Talk:Pancreatic cancer

Pathophysiology

@Doc James: I think the "Precancer" subheading under "Pathophysiology" helps the reader to understand, especially since the larger volume of text under "Pathophysiology" deals with precancerous states. Will put it back and hope you agree. Figgep (talk) 17:59, 28 September 2017 (UTC)

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Risk factors: herbicide use

I added a section for herbicide use under "risk factors" for pancreatic cancer and cited to a NIH summary of a study published in the International Journal of Cancer. A user named Zefr deleted my entry almost instantaneously, asserting that the research was only preliminary. I see no basis for that assertion, and no studies to the contrary. I am suspicious of the motives of "Zefr."

Zefr also suggested that my style of citation was incorrect, which it very well may be, and I would welcome help in understanding the proper method of citation.

I would like to add the risk factor section back in, and would welcome suggestions for language identifying the study as limited or preliminary perhaps, though I think it really should be included.

Thank you. Katy

Hello Katy. First, please sign and date-stamp your conversation by using the pencil icon in the upper left of the edit box. The section below was removed from the article because it is preliminary research unsubstantiated by WP:MEDRS-quality reviews; see MEDSCI and MEDASSESS for the level of evidence needed to support an encyclopedic medical statement. This study has not been confirmed in a review for its role in causing pancreatic cancer. It is a beginning finding from a limited cohort study, needing much additional work to verify the potential link to the herbicides; therefore, it is preliminary research. Please review the MEDRS guide and this tutorial for sourcing in medical articles. Further, you can use the Templates pick list in the upper left of the edit box to format a reference properly. This is explained in WP:CIT. --Zefr (talk) 16:05, 1 December 2017 (UTC)

• Herbicide use: Exposure to the Pendimethalin and EPTC, pre-emergence herbicides used in the production of a wide variety of crops in the U.S., has been shown to triple the risk of developing pancreatic cancer. A study published in the International Journal of Cancer revealed a 300% increase among applicators in the top-half of lifetime use of Pendimethalin and a 256% increase among applicators in the top-half of lifetime use of EPTC. [1]

Risk Factors: Specific types of food (as distinct from obesity)

The reference given for specific types of food not have any risk factor doesn't mention Specific types of food at all. It mentions Aspirin, so if you wanted to state what doesn't have a risk factor, you could replace this with Aspirin, although listing all the things not a risk factor could be anything, like the kitchen sink. So perhaps we should remove that text all together. --Zaurus (talk) 00:19, 8 February 2019 (UTC)

Aspirin is mentioned (in the paper but not in the text) as not being shown to be protective. The risk table lists a number of risks but, as you say, no types of food. I'm inclined to leave it - otherwise that ref should just be removed, letting the one at the end of the sentence reference the whole text. Johnbod (talk) 03:55, 8 February 2019 (UTC)

@Johnbod: What was your issue with my edit? --Zaurus (talk) 02:27, 13 February 2019 (UTC)

Your wording implied that there was a long list of dietary factors increasing risk, from which the article was selecting a couple of examples ("such as"). As you probably know, this is not the case, and so the wording was misleading. This article has received very thorough reviews, and like all articles on medical topics, the wording needs to be very precise and careful. Johnbod (talk) 13:31, 13 February 2019 (UTC)

How exactly? The current wording is like saying "the kitchen sink is not a risk". Listing what is not a risk does not belong in a section called Risk factors. I'm sure this wouldn't be the first time some ambiguous/erroneous language made it through the review process. --Zaurus (talk) 13:48, 13 February 2019 (UTC)

Well, I disagree there, and as far as I'm concerned the "ambiguous/erroneous language" came from your edit. There is so much press nonsense about foods raising cancer risk that it is important to say so when there is no evidence established for this - it's not like there hasn't been research into the subject. Johnbod (talk) 02:48, 14 February 2019 (UTC)

I was trying to address your off-topic point of "article has received very thorough reviews". To your other off topic point about nonsense in the press, perhaps you could create a separate section about that with sources. But from my perspective you've introduced two red-herrings to distract. I gave my argument, that defining what is not a risk is as useful as saying a kitchen sink is not a risk. Can you make an argument for keeping "Specific types of food (as distinct from obesity) have not been clearly shown to increase the risk of pancreatic cancer."? It actually sounds barely grammatical to me.

Also, what was ambiguous/erroneous about my wording?Zaurus (talk) 12:18, 14 February 2019 (UTC)

Yes, I told you I don't agree with that, and why. I also explained "what was ambiguous/erroneous about my wording" ("such as" implying there were others). Precision doesn't seem to be your thing, I have to say. Johnbod (talk) 13:42, 14 February 2019 (UTC)

This discussion belongs on the talk page.[2] Not within the articles text.

There is a nice table that lists the risk factors for pancreatic cancer as "obesity" and does not list specific dietary factors.

Cancer.org from 2014 says "Though evidence is still accumulating, consumption of red or processed meat, or meat cooked at very high temperatures, may slightly increase risk". So no conclusive evidence is supported. Doc James (talk · contribs · email) 18:53, 14 February 2019 (UTC)

@Doc James: Please read before commenting. ;-) a) The point about Aspirin was made on the talk page before being added to that edit summary. b) nobody is debating cooked meat. Zaurus (talk) 15:51, 16 February 2019 (UTC)

The issue here is whether, when considerable research has failed to demonstrate increased risk, this is worth mentioning. I say it is, Zaurus disagrees. Johnbod (talk) 16:20, 16 February 2019 (UTC)

Agree with Johnbod about mentioning that the evidence for specific foods is poor. Doc James (talk · contribs · email) 16:44, 16 February 2019 (UTC)

Again off topic. The question is whether listing things that are not a risk is relevant. Zaurus (talk) 21:29, 16 February 2019 (UTC)

For certain ones that are notable, yes. Doc James (talk · contribs · email) 21:45, 16 February 2019 (UTC)

Which ones? And as I suggested above, if they need to be mentioned, shouldn't there be a supporting ref? The refs you've supplied (by way of reverting edits) do not mentioned "non-risks" except for Aspirin. Zaurus (talk) 22:41, 16 February 2019 (UTC)

Role of galectins in pancreatic cancer

I am planning to add brief mention of the research in galectins in pancreatic cancer with several references. This is an active research area specific to pancreatic cancer pre-clinical models.

Please sign and timestamp your talk page edits. This edit is a problem for many reasons: 1) the research is at a very preliminary stage, with unknown significance as of 2019; 2) the journal Oncology Letters has a low impact factor (1.5) and is not a place where high-quality WP:MEDASSESS reviews appear; 3) the value of the research and future uses in therapy cannot be defined; WP:CRYSTAL. --Zefr (talk) 19:36, 1 May 2019 (UTC)

1) The research was properly described in my addition as pre-clinical but it is incorrect to characterize this as "very preliminary with unknown significance." It sounds like you are not aware of the large number of research papers regarding the role of galectins in pancreatic cancer. Just because you, personally, are not familiar with this research does not mean it has unknown significance.

2) There are other papers on this topic that have a higher impact factor. If that remains the only problem, I can reference those papers. I included this paper because it is a very current secondary review.

3) See #1 above.

It is a disservice to suppress this information. I find your reversion a bit over-zealous. I will try again, perhaps re-wording the edit next time. If that doesn't work I will submit to dispute resolution. Fpbear (talk) 19:46, 1 May 2019 (UTC)

A main purpose of the talk page discussion is to gain consensus among several other editors, WP:CON, which you do not have, so please don't start edit warring to make your edit stand. You can request individuals to review the edit and source, or post a discussion on WT:MED. --Zefr (talk) 20:33, 1 May 2019 (UTC)

Ok Zephyr, I can post it for pre-review and then we can see how to word this for consensus. Fpbear (talk) 20:45, 1 May 2019 (UTC) Editors: I posted my suggested addition to WT:MED. Fpbear (talk) 22:54, 1 May 2019 (UTC)

Fpbear. You have not completed the consensus process here or at WT:MED; you need several editors to offer interpretations and revisions for a consensus opinion, yet you went ahead and reinserted your content with numerous duplicate sources; this is not how consensus is supposed to work. I edited the Preliminary research section to remove excessive content, speculation, and sources per WP:CITEKILL. Other editors may remove further content and sources. There are dozens of candidate mechanisms and drug compounds, and galectins are among them. Collectively, all this is early-stage research too preliminary for an encyclopedia; see this section in WP:WHYMEDRS. --Zefr (talk) 15:01, 2 May 2019 (UTC)

ZefrTwo of the references that you removed are very important - the review paper in Oncology Letters, and the paper in the journal Nature. The editor on medpage talk agreed with me that these are strong references. This is NOT merely another molecular mechanism buried among other candidates, but rather the most promising new area of research in pancreatic cancer. There are drugs in clinical development (not mentioned) that inhibit galectins which are promising, yet you want to suppress even the fundamental research in this area with your edits. You are making instant reversions without understanding the implications of hiding this information from the cancer community.Fpbear (talk) 15:24, 2 May 2019 (UTC)

This is your opinion which is WP:OR, so please wait until several other editors agree with you. You are relying on your own interpretations about importance and speculating about future success, WP:CRYSTAL. An encyclopedia expects much more advanced research. Please read WP:MEDASSESS and WP:WHYMEDRS to improve your understanding about encyclopedic sources. --Zefr (talk) 15:41, 2 May 2019 (UTC)

ZefrActually, this research is well established as evidenced by the many review papers in top journals. It sounds like you are unfamiliar with this area of research so you are reacting with your WP:OR to revert these additions. For now I have kept your revised text and added back the two important references because one of them is a comprehensive secondary review, and the other is a very important finding in the journal Nature.Fpbear (talk) 15:56, 2 May 2019 (UTC)

(←) I think it is very easy to overemphasise new research findings. A good secondary source will place new findings in context, and how they might affect diagnostics and therapeutics in the future. If there is a secondary source that says that galectin signalling is hugely likely to lead to such developments, such a source can be cited to that effect. I would support 1-2 sentences at most at this stage. JFW | T@lk 16:57, 2 May 2019 (UTC)

JfdwolffIndeed, there are secondary sources that describe how targeting galectin is a very promising therapeutic approach (for example the Munkley reference). This is backed up by a number of primary sources in top journals (e.g. the Nature reference) regarding the critical role of galectin in pancreatic cancer.Fpbear (talk) 17:30, 2 May 2019 (UTC)

JfdwolffI do not understand why you removed the secondary source reference (Munkley). This is perplexing because in your writing above, you state that "A good secondary source will place new findings in context, and how they might affect diagnostics and therapeutics in the future" which I completely agree with. Then shortly after writing this, you removed the secondary reference! Did you do this by accident? This is a very good review paper that compiles research that was published in other top journals. Although this particular review paper is not itself in journal with a very high impact factor, please recognize that pancreatic cancer is a specialized field of oncology, so the reviews in this field are often found in specialized publications.Fpbear (talk) 17:30, 2 May 2019 (UTC)

Please sign your posts. Could you clarify what the Munkley reference adds to the source that is already cited? Also, please do not separately approach me on my talk page. JFW | T@lk 17:28, 2 May 2019 (UTC)

JfdwolffThe Munkley reference has a more comprehensive review of how aberrant glycosylation is involved in pancreatic cancer, with a more comprehensive picture of the rationale for targetin galectins, in the context of pancreatic cancer. The existing reference is much more general, and the two references would complement each other. Fpbear (talk) 17:37, 2 May 2019 (UTC)