Re: Weighing the Risks and Benefits of Tamoxifen Treatment for Preventing Breast Cancer
Bibliographic record
Abstract
In April 1998, the Breast Cancer Prevention Trial (P-1) was halted 14 months early because of a 45% reduction in breast cancer among those patients receiving tamoxifen. At that time, all of the major networks and newspapers made a lead story out of the National Cancer Institute's announcement of this finding. Many of the media reports repeated the investigators' contention that the trial's entry criteria identified women who are potentially eligible for tamoxifen therapy, e.g., all women over the age of 60 years (1). Now, 1½ years later, the Journal has published a special article entitled “Weighing the Risks and Benefits of Tamoxifen Treatment for Preventing Breast Cancer” (2). Its authors assessed the data from the Breast Cancer Prevention Trial P-1 (3) and estimate that the benefits of taking tamoxifen substantially outweigh the risks only for younger high-risk women; conversely, the risks might outweigh the benefits for most black women older than 60 years of age and most white women older than 60 years with a uterus. In other words, tamoxifen therapy is an appropriate consideration for a much smaller subset of high-risk women than was originally thought. The Journal special article (2) states that the risk/benefit assessment grew out of a National Cancer Institute-sponsored workshop held in July 1998. Why did it take so long to get this assessment into print? By contrast, results of the P-1 trial were published by the Journal less than 6 months after the trial ended. Until this assessment was published, it was not known which women are at enough of a high risk to make tamoxifen's potentially fatal side effects worth its potential benefits. Yet as early as October 1998, tamoxifen received U.S. Food and Drug Administration (FDA) approval for risk reduction which, in turn, allowed its producer, AstraZeneca (Wilmington, DE), to mount an immediate and extensive direct-to-consumer advertising campaign. At the time, we believed that the FDA approval was premature; this assessment only confirms our conviction. For the first time, an anticancer drug is being marketed to healthy people; more care should have been taken beforehand to estimate who can safely benefit from tamoxifen.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.112 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.006 | 0.006 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.006 | 0.009 |
| Insufficient payload (model declined to judge) | 0.051 | 0.029 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".