Survival and reduction in mortality from breast cancer
Notice bibliographique
Résumé
# Impact of mammographic screening is not clear {#article-title-2} EDITOR—We should all rejoice that there has been an improvement in survival and reduction in mortality for carcinoma of the breast, but Richards et al in their paper perpetuate the myth that this is related to the breast screening programme.1 The periods for comparison were 1981-5 and 1986-90. The Forrest report on mammographic screening was published in 1986,2 the first screening centres were established in 1988, and the country was not covered by the programme until 1990. Even the greatest zealots for mammographic screening would not expect an impact on mortality until 1997. The fall in mortality could therefore be attributed only to improvements in treatment, and it is relevant to note that the first overview of the trials of adjuvant systemic treatment were published in 1985.3 The only support for the assertion that the reduction in mortality can be attributed to the breast screening programme was a personal communication from S M Moss. Many people are of the opinion that mammographic screening is saving thousands of lives, but opinion alone does not provide sufficient data to support a publication in a prestigious journal such as the BMJ . 1. 1.↵1. Richards MA, 2. Stockton D, 3. Babb P, 4. Coleman MP . How many deaths have been avoided through improvements in cancer survival? BMJ 2000;320:895–898. (1 April.) [OpenUrl][1][Abstract/FREE Full Text][2] 2. 2.↵1. Forrest P . Breast cancer screening: Report to the Health Ministers of England, Wales, Scotland and Northern Ireland. London: HMSO, 1986. 3. 3.↵1. Early Breast Cancer Trialists Collaborative Group . Effects of adjuvant tamoxifen and of cytotoxics on mortality in early breast cancer: an overview of 61 randomised trials amongst 28,896 women. N Engl J Med 1988;319:1681–1692. [OpenUrl][3][PubMed][4][Web of Science][5] # Diagnostic practice in the United States is different {#article-title-5} EDITOR—Richards et al seem to have made inferences about “deaths avoided” using data on five year survival.1 This measure is, however, powerfully affected by diagnostic practice and is not a reliable indicator of mortality.2 In the United States the problem is best exemplified by prostate cancer. Five year survival has increased from about 40% in the 1950s to about 95% currently.3 Although it is tempting to conclude that we Americans have made major medical advances (and left the United Kingdom in the dust), the truth is that this largely reflects our diagnostic practice. As we aggressively seek and find early stage (and often innocuous) tumours, … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DRichards%26rft.auinit1%253DM%2BA%26rft.volume%253D320%26rft.issue%253D7239%26rft.spage%253D895%26rft.epage%253D898%26rft.atitle%253DHow%2Bmany%2Bdeaths%2Bhave%2Bbeen%2Bavoided%2Bthrough%2Bimprovements%2Bin%2Bcancer%2Bsurvival%253F%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.320.7239.895%26rft_id%253Dinfo%253Apmid%252F10741993%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=320/7239/895&atom=%2Fbmj%2F321%2F7274%2F1470.2.atom [3]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.volume%253D319%26rft.issue%253D26%26rft.spage%253D1681%26rft.epage%253D1692%26rft.atitle%253DEffects%2Bof%2Badjuvant%2Btamoxifen%2Band%2Bof%2Bcytotoxic%2Btherapy%2Bon%2Bmortality%2Bin%2Bearly%2Bbreast%2Bcancer.%2BAn%2Boverview%2Bof%2B61%2Brandomized%2Btrials%2Bamong%2B28%252C896%2Bwomen.%2BEarly%2BBreast%2BCancer%2BTrialists%2527%2BCollaborative%2BGroup%26rft_id%253Dinfo%253Apmid%252F3205265%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=3205265&link_type=MED&atom=%2Fbmj%2F321%2F7274%2F1470.2.atom [5]: /lookup/external-ref?access_num=A1988R516200001&link_type=ISI
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,038 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,004 | 0,007 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».