also influenced these trends to some extent. Over the study period, 5-year relative survival rate did not change appreciably for lung cancer, suggesting that therapeutic advances have had little effect.

Thus, adenocarcinoma is the most frequent, not sq cell carcinoma. <3 —Preceding unsigned comment added by213.29.201.22 (talk) 11:21, 2 September 2008 (UTC)

The SEER data (Travis) is the largest database of histological sub-types of lung cancer. You are correct: the most recent data does indeed show a shift towards adenocarcinoma. However the overall data is included in the article. I'll try to find some more recent histological sub-typing. Axl (talk) 20:35, 2 September 2008 (UTC)

I have updated the table. I'll keep working on the text. Axl (talk) 21:02, 3 September 2008 (UTC)

Why is adenocarcinoma replacing squamous cell carcinoma? Emmanuelm (talk) 07:21, 24 October 2008 (UTC)

It's probably due to a change in the composition of cigarettes. Modern cigarettes contain less nicotine. Thus the smoker has to inhale more deeply to extract the same amount of nicotine. This leads to smoke going deeper into the peripheral airways, which is where adenocarcinoma usually arises. Axl ¤ [Talk] 08:47, 24 October 2008 (UTC)

Thanks Axl. I looked it up, this info is not in the article -- it should. 02:19, 26 October 2008 (UTC)

I added some info about this in the epidemiology section. Axl ¤ [Talk] 09:42, 26 October 2008 (UTC)

Cite formats

The article as a mix of cites, some use author= while others use first=,last=,coauthor=. They result in different formats, only the first complying with Wikipedia:MEDMOS#Citing medical sources. They should be converted.LeadSongDog (talk) 07:49, 5 October 2008 (UTC)

Please show where the policy indicates that "last=... first=..." is wrong. Axl ¤ [Talk] 15:42, 5 October 2008 (UTC)

It doesn't. What it does do is provide exactly one example of a full citation. That example is in URM format, not APA format. As presently implemented, template:cite journal will render APA style if provided with last=|first = parameters, but URM style if provided with author=. This modal behaviour is poorly documented if at all, but you can see that it happens by comparing the results. There's discussion going on about how it should be addressed globally. This is just a microcosm of the issue, which impacts all biomedical articles.LeadSongDog (talk) 16:03, 7 October 2008 (UTC)

Photo of lung is "gross"?

Should this photo really be labelled as "gross"? Is this a grown-up encyclopedia, or a 5 year-olds science book? A photo's appearance being "gross" is subjective, and therefore it is innapropriate to use "gross" as an adjective in this situation. —Preceding unsigned comment added by 90.207.120.244(talk) 14:57, 23 October 2008 (UTC)

I assume you're joking, but if not, try following the link from "gross". —KCinDC (talk) 15:07, 23 October 2008 (UTC)

What KCinDC means is: "gross" is a medical term for macroscopic, visible to the naked eye. --Steven Fruitsmaak(Reply) 18:03, 23 October 2008 (UTC)

How very dare you speak to me like that. —Preceding unsignedcomment added by 90.207.118.198 (talk) 10:13, 4 November 2008 (UTC)

If you're not interested in lung cancer, then why go to the article? Censorship has no place in an encyclopedia. —Preceding unsigned comment added by 85.225.191.184 (talk • contribs) 10:58, 14 July 2010

Mortality in women

The article states "Lung cancer is the second most common [cause of cancer-related death] in women",reference here. The reference indicates that the mortality among women from breast cancer was 474,000 (1.7% of deaths), and from lung cancer was 353,000 (1.3%). Axl¤ [Talk] 18:49, 2 November 2008 (UTC)

In some countries lung cancer causes the deaths of more women than any other cancer. For example, in the UK, about 14,000 women died of lung cancer last year, compared to about 12,000 from breast cancer. The ref for the world statistics above is from 2004. Much more recent statistics are needed to see what the total death stats are for the world for each type of cancer. Gerhard Gruber(talk) 16:38, 26 September 2010 (UTC)

Clinical trials

Would it be possible to add a section on Clinical Trials for Lung Cancer? Not only do I work on these trials, but I have a friend that was recently diagnosed with breast cancer- clinical trials can be especially helpful for information and also alternative treatments as well as assistance with standard treatments. —Preceding unsignedcomment added by 205.181.102.108 (talk) 17:39, 3 November 2008 (UTC)

No, this is not the purpose of Wikipedia. Try clinicaltrials.gov.JFW | T@lk 19:56, 30 November 2008 (UTC)

Wrong sources and no NPOV

The article states that "Passive smoking—the inhalation of smoke from another's smoking—is a cause of lung cancer in nonsmokers" but in fact there´s no strong scientific evidence to support that statament.

The Source from Europe(http://wiki.riteme.site/wiki/Lung_cancer#cite_note-Boffetta-39) states: "Conclusions: Our results indicate no association between childhood exposure to ETS and lung cancer risk. We did find weak evidence of a dose–response relationship between risk of lung cancer and exposure to spousal and workplace ETS. There was no detectable risk after cessation of exposure."

That´s very diferente from "have consistently shown a significant increase in relative risk among those exposed to passive smoke."

So please, remove the source. Thanks! --V3n0w (talk) 07:04, 18 November 2008 (UTC)

Does PMID 18559546 suit you better?LeadSongDog (talk) 16:55, 18 November 2008 (UTC)

Of course not. I will try to correct the article... Please anyone correct my english if needed.--201.62.146.129 (talk) 04:36, 19 November 2008 (UTC)

Clearly the European study is cited to support the claim that there is a dose-response relationship between exposure to spousal and workplace ETS and lung cancer. The fact that the findings were not positive along the line does not matter greatly. In general, please bear in mind that this is a featured article and that significant changes should be discussed here first and only be implemented once consensus has been achieved. JFW | T@lk 07:14, 19 November 2008 (UTC)

Hello Doctor. Well for significant errors we need significant changes. That´s not clearly at all... Just read: "Studies from the U.S.,[39] Europe,[40] the UK,[41] and Australia[42] have consistently shown a significant increase in relative risk among those exposed to passive smoke." that´s clearly not the case of the study. And the article also make false suggetions like: "Recent investigation of sidestream smoke suggests that it is more dangerous than direct smoke inhalation.[43]". Sidestream smoke is also inhaled by smokers so there´snothing to do with passive smoking. I hope you and the other adm undestand that. Thanks. --V3n0w (talk) 07:30, 19 November 2008 (UTC)

If this study shows a statistically significant elevated risk of lung cancer due to passive smoking, even if not consistent in all groups, we can still cite the general conclusion. I'm not entirely clear why you think the European study should not be cited with other studies showing harm from passive smoke.

With regards to your other claim, namely that the Schick study might be misquoted, please explain clearly why you think we cannot cite this conclusion. JFW | T@lk 23:02, 19 November 2008 (UTC)

Ok. Just answer me this: Since when "weak evidence" == "statistically significant" ? Bacause it can lead people to think that passive smoking do more harm then the active one, what is an absurde. Clearly that statement was put with that intention... Bad faith. Thanks--V3n0w (talk) 00:49, 20 November 2008 (UTC)

Here are the edits that added that content on 14 July 2006. Still think it was bad faith?LeadSongDog (talk) 15:12, 20 November 2008 (UTC)

Ok, but now it is linked with passive smoking and it can lead people to missunderstod that. So I think that´s important to point out two things: 1. Active Smokers also smokes sidestream smoke.2. Active Smokers smokes more sidestream smoke than passive smokers.Agree?

I see what V3n0w means, although it appears to be a matter of semantics. I suggest removal of the word "consistently". How about "Studies from the U.S.,[39] Europe,[40] the UK,[41] and Australia[42] have shown a significant increase in relative risk among those exposed to passive smoke"? This evidence is indeed statistically significant. I suggest changing the sidestream smoke comment to "Investigation of sidestream smoke suggests that it is more dangerous than mainstream smoke." Axl ¤ [Talk] 11:13, 22 November 2008 (UTC)

Hello, everyone. Briefly, I'm not entirely happy with the quotation above from the Source From Europe (Boffetta et al, PMID 9776409) which seems to me to be somewhat selective. This is a study which opens its discussion by saying (my emphasis) "The results of our study of the risk of lung cancer from ETS in several European countries showed a reduced risk for exposure during childhood and a measurable effect of exposure to ETS from the spouse and at the workplace, in particular when these two sources were combined to better represent total adult exposure." The study also makes quite clear that this was significant ("Statistically significant results were the reduced risk from childhood exposure and the increasing trend in risk for weighted duration of exposure to ETS").

It's worth mentioning that this sort of data is being reinforced by more data as time goes on. I'll add some recent work in the area to the New Source? heading below. Nmg20 (talk) 13:29, 24 November 2008 (UTC)

Ok then. Here´s my hole point. Anti-smoking is a SCAM. There´s a lot of prejudice in it. People now thinks that smokers are dumb and etc...The studies force the numbers to say that seconds of passive smoking can actually kill you. The european study have to put smoke all day long in the face of people to produce weak evidence. The governament ban smoking in bars, pubs, night clubs with the non-scientific argument that passive smoking can do harm in minutes and that´s a big LIE. If anyone here have this evidence, with the distance of the smoker, time on the smoke and the wind of the day I will be GLAD to take a look. --V3n0w (talk) 20:32, 24 November 2008 (UTC)

You'll have a tough time finding solid references to back up those statements, but good luck trying.LeadSongDog(talk) 21:34, 24 November 2008 (UTC)

Lordy lordy. Looks like things hain't changed much while I've been gone! Nmg20 (talk) 23:17, 24 November 2008 (UTC)

Hello. I´m waiting for an reply about sidestream smoke on the statement I put before. The same problem is also here: Passive smoking. Both leave implicit that passive smoking do more harm than active.

And to justify bars, pubs and night club bans you guys put that passive smoking do harm on who live or work with smokers... That´s the best you can do physicians?

If you do don´t like smoke don´t go to a private place that people can smoke. Why is that to complicated? Let the owner of the bussines decide who he want in. --V3n0w (talk) 01:40, 25 November 2008 (UTC)

Hello. Wikipedia is not a soapbox. Please feel free to take advantage of any of the dozens of venues in which to advocate your viewpoint. This is not one of them. Please read and respect the talk page guidelines, as this sort of free-form preaching is inappropriate for this venue. MastCell ^Talk 06:20, 25 November 2008 (UTC)

Hello, well, I´m just explaining my POV. See that I´m pointing some logic errors on the article. Wikipedia must also not be a place to advocate for the Anti-smoking SCAM. I mean, you can´t justify bans on bars without a especific study about passive smoking on bars... But for this article, no one thinks that the sidescream smoke part can be misunderstood? ps: Nice personal page MastCell. --V3n0w(talk) 17:28, 25 November 2008 (UTC)

What are the odds that User:V3n0w is the owner of a bar in a jurisdiction that recently banned smoking in bars? Most such are so afraid of a brief dip in business that they'd prefer to see any or all of their minimum-wage employees get sick. The same pattern repeats every time. The smart owners jump in front of the parade, convert to non-smoking before they're forced to (while it's still a novelty, and quickly grab business that stays after the ban comes in. The rest waste their energy and money in futile rearguard actions. Enough on this sideline.LeadSongDog (talk) 19:09, 25 November 2008 (UTC)

There's no need for ad hominem arguments. I am prepared to collaborate with V3n0w to achieve a fair, balanced view. However V3n0w's biased tirade against the evidence and the medical profession leaves me rather cynical. Axl¤ [Talk] 14:45, 26 November 2008 (UTC)

Guys, guys... Let´s focus on the sidestream smoke. I mean, there are some people out there that thinks passive smoking do more harm then active, and that´s the kind of myth wikipedia is helping spread.

Don´t take it personally, I live in Brasil, here we still can smoke in bars and night clubs :D. And my sister is a doctor.

I´m here more to defend political and philosophical views that I stand for. I don´t wanna see state telling me what to think, eat and smoke. In this aspect I think you guys don´t have any argument. But we are not here to discuss that right?--V3n0w (talk) 20:20, 27 November 2008 (UTC)

"The studies force the numbers to say that seconds of passive smoking can actually kill you.... The governament ban smoking ... with the non-scientific argument that passive smoking can do harm in minutes and that´s a big LIE."

— V3n0w

V3n0w, your deliberate misrepresentation to promote your own agenda leaves me unwilling to collaborate with you any further. Axl ¤ [Talk] 11:34, 28 November 2008 (UTC)

New source

Useful? Thun MJ, Hannan LM, Adams-Campbell LL, Boffetta P, Buring JE, Feskanich D, Flanders WD, Jee SH, Katanoda K, Kolonel LN, Lee IM, Marugame T, Palmer JR, Riboli E, Sobue T, Avila-Tang E, Wilkens LR, Samet JM (2008). "Lung cancer occurrence in never-smokers: an analysis of 13 cohorts and 22 cancer registry studies". PLoS Med. 5 (9 e185). doi:10.1371/journal.pmed.0050185. PMID 18788891. {{cite journal}}: Unknown parameter |month= ignored (help); Unknown parameter |pmcid= ignored (|pmc= suggested) (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link) —Preceding unsigned comment added by LeadSongDog (talk • contribs)

Just to say the above does look interesting, particularly on geographical differences in lung cancer incidence. In terms of the passive smoking debate, there is work coming out all the time supporting the link between the two, from France, Poland, Mexico - you name it. Two of the more interesting are:

Kurahashi et al 2008, PMID 17935128. This is a prospective study of 28,414 non-smoking women over 13 years which found that exposure to passive smoke was significantly associated with lung cancer and that, in keeping with Boffeta et al, combining workplace and domestic exposure also increased risk.

Taylor et al 2007, PMID 17690135. This is a meta-analysis of 55 trials which concludes - pretty unequivocally - "The abundance of evidence, consistency of finding across continent and study type, dose-response relationship and biological plausibility, overwhelmingly support the existence of a causal relationship between passive smoking and lung cancer."

I can't put it better than that. Nmg20 (talk) 13:38, 24 November 2008 (UTC)

Viruses?

Is there any evidence that lung cancer specifically is linked to viruses? I wouldn't know where to find such information, but it would probably be a useful addition to the section. Postscript2010 (talk) 03:42, 19 January 2009 (UTC)

Er, did you read Lung cancer#viruses? Axl ¤ [Talk] 14:32, 19 January 2009 (UTC)

Mind map

• 

This mind map has arrived in the classification section. However some of the information is questionable. There are no references provided. Some of the capitalization is inappropriate. There is at least one spelling mistake. I am unable to edit the map's content. In my opinion, the article would be better served without the map. Axl ¤[Talk] 07:55, 9 March 2009 (UTC)

From my point of view mind maps are great for textbooks, and fit perfectly in wikibooks; but they do not in wikipedia; and can be considered most times OR unless they have been published as such... and anyway they are not very encyclopedic. (Mind maps were first proposed as a learning tool). I know nothing about cancer, but I think that it applies also here. --Garrondo (talk) 08:29, 9 March 2009 (UTC)

I have to agree with the limitations highlighted above, but would emphasize two: duplication of content, and they (mindmaps) cannot be edited by most WP editors. This latter weakness is a lethal blow, in my opinion, because WP content must be editable by the entire community unless there is a compelling reason to the contrary. --Scray (talk) 09:50, 9 March 2009 (UTC)

I make these things for myself, and I see some value in this one, as an outline of the article topic. However, I would not use it in the article. In addition to the issues already mentioned, it is telegraphic. --Una Smith (talk) 13:43, 9 March 2009 (UTC)

Thank you all for your concerns about the mind map, first can we solve this out by making it editable??, I agree with every one of you, my point of view was to make a short summary of the classification, about the citation, it was derived from Robbins basic pathology, i can include that, after all, I noticed this is a featured article and i don't mind removing it for the best of wikipedia Maen. K. A. (talk) 15:36, 9 March 2009 (UTC)

It is not an easy format to look at. Would prefer it we stick to text and pictures. Agree that it would belong at wiki books.--Doc James (talk ·contribs · email) 16:34, 9 March 2009 (UTC)

I don't think mindmaps are useful in any way on Wikipedia, mainly because they appear too complex to illustrate an article.--Steven Fruitsmaak (Reply) 20:58, 9 March 2009 (UTC)

Mind maps are ultimately original research. Editable or not, it is practically impossible to add sources to a mind map. I have removed it as this is a featured article and not really the place for introducing novel concepts of this kind.JFW | T@lk 21:23, 9 March 2009 (UTC)

New relation between long-term exposure to ambient air pollution and chronic diseases

A recently published research supports a connection between SO2 exposure and increased mortality rate here goes the research

• Chen H, Goldberg MS, Villeneuve PJ (2008). "A systematic review of the relation between long-term exposure to ambient air pollution and chronic diseases". Rev Environ Health. 23 (4): 243–97. PMID 19235364.{{cite journal}}: CS1 maint: multiple names: authors list (link)

please discuss here possibility of adding this section to the article Maen. K. A. (talk) 15:32, 9 March 2009 (UTC)

Systematic reviews are usually good sources, especially when they appear in journals with a high impact factor. See WP:MEDRS for more background. JFW | T@lk 21:24, 9 March 2009 (UTC)

Epidemiology and History sections

"From the 1950s, the incidence of lung adenocarcinoma started to rise relative to other types of lung cancer.[121] This is partly due to the introduction of filter cigarettes. The use of filters removes larger particles from tobacco smoke, thus reducing deposition in larger airways. However the smoker has to inhale more deeply to receive the same amount of nicotine, increasing particle deposition in small airways where adenocarcinoma tends to arise.[122] The incidence of lung adenocarcinoma in the U.S. has fallen since 1999. This may be due to reduction in environmental air pollution."

Weasel words: "Partly," "tends," (in the context of what would seem to be statistically quantifiable) and "may be due" with no citation or further explanation. IMO of course.

The history section cites http://www.smokinglungs.com/cighist.htm for much of its content. This is not peer reviewed, nor NPOV, nor does it properly cite sources for its own data.

Related note: "Case reports in the medical literature numbered only 374 worldwide in 1912,[126] but a review of autopsies showed that the incidence of lung cancer had increased from 0.3% in 1852 to 5.66% in 1952." A conjunction between two sets of data would indicate to most that they are related. This sentence implies that the increase cited is also worldwide. According to the cited source, it occurred in Dresden, Germany rather than worldwide.

Disclaimer: No I'm not pushing "smoking is fine." This isn't political, it just doesn't strike me as a very solid bit of the article.

Jasruler (talk) 08:52, 2 April 2009 (UTC)

`Smoking' and `smoking rate'

The expression "the incidence of lung cancer is highly correlated with smoking" in the caption of the graph from NIH is jumpy. Correlation can be seen only with the smoking rate, but with smoking itself. --Milestones1978 (talk) 14:15, 16 June 2009 (UTC)

I agree that the caption isn't representative of the graph. I have changed to caption: "Following an increase in smoking in the population, the rate of lung cancer death increases." Axl ¤ [Talk] 18:49, 16 June 2009 (UTC)

Well, it's still so much biased. Correlation is just a similarity, and doesn't necessarily mean that increase of one follows that of the other. "High correlation between the somking rate and the lung cancer rate can be seen." might be OK. But I don't think the figure is fair nor scientific. It has no curve related with air pollution, and intentionally leads the conclusion that only smoking is harmful.--Milestones1978 (talk) 05:54, 30 April 2010 (UTC)

Were you asking or telling us? I naively set about rewording the graph caption appropiately, only to discover that you were going ahead with your own preferred wording. Since you didn't indicate your intent here to make an edit, I've replaced your version with my own caption. Hope it works. Franamax (talk) 06:35, 30 April 2010 (UTC)

I'm afraid I was claiming that the previous version had some misleading extended interpretation of statistics, and I edited it. I also suggested in the previous note that the comparison in the figure is not very fair, but I shouldn't have done that because the source of the figure seems to be peer-reviewed. I like your current version. Thank you. --Milestones1978 (talk) 10:26, 30 April 2010 (UTC)

I see that you responded ten months after your initial comment. ;-) "Correlation is just a similarity, and doesn't necessarily mean that increase of one follows that of the other." Actually this is exactly what "correlation" means. Axl ¤ [Talk] 20:41, 1 May 2010 (UTC)

I suspect that Milestones intent was that simple correlation of two time series does not prove causation, which of course is true, bothcould be responding to the same hidden input. In this instance, however, copious expert study has reached the obvious conclusion that inhaling hot poison is bad for you.LeadSongDog come howl 03:09, 2 May 2010 (UTC)

I'll wait for Milestones to confirm his intent. [Shall I check back next year?] Axl ¤ [Talk] 08:07, 2 May 2010 (UTC)

Sorry for such slow response, Axl. I thought this article was still developing and my point was kanda minor, but I can't pass through it after this article was chosen to be a featured article. You're right Axl, my explanation above about correlation was strange. And thanks LeadSongDog, that's what I mean. Axl's version can be read as if the figure prove that smoking increased the lung cancer death. Also, according to Wikipedia:Verifiability, we have to show exactly which paper regards the cigarrette as hot poison.--Milestones1978 (talk) 10:59, 2 May 2010 (UTC)

"Axl's version can be read as if the figure prove that smoking increased the lung cancer death." I disagree. The caption that I suggested above: "Following an increase in smoking in the population, the rate of lung cancer death increases", makes no claim of causation. Neither does the current caption: "NIH graph showing the correlation and time-lag between tobacco smoking and lung cancer rate in the U.S. male population". [It's incidental that overwhelming evidence demonstrates that cigarette smoking directly causes lung cancer; smoking is indeed "hot poison".] Axl ¤ [Talk] 17:37, 2 May 2010 (UTC)

Are you suggesting any update? If not, I want to leave the current caption and finish this discussion.--Milestones1978 (talk) 05:30, 4 May 2010 (UTC)

I'm happy with the current caption. It is accurate and represents the graph. Axl ¤ [Talk] 07:12, 4 May 2010 (UTC)

The disease and its dietary concern....

• http://scholar.google.com/scholar?hl=en&q=allintitle%3A+lung+cancer+diet&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0
• http://scholar.google.com/scholar?hl=en&q=allintitle%3A+lung+cancer+dietary&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--124.78.212.48 (talk) 07:55, 19 January 2010 (UTC)

• http://scholar.google.com/scholar?hl=en&q=allintitle%3A+Vitamin+A+lung+cancer&btnG=Search&as_sdt=2000&as_ylo=2005&as_yhi=2009&as_vis=0

--124.78.212.48 (talk) 08:02, 19 January 2010 (UTC)

• http://scholar.google.com/scholar?hl=en&q=allintitle%3A+lung+cancer+sweet&btnG=Search&as_sdt=2000&as_ylo=2005&as_yhi=2009&as_vis=0

--124.78.212.48 (talk) 08:07, 19 January 2010 (UTC)

Disclaimer
If the contents in the above links are involved in Glycemic index, Glycemic load and Insulin index, please ignore them as the measures have been questioned--222.67.204.237 (talk) 07:33, 20 January 2010 (UTC)

TNM classification of malignant tumors

See PMID 19960300 and related for sourcing. It appears on pubmed that the new version is iminent but not presently out. NLM books has the older version. User:LeadSongDog come howl 16:25, 26 February 2010 (UTC)

Most common cause of death in lung cancer patients

Uploadvirus (talk • contribs) 15:58, 28 February 2010 (UTC)

Dear Dr. Wolff:

Thanks for your courtesy to this newbie with interest in lung cancer, particularly rare histological subtypes. Your note regarding the most common causes of death in lung cancer patients to be overwhelming infection or PE was VERY interesting. Perhaps in a week or so I will look up some refs as to my [now withdrawn] contention that distant metastasis is the most common cause of death in LC patients, but right now I'm having too much fun playing in the sandbox on several other pages. After your first note, I got to guessing that maybe I was wrong because I was thinking of RESECTED patients, and since most cancer patients are not resected (?) due to advanced stage, comorbidity, etc., that the correct answer might be just locoregional progression.

Also, and PLEASE know that I MEAN ABSOLUTELY NO DISRESPECT by this question, sir, but would "your clinical experience" be considered a "reliable source"? :-)

In closing, you also make a potentially BAD mistake by ao kindly offering to discuss lung cancer with me. Unless you withdraw your offer, you're likely to get A LOT more than you bargained for. Retract, or suffer the consequences! *remove tongue from cheek*

With very best regards:

Cliff L. Knickerbocker, MS DDF 21:57, 27 February 2010 (UTC)uploadvirus —Precedingunsigned comment added by Uploadvirus (talk •contribs)

Welcome to Wikipedia. I hope that you continue contributing.

Clinical experience is not a reliable source, because it's not published. Actual publication is an absolute requirement forreliable sources. WhatamIdoing (talk) 23:12, 24 March 2010 (UTC)

I'm not sure this belongs here - or in the middle of a debate above (which I shall also comment on in a second), but I would also like to raise a concern over the word 'cause' and the section 'Causes' in this article. Smoking does not cause lung cancer any more than breathing does - it is simply a much more significant risk factor. I was thinking about amending the article to reflect this (Causes -> Contributing Factors or Risk Factors for example) but since there is an ongoing discussion here about this, I thought I would put my thoughts here first. I of course accept that if you smoke you are significantly more likely to get Lung Cancer than if you do not, but that is not the same as a causal relationship. Medically, there is no way to tell if a particular patient developed lung cancer specifically because they smoked. It is also true that you cannot ever tell someone who has lung cancer that if they had not smoked, they would not have got it. This is simply the nature of the disease. If no-one can convince me otherwise, I will make some changes to the article to reflect this. Additional comments above. Xeodus (talk) 00:37, 11 December 2011 (UTC)

Article proliferation

We've got at least two new articles, Targeted therapy of lung cancer and Treatment of lung cancer. Perhaps there are more, but the 'treatment' article contains less information than this one, and yet is marked as being the "main" place for readers to find out information.

This is a large article on a huge topic, so maybe it's time to properly split it. What do you think? WhatamIdoing (talk) 23:09, 24 March 2010 (UTC)

Re: Article proliferation

I've nearly finished an article on "combined small cell lumg carcinoma". I'd be grateful if some expert(s) would review it, help clean it up, tell me what you think, etc. Thanks to you all in advance. With best regards: Cliff (a/k/a Uploadvirus) Cliff L. Knickerbocker, MS DDF 02:18, 26 March 2010 (UTC) —Preceding unsignedcomment added by Uploadvirus (talk • contribs)

Cancer epidemiology

LeadSongDog,

Can you explain why you say that PMID 20079703 is not MEDRS and doesn't support the statement? I'd have understood a copyvio complaint: It's practically word-for-word out of the abstract. WhatamIdoing (talk) 06:40, 2 May 2010 (UTC)

It's a primary report that (so far as PubMed shows) has not been mentioned in a review. (It's also based on a very small cadre (n=250) for the three-digit precision in results claimed at p=0.916, which seems a rather basic error in statistics for an epidemiology paper to make, but that's my own editorial judgement and should not count for much here.)LeadSongDog come howl! 16:30, 14 July 2010 (UTC)

5 year survival

At the end of the lead section, it says that 5 yr survival is 14%, but does not say which part of the world that applies to. Survival rates vary significantly throughout the world. The current figure for the UK is about 6%, compared to about 16% for the US. Gerhard Gruber (talk) 16:38, 26 September 2010 (UTC)

It's on page 551 of the named source (a highly regarded medical textbook), which appears to cite US results from the 1980s. If you can find an equally high-quality source that is either more current or less US-specific, then please feel free to update it. WhatamIdoing (talk) 17:44, 18 October 2010 (UTC)

article needs repair

the references and notes sections are in bad shape, lots of red text indicating missing or bad info. i don't know how to fix this. help?Bloggyelf (talk) 23:04, 2 December 2010 (UTC)

Not as bad as it looked. Just an erroneous extra {{Reflist}}.

 FixedLeadSongDog come howl!01:04, 3 December 2010 (UTC)

It was a problem again. I deleted the following refs, which were causing parsing errors:

— kwami (talk) 22:58, 16 February 2011 (UTC)

• So we can see the above, LeadSongDog come howl! 17:44, 17 February 2011 (UTC)

The above named refs were shown as not used following the deletion by Jmh649 of the following para, presumably because they are primary sources. To be clear however, those were not parsing errors, they were warnings that the refs were not used in the text.LeadSongDog come howl! 18:26, 17 February 2011 (UTC)

Advances in cytotoxic drugs, pharmacogenetics and targeted drug designshow promise. A number of targeted agents are at the early stages of clinical research, such as cyclo-oxygenase-2 inhibitors, the apoptosis promoter exisulind, proteasome inhibitors, bexarotene, the epidermal growth factor receptor inhibitor cetuximab, and vaccines. Crizotinib has shown significant promise in early clinical trials in a subset of non-small cell lung cancer that is characterized by the EML4-ALK fusion oncogene, found in some relatively young, never or light smokers with adenocarcinoma. Sorafenib (marketed as Nexavar for use in renal and liver cancer) showed promise in a clinical trial matching targeted treatment to the cancer's genetic profile. Future areas of research include ras proto-oncogene inhibition, phosphoinositide 3-kinase inhibition, histone deacetylase inhibition, and tumor suppressor gene replacement.

Palliative care

This edit removed sourced content re palliative care. I think some explanation is needed. LeadSongDog come howl! 03:44, 21 May 2011 (UTC)

Have you asked OrangeMarlin about his edit? His explanation seemed reasonable enough to me. NW (Talk) 13:58, 25 May 2011 (UTC)

I agree with OrangeMarlin regarding the undue weight given to this aspect in the article "Lung cancer". Also, the deleted text is written more like an essay than an encyclopedia. If editors believe that some or all of the deleted content is appropriate for Wikipedia, it may be better placed in a spinout article. Axl ¤[Talk] 18:35, 25 May 2011 (UTC)

I also agree that the amount of text dedicated to palliative care was UNDUE and needed to be trimmed. Yobol (talk) 00:50, 26 May 2011 (UTC)

OM's talkpage is clear, he doesn't want article discussions there so he watchlists articles he edits, but since he hasn't yet responded I'll drop him a tickler anyhow. He cut that palliative section, which pertains to the vast majority of lung cancer cases, from four to two paragraphs. Compare it to the radon discussion, which is longer yet relevant to a far smaller portion of cases. While the deleted text could be improved, I don't see the rationale for considering the amount as undue. The article doesn't avoid the sad truth that even today most lung cancers are fatal, it shouldn't minimize the end of life implications of that. LeadSongDog come howl! 05:46, 26 May 2011 (UTC)

I should create a list of people who are allowed to talk about articles on my user talk page, and all of you would be.  :) Anyways, as I recall, it was a five paragraphs of stuff about palliative care. I have nothing against palliative care per se, but it's the end stage health care cancer patients, it's not a cure, treatment or anything else. And as far as I know, there's not much difference between palliative care for a lung cancer patient or a stomach cancer patient. So, one sentence is acceptable. But it was four paragraphs. I left the one that actually worked. So, as I wrote, it's undue weight. By the way, it's not the job of Wikipedia to provide information about end-of-life issues for every single disease. OrangeMarlin ^{Talk•Contributions} 06:00, 26 May 2011 (UTC)

The removed text was:

However, palliative care may often be more appropriate in conjunction with chemotherapy at some point in the treatment of the cancer, rather than on its own. Over the past 20 years, the opposite question has also been asked: does chemotherapy add to supportive care? Superior survival has been repeatedly found in advanced non-small-cell lung cancer when study eligible recipients receive appropriate chemotherapy rather than supportive care alone. For example, 1994 recommendations based on reports that combined the results of several available studies found an increase in average survival from 3.9 months for best supportive care alone to 6.7 months with the addition of chemotherapy, as well as an improved quality of life. A systematic review from Sweden in 2001 looked at numerous chemotherapy reports over many years in lung cancer with adequate physical fitness. Compared to supportive care alone there was a 1.5 to 3 months prolongation of survival with chemotherapy in general, with better results seen with what were then newer agents. Symptomatic relief and an improvement in quality of life were also evident. A contemporaneous independent British review was consistent with this conclusion.

Despite a change in population demographics, this continues to hold up. A 2008 update by the NSCLC Meta-Analyses Collaborative Group looked at individual patient data from clinical trials subsequent to 1995, and recommended that chemotherapy should be considered in advanced non-small-cell lung cancer provided the recipient wanted treatment and was adequately fit to be able to tolerate it. This analysis was the basis of a 2010 Cochrane Review reporting that chemotherapy improves overall survival in advanced non-small-cell lung cancer, and finding a benefit in different subtypes of the cancer.

Palliative care is an essential and routine component of evidence-based, high-quality care for the management of advanced lung cancer but it is also clear that the best way to deliver palliative care is unknown. By way of emphasis, an analysis of almost 400 randomized controlled trials of palliative care concluded that the evidence for specialized palliative care as a specific intervention is limited, due to methodological shortcomings of the data. That review found that the most consistent benefit of palliative care was a increased perception by family members of good quality care. Which specific components of palliative care are of benefit is unknown, warranting further clinical assessment of different palliative approaches.

I'd suggest a slimmed-down version, such as:

Chemotherapy may be combined with palliative care at some point in the treatment of the non-small-cell lung cancer. In advanced NSCLC, a 1994 meta-analysis found that appropriate chemotherapy improved average survival over supportive care alone, as well as improving quality of life. With adequate physical fitness, maintaining chemotherapy during lung cancer palliation offers a 1.5 to 3 months prolongation of survival, symptomatic relief and an improvement in quality of life, with better results seen with modern agents. Since 2008, the NSCLC Meta-Analyses Collaborative Group has recommended that if the recipient wants and can tolerate treatment then chemotherapy should be considered in advanced NSCLC, including in different subtypes of that cancer.

This would remove the portion which is not specific to lung cancer and condense that which is. It states more directly the results of systematic reviews, since they are not challenged as wp:MEDRS and trims much of the redundancy. How does it look?LeadSongDog come howl! 16:19, 26 May 2011 (UTC)

"Chemotherapy may be combined with palliative care at some point." At what point? I don't think that "at some point" needs to be mentioned.

"including in different subtypes of that cancer." I don't think that this part needs to be mentioned.

Otherwise, I would be happy to include your suggested text in the article. Axl ¤ [Talk] 16:19, 27 May 2011 (UTC)

Tweaked per Axl. LeadSongDog come howl! 02:51, 30 May 2011 (UTC)

I'm happy with this. Axl ¤ [Talk] 10:22, 30 May 2011 (UTC)

What's happened to the references? They aren't visible in the reference list. Axl ¤ [Talk] 10:24, 30 May 2011 (UTC)

Excellent discussion, folks. I'd only add that differential chemo/palliative treatment of different subtypes of NSCLC is rapidly becoming the norm. In squamous cell lung carcinoma, say YES to gemcitabine, NO to bevacizumab. In large cell carcinoma, say YES to pemetrexed. In adenocarcinoma, EGFR (in nm-BAC AdC, papillary AdC), K-ras (mucinous/mixed mucinous BAC, others), and EML4-ALK (signet ring cell AdC, papillary Adc), targets, just to mention a few. Respectfully STRONGLY suggest keeping the "subtype" stuff :-)Cliff Knickerbocker, M.S. ([[User talk:Uploadvirus|talk]]) (talk) 01:17, 16 June 2011 (UTC)

This was a very useful discussion. I made a much earlier edit to this section which was also aimed at reducing the weight given to palliative care over the other treatments but now I see the article has featured status and the way the treatment section is organized is very professional looking. This is a model for how a medical article should be on wikipedia. The palliative care stuff is important as lots of cancers present late and a palliative approach is warranted. Also the article in the NEJM shows that palliative care (i.e. symptom management and holistic approach) can work alongside the other treatments. Lonnyz (talk) 08:18, 12 December 2011 (UTC)

Residential radon

“Wikipedia:Identifying reliable sources” says: “Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature”. Many regard British Medical Journal, Journal of Clinical Oncology, Oxford Journals: Radiation Protection Dosimetry and Epidemiology as typical reliable. My text provides an important complement to the preceding text, displays essential uncertainties and are cautiously formulated to avoid to deceive the public or annoy sensitive people.

Review articles should be used almost exclusively ( yes primary sources may be occasionally used but this would not be the occasional case ). We can wait for others opinion on this aswell. Doc James (talk · contribs · email) 00:19, 16 June 2011 (UTC)

I understand Wikipedia's rules in a different way. Like you I think it should describe what is perceived as a research consensus, "the traditional research position" (using "secondary literature"), BUT ALSO leave some space for well documented contemporary criticism of this (using "reliable primary sources"). Especially if the criticism is based on good science, and in line with the thinking Cochrane stands for. Is this not good for Wikipedia as an updated and free encyclopedia? — Precedingunsigned comment added by T020 (talk • contribs) 15:23, 16 June 2011 (UTC)

The main article on lung cancer should however be an overview. I agree that there is space for reasonable main stream criticism. We could create a sub article of this one like Causes of lung cancer where the details and evidence can be discussed in greater detail if you wish. Doc James (talk ·contribs · email) 18:46, 16 June 2011 (UTC)

I do not understand what the original comment refers to. Axl ¤ [Talk] 21:17, 16 June 2011 (UTC)

I inserted this text, which was intended partly to complement the picture of the risk from radon which is given in the present text and to clarify the role of smoking on the risk from radon. The text was deleted for reasons which I found it difficult to understand. (The idea of ​​a special page "Lung cancer - risk factors" is worth thinking on.)

Residential radon

Results from epidemiological studies indicate that the risk of lung cancer increases with exposure to residential radon. However, there are always major uncertainties in theese studies. A classical and well-known example of source of error is smoking.// Radon is, like other known or suspected external risk factors for lung cancer, especially a threat for smokers and former smokers. This was clearly demonstrated by the European pooling study. A commentary to the pooling study stated: “it is not appropriate to talk simply of a risk from radon in homes. The risk is from smoking, compounded by a synergistic effect of radon for smokers. Without smoking, the effect seems to be so small as to be insignificant.”// A study of radiation from postmastectomy radiotherapy (PMRT) shows that the simple models previously used to assess the combined and separate risks from radiation and smoking need to be developed. This is also supported by new discussion about the calculation method, LNT, which routinely has been used. If also passive smoking can cause a similar synergy effect with residential radon has been insufficiently studied. The basic data for the European pooling study makes it impossible to exclude that such synergy effect is an explanation for the (very limited) increase in the risk for lung cancer from radon that was stated for non-smokers. A study from 2001 which included 436 cases (never smokers who had lung cancer), and a control group (1649 never smokers) showed that exposure to radon increased the risk of lung cancer in never smokers. But the group that had been exposed to passive smoking at home appeared to bear the entire risk increase, while those who were not exposed to passive smoking did not show any increased risk with increasing radon level. This needs confirmation by additional studies.

T020 (talk) 18:51, 20 June 2011 (UTC)

Our articles should be based on secondary sources such as medical reviews, per our guideline on sources for medical claims. This is to prevent us from placing too much undue emphasis on any particular single study over what is recognized in the medical literature. The sources in the above section seem to not meet these criteria. Yobol (talk) 21:27, 20 June 2011 (UTC)

Agree with Yobol Doc James (talk ·contribs · email) 21:32, 20 June 2011 (UTC)

Agree. At the risk of committing talkpage wp:OR, the pooling study does not look at the dose-response of second hand smoke, just of radon. Clearly in an epidemiological study this is a gross omission. Poorly ventilated homes will tend to have higher levels of both.LeadSongDog come howl! 21:49, 20 June 2011 (UTC)

I can not agree. You seem to give to much credence to the secondary literature's reliability. The rules you refer to says: "Finally, make readers aware of any uncertainty or controversy." Wikipedia readers should be made to understand that a negotiated consensus in secondary literature can be surrounded by uncertainties and critical issues. Is it not a task for the "Medicine wiki project" to promote a broad and nuanced approach?

Perhaps a special page on risk factors is the best solution? I agree that the original text should be kept short. A special text on risk factors could probably give a better picture of the complexity. T020 (talk) 18:11, 21 June 2011 (UTC)

Whether or not you personally agree, that is the guidelines we follow, and there is a clear consensus against your interpretation. We use secondary reviews, and we do not use primary articles to rebut or open controversies that the secondary reviews do not touch upon. You need to read the guideline and take it in as a whole rather than try to justify your additions by taking bits and pieces of the guideline out of context. Yobol (talk) 18:18, 21 June 2011 (UTC)

From the guideline (Wikipedia:No original research):

1) Wikipedia articles usually rely on material from secondary sources

2a) primary sources that have been reliably published may be used in Wikipedia, but only with care, because it is easy to misuse them.

2b) primary sources are permitted if used carefully

3) interpretive, analytic or evaluative claims about primary sources must be referenced to a secondary source

4) Deciding whether primary, secondary or tertiary sources are appropriate on any given occasion is a matter of common sense and good editorial judgment,

T020 (talk) 20:03, 21 June 2011 (UTC)

All of which is in keeping with WP:MEDRS, which applies these policies to the medical claims. When editors (who have been editing medical articles for years) suggest a path forward (i.e. find secondary sources to source any medical claims), it is probably best to heed those suggestions rather than try to push through your own personal viewpoint against consensus. Yobol(talk) 20:11, 21 June 2011 (UTC)

OK. But if this is the Wikipedia practice, it is risky (I read it the guidelines differently).

Research into the history of medicine shows that consensus on therapies often may have have been relevant, but assessments of risk factors have not always been sustainable. Far too often, they have been infected by political, moral or economic interests. Consensus is not always identical with the truth. A critical attitude is always good, indeed necessary. A scientific basis is to ask challenging questions. But everything depends basically on what you want to serve Wikipedia's readers. T020 (talk) 19:38, 27 June 2011 (UTC)

Time to review wp:NOT. We don't create content, WP is a tertiary reference. There are many other publications for the purpose you seek, but this is not one of them.LeadSongDog come howl! 22:07, 27 June 2011 (UTC)

Using exclusively review articles to create an over view of a major topic is required. If we all comply with this things are easier. When I edit a I do a pubmed search for the topic I wish to write about. Limit the search to reviews (button on the right side of the search) and then look for recent papers. I let the sources lead. Doc James (talk · contribs · email) 23:39, 27 June 2011 (UTC)

When I read W:s guidelines, I see that only two of my five sources are considered to be primary. And one of these I could refer to by a secondary source, if it feels better for you. Otherwise, the text was based on well-established medical knowledge that hardly need references. And I hope you will note that I still have not received an objection to contents. Only objections on formal grounds. A similar text has been available under "radon" during a long time. Many people, including international "radon experts" have surely read the text, but have decided not to editing. Which I hope someone will do.

When I read the guidelines, it strikes me that the "consensus" may be more important to Wikipedia than "secondary sources". My impression is that you overemphasize the importance of "secondary" (as I pointed out earlier).

From “Wikipedia: Consensus”:

“When there is a more serious dispute over an edit, the consensus process becomes more explicit. Editors open a section on the talk page and try to work out the dispute through discussion. Consensus discussion has a particular form: editors try to persuade others, using reasons based in policy, sources, and common sense. The goal of a consensus discussion is to reach an agreement about page content, one which may not satisfy anyone completely but which all editors involved recognize as a reasonable exposition of the topic. It is useful to remember that consensus is an ongoing process on Wikipedia. It is often better to accept a less-than-perfect compromise – with the understanding that the page is gradually improving – than to try to fight to implement a particular 'perfect' version immediately. The quality of articles with combative editors is, as a rule, far lower than that of articles where editors take a longer view.”

“Consensus is not immutable. Past decisions are open to challenge and are not binding. Moreover, such changes are often reasonable. Thus, "according to consensus" and "violates consensus" are not valid rationales for accepting or rejecting proposals or actions. While past "extensive discussions" can guide editors on what influenced a past consensus, editors need to re-examine each proposal on its own merits, and determine afresh whether consensus either has or has not changed.

Wikipedia remains flexible because new people may bring fresh ideas, growing may evolve new needs, people may change their minds over time when new things come up, and we may find a better way to do things.

A representative group might make a decision on behalf of the community as a whole. More often, people document changes to existing procedures at some arbitrary time after the fact. But in all these cases, nothing is permanently fixed. The world changes, and Wikipedia must change with it. It is reasonable and indeed often desirable to make further changes to things at a later date, even if the last change was years ago.”

T020 (talk) 17:41, 28 June 2011 (UTC)

Wikipedia:Policies have very broad consensus. wp:V is a policy, as is wp:NOR. Wikipedia:Guidelines have broad consensus. wp:RS and wp:MEDRS are guidelines. There is no desire to quash or censor novel ideas, but neither is the function of an encyclopedia to list every idea that anybody comes up with. We have to select on the basis of merit. Since we are mostly pseudonymous there is no trust residing in the editors reputations: rather the published secondary sources tell us which ideas have merit amongst the primary sources they were based upon. As wp:MEDRS makes clear, all medical assertions should be based on published reviews. As Doc James explained above, these are very easy to identify on Pubmed. Four of the five papers you identified are not shown as reviews there. If you think otherwise, it would be helpful to know what evidence you have that they are.LeadSongDog come howl! 18:17, 28 June 2011 (UTC)

Thank you for your interest and patience!

It feels awkward to give high value to secondary sources and low value to primary sources. Normally it's the opposite. But I understand, of course, the cause and the idea - individual research reports may point in different directions.

It is weird to prove that my sources were secondary. But OK.

1) The European pooling study is a compilation of, and an attempt to draw conclusions from, a large number of primary sources.

2) Higson is a renowned expert in radiation risks and comment here a secondary source (ie, tertiary).

3) The study of PMRT is undoubtedly primary (but there is a review).

4) REVIEW AND EVALUATION OF UPDATED STUDIES ON THE HEALTH EFFECTS ASSOCIATED WITH LOW-DOSE RADIATION IONISING is secondary and there is no need for arguments.

5) Lagarde et al. is primary, but I could refer to a heavy and reliable secondary source which reflects its results.

Maybe I come back with a slightly shorter text, which is better adapted to the W guidelines.

T020 (talk) 20:36, 28 June 2011 (UTC)

See PMID 21489214, PMID 21257878, PMID 20371364 for recent secondary sources. LeadSongDog come howl! 06:17, 29 June 2011 (UTC)