The Canadian Task Force on Preventive Health Care should not receive high ranking based on AGREEII or GRADE
Bibliographic record
Abstract
I read with interest, the article by Ren et al. Global guidelines for breast cancer screening: A systematic review [[1]Ren W. Chen M. Qiao Y. Zhao F. Global guidelines for breast cancer screening: a systematic review.Breast. 2022; 64: 85-99Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar].It was a disappointment that the breast cancer screening guideline from the Canadian Task Force on Preventive Health Care (CTF) was ranked highly. Although ranking was according to 6 domains using AGREEII criteria, the authors would not be aware from just reading the guideline paper, that CTF did not follow the spirit/intent of AGREE [[2]The appraisal of guidelines for research and evaluation (AGREE) II instrument: introduction, user's manual and AGREE II instrument. https://www.cmaj.ca/content/cmaj/suppl/2010/07/05/cmaj.090449.DC1/advance-brouwers-appendix.pdf.Google Scholar], specifically with respect to Stakeholder Involvement or Rigour of Development and did not follow the GRADE system [[3]Guyatt G.H. Oxman A.D. Vist G.E. Kunz R. Falck-Ytter Y. Alonso-Coello P. et al.GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.BMJ. 2008; 336: 924https://doi.org/10.1136/bmj.39489.470347.ADCrossref PubMed Google Scholar] for determining which evidence to consider.AGREEII states that the "guideline development group includes individuals from all relevant professional groups." There were no experts in breast cancer on the CTF panel. They further state that "views and preferences of the target population (patients, public, etc.) have been sought." The CTF ignored input from advocates for breast density notification. AGREE states, "The guideline has been externally reviewed by experts prior to its publication." Indeed, many experts did review and criticize the guideline, but their input was ignored by CTF.GRADE states that although randomized clinical trials (RCTs) generally produce more reliable evidence than observational studies, they also specify that flawed RCTs may be downgraded, and observational studies may be upgraded when they are carefully performed and show large magnitude benefits. CTF included the Canadian National Breast Screening Studies (CNBSS) even though their results suggested compromised randomization [[4]Seely J.M. Eby P.R. Gordon P.B. Appavoo S. Yaffe M.J. Errors in conduct of the CNBSS trials of breast cancer screening observed by research personnel.J Breast Imag. March/April 2022; 4: 135-143https://doi.org/10.1093/jbi/wbac009Crossref Scopus (10) Google Scholar] which has now been confirmed, and excluded the Pan-Canadian observational study [[5]Coldman A. Phillips N. Wilson C. Decker K. Chiarelli A.M. Brisson J. Zhang B. Payne J. Doyle G. Ahmad R. Pan-Canadian study of mammography screening and mortality from breast cancer.J Natl Cancer Inst: J Natl Cancer Inst. November 2014; 106: dju261https://doi.org/10.1093/jnci/dju261Crossref PubMed Scopus (162) Google Scholar], which showed 40% mortality reduction. I read with interest, the article by Ren et al. Global guidelines for breast cancer screening: A systematic review [[1]Ren W. Chen M. Qiao Y. Zhao F. Global guidelines for breast cancer screening: a systematic review.Breast. 2022; 64: 85-99Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. It was a disappointment that the breast cancer screening guideline from the Canadian Task Force on Preventive Health Care (CTF) was ranked highly. Although ranking was according to 6 domains using AGREEII criteria, the authors would not be aware from just reading the guideline paper, that CTF did not follow the spirit/intent of AGREE [[2]The appraisal of guidelines for research and evaluation (AGREE) II instrument: introduction, user's manual and AGREE II instrument. https://www.cmaj.ca/content/cmaj/suppl/2010/07/05/cmaj.090449.DC1/advance-brouwers-appendix.pdf.Google Scholar], specifically with respect to Stakeholder Involvement or Rigour of Development and did not follow the GRADE system [[3]Guyatt G.H. Oxman A.D. Vist G.E. Kunz R. Falck-Ytter Y. Alonso-Coello P. et al.GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.BMJ. 2008; 336: 924https://doi.org/10.1136/bmj.39489.470347.ADCrossref PubMed Google Scholar] for determining which evidence to consider. AGREEII states that the "guideline development group includes individuals from all relevant professional groups." There were no experts in breast cancer on the CTF panel. They further state that "views and preferences of the target population (patients, public, etc.) have been sought." The CTF ignored input from advocates for breast density notification. AGREE states, "The guideline has been externally reviewed by experts prior to its publication." Indeed, many experts did review and criticize the guideline, but their input was ignored by CTF. GRADE states that although randomized clinical trials (RCTs) generally produce more reliable evidence than observational studies, they also specify that flawed RCTs may be downgraded, and observational studies may be upgraded when they are carefully performed and show large magnitude benefits. CTF included the Canadian National Breast Screening Studies (CNBSS) even though their results suggested compromised randomization [[4]Seely J.M. Eby P.R. Gordon P.B. Appavoo S. Yaffe M.J. Errors in conduct of the CNBSS trials of breast cancer screening observed by research personnel.J Breast Imag. March/April 2022; 4: 135-143https://doi.org/10.1093/jbi/wbac009Crossref Scopus (10) Google Scholar] which has now been confirmed, and excluded the Pan-Canadian observational study [[5]Coldman A. Phillips N. Wilson C. Decker K. Chiarelli A.M. Brisson J. Zhang B. Payne J. Doyle G. Ahmad R. Pan-Canadian study of mammography screening and mortality from breast cancer.J Natl Cancer Inst: J Natl Cancer Inst. November 2014; 106: dju261https://doi.org/10.1093/jnci/dju261Crossref PubMed Scopus (162) Google Scholar], which showed 40% mortality reduction.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".