Wikipedia:Featured article candidates/Lung cancer


 * The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted 01:38, 29 September 2007.

Lung cancer
Self-nomination. I have been working on this article for about six months. It is accurate, comprehensive and well-referenced. It may still need a little work on criteria 1a and 2a. Thanks. Axl 17:10, 4 September 2007 (UTC)


 * Fixes needed - I agree, a quick glance shows it needs a copyedit. I feel there'd be too many examples for me to list out here. I am happy if you'll permit me to go through and massage teh text a bit. As well, there needs to be more prominent mention of the fact that just about all primary lung cancers are carcinomas (i.e. arise from epithelial tissue), also the incidence of Ca lung is much higher with contact with asbestos. On the plus side, it does look comprehensive on a quick view. cheers,  Casliber (talk · contribs) 06:34, 5 September 2007 (UTC)
 * All help appreciated. :-) Thanks, Casliber. Axl 14:02, 5 September 2007 (UTC)


 * Comment—the article is very comprehensive and well-referenced. However, on a quick glance, many sections seem...a bit too concise :) Summary style is a good thing, and I know the article is already at 60 kB, but—I can't believe I'm saying this—most paragraphs seems strangely short!
 * Anyway, some more actionable comments:
 * "Signs and symptoms" could use more references, particularly for the third paragraph; it's uncontroversial information, but it would still be nice to attribute it to a source.
 * I have added three extra references. Axl 17:37, 7 September 2007 (UTC)
 * Pardon my asking, but is there a strong enough link between viral infection and lung ca for it to be mentioned along with the "main" causes?
 * That's a very reasonable comment. Currently, the article contains two (well-referenced) sentences at the bottom of the "Causes" section. I am happy to take consensus on this; it's certainly not essential to the article. Axl 18:10, 5 September 2007 (UTC)
 * There are a few inconsistencies in the references; e.g., reference 94 doesn't use the cite journal format, one or two references may still have hyphens where en dashes would be appropriate (quick fix :)
 * That reference ("Adler") was inserted by SandyGeorgia. It is unusual because the reference quotes a different paper, hence the odd format style. I'm not sure how best to resolve this, but would be grateful for suggestions. Axl 17:42, 5 September 2007 (UTC)
 * A couple of months ago, SandyGeorgia advised to me to ask someone to run a dash-fixing script. Unfortunately I forget who runs that script. :-( If someone can remind me, I'll ask the script owner to run it again. Axl 18:13, 5 September 2007 (UTC)
 * That would be ;) I don't think there are many, though; probably just a couple. Fvasconcellos (t·c) 18:23, 5 September 2007 (UTC)
 * OK, now I get it. I've formatted it for consistency with the others and added the OCLC ID number for the Adler book. Fvasconcellos (t·c) 18:00, 5 September 2007 (UTC)
 * could you find the ISBN for The Nazi War on Cancer?
 * I've fixed it. I had the "isbn" in capitals in the reference. Axl 17:39, 5 September 2007 (UTC)
 * Thanks! Fvasconcellos (t·c) 18:00, 5 September 2007 (UTC)
 * I'll read more thoroughly later, but I'm really pressed for time—sorry. Fvasconcellos (t·c) 16:47, 5 September 2007 (UTC)


 * Comments:
 * "People with these polymorphisms are more likely to develop lung cancer after exposure to carcinogens." (reference?)
 * There are three references in the previous sentence ("Engels", "Wenzlaff" and "Yin"). Axl 18:15, 7 September 2007 (UTC)
 * "The Asian state of Bhutan has a complete smoking ban since 2005" (reference?)
 * I have added one. Axl 18:09, 7 September 2007 (UTC)
 * More external links? Like: lungcancer.org; National Cancer Insitute; Lung Cancer Online?
 * Okay, I have added them. Axl 22:07, 7 September 2007 (UTC)
 * Oops, and I deleted some of them again. They don't rise to the level of highly reliable sources, and they should be in the DMOZ link anyway. We don't need to expand External links for the sake of expansion. Sandy Georgia  (Talk) 18:28, 13 September 2007 (UTC)
 * Anyway, it's a comprehensive, well-written article. When it doesn't contain any citation needed template and these references are added to the article, I'll support it! Well done, Axl! NCurse work 06:16, 7 September 2007 (UTC)


 * The article needs a better chest x-ray. Surely we can find a better CXR of lung cancer? -- Samir 06:18, 7 September 2007 (UTC)
 * There isn't another one on Wikimedia Commons. I don't actually have an account on Wikimedia Commons, but I could possibly upload one directly to Wikipedia. Axl 21:49, 7 September 2007 (UTC)
 * I'll see if I can get one -- Samir 19:34, 8 September 2007 (UTC)


 * Also, it's very well written. Good job -- Samir 06:19, 7 September 2007 (UTC)


 * The most significant risk factor for developing lung cancer is long-term exposure to inhaled carcinogens, especially tobacco smoke. - while strictly true, this seems to be a case of soft-peddaling. A risk factor is, by definition, a corrolation; whereas it has been proven beyond-a-shadow-of-a-doubt that cigarette smoke (including passive smoke) is an active cause of lung cancer. This sentence should be reworded to make it clear that cigarette smoke isn't just correlated with higher lung cancer rates, but actively causes it. Raul654 05:32, 10 September 2007 (UTC)
 * Hmm. How about "The most important cause of lung cancer is exposure to tobacco smoke." Axl 07:00, 10 September 2007 (UTC)
 * Sounds good to me, although you may need to change the reference at the end of the sentence too. Raul654 07:41, 10 September 2007 (UTC)
 * Okay, I've done it. Axl 19:20, 10 September 2007 (UTC)
 * Support Raul654 16:44, 24 September 2007 (UTC)


 * Support: Thank you, Axl, for the changes! Comprehensive, well-referenced article! NCurse work 14:56, 10 September 2007 (UTC)


 * Comment comprehensive article, but I think it could benefit from splitting it up in two articles: small cell and non small cell lung cancer (with perhaps a shorter general lung cancer article). --WS 20:17, 10 September 2007 (UTC)
 * I strongly disagree with this suggestion. The article is not overly long, and I think such an arbitrary split would be detrimental. Raul654 20:35, 10 September 2007 (UTC)
 * It is not as arbitrary as you might think. Pathogenesis, staging and treatment differ considerably between the two types. It is hard to cover both in one article and not generalize from one type to the other. Medical resources such as emedicine and uptodate also have separate articles. Most of the studies found on pubmed focus on one type. --WS 22:17, 10 September 2007 (UTC)
 * My take is on how the public perceives it, which is that lung cancer in common parlance = Ca lung, with some comments on secondary tumours and quick mention of the very rare ones, so I think the main article has the subject and organization right. Nothing to stop subarticles later..cheers, Casliber (talk · contribs) 23:02, 10 September 2007 (UTC)
 * The sections "Signs and symptoms", "Causes", "Diagnosis", "Prevention", "Epidemiology", and "History" are the same for both NSCLC and SCLC. Differences arise in the sections "Classification", "Pathophysiology", "Treatment", and "Prognosis". In my opinion, the similarity of sections outweighs the differences. More importantly, most people who read this article do not have detailed medical knowledge beforehand; they are unlikely to appreciate the difference between NSCLC and SCLC. I have informed many patients that they have lung cancer, yet very few have subsequently asked me what type. Hence it is preferable to keep most of the information in a single article. Axl 06:47, 12 September 2007 (UTC)


 * Fixes needed, sorry to be late to this, Axl, been traveling. Some random things I noticed that need attention; I don't think the article is quite ready yet:
 * Undefined acronym, IARC, pls check all acronyms throughout.
 * Okay, done. Axl 15:08, 13 September 2007 (UTC)
 * I think you can do better on the awkward formatting of this sentence:  Studies from the U.S. (1986,[34][35] 1992,[36] 1997,[37] 2001,[38] 2003[39]), Europe (1998[40]), the UK (1998[41][42]), and Australia (1994[43]) have consistently shown a significant increase in relative risk among those exposed to passive smoke. Perhaps eliminate the years and use a combined ref format like on Tourette syndrome?
 * Done; I have removed the years. Axl 15:20, 13 September 2007 (UTC)
 * I furthed edited to change the unsightly string of ref tags to one ref tag. Sandy Georgia  (Talk) 16:54, 13 September 2007 (UTC)
 * Two-sentence sections (like Viruses, Emerging treatments and Non-small cell lung cancer prognosis, as examples only) are not ideal; can short sections be expanded, or merged?
 * "Viruses" expanded. Other sections merged. Axl 15:43, 13 September 2007 (UTC)
 * See WP:MOS, avoid the use of e.g. and i.e. (use prose instead).
 * Abbreviations removed. Axl 15:58, 13 September 2007 (UTC)
 * Please reveiw all of your wikilinking to help out layreaders; for example, I noticed no link to differential diagnosis. I also encountered lobectomy and wedge excision. Laypersons don't know these terms; stubs should be created and wikilinked, or the terms need definition.
 * Links & stubs added. Axl 21:59, 14 September 2007 (UTC)
 * Per WP:MEDMOS suggested sections, not sure why Screening is under Prevention rather than separate (MEDMOS accepts variation, but is there a reason?)
 * There is a reason: MEDMOS recommends "Prevention" or "Screening". There is no guideline on the use of both headings in an article. In any case, I have separated "Screening" into its own section. Axl 22:03, 14 September 2007 (UTC)
 * There is a lot of redundant prose: have a look at 's exercises to reduce prose redundancy, needed throughout. One sample:  Randomized controlled trials are underway in this area to see if decreased long-term mortality can be directly observed from CT screening.  There are also some throw-away sentences that need tightening up, example:  The treatment of lung cancer continues to evolve.  Furhter prose tightening needed throughout, for example:  About 10% of people with lung cancer do not have symptoms of it at the time of diagnosis; these cancers are usually found on routine chest x-rays.  How about, About 10% of individuals with lung cancer are asymptomatic at diagnosis ...
 * I'm not sure that "asymptomatic" is appropriate for lay readers. In any case, I have trimmed that sentence. I have tried to ensure that the grammar is technically correct and the spelling is accurate. I accept that more work is required to achieve criterion 1a. I have read Tony1's essay. However I am reaching the limit of what I can achieve. Perhaps I should hand this over to someone else? Axl 22:30, 14 September 2007 (UTC)
 * No, Axl, please keep at it and don't be discouraged. Articles make it to FA usually because of the commitment of one passionate editor.  You can eventually fix everything here, but sometimes you need distance from the text to see the prose issues.  Take a few days off and then read a printout, maybe, and work on developing your own resources on Wiki; unfortunately, I've not found that posts to the Medicine project about FACs or FARs are often likely to result in direct help, so you've got to seek out the people who will help and who are strong in prose.  You're very close, so you shouldn't give up now.  (I haven't yet had a chance to review your wikilinking, but would rather do that after you've made another pass at the prose.)  Sandy Georgia  (Talk) 15:06, 15 September 2007 (UTC)
 * See WP:DASH, no un spaced emdashes on Wiki, and endashes on date and number ranges.
 * There were a few stragglers which I fixed. Sandy Georgia  (Talk) 16:54, 13 September 2007 (UTC)
 * See WP:MOSNUM, ... with 1,35 million new cases per year and 1,18 million deaths, ...
 * Numbers fixed. Axl 08:39, 15 September 2007 (UTC)
 * There are uncited statements, for example: Primary lung tumors themselves most commonly metastatize to the adrenal glands, liver, brain, and bone.

Followup on size: I noted Fvasconcellos' comment above about the use of summary style. At 22KB prose, this is perhaps the shortest medical FA, and you have much room to expand some of the content if needed (for example, see Tuberculosis). It does seem a bit over-summarized in some places; I won't object on this because others say it's comprehensive, but in the event you want to expand some of the stubbier sections, the article could double in size and still be within WP:SIZE guidelines. Sandy Georgia (Talk) 18:28, 13 September 2007 (UTC)
 * Sandy Georgia (Talk) 23:34, 12 September 2007 (UTC)
 * No unspaced em dashes? Are you sure? :) Fvasconcellos (t·c) 23:36, 12 September 2007 (UTC)
 * oops, fixed. Sandy Georgia (Talk) 00:34, 13 September 2007 (UTC)
 * As long as you're fixing things, you might bother to read what WP:DASH actually says: emdashes are normally unspaced on Wikipedia. If there is consensus to join the majority, fine; but this is not the prohibition Sandy would make it. Most of the rest of Sandy's "fixes" are equally trivial. Septentrionalis PMAnderson 16:30, 13 September 2007 (UTC)
 * ho, hum, standard PMAnderson disclaimer; Raul654 is the person who decides if my commentary is trivial. Axl, pls review WP:MOSBOLD and WP:LEAD; there's a problem with the bold linking in the article lead.  Struck some, good work so far.  Sandy Georgia  (Talk) 16:54, 13 September 2007 (UTC)
 * I trust he will. Septentrionalis PMAnderson 17:39, 13 September 2007 (UTC)

It's still rough going.
 * I'm not sure why this sentence is stuck in where it is: When NSCLC cannot be subtyped, it is assigned SNOMED code 8046/3. There's no mention of any other codes, and the SNOMED throws a layreader.  Why do we need a code here and not in other cases?
 * Here's a sample of the kind of linking still needed. I linked bronchus and cavitation, but it still seems the passage could be made more layreader-friendly, so they don't have to click on cavitation:  Accounting for 31.1% of lung cancers, squamous cell lung carcinoma usually starts near a central bronchus. Cavitation and necrosis within the center of the cancer is a common finding.
 * I don't know what to do with the word neurosecretory, no link. These are the kinds of medical terms that need to be linked or defined.
 * I don't know what this sentence means, it's not layreader friendly and none of the terms are linked: The "oat" cell contains dense neurosecretory granules which give this an endocrine/paraneoplastic syndrome association.  I think this is defined later in the text (Depending on the type of tumor, so-called paraneoplastic phenomena may initially attract attention to the disease), so I'm not sure why it can't be explained on the first occurrence.
 * I shouldn't still be finding unlinked terms like carcinogen and comorbidity (they should be linked on first occurrence).
 * British or American throughout, not sure? Radon is a colorless and odourless gas ...
 * I only got as far as pathophysiology. This series seems choppy, and that it could be merged into sentences that flow better:
 * Mutations in the K-ras proto-oncogene are responsible for 20–30% of non-small cell lung cancers.[52] Chromosomal damage can lead to loss of heterozygosity. This can cause inactivation of tumor suppressor genes. Damage to chromosomes 3p, 5q, 13q and 17p are particularly common in small cell lung carcinoma. The TP53 tumor suppressor gene, located on chromosome 17p, is often affected.[53]
 * Looking over the edit history and talk page, I see two edits from WS, some input from Casliber a few weeks ago, and no other indication that the Medicine Projects have given you a hand here. That's frustrating. I feel the prose still needs attention, but if the Projects aren't going to lend a hand with all your hard work, Raul may as well promote it as is. Sandy Georgia  (Talk) 22:49, 25 September 2007 (UTC)


 * Oppose --> mild oppose; surely someone can lend a hand to smooth out the choppiness and fill out the history and developing-world sections?—1a, not comprehensive.
 * "This distinction is important because non-small cell lung cancer is sometimes treated with surgery, while small cell cancer is not. Also, small cell lung cancer usually responds better to chemotherapy." Please do not start a sentence with "also". Integrate the ideas smoothly and logically into the sentences.
 * Text changed. Axl 17:36, 17 September 2007 (UTC)


 * "The most important cause of lung cancer is exposure to tobacco smoke." Wouldn't it be more direct to say "The most common cause ..."?
 * Okay, I have changed it. Axl 17:38, 17 September 2007 (UTC)


 * "less than 10% of cases"—ungrammatical: "fewer".
 * Done. Axl 17:41, 17 September 2007 (UTC)


 * Why is "surgery" linked on second occurrence, not first? I'm unsure a link is necessary, since it's not to what I'd hoped: an article on a particular type of surgery; too general to bother the readers with this common dictionary word.
 * I have changed the link: now the first entry links to lung cancer surgery. Axl 17:44, 17 September 2007 (UTC)


 * Insert "only" before "14%; that is the point you're making, isn't it? What does "overal" mean here?
 * I have removed "overall". I haven't included "only" because that is value-laden (in my opinion). If reviewers consider it appropriate, I'll add "only". Axl


 * In the first caption, the white area is "cancer"? Can't it be more precise? Cancerous tumour? "Cancer" is the disease.
 * I have changed the captions. Axl 19:34, 17 September 2007 (UTC)


 * "non-small cell (80%) and small-cell (roughly 20%) lung cancer"—One is exact and one is rough?
 * Different sources quote slightly different rates. Most sources quote NSCLC at about 80%, while SCLC quoted rates vary from 15% to 21%. I have looked through the seminal epidemiological study (SEER, summarized by Travis) from 1995 and I added a couple of tables indicating rates of lung cancer types. Axl 07:07, 19 September 2007 (UTC)


 * "Very" is usually very redundant. Use "critical" or "major" is you have to.
 * I have removed "very". Axl 07:09, 19 September 2007 (UTC)


 * Do we find out whether those rarer forms are non-small or small cell, since you've just categorised all into an 80/20 division? Good way to fill out the stubby para. And what about the rates per 100,000 annually for those rarer ones?
 * I have included that info in the tables. Axl 07:10, 19 September 2007 (UTC)


 * It's first-world centric. Why just US figures for smoking? China and India are the time-bombs, and the locations of the greatest human suffering from smoking. Not a mention.
 * Not comprehensive; too short. The History section is a joke far too short. The are certainly enough footnotes, but not enough meat hanging off them. Tony 14:41, 15 September 2007 (UTC)
 * Nice work, Axl. Still concerned at the lack of information on the developing world (hasn't the WHO got some stuff there?). And history could be fascinating if three times the length. The tables do now look intrusive—they're very large and early in the piece; see what other reviewers think. BTW, there's a "3" that probably should be "3.0". Generally a choppy read. Tony   (talk)  02:11, 21 September 2007 (UTC)
 * SandyGeorgia has adjusted the tables and improved the layout; thanks Sandy. Axl 19:04, 21 September 2007 (UTC)
 * Please feel free to revert it if you don't like it; if you do like it, you can see more color/features that can be added at Diagnosis of Asperger syndrome. Sandy Georgia  (Talk) 19:09, 21 September 2007 (UTC)
 * Axl, my sincere apologies for neglecting this FAC; I have been distracted on the Asperger syndrome FAR and didn't have time for FAC. I promise to review tomorrow or the next day.  On a quick glance, I just saw another undefined, unlinked term (Stage IB cancer—as a layperson, I have no idea what Stage IB is and I don't find it defined in the article, but I may need to review more closely).  I'll place any further review on the article talk page later today or tomorrow, as I don't like to fill up the FAC page with such items.  I appreciate your patience.  Sandy Georgia  (Talk) 19:59, 24 September 2007 (UTC)
 * The staging system is seen at non-small cell lung carcinoma staging. Perhaps I should move this information to lung cancer? Axl 07:30, 25 September 2007 (UTC)
 * The above discussion is preserved as an archive. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.