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2017 ; 6
(1
): 105
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Conclusions in systematic reviews of mammography for breast cancer screening and
associations with review design and author characteristics
#MMPMID28532422
Raichand S
; Dunn AG
; Ong MS
; Bourgeois FT
; Coiera E
; Mandl KD
Syst Rev
2017[May]; 6
(1
): 105
PMID28532422
show ga
BACKGROUND: Debates about the benefits and harms of mammography continue despite
the accumulation of evidence. We sought to quantify the disagreement across
systematic reviews of mammography and determine whether author or design
characteristics were associated with conclusions that were favourable to the use
of mammography for routine breast cancer screening. METHODS: We identified
systematic reviews of mammography published between January 2000 and November
2015, and extracted information about the selection of evidence, age groups, the
use of meta-analysis, and authors' professions and financial competing interest
disclosures. Conclusions about specific age groups were graded as favourable if
they stated that there were meaningful benefits, that benefits of mammography
outweighed harms, or that harms were inconsequential. The main outcome measures
were the proportions of favourable conclusions relative to review design and
author characteristics. RESULTS: From 59 conclusions identified in 50 reviews,
42% (25/59) were graded as favourable by two investigators. Among the conclusions
produced by clinicians, 63% (12/19) were graded as favourable compared to 32%
(13/40) from other authors. In the 50-69 age group where the largest proportion
of systematic reviews were focused, conclusions drawn by authors without
financial competing interests (odds ratio 0.06; 95% CI 0.07-0.56) and
non-clinicians (odds ratio 0.11; 95% CI 0.01-0.84) were less likely to be graded
as favourable. There was no trend in the proportion of favourable conclusions
over the period, and we found no significant association between review design
characteristics and favourable conclusions. CONCLUSIONS: Differences in the
conclusions of systematic reviews of the evidence for mammography have persisted
for 15 years. We found no strong evidence that design characteristics were
associated with greater support for the benefits of mammography in routine breast
cancer screening. Instead, the results suggested that the specific expertise and
competing interests of the authors influenced the conclusions of systematic
reviews.