Talk:Lung cancer/Archive 1

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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

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)

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?

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)

---

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)

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)

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)

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)

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)

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)

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 relisted 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)

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

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.

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)

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)

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)

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)

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)

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)

Air pollution

A number of edits have been made in the last day or so (as at 27th April 2007) suggesting that air pollution causes lung cancer. I do not believe there is any scientific evidence to support this, and so such references should be removed pending support from the literature (in brief, the fact that lung cancer was virtually unknown before the 20th century despite the industrial revolution a century or so earlier is perhaps the most obvious argument against this).

Can anyone find refs supporting the idea that general air pollution rather than first- and secondhand smoke and asbestos cause lung cancer? If not I'll remove the following additions (removals in italics):

• Line 14: The most common means of such exposure is air pollution and tobacco smoke.
• Line 27: Exposure to carcinogens, such as those present in air pollution and tobacco smoke, immediately causes cumulative changes to the tissue

I've removed some of the more extreme changes already. Nmg20 09:49, 27 April 2007 (UTC)

• There seems to be some weak evidence. I'll add a couple of references. Axl 19:36, 9 May 2007 (UTC)

Heavy vandalism

This page was under constant attack on 7 and 8 May. Obviously, it is an easy target for vandals. I have indefinitely {{sprotected}} the page; let me know if there are reasons to reverse this. JFW | T@lk 13:43, 9 May 2007 (UTC)

I wouldn't call vandalism by 3 anonymous users heavy and continued vandalism (the criterium for semi-protection). This can easily be resolved by warning and eventually blocking them. --WS 17:13, 9 May 2007 (UTC)

I understand what you're saying, Wouterstomp - but this page is *constantly* under attack. The talk page here lists heavy attacks at the start of December and all through March, and that's not counting the weeks when editors waste god knows how many hours reverting changes like "Bobbi loves Mickey!" or "OMFG smokin is bad 4 u". I'd love to see the page permanently semi-protected if at all possible - it's sucking up editors time at the moment for no real reason. Nmg20 00:03, 10 May 2007 (UTC)

Good article

I wonder if it is ready to be a good article? [Declaration of conflict of interest: I have made numerous contributions to the article.] Axl 11:07, 19 May 2007 (UTC)

Looks good IMHO. I've made several edits to this page as well, almost all to revert vandalism rather than add content, but I'll still not review it to avoid a COI. If you'd like to take it to GA, I'd suggest you take a look at WP:MEDMOS and the other Manuals of Style; add references to the Surgery section; check the existing refs to make sure they are up-to-date, well-formatted (access dates for all web references, PMIDs for all Medline-indexed journal articles) and come from reliable sources; a quick wikify; and you're in business :) Fvasconcellos (t·c) 12:05, 19 May 2007 (UTC)

Here are my suggestions:

• references would be needed:

• "the leading cause of death of men between the ages of 40 and 65."
• "About 10% of people with lung cancer do not have symptoms of it at the time of diagnosis; these cancers are usually found on routine chest x-rays."
• "local recurrence rate is 3 times as high (19% compared to 5%, respectively)"

• The Adjuvant chemotherapy section should be rewritten as it seems to be too unreadable for laypeople.

Thanks in advance. NCurse _work 16:58, 30 May 2007 (UTC)

Thanks for your comments.

"the leading cause of death of men between the ages of 40 and 65." While this is probably true, I couldn't find a reference that explicitly states this. Here is the closest that I've found. I'll keep looking. Axl 18:13, 30 May 2007 (UTC)

Sorry, I have looked in several places for this. Unfortunately I can't find any source data. I have deleted the statement from the article. Axl 17:04, 31 May 2007 (UTC)

"About 10% of people with lung cancer do not have symptoms of it at the time of diagnosis; these cancers are usually found on routine chest x-rays." I wrote this. It is straight from "Harrison's Principles of Internal Medicine". Almost all of that section ("Signs and symptoms") can be found in any good medical textbook. [I happen to prefer Harrison's]. It is (currently) reference number 9 on the list. I'll add the reference explicitly to that sentence. Axl 18:17, 30 May 2007 (UTC)

"local recurrence rate is 3 times as high (19% compared to 5%, respectively)" The subject of surgery for lung cancer is rather complicated, perhaps even beyond my skill to describe (I'm a pulmonologist). The use of wedge resection is indeed a controversial issue, and different surgeons have different approaches. As to the quoted recurrence rates, I do not know where they came from. I have simplified the "Surgery" section and included an extra reference (one which is fairly recent and has a good number of patients). If you would like a more in-depth treatment of surgery for lung cancer, I'll create a new article. Axl 18:57, 30 May 2007 (UTC)

I have re-written (simplified) "Adjuvant chemotherapy". Axl 19:30, 30 May 2007 (UTC)

I have changed the lead section, so that it demonstrates referenced statements, while hopefully still emphasizing the mortality burden of lung cancer. Axl 17:56, 1 June 2007 (UTC)

Thank you, Axl for your hard work. I really have just some minor additional suggestions:

• the order of sections should follow WP:MEDMOS
• In the United States, smoking is estimated to account for 87% of lung cancer cases (90% in men and 79% in women), and in the UK for 90%. (reference?)
• Radiotherapy sections contains doses. Wikipedia articles mustn't contain doses.

Anyway, it's getting closer and closer not just the GA, but the FA criteria. NCurse _work 16:12, 10 June 2007 (UTC)

Just thought I'd echo NCurse's words - terrific work, Axl. I haven't been commenting myself because I've contributed significantly to the article in the past and so am not eligible too - but you've improved it really dramatically. Nmg20 19:03, 10 June 2007 (UTC)

Thanks NCurse & Nmg20. Nmg20, you are still eligible to comment; you simply aren't allowed to pass the article. Axl 20:32, 10 June 2007 (UTC)

"the order of sections should follow WP:MEDMOS". I have re-arranged the sections appropriately. I shall try to work on the "missing" sections. Axl 20:35, 10 June 2007 (UTC)

I don't think you need to worry overly about the History and Cultural whatnot sections unless they're relevant; that said, the Witschi info on pre-WWI lung cancer rates makes more sense as history rather than epidemiology, so I've moved it down. Happy for it to go back if the history section's felt to be defunct, obviously. Nmg20 22:16, 10 June 2007 (UTC)

"In the United States, smoking is estimated to account for 87% of lung cancer cases (90% in men and 79% in women), and in the UK for 90%. (reference?)" I have added an appropriate reference and adjusted the figures slightly to fit the reference. I have also inserted another reference that provides similar information displayed in a different way. Axl 17:25, 11 June 2007 (UTC)

"Radiotherapy sections contains doses. Wikipedia articles mustn't contain doses." Really? I didn't know that. I have removed those doses. Axl 06:48, 15 June 2007 (UTC)

It's a policy thing from MEDMOS: "Do not include detailed dosage and titration information. Such details can be construed as medical advice, they border on trivia, can be country-specific and become quickly out-of-date or easily subject to uninformed edits." Nmg20 09:00, 15 June 2007 (UTC)

Thank you for the hard and valuable work! Lung cancer is now a good article. If you don't stop working on it, you should consider a possible featured article nomination in the future. NCurse _work 21:05, 22 June 2007 (UTC)

Thank you, NCurse. Also, thanks and congratulations to all contributors. :-) Axl 10:37, 23 June 2007 (UTC)

NOT JUST a Smoker's Disease

Lung cancer is not only a smoker's disease. 60% of people diagnosed with lung cancer are non-smokers at the time of their diagnosis (10-15% are never-smokers and 45-50% have quit). These stats come from a thoracic oncologist at Memorial Sloan-Kettering Cancer Center. I will begin looking for web sourcing for this important fact today. I have noticed that much of this article is dedicated to linking this disease with smoking (something that is no doubt important), but there are a lot of people with lung cancer who never touched a cigarette in their lives (see Thomas G. Labrecque). Labrecque was an athletic looking man who never smoked and died just 8 weeks after his diagnosis. There is no doubt that smoking negatively affects the lungs; it promotes the expression of the genes that produce lung cancer. But the cancer is in the genes. It affects smokers and non-smokers and would still exist if cigarettes were never created or used in the first place. It would be great to see as much money dedicated to lung cancer research as is set aside for breast cancer research. But, I doubt that will happen so long as the public views this disease as a smokers' problem. [Message left by User:Ask123]

I draw your attention to these sentences: -

In the lead section: "Current research indicates that the factor with the greatest impact on risk of lung cancer is long-term exposure to inhaled carcinogens, especially tobacco smoke. While some people who have never smoked do still get lung cancer, this appears to be due to a combination of genetic factors and exposure to secondhand smoke. Radon gas and air pollution may also contribute to the development of lung cancer."

In the "Causes" section: "Smoking, particularly of cigarettes, is by far the main contributor to lung cancer. In the United States, smoking is estimated to account for 87% of lung cancer cases (90% in men and 85% in women)."

Axl 18:21, 19 July 2007 (UTC)

Thank you for pointing out these passages, Axl. I actually saw them upon my first perusal of the article, but I appreciate you bringing them to my attention again.

I am not disputing what is written in this article but rather am trying to shine a spotlight on the proportions that are being used -- e.g. weight distribution. Space -- a sizable amount of space -- must be dedicated to the major external factors that promote lung cancer (e.g. tobacco smoke). There is no question of its importance. After all, cancer would not be the leading cause of death among cancers if not for tobacco smoke. But, that is only a factor that promotes lung cancer. Again, lung cancer is caused by genes, which can be mutated by the inhalation of tobacco smoke, exposure to Radon, etc. Since this is the case, there are some occassions in which smokers never develop cancer and do live long lives (although this is far from the norm). I am not pointing this out to deny the tobacco/cancer connection -- this is obviously true -- but rather to prove a point. That point is that tobacco smoke causes genetic expression -- namely the formation of tumors, aka cancer. If the genetic predisposition didn't exist, the person would not get cancer. In humans, the vast majority of the population is predisposed. Almost everyone who smokes is putting themselves at risk. Lung cancer would not be at epedemic levels if not for tobacco smoke. However, because tobacco smoke merely promotes genetic expession, there are people who develop lung cancer who never smoked in their lives. It doesn't matter how old they are or how good their health is. Still, for some reason (which is not entirely known), these people develop lung cancer, often in the prime of their lives and in their best of health. While there is much evidence that secondhand smoke leads to lung cancer, in the cases of these "never-smokers," this does not account for anywhere near their whole population. In other words, there are some people -- hundreds of thousands, to be a little more precise -- that get lung cancer not because they smoke, not because they inhaled secondhand smoke, but because of other reasons. Maybe their genetic clock was up; the reasons are not entirely understood.

But I think it is important to note in this article -- in more than a passing statement -- that cancer can be developed in people other than smokers. And more space should be devoted to the pathophysiology and genetic factors of the disease. After all, oncology researchers look at the genes of the sick to determine how they have mutated and how they can penetrate the pathways of malignant cells to fight the illness. Nowadays, fighting lung cancer amounts to more than just saying: stop smoking. And, thank heavens it does. There was a time when no one knew that non-smokers got sick. Now it's time to tell them that it affects a very large amount of non-smokers. If there was no tobacco in the world, lung cancer would still affect hundreds of thousands -- a number large enough to cause an impact. But because there are another 800,000 thousand people with the disease that also smoked at one point in their lives, as far as the public (and research community for that matter) is concerned, it is as if these never-smokers don't exist. And, after reading this article, they seem more invisible than ever.

I know that I am new to this article and that you all have probably spent a lot of time honing in on it, but I hope that you will all accept a new person taking a stab at making this entry more complete. As I said before, everything that's been written is great. I would just like to add more on the genetic factors, pathophysiology and treatment. I will consult a friend of mine that work as a research and clinincal oncologist in the thoracic department of Memorial Sloan-Kettering. Obviously, he's up-to-date on the latest research into fighting this disease and attends all meetings of the oncological community (e.g. the American Society of Clinical Oncology Annual Meeting) I'm sure that any input he has would be appreciated. Cheers! ask123 19:21, 19 July 2007 (UTC)

Ask123, you make some valid points. Please feel free to be bold. You may wish to explicitly add the numbers of non-smokers who develop lung cancer (with the relevant reference). Much of the data about genetic factors and pathophysiology is technical scientific jargon, and fairly recent research. I tried to keep the text to the most well-recognised mutations. The "treatment" section is fairly comprehensive. What extra information do you want to see? Details of specific chemotherapy regimens? That sort of information is probably better placed in its own article. Regards. Axl 06:08, 20 July 2007 (UTC)

"malignant (progressively worsening)"

I applaud the attempt to make the article more understandable to lay readers. That requires a tradeoff between making it too simple and too complicated.

I agree that calling lung cancer a "malignant transformation and expansion of lung tissue" is too complicated, because the average reader doesn't know what it means.

But defining "malignant" as "progressively worsening" doesn't help. That's abbreviating it too much from the Wikipedia entry Malignant.

It's not really accurate. There are lots of conditions that are progressively worsening without being malignant -- infectious diseases, immune diseases, heart failure, etc.

Just to pick a couple of handy authoritative textbooks, the American Cancer Society's Clinical Oncology defines malignant as proliferating, invasive, and metastatic. Those are the basic characteristics.

The Merck Manual Home Edition says, "A cancer is a cell that has lost its normal growth mechanisms and thus has unregulated growth," and then explains invasion and metastasis.

I think the 3 defining characteristics of cancer are proliferation, invasion and metastasis (spread to other parts of the body). That should be in the introduction.

How about, "Lung cancer is a change in the cells of the lung that leads to proliferation, invasion and spread (metastasis) to other parts of the body"?

I'm not sure it helps to include the word "malignant". If it's synonymous with "cancer", then why not say "cancer"?

When I have to write something like this, I write 5 alternative definitions and pick the best one. Does anybody have any others? Nbauman 20:56, 15 August 2007 (UTC)

The "if it means cancer, say cancer" bit was my original impetus to link malignant to the malignant article. I'm not getting my definition of malignant from Wikipedia, although it does agree with the usage I've selected. I added the progressively worsening part because the rest of the "malignant" definition was otherwise encompassed in the context of the first two sentences. That said, my goal is to find a readable and compelling intro, so there's no need to stick with my phrasing. I agree completely with your thoughts on "malignant" being essentially redundant with cancer.

Very roughly modeling this on the prostate cancer article, how about, "Lung cancer is a disease in which cells within the lungs mutate and begin to multiply out of control. These cells may spread (metastasize) from the lungs to other parts of the body." ? Antelan ^talk 23:17, 15 August 2007 (UTC)

Just make sure you include the 3 defining characteristics of cancer: (1) proliferation (2) invasion and (3) metastasis. Nbauman 13:59, 16 August 2007 (UTC)

I'm not sure that every lay reader understands what "cells" are, or what "mutate" means. My suggestion (based on Nbauman's requirements): "Lung cancer is a disease where tissue in the lung proliferates out of control. This leads to invasion of adjacent tissue and infiltration beyond the lungs (metastasis); these are the hallmarks of cancer." All potential technical terms are linked. I accept that some readers may not understand what "tissue" means in this context. However it is probably less problematic than "cells". Axl 21:58, 16 August 2007 (UTC)

I think that people are more likely to understand "cell" than "proliferate". What do you think of going with your version but using "reproduces" in place of "proliferates"?Antelan ^talk 22:17, 16 August 2007 (UTC)

My slight concern is that "reproduce" redirects to "reproduction", the process of formation of new organisms: clearly not an appropriate link. How about "grows"? Axl 08:24, 17 August 2007 (UTC)

Grows is fine by me; either of those could/should be wikilinked to proliferation, perhaps? Antelan ^talk 16:19, 17 August 2007 (UTC)

Okay. I think that cell growth is the most appropriate wikilink, although mitosis could be valid too. I'll make this change to the opening text. Of course, if Nbauman or any other readers want to discuss this further, I am happy to do so. Axl 17:52, 17 August 2007 (UTC)

Sounds good to me. Antelan ^talk 17:56, 17 August 2007 (UTC)

Actually, can we take out the "these are the hallmarks of cancer" line? It just seems redundant with the title. Antelan ^talk 17:58, 17 August 2007 (UTC)

Okay. Y Done Axl 20:09, 17 August 2007 (UTC)

Looks great. Thanks. Antelan ^talk 20:20, 17 August 2007 (UTC)

Prostate cancer's opening line is "Prostate cancer is a disease in which cancer develops in the prostate...". This text seems redundant to me. Axl 22:03, 16 August 2007 (UTC)

Yes, I agree that we should fix that odd redundancy in the prostate cancer article. Antelan ^talk 22:17, 16 August 2007 (UTC)

Comments on organisation

1. Lead is a bit too short, could be expanded to about double that size. Does not summarise all the main sections of the article.
2. Putting epidemiology and causes in separate areas seems a bit strange, as one is directly related to another. Perhaps merge these sections?
3. The History section doesn't tell a comprehensible story and seems to be three unrelated paragraphs.
4. All one-sentence paragraphs should be merged or expanded. - A major problem with the article.

Hope this helps. Tim Vickers 21:14, 17 August 2007 (UTC)

Okay, thanks Tim. I'll work on it. Axl 16:49, 18 August 2007 (UTC)

"Causes" vs. "Epidemiology"

I have addressed most of Tim's points. However the separation of "Causes" from "Epidemiology" is derived from WP:MEDMOS guidelines. Axl 08:32, 1 September 2007 (UTC)

Additional comments on organisation

I'm wondering whether we should consider splitting the SCLC section away from NSCLC. Given that they are quite distinct diseases with quite different treatment/prognosis, it may be better to have a separate entry for each. Certainly most medical texts and patient info sheets do not lump these 2 entities together. I find the way this entry reads at present quite confusing as it keeps "ping pong" between the two diseases. Any thoughts on this would be appreciated. --Serenity forest 05:26, 22 August 2007 (UTC)

I see your point. The separation of SCLC from NSCLC would require two sections for "staging", "treatment" and "prognosis". Axl 07:23, 22 August 2007 (UTC)

oh dear....

Sorry, the more I look at this I am thinking it needs quite a bit more info to be comprehensive and make a nice layout. Many of the sections are very small yet it is extremely hard to combine them. Each could do with a few more sentences. I have put a couple in here or there but don't have the books handy and I need to go to bed now...cheers, Casliber (talk · contribs) 14:42, 6 September 2007 (UTC)

Targeted therapies

J Clin Invest this month doi:10.1172/JCI31809 JFW | T@lk 20:49, 10 October 2007 (UTC)

"Carcinoma of the lung"?

What about malignant secondary cancers not from lung tissue? These may not be of epithelial origin, so may not be carcinomas. Maybe we should change this to "Neoplastic tissue of the lung". Carcinoma separates cancers from epithelial origin from cancers of non-epithelial origin. Russthomas15 02:22, 28 October 2007 (UTC)

Good point. The intro also does not encompass sarcomas of the lung, which also classify as lung cancer. Djma12 ^(talk) 03:38, 29 October 2007 (UTC)

"malignant secondary cancers not from lung tissue" – These secondary cancers are usually defined by the primary site of origin, thus are not regarded as "lung cancer". Axl 18:34, 29 October 2007 (UTC)

Explaining something to that effect may be a good addition to this article, since I suppose we can't expect readers to go through the cancer article itself to discover that. What do you think? Antelan ^talk 17:02, 31 October 2007 (UTC)

Antelan, do you mean that it should be added to the lead section? Sure, go ahead. Axl 18:18, 31 October 2007 (UTC)

Thanks; I'll wait to make any change until after this article is finished on the front page. Since the topic is discussed in the article, it is really probably unnecessary in the lead anyway. Antelan ^talk 15:58, 11 November 2007 (UTC)

ARE YOU GETTING ADEQUATE LUNG CANCER DIAGNOSIS AND TREATMENT FROM THE NATIONAL HEALTH SERVICE ?

PLEASE include a link to the National Institute for Clinical Excellence (NICE) and Scottish equivalent (SIGN) guidelines for the treatment of lung cancer on this page - most of the readers who Google this site are very worried, newly diagnosed patients, and much of the information you give is out of date and misleading, particularly survival rates. The survival rates you cite are based on very very old research statistics, and very old treatment regimes. Survival chances significantly longer than 5 years are not as rare as you imply, PROVIDED PATIENTS PUT THEIR FOOT DOWN WITH CONSULTANTS AND FIGHT TO GET THE BEST AVAILABLE TREATMENT, which is Surgery in the first instance (for non small cell cancer, often 100% curative), Radiotherapy as a second choice (not as good as surgical removal of the primary and secondaries, but significantly better than chemotherapy ), and Chemotherapy as a very very poor third choice. The UK is short of dedicated thoracic surgeons AND radiographic Consultants, so a huge number of people are misled, and told they have 'metastases' without any biopsies of the suspected lumps being taken. Once your lung cancer has been judges as already spread out of the lung, the NHS dont have to offer either surgery or radiotherapy, so they 'guess' it already has, particularly if you're over 40 and in an area that has poor facilities - guidelines which explain lung cancer, and what tests should be performed are available at <http://www.SIGN.org>(best at explaining what tests are needed to assess TNM status) and <http://www.NICE.org>. If my own family hadn't found the information at SIGN and NICE, we would never have discovered that Dorset CancerCare Network had a) misdiagnosed us with the wrong type of lung cancer, b) guessed an enlargedadrenal gland and thyroid were 'metastases' when they were in fact benign, c) used TNM Mountain tumour classification systems that were 12 years out of date, d) entrusted us to the care of a man who had no training in Lung Cancer (specialist in Breast /Renal Cancer), e) had a pathology laboratory that did not have sufficiently high standards to meet the Governments' own Quality Control Minimum (ie lacked a CPA licence), and f) never performed biopsies. They wrongly turned us down for curative surgery - we're still here after 4 years, having been intitially told we would be dead in 4 months! To see how your areas CancerCare Network services are in the league table, you can also find the Peer Assessments for every NHS area at the NHS 'CQuins' site on a Google Search. Thank you. —Preceding unsigned comment added by 80.225.121.175 (talk) 02:18, 3 November 2007 (UTC)

Synthetic compound promotes death of lung-cancer cells, tumors

“We found that certain kinds of lung-cancer cells were sensitive to this compound, which sends a signal to cancer cells to self-destruct,” said Dr. Xiaodong Wang, professor of biochemistry at UT Southwestern and senior author of the study. [2] Brian Pearson 05:33, 13 November 2007 (UTC)

It's an interesting finding, but at too early a stage of development to be worthy of a place in the article. Axl 14:05, 13 November 2007 (UTC)

Possible Improvement: better link for "cavitation"

The fourth sentence of the section "non-small cell..." uses the word "cavitation" with a link. The entry at the link does not include any information on cavitation in this sense. This article could be improved by the addition of such information to the cavitation article, or by fixing (or removing) the link. Unfortunately, I do not have the necessary information to make the change. --Pete Jacobsen (talk) 00:59, 18 November 2007 (UTC)

Cigarettes line

Lung cancer was extremely rare before the advent of cigarette smoking.

If it can be inserted without distracting too much from the subject of the article, I thought at this point it should be explained why it was "extremely rare" in the era of cigar and pipe smoking, both popular before 1900 in certain segments of North American and European populations. Tempshill (talk) 06:43, 18 November 2007 (UTC)

How many people inhale cigar and pipe smoke? JFW | T@lk 19:08, 18 November 2007 (UTC)

Treatment Section, Getting a Transplant??

I'm not really inclined into medical things but is it possible to get a transplant for someone who has lung cancer??? --Edson88888 (talk) 07:55, 18 November 2007 (UTC)

Depends on the stage. I have personally never heard about it. It makes perfect sense: remove lung with tumour, insert someone else's lung without tumour. This is certainly done with small liver tumours. JFW | T@lk 19:08, 18 November 2007 (UTC)

Most people can survive with one lung. Therefore in early stage disease (NSCLC), removal of the affected lung (or lobe) is sufficient. Metastasis to the other lung carries a much worse prognosis, and usually implies metastasis elsewhere in the body; thus removing both lungs is very unlikely to cure the cancer. Then there's the added risks of the transplant surgery itself, ongoing immunosuppression, etc. Axl (talk) 12:22, 20 November 2007 (UTC)

Good graphic cries out for commentary

That's a really cool graphic of the distribution of lung cancer in the United States. The moment I saw it, I was hoping to find a discussion about why the highest lung cancer rates seem to be concentrated in the southeastern U.S. and why the lowest seem to be in a wide north-south band just east of the Rocky Mountains. Did anyone ever see any reliable sources that speculate on the reason for the distribution? =Axlq (talk) 08:45, 18 November 2007 (UTC)

I'd be willing to bet that the reason that the lowest rate is in Utah (and surrounding states) is due to the high concentration of Mormons there, specifically due to the LDS belief in the Word of Wisdom, which prohibits tobacco usage (among other things) Regoarrarr (talk) 01:58, 19 November 2007 (UTC)

...contaminant particles are gradually removed

I know putting a {{fact}} tag on the main page is ugly, but as an ex-smoker, this info is highly important to me. Please reference it! Thanks! Ling.Nut (talk) 13:23, 18 November 2007 (UTC)

Epidemiology Section

This section states;

Worldwide, lung cancer is the most common cancer in terms of both incidence and mortality . . . . Lung cancer is the second most commonly occurring form of cancer in most western countries, and it is the leading cancer-related cause of death.

How can it be both the most common in terms of incidence and simultaneously the second most common cancer? Logically, the implication is that lung cancer is first worldwide while only second in the West but I suspect that there is an unintentional error in the logic of this paragraph.
Spinningspark (talk) 18:10, 18 November 2007 (UTC)

I'm not sure what the problem is - it makes sense to me. On average, it is the most common cancer in the world. However, in the West, it is the second most common.-Wafulz (talk) 19:47, 18 November 2007 (UTC)

Just took a look at reference 97 (Global Cancer Statistics, 2002). Seems to say that incidence of lung cancer in developed nations is second for males after prostate cancer and third for females after breast and colon cancers. For combined male/female together, lung cancer is first because prostate and breast are gender specific. For females in developing countries it is still only second and one again has to take male/female combined to get it to first. To my mind, for consistency, the article should be saying lung cancer is no.1 both globally and in the West.
Spinningspark (talk) 20:10, 18 November 2007 (UTC)

Assessment comment

The comment(s) below were originally left at Talk:Lung cancer/Comments, and are posted here for posterity. Following several discussions in past years, these subpages are now deprecated. The comments may be irrelevant or outdated; if so, please feel free to remove this section.

Comment(s)

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I looked at this article a few years ago. I remember it as an impressive and scholarly medical article. Since then it seems to have deteriorated. The anti-tobacco propagandists who control the passive smoking page and the relative risk page have got hold of it. Shame. 130.88.16.205 (talk) 14:27, 7 August 2009 (UTC) There is too much emphasis on smoking and passive smoking. There is a lot of duplication of the passive smoking and smoking ban pages. I don't agree that 17.2% of male smokers get lung cancer and no reference is provided. This isn't even true for very heavy smokers. Presumably it is claimed that passive smoking causes lung cancer in the same way as active smoking. the claimed excess risk for passive smoking (living with a smoker for 20 years) is 0.2 and for active smoking 2 to 40 depending on the length and duration of smoking. Call it 20. So active smoking is about 100 times as risky as passive smoking which, according to the article, is about a third as risky as radon exposure. Why not explain this and then point anybody who's interested to the passive smoking page, or better still the passive smoking discussion pages, where they will lose the will to live. Cut out all the high school debating society crap about Big Tobacco. Cut out the epidemiology and prevention sections. All this belongs in articles on smoking and smoking bans. Don't refer to Government documents as "studies".130.88.16.205 (talk) 15:44, 7 August 2009 (UTC)

Last edited at 15:44, 7 August 2009 (UTC). Substituted at 20:51, 3 May 2016 (UTC)