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* IMO the lead should be written in simpler language. We should not be trying to cram everything into a single sentence as well this may be fine for those who speak English as a native language and are highly educated, those from other countries and with a less academic background may have difficulty with the complicated syntax. * IMO the lead should be written in simpler language. We should not be trying to cram everything into a single sentence as well this may be fine for those who speak English as a native language and are highly educated, those from other countries and with a less academic background may have difficulty with the complicated syntax.
* IMO we should go with "HPV vaccines reduce the risk of cervical cancer. They were developed in the early 21st century." ] (] · ] · ]) (if I write on your page reply on mine) 18:58, 17 June 2014 (UTC) * IMO we should go with "HPV vaccines reduce the risk of cervical cancer. They were developed in the early 21st century." ] (] · ] · ]) (if I write on your page reply on mine) 18:58, 17 June 2014 (UTC)
*I think that you suggesting is a good idea, and would be a fine alternative. However, some people like longer sentences. I completely deny that I have been editing aggressively. I think that your use of TW should have been used with a better edit summary, even if I was not been working on the page. ] has modified the same line, which needed re-phrasing, three times, without putting in the required extra meaning. I would rather work to improve the page. My third edit to the page was not a revert, but followed the general format as indicated by ] and ] in discussion on this talk page. ] (]) 19:25, 17 June 2014 (UTC)

Revision as of 19:25, 17 June 2014

Cervix

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I've listed this article for peer review because I believe in striking while the iron is hot -several editors have invested time in writing and reviewing this article in recent months (LT910001, 97198, CFCF, Snowmanradio and TonyTheTiger to name some) and I think it'd be great to push on to FAC while the article is still fresh in folks' minds. It's a while since I've done something so bvroadly collaborative but this is what the wiki is supposed to be about, so let's try an examine constructively what needs doing from here on. As this is a Peer Review, there's no set expiry nor obligatory tasklist. I think this will then provide a better template for other anatomy/medical articles if an FA than a GA. Also always good to get broader articles to FA status.

I think it needs a non-human section but would not know what the best sources are for that. And also needs some expansion on its three layers.

(NB: My edition of Gray's Anatomy is 1967 - if anyone has a recent one, that'd be great!)

All comments welcome - cheers, Cas Liber (talk · contribs) 02:12, 11 June 2014 (UTC)

Images

  • Oddly, the "cervix" label (12) does not seem to be pointing at the cervix. The labels for "urethra" (6) and "vagina" (7) seem to fall short. The label for "sigmoid colon" (9) could be better placed too. Axl ¤ 09:17, 11 June 2014 (UTC)
I think it might be very hard to get anything additionally out of this image. There is an image in Grant's anatomy that might be useful, but not really anything like this. My best suggestion would be to try and get someone to vectorise it. I'll supply some alternative images for the article soon. -- CFCF (talk · contribs · email) 15:07, 11 June 2014 (UTC)
Some alternatives or something to source a new image from:

Note, any of the images from Sobotta 1906 I can find and upload in higher quality on request. Currently there are so many I don't have time to get them all properly.

  • Same type
  • Lacking relevant labels, and non-colored. Otherwise of higher quality. Lacking relevant labels, and non-colored. Otherwise of higher quality.
  • Also lacking labels Also lacking labels
  • Black and white, otherwise well labeled Black and white, otherwise well labeled
  • Same image as above, no labels Same image as above, no labels
  • Different dissection Different dissection
  • Different dissection, no labels Different dissection, no labels

May be good sources to build a new image from.

  • Additional angles
  • Cross sections
-- CFCF (talk · contribs · email) 15:37, 11 June 2014 (UTC)
Just realised I missed this image (that I had uploaded myself):
  • Split - lateral Split - lateral
  • Split - anterior Split - anterior
Can be cropped so that it only has the top image (or the bottom one for that matter).
-- CFCF (talk · contribs · email) 15:47, 11 June 2014 (UTC)
Several of the sagittal section images look good, although some have partially faded text. It may be best to use one that doesn't have labels, and add the labels yourself. Axl ¤ 16:09, 11 June 2014 (UTC)
Okay, that can be fixed by uploading equivalent images from the 1913 edition. I wasn't sure if there was any point, but in that case I will do so. -- CFCF (talk · contribs · email) 18:57, 11 June 2014 (UTC)
Thanks. Axl ¤ 11:20, 12 June 2014 (UTC)
FWIW, Agree with choosing a labelless one and adding the words ourselves. Cas Liber (talk · contribs) 14:41, 12 June 2014 (UTC)

I've uploaded a much higher resolution image of:

I'm presuming this is the preferred image as it has no labels etc. and would be the best to modify. Do you think we also ought to colorize it in the same way as the current lead image is colored? I think it could be made to look pretty okay. -- CFCF (talk · contribs · email) 03:44, 15 June 2014 (UTC)

Note:I got hold of a new 1906 source of Sobotta's with better scans, and all these images have now been updated. -- CFCF (talk · contribs · email) 04:27, 15 June 2014 (UTC)

Other comments

  • From the lead section, paragraph 2: "The extent of the dilation of the cervix is used by midwives and medics to assess the progress of labour." "Medics"? Axl ¤ 09:23, 11 June 2014 (UTC)
tweaked Cas Liber (talk · contribs) 13:09, 11 June 2014 (UTC)
Thanks. Axl ¤ 16:12, 11 June 2014 (UTC)
Out of interest, what was wrong with "medics"? Snowman (talk) 18:56, 11 June 2014 (UTC)
Medic carries certain associations to the military (at least in the US), and I at least feel it's better to simply use doctor or physician instead. It isn't inherently wrong, just not entirely correct either. -- CFCF (talk · contribs · email) 22:41, 11 June 2014 (UTC)
I did not know that about its meaning in USA. Medic is simply equivalent to medical doctor in the UK. Snowman (talk) 23:08, 11 June 2014 (UTC)
Medic is not simply equivalent to medical doctor in the UK. The term "medic" is often used colloquially by Emergency Department staff, surgical staff and other non-internists to mean "physician", i.e. internal physician. (Personally, I don't like this terminology.) Also, once when I was at an Advanced Life Support course, I asked a guy which department he worked in. He told me that he was a "medic", which surprised me because I did not recognise him from the hospital. It turns out that he was a paramedic. Axl ¤ 11:25, 12 June 2014 (UTC)
Now that I have thought about this more, I would agree with User Axl. Medics could also be a colloquial term for medical students. I recall avoiding adding "doctor" and choosing "medic" for the introduction, because I thought "doctor" could include PhD doctor, but in context in the introduction it is clear that "doctor" means "medical doctor". Snowman (talk) 11:46, 12 June 2014 (UTC)
It's just too informal anyway, and vague because informal. Wiki CRUK John (talk) 14:16, 12 June 2014 (UTC)
  • From the lead section, paragraph 3: "Infection with the HPV virus can cause changes in the epithelium." "HPV virus" is a tautology. It may be better to spell out "human papillomavirus", at least on its first appearance. Axl ¤ 09:27, 11 June 2014 (UTC)
tweaked Cas Liber (talk · contribs) 13:09, 11 June 2014 (UTC)
Thanks. Axl ¤ 16:15, 11 June 2014 (UTC)
  • From "Structure", paragraph 1: "Part of the cervix protrudes into the vagina and is referred to as the ectocervix, and the part within the external opening and vagina is known as the endocervix." The latter half of the sentence does not seem right. Axl ¤ 12:55, 11 June 2014 (UTC)
Done I changed the wording to be less ambiguous, it should be correct now. -- CFCF (talk · contribs · email) 15:05, 11 June 2014 (UTC)
That's not correct. The endocervix is the mucous lining within the canal (or, less commonly, the internal os). Axl ¤ 16:21, 11 June 2014 (UTC)
User Axl is correct. The endocervix is to the cervix as the endometrium is to the uterus. The ectocervix is another name for the vaginal portion of the cervix, the visible part with a stratified squamous covering. Snowman (talk) 18:23, 11 June 2014 (UTC)
Which is to be honest what I meant, but I understand the confusion. I'll try and clarify tomorrow. I'm not sure how all the sources define the myometric layer adjacent to the cervix. Is it a part of the cervix or not though? Our text claims it is, and then of course I see the reason for misunderstanding. -- CFCF (talk · contribs · email) 19:55, 11 June 2014 (UTC)
The cervix approximately a cylinder with a narrow channel along the middle, much of the wall of the cervix is a thick tough layer of smooth muscle, which is continuous with the smooth muscle wall of the corpus uteri. The supravaginal cervix is the part of the cervix that does not protrude into the vagina, which is what you seemed to be confused with. The vaginal part of the cervix is the part that protrudes into the vagina. I should add that I not sure if it is necessary to define supravaginal and vaginal parts of the cervix in the article, unless it helps to understand endocervix. I think that gives you enough information to have another go at re-writing it tomorrow with RS. Incidentally, it is not generally necessary to put ticks when providing feedback, because the person who raised an issue will usually cross-out his comment with strike marks when he is happy with it. Snowman (talk) 20:24, 11 June 2014 (UTC)

I'm not sure it is really this clear cut. I realise I've confused endocervical canal with endocervix or endocervical, but I don't think I'm the only one to do so. For example: endocervical is ambiguous in the way I've been using it according to: . Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier. says endocervical = intracervical

I would not use the on-line free dictionary for mission critical tasks. Snowman (talk) 23:11, 11 June 2014 (UTC)
That online dictionary is simply a repository for other dictionaries. I have even linked the book it is cited from, so I don't know what you are referring to? Are you suggesting they are misattributing this to Mosby's Medical Dictionary, because my library carries that volume and I can bring the entire reference if you feel the need for me to do so, even for the purpose of this discussion. -- CFCF (talk · contribs · email) 07:37, 12 June 2014 (UTC)
Excuse me, but I did not understand your comment, because I thought that the small text was an extra definition. I have not considered "endocervical = intracervical" in depth, but at first glace there does not seem to be anything wrong with it. There is a disclaimer at the bottom of every page in the free dictionary that includes the statement; "This information should not be considered complete, up to date, and is ...". Any comments? Snowman (talk) 08:33, 12 June 2014 (UTC)

On a lesser note, we're talking about the smooth muscle layers surrounding the cervix, what is the correct term? What term should we use?
Are they considered myometrium googlePubmed, myocervix googlePubmed , or should we name them at all?
Should we mention exocervix Pubmed 118 hits, wikt:exocervix. I realise this is pretty pedantic, but if we're aiming for FA maybe we need to define this? -- CFCF (talk · contribs · email) 22:14, 11 June 2014 (UTC)

I would not use the Witionary for mission critical tasks. Snowman (talk) 23:11, 11 June 2014 (UTC)
No, my reason for linking there is simply to show the article. If we find it isn't a proper term we should remove that entry. -- CFCF (talk · contribs · email) 05:36, 12 June 2014 (UTC)

states the exocervix is to the ectocervix, what the endocervix is to the cervical canal. Relevant? -- CFCF (talk · contribs · email) 22:25, 11 June 2014 (UTC)

Netter's Essential Histology says the same thing (and is a much newer source). I'll look into clarifying this tomorrow. -- CFCF (talk · contribs · email) 22:49, 11 June 2014 (UTC)

Terminologia Histologica's definitions don't give me much clarity personally: -- CFCF (talk · contribs · email) 22:35, 11 June 2014 (UTC)

I have amended the section we have been discussing. I think that it is important to give a good description of the anatomy; however, I think it is possible to go over-the-top with naming of parts. I do not mind defining them all, but I think that it is not necessary or helpful to include the obscure names. I would suggest calling the muscle of the cervix something descriptive and clear like the "muscular wall of the cervix" and using other descriptive phrases in a similar way. My Gray's does not have a specific name for the cervical muscle layer. I think that it is not important to define the word "myocervix". However, Gray's does use a phrase "isthmus of the cervix" and I think that this region should be included, because of its differences from the rest of the cervix. I am in two minds about including the word "exocercix" (the covering of the vaginal portion of the cervix), but I have put it in at present with a cn tag. Snowman (talk) 09:59, 12 June 2014 (UTC)
I added the Netter source, so no longer cn at least. -- CFCF (talk · contribs · email) 10:46, 12 June 2014 (UTC)
Fine. Thank you finding a ref. Snowman (talk) 10:52, 12 June 2014 (UTC)
Damn, I wasn't expecting this much debate over it. I have made a slight adjustment to the current text. Axl ¤ 11:38, 12 June 2014 (UTC)
The debate was about a raft of terminology. Thank you for fixing the minor typos. 11:49, 12 June 2014 (UTC)
Agree about keeping it simple - the other thing we could do is have a footnote that mentions alternative names maybe. Cas Liber (talk · contribs) 14:44, 12 June 2014 (UTC)

I have used footnotes ({{efn}} and {{notelist}}) in other anatomy articles and feel these offer a good way to cover specific, technical or nuanced content that may clutter up text and impact on readability for lay people. Such a note could read "Alternate names for these include..." --LT910001 (talk) 01:24, 13 June 2014 (UTC)

I think this is the best solution. The problem now is among other things that we define exocervix in the main structure section, where it really has more relevance is in the histology section. If you're all fine with it I will research the different terms and try to define all of them under footnotes. Terms I will be explaining:
  • Parametrium
  • Endocervix vs. endocervical vs. endocervical canal
  • Cervical myometrium, myocervix
  • Exocervix
Clarifying the terminology in the main text would be clutter, but I feel a short footnote and a link would be useful as some of the terms are being used in research. -- CFCF (talk · contribs · email) 07:17, 13 June 2014 (UTC)
  • Some of the convert templates are not suitable; for example 2–3 centimetres (0.79–1.18 in). 0.79 inches should be expressed as 0.8 inches while at the same time stating the range as 0.8 to 1.2 inches. Would it be best to write out all the convert template out in full? Snowman (talk) 12:19, 12 June 2014 (UTC)
Yes-I am perplexed by this as I added the sigfig=1 parameter and it didn't work for some reason. Cas Liber (talk · contribs) 14:44, 12 June 2014 (UTC)
I have just read the documentation for Template:Convert, and I think that I understand it a bit better now. I think it is better to use a "precision" parameter of "1" for the range of the length of the cervix, so that the conversion is presented to an accuracy of one decimal point. Snowman (talk) 22:12, 15 June 2014 (UTC)
  • From "Structure", paragraph 3: "The cervical canal... can measure 7–8 millimetres (0.3–0.3 in) at its widest diameter in pre-menopausal adults.... Where no natural childbirth has taken place, the external os appears as a small, circular opening of about 8 millimetres (0.3 in)." It is odd that the widest diameter could be narrower than the external os. Axl ¤ 19:02, 12 June 2014 (UTC)
The source for that is given at "Blaustein's Pathology of the Female Genital Tract (4th ed.). New York, NY: Springer New York. pp. 185–201." Unfortunately, the page range has been given as a 16-page range, which is probably not consistent with WP:V, and might be difficult to verify quickly. I do not have access to the 4th edition of this book, but I have been looking at the 5th edition in Google books, which gives partial on-line access. I can not trace the equivalent likely updated page from the 5th edition without a narrower page range to work with, so I would be grateful if anyone could provide a narrower page range for the ref from the 4th edition. A large page-range like this from a book is likely to be questioned at FA. I have amended the article using the 5th edition and hope that I have sorted out this problem, at least for a first re-write of this part of the text. Snowman (talk) 12:57, 14 June 2014 (UTC)
Okay, thanks. Axl ¤ 15:09, 14 June 2014 (UTC)
Missing content

It's great to have such a collaborative endeavour on one of WP's anatomy articles. For FA I agree with Casliber that a section about the cervix in non-humans would be very appropriate. --LT910001 (talk) 07:16, 12 June 2014 (UTC)

I posted a note at the veterinary wikiproject...fingers crossed! Cas Liber (talk · contribs) 15:16, 12 June 2014 (UTC)

Society and culture

I am also trying to find any information about traditional knowledge of the cervix in non-Western cultures and societies, and any social and cultural beliefs or traditions regarding the cervix, something often overlooked in anatomy articles. --LT910001 (talk) 06:59, 12 June 2014 (UTC)

I'm not sure where to start and would value if other users had some idea where to find this content, so I'll just jot down some sources that may be used in the future:

  • Cervix in ancient Chinese culture
  • Cervix in the middle east, approx 1000AD:
  • Pessaries in ancient India:
  • Cervix and birth control from Egypt onwards:

Feminism & the cervix

  • Summary:

I'm sure there are many more. Please add any relevant sources to the list. Only reliable sources will be used in the article proper, but other sources may provide a useful starting point for further research. --LT910001 (talk) 07:30, 12 June 2014 (UTC)

This is a fantastic idea - am just going to sleep now but will look later - {ping|LT910001}} I think this will be good material to add definitely, just read and go for it. Cas Liber (talk · contribs) 15:16, 12 June 2014 (UTC)

The missing link - Cervical screening

The whole screening passage should be re-written to talk about "screening" instead of "Pap tests" - an undesirable US-led way of looking at things. This will also save you from having to make up your minds how to capitalize pap/Pap - currently all over the place. It would be nice if someone could add more on the issue of the varying international starting ages at Cervical screening while at it. You might mention, as cervical cancer doesn't, falling rates in the developing world, which has "almost 70% of the global burden" (WHO World Cancer Report 2014, p. 466) as their economies and healthcare improves, and rising rates in some Eastern European countries. Wiki CRUK John (talk) 14:16, 12 June 2014 (UTC)

Need to re-read this bit again in article (tired now) but warming to this. Cas Liber (talk · contribs) 15:16, 12 June 2014 (UTC)
A good alternate solution. Could be a defined subsection in 'cervical cancer'. --LT910001 (talk) 01:18, 13 June 2014 (UTC)
I think "Cervical screening" could have its own section, rather than being subsection of "Cervical cancer". Snowman (talk) 18:53, 13 June 2014 (UTC)
I've just chiselled out the nub of a section - would agree on it being separate as it is a big topic - the discussion also has to cover HPV and precancerous changes. Looking on google scholar and just typing in keywords is a bit frustrating as older articles keep popping up, but by following some links I have found , , , and . There is also page 333 onwards in the Cervix Book but it is amazing how quickly technology is evolving so I am careful to check for latest (and hence read the latest articles). There is alot about anxiety as well. Anyone is welcome to read and add content. I will try but might be caught up in real life chores soon. Cas Liber (talk · contribs) 21:09, 14 June 2014 (UTC)
I understand that cervical screening has quite a lot of international variation, so writing a balanced short summary of it seems difficult to me. However, lets not forget the anxious and the "worried well", such as those women who are invited for annual smears for a while to follow-up a slight abnormality (perhaps mild or moderate dyskaryosis seen on the cytology test) which can eventually revert back to normal or alternatively can get worse. Also, I am sure that the concept of CIN was important, as well as the new nomenclature of SIL. Snowman (talk) 23:03, 14 June 2014 (UTC)
I used the "The Cervix" book as a ref in the development section with the name <ref name=Cervix2006>. Snowman (talk) 12:55, 16 June 2014 (UTC)
I think we can use the source judiciously. It provides some global/consensus-type material. Specific figures might be better referenced with Review Articles though. Cas Liber (talk · contribs) 13:34, 16 June 2014 (UTC)
I have not used the WHO website as a source, but after a quick look it seems quite good to me. Snowman (talk) 15:16, 16 June 2014 (UTC)

Organising the screening and cancer material is a bit of a headache. I am going to bed and have no objection to folks trying to make the material flow better. More data needs to be added too. Cas Liber (talk · contribs) 14:59, 16 June 2014 (UTC)

Likewise, I am thinking about amendments to screening, cytology and histopathology. I have put down a solid "foundation stone" today (or at least that is the way I see it) with clarification of the functional SCJ, original SCJ and the transformation zone. I hope the new vocabulary will help a lot in subsequent explanation of pathogenesis, cytology and histopathology. I have made a first re-write of the histology section, but it will probably need a footnotes. Snowman (talk) 15:13, 16 June 2014 (UTC)

Jmh649 has recombined the sections and upon reading it, I think they flow better this way and agree with the merge. Cas Liber (talk · contribs) 06:18, 17 June 2014 (UTC)
If screening was done for anything other than cancer than yes it would need a different section. There is screening for STIs but this is often not cervical and is not typically referred to as cervical screening. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:22, 17 June 2014 (UTC)
I think that cervical screening as a separate heading or merged with the cancer section both work; but in the merged section I think that the heading should be something like "Cancer and cervical screening". Snowman (talk) 07:23, 17 June 2014 (UTC)
IMO we should keep the heading short. I am happy with cancer screening. Cervical is not really needed as that is the name of the article in question. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:35, 17 June 2014 (UTC)

Names

At the risk of opening a kettle of fish, we are starting to give multiple names for things, a problem identified by Snowmanradio above. Examples include "external orifice of the uterus (or external os) " and "posterior labia (lip-shaped structures). ". I suggest that one name is picked, and alternate names are removed and defined in the sub-articles. Having more than one name is quite confusing, and in some instances such as "posterior labia (lip-shaped structures). " it feels like we are paraphrasing ourselves and ought to just choose a single title. --LT910001 (talk) 01:29, 13 June 2014 (UTC)

I do not understand what you mean by opening a "kettle of fish" (or awkward situation). I do not see any risk of this developing into an awkward situation, because I anticipate that people can discuss this topic logically and objectively here. Excuse me, if I am not aware of previous discussion that may have taken place in WP Anatomy on this topic. Personally speaking, I would rather not made a rule for this sort of thing here nor on any other anatomy article. I think that some alternative names can be useful to know immediately and that a wait for a few clicks for clarification could be distracting. Alternative names can be seen in Wiki articles almost everywhere, so it is a concept that readers are familiar with and so this style need not be confusing. I would think that mentioning some commonly used alternative names once in the body of the article or introduction can be helpful to readers. I can envisage sometimes that it could problematic picking only one name to use. Many of the sub-articles have longish descriptive titles (for example external orifice of the uterus and vaginal portion of the cervix) suggesting that these are the commonly used names for these structures, and superficially these would seem to be the names to choose, if one name was chosen. Some examples of alternative names for discussion: Snowman (talk) 10:57, 13 June 2014 (UTC)
  • "body of the uterus (or corpus uteri)" would be one of the few Latin names I would include in this article, partly because "cervix uteri" is also included. I think that having the Latin names for both parts of the uterus is complementary. Snowman (talk) 10:57, 13 June 2014 (UTC)
  • Whoops, I did not explain that very well. "corpus uteri" and "cervix uteri" are names that are complementary to each other, and easy to understand. I did not mean to imply that using them is compulsory. Snowman (talk) 20:49, 15 June 2014 (UTC)
Its very likely it isn't used in Gray's, but that doesn't mean it doesn't exist. Gray's isn't the only source out there, the reason I brought it up was because there are pubmed articles that use the terminology. That said it isn't normal terminology at all, so I would advise against mentioning it anywhere else than a foot-note (most definitely does not deserve an article of its own). If you're looking for sources for names you should be looking at Terminologia Histologica & Anatomica. I'm trying to find a source with a definition, not just usage so that we don't commit to WP:OR. -- CFCF (talk · contribs · email) 11:27, 13 June 2014 (UTC)
I think that you have presented a good case for putting the term "Myocervix" in a referenced footnote providing a RS is available. I noticed the term "myocervix" in a few papers, when I searched for it. I would anticipate that a new redirect could be made for "Myocervix", which would lead to "Cervix". I look forward to seeing what you make of it. Snowman (talk) 18:36, 13 June 2014 (UTC)
I think that using "smooth muscle layer" is probably easier for the layperson to read than "myocervix" as the term is not particularly common - I am leaning towards that being in a footnote. Will check some more sources. Cas Liber (talk · contribs) 20:41, 15 June 2014 (UTC)
For instance, this book appears not to use the term at all. Cas Liber (talk · contribs) 07:14, 16 June 2014 (UTC)
  • "The transformation zone, also referred to as the squamocolumnar junction, ...". The in-line ref provided is; "Daftary (2011). Manual of Obstretics, 3/e. Elsevier. pp. 1–16. ISBN 81-312-2556-9.". I have verified that the ref says that the abrupt epithelial junction is called the squamocolumnar junction, but I have not been able to confirm that the source regards this junction as equivalent to the transformation zone, but perhaps I missed it. The cite has sourced a 17 pages (ie pages 1 to 16), which is too large for WP:V from a book. I have some difficulty with verification, and I have only focused on the likely sections on the cervix rather than reading all 17 pages. In other books and on the internet (? RS), I have found two definitions of the transformation zone, one as above and the other that it is the zone between the original sc junction and the current sc junction (ie the zone of unstable epithelium). Snowman (talk) 19:56, 15 June 2014 (UTC)
I have used an alternative book references for the transformation zone. I will probably need to add some footnotes to explain the "original scj", "new scj", "functional scj" and transformation zone. Snowman (talk) 15:03, 16 June 2014 (UTC)

Headings

  • "Contraception" is currently a level three subsection under the level two heading "Function". I am thinking about moving "Contraception" to its own level two heading, because contraception does not seem to fit under the heading of functions of the cervix to me. Does "Contraception" fit under the "Clinical significance" heading? Snowman (talk) 15:30, 16 June 2014 (UTC)
  • Hmmm, I see what you mean, but "clinical significance" makes me think of pathological processes. I thought it might be better as a level 4 heading under fertility. Incidentally, I think cervical mucus should follow on from fertility Cas Liber (talk · contribs) 20:30, 16 June 2014 (UTC)
  • Those were just some my thoughts about where to move the contraception section to. As the article develops, it should be clearer where to move the contraception section to. A level four heading, under a level three "Fertility" heading would still be under the level two "Function" heading, which seems problematic, because contraception is not a function of the cervix. If "Contraception" was put in its own level 2 heading, then it would not be in the "Function" nor "Clinical significance" section. I have difficulty in interpreting "Hmmm", what does that mean? Snowman (talk) 21:33, 16 June 2014 (UTC)
To me, the heading "Structure" is not quite right for what is in the section. To follow on from your comment on the talk page, I presume that the heading can be changed from "Structure" to "Structure and anatomical relations" for clarity. Snowman (talk) 21:33, 16 June 2014 (UTC)
I'm not sure other mammal cervixes are that notable - need to read up on it. Cas Liber (talk · contribs) 01:08, 17 June 2014 (UTC)

Citation format

what parameters are you concerned about? Do you see two styles being used? I am thinking it is "Smith, John; Doe, John. etc." Cas Liber (talk · contribs) 06:19, 17 June 2014 (UTC)
Oh I see - the sfn template is good. Cas Liber (talk · contribs) 06:20, 17 June 2014 (UTC)
No this article is current written with the cite journal and cite book templates. That means without clear consensus we do not switch the entire article to another template format. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:32, 17 June 2014 (UTC)
I only meant using it for books for which more than one pagerange or pageref is used. For instance, if you look at Canis Major, the vast majority of refs are in that format you mention, but I've had to use several books for which different pages have been used, and the sfn allows this. Cas Liber (talk · contribs) 12:12, 17 June 2014 (UTC)

Introduction

  • There are some niceties of the terminology for the introduction. CIN is a form of cancer, but not a form of invasive cancer. Cervical screening can detect cancer of the cervix at a stage prior to invasion. The text that is relevant here is: Snowman (talk) 08:01, 17 June 2014 (UTC)
1. "Cervical cytology tests can often detect precursors of cervical cancer" - this would mean that screening would only detect HPV changes, because CIN is a form of cancer. Snowman (talk) 08:01, 17 June 2014 (UTC)
2 "Cervical cytology tests can often detect precursors of invasive cervical cancer" - this would mean that screening would only detect HPV changes and pre-invasive cancer. Which is correct, because CIN is cancer, but not invasive cancer. Snowman (talk) 08:01, 17 June 2014 (UTC)
  • With regards to vaccination, a vaccination does not stop viruses from entering the body. An infection does occur, the memory within the immune system boosts the relevant antibodies within about 2 days, and so the infection does not become serious. The terminology for discussion here is as follows: Snowman (talk) 08:01, 17 June 2014 (UTC)
1. "HPV vaccines, developed in the early 21st century, can be given to prevent HPV infection." - not accurate. Snowman (talk) 08:01, 17 June 2014 (UTC)
2. "HPV vaccines, developed in the early 21st century, can be given to combat HPV infection." Snowman (talk) 08:01, 17 June 2014 (UTC)
  1. First comment "CIN is a form of cancer". Not exactly. CIN is a neoplasm but not a cancer. This is not the greatest source but it is correct when it states CIN is not cancer As I wrote on the talk page cancer is by definition invasive. Check out the definition by the NCI . CIN is not cervical intraepithelial cancer but cervical intraepithelial neoplasm. This is why it is an N and not a C
  2. If we read about what the Template:Main is we find that "This template is used after the heading of the summary, to link to the sub-article that has been (or will be) summarised" This section is about the role of the cervix in childbirth it is not a summary of childbirth. Thus main article for it would be "Childbirth and the cervix"
  3. Does the HPV vaccine "combat" which implies treats HPV infection once establish? As far as I am aware the answer is no. If you have a high quality ref that shows otherwise happy to look at it. The evidence we do have is that the CDC says prevents HPV and the NCI and FDA also say prevents HPV infections

To make discussion go smoothly please provide references for all medical states per WP:V. Per the comment regarding TW I am not under the impression that it is used just for vandalism. I reverted your edit assuming good faith. Per WP:TW "should not be used to undo good-faith changes unless an appropriate edit summary is used" and I agree that I should have used a better clarified edit summary. However I had made a detailed talk page comment here Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:09, 17 June 2014 (UTC)

To me, a revert with combined with edit summary "Yup it is not cancer I agree", see your edit is not ideal. The edit summary did not say that anything about the discussion you started on the talk page, which I was not aware of until you linked it on this page. I note that you report that you should have used a better edit summary. Snowman (talk) 09:00, 17 June 2014 (UTC)
  • I had not included references in the discussion initially while I explore other users knowledge of the relevant issues. Specialized references will be needed, because the concepts are not particularly well explained in the mass media and in patient information leaflets. See Carcinoma in situ. CIN is a spectrum, the severe end of CIN is a form of carcinom in situ. CIN (at least grade III and some of grade II) is cancer albeit in situ cancer. CIN I can be due to a number of causes. I think that it will be important to retain the concept of carcinoma in situ in the article, and I anticipate that it will be expanded upon in the article as it develops. Snowman (talk) 08:30, 17 June 2014 (UTC)
    • A great example of why Misplaced Pages is not a reliable source. Yes the first part of the Misplaced Pages article got it wrong when it stated "is an early form of cancer" but then it corrected itself "most doctors will refer to CIS as "pre-cancer", not cancer".
    • On page 34 of this document says "dysplasia: Cells that look abnormal under a microscope but are not cancer. LSIL, HSIL, and AIS are all forms of cervical dysplasia." Than if you look at page 36 it says "Cells of the uterine cervix that are moderately or severely abnormal and may become cancer. It may also be called moderate dysplasia, severe dysplasia, cervical intraepithelial neoplasia-2 (CIN-2), CIN-3, or carcinoma in situ."
    • Carcinoma in situ is not cancer. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:51, 17 June 2014 (UTC)
  • We would be looking for an accurate statement of the pathology and cell biology, and there is plenty of time do to this. This topic may be easy to misunderstand and there may be some misinformation out there. There is some information on the Cancer Research UK website, which is worth thinking about, but it might not be RS for the Wiki; their website says; "If you have ductal carcinoma in situ (DCIS), it means that cells inside some of the ducts of your breast have started to turn into cancer cells." To me this means that carcinoma in situ is cancer, albeit not an invasive cancer. This is this sort of think that User:Wiki CRUK John will be interested in. Snowman (talk) 09:26, 17 June 2014 (UTC)
"Starting to turn into cancer cells" means that they are not cancer yet.Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:31, 17 June 2014 (UTC)
The Cancer UK webpage goes on to say that "Doctors use various terms to describe DCIS, including pre invasive, non invasive, or intra ductal cancer." Snowman (talk) 12:12, 17 June 2014 (UTC)
That is breast cancer not cervical cancer. In this one type of "carcinoma in situ" there is some controversy regarding whether or not it is cancer. Per this book "Researchers and doctors disagree about whether DCIS is even cancer." Doctors use language poorly all the time. That is why we base stuff of reliable sources rather than say me :-) Anyway this is of topic. 18:48, 17 June 2014 (UTC)
I said I am happy with the removal of the word "invasive" - as tautological. Alternately we can think of both CIN and Ca as unwanted, hence "cancer" can cover both if taken broadly. Either way better without "invasive" Cas Liber (talk · contribs) 09:40, 17 June 2014 (UTC)
I am not convinced about the removal of the word invasive. I welcome the opinion of User:Wiki CRUK John about "carcinoma in situ" as described on the Cancer Research UK website. I would also welcome his opinion about today's modifications of other wiki pages on the concept of carcinoma in situ. The relevance to this page is that cervical screening detects abnormal cervical cells, the severely abnormal and severely dysplastic forms of which arise from an area of carcinoma in situ of the cervix, which is likely to be reported as CIN II or CIN III (older classification) or high-grade SIL or HGSIL; see University of Michigan website, CRUK about cervix, and CRUK about VAIN. Snowman (talk) 14:55, 17 June 2014 (UTC)
I have been thinking about "prevent" - I guess what can be said is that it doesn't prevent exposure but prevents infection (i.e. disease), so am happy with "prevent" Cas Liber (talk · contribs) 09:40, 17 June 2014 (UTC)
  • With regards the vaccination; It is worth thinking about the phrase "Some health effects caused by HPV can be prevented with vaccines" in the introduction at www.cdc.gov (again not RS for the wiki). The article is careful to avoid saying that HPV infection is prevented by HPV vaccination. It is about how vaccines and the immune system works that makes it impossible for a vaccine to entirely prevent an infection. The best that an active vaccine can do is to provide immunological memory and to enable quick production of clones of plasma cells to produce an appropriate antibody and fight off the infection within a few days, rather than the slower first-time immunological response which will take about 8 days to manufacture antibodies in quantity, although interferon is naturally produced sooner to combat viral infections. Snowman (talk) 09:42, 17 June 2014 (UTC)
    • Yes the CDC is a reliable source per WP:MEDRS. It produces "position statements from nationally or internationally recognised expert bodies". The page you linked to was not the page I linked to however. See were it says "Both vaccines are highly effective in preventing the targeted HPV types, as well as the most common health problems caused by them." Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:44, 17 June 2014 (UTC)

(edit conflict) Right, given we're trying to get the intro right, I reverted these two sentences as the combined sentence is not very long - separated it makes the flow very wooden. Cas Liber (talk · contribs) 09:49, 17 June 2014 (UTC)

  • The HPV vaccine is not even designed to give protection against all HPV infections, because there are about 80 to 100 strains of HPV and the vaccine only combats a few of these strains that tend to lead to suspicious viral changes in the cervix. All the other types of HPV infections including those that cause warts are not prevented by the vaccine. The current phrase "HPV vaccines, developed in the early 21st century, can be given to prevent HPV infection" is misleading; for example, it could mean that the vaccine also protects against wart inducing HPV viruses, which is wrong. HPV only gives protection against the targeted HPV types. The body of the article has it correct by saying; "Vaccines against HPV, such as Gardasil and Cervarix, also reduce the incidence of cervical cancer, by inoculating against the viral strains involved in cancer development.". The introduction should mirror the article. Snowman (talk) 09:59, 17 June 2014 (UTC)
Snowmanradio are you going to start providing reliable sources? This discussion is not productive without them. We are not here to decide how we think things should work. We are here to reflect reliable sources.
"inoculating" is not combating. Reliable sources do not use combating. This sort of terminology is used by the popular press. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:24, 17 June 2014 (UTC)
I think that you have not provided adequate RS to say that HPV vaccine can protect against all HPV strains of the virus including the wart forming strains, as the phrase "can be given to prevent HPV infection" implies. Normally, the introduction reflects the main body of the article, but your amendment of the introduction is not consistent with the paragraph about vaccination in the "Cancer" section, which specifically states that the HPV targets specific strains of the virus. Here is a reviewed article on HPV and vaccination at www.cancer.gov. Snowman (talk) 10:41, 17 June 2014 (UTC)
I never said "protect against all HPV strains" and the phrase "can be given to prevent HPV infection" does not imply that it protects against all cases / strains.
We say that the measles vaccine "can" prevent measles even though it is not 100% effective. We say morphine "can" help with pain even though it doesn't 100% of the time. We use English in medicine like this all the time.
The ref you have provided states "Both vaccines are highly effective in preventing infections with HPV types 16 and 18. Gardasil also prevents infection with HPV types 6 and 11." It does not say "combates HPV" Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:47, 17 June 2014 (UTC)
Do you think that the induction can be improved from what it is now? Perhaps, something like; "HPV vaccination protects against the strains of HPV that are most likely to lead to cancer of the cervix". Snowman (talk) 10:55, 17 June 2014 (UTC)

I would be happy with "can be given to reduce the risk of cervical cancer" or "can be given to reduce the risk of HPV infection". What I objected to was the word "combat". Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:00, 17 June 2014 (UTC)

I think that we should soon sort out what to put in the introduction with a number of constructive edits building upon the previous edits. I will amend the article, so please re-phase my English if it does not turn out clear after the first re-write and then I will have a look at what you have put, and so it until a satisfactory line is made. Alternatively, you can do the next first amendment. Snowman (talk) 11:10, 17 June 2014 (UTC)
We should probably get consensus here first before making the changes. And have someone else make the change. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:16, 17 June 2014 (UTC)

I expect that the amendment can wait a day or two while a consensus is formed. Should it also say that it is usually given to schoolgirls? What about: Snowman (talk) 11:53, 17 June 2014 (UTC)

I am not a fan of "can be given" as that implies optional, whereas both are part of established screening programs (i.e. one has to opt out not opt in) - I'd say "HPV vaccination protect against HPV infection and hence reduce risk of cervical cancer" Cas Liber (talk · contribs) 12:57, 17 June 2014 (UTC)
To build upon that, what about; "HPV vaccination protects against the main carcinogenic strains of HPV infection to reduce risk of cervical cancer". Snowman (talk) 13:07, 17 June 2014 (UTC)
Yes I like that, Jmh649, what do you think of the last one? Cas Liber (talk · contribs) 13:26, 17 June 2014 (UTC)
  • A couple of things. Snowmanradio is editing very aggressively. I placed a notice on his talk page that he had hit three reverts. Today he has continued and possible make a forth within 24 hours. I would recommend that his next edit be him reverting his changes.
  • IMO the lead should be written in simpler language. We should not be trying to cram everything into a single sentence as well this may be fine for those who speak English as a native language and are highly educated, those from other countries and with a less academic background may have difficulty with the complicated syntax.
  • IMO we should go with "HPV vaccines reduce the risk of cervical cancer. They were developed in the early 21st century." Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:58, 17 June 2014 (UTC)
  • I think that you suggesting is a good idea, and would be a fine alternative. However, some people like longer sentences. I completely deny that I have been editing aggressively. I think that your use of TW should have been used with a better edit summary, even if I was not been working on the page. User:Jmh649 has modified the same line, which needed re-phrasing, three times, without putting in the required extra meaning. I would rather work to improve the page. My third edit to the page was not a revert, but followed the general format as indicated by User:Casliber and User:Jmh549 in discussion on this talk page. Snowman (talk) 19:25, 17 June 2014 (UTC)
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