Abstract
BackgroundDebates 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.MethodsWe 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.ResultsFrom 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.ConclusionsDifferences 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.
Highlights
Debates about the benefits and harms of mammography continue despite the accumulation of evidence
Our aim was to quantify the degree of disagreement in the conclusions of systematic reviews of mammography for breast cancer screening and measure associations between the conclusions, design characteristics of the reviews, and the professions and financial competing interests of the authors
The analyses demonstrated that authors of systematic reviews may introduce biases in the design and reporting of systematic review to produce conclusions that are aligned with their interests
Summary
Debates about the benefits and harms of mammography continue despite the accumulation of evidence. The relative harms and benefits of mammography have been the subject of ongoing debate. Both the age at which to begin breast cancer screening and the frequency of screening have been disputed. The debate was renewed in 2009 when the US Preventive Services Task Force (USPSTF) revised their guidelines to initiate biennial screening at 50 years of age instead of 40 [6]. Conflicting recommendations about breast cancer screening make it difficult for clinicians and patients to make informed choices about when to start and how often to repeat mammography for women at average risk
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