Give us clear, not convoluted, clinical practice guidelines
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* Michael R. Lawrence

The recent article on chemoprevention of breast cancer has left me a confused general practitioner.1 The authors refer to assessment of a woman's risk of breast cancer using the Gail index and make recommendations regarding the prescription of tamoxifen to women who have a Gail index that is greater than or equal to 1.66% over 5 years. But they point out that the Gail index has not been validated and has not been evaluated for use as a routine screening or case-finding instrument. Nowhere in the article can I find satisfactory reconciliation of these conflicting notions. 

Because the Gail index has not been evaluated and validated it does not seem to me that there are sufficient grounds for publication of a high-profile article setting out official guidelines for all Canadian physicians.

As a result of the publication of this article many patients will no doubt visit their physician's office to discuss chemoprevention of breast cancer with tamoxifen. When I am faced with such patients I will be at a loss as to how to proceed, not knowing whether the advice given in the article is valid or not. 

## Reference

1.  1. Levine M, Moutquin J-M, Walton R, Feightner J. Chemoprevention of breast cancer. CMAJ 2001; 164(12):1681-90. 
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTY0LzEyLzE2ODEiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTY1LzExLzE0NjguMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)