Talk:Lung cancer/Archive 3

Replacing 'cause' with 'risk' in cancer articles - or why smoking does not cause lung cancer
Right! By request, I'm starting a new section for this, as OrangeMarlin rightly pointed out that this discussion has been going for a while - and it makes sense to start afresh.

What I want to discuss is the use of the word 'cause' in cancer articles here on Wikipedia. This one is a good example - where there is actually a 'Causes' section. Now this has been brought up in the past, about a year ago further up the page - but I'd like to argue from a different point. Firstly though, let me be clear, I am not trying to argue that if you smoke, you are not more likely to get cancer. I am aware there is a ton, in fact overwhelming evidence of this - and I'm not going to contradict that without a really good reference to the contrary. Right, moving on.

My objection to 'cause' is that unlike many other diseases e.g. flu, there is not a single causative agent (the influenza virus) for cancer. For a cell to become cancerous, a series of specific mutations must accumulate in the cells DNA, for example to prevent the cells responding to a 'suicide' signal. General DNA damage occurs all the time e.g. as caused by ionizing radiation when you sunbathe, but we have DNA repair mechanisms in place to try to fix any damage. The more damage you cause, for example by sunbathing for too long, the more chance the damage to your DNA goes without repair, and mutations can continue to build up. This is a random process - the mutations do not occur at pre-ordained places in the DNA - it's purely a numbers game. The more damage you do to your cells, the more repair is required. The more repair is required, the higher chance that a mutation is not properly repaired. The more mutations that accumulate in a cell, the higher chance that cell has of obtaining the mutations required to become cancerous. The analogous damage in lung cancer is caused by chemicals in tobacco smoke, or radon etc. Asbestos is the same again, tiny particles of glass damage your cells, causing continual need for repair.

So - because of this, I'm arguing that smoking does not cause cancer, it simply increases the risk of developing it. This might seem like a petty difference, but it is actually quite fundamental to the nature of the disease, and so I think it's worth discussing.

Finally - as I mentioned above, something to think about. Although you can take a (preferably large!) sample of the population and show statistically that people who smoke are much more likely to develop lung cancer, you cannot then point to the people within that sample and determine which person developed lung cancer because they smoked. This is for the reasons above - smoking is just one of many risk factors that contribute to the development of cancer, like ionising radiation and many others.

Looking forward to some thoughts Xeodus (talk) 02:43, 11 December 2011 (UTC)

Apologies, I don't know how to keep this above the references section :( can someone move it for me?! Thanks! (Wikipedia newbie) Xeodus (talk) 02:45, 11 December 2011 (UTC)
 * OK, as a newbie, there are few things you need to understand. First of all, and probably most important, our opinions really are irrelevant only what we can WP:VERIFY with reliable sources.  There are numerous reliable sources (that is, published in peer-reviewed journals) that provide a causal linkage between smoking and lung cancer.  Yes, we can discuss risk as a mathematical issue (meaning not all smokers get lung cancer and not all lung cancer is caused by smoking), but that doesn't negate the causal factor.  Using influenza, as you mentioned, you may stand in a room with someone with the flu with other healthy people.  Maybe 75% will contract the virus (and not all 100% of them are going to become symptomatic).  But we can conclude that the risk is 75% but that causative factor is the influenza virus.  Same with smoking and lung cancer.  We shouldn't conflate risk and cause, but they do overlap in meaning somewhat.   Orange Marlin  Talk• Contributions 03:02, 11 December 2011 (UTC)

Thanks for the quick response - and I appreciate the advice. I think that our opinions are relevant here though as we are not disputing already established evidence - but discussing how best to communicate it. I take your point about the possible overlap in meaning between risk and cause - but I think that is mainly lack of accuracy in common usage, and in this case I think it is actively misleading. Although it is not ideal, sticking with the influenza example, there is a clear difference between getting influenza via exposure to the virus, and developing lung cancer as a smoker. When you get influenza, there is a clear mode of action - you inhale the virion, and assuming your immune system doesn't catch it too quickly (due to vaccination/prior exposure to similar virus) - it attaches to and enters a cell where it establishes an infection. It then replicates and transmits before in most cases your immune system clears it. If you were never exposed to the virus - you would never get influenza. That to me is a clear causal link. This is not the same with smoking and lung cancer. You can get lung cancer without ever smoking - because as I discussed above, the mode of action for cancer is not a simple infectious agent, but the accumulation of particular mutations. You can just get unlucky. Smoking just increases the chance these mutations will be acquired and so increases the chance of developing lung cancer. That is not the same as saying it caused cancer - it increased the risk that you will develop it.

If there is a particular reference that you think proves that smoking causes cancer, and doesn't just increase risk, I'd love to read it. Xeodus (talk) 03:31, 11 December 2011 (UTC)


 * I was asked to comment. I agree with OrangeMarlin that at a certain level of risk one is entirely entitled to speak of causation. The vast majority of people who have lung cancer and have smoked would not have developed the cancer if they had not smoked. This can be shown epidemiologically. Decapitation markedly increases the risk of death.
 * At this point it might make sense if you disclosed your conflicts of interest, by the way. If you have none, we can focus on rationally addressing the issues. I am a practicing doctor, and I have treated many people with smoking-related diseases. JFW &#124; T@lk  10:41, 11 December 2011 (UTC)


 * 10.1016/j.ypmed.2011.08.008 seems to be a relevant source, but I have difficulty drawing clear conclusions from its rather opaque phraseology. JFW &#124; T@lk  10:49, 11 December 2011 (UTC)

Thanks for responding Jfdwolff, I'm impressed that people are so active here! I have no conflict of interest in this matter. I'm a research scientist working at a university in the UK. I'm technically a chemist, although I work mainly on infectious disease, and have a biological background - including pathology. Before I get back to the discussion, your example of decapitation is not really comparable as decapitation always results in death, it's nothing to do with risk - there isn't much chance of the opposite outcome. We could get into a debate about what constitutes being alive exactly, but this seems off the point.

I do not dispute that statistically, using epidemiological evidence or otherwise that you can show smoking drastically increases the risk of lung cancer, and I'm glad this is now an established fact. However, that still does not mean that on an individual level, there is any evidence the carcinogens in tobacco smoke to have caused the mutations that lead to a particular patient developing lung cancer. The mutations have clearly occurred as they have the cancer, however they could have been caused by many other factors, or simply occurred spontaneously. This is of course less likely, but then you cannot rule it out. You could argue that this is mealy a technological limitation. Maybe in the distant future, we will be able to track all mutations back to an exact 'cause' - however I'd still argue that we should use the term 'risk'. When we say that smoking causes lung cancer, we are losing information. 'Cause' implies a simple relationship - whereas there reality is more complicated. In terms of communicating this to people on Wikipedia, or elsewhere - I see a conflict. People understand cause and effect much better than they do comparative risk, and so for public health reasons, it might make more sense to use 'cause'. I'm thinking in particular of the warnings on cigarette packets. I imagine they'd be less impactful if they said 'Smoking significantly increases the chance you will develop cancer' instead of 'Smoking causes lung cancer'. Maybe this is the real question here, are we using a term which overly simplifies things, and is this appropriate for a reference encyclopaedia. 131.111.61.144 (talk) 12:06, 11 December 2011 (UTC)

Ach - forgot to log in again, apologies. Also thanks for the reference, it does seem to be quite relevant, although will take some time to decipher! Xeodus (talk) 12:09, 11 December 2011 (UTC)


 * Xeodus, I'm no epidemiologist either (passing-by physicist), but here a a few thoughts following your statements.
 * Your main argument seems to be that the acquisition of lung cancer is not a single-cause, determinist process but rather a multiple-cause, stochastic process. I have no argument there, but I still disagree with your conclusion that "we should use the term 'risk'".
 * For simplification, let us first consider a single-cause stochastic process: russian roulette. Before anything bad happens, the shooting only is a risk factor. After something bad has happened, the shooting has ceased to be a risk factor to the deceased players: it caused their deaths, for which it is the sole and only causal factor. Smoking is just the same: it only is a risk factor for the smoking population, but it is a cause for the patients with cancer.
 * In the discussion above, I have obviously discarded the multifactorial part of cancer causation. Are there lung cancers where the smoking is the sole and only cause? I don't know, but I actually rather doubt it (health is never that simple). Yet, if patients got cancer through some combination of events (inflammation, mutation...), and that smoking was responsible for 90% of these events, I feel calling smoking a "cause" seems appropriate, for lack of a better word. ConradMayhew (talk) 16:06, 11 December 2011 (UTC)


 * Jolly good points. Let's just state that prior to widespread cigarette smoking, lung cancer was considered rare. JFW &#124; T@lk  16:38, 11 December 2011 (UTC)
 * Of course, before cigarette smoking, the average human lifespan was 40 years? Probably not long enough for widespread lung cancer.  Smoking is more than just a "risk factor"...it is causative.  But in all causation there are variables.  Lung cancer is caused by smoking (mostly).  All causes have some risk number, of course.   Orange Marlin  Talk• Contributions 19:51, 11 December 2011 (UTC)
 * There may be some misunderstanding there: at the end of the day, I fully agree that smoking is BAD (I quit smoking 8 months ago, I didn't want to play russian roulette any more). However, it's not the sole and only cause, as there are others culprits (or rather accomplices) such as radon - although they are very closely connected together ("Best way to lower radon risk is to stop smoking", quoted from Radiation Epidemiology: The Golden Age and Future Challenges, Lecture at NCRP 2009 Meeting by John D. Boice Jr.).ConradMayhew (talk) 21:37, 11 December 2011 (UTC)
 * I don't think that there's any argument there maybe other contributor factors to lung cancer, or that there are non-smoking causes of lung cancer. Radon, air pollution, particulates, etc. all are contributory.  I think the OP wanted to replace "cause" with "risk", so that if someone would think that if you only have a 1% risk of getting lung cancer from smoking it really isn't a cause.  I'm with JFW, I'm a bit concerned about the OP's intent for requesting this change.   Orange Marlin  Talk• Contributions 00:02, 12 December 2011 (UTC)

I didn't realise my intentions were causing concern! So you can relax, I'd like to clarify why I'm proposing this change. I think that saying 'smoking causes lung cancer' is an oversimplification of the truth, and by rephrasing the article in terms of risk, we are being more accurate when communicating this information to the reader. I have no vested interest in the topic itself either way, it is the difference in language is important to me, which is something that's open to debate - hence this discussion. So, my intention is to improve how this article communicates the relationship between smoking and lung cancer to the reader. Back to the points raised above - ConradMayhew - no need to apologise for being a physicist, the more the merrier! The difference between your russian roulette example and this is indeed that it is not multifactorial. It is precisely this difference that means I think it is more appropriate to refer to smoking as a 'risk factor' rather than a 'cause'. Orangemarlin, that was not my intention at all. I don't want to leave people who read this article with the idea that it is a small effect - but surely it is more informative to use wording like 'if you smoke more than X cigarettes a day, you are 10 times more likely to develop lung cancer', than just stating 'smoking causes lung cancer'?

Also for anyone interested, I have been reading around about the use of the word 'cause' and you might find the article on Probabilistic causation interesting. I think this is exactly what we are talking about here in the end, the difference between deterministic and probabilistic cause. I'm happy to accept that smoking in a probabilistic cause of lung cancer, but for the average reader, this wouldn't make that much sense, which is why I think we are better working the probability in using the language of risk. Xeodus (talk) 15:50, 12 December 2011 (UTC)

So - what do people think after reading that article? I'm sorry to have brought philosophy into it, but you left me no choice! 82.45.234.129 (talk) 01:31, 14 December 2011 (UTC)


 * That article is in need of considerable work, and in any case we don't cite wikipedia articles. The discussion therein cites Pearl's Causality which indeed addresses smoking and cancer, but it fundamentally is a work on statistical methods by a computer scientist, not on medicine. I'd be reluctant to use its language in preference to that of top-quality works that are directly on the topic of smoking and lung cancer. Given the systemic and active denialism that has pervaded the discussion, we must be very careful not to fuel it. It suffices to state that "in excess of X% of lung cancer occurs in smokers or former smokers". Alternatively, "fewer than Y% of lung cancers occur in people who never smoked". Of course it is possible to argue that some hidden variable causes both smoking and lung cancer independently, but no credible candidate has been proposed that is consistent with the data. LeadSongDog come howl!  04:16, 14 December 2011 (UTC)


 * I wasn't proposing to use that article as a reference in a medical context, simply for the interest of the people involved in this discussion. I agree that it is hardly definitive, but I found it interesting to look into the different meanings of 'cause' a bit, that's all. I also agree that if such a change would fuel denialism, that alone might be reason to reject it - however I'd hope the raw data was strong enough by now to stand alone without the need of defence. I'm not quite sure I follow what you mean about a 'hidden variable' though. Xeodus (talk) 11:32, 14 December 2011 (UTC)


 * The word cause does not mean "sole and only cause". There is not just an association, but biological bases for causation both as mutagen and mitogen. There is a dose-effect relationship. Animal models support it. The CDC says, "Cigarette smoking causes lung cancer." There is enough reliably sourced data to support the use of the word "cause".Novangelis (talk) 04:28, 14 December 2011 (UTC)


 * I think quoting just that part of the CDC statement is misleading, the CDC quote in full is: "Cigarette smoking causes lung cancer. In fact, smoking tobacco is the major risk factor for lung cancer. In the United States, about 90% of lung cancer deaths in men and almost 80% of lung cancer deaths in women are due to smoking. People who smoke are 10 to 20 times more likely to get lung cancer or die from lung cancer than people who do not smoke. The longer a person smokes and the more cigarettes smoked each day, the more risk goes up." It seems to me that stating that smoking causes lung cancer is somewhat throwaway here, as what matters is the stats that follow. It's an interesting statement though as they seem to contradict themselves quite a bit! Is it really valid to say "Cigarette smoking causes lung cancer" and then follow it with "People who smoke are 10 to 20 times more likely to get lung cancer or die from lung cancer than people who do not smoke", which actually doesn't mean the same thing at all? Also - notice the page is called risk_factors.htm Xeodus (talk) 11:32, 14 December 2011 (UTC)


 * After looking into the references from that CDC page, the first is a 2005 American Cancer Society report 'Cancer Facts and Figures'. In both that report and the 2011 version , they have sub headings for each cancer, New cases, Deaths, Signs and symptoms, Risk factors, Early detection, Treatment and Survival. Under Risk factors they state "Cigarette smoking is by far the most important risk factor for lung cancer. Risk increases with quantity and duration of smoking. Cigar and pipe smoking also increase risk.". This is an example of the sort of language I think is more informative than X causes Y. Xeodus (talk) 11:50, 14 December 2011 (UTC)


 * Xeodus, I do believe that the Russian roulette analogy holds, even for a multifactorial disease such as cancer. At the end of the day, each cigarette is a bullet: it takes more than one hit to kill you, and you can get hit by other projectiles as well (other carcinogenic substances or effects) but it doesn't change a thing.
 * In any case, although I'm not a big fan of the authoritative argument, I second Novangelis' position: "risk factor" may be the right term in some contexts (maybe that's how carcinogenic substances could be termed in occupational safety materials), but if "cause" is the reference domination in medicine literature, cause it is then! Wikipedia must reflect real-world knowledge and terms, never make them up. It's called the no original research rule.ConradMayhew (talk) 07:07, 14 December 2011 (UTC)


 * Except that after the fact, it's pretty clear what killed you when someone finds the smoking gun in your hand, and a bullet wound in your head - whereas there's currently no way to definitively say that a person's cancer was caused by smoking. (I refer to a single patient here, not a statistical sample!) I actually didn't realise there was such a thing as Argument from authority until you mentioned it, thanks for that :) I don't claim to be an authority, just that I am questioning the way this article and others communicates the causal link between smoking and lung cancer. I take your point about "cause" being the dominant term in the medical literature, but when someone with a medical background reads the statement "Smoking causes lung cancer", they know that it isn't as simple as that. This is not the case for someone coming here with no prior knowledge of the disease, and that is what troubles me. I don't see how the no original research rule affects this discussion at all, as I'm not proposing inventing new terms or facts, just changing the way something is presented to make it more informative to the reader. In the end, if the majority of people participating in this discussion conclude that such a change would not make the article more informative, then I'm happy to accept that. Up to now however, I'm not convinced anyone has really shown this. Xeodus (talk) 11:32, 14 December 2011 (UTC)
 * Of course it is valid to say "smoking causes lung cancer". It does, and we have excellent sources to support that. No one is suggesting "smoking causes each and every case of lung cancer", it doesn't, and we have no sources that would support such a statement. The risk factor analysis only comes into the more subtle discussion when considering an individual as part of a population. Sure there are special populations significantly exposed to other carcinogens, and that should be discussed in the article body, but that in no way invalidates the simple direct statement that "smoking causes lung cancer" which belongs in the lede. LeadSongDog come howl!  14:36, 14 December 2011 (UTC)


 * I don't think there is anything subtle about considering things from an individual standpoint! In fact, I imagine that the majority of people who read this article are not interested in the population level statistics, but what it means for them or someone they know. Can we agree that when talking about an individual, it is not really valid to say 'smoking caused your lung cancer'? Xeodus (talk) 14:43, 14 December 2011 (UTC)


 * Not all bullets to the head cause death. An individual with a bullet in the head might have died from a knife in the back. The fact that some individuals do not die of bullets to the head does not change the fact that bullets to the head cause death. Smoking causes lung cancer as backed by numerous studies, and the biological bases that go beyond the mere association. The article does not say that "smoking caused you lung cancer". Let me introduce you to another fallacy: the straw man argument. While you have shifted your objection from above, there are far to many objective bases to support the use of the word "cause". Citing reliable organizations that use the word cause (despite decades of pressure from the tobacco companies) is not argument from authority fallacy when it is backed by extensive data, and the point is that reliable resources use the word cause. It still relies upon authority, but Wikipedia is founded upon authority—reliable sources.Novangelis (talk) 15:59, 14 December 2011 (UTC)


 * When you say 'The fact that some individuals do not die of bullets to the head does not change the fact that bullets to the head cause death.' I think you mean 'The fact that some individuals do not die of bullets to the head does not change the fact that bullets to the head can cause death.'? I also don't see why people keep bringing up 'the tobacco companies' or talk of 'denialism' as it simply isn't relevant to my argument. I'm not disputing the statistical data in any way, or trying to re-word the article to weaken the link between smoking and lung cancer so can we please move on from that.


 * You say it is not argument from authority fallacy when it is backed by extensive data, and I absolutely agree. My point is the the extensive data shows that statistically, smoking increases the risk of developing lung cancer, and the more you smoke, the more that risk is increased, and that if you stop, the risk decreases. That is all. Just because it has become common to use the word 'cause' in reliable sources, is not an argument for using it as the data doesn't actually back it up. Xeodus (talk) 17:34, 14 December 2011 (UTC)


 * I think we can move on. There is clear WP:Consensus backed by reliable sources for the statement that smoking causes lung cancer. I would suggest that this thread be closed.Novangelis (talk) 18:01, 14 December 2011 (UTC)


 * Seconded. Let's move on. JFW &#124; T@lk  18:46, 14 December 2011 (UTC)
 * Risk and cause are basically the same thing. Cause is more clear and supported by sources thus we should use it.  Doc James  (talk · contribs · email) 19:25, 14 December 2011 (UTC)

"" Just because it has become common to use the word 'cause' in reliable sources, is not an argument for using it as the data doesn't actually back it up. ""

- Xeodus

On Wikipedia, out duty is not to interpret the data: it is to report the findings and conclusions of reliable sources. Your argument hinges on the definition of the word "cause". This is reminiscent of sophistry used by a certain type of lawyer.

In any case, words are defined in part by the way in which they are used. If reliable sources use the word with this meaning (that differs from your meaning), the reliable sources are not wrong. Axl ¤  [Talk]  00:30, 15 December 2011 (UTC)


 * The National Cancer Institute says cigarette smoking causes cancer: Nuff said.  We should also use "cause".

Quote: "Cigarette smoking causes many types of cancer, including cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia." Imersion (talk) 18:31, 24 March 2013 (UTC)

Screening
I hope I'm editing this into the correct section of this discussion page. I note that this is a featured article and is a fantastic medical summary of the topic in a very well laid out format. The small section on screening appears to be a little out of date and there is a newer trial which is actually mentioned in the lung cancer screening article which shows a benefit in mortality using low dose CT screening. Lonnyz (talk) 08:45, 12 December 2011 (UTC)
 * Looks like an interesting trial, but it still counts as a primary publication according to wp:MEDRS. I was not able to find a review yet published that demonstrates its notability. The paper is
 * Even the editorial in that issue (which we do not consider to be completely independent) sounds some cautionary notes about the paper: "makers should wait for more information before endorsing lung-cancer screening programs" LeadSongDog come howl!  16:10, 12 December 2011 (UTC)
 * Oops, there is a MEDRS review:

It seems to say further (stratified) analysis is still needed before the trial results are useful in any practical sense.LeadSongDog come howl!  16:20, 12 December 2011 (UTC)

Update needed
This article has a fair bit of primary research. Wondering if anyone wishes to take up the task of updating it to current secondary sources? -- Doc James (talk · contribs · email) 21:15, 1 January 2012 (UTC)


 * It was originally taken to FA by, and I get the impression that has done a fair amount of work on it as well. Perhaps these editors could be persuaded to give it a good scrub? JFW &#124;  T@lk  01:06, 2 January 2012 (UTC)
 * *sigh* I'll add it to my "to do" list. After I finish reviewing "Pneumothorax".... Axl  ¤  [Talk]  20:36, 2 January 2012 (UTC)
 * Thanks wish to get all article in top shape before translation efforts begin. Doc James  (talk · contribs · email) 20:52, 2 January 2012 (UTC)

has just flagged a few of them. I agree that this remains a problem. JFW &#124; T@lk  11:36, 16 March 2012 (UTC)

Secondary substitutes
5. Gorlova This might be replaced with, we'd need a Chinese-reading editor to verify. Another possibility is (I've only seen the abstracts)

10. Coyle Have a look at, PMC 2791455. Looks like it should cover this and maybe some others.

30. Boffetta I think ought to cover this and adjoining refs. Free full text available here.

38. Field This should be more or less replacable with CMAJ. 2008 Jul 15;179(2):147-52. Quality of indoor residential air and health Dales R, Liu L, Wheeler AJ, Gilbert NL. It might also be useful to see (I have not done so, but the abstract is suggestive.)

46. Pope should cover this. In any case should be updated to, the 2011 revisitation of Pope et al. (only abstracts seen)

LeadSongDog come howl!  19:15, 16 March 2012 (UTC)


 * LeadSongDog, thanks for the suggestions. I have identified the primary sources. (There are a couple more in the "History" section, which I think is acceptable.) There are a lot more than I was expecting. Replacement of these is a major undertaking. It will take me at least a couple of months. I shall tackle them in reverse order, to preserve the numbering. If anyone wants to help with this, please feel free. Axl  ¤  [Talk]  19:40, 25 March 2012 (UTC)
 * Wow, that was brutal. A team effort might be needed for the replacements. Given the importance of the subject, it should be an easy favourite for Med collaboration of the month. Suggest raising it at WP Med, if you agree.LeadSongDog come howl!  22:23, 27 March 2012 (UTC)
 * Thanks for the suggestion, LeadSongDog. I welcome any assistance from other editors. Axl  ¤  [Talk]  11:53, 28 March 2012 (UTC)
 * I think the status-quo version (for purposes of comparison and for identification of the old usage of the above refs) can be taken as rev 482030352 by Anthonyhcole on 15 March. Since some of the deleted primary sources were redundant, would the next logical step be a shortlist of the ones that actually need to be replaced? LeadSongDog come howl!  16:26, 28 March 2012 (UTC)
 * I'm not sure what you mean by "redundant" in this context. Do you mean "Both a primary source and a secondary source are used as references to the same text. Therefore the primary source can be deleted and no new reference is required"? If that is what you mean, that is actually the easiest situation to handle. An editor who finds this can just delete the primary source in one edit. I don't see how flagging the "non-redundant" primary sources on a separate list would be helpful. Axl  ¤  [Talk]  20:54, 28 March 2012 (UTC)
 * Yes, that's what I meant. I was approaching it wrong, though. I had thought, "start from the end of the list and work up", but on reconsideration, it makes more sense to start with the most-cited refs. LeadSongDog come howl!  13:22, 29 March 2012 (UTC)
 * FYI there are 89 Cochrane reviews (generally quite good sources) mentioning lung cancer: http://www.cochrane.org/search/reviews/lung%20cancer Some might be useful. pgr94 (talk) 15:22, 29 March 2012 (UTC)


 * and  look useful. LeadSongDog  come howl!  15:57, 3 May 2012 (UTC)
 * Park [371 Park.pdf "Aetiology of Cancer in Asia"] (2008) might be helpful. LeadSongDog  come howl!  13:28, 11 June 2012 (UTC)


 * Adding References as general collection point. Franamax (talk) 00:00, 17 April 2012 (UTC)


 * Okay, I have finally removed the offending primary sources. There is still more clean-up required though. In particular, some of the references are a little old and need updating. Axl  ¤  [Talk]  21:11, 18 June 2012 (UTC)

Infobox image
Only 40% of lung cancer patients are smokers at the time of diagnosis. Around 60% are non-smokers and 15% or more are "never smokers" (having never smoked a tobacco product in their entire lives). So while the link between smoking and lung cancer is critically important and must be a major part of this article, perhaps it's time to put a different image in the infobox and move the image of the smoker's lung to a different section of the article.

The image wrongly suggests that the disease is a "smoker's disease." Now it's extremely important to educate people about the link between smoking and lung cancer, but it's also important to spread awareness that smoking is a disease that affects much more than just smokers. You can't just avoid the disease by not smoking.

A histological image of a grouping of non-small cell lung cancer cells or an MRI of the chest region would be more cause-neutral and would be inline with many other Wikipedia cancer articles. (The breast cancer article shows a mammogram of a breast. The brain cancer article shows a head MRI with tumor.)

Unfortunately, by pushing too hard with images of smoked out lungs, this article gives people the impression that LC is a "smoker's illness." This impression is one of the major reasons that lung cancer research does not receive as much funding as does research into certain other cancers -- despite that affects many more people. And, we all know it takes research money to find treatments and, hopefully one day, a cure. So maybe it's better not to brand this article a "smoker's cancer" article. I say "brand" because images speak louder than words, and the infobox image speaks volumes about the tone of the article -- even though the actual wording of the article is even-handed and appropriate.

Again, I'm not saying get rid of the image. I'm just saying move it to the prominently-placed sub-section on smoking. Smoking is and remains a critically important part of this article.

Thoughts? Cheers, ask123 (talk) 20:13, 26 April 2012 (UTC)


 * 87% of lung cancer is attributable to smoking. The picture shows lung cancer in a person who also smoked. That's pretty representative.


 * Whether lung cancer is a "smoker's disease" is a matter of opinion. Whether this picture suggests that lung cancer is a smoker's disease is also a matter of opinion.


 * In any case, I believe that the picture is representative and a good choice for the Infobox. It is the same image from when the article passed FAC in 2007. Axl  ¤  [Talk]  20:52, 26 April 2012 (UTC)


 * I couldn't disagree more strongly. If there is one single thing that people need to know about primary lung cancer it is that it is in very large measure the result of inhaling smoke. Because of this, it is largely preventable by avoiding smoke. Sure there are a few exceptions for other carcinogens, but the tobacco industry has tried without any sign of remorse to obscure this central truth as much as possible. We must not be party to their big lie. LeadSongDog come howl!  21:01, 26 April 2012 (UTC)

I thought that we had crossed paths before. Here's a discussion from 2007. Axl ¤  [Talk]  23:46, 26 April 2012 (UTC)
 * You need recent high quality secondary sources to back up statements Ask123. Doc James  (talk · contribs · email) 08:07, 27 April 2012 (UTC)


 * I will probably DEEPLY REGRET sticking my chin out here at THIS place :-) but JUST FYI => with respect to "never smokers" not having "ever smoked a single tobacco product in their entire lives" ... it has been my LONG experience (as I recall, anyway - lol) that "Never Smokers" are most often - dare I say "almost always"? - NOT defined as "never ever EVER having smoked ANY tobacco", but instead are defined as individuals who have smoked less than 100 cigarettes (combined) in their entire lifetime. No biggee, just couldn't help but mention that!


 * Axl, you are doing an INCREDIBLE job busting your hump on this article, and I publicly commend you (in lieu of doing the work to give you yet another barnstar) :-) THANKS!


 * Best regards to all:
 * Cliff (a/k/a &#34;Uploadvirus&#34;) (talk) 16:27, 3 May 2012 (UTC)
 * Hehe, one patient told me that EVERYONE is an ex-smoker. Everyone has tried a cigarette at some point. And no-one is actually smoking while I interview them. Axl  ¤  [Talk]  19:02, 3 May 2012 (UTC)

Dietary factors
From Murray & Nadel's Textbook of Respiratory Medicine, fifth edition, chapter 46, section "The etiology of lung cancer: overview": "The contribution of nutritional factors remains to be determined, but dietary factors have been hypothesized to account for approximately 20% (range, 10%–30%) of the lung cancer burden." This seems to me to be an unusually high estimate. The contributions from other risk factors quoted by Murray & Nadel are more in line with my expectations.

I would appreciate other opinions regarding the reliability of the quoted figure.

While I am mentioning dietary factors, I would also appreciate opinions regarding the significance of fruit and vegetables as stated in the "Prevention" section. Axl ¤  [Talk]  09:19, 27 May 2012 (UTC)


 * Murray & Nadel quotes this paper by Willett from 1995. If 87% of lung cancer is attributable to smoking, it is implausible that 20% of lung cancer deaths can be avoided by dietary change. Willett's values are based on case-control studies and cohort studies, not interventional studies. There is no mention of correction for smoking. Willett concedes "A fundamental problem with this approach is that nondietary factors, such as smoking habits... may also contribute to international differences."


 * In my opinion, Willett's paper is unreliable. I am surprised that Murray & Nadel reference it. By extension, I believe that Murray & Nadel's figure is also unreliable. Axl  ¤  [Talk]  09:21, 28 May 2012 (UTC)
 * While a primary source, would seem to explain Willett's figure. It finds a large "smoking-related carcinogen-modulating effect of isothiocyanates, a group of phytochemicals uniquely present in cruciferous vegetables", particularly with the consumption of raw cruciferous vegetables (where the isothiocyanates are more available than cooked ones). If I'm reading it correctly, they're discussing a large relative risk reduction (on the order of 30-55%) among short-term smokers of less than 30 years duration, a very pronounced protective effect if correct. Depending on how rare such consumption is, it may account for the Mediterranean diet effect on lung cancers (discussed at ).LeadSongDog  come howl!  19:44, 29 May 2012 (UTC)


 * Thank you for pointing out the paper by Tang. Tang clearly made an effort to match controls by smoking status. But there is a caveat: "However, despite the matching on smoking status, mean smoking intensity and duration were significantly different between cases and controls. Among both former and current smokers, compared to controls, cases smoked more cigarettes per day (29.3 versus 22.6, p < 0.0001) and accumulated more years of smoking (37.0 versus 27.1, p < 0.0001)." Tang used a logistic regression model to adjust for smoking intensity/duration. Tang also ackowledges several potential areas of bias in the case-control study. Nevertheless, this is still a good quality study. Note that this study was not designed to investigate the proportion of lung cancers that are attributable to dietary factors. Tang's conclusions could be used to identify the underlying mechanism behind Willett's finding, but cannot be used to justify the magnitude quoted by Willett.


 * Key's review (which I have already included as a reference in the "Prevention" section) ascribes these apparent associations to confounding, although Tang's paper isn't included in the analysis. However Key does not investigate cruciferous vegetables. Axl  ¤  [Talk]  11:10, 30 May 2012 (UTC)
 * While this is clearly wp:SYNTH and wp:CRYSTAL, a 30-55% reduction possibility of the 87% would rather clearly exceed 20% of deaths if it could be realized. Not that even certain knowledge of efficacy would result in widespread conversion of smokers to doubling the average consumption of these foods. Dietary demographics don't often change that much, but as an unrealized potential it does suggest to me that Willett's figure is sufficiently plausible that the figure should not on its own be cause to editorially reject his result. Do we have a published wp:RS that challenges it? LeadSongDog come howl!  14:12, 30 May 2012 (UTC)


 * Willett is cited by 18 papers. This paper references Willett with regard to colorectal cancer, but not lung cancer. This paper also references Willett, this time with respect to reduction of all cancers in general. Interestingly, the paper describes several studies that found a reduced risk of lung cancer with high apple consumption.


 * If high vegetable intake truly is associated with reduced lung cancer risk, why don't more textbooks report this? (The Oxford Textbook of Medicine does not.) Harrison's Principles of Internal Medicine gives us a clue: "The risk of lung cancer appears higher among individuals with low fruit and vegetable intake during adulthood. This observation led to hypotheses that specific nutrients, in particular retinoids and carotenoids, might have chemopreventive effects for lung cancer. However, randomized trials failed to validate this hypothesis. In fact, studies found the incidence of lung cancer was increased among smokers with supplementation."


 * Key's paper states: "Many observational studies have found that lung cancer patients report a somewhat lower intake of fruits and vegetables than controls, but the effect of smoking is so large, compared with the small association with diet, that residual confounding by smoking is likely, and recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and the risk for lung cancer."


 * What do you think about Key's paper, LeadSongDog? How do you resolve Key's conclusions with Willett's? Axl  ¤  [Talk]  21:19, 30 May 2012 (UTC)
 * Key seemed to be looking at the broader question of undifferentiated fruits and vegetables. If only a few have significant effect it isn't really surprising that the undifferentiated greengrocer's aisle shows nothing much. I'm no expert, just an interested editor. But the findings about isothiocyanates and their selenium-substituted equivalents, their uptake into blood, their binding to p53, and their effects on apoptosis are all fairly recent. Anything useful on the topic would have to be from the past five years or so., , all pertain. It may be too soon to use this material on WP, I leave it to your informed judgement. LeadSongDog  come howl!  22:56, 30 May 2012 (UTC)
 * Willett also looked at generic vegetables. Axl  ¤  [Talk]  23:30, 30 May 2012 (UTC)


 * I was looking around for some information on asbestos when I found this paper by Alberg. It considers the data regarding antioxidants, cruciferous vegetables, flavonoids and isothiocyanates. Although it is a little dated (from 2007), it states "Cigarette smoking is now so closely associated with less healthful lifestyles in the United States and some other countries, such as less healthful diets, that it is often difficult to disentangle the dietary factor(s) of interest from the effects of smoking.... In addition, associations between dietary factors and lung cancer risk are likely to be far weaker than the association with active smoking, and diet is measured with much greater error in general than is smoking. Even for a dietary factor, such as vegetable consumption, which is fairly consistently associated with a lower risk for lung cancer, the highest exposure category is typically associated with at most a halving in the risk for lung cancer. Therefore, in interpreting the evidence, residual confounding cannot be readily set aside as an explanation for the observed associations between dietary factors and lung cancer." Axl  ¤  [Talk]  18:22, 31 May 2012 (UTC)
 * Curiously, the authors of this paper are also the authors of Murray & Nadel's chapter on "Epidemiology of Lung Cancer". Axl  ¤  [Talk]  18:33, 31 May 2012 (UTC)

As we know all too well, corelation is not causation. But the evidence for isothiocyanates, and particularly for sulforaphane is much more than just epidemiology. There's a documented uptake from the food into the blood, with an understood difference between the raw an cooked food. There's a way to monitor the uptake as it is eliminated in urine. There's a reasonably well elucidated mechanism of action at specific mutant protein target sites to inhibit angiogenisis signalling. There's an established dose response. There are specific genetic characteristics distinguishing the sub-population who benefit. There are in vitro, mouse, and human studies. There are derivative products (concentrated extracts, "functional foods", and now synthetic small molecules such as SFN-isoSe -- which substitues selenium for sulfur)

You might want to have a look at: Joanna Tomczyk, Anna Olejnik. "Sulforafan – potencjalny czynnik w prewencji i terapii chorób nowotworowych" (in Polish with English abstract) [Sulforaphane – a possible agent in prevention and therapy of cancer] Postepy Hig Med Dosw, 2010; 64: 590-603. (Google translation isn't too bad, but mind the Polish hyphenation in "chemo-preventive".) With regard to lung cancers, its citations 61, 88, and 93 pertain. It also discusses prostate, melanoma, breast and others, but there's no reason to get into them here except to note that it does discuss melanoma mets to the lung. Also, the related trials. Cheers, LeadSongDog come howl!  21:28, 31 May 2012 (UTC)


 * Those findings are interesting, but no better than circumstantial evidence. Even case-control & cohort studies have significant limitations. What is really needed is a large randomized controlled trial.


 * For what it's worth, I suspect that isothiocyanates may be the basis for the development of new drugs to treat cancer in the future. Even if there turns out to be small effect in prevention (of which I'm not convinced), smoking cessation will always remain the top priority for prevention of lung cancer. Axl  ¤  [Talk]  09:04, 1 June 2012 (UTC)
 * As I've often reminded others, there's wp:NODEADLINE. If and when there are adequate sources that connect the dots, the article can always be revised. And yes, of course smoking prevention is the first best plan, followed by cessation, but harm reduction still has a part to play for those who can't or won't yet quit. LeadSongDog come howl!  03:19, 4 June 2012 (UTC)

Back on topic, here is a summary of relevant secondary sources:-

Axl ¤  [Talk]  11:44, 4 June 2012 (UTC)
 * The apparent conflict in results is discussed in Parkin & Boyd 2011 (see the Discussion section). The Key result is directly addressed. The heterogenaety of some of the groups is thought to have masked effects. Treating all fruits and vegetables as equivalent was not helpful, particularly as the best candidate components are not common. Indeed for mustard oils and garlic oils, their strong flavours tend to be polarizing factors: some people love them, others hate them. (It's almost sterotypical that some children would rather go to bed hungry than eat brocolli, brussel sprouts, or cabbage.) LeadSongDog  come howl!  21:40, 4 June 2012 (UTC)
 * Well, Parkin mentions Key's main conclusion; I wouldn't say that "the Key result is directly addressed". Anyway, I shall add Parkin to the table above. Axl  ¤  [Talk]  10:26, 5 June 2012 (UTC)

Duplic ref
Why are refs 8 and 9 different editions of the same book? Looks to me like REF 9 could be consolidated to Ref 8.
 * REF 8: Lu C, Onn A, Vaporciyan AA et al. (2010). "78: Cancer of the Lung". Holland-Frei Cancer Medicine (8th ed.). People's Medical Publishing House.ISBN 9781607950141.
 * REF 9: Vaporciyan, AA; Nesbitt JC, Lee JS et al. (2000). Cancer Medicine. B C Decker. pp. 1227–1292. ISBN 1-55009-113-1.

FeatherPluma (talk) 21:03, 3 July 2012 (UTC)
 * Please avoid crossposting. I have replied on my talk page. Axl  ¤  [Talk]  22:15, 3 July 2012 (UTC)

Passive smoking "risk"
Recent tweaks to the relative risk numbers (home passive- vs workplace passive- vs never- smokers) may be an improvement, but they don't address the lack of clarity on just what it is a risk of. Is it lifetime risk of developing the disease? One-year risk? Of new diagnosis? Of dying from it? The cited FAQ in turn cites Fontham et al. JAMA 1994; 271(22): 1752–1959. for the figures used, if someone has access. In any case, there must be more current figures published somewhere. Much has changed in eighteen years. LeadSongDog come howl!  21:49, 25 July 2012 (UTC)
 * Oh dear, the original paper is unclear. . It clearly is discussing accumulated lifetime exposure, but not clear whether it is discussing lifetime risk. Am I missing something? Would "rate" be the normal term for one-year, with "lifetime" implied otherwise? LeadSongDog come howl!  22:05, 25 July 2012 (UTC)
 * Hmm, I'll try to find a better source. Axl  ¤  [Talk]  22:56, 25 July 2012 (UTC)
 * This is a familiar paper. The meta-analyses use a mix of cohort and case-control studies. I suppose that cohort studies are the best quality studies that we can hope for with this variable. Without looking into the individual studies, I suspect that each study has its own time period over which it monitored the participants. Thus the increase in risk is the average for the duration, and this will vary with different studies. Axl  ¤  [Talk]  23:18, 25 July 2012 (UTC)

"" Would "rate" be the normal term for one-year, with "lifetime" implied otherwise? ""

- LeadSongDog

"Rate" does not default to one year. "Incidence" or "incidence rate" usually apply to one year, although the population size must be included. Stating a single percentage for the increase in risk implies that duration doesn't matter. Axl ¤  [Talk]  10:46, 26 July 2012 (UTC)

Introductory section
The introduction is weak in at least one way. A reader to he section is quite likely to want to know the relation betwen smoking and cancer. At the moment, this is defined only in a complementary way, that 15% of cases are not caused by smoking. It would be better to state this positively: SO,: In the United States, smoking causes 80–90% of lung cancer cases.[7] Imersion (talk) 12:25, 25 August 2012 (UTC)
 * I have added the statement to the lead section. Axl  ¤  [Talk]  22:06, 18 September 2012 (UTC)

misplaced / irrelevant statements
Some statements are not really relevant/applicable to this page. E.g.: "The influence of "Big Tobacco" plays a significant role in the smoking culture.[106] Young nonsmokers who see tobacco advertisements are more likely to take up smoking.[107]". Regardless of its truth and absolute relevance, this statement is unrelated whatsoever to lung cancer. Should be moved (if not there already) into the article about tobacco addiction for instance.--MarmotteiNoZ 04:44, 6 December 2012 (UTC)
 * Nonsense. Advertising carcinogens causes their consumption and so causes cancer. You're welcome to try and find a recent wp:MEDRS that contradicts this, of course.LeadSongDog come howl!  19:30, 10 December 2012 (UTC)


 * Neither reference actually mentions cancer in its text. However the first reference was funded by the National Cancer Institute, and the second reference was funded by the Canadian Cancer Society. It could be argued that the causal link between smoking and lung cancer is so well known to healthcare professionals that it is superfluous to the journal articles.


 * The preceding sentence in that paragraph states "For every 3–4 million cigarettes smoked, one lung cancer death occurs." The implication is that increased smoking (in the population) leads to more lung cancer deaths. Your claim that "this statement [about tobacco advertising] is unrelated whatsoever to lung cancer" is false.


 * There may be an argument for moving the text up to the "Prevention" section. In any case, I believe that this information is directly relevant to "Lung cancer" and should remain in this article. If you still disagree, we could ask WikiProject Medicine for input, to draw a wider consensus. Axl  ¤  [Talk]  22:49, 10 December 2012 (UTC)

Clubbing of toe and finger nails
Hi I recently had a large cancer removed from my lung, I am still having club finger , my nails are continuing to grow this way, Will this stop ? I believe they removed all the lung cancer by removing the lobe of the right lung. any help or suggestions from anyone ? --122.62.138.68 (talk) 23:25, 27 April 2013 (UTC)
 * We are not permitted to answer questions of this nature on Wikipedia. I suggest that you contact your doctor. Axl  ¤  [Talk]  23:37, 27 April 2013 (UTC)

Lung ca image
Wonder if an X ray is more representative? Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:35, 22 May 2013 (UTC)
 * This issue has been discussed before, although I am struggling to find it in the talk page archives. During the FAC in 2007, the image used was a pathological specimen. This was later replaced by a different pathological specimen. More recently, the fancy CT image was used. I don't have a strong opinion either way. Axl  ¤  [Talk]  10:48, 24 May 2013 (UTC)
 * It is just that I would associate lung cancer more with an X ray or a none fancy CT image. I have never seen a CT image like this before. It is off poor quality resolution and appears to simply be taken off of the monitor. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:01, 24 May 2013 (UTC)
 * As I said, I have no strong opinion either way. If you want to replace the fancy CT picture, please go ahead. If someone objects, we can discuss it again.
 * I see that you uploaded the x-ray to Wikimedia Commons. Do you also have the x-ray without the arrow available, in case someone wants to use the original? Thanks. Axl  ¤  [Talk]  11:07, 24 May 2013 (UTC)
 * Yes should have the original without the marking somewhere. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:08, 24 May 2013 (UTC)

"Rate" vs. "Incidence"
In "Diagnosis", subsection "Classification", in the table the word "incidence" has been changed to "rate". I am unhappy about this. "Incidence" has a distinct epidemiological meaning while "rate" is vague. Even though "incidence" is stated in the table's main heading, given that values are quoted, I believe that "incidence" should also be used in the secondary heading. Axl ¤  [Talk]  10:10, 10 June 2013 (UTC)
 * I sort of consider rate and incidence to be more or less the same with rate per 100,000 being more understandable. Have switched it back per your preference. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:14, 10 June 2013 (UTC)
 * Thank you for changing the table heading. I note that you say "rate and incidence [are] more or less the same with rate per 100,000 being more understandable." It is precisely this sort of interpretation that leads to confusion with prevalence. Axl  ¤  [Talk]  20:25, 10 June 2013 (UTC)
 * One is per year and the other is not. I added the per year bit. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 23:28, 10 June 2013 (UTC)
 * No! Incidence is the number of new cases per unit population per unit time. Prevalence is the number of current cases per unit population at a given moment in time. Axl  ¤  [Talk]  09:04, 11 June 2013 (UTC
 * Yes so should we change it to "New cases per 100,000 per year"? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:16, 11 June 2013 (UTC)
 * I'm not keen on doing that, but it would be accurate and unambiguous. Axl  ¤  [Talk]  12:24, 11 June 2013 (UTC)

Out of date information
I came here looking for surivival rates, and found a 5 year survival rate of 10%, cited to an article from 2007. This contrasts with http://www.medicinenet.com/lung_cancer/page7.htm#what_is_the_prognosis_outcome_of_lung_cancer which gives a 5 year survival rate of 17%, along with more details of types and stages and their survival rates. I don't know the reliability of that site, which fails to cite its own sources - but its article is labelled as last reviewed on 12/3/2013, so I strongly suspect it is in fact reliable, but things have improved in the past 6 years. My wikipedia mentor has told me not to touch anything medical; apparantly the owning projects have unique standards for reliable sources, and have been known to ban people for using unapproved ones. So I'm commenting here - how about at least putting accurate dates on potentially out of date information - or better yet, updating the information based on more recent sources - rather than giving out-dated and frightening information to readers whose interest in some medical issue stems from someone's recent diagnosis. Kobnach (talk) 19:21, 7 December 2013 (UTC)
 * Were does our article say the overall 5 year survival is 10%? Are you sure you are looking at the most recent version of the article? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:37, 7 December 2013 (UTC)
 * Yes medicinenet is not a great source. Globally what is the 5 year survival? This ref says 15% but it is probably for aggressively treated disease in the wealthy parts of the world.  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:33, 7 December 2013 (UTC)
 * Yes this ref says 15% in the USA and worse in the developing world . Will update. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:33, 7 December 2013 (UTC)
 * Where did the article say 10%? Axl  ¤  [Talk]  22:36, 7 December 2013 (UTC)
 * It might have years ago. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 00:31, 8 December 2013 (UTC)

Screening
In screening section, it is not mentions anything about tumor marker. Use CT Scan and MRI is expensive and same with tumor marker, it are not diagnosis test, the tumor/cancer should be diagnosed by biopsy. Today, M2-PK cheap tumor marker is very usefull because of high sensitivity compare to use expensive and invasive colonoscopy. The tumor marker tests will be developed further in line with the time.

I propose to add article as below:

According to http://www.aacc.org/SiteCollectionDocuments/NACB/LMPG/tumor/chp3p_lung.pdf CYFRA 21.1 can aid in diagnosis especially when biopsy cannot to be done and CYFRA 21.1 is the most sensitive tumor marker for NSCLC. Together with CEA, CYFRA 21.1 will give more sensitivity. While NSE and ProGRP has more specificity of SCLC when is compared to CEA and CYFRA 21.1. ProGRP is more sensitive than NSE. However, the National Academy of Clinical Biochemistry says that for lung cancer screening purposes uses a single tumor marker only is not recommended. The tumor markers are also useful for monitoring, before and post therapy follow up. Gsarwa (talk) 13:49, 29 December 2013 (UTC)

USPSTF screening guidance
Published 10.7326/M13-2771 JFW &#124; T@lk  07:47, 31 December 2013 (UTC)

Pulmonary tumors
"Lung cancer" designates only "Malignant tumors of the lung". It would be interesting tocreate a page "Pulmonary tumors", including benign tumors and malignant tumors. patho (talk) 10:14, 9 February 2014 (UTC)

Risk with fruit and vegetables
There has been a lot of editing of the fruit & veg part of the "Prevention" section recently. The reference (Key) states: "Many observational studies have found that lung cancer patients report a somewhat lower intake of fruits and vegetables than controls, but the effect of smoking is so large, compared with the small association with diet, that residual confounding by smoking is likely, and recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and the risk for lung cancer." This certainly does not imply "unidentified lifestyle factors" as currently stated in the article. Axl ¤  [Talk]  19:02, 30 January 2014 (UTC)
 * Yes feel free to fix. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:17, 30 January 2014 (UTC)
 * I have changed the text to mention only "confounding". Interested readers can read the reference. Axl  ¤  [Talk]  22:34, 15 February 2014 (UTC)
 * Many of our readers will not know what "confounding" is. We should at least describe it. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:50, 15 February 2014 (UTC)
 * I have expanded on the statement. Axl  ¤  [Talk]  00:55, 17 February 2014 (UTC)

How about mentioning the Finnish study that showed excess consumption of vitamins etc. such as ß-carotene and vitamin A decreased survival in lung cancer? I think its been reviewed multiple times. CFCF (talk · contribs · email) 21:00, 21 February 2014 (UTC)
 * Saw some mention, but maybe more is due, will look up some articles. CFCF  (talk · contribs · email) 21:02, 21 February 2014 (UTC)

Technical terms
Typically we list both lay and technical terms in the first sentence of the lead. Thus restored carcinoma of the lung. What are peoples thoughts? Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:33, 20 February 2014 (UTC)
 * Looking at various other cancer articles, I do not see any clear pattern of giving a technical term in the first sentence of the lead. See for example Brain tumour, Skin_cancer, liver cancer, stomach cancer, kidney cancer.
 * Google ngrams tells me that the term "lung cancer" is about 10-15 times more common in general literature than "carcinoma of the lung", and google scholar and pubmed return similar proportions in the scientific and medical literature.
 * The article itself states that not all lung cancers are carcinomas.
 * In conclusion I cannot see a good reason for the term "carcinoma of the lung" to be presented in the lead as if it is an equivalent term in similar use to "lung cancer". 200.120.73.176 (talk) 23:36, 20 February 2014 (UTC)
 * Lung cancer as a term, while common, is pretty generic and could be applied to mediastinal and wall neoplasms (lymphomas or sarcomas) that are not carcinoma. This article, deals exclusively with carcinoma of the lung.  It also applies to every histopathologic diagnosis named in the article, "xxxx cell caricinoma of the lung".  It's also in many article in pubmed (although lung cancer is more common).  I think it's a more precise definition of what this article discusses.  I'd leave it in. Ian Furst (talk) 00:12, 21 February 2014 (UTC)


 * Yes carcinoma of the lung and lung cancer are not exact synonyms if we are being exact. This came up in another cancer article a while ago. Can't remember what consensus was or which article, sorry. Lesion  ( talk ) 00:18, 21 February 2014 (UTC)


 * If the article is not about lung cancer but specifically about carcinoma of the lung, then its title should be changed. 200.120.73.176 (talk) 02:38, 21 February 2014 (UTC)
 * I don't think that a name change is good. The main meaning of lung cancer is carcinoma of the lung, and this is the commonest term (even among professionals) for carcinoma of the lung.  The most precise term is used when it is necessary to be precise, but reviews like this one may not mention the word carcinoma at all.
 * That said, I think that the other types of neoplastic lung conditions ought to be mentioned here, either as points of comparison (e.g., this type is far more common than that type, this class does not include those types) and/or with brief mentions to WP:Build the web and help place the carcinomas in context. WhatamIdoing (talk) 03:13, 21 February 2014 (UTC)

I don't think removing the more technical term makes much sense. On many pages we list all the names for conditions (e.g. hepatic encephalopathy has four names for the same condition) and this is to make the terminology accessible to the reader rather than befuddle them. As for carcinoma vs cancer, this distinction is clarified later in the article. "Lung cancer" without a modifier is always carcinoma, because other lung tumours will immediately be labelled more specifically (e.g. carcinoid). JFW &#124; T@lk  08:02, 21 February 2014 (UTC)


 * I don't think that a name change would be good either. I think that an article about lung cancer should discuss all the types of lung cancer, even if one particular subset accounts for the vast majority of cases.  I just don't think there's much point in forcing in an "also known as" for a term which is infrequently used in both popular and medical usage, and is not even a direct synonym for the article's title.  It's mentioned in both the lead section and in the body of the article that most but not all lung cancers are carcinomas, and this makes it clearly incorrect to say that "lung cancer is also known as carcinoma of the lung".  200.120.73.176 (talk) 10:21, 21 February 2014 (UTC)


 * I remember this happened on Talk:Penile_cancer. The page used to be called "carcinoma of the penis", but it was decided to rename it to "Penile cancer" and widen the scope to include mention of sarcomas etc. Similar situation, almost all of these were carcinomas. Agree with WAID that should mention other types of malignancy that occur in the lungs, even if just to say they are rare. As to mention of "carcinoma of the lung" in parentheses in the lead, I have no particular opinion on this. Lesion  ( talk ) 11:44, 21 February 2014 (UTC)


 * MEDMOS addresses this, though perhaps it needs to be made clearer.LeadSongDog come howl!  13:58, 21 February 2014 (UTC)

"" Lung cancer as a term, while common, is pretty generic and could be applied to mediastinal and wall neoplasms (lymphomas or sarcomas) that are not carcinoma. ""

- Ian Furst

While it "could" be applied, I am not sure that it ever is. The medical profession would certainly never refer to mediastinal lymphomas as "lung cancer". Histologically proven chest wall sarcomas would only ever be referred to by their histological status: "sarcoma", and never as "lung cancer". There are enough non-malignant nodules (hamartomas, etc.) that we never categorically describe an unknown nodule as "lung cancer". If pressed, we might say that lung cancer is a possibility.

In summary, the medical profession only ever uses the phrase "lung cancer" to mean "lung carcinoma".

The article currently includes the statement "The vast majority of lung cancers are carcinomas—malignancies that arise from epithelial cells." I am not sure if I added the statement. In any case, I think that this is sufficient to imply the few parenchymal sarcomas, etc., that arise within the lungs. I am happy to leave the statement "also known as carcinoma of the lung" in the opening sentence. Axl ¤  [Talk]  14:30, 21 February 2014 (UTC)
 * How about neuroendocrine tumors of the lung? Normally these aren't referred to as carcinomas, but rather as carcinoid. I'm not sure I share JFW's sentiment that a patient would always know the difference between this an "regular" lung cancer. CFCF  (talk · contribs · email) 20:52, 21 February 2014 (UTC)
 * Upon inspection there are two articles:
 * Pulmonary carcinoid tumour
 * Typical pulmonary carcinoid tumour
 * None of which are of any particular standard (the typical article doesn't even mention that it is a neuroendocrine tumor), but I know pathologists where I come from will call these cancers lung cancer at least when talking to or informing patients. This complicates the mention in the first sentence in my opinion. Maybe a mention of both is in order? Might look into fleshing out the mention of carcinoid/neuroendocrine tumors in this article myself, at least adding a sentence or two. CFCF  (talk · contribs · email) 21:09, 21 February 2014 (UTC)

Hey - I should have clarified. What I'd meant is that a layperson might refer to other thoracic/mediastinal tumors as "lung cancer", not realizing the distinction. I thought leaving the technical term in the first sentence might be helpful in this regard. Ian Furst (talk) 00:49, 22 February 2014 (UTC)

"" I'm not sure I share JFW's sentiment that a patient would always know the difference between this an "regular" lung cancer. ""

- CFCF

JFW does not assert that a patient would always know the difference. JFW states: " "Lung cancer" without a modifier is always carcinoma, because other lung tumours will immediately be labelled more specifically (e.g. carcinoid). " I agree with JFW's statement. Axl ¤  [Talk]  02:29, 22 February 2014 (UTC)

"" I know pathologists where I come from will call these cancers lung cancer at least when talking to or informing patients. ""

- CFCF

That's a first for me. I have never heard of pathologists talking to patients. Axl ¤  [Talk]  02:31, 22 February 2014 (UTC)
 * (Well to be frank, it depends on definition here; cytologists do, cytology being considered a sub-speciality here, but lets not get into that). On the other hand Robbins Pathology of disease differentiates between Lung cancer (which is carcinoma) and Lung tumors, which include the lot. Maybe a disambiguation page? CFCF (talk · contribs · email) 08:54, 22 February 2014 (UTC)
 * You're saying that cytologists inform patients that they have lung cancer? With respect, I don't believe you. Axl  ¤  [Talk]  12:49, 22 February 2014 (UTC)
 * I've only seen a pathologist called out to a clinic once. Sometimes they might do fine-needle aspiration cytology. Rarely they may be present in theatre (e.g. Moh's micrographic surgery although I've never seen this, but then the patient is unconscious).
 * To clarify and move the discussion forwards, I think the argument is that laypersons would call any cancer occurring in the lungs "lung cancer". Lesion  ( talk ) 13:04, 22 February 2014 (UTC)
 * Well it seem things are done slightly differently in Sweden, there are consultations with cytologists, where the patient visits the clinic for any number of punctions, some of which where a cytologist may inform the patient of possible diseases before analyzing the sample, or upon follow-up. Fine needle aspiration is the least invasive, and may be done when a cytologist is called out to another clinic (simply bringing the set along), but for larger liver, kidney, breast biopsies etc., which do not require invasive surgery but require more kit are performed at the cytology clinic as long as the patient isn't bed-ridden. (Swedish)
 * Now to get the my suggestion, what about mentioning in the lead that there are other cancers, and linking to for example a lung tumor disambiguation page? CFCF  (talk · contribs · email) 13:50, 22 February 2014 (UTC)
 * What do you think? CFCF  (talk · contribs · email) 14:03, 22 February 2014 (UTC)

Based on what I'm reading, everyone agrees the term "lung cancer" is only used to refer to carcinoma of the lung when used by professionals. Some of us, believe a layperson might type in lung cancer when in fact they should be looking for another topic (carcinoid, lymphoma, sarcoma, whatever). I think it's less confusing to the average reader to leave the "also known as lung carcinoma" in place and add some "See also"s for other malignancies of the thorax and mediastinum. I'd assume that 99% of people searching for lung cancer are, in fact, looking for information on carcinoma of the lung. Ian Furst (talk) 22:04, 22 February 2014 (UTC)

From Harrison's Principles of Internal Medicine, 18th edition, 2012: "The term lung cancer is used for tumors arising from the respiratory epithelium (bronchi, bronchioles, and alveoli). Mesotheliomas, lymphomas, and stromal tumors (sarcomas) are distinct from epithelial lung cancers. According to the World Health Organization classification, epithelial lung cancers consist of four major cell types: small cell lung cancer (SCLC) and the so-called non-small cell lung cancer (NSCLC) histologies including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. These four histologies account for approximately 90% of all epithelial lung cancers. The remainder include undifferentiated carcinomas, carcinoids, bronchial gland tumors (including adenoid cystic carcinomas and mucoepidermoid tumors), and rarer tumor types."

I should point out that "carcinoma" is by definition an epithelial-derived cancer. Our article has a short subsection about "Others", mentioning the rare types.

Fishman's Pulmonary Diseases and Disorders, 4th edition, 2008, does not explicitly define lung cancer. However it does have separate sections for non-small cell lung carcinoma/cancer and small cell lung cancer. Subsequent to these, it includes a chapter on "Primary lung tumors other than bronchogenic carcinoma: benign and malignant". The malignant list includes pulmonary blastoma, carcinoid, carcinosarcoma, epithelioid haemangioendothelioma, lymphomas, plasmacytoma, malignant melanoma, malignant germ cell tumours, salivary gland-type tumours, and sarcomas.

The Merck Manual uses the title "Lung carcinoma" while using "lung cancer" through most of the text. The two are clearly regarded as equivalent.

Holland-Frei Cancer Medicine, 8th edition, 2010, lists the WHO classification. This list of epithelial malignant tumours includes the main four, adenosquamous carcinoma, carcinoid tumour, bronchial gland carcinomas, and "others".

Murray & Nadel's Textbook of Respiratory Medicine, 5th edition, 2010, does not explicitly define "lung cancer".

Of these five sources, two clearly imply that "lung cancer" is synonymous with "lung carcinoma". The other three are non-committal, but certainly do not contradict the assertion. Axl ¤  [Talk]  02:38, 23 February 2014 (UTC)


 * I really do not understand the voluminous discussion here about the presence of five words in the lead section. We have the manual of style for guidance; it says that "the first occurrence of the title and significant alternative titles are placed in bold", and "significant alternative names for the topic should be mentioned in the article, usually in the first sentence or paragraph".  In general literature, and in medical literature, the rate of use of the term "lung cancer" exceeds the rate of use of the term "carcinoma of the lung" by a factor of about 15 to 1.  Therefore, "carcinoma of the lung" is not a significant alternative name.  It may be useful and indeed essential to discuss this term in the article, but it does not need to be forced into the first sentence of the article.
 * I also found it spectacularly irritating to have been reverted first of all with the inane summary "try the talk page". If you are going to revert an edit, you are obliged to give a sensible explanation of why you are reverting.  That was not a sensible explanation.  200.120.73.176 (talk) 03:03, 23 February 2014 (UTC)
 * You made three assertions in your initial statement:-


 * "Looking at various other cancer articles, I do not see any clear pattern of giving a technical term in the first sentence of the lead. See for example Brain tumour, Skin_cancer, liver cancer, stomach cancer, kidney cancer." These comparisons are circumstantial evidence at best. Of more relevance, when the article was promoted to FA status, it included the statement. None of the FAC reviewers voiced misgivings about the statement. Actually, you are the first person to do so in the eight or nine years that I have watched this article.


 * "Google ngrams tells me that the term "lung cancer" is about 10-15 times more common in general literature than "carcinoma of the lung", and google scholar and pubmed return similar proportions in the scientific and medical literature." That is a good reason to make the article's title "Lung cancer" and not "Lung carcinoma". By the way, PubMed has 89,775 papers with "lung cancer" and 14,551 papers with "lung carcinoma". That's a ratio of about 6:1.


 * "The article itself states that not all lung cancers are carcinomas." I have demonstrated that lung cancer often, if not always, is synonymous with lung carcinoma.


 * The bottom line is this: you say that lung carcinoma is not a significant alternative name. No-one agrees with you. Axl  ¤  [Talk]  04:43, 23 February 2014 (UTC)
 * Did you read the comment by the guy who reverted me? After he'd first inanely just said "try the talk page", he then claimed it was about giving technical language.  My comments were in response to that.  I don't particularly care if you agree with me, as you seem to be trying to be unpleasant about this.  Google, google scholar, google ngrams and pubmed all agree with me.  Lung cancer is the overwhelmingly used term, and of course medical synonyms should be mentioned in the article but a little used term that most general readers would not use should not be forced into the article's first sentence.
 * Also, FA status does not make an article immune from improvement. 200.120.73.176 (talk) 12:34, 23 February 2014 (UTC)


 * "Did you read the comment by the guy who reverted me? After he'd first inanely just said "try the talk page", he then claimed it was about giving technical language." You are referring to these edits:, , by Jmh649/Doc James. I see that there has also been some "discussion" on your talk page.


 * At the time of Jmh649's first reversion, he should have left a message on your talk page to expand upon the edit summary. However we are busy editors, and we don't always make time to leave appropriate messages. Also, the signal-to-noise ratio from IP editors tends to be lower than that of named editors, often causing regular editors to be more dismissive of IP editors. Another factor is that this article tends to receive biased edits from pro-tobacco lobbyists, typically IP editors. (Although in this case, it is clear that you are earnestly trying to improve the article.)


 * On the other hand, you exacerbated the problem by reverting rather than attempting to engage in discussion. I see that you have a history of edit warring ("The Holocaust in Poland"). This edit is particularly odious.


 * "I don't particularly care if you agree with me, as you seem to be trying to be unpleasant about this." That's a particularly ironic accusation considering the Holocaust discussion. Anyway, I am sorry that you found my comments unpleasant. That was certainly not my intention. Consensus is an important principle in Wikipedia. Thus you should care if I agree with you, regardless of how pleasant or otherwise I am.


 * "FA status does not make an article immune from improvement." I agree. This article has continued to improve since it reached FA status in 2007. My point is that the FAC reviewers showed a consensus that inclusion of the alternative name is acceptable. That consensus has not changed. Axl  ¤  [Talk]  18:22, 24 February 2014 (UTC)


 * In my experience, an IP editor making an obviously productive edit can expect that someone will revert that edit for no reason probably about 10 per cent of the time. And so it was here.  The first reason given was "try the talk page", which is singularly unhelpful and seems designed to irritate.  The second reason given was a claim that both technical and lay terms were given in the lead for cancer articles generally.  As I said in my edit summary, a cursory glance at a number of other cancer articles shows that that's not true.  So, I conclude that the editor simply didn't like an editor from an IP number touching "his" article.  Others such as yourself join in, motivated by the prejudice against IP editors that you outlined above.  In the end, nothing will satisfy you except the complete expungement of whatever I tried to do in the first place.  Your justifications get ever more extreme; FAC does not imply a consensus over the exact wording of any part of the article.  You might feel like you sound perfectly pleasant.  Your actions are not.  I am all too familiar with the unpleasant gang actions of editors who can't stand the thought that someone editing from an IP address might actually know how to improve "their" article.
 * Here's the simple fact. "Lung cancer" is the overwhelmingly used and familiar term.  All sources of usage statistics show this to be the case.  The insertion of "also known as carcinoma of the lung" is jarring and unnecessary.
 * And do tell me, as you want to bring in that Holocaust discussion - how do you react when someone accuses you of holocaust denial for this edit? 200.120.73.176 (talk) 00:31, 25 February 2014 (UTC)
 * Well, there is nothing to be gained by further discussion here. I shall let other readers/editors decide the validity (or otherwise) of your statements. Axl  ¤  [Talk]  01:49, 25 February 2014 (UTC)


 * - I think you're in the appropriate specialty. How does path usually sign out carcinoma of the lung?  Do they label it "lung cancer" or do they give a more detailed histopathologic diagnosis? Ian Furst (talk) 04:09, 23 February 2014 (UTC)
 * They use the formal histopathological subtype: either small cell lung carcinoma or non-small cell lung carcinoma. Actually it would be unhelpful for them to say "lung cancer" because the treatments are totally different. Axl  ¤  [Talk]  04:47, 23 February 2014 (UTC)

If there are no objections I will create this page, and add the about template at the top of the page:

-- CFCF  (talk · contribs · email) 08:32, 23 February 2014 (UTC)

Palliative Care Section
I'm new to editing wikipedia but I feel like the palliative care section is somewhat lacking mainly because it is focused mainly on chemotherapy, not necessarily palliative care (indeed the second paragraph is really all about chemotherapy and not palliative care). I'd like to make the following suggestion as an edit to the palliative care section to talk about the value of palliative care in lung cancer:

Palliative care that is integrated into usual oncologic care benefits patients even when they are still receiving cancer directed chemotherapy. The results of a 2010 study in The New England Journal of Medicine showed that patients with metastatic non-small cell lung cancer receiving early outpatient palliative care experienced less depression, increased quality of life and survived 2.7 months longer than those receiving standard oncologic care alone. Palliative care in this study included meetings with a palliative care team that focused on issues such as assessing physical and psychosocial symptoms, establishing goals of care, assisting with decision making regarding treatment, and coordinating care. For individuals who have more advanced disease, hospice care has been shown to can improve symptom management and quality of life. Ewidera (talk) 06:25, 1 March 2014 (UTC)
 * Per WP:MEDRS we typically use secondary sources such as review articles as references. If you put together a paragraph using secondary sources we can look at adding it. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 06:46, 1 March 2014 (UTC)
 * A good place to start might be :

CheersLeadSongDog come howl!  15:27, 1 March 2014 (UTC)
 * Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Cochrane Database Syst Rev. 2013 Jun 6; 6:CD007760. Epub 2013 Jun 6.
 * Closing the quality gap: revisiting the state of the science (vol. 8: improving health care and palliative care for advanced and serious illness). Dy SM, Aslakson R, Wilson RF, Fawole OA, Lau BD, Martinez KA, Vollenweider D, Apostol C, Bass EB. Evid Rep Technol Assess (Full Rep). 2012 Oct; (208.8):1-249.
 * Early palliative care and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival. Irwin KE, Greer JA, Khatib J, Temel JS, Pirl WF. Chron Respir Dis. 2013 Feb; 10(1):35-47.


 * Thanks for the help. Trying to learn the rules the best that I can. What about the following (same paragraph except two review articles added, one from the NEJM and one a NCCN review article)


 * Palliative care that is integrated into usual oncologic care benefits patients even when they are still receiving cancer directed chemotherapy.  The results of a 2010 study in The New England Journal of Medicine showed that patients with metastatic non-small cell lung cancer receiving early outpatient palliative care experienced less depression, increased quality of life and survived 2.7 months longer than those receiving standard oncologic care alone.    Palliative care in this study included meetings with a palliative care team that focused on issues such as assessing physical and psychosocial symptoms, establishing goals of care, assisting with decision making regarding treatment, and coordinating care. For individuals who have more advanced disease, hospice care has been shown to can improve symptom management and quality of life.Ewidera (talk) 01:42, 2 March 2014 (UTC)

I am reluctant to expand the "Palliative care" section in this way. Most of the principles of palliative care in lung cancer are not actually specific to lung cancer. Parikh's paper is certainly not specific to lung cancer. The relevant trial is mentioned in a table alongside several other generic cancer trials. Similarly, Levy's paper is not specific to lung cancer. Axl ¤  [Talk]  16:14, 2 March 2014 (UTC)

I agree that the principles are not specific to lung cancer however the NEJM study by Temel (RTC on outpatient palliative care) is specific to lung cancer. Not including any discussion about this, rather than focusing most of the palliative care section on chemotherapy is misleading (the prior section on chemotherapy seems like a better place to talk about chemotherapy than the section on palliative care).Ewidera (talk) 05:37, 3 March 2014 (UTC)


 * Temel's paper is a primary source describing a randomized controlled trial. I don't think that this is a suitable source for Wikipedia's article. (As an aside, it is ironic to see that they used an en dash in "non–small-cell lung cancer".) This paper by Yates looks like a reasonable source.


 * Anyway, my main point is that readers should be directed towards the main article "Palliative care", with only brief information provided in this article. Axl  ¤  [Talk]  20:55, 3 March 2014 (UTC)

Diet
Anonywiki has changed the statement "More rigorous studies have not demonstrated a clear association between diet and lung cancer risk" to "Other studies have not demonstrated a clear association between diet and lung cancer risk", with the edit summary ""more rigorous" is an opinion unsupported by source cited."

The source (Key) states: "Many observational studies have found that lung cancer patients report a somewhat lower intake of fruits and vegetables than controls, but the effect of smoking is so large, compared with the small association with diet, that residual confounding by smoking is likely, and recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and the risk for lung cancer." This clearly implies that the later studies are more rigorous. Axl ¤  [Talk]  23:19, 27 May 2014 (UTC)

Hi Axl, thanks for raising this issue in a clear way. Unusually there are multiple studies listed in that single citation and I didn't actually read that bit. Maybe you should change it to something like: "However recent large prospective analyses with detailed adjustment for smoking", so that it's almost exactly the same as the source including implying that it's overturning the earlier studies. I believe we should avoid introducing new words like "more rigorous". Anonywiki (talk) 01:40, 28 May 2014 (UTC)
 * I am concerned about close paraphrasing with your suggestion. I have invited WikiProject Medicine editors to comment here. Axl  ¤  [Talk]  11:53, 28 May 2014 (UTC)
 * You could just put that bit in quotes. Wiki CRUK John (talk) 12:02, 28 May 2014 (UTC)
 * We want to use simple language. I think what we had before was better. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 15:38, 28 May 2014 (UTC)
 * Concur with Doc James, "more rigorous" seems better. Though frankly the entire paragraph could use a rewrite. NickCT (talk) 16:45, 28 May 2014 (UTC)
 * Thank you, everyone. I have changed the text back to "More rigorous". Axl  ¤  [Talk]  23:59, 28 May 2014 (UTC)

Cancer
A cancer is a malignant tumour of any sort, but the article with the heading "Lung cancer" does not include sarcoma and lymphoma, and other non-carcinoma primary malignant tumours of the lung. A much better name for the article as it currently stands is "carcinoma of the lung" or "lung carcinoma". Snowman (talk) 17:20, 28 May 2014 (UTC)
 * While technically true "lung cancer" is so much more commonly used and I think this is a small sacrifice. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:39, 28 May 2014 (UTC)
 * I think that these sort of unnecessary over-simplifications could be confusing or misleading to some. If the page title is staying at "Lung cancer", then the article should include all the sorts malignant tumours. A patient would probably say correctly that he or she has lung cancer, if he or she has lung sarcoma. Snowman (talk) 19:56, 28 May 2014 (UTC)
 * We discussed the matter in this section. The onus is upon you to demonstrate that the term "lung cancer" includes sarcomas of the lung and lymphomas within the lung. Axl  ¤  [Talk]  00:02, 29 May 2014 (UTC)
 * It was discussed earlier, but there is still a problem. I think that anyone interested in the article could be more self reflective than saying that it is someones onus to prove something. Snowman (talk) 13:12, 29 May 2014 (UTC)


 * First of all, the article has internal contradictions; the navbox includes the lung cancers: Sarcoma Lymphoma, Immature teratoma, Melanoma. Snowman (talk) 13:12, 29 May 2014 (UTC)
 * There is no contradiction within the navbox. "Lung cancer" is not synonymous with "cancers in the lung". Axl  ¤  [Talk]  13:38, 29 May 2014 (UTC)


 * The first line of the article says; "Lung cancer (also known as carcinoma of the lung) is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung.". Hence, this mixes up cancer and carcinoma. Snowman (talk) 13:12, 29 May 2014 (UTC)
 * The first three dictionaries I looked at all defined "Cancer" as any malignant growth and "Carcinoma" as a malignancy of epithelial tissue. The three dictionaries: Snowman (talk) 13:12, 29 May 2014 (UTC)
 * 1. Oxford English Dictionary. Current on-line version. Snowman (talk) 13:21, 29 May 2014 (UTC)
 * 2. Snowman (talk) 13:21, 29 May 2014 (UTC)
 * 3. Snowman (talk) 13:12, 29 May 2014 (UTC)
 * Do they define "lung cancer"? Axl  ¤  [Talk]  13:35, 29 May 2014 (UTC)
 * 1. the on-line OED lists lung cancer and gives some quotes, one from 1927 saying; "A diagnosis of endothelioma has been made frequently in primary lung cancers." It does not give a definition, but the mention of endothelioma, would tend to suggest that lung cancer is not limited to only carcinomas. Snowman (talk) 20:01, 30 May 2014 (UTC)
 * 2. On page 940, Miller-Keane defines "lung cancer" as malignant growths of the lung and continues with general information. Snowman (talk) 20:01, 30 May 2014 (UTC)
 * 3. Stedman's does not have an entry speficially for "lung cancer". Snowman (talk) 20:01, 30 May 2014 (UTC)

A few uninvolved remarks:
 * I think WP:COMMONNAME is of some relevance here. I feel that finding an editorial solution that is intuitive to lay users is a relevant factor. In particular, I'm wondering whether the dab to "Lung tumors" is sufficient for readers to find everything they're likely to be looking for without having to reach the helpful table at the the foot of the page (the only place, incidentally, where "sarcoma" or "sarcomatoid" currently appears to be mentioned).
 * On strictly editorial grounds, WP:SCOPE is surely relevant here... For instance, at present tracheal tumors don't seem to be specifically mentioned in the main text, even though they're the subject of one the ICD-10 categories currently cited in the infobox (and I notice Trachea/bronchus/lung cancers is a redirect).
 * Fwiw, entering "lung cancer" in the MeSH browser retrieves Lung neoplasms (rather than Bronchial carcinoma, as currently cited). 86.181.67.132 (talk) 14:49, 29 May 2014 (UTC)

Here's my thinking:


 * What's the subject of the article? (It appears to be carcinomas of the lung.)
 * What's the common name for that subject? (It appears to be "lung cancer"—so far, so good.)
 * Are there other things that also use that name, but that aren't the subject of this article? (The answer appears to be "yes".)  If so, then make a disambiguation page and/or otherwise redirect people to those other subjects—and then quit worrying about it.  A page titled "Lung cancer" is not required or expected to cover every single thing that might have that name.  WhatamIdoing (talk) 20:19, 29 May 2014 (UTC)
 * That sounds right to me. We already have Lung tumor as a quasi-disam page and might expand on that - the definition of "lung cancer" there is "Lung cancer, used to refer to carcinoma of the lung" btw. Wiki CRUK John (talk) 09:33, 30 May 2014 (UTC)
 * Sounds good to me too. I feel some editorial tidy up could be the key: basically, better dab, based on the scope of the page, to orient readers better. (Wikipedia medical pages aren't expected to mirror any one particular subdivision of topics; some of the codes we cite in the infobox perhaps need some editing/pruning.) 86.181.67.132 (talk) 12:57, 30 May 2014 (UTC)


 * Looking at the percentages in Lung Cancer: A Multidisciplinary Approach to Diagnosis and Management by Kemp Kernstine (2011) at Google books, then it can be inferred that 99% of lung cancers are lung carcinomas in the introduction to paragraph 3 of the book. The introduction goes on to say that it discusses the most common histological types of lung cancer. I think that many articles like the Merck manual and Encyclopaedia Britannica say "the main groups of lung cancer are xzy" without saying what the minor groups are (ie without including the 1% non-epithelial tumours). I think that the article should not use "lung cancer" and "lung carcinoma" as synonymous. Snowman (talk) 18:56, 30 May 2014 (UTC)


 * That's why we need better disambiguation. "Lung cancer" is the common name for "lung carcinoma" (not for sarcomas or lymphomas, etc of the lung). The basic scope of the page is fine. If we go for the broadest usage of the term (as Snowman seems to be advocating), then we risk creating kind of a mini-encyclopedia in itself, rather than a manageable Wikipedia page. The page may need one or two tweaks in the infobox, etc, but the key issue here is surely better disambiguation, for the benefit of everyone, including general readers. So that our readership can readily find the less common, non-epithelial tumors you're mentioning (which, to say it again, aren't commonly referred to as "Lung cancer"). 86.181.67.132 (talk) 20:24, 30 May 2014 (UTC)


 * In the introduction to chapter 3, Kernstine states "The most frequently occurring types are small cell lung carcinoma (SCLC, 15%), and non-small cell lung carcinoma (NSCLC), with NSCLC consisting of squamous cell carcinoma (SCC) (30%), adenocarcinoma (45%), and large cell carcinoma (9%) subtypes." I presume that you have derived the value of 99% by adding together the values of the different subtypes listed. It is possible that rounding of values may have led to the 1% discrepancy. However, given that Kernstine indicates that these are the "most frequent" subtypes, it is plausible that there are another 1% not listed. Even if this is the case, Kernstine certainly does not imply that the remainder are not carcinomas.


 * By the way, have you reviewed the text in the Merck Manual and Harrison's Principles of Internal Medicine? Axl  ¤  [Talk]  20:34, 30 May 2014 (UTC)
 * Note that the relevant article in the Merck Manual is entitled "Lung Carcinoma". Snowman (talk) 14:11, 2 June 2014 (UTC)
 * I hope that you looked at more than just the title. Axl  ¤  [Talk]  14:21, 2 June 2014 (UTC)

Cannabis
I am adding a statement about how i believe marijuana smoke and tobacco smoke should be compared in the main article on lung cancer. I agree that the actual smoke generated from the physical burning of tobacco and marijuana can be harmful because it is generally not healthy to inhale smoke of any kind, however, the argument hear is about the carcinogens and their cancer causing agents. Marijuana smokers typically smoke the bud of the plant and not the leaf, which is the opposite of that of tobacco smokers. Studies have also shown that marijuana contains 33% as much tar as tobacco, which is substantially less. Studies have also shown that THC may lessen the effects of such carcinogens as where tobacco smoke increases the effects of such carcinogens. Furthermore, studies have also shown that long term effects of moderate to heavy marijuana use have yielded better lung tests as compared to the lungs of tobacco smokers. Those tested for smoking marijuana over a long period of time have actually showed better results when it comes to lung function as where tobacco smokers have shown opposite results. Studies have also shown that marijuana smoke can increase the function of the lungs since smoking the plant involves long inhales and holding your breath which in return expands the passages in the lungs. Tests were conducted in the 1970's by the government (keep in mind that this was the 1970's. Medical technology was not as advanced and marijuana was a likely competitor to tobacco) and i am saying that tobacco companies may have lobbied government officials into conducting biased tests, thus creating the illusion that marijuana was more lethal than tobacco when it was actually the opposite. Also, the THC levels in marijuana in the 1970's were far less than they are today meaning that tests were ultimately biased. There are higher levels of THC in today's marijuana then there ever were previously and tests of today are still yielding better health results than the results of tobacco smoke. — Preceding unsigned comment added by Johnthegreat2014 (talk • contribs) 18:18, 15 July 2014 (UTC)
 * John, please be mindful that this article is specifically about lung cancer. It is not appropriate to add detailed information about the effects of marijuana on the lungs to this article. Axl  ¤  [Talk]  18:59, 15 July 2014 (UTC)

Airway stem cells in lung cancer
10.1093/qjmed/hcu040 - review in QJM. JFW &#124; T@lk  10:55, 24 July 2014 (UTC)

CRUK review
This is a write-up of the notes made in an initial review by a CRUK specialist. The idea is to sort these points out in the article before sending the article for review by other outside specialists. Epidemiology & the missing research section were not covered - will be done with other people. Not all points made are written up. I'm hoping this gives the medical editing community enough to go on to start serious work on the article, but I realize it may not. This is 3rd in a series - see also Talk:Esophageal_cancer and Talk:Pancreatic_cancer. Wiki CRUK John (talk) 12:13, 10 July 2014 (UTC)

DC points JB points
 * Stats - TNN 2009 figures are more recent and global. Better to use. Ref 54 (Rami-Porta et al). Used already
 * distinguish between earlier & more advanced symptoms
 * needs explaining: "symptoms due to local compress: chest pain, bone pain, superior vena cava obstruction, difficulty swallowing"
 * "so-called paraneoplastic phenomena " explain, check refs, esp. syndrome of inappropriate antidiuretic hormone (SIADH)
 * the PAIN caused by "as well as damage to the brachial plexus." is the symptom.
 * "Cigarette smoke contains over 60 known carcinogens", - 2003 ref, there are more
 * Pathogenesis needs more explaining
 * Screening - needs to explain not in normal practice anywhere yet done - see below   Blue Rasberry   (talk)  17:12, 22 July 2014 (UTC)
 * Targeted therapy of lung cancer only just linked here; this stuff needs expanding.
 * Radioactive iodine brachytherapy - not common in UK anyway
 * ".[72] Video-assisted thoracoscopic surgery (VATS) and VATS lobectomy use ..." - odd. Should be either "in the the form of" or "including".
 * UK Lung Cancer guidelines are full and recent - online at NICE site. Also ESMO
 * Make clearer Radio/chemo often palliative only - move up last sentence in radio
 * Options for early cancer trtmts when surgery not possible or palliative need expanding
 * Biological treatments need adding - see NICE
 * Epidemiology not looked at
 * Research section needed
 * Types are messy: are Adenocarcinoma of the lung, Typical pulmonary carcinoid tumour, Atypical pulmonary carcinoid tumour, Pulmonary neuroendocrine tumor even linked?
 * Yes,yes, no, no currently Wiki CRUK John (talk) 12:22, 28 July 2014 (UTC)
 * fill out later Wiki CRUK John (talk) 11:45, 10 July 2014 (UTC)

Comments/discussion
I shall try to deal with these recommendations. Axl ¤  [Talk]  11:27, 11 July 2014 (UTC)
 * Many thanks - I should have told you directly this was under way. Wiki CRUK John (talk) 13:44, 11 July 2014 (UTC)


 * I have added a statement about the symptoms of metastatic disease. Axl  ¤  [Talk]  10:09, 12 July 2014 (UTC)
 * I have clarified local compression. Axl  ¤  [Talk]  19:38, 11 July 2014 (UTC)
 * I have expanded on "paraneoplastic phenomena". Axl  ¤  [Talk]  19:42, 11 July 2014 (UTC)
 * I am not really sure what the issue about SIADH is. Lung cancer is well known to cause SIADH. The statement is referenced to Harrison's Principles of Internal Medicine and I have confirmed this. Axl  ¤  [Talk]  09:40, 12 July 2014 (UTC)
 * I have added a very brief description of SIADH: "abnormally concentrated urine and dilute blood". Axl  ¤  [Talk]  09:51, 12 July 2014 (UTC)


 * Brachial plexus damage certainly may cause pain. However I suspect that neurological dysfunction&mdash;sensory loss/paraesthesia or motor palsy&mdash;is a more common finding. We could link to "brachial plexus injury". I don't really want to expand this article into a discussion of the various manifestations of brachial plexus injury. Axl  ¤  [Talk]  20:32, 13 July 2014 (UTC)


 * I have updated the carcinogens statement & reference. Axl  ¤  [Talk]  11:44, 11 July 2014 (UTC)


 * I have tried updating and expanding the "Pathogenesis" section. It is still rather disjointed. If someone else would like to improve this, that would be great. Axl  ¤  [Talk]  07:50, 24 July 2014 (UTC)

Screening updated
I took recommendations from the American Association for Thoracic Surgery and integrated them into the screening section. I was unable to find suggested information about prevalence of use, but I did rephrase the section to match the sources in saying that one test is recommended, that it is new, and that the other tests regardless of their use are reported by Cochrane to not be backed by evidence.  Blue Rasberry  (talk)  17:12, 22 July 2014 (UTC)
 * Thank you for tweaking my addition. You put this sentence back in that section "For each true positive scan there are more than 19 falsely positives scans".


 * In the original source, this "19" number does not appear. I am not sure of the source of this figure. This stuff is a bit heavy, but I think a close statement is "Across studies, the average nodule detection rate per round of screening was 20% (Table 5, eFigure 1), but varied from 3–30% in RCTs and 5–51% in cohort studies. Most studies reported that >90% of nodules were benign". I think this means that when high-risk individuals were screened, 20% of them tested positive, but only 2% of those actually had cancer. To me, this seems like 1 in 10 (or 9 false positives per true detection) and not 1 in 20 (or 19 for every 1, as originally stated). Lots of false positives are certain but I am not sure of the utility of leaving numbers here. I changed your text to "20% of people at high risk for lung cancer tested with CT screening tested positive, but among those, 90% got a false positive and did not actually have the cancer the test was designed to detect." This still seems complicated to me to drop numbers like this in a summary, but I have no strong feelings about including it here. If you know more about these numbers then feel free to correct or improve what I did.  Blue Rasberry   (talk)  18:31, 23 July 2014 (UTC)
 * The abstract states "In terms of potential harms of LDCT screening, across all trials and cohorts, about 20% of individuals in each round of screening had positive results requiring some degree of follow-up, while approximately 1% had lung cancer." Axl  ¤  [Talk]  18:45, 23 July 2014 (UTC)
 * Yup thanks Axl. IMO "For each true positive scan there are more than 19 falsely positive scans" is a similar way to say it. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:09, 23 July 2014 (UTC)
 * I see it now. What you say is a correct way of presenting what is written. I think this is a clear way of giving the information, so I put it back to the way it was.  Blue Rasberry   (talk)  19:54, 23 July 2014 (UTC)
 * At a rapid glance (and I could be wrong), my understanding is that 20% of the women screened were followed up due to radiographic evidence of nodules; and of all the women screened (ie including those 20%), 1% eventually turned out to have "the cancer the test was designed to detect". So, if I've understood correctly, that would actually mean that 1 out of 20 of the positive scans is a true positive. Or, in other words (expressing the concept as a ratio rather than a proportion) "For each true positive scan there are more than about 19 falsely positive scans." 31.48.175.145 (talk) 19:35, 24 July 2014 (UTC)
 * Yes, which is why I have already edited the article to say that. (Both men and women were included in the analysis.) Axl  ¤  [Talk]  19:52, 24 July 2014 (UTC)
 * Oops, sorry Axl... I'm really good at doing misreadings. 31.48.175.145 (talk) 20:03, 24 July 2014 (UTC)

Other

 * "Cite error: A list-defined reference named "Salgia" is not used in the content (see the help page). Cite error: A list-defined reference named "Fong" is not used in the content (see the help page)." - I presume these can just be removed.
 * Thorax, 2010;65:iii1-iii27, doi:10.1136/thx.2010.145938, Supplement, "Guidelines on the radical management of patients with lung cancer", by Eric Lim, David Baldwin, etc etc. open access - useful?
 * Should we link to Manchester score? Recent refs seem hard to find. Wiki CRUK John (talk) 13:07, 28 July 2014 (UTC)
 * No, there's this "The Manchester score is a valuable tool for decision making for administering chemotherapy in patients admitted to the ICU and ICU admission (30). ....We recommend based on the published literature that the LOD score is used as a predictive factor for extensive stage lung cancer patients (25) and the Manchester score when we want to administer chemotherapy in ICU admitted lung cancer patients." Wiki CRUK John (talk) 16:00, 28 July 2014 (UTC)


 * I deleted the old information referenced to Salgia & Fong. I have now deleted the references. Axl  ¤  [Talk]  17:06, 28 July 2014 (UTC)
 * I previously (some years ago) included Manchester score in the article. I don't know when it was removed or by whom. Axl  ¤  [Talk]  17:32, 28 July 2014 (UTC)
 * Just now, by me. It was clearly misplaced as "main". The survival figures are referenced to a 1997 paper btw. Wiki CRUK John (talk) 17:51, 28 July 2014 (UTC)
 * Indeed I wrote the article "Manchester score" in 2006–07. Axl  ¤  [Talk]  17:34, 28 July 2014 (UTC)
 * lol, okay. I added the Rami-Porta data a few years ago. This is more relevant and more useful than the somewhat outdated Manchester score.
 * I created the article "Non-small cell lung cancer staging" in 2007. That article included the TNM classification and subsequent grouping because I felt that the size of the tables would have occupied too much room in this article. That article has since been heavily edited by other people and the information moved around. I am intending to add the TNM classification to this article&mdash;I just haven't got around to it yet. Axl  ¤  [Talk]  20:01, 28 July 2014 (UTC)
 * Great, thanks. I'm pretty much leaving this alone but do let me know if you think there's anything I can help with. Wiki CRUK John (talk) 11:00, 29 July 2014 (UTC)
 * I have added a table with the "T" part of the TNM classification. It is already rather unwieldy&mdash;and that's without the "N", "M", and grouping information. Axl  ¤  [Talk]  19:50, 30 July 2014 (UTC)

Nature Outlook articles on LC
A series just out, produced in conjunction with CRUK. Not sure these are MEDRS, but interesting reading. Summary and links at The big issues affecting lung cancer worldwide - CRUK science blog. Wiki CRUK John (talk) 17:29, 11 September 2014 (UTC)

Statement that has little meaning
The article says "Overall, 16.8% of people in the United States diagnosed with lung cancer survive five years after the diagnosis" but doesn't go any further. Do the other 83.2% live longer, or die before 5 years?! Yevad (talk) 16:02, 11 September 2014 (UTC)
 * They die - but it's a fair point. Statements about cancer survival tend to use slightly veiled language, on and off-wiki. Wiki CRUK John (talk) 17:10, 11 September 2014 (UTC)
 * I thought that meaning of "survive" was fairly well known. They are either alive after five years, or not alive. Anyway, I have changed the text to "at least five years". Axl  ¤  [Talk]  17:14, 11 September 2014 (UTC)
 * and I've changed the link to Five-year survival rate. Wiki CRUK John (talk) 17:29, 11 September 2014 (UTC)
 * Thanks. Axl  ¤  [Talk]  18:44, 11 September 2014 (UTC)

Cornwall, radon
"For example, in areas such as Cornwall in the UK (which has granite as substrata), radon gas is a major problem, and buildings have to be force-ventilated with fans to lower radon gas concentrations." - unreferenced. My impression was that this has normally been dealt with for some time by membranes impervious to the gas underneath the ground floor, venting to the outside of the house. Fans are mostly for back-up and maybe older properties where a membrane can't be fitted. At least most of Cornwall is pretty windy. From the council: "Since the 1990’s all new build properties have had radon precautions installed. This is inevitably a radon barrier (plastic membrane) and depending upon its construction type, a mini sump or air bricks. If the barrier fails then the sump if fitted can be activated by attaching an electric fan. It is suggested that all new build properties are tested for radon once they are inhabited." (from here) I'll try to get an accurate picture here. Wiki CRUK John (talk) 16:14, 4 September 2014 (UTC)
 * The reference used does not support the statement. Therefore I have deleted the statement from the article. Actually I think that there should be a short subsection about radon in the "Prevention" section. Axl  ¤  [Talk]  18:27, 4 September 2014 (UTC)
 * Certainly there should. Government sources are fine for regulations and typical measures taken (I mean the right, here UK, government). Johnbod (talk) 21:43, 4 September 2014 (UTC)
 * Agree that radon (second most important risk factor after smoking) deserves appropriate space in the Prevention section. Despite being a UK resident in another area with high exposure to radon, I'd like the perspective to be broadly international. Anyhow... perhaps this critical appraisal from the Centre for Reviews and Dissemination of a (UK-based) cost-effectiveness analysis  could qualify as a MEDRS? 86.164.164.123 (talk) 19:23, 10 September 2014 (UTC)
 * Radon is a risk for smokers, but practically harmless for never smokers. Apparently something of a hoax, directed by the radon industry, mass media, politicians and others. See for example Edelstein & Makofske, Radon´s Deadly Daughters, 1998. — Preceding unsigned comment added by Ravenlogos (talk • contribs) 23:08, 30 September 2014 (UTC)

radon effects by cancer type
"The risk from radon differs by lung cancer type. Small cell lung carcinoma has a high risk from radon. For other histological types such as adenocarcinoma the risk from radon appears to be lower. "

Thoughts? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:51, 30 September 2014 (UTC)


 * Ravenlogos recently added information about the relative proportions of the different histological subtypes caused by radon. This text was further edited by Jmh649.


 * I saw these edits and looked at the references. The first reference is Darby. It is a primary source, albeit a large one, from 2005. It does indeed show an increased risk for small-cell lung carcinoma, with little/no increased risk for the other types.


 * The second reference is Field. It is unclear if this is an article in a peer-reviewed journal. It is certainly not indexed in Pubmed. Given that it includes the subtitle "Testimony", I suspect that it is actually a legal document written by an expert witness. Field's document refers to three papers that assess the different proportions of the histological subtypes. The first paper is the Iowa Radon Lung Cancer Study. This found a positive trend for large-cell lung carcinoma and a suggestive trend for squamous-cell lung carcinoma. The second paper, Darby, showed a big increase for small-cell lung carcinoma. The third paper, the North American Pooling, also suggested a bigger increase for small-cell lung carcinoma.


 * After reviewing these documents, I did another Pubmed search for review papers about radon that might discuss these findings. (I have recently looked into radon & lung cancer so I have an idea about it anyway.) I did not find any secondary sources that discuss these findings. Neither Darby's paper nor Field's document are suitable for use as references in Wikipedia's lung cancer article. In the absence of any suitable secondary sources, I deleted the text.


 * Ravenlogos reverted my edit, indicating that this is "reputable information from the most recent study".


 * Jmh649 then reverted Ravenlogos and opened this discussion.


 * It is interesting to see that Ravenlogos now states that "radon is ... something of a hoax, directed by the radon industry, mass media, politicians and others." Axl  ¤  [Talk]  10:23, 1 October 2014 (UTC)
 * I'll ask here. Wiki CRUK John (talk) 11:05, 2 October 2014 (UTC)

Epidemiology Section
We are from CRUK and going to add some UK stats to this section using data compiled from ONS, Welsh Cancer Intelligence and Surveillance Unit, ISD Scotland and the Northern Ireland Cancer Registry.

Gireland89 (talk) 15:25, 3 October 2014 (UTC)

Primary versus secondary sources
Per WP:MEDRS we typically use secondary sources. This edit replaced a 2013 review with a 2006 primary source. The 2013 review takes the primary source into account thus reverted to the previous sourcing and wording. Doc James (talk · contribs · email) 02:00, 2 January 2015 (UTC)


 * Perhaps can join the discussion here rather than repeatedly adding the same dopecruft. JFW &#124;  T@lk  23:11, 3 January 2015 (UTC)

IIB
There is a minor anomaly with this diagram of stage IIB. Tumour in the main bronchus (more than 2 cm away from the carina) is T2 disease. If the tumour is within 2 cm of the carina, it is T3. Axl ¤  [Talk]  11:48, 29 August 2014 (UTC)
 * Ok thanks, I'll raise this. I take it there is no issue of different systems? Wiki CRUK John (talk) 11:53, 29 August 2014 (UTC)
 * No. The old system used the same distance from the carina to differentiate between T2 & T3. Axl  ¤  [Talk]  11:59, 29 August 2014 (UTC)
 * Does the expanded caption resolve this? Wiki CRUK John (talk) 15:15, 5 January 2015 (UTC)
 * No, not really. I don't think that it is a good idea to mix different stages in the same image. It would be better to change the image itself. Axl ¤ [Talk] 12:20, 6 January 2015 (UTC)

IIIA


The second diagram of stage IIIA seems to be somewhat confusing. Axl ¤  [Talk]  11:57, 29 August 2014 (UTC)


 * Does how they now look in the article resolve this? It all is "somewhat confusing" really, and the diagrams have possibly bitten off at least as much as they can chew. I think they are still helpful, & I've now set them up so it should be possible to read the text straight from the article page, with space to add further explanation in the captions. But if there are specific changes to the internal labels that would help, please let me know. Wiki CRUK John (talk) 15:35, 5 January 2015 (UTC)
 * My main concern about this image is that it should imply one feature from the left column and one feature from the right column. I'm not sure if this is clear to readers. Still, if you are comfortable with the current image, I won't press the matter further. Axl ¤ [Talk] 12:25, 6 January 2015 (UTC)
 * I hope I have clarified this by adding to the caption, now "Stage IIIA lung cancer, if there is one feature from the list on each side". It is easy to do this. But if changes to the internal image labels themselves are wanted, I really need a new text to take to the graphics person, so we should agree this in advance. Wiki CRUK John (talk) 13:09, 6 January 2015 (UTC)

IIIA again


This diagram seems to be demonstrating T4 N1. However invasion into the diaphragm is T3. While T3 N1 is also stage IIIA, it seems odd to single out invasion into the diaphragm, and in any case, diagram 2 already implied this.

Also, there is no diagram that demonstrates T4 N0. Axl ¤  [Talk]  22:32, 4 September 2014 (UTC)


 * See above - are there specific changes that would improve it? Wiki CRUK John (talk) 13:16, 6 January 2015 (UTC)

Pulmonary nodules
The following text was recently added to the "Diagnosis" section: "Clinical practice guidelines have recommended frequencies for pulmonary nodule evaluation and surveillance. The therapy should not be used for longer or more frequently than indicated. Extended surveillance exposes people to increased radiation." The reference provided is here.

I am unconvinced that this text is helpful in the article. The "Diagnosis" section already mentions the solitary pulmonary nodule, and interested readers are able to use the wikilink to go to that article. I don't think that the reference is suitable. If the text (or a modification of it) is to remain, it would be better to use the actual ACCP guideline. Also, the word "therapy" is misused. Axl ¤ [Talk] 11:06, 28 April 2015 (UTC)
 * Can the existing mention be expanded with a phrase on the frequency issue? Generally I will support your judgement; anything involving radiation has similar risks and guidelines, & we may not always need to spell this out. Also, I think "evaluation and surveillance" are not "therapy". The editor concerned recently introduced herself at the med project talk. She is experienced but new to medical editing, which as I know, is a steep learning curve.  I wonder if someone suggestede to her this point needed expansion? Johnbod (talk) 12:29, 28 April 2015 (UTC)
 * Yes maybe in the section on screening? Or on another page would be better. Feel free to adjust as you see fit. Doc James  (talk · contribs · email) 17:56, 28 April 2015 (UTC)

URFA note
Per the ongoing review to develop a new WP:URFA list, this is a 2007 promotion that has taken on a few (hopefully minor) issues:
 * 1) There is a bit of uncited text
 * 2) Citation style is inconsistent (it appears that the article once used the Diberri format, but newer citations do not)
 * 3) Image layout could use work to avoid text squeeze and jumble
 * 4)  Pls review for WP:REALTIME (words like current, recent, today, etc and the use of as of date)
 * 5) There are unformatted citations.

Thankfully that is generally stuff that should be easy to fix! Sandy Georgia (Talk) 16:51, 4 May 2015 (UTC)

ICD10 - C33
Previous versions (ICD8 from the 60's and ICD9 from the 70's) grouped the lower respiratory tract together so that trachea and lung fell under a main code (162) with distinctions based on the subcode (162.0 was trachea and 162.5 was lower lobe of the lung). With ICD10 they broke these apart and applied C33 to trachea and C34 to lung cancer. I feel like there is a reason for that. So I'm not sure about listing C33 as a code for lung cancer. But I am not well versed on the ICD10 and somebody with a better knowledge base might be able to clarify. There is not enough evidence to warrant an edit but it is possibly worth an investigation/dialogue to determine.

Thanks — Preceding unsigned comment added by Cdmphy (talk • contribs) 20:52, 11 November 2015 (UTC)

Harrison's Principles
It is about time that someone (i.e. me) updated the Harrison's Principles of Internal Medicine references to the current (19th) edition – chapter 107, page 506. I shall do them in reverse order. Axl ¤ [Talk] 14:06, 15 December 2015 (UTC)

z. Not supported. Reference deleted. Another existing reference already supports the statement.

y. Supported.

x. Not supported. I couldn't find a reference to support the statement. Statement deleted.

w. Supported.

v. Supported.

u. Supported.

t. Supported.

s. Supported.

r. Supported.

q. Supported.

p. The second half of the statement is supported. The first half is not explicitly supported. I have added a new reference.

o. The immunostaining table is somewhat outdated. I have updated the table for Napsin-A & TTF-1. I have also added a little extra text. There is more scope to add information about immunostaining.

n. Not supported. I have changed the statement and added a new reference.

m. Not supported. I have changed the statement to refer only to extensive stage SCLC.

l. Supported. I have also expanded the statement.

k. Supported.

j. Oddly, only the first half of the statement is supported. I have moved the citation and added a new reference.

i. Supported. I have also expanded the information about neuroendocrine SCLC.

h. Supported.

g. Not supported. I have changed the text and the reference.

f. Supported.

e. Supported. I have added ectopic ACTH production.

d. Supported.

c. Weakness rather than fatigue. Otherwise supported.

b. Not supported. I have deleted the reference and changed the existing text in line with the other reference.

a. I am struggling to find a suitable reference for the first part of the statement. I shall keep looking. Okay, I have found a new reference.

Axl ¤ [Talk] 14:06, 15 December 2015 (UTC)

Finished! Axl</b> ¤ <small style="color:#808000">[Talk] 13:29, 21 December 2015 (UTC)


 * Great work . JFW &#124; T@lk  20:21, 21 December 2015 (UTC)

This article in the news
http://www.healthitoutcomes.com/doc/wikipedia-is-wrong-of-the-time-0001 http://jaoa.org/article.aspx?articleid=2094721&resultClick=1 This and 10 other articles are making the rounds in blogs and news for having been part of a study in The Journal of American Osteopathic Association. Worth a look if it could help better this article. 68.51.136.127 (talk) 17:28, 22 December 2015 (UTC)


 * I responded to that paper here. (Sorry for the late response&mdash;I have been away over Christmas & New Year.) <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 14:05, 14 January 2016 (UTC)

alternative medicines
This article is very well written, it is a featured article for a reason. All the information is well cited, it is presented from a fair and balanced point of view, and it is well organized. The one suggestion that i can make for this article is that it needs to expand more on the management heading. there should be a subheading for alternative medicines. While this aspect of treatment is highly debated, it still should have a few sentences about the different kinds, and which ones may have credibility. Jacobhutchinson95 (talk) 02:31, 2 February 2016 (UTC)
 * none of them do. That is why they are not medicine. Jytdog (talk) 03:40, 2 February 2016 (UTC)
 * There seems to be some benefit for symptomatic treatment. &  I shall keep looking for a decent source. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk]  15:00, 2 February 2016 (UTC)
 * Lung cancer: the facts (3rd ed., page 106) has a very brief mention of hypnosis & acupuncture. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 15:21, 2 February 2016 (UTC)
 * none of those are treatments for lung cancer per se. they are alt med approaches to try to help people deal with anxiety, nausea etc that follow from having lung cancer and side effects of actual treatments.  All the sources you have brought are very very clear on that. Jytdog (talk) 17:35, 2 February 2016 (UTC)

Why SCLC/NSCLC split rather than say adeno/non-adeno
Article (here and in NSCLC) is vague on why the traditional split is NSCLC/SCLC. Is it because only NSCLC has been eligible for surgery ? or that SCLC has a poorer prognosis ? Can we have some history of why the NSCLC term was introduced and is still used ? - Rod57 (talk) 11:46, 27 October 2016 (UTC)

Lancet seminar on therapeutics
10.1016/S0140-6736(16)30958-8 JFW &#124; T@lk  08:20, 2 September 2016 (UTC)
 * Summary says "In this Seminar, we discuss existing treatment for patients with lung cancer and the promise of precision medicine, with special emphasis on new targeted therapies." but the Lancet article is not open access. What does the seminar say that is relevant to this WP article ? - Rod57 (talk) 11:56, 27 October 2016 (UTC)

Prognosis
This section seems to focus on the gloomy prognosis for the average case, typically detected at phase IV. By comparison, if detected at phase I the 5-year survival is better than 55%. Shouldn't this be discussed? LeadSongDog come howl!  17:43, 2 November 2016 (UTC)

Chart (lag-time)
The chart showing a rise in cigarette use followed by a rise in lung cancer in US males is misleading because it does not show other countries where there is no such time lag, such as in Sweden for example ,. While these sources (both obtained from my blog) may not be considered a good enough to appear on this lung cancer wiki page, the data used are publicly available data. The lung cancer statistics are obtained from the WHO and the cigarette statistics obtained from P N Lee Statistics and Computing. Anyone can check these data and see that Sweden had its male lung cancer epidemic at the same time as the US despite the fact cigarette use became popular in the US decades before Sweden.

The current chart should be removed as it misleading because it is contradicted by publicly available data from reputable sources.

82.23.33.195 (talk) 22:05, 13 May 2016 (UTC) — Preceding unsigned comment added by 82.23.33.195 (talk) 21:40, 13 May 2016 (UTC)
 * Yes that blog is not a sufficient source. Doc James  (talk · contribs · email) 23:47, 13 May 2016 (UTC)
 * This is a good source though http://clincancerres.aacrjournals.org/content/18/21_Supplement/S1/F33.expansion.html Doc James  (talk · contribs · email) 23:52, 13 May 2016 (UTC)
 * I am not arguing that my personal blog is a sufficient source, I am arguing that the publicly available data referenced on my blog is reputable and contradicts the fallacy that lung cancer epidemics follow rises in cigarette use with a fixed time lag.
 * The source you have provided is also contradicted by publicly available data. Smoking prevalence remains high in the former soviet union and yet lung cancer rates fell inline with countries such as the US at the same time.
 * The chart is misleading and contradicted by data provided (verifiable by anyone) and should be removed.


 * — Preceding unsigned comment added by 82.23.33.195 (talk • contribs) 10:52, 14 May 2016‎ (UTC)
 * You are making arguments in which you interpret primary sources, and you are asserting your interpretation should prevail over the interpretation made in reliable secondary sources. That is not how Wikipedia works. You need to bring reliable sources that make the same interpretation as you, that are stronger than our current sourcing. Jytdog (talk) 15:24, 14 May 2016 (UTC)

The secondary source that the chart in question comes from is an archive engine and the link that it is reported to come from is no longer active. The text of the archived source makes no reference to primary sources or any other source and unlike the chart in question and makes no reference to male lung cancer rates in the US. It is therefore, arguably, weak secondary evidence. I am not asserting that my interpretation should prevail over the interpretation made in the secondary source. I am asserting that the emperical evidence available on the reliable primary sources contradict what is available on the unreliable archived secondary source and that any moderator from Wikipedia or any other person can verify that the numbers from primary sources contradict the source from the archive (see Sweden & US for example). Surely there are exceptional circumstances where the available primary empirical evidence is so strong and that the interpretation of the data is such a trivial exercise that the secondary evidence could be discarded on the grounds that it is clearly misleading?

— Preceding unsigned comment added by 82.23.33.195 (talk) 22:51, 16 May 2016 (UTC)
 * You are interpreting the data you used in your website; when you say "asserting that ..." you are saying that you interpretation of your collation of data should outweigh the interpretation in the chart provided by a 'major health authority, the strongest kind of secondary sources we have in the medical field, per WP:Identifying_reliable_sources_(medicine). Also you are performing a kind of peer review and  per WP:MEDASSESS we don't do that. Jytdog (talk) 23:16, 16 May 2016 (UTC)
 * The chart seems to need a far more reliable source since it is not clear if it is based on real or hypothetical data to illustrate the term 'lag-time'. How have they measured cigarette consumption in males specifically ? Are we sure it is based on USA data ? Surely we can replace this with something from a peer reviewed journal review ? - Rod57 (talk) 12:18, 27 October 2016 (UTC)


 * The misleading chart has been replaced by another misleading chart which is, again, US focused. If the chart has to remain then surely as a matter of impartiality, evidence that shows a massive rise in lung cancer among never-smokers, in the US, during the time period in question should be added. The reader can then be better informed about the theory that the global lung cancer epidemic was driven by cigarette consumption. As the following study states in it's abstract.
 * "'lung cancer mortality rate has risen substantially between 1914 and 1968 among persons who never smoked cigarettes . For white males the relative increase for ages 35--84 years has been about 15-fold ; the relative increase for ages 65--84 years has been about 30-fold . '"


 * As a matter of transparency I am the same blogger that raised this issue in the first place and this is my blog — Preceding unsigned comment added by 81.152.196.90 (talk) 17:38, 25 June 2017 (UTC)
 * You have been directed to WP:MEDRS several times and you are just ignoring it. Content about health in WP is sourced per MEDRS, and summarizes MEDRS sources. Jytdog (talk) 19:48, 25 June 2017 (UTC)

I assumed that the US National Library of Medicine National Institutes of Health " was a reputable source. Does Wikipedia have a policy of excluding all evidence from this source? Or do I have to track down a Journal that publish the same study? Please advise! — Preceding unsigned comment added by 81.152.196.90 (talk) 12:47, 26 June 2017 (UTC)


 * Once again, read WP:MEDRS, and perhaps read it again after that. You have linked to the URL of a PubMed abstract from an article published in 1979. MEDRS specifically suggests secondary sources within the last five years. I can't imagine why you would want to write an encyclopedia using sources that are almost 40 years old. JFW &#124; T@lk  20:41, 26 June 2017 (UTC)

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incorrect use of the term gender for sex
According to the National Institutes of Health (NIH) and the Canadian Institutes of Health Research (CIHR), sex is considered a biological component, defined via the genetic complement of chromosomes, including cellular and molecular differences. Karyotype at birth is nearly equal for46XX and 46XY. Sex is reflected physiologically by the gonads, sex hormones, external genitalia, and internal reproductive organs. The terms male and female should be used when describing the sex of human participants or other sex-related biological or physiological factors. Descriptions of differences between males and females should carefully refer to “sex differences” rather than “gender differences.” Gender comprises the social, environmental, cultural, and behavioral factors and choices that influence a person’s self-identity and health. Gender includes gender identity (how individuals and groups perceive and present themselves), gender norms (unspoken rules in the family, workplace, institutional, or global culture that influence individual attitudes and behaviors), and gender relations (the power relations between individuals of different gender identities). At present, there are no agreed-upon, validated tools for assessing gender. A 2-step approach to questioning has been proposed, whereby participants are asked both their sex assigned at birth and their current gender identity. Authors should consider appropriate use of the words sex and gender to avoid confusing both terms.

The term gender should be replaced by the term sexYofrecabeza (talk) 05:09, 19 August 2018 (UTC)

Semi-protected edit request on 25 October 2018
https://www.perfectmedicalcare.com/2018/10/7-early-signs-of-lung-cancer.html Perfectmedicalcare (talk) 15:12, 25 October 2018 (UTC)
 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. &mdash; KuyaBriBri Talk 15:16, 25 October 2018 (UTC)
 * That website (your website?) doesn't add anything to this article. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 15:17, 25 October 2018 (UTC)

Recent edit by an IP to the Palliative care section
Thank you for helping to share information and improve the Lung cancer article. I have moved your suggestions to the talk page so that citations can be found to support this evidence. If you have any questions, please post them below or feel free to reach out to the WP:MED community. We can edit directly below on the this talk page, and when the section is ready, it can be moved back to the article. If you are looking for more information about how to add citations please see WP:MEDHOW and to determine which citations are appropriate to use to support medical content on Wikipedia, please see WP:MEDRS. Thanks again, JenOttawa (talk) 14:13, 13 November 2018 (UTC)

Palliative care
Palliative care is a multidisciplinary approach to specialized medical and nursing care for people with life-limiting illnesses. It focuses on providing relief from the symptoms, pain, physical stress, and mental stress at any stage of illness. The goal is to improve quality of life for both the person and their family.[2][3] Evidence as of 2016 supports palliative care's efficacy in the improvement of a patient's quality of life.[4]

Palliative care is provided by a team of physicians, nurses, physiotherapists, occupational therapists and other health professionals who work together with the primary care physician and referred specialists and other hospital or hospice staff to provide additional support. It is appropriate at any age and at any stage in a serious illness and can be provided as the main goal of care or along with curative treatment. Although it is an important part of end-of-life care, it is not limited to that stage. Palliative care can be provided across multiple settings including in hospitals, at home, as part of community palliative care programs, and in skilled nursing facilities. Interdisciplinary palliative care teams work with people and their families to clarify goals of care and provide symptom management, psycho-social, and spiritual support.

Physicians sometimes use the term palliative care in a sense meaning palliative therapies without curative intent, when no cure can be expected (as often happens in late-stage cancers). For example, tumor debulking can continue to reduce pain from mass effect even when it is no longer curative. A clearer usage is palliative, noncurative therapy when that is what is meant, because palliative care can be used along with curative or aggressive therapies.

Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease or cause. This can include treating nausea related to chemotherapy or something as simple as morphine to treat the pain of broken leg or ibuprofen to treat pain related to an influenza infection.

Cancer Survival Rates (New Data)
We have old (2009) data for cancer survival rates in this wikipedia article. Can we please update it with new (2015) data? Here is newest cancer survival data By stage at diagnosis and cancer type (PDF) http://www.bccancer.bc.ca/statistics-and-reports-site/Documents/survival_bysite_stage_tables_20180417.pdf from http://www.bccancer.bc.ca/health-info/disease-system-statistics/cancer-survival-rates. Please edit, I don't have account (not registered). 142.179.74.27 (talk) 18:11, 2 February 2019 (UTC)

Immunotherapy
added a number of drugs recently approved by the FDA. I do think this content is encyclopedic and should be maintained, but FDA approval is not evidence of widespread adoption and improvement in major end points. We ought to be able to add a secondary source summarising the data for these drugs, and how people are selected for their use (e.g. on the basis of mutation analysis). JFW &#124; T@lk  18:40, 18 June 2019 (UTC)

Suggestion to submit to the WikiJournal of Medicine
T.Shafee(Evo &#38; Evo)talk 12:04, 6 July 2019 (UTC)

Discussion

 * User:Axl, I'm guessing you would like to preserve your anonymity. T.Shafee(Evo &#38; Evo), I did have a general question for the WikiJournal of Medicine. If Axl wants to remain anonymous and this article was published would there be a way to acknowledge that Axl (assuming they're OK with being acknowledged by their Wikipedia user name in an academic publication) is the first author? I know they've put a ton of work into this article. Or would there be a mention that the person whose real name is the "first author" isn't the actual first author? Could et al as the abbreviated form of anonymous editors be designated the first author? Are pen names allowed? I was curious about these kinds of scenarios. Thanks. Biosthmors (talk) 14:47, 9 February 2020 (UTC)
 * I don't particularly feel any need to preserve my anonymity. I have previously rebutted a critique of this article by Hasty, using my real name. I am certainly happy to accept the scrutiny of the WikiJournal of Medicine.
 * Perhaps most importantly, it has been a few years since I fully reviewed all of the sources. I suspect that some parts of the article are outdated. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 17:17, 9 February 2020 (UTC)
 * Two statements about the article that include my real name. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 18:02, 9 February 2020 (UTC)
 * Hi both. Notwithstanding Axl's previous comment on being comfortable with open identity, I through I'd also add a note here on anonymity/pseudonymity generally. We've so far had to avoid anonymous listed authors, since one of the ICMJE Authorship criteria has traditionally been interpreted as indicating that authors must be identifiable (name, affiliation, contactable):
 * "Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved."
 * However, other journals have published items by anon/pseudonymous authors in the past (example). I've been looking into making an ICMJE compliant pocess, but have been shocked that there's currently no published documentation on best practices. What that means is that in the short term, although we can't include an anon/psudonymous authors in the author list, we could include one or more as named 'contributor(s)' at the end of the authors list (same way that we include the et al hyperlink to a full contributor list). Considering that journals are used to dealing with anonymous peer reviewers, it should be possible to eventuially put systems in place. T.Shafee(Evo &#38; Evo)talk 06:10, 10 February 2020 (UTC)
 * Thank you <b style="color:#808000">Axl</b> and T.Shafee(Evo &#38; Evo) for your replies. Axl, FYI, I'm updating deep vein thrombosis right now with the end goal of submitting it to the journal. Maybe 2020 is the year to to get both of these articles published formally. Biosthmors (talk) 14:46, 11 February 2020 (UTC)

Immunotherapy: New compounds
Should the section mention Nivolumab and Ipilimumab? Opdivo (nivolumab) and Yervoy (ipilimumab) are labeled in both USA and EU at this point, combination therapy just being filed — Preceding unsigned comment added by Sprevrha (talk • contribs) 21:45, 6 May 2020 (UTC)

Research section
I just posed on TRACERX, but most of the research section is out of date, the most recent citation is 4 years old, but many of the research directions are from 2014 and indicate that trials are "underway". Unfortunately I will not have time to tackle this before August. I just wanted to flag this as it would be a a fun little project to update this section.JenOttawa (talk) 16:59, 9 July 2021 (UTC)
 * The research section is indeed out of date. (However I wouldn't call the update process a "fun little project".) <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 22:11, 9 July 2021 (UTC)

TRACERx Research
Hello, I popped by to do some general cleaning of the article. I noticed this section that contains references from 2014 sharing a new treatment that was being tested. Does anyone have an update that can added in to remove the primary research?

The TRACERx project is looking at how NSCLC develops and evolves, and how these tumors become resistant to treatment. The project will look at tumor samples from 850 people with NSCLC at various stages including diagnosis, after first treatment, post-treatment, and relapse. By studying samples at different points of tumor development, the researchers hope to identify the changes that drive tumor growth and resistance to treatment. The results of this project will help scientists and doctors gain a better understanding of NSCLC and potentially lead to the development of new treatments for the disease.

Thanks!

Jenny JenOttawa (talk) 16:55, 9 July 2021 (UTC)
 * I found this collection of mostly primary research from Nature: https://www.nature.com/collections/haffgaicaf . The trial is still underway (clinicaltrials.gov link). Here is a more recent review article (although the PLOS article from 2014 is actually pretty good as well for background). 2021 review in Cancer Discovery. I will try to review these in a few weeks. JenOttawa (talk) 13:31, 11 July 2021 (UTC)

Lancet
New seminar 10.1016/S0140-6736(21)00312-3 JFW &#124; T@lk  12:55, 16 July 2021 (UTC)
 * Thanks, but link doesn't work:

"This DOI cannot be found in the DOI System. Possible reasons are:

The DOI is incorrect in your source. Search for the item by name, title, or other metadata using a search engine. The DOI was copied incorrectly. Check to see that the string includes all the characters before and after the slash and no sentence punctuation marks. The DOI has not been activated yet. Please try again later, and report the problem if the error continues" Johnbod (talk) 12:58, 16 July 2021 (UTC)