Talk:Lung cancer

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Sodium,

While I generally like this well fleshed-out article I must point out some inconsistencies and present my reservations and remarks.

"For lay people or for academics" - this issue has not been tackled properly by Wikipedia community yet. It seems to be really hard to strike a balance between these two approaches.
Obviously I am looking at this article from the professional's perspective and I feel the article is lacking something.

There is another thing, in the last decades medicine has changed considerably.
Evidence-based medicine, large international studies and meta-analyses pave the way for everyday practice. We no longer take medical standards and medical knowledge for granted it must be well researched and put under scrutiny of double-blind randomised studies. A statement is never complete without references from respected peer-reviewed medical journals.
Considering this health science articles seem incomplete or even sound like the medical knowledge of the past.

  1. "present in cigarettes" - better "in cigarette smoke" or better still - "in tobacco smoke"
  2. "lung cancer" - "lung neoplasm" - "lung tumour" -- these can not always be used interchangably and can be misleading sometimes
  3. "cells lining the bronchi" - bronchial mucous membrane (consider changing in some places "cells" into "tissue")
  4. "patient here would start to cough up blood-stained material" -it is unclear because of cancer or abscess
  5. histology of lung neoplasms -- asbestos is carcinogenic in case of mesothelioma mainly AFAIR
  6. treatment section needs more material
  7. all in all this article needs some rewrite and probably should fork into several other articles about specific histological types of neoplasms - they are diferrent in many respects. A good job but let's combine our efforts to make it even better.


Kpjas

Contents

[edit] State of play (rant)

This article, in its present form, is abysmal. I have done some rough hewing & cutting, but much more work needs to be done to remove all sorts of wild statements and bring it into line with actual clinical practice. Everyone may help. I have removed the idiotic statement that there are many treatments "listed" on Pubmed that don't reach clinical practice, suggesting that lay people should start searching Medline and pick&choose therapies etc. I found the PET-scan screening link too "fringe" to keep it in the article, especially because it does not otherwise reference to any peer-reviewed material. JFW | T@lk 21:29, 16 Dec 2004 (UTC)

[edit] Where is the data? (rant)

It is poor science to use the term "most important risk factor..." It is a little like saying peanuts are a high risk factor in the deaths related to legume allergies. Peanuts can and do cause death from legume allergy.

Instead, put in the statistic for number of cancer cases that are smokers. 80, 90 95% of all cases of cancer are smokers.

This article is lacking that one most important statistic. What is the rate of smokers in the group of lung cancer cases?

Eric Norby 2006-Jan-2 09:28 (PST)

Smoking is estimated to account for 87% of lung cancer cases in the U.S. (90% in men and 79% in women). A general figure for smoking is already in the text under "role of smoking." Andrew73 01:38, 3 January 2006 (UTC)

Interesting. Source?

[edit] Primary Prevention

I removed this sentence:

However, it should be noted that an illegal black market in tobacco would be much more difficult to operate, than with alcohol or marijuana.

Anyone got some support for this claim? I fail to see the difficulty. Equalpants 23:42, 25 January 2006 (UTC)


[edit] QUESTION:

I noted that the statistics posted claim that roughly 80% of lung cancer patients have non-small cell lung cancer. It then goes on to say that the 20% who have small cell lung cancer have a strong correlation to smoking. Elsewhere, and common knowledge to most laypeople, is that smoking is one of the biggest, if not the biggest, risk for lung cancer. Do patients suffering from NSCLC also have a correlation to smoking patterns?

Hi first-time editor of this article here. I added a bit more details on NSCLC & smoking. Ming-Chih Kao 15:08, 12 June 2006 (UTC)

[edit] Improvings

I'd like to list here my problems with the article. I believe that it could become fac with some cooperation. So:

NCurse work 15:15, 16 July 2006 (UTC)

I've changed the table, it looks better now. NCurse work 15:10, 16 July 2006 (UTC)
There is an unsourced statement. I can't find a solution. NCurse work 16:58, 16 July 2006 (UTC)

[edit] Screening CT

Early Detection When Lung cancer is detected early, the survival rate for affected individuals can go up from 14 percent (the current overall five-year survival rate of lung-cancer victims in the U.S.) to over 80 percent. The key to early detection is a CT Scan which can uncover small tumors in the lungs of asymptomatic persons. By the time an individual experiences one or more symptoms of lung cancer, his/her disease is usually in an advanced state. A CT scan can uncover tumors not yet visible on an x-ray. A study published in 2006 by oncologists at New York Cornell-Weil confirmed the wisdom of scans for those in lung cancer risk groups.

At present, there are no official early-detection guidelines for lung cancer as there are for other cancers, although lung cancer claims far move lives. Many oncologists and pulmonologists recommend CT chest scans for people near 50 years of age who have a significant smoking history, even if these smokers quit some time ago. An informal 50-20-10 rule is commonplace: If an individual is age 50 or older and has smoked a pack a day for 10 years, or half a pack a day for 20 years, a CT-scan of the chest is advised.

There are those who argue against such scans on the ground of false positives, yet almost all medical tests show some false positives. Chest scans that indicate tumors are always followed up by cell extraction and biopsy that must confirm a tumorous cancer before treatment begins.

Lung cancer is woefully underfunded in the areas of prevention, detection and cure. Little is definitive except that smoking significantly increases an individual's risk of getting lung cancer. Unfortunately, quitting smoking (although a sound health choice for many other reasons) does not necessarily bestow a free pass when it comes to lung cancer.

Yes, more research is needed. But it is clear that smokers and ex-smokers (along with asbestos workers) are at high risk for lung cancer, and that waiting for lung cancer to show itself almost guarantees a poor outcome. CT-scans could saves hundreds of thousands of lives each years in North America alone.

Alerting the public that ex-smokers remain at risk for lung cancer would complicate the public health stop-smoking campaigns, it's true. But remaining silent is not an ethical choice. The above comment was added by User:Ilenebarth at 03:42 on 28 September 2006, and moved from the top of the article by User:nmg20

Hi - thanks for the comment. Can you provide references for the studies you mention? The figure of 80% which you give is 10% higher than that referenced in the Non-small cell lung cancer staging article, and "Many oncologists and pulmonologists recommend..." is weasel words - how many and who?
To my mind, the main problem with false positives is that exposing individuals to high doses of radiation (from the CT) and then a proportion of well individuals to biopsies and the concomitant risks of surgery - which would be higher in elderly smokers - is irresponsible until a randomised controlled trial has demonstrated long-term benefit. If you have details of such research, I'd love to see them.
May I also take umbrage with the statement about lung cancer being woefully underfunded in the areas of prevention, detection, and cure? The means of prevention is already known - stop smoking and stop passive smoking and we'll return to the time before cigarette smoking was commonplace, when lung cancer was an exceptionally rare condition. The only research needed here is how to help people give up - and that's pretty well funded as health promotion interventions go. Detection is similarly excellent - the issue is that (as the article says) it is an insidious, subtle disease which presents clinically very late in its course and with non-specific symptoms. Granted, the late presentation might be an argument for a screening program - but until someone has shown that the benefits of screening outweigh the risks, I don't see a place for advocating what would in the US be extremely expensive scans for all in the article.Nmg20 15:19, 28 September 2006 (UTC)
  • removed: "Alerting the public that ex-smokers remain at risk for lung cancer would complicate

the public health stop-smoking campaigns." There are non NPOV statements from both sides in this article, and the removed statement is one of them, and it's also unsourced. I think it is sarcastic and insinuates dishonesty. But mainly, is it true and can it be verified in the first place that antismoking campaigns do not give due notice that some elevated risk for lung cancer remains after you stop smoking? Bearing in mind that common sense tells smokers that some risk would remain, or even that they already might have cancer?Rich 09:07, 4 October 2006 (UTC)

"stop smoking and stop passive smoking and we'll return to the time before cigarette smoking was commonplace, when lung cancer was an exceptionally rare condition." When was that? Where are those studies? How rare was lung cancer? How many cases were never known because the science wasn't there? How many people died of lung cancer from passive smoke when most adults smoked? How many die now from passive smoke? How do scientists single this out and separate it from all other air-bourne pollutants? In other words I believe your comment to be very strong POV. --Lorraine LeBeau 18:32, 19 October 2006 (UTC)
(Moved your comment to the bottom of the list. To answer your questions:
  • The time when lung cancer was an exceptionally rare condition was before cigarette smoking was commonplace. This is in the sentence of mine you quote.
  • Those studies are on pubmed. The best is probably Witschi 2001, A Short History of Lung Cancer, PMID 11606795. The quotations which follow are from this paper.
  • How rare was it? "Some 150 years ago, it (lung cancer) was an extremely rare disease. In 1878, malignant lung tumors represented only 1% of all cancers seen at autopsy in the Institute of Pathology of the University of Dresden in Germany." This is versus 10-15% by the start of last century, a trend noted in the Springer Handbook of Special Pathology. Another source is Adler I. Primary malignant growths of the lungs and bronchi. New York: Longmans, Green, and Company; 1912., cited in Spiro SG, Silvestri GA. One hundred years of lung cancer. Am J Respir Crit Care Med. 2005 Sep 1;172(5):523-9. Epub 2005 Jun 16. PMID: 15961694. Adler could only identify 374 cases of lung cancer in the worldwide literature at the time of writing.
  • How many cases were never known because the science wasn't there? Lung cancer is identifiable on gross histology at post-mortem. Histology has existed as a science for hundreds of years - so the short answer to your question is that the diagnosis was basically the same then as it is now (although normally post-mortem), so no more would be missed than are now.
  • Passive smoking - I suggest you go read that article on Wikipedia for info on this.
  • The only pollutant which has been shown to have had an effect on lung cancer is radon gas, and this applies only to specific locations, i.e. workers in mines. Other airborne pollutants have been looked at in the Springer Handbook, cited in the article above.
In other words, my comment is not POV: that lung cancer was exceptionally rare until the onset of smoking is not something that people will waste time studying because it's a matter of historical record, and if you'll excuse my saying so, it takes a certain degree of gall to question that fact. Where someone wishes to challenge a view which is commonly held as fact, I believe it's incumbent on them to provide evidence for their alternative position, not on me to defend the academic status quo. Thanks for your questions, and enjoy Witschi. Nmg20 08:55, 20 October 2006 (UTC)

[edit] Screening section tagged for date cleanup

I added the {{Update-section}} template to the Screening and secondary prevention section because there are statements discussing research being "currently" researched. This alone gets icky in encyclopedic texts, if you agree with the discussion at Wikipedia:Avoid_statements_that_will_date_quickly. It's made worse by the fact that this text was added December 31, 2004, making it nearly two years out of date. -Quintote 00:22, 6 October 2006 (UTC)

[edit] NSCLC

Shouldn't it be non–small-cell lung cancer instead of non-small cell lung cancer? Fvasconcellos 13:59, 16 November 2006 (UTC)

No. Axl 08:24, 20 November 2006 (UTC)

[edit] Treatment modalities?

What are treatment modalities? How do they differ from treatments? (Referring to last sentence of intro.) Nurg 00:59, 20 November 2006 (UTC)

The 'modality' refers to the generic treatment method. Examples: -
Surgery
Radiotherapy
Chemotherapy
The 'treatment' may refer to the modality, or may refer to the specifics. Examples: -
Right lower lobectomy
Single fraction 10 Gray radiotherapy
Etoposide and cisplatin chemotherapy
Axl 08:29, 20 November 2006 (UTC)
So for the non-specialist reader would it be ok to say "Possible treatments include surgery, chemotherapy, and radiotherapy" rather than "Possible treatment modalities include surgery, chemotherapy, and/or radiotherapy"? Nurg 09:39, 20 November 2006 (UTC)
Yes. I have adjusted the sentence. Axl 17:25, 20 November 2006 (UTC)

[edit] Repeated vandalism

Given the regularity of the vandalism over the last month or so, I'm inclined to ask that the page be semi-protected. All in favour? Nmg20 08:25, 1 December 2006 (UTC)

  • Done. Hopefully they will get bored in a few days -- Samir धर्म 08:27, 1 December 2006 (UTC)
Thanks very much - it worked while it was protected! I've just [it as a request for protection], as there have been six malicious edits and four reverts needed in the 24 hours since it came off protection again... Nmg20 20:34, 4 December 2006 (UTC)

[edit] Treat Ment

I heard that if you are under 18 and pressure to smoke their is a hot line. I think it is 1-800-Smoking-hotline. Thats what I heard

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