Talk:Lung cancer

From Wikipedia, the free encyclopedia

This article is part of a WikiProject to improve Wikipedia's articles related to medicine. For guidelines see WikiProject Clinical Medicine and Wikipedia:Contributing FAQ.

This article has been selected for Version 0.5 and the next release version of Wikipedia. This Natsci article has been rated B-Class on the assessment scale.

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 1 State of play (rant) 2 Where is the data? (rant) 3 Primary Prevention 4 QUESTION: 5 Improvings 6 Screening CT 7 Screening section tagged for date cleanup 8 NSCLC 9 Treatment modalities? 10 Repeated vandalism 11 Treat Ment 12 Bronchogenic carcinoma vs. lung cancer 13 Who is this page for - <<suitability of image>> 14 Deaths 15 Numbers in Epidemiology 16 Treatment 17 Cement paint 18 Weird spacing

[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:

• "Lung cancer is one of the most lethal of cancers worldwide, causing up to 3 million deaths annually. Only one in ten patients diagnosed with this disease will survive the next five years." (REFERENCE?)
• A short leading paragraph is needed for Signs and symptoms section because it starts witha list. NCurse _work 15:06, 16 July 2006 (UTC)
• Images we could use:
  • Image:Cancer smoking lung cancer correlation from NIH.png
  • Image:Histogram from cytometry - hypertetraploidy.PNG - it is from lung cancer
  • Image:Histogram from cytometry - tetraploidy.PNG - it is from lung cancer
  • Image:Carcinoma microcellulare oatcell carcinoma or anaplastic carcinoma (lung)H&E magn 200x.jpg - Anaplastic (micorocellular, oat cell) carcinoma from the lung
  • Image:Rugova-Douste-Blazy.jpg - President of Kosovo Ibrahim Rugova with French Minister of Foreign Affairs Philippe Douste-Blazy, December 9-10, 2005. This photo was taken when Rugova was in an advanced stage of the lung cancer of which he died the next month, which affects his appearance.

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)

The latest NEJM (15 Feb 2007, PMID isn't available yet) has a letters section full of mostly negative comments about Henschke's I-ELCAP study. For example, Henschke found 269 cases of lung cancer per 100,000 persons at risk, whereas CDC reported an annual incidence of 62.8 per 100,000 men, 52.7 per 100,000 women. Therefore, argued Lee et al., CT screening may be overdetecting 200 cases per 100,000 of clinically insignificant lung cancers which would never have progressed to clinical lung cancer. Therefore, their survival rates after treatment will be excellent, because they never had clinically significant lung cancer in the first place. Nbauman 10:07, 15 February 2007 (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)

I would like to qualify the following statement by adding a reference: "This is important when one considers that repeated radiation exposure from screening could actually induce carcinogenesis in a small percentage of screened subjects, so this risk should be mitigated by a (relatively) high prevalence of lung cancer in the population being screened." A study by DJ Brenner attempted to study the effect of radiation from low-dose CT in Radiology in 2004. He concludes, based on extrapolation of data from Japanese atomic bomb survivor rates, that the radiation exposure from screening current and former smokers from age 50 to 75 would increase lung cancer rates by 1.8%. People have concerns with the article, such as this letter to the editor but it's the only attempt I've seen that has tried to quantify the risk due to screening. All this information probably doesn't need to be listed in the article, but I thought the reference would be helpful.--Clicq 17:08, 17 January 2007 (UTC)

It is certainly worth adding the reference. Axl 19:28, 17 January 2007 (UTC)

[edit] Screening section tagged for date cleanup

1. REDIRECT [[Insert text
   _{Subscript text}]]

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)

We're back into spates of vandalism - I make it 11 or 12 in 36 hours or so... Nmg20 14:06, 8 March 2007 (UTC)

That's another dozen or so in the last 24 hours - I'm off to request protection again. Grrrr. (edit) Scratch that - User:Pyrospirit has beaten me to it. Hopefully this will clear things up. Nmg20 16:34, 13 March 2007 (UTC)

I've just re-requested this, and it looks like one of the admins has kindly semi-protected it. Cup of tea, anyone...? Nmg20 12:41, 29 March 2007 (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

[edit] Bronchogenic carcinoma vs. lung cancer

The introductory paragraph states "the most common histologic type is bronchogenic carcinoma, constituting about 90% of all lung cancers." I am not aware of a difference between "lung cancer" and "bronchogenic carcinoma" ... and I'm a pulmonologist. Axl 08:12, 28 December 2006 (UTC)

I have read the bronchogenic carcinoma article. It should redirect to lung cancer. Axl 10:44, 28 December 2006 (UTC)

Done. This was pretty straightforward redirect issue. Andrew73 14:13, 28 December 2006 (UTC)

Thanks, Andrew. Since you agree with my point of view, I have removed the offending sentence from 'Lung cancer'. Axl 17:51, 28 December 2006 (UTC)

Agreed too, thanks. When I was editing, that sentenced seemed really awkward for some reason. Andrewr47 03:32, 29 December 2006 (UTC)

Things may be different from an European viewpoint: not all lung cancer is bronchogenic cancer. This article appears to ignore the existence of those cancers arising from alveolar epithelium.

[edit] Who is this page for - <<suitability of image>>

Who is this page for? I have a family member who probably has metastatic lung cancer, yes after a lifetime of smoking. I am not going to send him here. The gory starting image, as real as it is, would probably put him in a coma. Some sensitivity and consideration of the emotional/physical side is called for if this is not just for technicians. The above comment was added by User:199.166.207.129 at 15:10, 29 January 2007. Four tildes ~~~~ will sign your name!

I agree the picture's a bit gory - but what else are you going to put up on a page about lung cancer if not pathological specimens? I can't think of much else, I'm afraid. What your family member needs right now is probably not to read about what causes lung cancer - if he does have metastatic disease, you might think about pointing him towards some of the support networks out there, and liaising with your doctors to be put in touch with appropriate nursing staff. Good luck. Nmg20 01:53, 30 January 2007 (UTC)

Well can't we at least place a warning or something? The picture's really not pretty. User:dewberry 16:57, 17 February 2007 (UTC)

There would be no encyclopedic reason to include a warning since Wikipedia is not censored. Wikipedia is also not a counselling or advice site directed at certain people, it is an encyclopedia for everybody. Appropriateness of content is evaluated on encyclopedic value, and nothing else. The only exceptions are content which violate Wikipedia policies or Florida law. That said, the best way to move the picture off from the very top would be to find a picture which has higher encyclopedic value and relevance to lung cancer which is more desirable at the top of the page as well as to look at. If you can find such an image, you can propose it here and if it's worth it I'm sure these editors would be happy to support the change. The gory picture would still be on the article but just bumped down a little so it's not the first thing you see; a similar format to what's going on with the penis article. --Davidkazuhiro 14:09, 3 March 2007 (UTC)

[edit] Deaths

I think someone who is informed should make it more clear how many die each year in the U.S. and if it is going up or down. For instance it says 70,000 out of 80,000 women die but nothing on the men, it all seems random and incomplete.

The reason it emphasizes the comparison to female cancers is that it's taken from a source about lung cancer in women. I agree that it's random and incomplete. Nbauman 18:42, 3 March 2007 (UTC)

I looked again at that source and the National Lung Cancer Partnership pamphlet is not a good source. Their statistics seem to be entirely taken from the American Cancer Society. Why use a secondary source when you can use a primary source? It's also not a good idea to cite the footnotes in patient pamphlets, even for the ACS. The ACS publishes a book called Clinical Oncology which has complete tables and explanations of where they got the numbers, so you don't have to get into debates over what the numbers mean. The primary source that the ACS gets their data from, I think, is the SEER study, and if you want to be reliable, that's what you should use. It seems like an easy decision. Do you want to be reliable or not? Nbauman 22:20, 3 March 2007 (UTC)

Unless anyone has any objection, I'm going to edit the introduction to remove the extensive comparison of lung cancer deaths to other deaths among women. That was simply taken from a pamphlet from a web site on the specific subject of lung cancer in women and it's a digression. A detailed discussion of lung cancer in women would be fine, but it should have its own section. Nbauman 15:21, 5 March 2007 (UTC)

[edit] Numbers in Epidemiology

I agree with the above posting that the numbers aren't very thorough. The section should be expanded and an article should be created to fully cover the statistics of both genders and all nations, at least the English speaking ones for starters. That would really help this article out. --Davidkazuhiro 09:38, 1 March 2007 (UTC)

The differences in gender are entirely the result of differences in smoking.

I've seen international statistics, and I have them somewhere on my bookshelf. They are tables that go on for pages. In order to figure out what to include, you have to first figure out what the purpose of that data will be. Epidemiologists like to examine comparative international statistics to establish causes and effective prevention and treatment. What reason would you have for including comparative international statistics in this article? How much detail would you need?

The most accurate statistics are the ones from the U.S. and developed countries, but statistics from non-developed countries tend to be inaccurate. I'd like to see a source for the 3 million figure in the introductory paragraph.

The first place I would go for those statistics is Harrison's Internal Medicine. The 16th edition gives an incidence (new cases) of 93,000 males and 80,000 females in the U.S., and a 5-year overall survival of 14%. Almost everybody who gets lung cancer is dead 10 or certainly 15 years after diagnosis.

Second place I would go is DeVita's Cancer. 5th edition gives incidence 177,000 new cases in 1996, 159,000 deaths. 80% of lung cancer in men (65,000 deaths per year) and 75% of lung cancer deaths among women (27,000 deaths per year) are attributed to smoking.

Curiously, the Merck Manual doesn't give incidence and deaths (not my 17th edition, anyway).

I read recently in the NEJM that non-smoking lung cancers are particularly common in asian populations.

Should I edit the introductory paragraph to reflect these numbers? Nbauman 19:13, 3 March 2007 (UTC)

It would be great to have more accurate information in the introductory paragraph - but changing the data to reflect US figures wouldn't really be appropriate, would it? Wikipedia is, after all, a global encyclopaedia... The numbers you cite are currently given in the epidemiology section, and I think it would make more sense to include them there. Nmg20 20:46, 3 March 2007 (UTC)

The reason for using U.S. numbers is that the U.S. spends more money on epidemiological research, and often has better data. Even the BMJ and Lancet often use U.S. numbers rather than U.K. numbers for some diseases. The problem with global figures is that the global figures are inaccurate and not reliable.

The reason for including basic incidence and mortality in the introduction is that almost every medical textbook and review article does that. Doctors regard it as essential facts about any disease.

In the U.S., a medical examiner fills out a death certificate for almost every death, and if the patient had lung cancer, it's noted on the death certificate. The data on the death certificates is collected. There are other monitoring systems to double-check the death certificates. In the undeveloped world, which is to say for most of the world's population, people can die without the death being reported to any central authority. The deaths are just estimates. I'd like to know what the best estimate of worldwide lung cancer deaths is that you can come up with.

I can easily get statistics on incidence and mortality of lung cancer in the U.S. from reliable sources, like Harrison's or DeVita. If you can get similarly reliable statistics from other countries, I'd like to see them. This is an English language encyclopedia, so I think the U.S., U.K. and Australia should be highlighted, but you can't include everybody in the introductory paragraph. Nbauman 22:08, 3 March 2007 (UTC)

I agree that Westernised nations will have more accurate data on lung cancer and indeed on pretty much every cause of morbidity and mortality: they have a lot more money to throw at the problem. However, there are three reasons why I don't think the change you suggest is appropriate.

(1) Wikipedia policy is that articles should present a global view, and giving US incidence figures in the opening paragraph of the article absolutely does not do that.

(2) Rates in the US may be higher than elsewhere in the world.

(3) High-quality, independent data exists on rates of (lung) cancer around the world, both from organisations like the WHO and the IARC, and from peer-reviewed journals at an individual country level (e.g. Ngoan le T. Anti-smoking initiative and decline in incidence rates of lung cancer in Viet Nam. Asian Pac J Cancer Prev. 2006 Jul-Sep;7(3):492-4. PMID 17059354, Blake et al. Trends in incidence and histological subtypes of lung cancer, Kingston and St Andrew, Jamaica, 1968-1997. West Indian Med J. 2006 Jan;55(1):13-8. PMID 16755813, Hanai et al. [Trends of lung cancer incidence and its prognosis in Osaka, Japan] Gan To Kagaku Ryoho. 1994 May;21(6):727-35. PMID 8185326)

Fundamentally, while I'm sure Western / US data is more accurate, that does not prove that the existing figures in the article are inaccurate, and that's the only thing that would justify removing them, IMHO.

Regarding mortality and incidence data, as a medical student I'm well aware of their importance, and am rather baffled as to where you got the idea I didn't want them in the article? In any case, I agree they should be in there.

On the nature of Wikipedia: yes, it is English-language, but it is an English-language version of a global encyclopaedia, and so should cover subjects at a global level primarily and at a national level secondarily. Perhaps a compromise would be to leave the introductory figure as-is, and include data by country in the epidemiology section? The International Agency for Research on Cancer is an excellent source for incidence data globally, and provides details of the number of cases on which figures are based, and whether they were identified morphologically or only on death certificate data.Nmg20 23:31, 3 March 2007 (UTC)

Nmg20, I can't find a worldwide total in any of those cites you gave. Can you provide a URL? The IARC seems to be a collection of registries, and they don't cover every country in the world.

I'd have a hard time believing that anyone in Haiti, for example, could provide accurate lung cancer incidence and death statistics, given Paul Farmer's description of their health care system. I'd be skeptical of statistics even from China, because their hospitals and doctors don't treat patients who can't afford to pay, and most rural people can't afford to pay. How do you count someone who doesn't enter the health care system? Have you actually read those studies of Vietnam and Jamaica?

What number would you like to use for the worldwide total of lung cancer incidence and death? What's your source? Nbauman 02:42, 4 March 2007 (UTC)

Here's one.

CA Cancer J Clin 2005; 55:74-108
Global Cancer Statistics, 2002
D. Max Parkin, MD, Freddie Bray, J. Ferlay and Paola Pisani, PhD
ABSTRACT
Estimates of the worldwide incidence, mortality and prevalence of 26 cancers in the year 2002 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. The results are presented here in summary form, including the geographic variation between 20 large "areas" of the world. Overall, there were 10.9 million new cases, 6.7 million deaths, and 24.6 million persons alive with cancer (within three years of diagnosis). The most commonly diagnosed cancers are lung (1.35 million), breast (1.15 million), and colorectal (1 million); the most common causes of cancer death are lung cancer (1.18 million deaths), stomach cancer (700,000 deaths), and liver cancer (598,000 deaths). The most prevalent cancer in the world is breast cancer (4.4 million survivors up to 5 years following diagnosis). There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors related to lifestyle or environment, and provides a clear challenge to prevention.

Nbauman 11:14, 4 March 2007 (UTC)

That looks perfect. Regarding the worldwide data, I can only repeat what I said earlier: I accept your point that some of them are likely to be less than perfect, but we're obliged to present a global view, and that being the case, these are the best data we have. Nmg20 22:44, 4 March 2007 (UTC)

[edit] Treatment

Correct me if I'm wrong, but I can't find any cited sources in the entire "Treatment" section, except for that essay by Hansen which itself doesn't have any cited sources (and doesn't support most of the statements); and except for the citation to Harrison's which I added myself. Nbauman 22:44, 3 March 2007 (UTC)

You're not wrong. I'll try to dig some up now. Nmg20 23:40, 3 March 2007 (UTC)

The source I'm working from (BMJ Clinical Evidence: concise) only references cisplatin and uracil plus tegafur regimens as chemotherapy in resectable NSCLC, and the primary sources in the article seem to do likewise. However, I'm leery of removing the list of other chemotherapeutic agents - can anyone find supporting data, as Nbauman suggests?

I'm going to hold off adding the rest of the refs until we've decided whether to leave the existing ones in; as things stand if I add a ref for cisplatin it may look like it's supporting all the drugs listed. Nmg20 23:47, 3 March 2007 (UTC)

I would suggest that you start by researching the standard guidelines. The U.S guidelines are listed in the U.S. National Cancer Institute web site, although that's not my favorite source. I think European, Australian and Japanese guidelines are similar. Everybody follows the Cochrane Collaboration.

In the U.S., one of the standard, established treatments for SCLC is cisplatin and irinotecan, and the standard treatment for NSCLC is cisplatin and vinorelbine, according to a NEJM article anyway. In other words, they use a platinum compound to cross-link DNA and a vinca alkaloid to interfere with tubulin. What are the standard treatments where you are? Nbauman 03:05, 4 March 2007 (UTC)

Guidelines like this [1] Try to stick to the A level evidence. Nbauman 03:58, 4 March 2007 (UTC)

Here's the NEJM article. Surgery, followed by vinorelbine plus cisplatin, seems to be the best-established treatment for stage IB or II NSCLC.

N Engl J Med. 2005 Jun 23;352(25):2589-97.

Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer.

Winton T, et al.

Newer chemotherapeutic agents (vinorelbine, gemcitabine, taxanes, and camptothecins), when coupled with a platinum derivative, have significantly increased response and overall survival rates as compared with previous regimens in advanced non–small-cell lung cancer.6,7 Trials confirming the superior efficacy of vinorelbine in combination with platinum as compared with previous combinations were published in the early 1990s.6,7 Simultaneously, serotonin-receptor antagonists were shown to be effective in reducing the severity of cisplatin-induced emesis.8 Thus, an outpatient regimen of vinorelbine plus cisplatin as adjuvant chemotherapy, administered with antiemetics and supportive care, was considered an excellent choice and led to the initiation of the National Cancer Institute of Canada Clinical Trials Group JBR.10 trial in patients with completely resected stage IB or stage II non–small-cell lung cancer.

Nbauman 11:48, 4 March 2007 (UTC)

[edit] Cement paint

Can exposure to the fumes produced by cement paint cause lung cancer? Scorpionman 00:37, 4 March 2007 (UTC)

Judging from the lack of a reply, I'll assume that it can. Scorpionman 22:51, 6 March 2007 (UTC)

No, Scorpionman, it can't to my knowledge. If you find any evidence to the contrary, do let us know. Nmg20 00:49, 7 March 2007 (UTC)

[edit] Weird spacing

Any way to fix the strange spacing in the Non-small cell lung cancer/Small cell lung cancer sections? I am an occasional user of Wikipedia and have figured out some of the basic coding, but I can't figure out how to fix this. Thanks. 209.179.168.31 23:54, 13 March 2007 (UTC)

• Edited to add: none of the links to the casetables in that section seem to work, either, so perhaps someone with a greater medical knowledge who knows how to search for casetables can fix those links. 209.179.168.31 23:58, 13 March 2007 (UTC)