Comments to the letters by Per‐Henrik Zahl and Jan Maehlen and by Peter C. Gotzsche concerning our article: Increased incidence of invasive breast cancer after the introduction of service screening with mammography in Sweden
Notice bibliographique
Résumé
Dr. Gotzsche questions our statement that the randomized trials are less well suited for estimation of the level of overdiagnosis. In fact, we wrote that “in general” the trial time, i.e., the time the study group was invited to screening and the control group not invited, was too short in the Swedish trials and elsewhere to study the incidence when it has stabilized after the start of screening. We agree that the Malmö trial had a trial time long enough to study the stabilized incidence. However, in the Canadian trial, only 5 annual mammography examinations were accomplished for the invited group.1 Gotzsche gives a relative risk figure for incidence in the trials at Canada and Malmö.2 However, there are some reasons why this figure is not comparable with ours. The relative risk incidence figures were based on the first 7 and 8.8 years of follow-up. In our paper, we analyzed the incidence 7–15 years after the screening started. The first round was included in their analysis. The objective of mammography screening is to detect cancer early, which will lead to an increased incidence in the first round. It is, therefore, misleading to include the first round when studying incidence/overdiagnosis. Noninvasive cancer was included in the Malmö trial,3 while it was not in our study. Noninvasive cancer is more frequently detected in screening. We acknowledge the comment by Dr. Zahl and Prof. Maehlen about spontaneous regression. They made a comparison based on our figures, which showed that only a minor part (27%) of the difference between a screened and unscreened population can be explained by slow growing cancers. However, we believe that the figure is somewhat underestimated. There are two reasons for this. The attendance can be lower in women aged 70–74 years than in younger women. We do not know the attendance in all 11 counties in our study, but for the three counties where we know the figures, the attendance was 7–8% lower in 70–74 years than in 50–69 years. Women who had screen-detected tumor in age 50–69 that hypothetically would have been clinically detected after 70 years of age without screening and died before 70 years contribute to the figure 1648 but not to the figure 452. The probability of death between 50 and 69 is 10–15%. However, these remarks can only explain a minor part of the remaining cancers, and we agree that this may indicate that spontaneous regression may occur. However, the interpretation has to be careful because the estimation of expected incidence was based on historical data and we cannot exclude a break in the incidence trend because of changes in background factors contemporaneous with the introduction of service screening.
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 | 0,015 | 0,119 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,003 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,003 | 0,003 |
| Communication savante | 0,004 | 0,004 |
| Science ouverte | 0,004 | 0,002 |
| Intégrité de la recherche | 0,023 | 0,031 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,008 |
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 ».