Talk:Lung cancer

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[edit] 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 at this 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 http://profiles.nlm.nih.gov/NN/B/B/M/Q/ 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)

[edit] 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 the relevant 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 the passive 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 [1], 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 at Passive_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 of User:ScienceApologist's talk on the Meetup project page Nbauman (talk) 21:45, 14 January 2008 (UTC)

[edit] 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.x JFW | 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)

[edit] 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)

[edit] 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)

[edit] 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.

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. 

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

[edit] 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 certain Lauren 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)

[edit] "Scientific evidence"

Sudsak (talk · contribs) continues to insert the incorrect claim that there is no scientific evidence linking smoking to lung cancer ([2]). 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)

[edit] 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 [3] and this search gives you lots of papers on not only the statistical evidence linking smoking to lung cancer, but also medical causation including [4], [5] 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)