Talk:Pancreatic cancer

Links mentioned with diet

Thus added "A diets high in red meat or processed meat has been linked to pancreatic cancer in men. As have diets high in sugar-sweetened drinks (soft drinks)." Doc James (talk · contribs · email) 16:48, 8 November 2014 (UTC)

Risk Factors | Diet

There has been some debate with regard to adding diet as a 'risk factor.' The current version suggests (per Johns Hopkins) that diet, in general times, 'may' be a risk factor. There are then specific reference to direct dietary links and references to the clear diet-diabetes-pancreatic-cancer-link and the clear diet-obesity-pancreatic-cancer-link. Both diabetes and obesity have been left in their own bullets as risk factors because while both are directly linked to diet, not all diabetes or all obesity is dietary.

An earlier version suggested that 'diet was not generally considered a risk factor' and Zaurus correctly added a 'by whom' tag which was then deleted. Since then there has been some resistance to including diet as a risk factor.SpecialFXavier (talk) 14:08, 9 November 2014 (UTC)

The most current MEDRS sources generally discount or are very cautious about diet, even red meat, as a direct factor, which the original reference covered. I shall return to this next week. Johnbod (talk) 14:29, 9 November 2014 (UTC)

The trouble with any one 'study' is that it might be very narrow in its approach to direct causality or relationship. The dietary link to pancreatic cancer is, however, crystal clear through its relationship with TYPE II Diabetes and Obesity. So while it might be hard to draw a straight line from, say, sugary drinks to the development of actual cancer cells in the pancreas; it is absolutely clear that sugary drinks contribute to both TYPE II Diabetes and Obesity and, therefore, to pancreatic cancer. It would concern me to have an article on Wikipedia that suggested that diet was not a risk factor when it clearly is, in specific terms, and probably is in more general terms. It would be irresponsible to say otherwise. When I arrived on this page the statement was the diet was 'generally accepted' NOT to be a risk factor. Of course, there was no ref for this. SpecialFXavier (talk) 18:16, 9 November 2014 (UTC)

As I keep telling you, there was a ref, which you find in the history. And the statement is correct. What should perhaps be made clearer is that "diet" means directly what you eat, not the 2nd & 3rd degrees of consequences of eating too much of it (for some people). Diabetes & I think obesity were already dealt with seperately, and should be kept distinct. Johnbod (talk) 01:27, 10 November 2014 (UTC)

Why did we duplicate all this content twice? Also we need to stay away from primary sources. Doc James (talk · contribs · email) 04:15, 10 November 2014 (UTC)

• I've gone to "Diet is not generally accepted as a direct risk factor (though see the sections on obesity and alchohol),[3][47] although some individual studies have found dietary factors such as diets high in red meat or processed meat,[47] sugar-sweetened drinks (soft drinks),[48] In particular, limited epidemiological studies link the common soft drink sweetener fructose with growth of pancreatic cancer cells.[49]". This has the advantage of being true, and in agreement with the latest RS. We should not conflate diet and obesity in these sections, let alone diabetes - there the true symptom/cause picture remains unclear anyway. Risk factor could does with some rewriting and explaining to clarify how these work - you can only take each step in a possible progression as its own factor. The reader will have seen the sections on obesity and diabetes before reaching this in any case. Most sources, such as Ryan and the IARC just don't regard diet itself, even red meat, as a confirmed risk factor, cautious though that may be. Wiki CRUK John (talk) 19:13, 10 November 2014 (UTC)
  • Why do you keep adding primary sources? We should be using secondary source.
  • And why did you remove the secondary source I replaced for the primary source?
  • Can we at least agree to use secondary sources? Doc James (talk · contribs · email) 07:46, 11 November 2014 (UTC)

Which ones are you talking about here? There are so many changes. Wiki CRUK John (talk) 12:13, 11 November 2014 (UTC)

Ok, sweet drinks - a mistake, sorry. Wiki CRUK John (talk) 15:32, 11 November 2014 (UTC)

Good as long as we all agree to use secondary sources :-) Doc James (talk · contribs · email) 05:57, 12 November 2014 (UTC)

• • • Which ref says "Diet is not generally accepted as a direct risk factor"? Doc James (talk · contribs · email) 08:01, 11 November 2014 (UTC)

Bizarrely enough, the one right after the statement, that has always been there, is freely available online, but apparently completely invisible to every one except me!!!! Larssen, 2012, immediately after the Abstract:"Dietary factors could conceivably influence the risk of developing pancreatic cancer, although no dietary factor has been convincingly associated with pancreatic cancer risk". There is also a lot of evidence by omission - Ryan has a long Table 1 listing risk factors, which has no dietary ones, but obviously obesity and diabetes. I haven't cited the ACS and CRUK pages, which both discuss the issue and confirm this uncertainty, or the IARC lists, which just omit it. And so on. Wiki CRUK John (talk) 12:13, 11 November 2014 (UTC)

This is the ACS:

"Factors with unclear effect on risk Diet Some studies linked pancreatic cancer and diets that include a lot of red meat, pork, and processed meat (such as sausage and bacon). Others have found that diets high in fruits and vegetables may help reduce the risk of pancreatic cancer. But not all studies have found such links, and the exact role of diet in relation to pancreatic cancer is still being studied." - [1]

See also the WCR 2014, which has "convincing evidence" for obesity, but only "limited" evidence for red meat, and doesn't mention even fructose etc, as most recent reviews don't. We are pretty much back where we started because that text was based on careful examination of a wide range of current sources, far more than were actually referenced. I'll add the WCR ref as belt and braces. I was already thinking that removing the soft drinks/fructose altogether might well be best, but will see what others think. Wiki CRUK John (talk) 17:43, 11 November 2014 (UTC) Wiki CRUK John (talk) 17:30, 11 November 2014 (UTC)

This bit "Dietary factors could conceivably influence the risk of developing pancreatic cancer, although no dietary factor has been convincingly associated with pancreatic cancer risk (2007)." is providing justification for their review with this sentence being followed by "We therefore conducted a dose–response meta-analysis of prospective studies to examine the associations of red and processed meat consumption with pancreatic cancer risk." Should we use paste tense? ie "Diet has not generally been accepted as a direct risk factor" Doc James (talk · contribs · email) 05:57, 12 November 2014 (UTC)

I think not, given their conclusions, and the pick-up from in other sources so far. That might change, but I think we should stick with what the sources say so far. The ACS page was revised this June, CRUK around the same time, and so on, and they keep the cautious language despite this 2012 study (in the journal CRUK own btw). Wiki CRUK John (talk) 11:24, 12 November 2014 (UTC)

This version is irresponsible and a game of ridiculous semantics. First of all, one reference that did not find a direct link to specific cancer cel growth does not suggest that "Diet is (or was) generally not accepted" but rather that one study made a statement loosely resembling that. Most cancer research and treatment centers acknowledge that diet (indirectly through obesity and diabetes) is a strong risk factor and that diet (directly) may be a risk factor. So for Wikipedia to suggest that it is 'generally' accepted that his is not true is ridiculous. And irresponsible. And feels like lobbying. Lets get clear: Diet IS a risk factor. Of that, there is no question. SpecialFXavier (talk) 15:35, 12 November 2014 (UTC)

Sadly none of the sources, many of which are open access online, agree with you. "Risk factors" must be direct, and the factors further up the progression have always been included in their own rights, as they should be. That is the standard terminology. Not everyone who eats a lot gets obese and not everyone who gets obese gets diabetes. Wiki CRUK John (talk) 17:04, 12 November 2014 (UTC)

The World Cancer Report says "convincing evidence that body fatness increases risk and probable evidence in relation to abdominal fatness, whereas evidence is limited for red meat consumption; coffee drinking is unlikely to affect risk" Doc James (talk · contribs · email) 23:31, 12 November 2014 (UTC)

Also the ref is about dietary factors not diet generally. Altered some to "Evidence for specific dietary factors is poor " Doc James (talk · contribs · email) 23:35, 12 November 2014 (UTC)

WP:LEAD

We should keep the lead of the article to 4 paragraphs. Doc James (talk · contribs · email) 21:35, 12 November 2014 (UTC)

User:Wiki CRUK John are you going to discuss? Doc James (talk · contribs · email) 23:41, 12 November 2014 (UTC)

(ec) It was 4 paras [2] until you made further changes. Wiki CRUK John (talk) 23:48, 12 November 2014 (UTC)

John take a little more time to look at things. You were the one that changed it from that diff not me. I am counting 5 here [3] Doc James (talk · contribs · email) 00:01, 13 November 2014 (UTC)

I took all the time I needed. It was at 4 paras, after you raised the point, and would have remained there if you had not made further, and imo largely unnecessary, changes. The main thing we must do is to avoid 2 people editing the same section at the same time, which just causes confusion. As here (note the timings) Wiki CRUK John (talk) 15:29, 13 November 2014 (UTC)

Just my 2p's worth: WP:LEAD says articles should 'ideally' be no more than 4 paras - I wasn't aware that this was a hard and fast rule (and something something 5th pillar something). Wouldn't it be infnitely more helpful to readers to divide up the paragraphs a little more, as it's a very dense piece, rather than squishing it together as it is at the moment? It is currently causing a numer of inadvertant non-sequiturs and repetitions, for example:

• There are also a number of other types of pancreatic cancer. Pancreatic cancer is usually diagnosed by a combination of medical imaging...

Which actually caused me to pause and re-read just now. HenryScow (talk) 14:45, 17 November 2014 (UTC)

Agree and also support WP:IAR when obligatory run-ons make for confusing reading, as here. Obviously slavish adherence to the general LEAD guideline wouldn't serve the purpose here (and I think elsewhere - I seem to remember backing down in the past on this issue due to FA considerations, and I wouldn't venture to interpret that "ideally" from an FA rule-abiding perspective). If the wording in the general style manual effectively discourages having enough paragraph breaks for clear presentation in the lead of the different topic areas that are mandatory for articles on disease, then surely we need to ignore the rule? Either that or specify in MEMOS exceptions for cases such as this? 109.157.83.50 (talk) 10:14, 18 November 2014 (UTC)

I'm happy with that if others are, though it might cause rumbles at FAC I admit. I always think WP (including medical articles) has far more too-short leads than too-long ones, though 4 paras is a decent guideline for the majority of articles. Wiki CRUK John (talk) 11:42, 18 November 2014 (UTC)

If the proposal is to have all medical articles be 5 or 6 paragraphs than we should request wider input. Doc James (talk · contribs · email) 18:32, 18 November 2014 (UTC)

I'm not suggesting this as a global change at all, just commenting that in this case, with the content as written, it needs more space to mitigate against confusion. I definitely think that for most cases, 4 paras will suffice, but in this case I think WP:IAR is worth invoking.

Basically all medical articles are similar with respect to the broad scope we are trying to get into 4 paragraphs. Thus WP:IAR is not suitable IMO. Doc James (talk · contribs · email) 18:37, 18 November 2014 (UTC)

Comments

• Not sure why "it is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body." was removed?
• Symptoms start rather than appear. Signs appear.

Symptoms seem to "appear" very often in the most respectable sources: [4] and [5]

Appear means visual. IMO start is clearer. Doc James (talk · contribs · email) 02:52, 14 November 2014 (UTC)

• This is not important by why use all caps for "Cause, Mechanisms and Diagnosis"

no reason, Henry I think. Wiki CRUK John (talk) 15:20, 13 November 2014 (UTC)

• Have arranged the lead to follow the layout of the body, thus put prevention with treatment rather than cause

Well whatever, but there is no logic there, and it goes against usual MEDRS sequences. Squeezing 10 or so sections into 4 paras will lead to crushing up whatever you do. Wiki CRUK John (talk) 15:20, 13 November 2014 (UTC)

• Not sure what the issue is with these hidden tags "<!-- Prevention and Treatment -->"

Nor am I - I didn't put them there & I expect FAC reviewers will complain. Aren't they to do with the translation project? Wiki CRUK John (talk) 15:20, 13 November 2014 (UTC)

We commonly use these at Wikiproject Med. Doc James (talk · contribs · email) 02:52, 14 November 2014 (UTC)

• Not sure why pancreatic adenocarcinoma needs bolding? IMO it doesn't

Really? It was bolded for the reason things are normally bolded, which is that they are the article title or a redirect - in this case the latter. This is a very basic MOS point which I notice medical articles often fail to observe. Wiki CRUK John (talk) 11:26, 13 November 2014 (UTC)

Hum yes medical articles typically do not bold. We can bold as you suggest.

Doc James (talk · contribs · email) 23:46, 12 November 2014 (UTC)

They are very often bolded (as at Lung cancer, Brain tumor etc), but not consistently. I'm not for bolding all redirects, but as you know this is the formal name for the disease in the great majority of "PC" cases, and unlike many of the much rarer types it has no other article of its own. Johnbod (talk) 03:36, 14 November 2014 (UTC)

I'm not very happy with the lead as it is, but will not change it for the moment. 15:20, 13 November 2014 (UTC)

What concerns do you have with it? Doc James (talk · contribs · email) 02:52, 14 November 2014 (UTC)

References

Repeated references clean-up

User: FeatherPluma is doing a great - and irksome - job cleaning up repeated references using shortened footnote templates. However, in in his citations the previous editor had been including the specific page where the cited information was found. Isn't it a better idea to use the shortened footnote template and still mentioning the specific page? NikosGouliaros (talk) 23:33, 15 November 2014 (UTC)

I agree that it is extremely easy to add the specific page to these shortened templates, using a reference page (rp) suffix. In principle, I considered doing so at the time I started going through the article. In broad terms, the modern compelling issue is that the rp information is not really adding much, for several reasons. Not the least of these is that electronic versions can be searched very rapidly for the specific component of interest. A lesser issue is that when I tested a quick subset of usage by electronic search and then cross-referenced to PDF format I found errors. FeatherPluma (talk) 23:56, 15 November 2014 (UTC)

Point taken. (To be honest, I only mention specific pages only within chapters from books or very long articles). On the other hand, I fear the result of the same reference being cited dozens of times might be impractical and unappealing to the eye. NikosGouliaros (talk) 00:11, 16 November 2014 (UTC)

A question was raised earlier here about adding page numbers. I added one wikitext option example. As you say, specific pages need only be given from books or very long articles, if at all. FeatherPluma (talk) 01:54, 16 November 2014 (UTC)

Pancreatic Cancer vs Pancreatic Adenocarcinoma

Hi! So this article is titled "Pancreatic Cancer" but the majority of info is of "Pancreatic Adenocarcinoma" meaning that "Signs and Symptoms" and "Risk factors" are all pertaining to panc. adenocarcinoma not the umbrella term "pancreatic cancer". Insulinom/Glucagonoma have separate articles. Is there any way we can make this article solely about "Pancreatic Adenocarcinoma"? and perhaps make another article about "Pancreatic Tumors" listing all the different tumors of pancreas?

We state in the lead that pancreatic cancer is sometimes used to mean pancreatic adenocarcinoma. We do discuss the other types briefly. As adenocarcinoma is the most common type it is also not unreasonable that much of the article covers that type. Feel free to add a bit more on the other types here. Doc James (talk · contribs · email) 21:36, 16 November 2014 (UTC)

Yes, it is noticable how many of the MEDRS sources are called "Pancreatic cancer" but explain in para 1 they are actually all or nearly all about "Pancreatic Adenocarcinoma" (eg those with Wolfgang, Syl De La Cruz, & Wolfgang as the lead authors). "Pancreatic cancer" can be regarded as the WP:COMMONNAME of "Pancreatic Adenocarcinoma". The next most common types all share many features with it in terms of management etc. "Pancreatic cancer" will certainly get by far the most traffic (little comes through the PA redirect page). Wiki CRUK John (talk) 11:21, 17 November 2014 (UTC)

Ok thank you.

New onset diabetes and prevention research?

Pinging HenryScow as this might, I suspect, be a pertinent topic [6] for the Research section he's kindly been compiling. (Though I don't think I'd support including it in the Prevention section, as it isn't currently used for screening, afaik.)

NB Perhaps worth bearing in mind that there currently seems to be relatively little mention on Wikipedia of pancreatogenic diabetes (see PMID 21757968), aka "type 3c diabetes mellitus" [7].

109.157.83.50 (talk) 14:13, 17 November 2014 (UTC)

Thanks! Good ref, have added a couple of mentions in the Research section. HenryScow (talk) 18:17, 18 November 2014 (UTC)

Cheers - I've rephrased one of the sentences to try to provide a specific focus on screening, though my wording can almost certainly be improved (not altogether straightforward to explain succinctly for lay readers, who may not have much background on harm issues in screening). 109.157.83.50 (talk) 19:11, 18 November 2014 (UTC)

Opening line

Hi all. Am a little concerned that there's some circularity/lack of clarity/precision in the opening line of the lead...

• 'Pancreatic cancer occurs when cancer cells develop in the pancreas'...

As it stands, this a) doesn't actually explain what cancer cells are (and directs people to the rather sub-optimal [Cancer] page for a definition), and b) implies cancer cells are conceptually some sort of uniform external 'other' when, as we know, it's a lot more complex than that and includes disregulated immune cells, fibroblasts etc. I would be much more comfortable talking about the disease as a condition arising from uncontrolled growth and regulation of cells or similar. How about either of these:

• Pancreatic cancer arises when the cells that make up the pancreas - a glandular organ located behind the stomach - begin to multiply out of control.

• Pancreatic cancer is caused by the uncontrolled growth of the cells that make up the pancreas - a glandular organ located behind the stomach.

Thoughts? HenryScow (talk) 14:56, 17 November 2014 (UTC)

Okay how about "Pancreatic cancer arises when there is uncontrolled growth of the cells that make up the pancreas - a glandular organ located behind the stomach."? Do not wish to refer to the mechanism as the cause. Also wish to define the disease before defining what the pancreas is. Doc James (talk · contribs · email) 00:03, 18 November 2014 (UTC)

I like having a link to cancer pretty early. At one stage I don't even think it was in para 1. Wiki CRUK John (talk) 01:08, 18 November 2014 (UTC)

Same. I have moved the link to the second sentence. Doc James (talk · contribs · email) 01:16, 18 November 2014 (UTC)

Much better! If I'm being really pedantic, I prefer 'growing' (a verb) to 'growth' (a noun) as it makes it more active and comprehensible. But basically happy as is.HenryScow (talk) 17:56, 18 November 2014 (UTC)

Sure sounds good to me. Doc James (talk · contribs · email) 18:33, 18 November 2014 (UTC)

HenryScow and Doc James The current version suggests that we are dealing with a diffuse process (hyperplasia), which is incorrect. I like Henry's first suggestion. (See also the FAC page.) JFW | T@lk 00:40, 19 December 2014 (UTC)

Yes agree not ideal right now. How about as two sentences? Doc James (talk · contribs · email) 01:01, 19 December 2014 (UTC)

Imo, the current version is pretty damn good. Just maybe (though really not sure... @HenryScow:...) more reader-friendly to use brackets for the gloss, like this:
Pancreatic cancer arises when cells in the pancreas (a glandular organ behind the stomach) begin to multiply out of control and form a mass.
109.158.8.201 (talk) 13:08, 23 December 2014 (UTC)

Peer review closed

From the peer review: Closing comments I'm closing this now, as it has run 3 weeks or so, and gone quiet. Very many thanks to all who contributed here, or just by editing the article, as several did. I think all points have been addressed, or by-passed by other changes, except for the image question in the last section. I'll copy that to the article talk page, and if anyone has further comments on other matters below, please continue the discussion there. I will take the article to FAC shortly. Thanks again for a great response! Wiki CRUK John (talk) 10:33, 1 December 2014 (UTC)

Thank you for doing good work together. How about a good article nomination? NikosGouliaros (talk) 10:55, 1 December 2014 (UTC)

Straight to FAC I think; this peer review has been more thorough than most GANs, with the advantage of several reviewers. Wiki CRUK John (talk) 12:00, 1 December 2014 (UTC)

Image error

I just noticed that the first image in the signs & symptoms section (File:1820 The Pancreas.jpg) erroneously shows pancreatic hormones flowing from the pancreas into the splenic artery (even in the wrong direction, against the bloodflow). The correct image should show hormones flowing into the splenic vein and the pancreaticoduodenal veins, which then drain into the portal vein. --WS (talk) 20:06, 23 November 2014 (UTC)

Damm! There doesn't seem to be another image as good. Can anyone else confirm this, though I'm sure WS is correct? Wiki CRUK John (talk) 09:05, 24 November 2014 (UTC)

Wouterstomp is right. The blood vessel below the splenic artery appears to be the splenic vein—at least it is in the right position, just behind the upper part of the pancreas. By anatomical convention, the splenic vein, like other systemic veins, is often coloured blue on diagrams. Axl ¤ [Talk] 12:26, 27 November 2014 (UTC)

Thanks. Oh well, it will have to go. Maybe the producers can correct it. Unfortunately the Commons images are not well categorized at all, but I can't see a decent substitute. Wiki CRUK John (talk) 13:22, 27 November 2014 (UTC).

How about this one? A wider scope, and less detail, but the best I can see for now. There is also room for this (COI declared), with more detail on the ducts. Wiki CRUK John (talk) 18:53, 30 November 2014 (UTC)

We can request the image to be fixed by filling in an errata report to CNX. I will do so, but until that has been done maybe we should use another image. -- CFCF 🍌 (email) 14:42, 1 December 2014 (UTC)

[8] We could potentialy use this image instead. -- CFCF 🍌 (email) 14:47, 1 December 2014 (UTC)

Thanks. If we used that, I think it should replace the 2 images now at "Signs and symptoms". I presume that can be loaded in terms of licensing etc? Wiki CRUK John (talk) 15:29, 1 December 2014 (UTC)

Anything else outstanding?

Please add here, if so. Wiki CRUK John (talk) 10:50, 1 December 2014 (UTC)

• RE the PR discussion about the repetition of symptoms (or signs?) opening of the "Diagnosis" section: I think Nikos raises a serious editorial point here (John, sorry not to have got onto this earlier!). If some combination of signs existed that can signal a specific diagnostic suspicion ('red flag') of this disease I would certainly support stating that. But here, apart from Courvoisier sign and early symptoms in functioning PanNETs, the only other clinical red flags I can see might conceivably be new onset of diabetes or pancreatitis. So it seems to me unhelpful to return to a generalized account of "symptoms" (ie experiences of the patient, as distinct from the range of "signs" available for a physician to interpret) which are really not diagnostic. The one pertinent part, imo, could be the opening sentence about the lack of clinical *signs* - after some rephrasing for focus. I think it should be possible to merge the other content on symptoms into the "Signs and symptoms" section in a way that is still friendly to lay readers. 2c, 86.164.164.29 (talk) 16:46, 2 December 2014 (UTC)

Any progress on this? The current text is potentially misleading to readers, imo (including perhaps to ones with a naive but probably inevitable gf tendency to "self-diagnose"). Not sure how to put it in WP:... terms, but I'll have a go... Is all the content you're repeating/presenting here actually sourced to specific passages of text directly discussing Diagnosis as such? If not, then I find it hard to see how it can meet the strict FA criteria (though I don't pretend to understand the process). In non-WP terms, I think a perfectly acceptable (imo) alternative editorial approach could be to reframe the three opening paragraphs of the section (that currently starts with "Pancreatic adenocarcinoma has a number of symptoms...") so as to focus directly on questions of diagnostic suspicion (rather than providing unfocussed content on "symptoms at diagnosis" and other general background information). Hope this helps. Fwiw, I am very supportive of the effort to increase reader-friendliness. 86.164.164.29 (talk) 10:37, 15 December 2014 (UTC)

• From the Bond-Smith et al review in the BMJ:

  "... Development of any of the above symptoms in the presence of late onset diabetes should strongly alert the physician to the possibility of pancreatic cancer... The clinician should be alert to a potential diagnosis of pancreatic cancer with patients over 50 years old who present with unexplained weight loss, persistent abdominal or back pain, dyspepsia, vomiting, or change of bowel function..."

  109.158.8.201 (talk) 10:26, 28 December 2014 (UTC) previously 86.164.164.29

Management of PanNETs

Fixed by FeatherPluma (commented at FAC). 109.158.8.201 (talk) 10:33, 28 December 2014 (UTC)
The following discussion has been closed. Please do not modify it.
This subsection] still contains several statements that are apparently unsourced. (The reader is also referred to a "section of the main article on neuroendocrine tumors", but I'm not sure how appropriately.) 109.158.8.201 (talk) 10:57, 21 December 2014 (UTC)

Review by SandyGeorgia

Citation work and other MOS stuff

Citations mostly cleaned up now. SandyGeorgia (Talk) 14:58, 8 December 2014 (UTC)
The following discussion has been closed. Please do not modify it.
I would like to put the article Template:In use during a quiet moment of editing to standardize the citation formatting (see crit 2c). Editing seems to have slowed down, but there has been no response on the FAC to my query about which format to use for dates and author names. It looks like the preferred date format is not ISO, rather spelled out as day month year, but the author name format is still all over the place. I prefer the Diberri/BogHog format, because its appearance is so clean: Jones AB, Smith CD, Miller EF and because you can generate a template from a PMID in that format by using the Diberri/BogHog PMID filler. I could switch all to that unless others prefer something else. The other format in the article now (several formats are present now) is less clean-looking: Jones, AB; Smith, CD; Miller, EF that is, more cluttered with extra punctuation. Please let me know, because doing this work is quite tedious, and getting edit conflicts or reverted afterwards stinks! And there are many incomplete citations. I can complete those when I'm in there. And do the WP:NUMERAL corrections. And WP:CAPFRAG. And WP:DASH (there are hyphens that should be WP:ENDASHes). I like to get the MOS-y stuff out of the way before reviewing content. Today is good for me to do this tedious stuff-- weekend, less likely. SandyGeorgia (Talk) 21:25, 5 December 2014 (UTC) Struck some done, but I wasn't checking comprehensively-- will look for more of those when I get into actually reading ... so far, just MOS flyover. SandyGeorgia (Talk) 03:18, 6 December 2014 (UTC) So, at the moment the article has, for one much-used source (this I think is as changed to by User:FeatherPluma): Ryan, DP; Hong, TS; Bardeesy, N (September 2014). "Pancreatic adenocarcinoma". N. Engl. J. Med. 371 (11): 1039–49. doi:10.1056/NEJMra1404198. PMID 25207767.{{cite journal}}: CS1 maint: multiple names: authors list (link) which using the edit window template (as it was originally put in by me) is: Ryan, DP; Hong, TS; Bardeesy, N (11 September 2014). "Pancreatic adenocarcinoma". The New England journal of medicine. 371 (11): 1039–49. PMID 25207767. and using the Diberri/BogHog PMID filler is: Ryan DP, Hong TS, Bardeesy N (2014). "Pancreatic adenocarcinoma". N. Engl. J. Med. 371 (11): 1039–49. doi:10.1056/NEJMra1404198. PMID 25207767. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) - FeatherPluma's style is similar but not identical to the Diberri/BogHog. He has commented in a section above, & that might be relevant. I won't even bother giving my own preference. There was a big edit in May 2014 by Boghog, just after the CRUK project began but nothing to do with it, this adjusted things in accordance with a Med project consensus on Doi's & such like. From that diff you can see the previous style, which also seems somewhat mixed, but perhaps mostly in the style that User:FeatherPluma recently adjusted many refs to. I must admit that when I began editing I didn't worry too much about the existing style, nor I am I quite sure what the existing project consensus is, or if that affects things here. For example the May edit changed from: Pannala R, Basu A, Petersen GM, Chari ST (January 2009). "New-onset Diabetes: A Potential Clue to the Early Diagnosis of Pancreatic Cancer". The Lancet Oncology. 10 (1): 88–95. doi:10.1016/S1470-2045(08)70337-1. PMC 2795483. PMID 19111249.{{cite journal}}: CS1 maint: multiple names: authors list (link) - to- Pannala R, Basu A, Petersen GM, Chari ST (January 2009). "New-onset Diabetes: A Potential Clue to the Early Diagnosis of Pancreatic Cancer". The Lancet Oncology. 10 (1): 88–95. doi:10.1016/S1470-2045(08)70337-1. PMC 2795483. PMID 19111249.{{cite journal}}: CS1 maint: multiple names: authors list (link) - ok those look the same. Sandy, I think there is probably no established style or it is Diberri/BogHog, and it has not been much enforced. So no one should object if you convert to D/B. I would certainly be very grateful. Wiki CRUK John (talk) 23:04, 5 December 2014 (UTC) We missed my afternoon free-time editing window, but I may be able to start cleanup after dinner. Maybe what I'll do is all the other little stuff first, and leave author formats for last. That way, if someone hates it, they can revert just that portion. Which would be a bummer because it's so time-consuming, but I can live with it ;) SandyGeorgia (Talk) 23:16, 5 December 2014 (UTC) Cool! If I am editing this page, tell me & I'll stop. If anyone else has views on the citation style, please speak now or .... Wiki CRUK John (talk) 23:25, 5 December 2014 (UTC) I'm going to fix dinner, and start work in about an hour. SandyGeorgia (Talk) 23:35, 5 December 2014 (UTC) I don't know what this is ... we have to give readers enough info to be able to verify, that is, find the information. Where do they look for this? Is it a journal, a website, Pubmed indexed, a book, what? Ryan DP. Chemotherapy for advanced exocrine pancreatic cancer. UpToDate. Review current through October 2014: Topic 2475, Version 46.0 SandyGeorgia (Talk) 04:40, 6 December 2014 (UTC) Diff of work done so far-- nowhere near complete, too tired to continue. I found and inline noted a couple of citations that I have no idea what they are, a book whose citation I can't fix, found many missing PMIDs and PMCs, moved quotes in to quote parameter, more different styles than I thought, haven't even begun to look at prose or suitability of sources. That was much more work than I expected, pls check my work. SandyGeorgia (Talk) 05:28, 6 December 2014 (UTC)

Uncited text

I see lots of uncited text in Diagnosis??? SandyGeorgia (Talk) 05:28, 6 December 2014 (UTC)

NORD

NORD now removed as a source. SandyGeorgia (Talk) 14:58, 8 December 2014 (UTC)
The following discussion has been closed. Please do not modify it.
I was just beginning to look at how to standardize the cite web templates, when I encountered this: NETs can occur in most organs of the body, including the pancreas, where the various malignant types are all considered to be rare. "Pancreatic neuroendocrine neoplasms (pNENs)". rarediseases.org – Rare Disease Database. National Organization for Rare Disorders. 28 January 2014. Retrieved 22 November 2014. NORD has them listed in their database of rare diseases, but the problem I have is that the NORD database is demonstrably inaccurate. Can a better source for this information be found? As an example of why NORD is not a good source, they state that a disease is rare if it affects fewer than 200,000 Americans. Yet they *still* list Tourette syndrome as a "rare disease", based on decades old prevalence estimates, when it has been acknowledged for a very long time that TS is not rare. (They don't remove things from their database when they are no longer considered rare.) Are NETs considered rare by someone other than NORD? Do we have a US prevalence number? So, I popped down to the Epidemiology section of this article to try to answer that, and am unable to find a satisfactory answer to the "fewer than 200,000 Americans" according to NORD. Can the "rare" issue here be either better sourced, or rephrased, or actual prevalence numbers given? Back to citations ... I got stalled on that. SandyGeorgia (Talk) 01:08, 6 December 2014 (UTC) I've removed the ref, which was not added by me. Previously went to the next ref, Burns & Edil, whose abstract begins ""Pancreatic neuroendocrine tumors are a diverse group of rare neoplasms." though they begin the "epidemiology" section with "Initially believed to be exceedingly rare, neuroendocrine tumors are likely more common than previously appreciated.", going on cite SEER US incidence for 2004 at 5.25 per 100,000, up x5 from 1973 (this is all NETs, not just PanNETs), and then further muddying the waters with autopsy studies. Very strictly it might be better to say "clinically-relevant" PanNETs are rare (which I don't propose to do). Burns & Edil are both from John Hopkins. This is enough I think, though there are issues identifying small tumours, and defining "rare", as Rare disease also points out. But as there are several types, with none predominating, the wording used meets all definitions, I think. I also think it's best not to get too specific on prevalence under the circumstances, though I could add something if people think I should. "Fewer than 200,000 Americans" is the definition per the US Rare Diseases Act of 2002, roughly = 15 per 100,000 (in the UK press size tends to measured in London buses or football pitches, but I don't think that's a good idea either). Thanks for the great work! Wiki CRUK John (talk) 01:37, 6 December 2014 (UTC) PS, I see NORD also list HIV/AIDS (under A)- if only! Wiki CRUK John (talk) 01:59, 6 December 2014 (UTC)

Other sourcing

I will catch up with posts here when I come up for air ... doing citation work requires full focus :) I also re-check my work for mistakes when done. Meanwhile ... Please convince me why this is the kind of source we want to use for an FA? It looks like an advocacy organization?? SandyGeorgia (Talk) 02:01, 6 December 2014 (UTC)

• "Pancreatic cancer research". Cancer Research UK. Retrieved 17 July 2014.

Well I suppose it is, though I'm not sure why you pick on CRUK rather than the adjacent ref to the American Cancer Society, which actually seems to spend a lower proportion of its revenue on research and a higher proportion on things you might call "advocacy". Both links go to a very up to date tour d'horizon of areas of current research activity, of the sort that classic MEDRS sources don't generally cover in one sweep (the statement referenced is "There are several fundamental unanswered questions"). At least we've not found such a source. Obviously I have a WP:COI with CRUK, as does User:HenryScow who added both refs back on 17 July. Wiki CRUK John (talk) 02:34, 6 December 2014 (UTC)

oopsie !!! Sorry, John, as I was editing it did not even occur to me that Cancer Research UK is you all ... not thinking CRUK, and since I'm from the other side of the pond, it's not on my brain. oh my. Well, OK, the problem I have with it is that it seems akin to, in my "world", citing Tourette syndrome to literature from the Tourette Syndrome Association, rather than journal-published research. Their agenda, for want of a better word, is more oriented to advocacy. I picked on CRUK because I had never heard of it (in its full name version, not realizing that was you all), but I actually do have the same problem with the American Cancer Society. I don't think they are the highest quality sources ... at least, in the realm I edit, citing TS to the TSA would not be the best sourcing. In fact, as discussed at WT:MED and WT:MEDRS several times, I don't even like citing to the NIH or Mayo (and this article cites Johns Hopkins)... the NIH has errors in its TS literature. So, yes, it is a broader, general question, and I only grabbed CRUK because it was the first I encountered that I didn't know. I hadn't yet gotten to the level of checking what text was being cited to these kinds of sources ... was just running through the cite web templates and hit one I didn't recognize :) I did cite web first because I want to be able to check everything cited to websites closely once I start reading ... which I haven't done yet. Back now, still have to clean up cite journal templates, and probably won't get to any reading until tomorrow. Just catching what I notice on flyover wrt prose. SandyGeorgia (Talk) 03:24, 6 December 2014 (UTC)

Don't worry, no reason you should. But there are some things charity websites can do very well - state of research & stats (for non-specialists) are 2 examples, both for us and ACS. Both are often cited on such things by the classic MEDRS papers, btw. The alternatives are primary papers, mostly in this case ones which won't be published for at least a year or so, or typically reviews etc (eg Wolfgang et al.) which are very good on depth, but tend to have a narrower focus when looking at research directions. Wiki CRUK John (talk) 03:20, 6 December 2014 (UTC)

Back to work for a bit. Best, SandyGeorgia (Talk) 03:24, 6 December 2014 (UTC)

Prose and sourcing concerns

Resolved. SandyGeorgia (Talk) 16:14, 15 December 2014 (UTC)
The following discussion has been closed. Please do not modify it.
Things I see as I'm checking citations (but please fix after I'm done so we don't edit conflict !!) The nature of the changes that lead to the disease are being intensely scrutinized, such as the role played by genes such as KRAS and p53. Repetitive prose ... such as ... such as ... and isn't gene linked sooner in the article? Nature ... are ?? Think the whole sentence needs to be rejigged. SandyGeorgia (Talk) 02:10, 6 December 2014 (UTC)  Done. SandyGeorgia (Talk) 16:11, 15 December 2014 (UTC) Ok, sorry if I caused an ec earlier. I'm off to bed now. Wiki CRUK John (talk) 02:35, 6 December 2014 (UTC) Hang on ... I'll go take my bubble bath in case you want to squeeze in any work now ... SandyGeorgia (Talk) 02:38, 6 December 2014 (UTC) Personal prose preference: "... that arise from neuroendocrine cells (i.e. cells responsible for integrating ... " I hate seeing i.e. in articles, doesn't seem very user friendly (some folks may not know what it is). Change only if you agree. Off for a moment, back later. SandyGeorgia (Talk) 02:38, 6 December 2014 (UTC) The 2 "i.e."s gone, and a purge of "such as" [9]. Wiki CRUK John (talk) 15:15, 15 December 2014 (UTC)  Done SandyGeorgia (Talk) 16:11, 15 December 2014 (UTC) I'll aim for a good run through over the W/e. Wiki CRUK John (talk) 03:09, 6 December 2014 (UTC)  Done WP:RED is a good thing (it helps build the website), but: Radiofrequency ablation (RFA), cryoablation, and hepatic artery embolization may also be used. the reader is left with no idea what a hepatic artery embolization is. That can be fixed by either writing a stub at the article, or adding a parenthetical explanation. As of now, we have to exit Wikipedia and go to google to figure out what it is. SandyGeorgia (Talk) 02:51, 6 December 2014 (UTC) Yes, I think that needs to go anyway, as I can't find a ref. Wiki CRUK John (talk) 03:09, 6 December 2014 (UTC) There are abundant sources for hepatic artery embolization, including recent reviews. See note below, entered chronologically (time stamp 00:57, 10 December 2014) FeatherPluma (talk) 01:01, 10 December 2014 (UTC)  Done SandyGeorgia (Talk) 16:12, 15 December 2014 (UTC)

I haven't started really reading yet, but just in there working on citations and MOS, I'm seeing rough prose everywhere I glance ... More than 90% of all grades carry a faulty KRAS gene ... grades carry genes? Or people with cancer at a certain grade carry a gene ? SandyGeorgia (Talk) 05:34, 6 December 2014 (UTC)

The latter: "cases at" added. Wiki CRUK John (talk) 20:20, 17 December 2014 (UTC)

Change in tense, change in number style, and not clear if the 46 is among that 2/3 or among entire population:

• In up to two-thirds of people abdominal pain is the main symptom, for 46% accompanied by jaundice, and 13% have jaundice without pain.

The latter, rephrased. Wiki CRUK John (talk) 20:20, 17 December 2014 (UTC)

This list changes in tense/style:

• Bearing in mind that the disease is rarely diagnosed before the age of 40, common symptoms of pancreatic adenocarcinoma occurring before diagnosis include:

The first three start with sentence fragments; the last two are full sentences/statements.

Yes, #4 includes various things in a sequence, and it would be misleading to start #5 with "diabetes" as it's more complicated than that. If consistency was absolutely vital I could scramble up 1-3 so they turn into sentences, but I don't think this would be an improvement. I'm inclined to leave it as is. Wiki CRUK John (talk) 22:34, 17 December 2014 (UTC)

Excessive wordiness:

• The undigested fat leads to fatty feces that are foul-smelling and difficult to flush away.
  • The undigested fat leads to foul-smelling, fatty feces that are difficult to flush.

Done, keeping "away". Wiki CRUK John (talk) 21:59, 17 December 2014 (UTC)

Parentheticals have the reader bouncing around the article:

• cancer (see Risk factors), the
• and, as noted in Signs and symptoms, ...
• Evidence for specific dietary factors is poor (though see the sections on obesity and alcohol).

ugh ... don't bounce the reader around, and why the need to repeat?

What is meant by "usual" here? Relative to all people with the disease, or what population?

• People over 50 who develop diabetes have eight times the usual risk of developing pancreatic adenocarcinoma within three years, after which the relative risk declines.

"compared to the general population" the source says, but that might be the general population of that age. to check his cited source. Wiki CRUK John (talk) 22:34, 17 December 2014 (UTC)

Yup: "In this cohort, we determined the likelihood of pancreatic cancer diagnosis within 3 years of meeting criteria for diabetes and compared observed rates with those expected for persons of similar age and sex distribution." - PMID 16083707. Is it enough to add this to the reference? The 2nd level ref is 2005, and I don't like to go beyond what the first ref actually says without the further reference. Wiki CRUK John (talk) 22:42, 17 December 2014 (UTC)

Is "some" really needed?

• with pancreatic cancer in some 10–20% of cases,

It helps to indicate that this is a very imprecise number, which it is. Wiki CRUK John (talk) 22:34, 17 December 2014 (UTC)

Awkward phrasing:

• The depression may be there before the cancer is diagnosed, and is perhaps caused by the cancer. The mechanism for this association is not known.

Or is perhaps? Or may be a result of? Why isn't final sentence merged in to first sentence?

Changed to "or". Short sentences are good. Wiki CRUK John (talk) 22:34, 17 December 2014 (UTC)

Wordiness? Unsure here:

• There may be symptoms of pancreatic cancer metastasis, where the primary pancreatic cancer has spread to other organs.

The primary pancreatic cancer may metasti (not sure if you are using british or english spelling) to other organs? Why so much wordiness? It reads as if the wordiness may be the result of trying to work in the wikilink ??

I don't think it is - just of trying to be accessible. Wiki CRUK John (talk) 22:34, 17 December 2014 (UTC)

Another list that doesn't have a consistent style:

• Risk factors for pancreatic adenocarcinoma include:

Some items in the list are bullet, fragments, while others are complete sentences. Some bullets end in periods, other in colons.

Tidied to sentences, with semi-colons after bullets as appropriate. Wiki CRUK John (talk) 22:51, 17 December 2014 (UTC)

Another "some":

• taking some 20 years to return ...

Average? Up to? Why the vague "some"?

No, some, about, around, more or less! Please think what "average" might mean in this situation, and you'll see why there isn't an average, and why it is vague. There's a clamour for unattainable precision from various reviewers here. Wiki CRUK John (talk) 22:06, 17 December 2014 (UTC)

Further, from the source: "... risk decreased with increasing time since cigarette cessation, the OR being 0.98 after 20 years. ... A 20% excess risk of pancreatic cancer was found among former smokers, which declines with time since quitting, and reached the level of never cigarette smokers ∼20 years after quitting.... ... More specifically, our large population and detailed data on smoking allowed us to confirm that after 20 years of smoking cessation, risk of pancreatic cancer approaches that of never smokers", and in another study the same source cites " ...the RR for those who had quit smoking for >15 years was similar to that of never smokers". Wiki CRUK John (talk) 23:00, 17 December 2014 (UTC)

WP:NUMERAL

• an almost 3-fold increase

should be three-fold, but there is a 1.5-fold later, so I left it for consistency.

Reduce wordiness?

• While the association between alcohol abuse and pancreatitis is well established, considerable research has failed to firmly establish alcohol consumption as a risk factor for pancreatic cancer. Overall, the association is consistently weak and the majority of studies have found no association.

Alcohol consumption and abuse is associated with pancreatitis, but have not been established as risk factors for pancreatic cancer; most studies have found no association. Or something to that effect, less wordy? — SandyGeorgia 14:08, 6 December 2014 UTC — continues after insertion below

More on sourcing

NOW, there I stop because the sources are not adequate to the statement (and I haven't even begun to look at sourcing throughout the article-- just saw that on my prose check). One source is an extremely old press release from an advocacy group, and the other source is a very old primary study. And the weakest kind of study (a questionnaire). So, having cleaned up the citations to the point of being able to see what the sourcing is, I'm concerned that this article needs work not only on prose, but more seriously, on sourcing. Upgrading all web sources to recent high-quality secondary journal reviews will help.

So, those are a few samples from just a few sections (it doesn't make sense at this point to list every problem). I'm finding (as I found five different citation styles and mechanisms in the article) that (perhaps because it was built by many editors??) the article does not have a smooth voice, and could benefit from an overall prose check and smoothing by one copyeditor.

At the same time, it would be optimal if all text cited to websites (individual hospital programs or advocacy groups) could be reviewed and cited where possible to journal sources. Because the alcohol information was not sourced to a secondary review, I'm concerned that every citation should be checked to make sure they are high quality, recent, secondary reviews. Someone (can't remember who?) at WT:MED has a script that can flag on talk which sources are primary and which are secondary. Perhaps ask Alexbrn is he knows?

If you ping me when a copyedit has been done, and sourcing has been tightened, I will next read through the entire article for jargon, layperson readability, etc. Best, SandyGeorgia (Talk) 14:08, 6 December 2014 (UTC)

Thanks enormously for this. A few parts of the article are pre-2014 survivals, but also the PR & start of the FAC generated loads of direct edits by several editors (over 700 edits in November I think), on prose as well as references, which have varied the "voice". The problem with alcohol is that recent reviews (and clinical reviews deal pretty briskly with well-established risk factors) simply don't mention alcohol - eg the Ryan & Wolfang ones, which both have tables of RFs, nor Vincent (against the grain, Bond-Smith does include it in a list in his BMJ review, but gives no specific source). Yet it was an issue some way back, and I think the lack of association should be stated (whereas the similar case of coffee doesn't need to be). This is similar to Breast cancer and smoking. I'll see if textbook sources can give better evidence of absence, but I'm not back in the office until Wednesday now. It certainly needs an all-over prose check. Wiki CRUK John (talk) 15:00, 6 December 2014 (UTC)

I was afraid you would say you regret knowing the former FAC delegate :) :) SandyGeorgia (Talk) 15:03, 6 December 2014 (UTC)

Checking back in, I see that Curly Turkey did a nice copyedit, but most of the above has not yet been corrected. SandyGeorgia (Talk) 14:58, 8 December 2014 (UTC)

Comprehensive, 1b; well-researched, 1c

I see NuclearWarfare suggested PMID 24403441 (a recent secondary review that has free full text available). Regards, SandyGeorgia (Talk) 15:03, 6 December 2014 (UTC)

A new review on screening: PMID 25479908 and PMID 25436129 SandyGeorgia (Talk) 00:48, 9 December 2014 (UTC)

A new review on treatment: PMID 25469016 SandyGeorgia (Talk) 00:48, 9 December 2014 (UTC)

Thanks, but I don't think this is needed; "ermerging" treatment in East Asia. Not mentioned in the several other general reviews from the last 12 months. Wiki CRUK John (talk) 02:44, 10 December 2014 (UTC)

OK ... I see Feather is hard at work, will look in tomorrow. SandyGeorgia (Talk) 03:17, 10 December 2014 (UTC)

There is extensive available sourcing for hepatic artery embolization and the other arterial approaches mentioned in the endocrine tumor section. To accommodate the above input I have put together a quick Wikipedia article so it's no longer WP:RED. I won't have time to work much on it right now but it's a start.FeatherPluma (talk) 00:57, 10 December 2014 (UTC)

Pingie pongie

I'm wondering if/when my outstanding points will be addressed? I'd like to unwatch sometime in this lifetime :) SandyGeorgia (Talk) 17:26, 17 December 2014 (UTC)

Comments from Doc James

Doc James, I've merged all of your comments to one thread for easier tracking of what has been completed for the FAC; please revert me if you dislike this :) SandyGeorgia (Talk) 15:00, 8 December 2014 (UTC)

Thanks for doing this Sandy. Doc James (talk · contribs · email) 21:58, 8 December 2014 (UTC)

Predictions

I am not convinced this belongs in the lead "Due to lack of progress with treatment, it is predicted to be the second leading cause within a decade."check to WCR ref"" I generally think predictions are not great as they depend on so many factors.

Also I am looking through the world cancer report and not seeing it mentioned. And what does within a decade mean? By 2024? Doc James (talk · contribs · email) 17:46, 7 December 2014 (UTC)

So you've removed. This was one of a few additions suggested by the top clinician outside reviewer. Yes 2024. I think, with a ref, it is useful in the distribution section rather than the lead. Wiki CRUK John (talk) 15:06, 15 December 2014 (UTC)

Were in the ref does it support this? Doc James (talk · contribs · email) 23:10, 17 December 2014 (UTC)

We appear to have some issues

While I updated the lead of the article a while ago these updates do not appear to have taken place consistently in the body of the text.

We stated that "Pancreatic cancer has one of the highest fatality rates of all cancers, and is the fourth-highest cancer killer among both men and women worldwide."

It is referred to cancer.gov [10] which usually only provides states for the States. It however has been like that for a long time. Have updated / fixed to represent actual global stats. Doc James (talk · contribs · email) 18:01, 7 December 2014 (UTC)

Article needs some simplification

Terms such as:

• "Definitional migration" have changed to "Changes in definitions over time"
• etc

Doc James (talk · contribs · email) 18:05, 7 December 2014 (UTC)

Now: "The definition and classification of PanNETs has changed over time[74] which adversely affects what is known about the epidemiology and outcomes without treatment for these tumors.[74]". No "etc"s left. Wiki CRUK John (talk) 15:03, 15 December 2014 (UTC)

suggest: "...the epidemiology and natural history of these tumors" (fwiw, I had to read the sentence twice to understand the phrase "...outcomes without treatment for these tumors"). 86.164.164.29 (talk) 09:27, 16 December 2014 (UTC)

Epidemiology and natural history are not simple English but technical terms. "outcomes without treatment" are at least common words. Doc James (talk · contribs · email) 22:12, 17 December 2014 (UTC)

Now fixed, I think. 109.158.8.201 (talk) 10:35, 28 December 2014 (UTC), previously 86.164.164.29

Aspirin

Concerned with this "Taking a daily low-dose aspirin regimen for more than five years may decrease the risk of developing pancreatic adenocarcinoma (ductal pancreatic cancer) by as much as 75%." which text supports this from the ref?

We also have [11] which did not find an effect from low dose ASA.

This was also much more reserved [12]

Doc James (talk · contribs · email) 05:38, 12 December 2014 (UTC)

And there's this, which doesn't mention those two. I didn't add this bit & haven't seen the Rothwell. "low" seems clearly wrong. There are also the complicating effects of other potential beneficial & harmful effects. I doubt anyone will or should take a decision on taking regular aspirin based mainly on pancreatic cancer. I'll cut for now, but if anyone disagrees please say so. Wiki CRUK John (talk) 14:42, 15 December 2014 (UTC)

Risk factors removed

I've cut these, previously commented out, as not typically found in recent reviews, and with older refs:

• Gingivitis or periodontal disease
• Partial gastrectomy PanNets?

Wiki CRUK John (talk) 14:18, 15 December 2014 (UTC)

"fatality rates"

Resolved, I think. 109.158.8.201 (talk) 17:09, 20 December 2014 (UTC)
The following discussion has been closed. Please do not modify it.
In the Distribution section: Pancreatic cancer has one of the highest fatality rates of all cancers, and is the seventh-highest fatal cancer among both men and women worldwide.[ref WCR-2014, chapter 5.7] Pancreatic cancer has one of the highest fatality rates of all cancers, and is the seventh-highest fatal cancer among both men and women worldwide. I assumed the intended meaning here was "Pancreatic cancer has one of the highest fatality rates of all cancers—the seventh(??) highest among both men and women worldwide", but when I consulted the 2014 World Cancer Report to check I couldn't find a corresponding statement regarding fatality rates as such. Was this statement perhaps sourced to the bullet point in the "Summary" (I couldn't see any more details provided in the rest of the chapter) "Pancreatic cancer is the seventh most common cause of cancer death worldwide..." If so, that refers to the absolute numbers of deaths, rather than a "fatality rate". 109.158.8.201 (talk) 12:36, 17 December 2014 (UTC) - previously 86.164.164.29 etc, etc This text "Pancreatic cancer has one of the highest fatality rates of all cancers" exactly how I copied and pasted it here used to be in the epidemiology section. 109 I do not know to what you refer. If one ranks all cancers by the number of people they kill pancreatic comes 7th. Doc James (talk · contribs · email) 17:12, 17 December 2014 (UTC) James, where did you copy and paste "Pancreatic cancer has one of the highest fatality rates of all cancers" from? (Not from WCR-2014 it would seem.) Sure, "If one ranks all cancers by the number of people they kill pancreatic comes 7th". But "the number of people they kill" isn't the same thing as a "case fatality rate", which is a specific epidemiological measure [13] (in fact, I'd be somewhat surprised if pancreatic cancer only ranked 7th on that particular scale). 109.158.8.201 (talk) 17:33, 17 December 2014 (UTC) I've readjusted the wording following your removal of the "fatality rate" phrase. I hope this is now sorted. 109.158.8.201 (talk) 19:03, 17 December 2014 (UTC) A related request for clarification: The number of cases that occur each year vary greatly by country, with those in the developed world generally having higher rates. "Rates" of what? (The statement appears to be unsourced, so I wasn't able to clarify). Adding: A possible source here could be the opening WCR-2014 bullet point: "A majority of pancreatic cancers occur in countries with high or very high levels of human development." This statement appears to refer to absolute numbers of cases rather than "rates". 109.158.8.201 (talk) 12:47, 17 December 2014 (UTC) I've now sourced the sentence, per above, and reworded it accordingly [14]. 109.158.8.201 (talk) 19:15, 17 December 2014 (UTC) RE PanNETS: However, studies of autopsies have incidentally found small PanNETs at much higher rates, suggesting that the prevalence of tumors that remain inert and asymptomatic may be relatively high. I think this sentence could be phrased more clearly, and that some sort of a link like subclinical/asymptomatic (as well as to 'Prevalence') could be useful. Perhaps something like: "Small PanNETs can be uncovered relatively frequently as an incidental finding at autopsy, suggesting that the prevalence of subclinical PanNETS that remain inert and asymptomatic may be considerably higher." 109.158.8.201 (talk) 13:17, 17 December 2014 (UTC) That is actually a significantly different statement, though no doubt also true. I'm not seeing the extra clarity, to be honest. 13:24, 17 December 2014 (UTC) Well, the current statement wouldn't be crystal clear to me if I wasn't already aware of the intended meaning (though, admittedly, I don't have access to the cited source). The only significant change I reckon I've made to the intended meaning regards avoiding the reference to "studies of autopsies" (based on the consideration that many of out readers aren't likely to be interested in the actual research methodology). I think you'll find that the second clause (beginning "suggesting that...) retains the original meaning ("considerably"[?] might be an editorial scruple, though that's ultimately the epidemiological message I think). 109.158.8.201 (talk) 13:37, 17 December 2014 (UTC) This is prognosis "Pancreatic cancer has one of the highest fatality rates of all cancers," and is dealt with there. Doc James (talk · contribs · email) 16:28, 17 December 2014 (UTC) Erm, actually no... (I think you must have misread this mislocated your last post James). This is about particular concern (bullet-point) regards small subclinical neuroendocrine tumors of the pancreas that are only diagnosed as incidental findings (or at some form of screening - e.g. those insurance/corporate programmes that are sometimes offered to employees). The potential clinical significance of such lesions is quite unclear, but we know from autopsy studies many exist that never progress during people's lifespan (as also seems to occur in some of the subclinical lesions uncovered, for example, by prostate cancer screening). This is all just by way of explanation – obviously, I'm not suggesting we mention screening issues under ==Distribution== 109.158.8.201 (talk) 17:07, 17 December 2014 (UTC) My comment should have gone above. Doc James (talk · contribs · email) 19:47, 17 December 2014 (UTC)

Arbitrary break: Prognosis of PanNETs

::::: Getting there... Yes, I agree with James (I think) that we need something on PanNETs in ==Outcome==. At present there's nothing ,whereas there's a sentence dedicated to prognosis under ==Distribution== (with 3 sources, of which one is primary and the other two are a bit old). I realize that succinct discussion of this highly diverse class of tumors isn't exactly straightforward. But I think we can find a slightly better solution (eg here?) Thoughts? 109.158.8.201 (talk) 20:26, 19 December 2014 (UTC)

I've now boldly removed the sentence in question [15]. 109.158.8.201 (talk) 17:48, 20 December 2014 (UTC)

History section

Done, I think – This content has now incorporated in the article. 109.158.8.201 (talk) 10:39, 28 December 2014 (UTC)
The following discussion has been closed. Please do not modify it.
Would PMID 6356946 (pdf) be useful here? 109.158.8.201 (talk) 11:16, 18 December 2014 (UTC) Possibly, if you read Spanish. But it's mainly about pancreatitis it seems. Thanks for looking anyway. Wiki CRUK John (talk) 11:30, 18 December 2014 (UTC) De nada... But why Spanish? The paper seems to be written in perfectly decent English, and there's a substantial section on "Pancreatic cancer" (pp. 544–546), as well as another on "Islet-cells tumors" (pp. 543–544). Despite its age, that source looked to me potentially more useful than PMID 10398904, though admittedly I wasn't actually able to access that one. (The title of PMID 23622134 looked promising, but it turns out that the content really is just about pancreatitis [16].) 109.158.8.201 (talk) 12:52, 18 December 2014 (UTC) How about something like this... The earliest recognition of pancreatic cancer has been attributed to the 18th-century Italian scientist Giovanni Battista Morgagni, the historical father of modern-day anatomic pathology, who claimed to have traced several cases of cancer in the pancreas. Many 18th and 19th-century physicians were skeptical about the existence of the disease, given the similar appearance of pancreatitis. Some case reports were published in the 1820s and 1830s, and a genuine histopathologic diagnosis was eventually recorded by the American clinician Jacob Mendes Da Costa, who also doubted the reliability of Morgagni's interpretations. By the start of the 20th century, cancer of the head of the pancreas had become a well-established diagnosis. Regarding the history of the recognition of PanNETs, the possibility of cancer of the islet cells was initially suggested in 1888. The first case of hyperinsulinism due to a tumor of this type was reported in 1927. Recognition of a non-insulin-secreting type of PanNET is generally ascribed to the American surgeons, R.M. Zollinger and E. H. Ellison, who gave their names to Zollinger–Ellison syndrome, after postulating the existence of this disease related to a gastrin-secreting PanNET in a report of two cases of unusually severe peptic ulcers published in 1955. In 2010, the WHO recommended that PanNETs be referred to as "neuroendocrine" rather than "endocrine" tumors.ref name=nomenclature Extended content: some extracts from p. 544 onwards of the suggested RS... Fitzgerald(Fitzgerald PJ. Medical anecdotes concerning some diseases of the pancreas. In.: Fitzgerald PJ, Morrison AB, eds. The pancreas. Baltimore: Williams and Wilkins, 1980:1-29.) attributed the earliest recognition of cancer of the pancreas to Morgagni who mentioned five cases that were previously published in the Sepukhretum of Bonet in 1679 and other cases reported before his own." "None of [Morgagni's] descriptions necessarily warrants the diagnosis of cancer of the pancreas as opposed to pancreatitis, and the confusion of the two is readily understandable because the problem of grossly differentiating the two diseases even today [to some extent persists]... Despite the belief of many physicians in the 18th and 19th centuries that there was no such disease as cancer of the pancreas, in the 1820s and 1830s cases of pancreatic cancer began to be reported, but not illustrated, in the medical literature... The first American writer on the subject, J. M. Da Costa, a Philadelphian clinician, in 1858 dismissed the reports of cancer of the pancreas by Morgagni and his predecessor. Instead, he found records of 35 autopsies of patients said to have had cancer of the pancreas and added one case of his own and another reported to him. In at least one of his cases there was a microscopic diagnosis of adenocarcinoma. At about the end of the 19th century, the clinical signs and symptoms of cancer of the head of the pancreas were well known and many cases were verified histologically. Bard and Pic distinguished between duct and acinar cell cancers and... [in 1888] mentioned the possibility of islet cell cancer. Shortly thereafter, clinical studies began to separate the signs and symptoms of cancer of the head of the pancreas from cancer of the body and tail. ... In 1927, the first case of hyperinsulinism due to a tumor of the islet cells was reported. Twenty-eight years later, Zollinger and Ellison described two patients with unusually severe peptic ulcer disease, both of whom had noninsulin-secreting tumors of the pancreatic islets [viz. PanNETs].(Zollinger RM, Ellison EH (1955). "Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas". Annals of Surgery. 142 (4): 709–23, discussion, 724–8. doi:10.1097/00000658-195510000-00015. PMC 1465210. PMID 13259432.)" Hope this helps, 109.158.8.201 (talk) 15:35, 18 December 2014 (UTC) Style content moved to FAC page, as requested 109.158.8.201 (talk) 14:15, 20 December 2014 (UTC) The following discussion has been closed. Please do not modify it. There's an unexplained quotation (following a semicolon): "For the next decade, little attention was paid to this report; however, over the subsequent 15 years, there has been a virtual explosion in the recognition of this tumor."[38] Without consulting the reference this juxtaposition makes no sense. I'd also question the explosive tone, which seems to jar with the more encyclopedic prose. Couldn't the quotation be inserted in the reference? (Note: I'm also unsure about the reliance on primary sources in the surrounding text - can't we have secondary source/s [PMID 24206780?] alongside?) 109.158.8.201 (talk) 20:48, 19 December 2014 (UTC) There are already two FAC points on this; can we try to keep everything together? Wiki CRUK John (talk) 00:53, 20 December 2014 (UTC) Done (sorry). 109.158.8.201 (talk) 14:15, 20 December 2014 (UTC)