The Authors Reply
Notice bibliographique
Résumé
We thank Dr. Weiss for his comments (1). However, we feel that Dr. Weiss is in error over several issues. First, for women aged 40–49 years, the “noninferiority” of the control arm in the Canadian National Breast Screening Study must be interpreted with a recognition that these participants received only an initial breast examination and were taught breast self-examination (2). Thus, after the first screen, the comparison was between mammography and usual care in the community, not regular clinical breast examinations. Second, the numbers of breast cancer deaths had increased since our previous reports (3, 4), thus substantially narrowing the confidence interval of the estimate of a null effect of mammography. In fact, the main results presented in our recent report (2) relate to the cancers diagnosed during the 5-year screening period. Compared with the previous reports (3, 4), the numbers of breast cancer deaths increased from 138 in the mammography arm and 128 in the control arm to 180 and 171, respectively, in our recent report (2). Further, for all breast cancer deaths, the numbers increased from 212 and 213 in the previous reports to 500 and 505 for the mammography and control arms, respectively. This refutes the claim that nothing has changed in our current report. There was always the possibility that a difference might emerge with long-term follow-up from mammography-detected cancers with a very long natural history. Our extended follow-up conclusively discounts this possibility. Third, the extended follow-up enabled us to estimate the extent of overdiagnosis from mammography with a precision that was not possible before, thus facilitating a more accurate recognition of the harms associated with mammography screening. We are not alone in pointing out how important it is to include overdiagnosis in estimates of potential benefits of mammography screening versus harms (5–7). In his letter (1), Dr. Weiss criticizes us for not reviewing the results of other breast screening trials. In fact, we did mention some of them but felt that it was not up to us to conduct a complete re-review of those findings at this time. Thus, in our view it is very important that the results of our study, with its unique design, demonstrating no beneficial effect of mammography screening (2), be reemphasized, and it seems that others agree with us (8, 9). Indeed, many investigators have failed to recognize the competing effects of screening and improved treatment of breast cancer (10–12). Thus, we renew our call for a reassessment of the value of mammography screening. Conflict of interest: none declared.
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 | 0,007 | 0,063 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,002 |
| Méta-épidémiologie (sens large) | 0,003 | 0,003 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,008 | 0,006 |
| Communication savante | 0,008 | 0,005 |
| Science ouverte | 0,004 | 0,005 |
| Intégrité de la recherche | 0,133 | 0,097 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,011 | 0,011 |
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 ».