Center for Health Promotion and Prevention Research, Division of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX 77030, USA.
J Natl Cancer Inst. 2010 Jul 21;102(14):1023-39. doi: 10.1093/jnci/djq223. Epub 2010 Jun 29.
Various interventions to promote repeat use of mammography have been evaluated, but the efficacy of such interventions is not well understood.
We searched electronic databases through August 15, 2009, and extracted data to calculate unadjusted effect estimates (odds ratios [ORs] and 95% confidence intervals [CIs]). Eligible studies were those that reported estimates of repeat screening for intervention and control groups. We tested homogeneity and computed summary odds ratios. To explore possible causes of heterogeneity, we performed stratified analyses, examined meta-regression models for 15 a priori explanatory variables, and conducted influence analyses. We used funnel plots and asymmetry tests to assess publication bias. Statistical tests were two-sided.
The 25 eligible studies (27 effect estimates) were statistically significantly heterogeneous (Q = 69.5, I(2) = 63%, P < .001). Although there were homogeneous subgroups in some categories of the 15 explanatory variables, heterogeneity persisted after stratification. For all but one explanatory variable, subgroup summary odds ratios were similar with overlapping confidence intervals. The summary odds ratio for the eight heterogeneous reminder-only studies was the largest observed (OR = 1.79, 95% CI = 1.41 to 2.29) and was statistically significantly greater than the summary odds ratio (P(diff) = .008) for the homogeneous group of 17 studies that used the more intensive strategies of education/motivation or counseling (OR = 1.27, 95% CI = 1.17 to 1.37). However, reminder-only studies remained statistically significantly heterogeneous, whereas the studies classified as education/motivation or counseling were homogeneous. Similarly, in meta-regression modeling, the only statistically significant predictor of the intervention effect size was intervention strategy (reminder-only vs the other two combined as the referent). Publication bias was not apparent.
The observed heterogeneity precludes a summary effect estimate. We also cannot conclude that reminder-only intervention strategies are more effective than alternate strategies. Additional studies are needed to identify methods or strategies that could increase repeat mammography.
各种旨在促进乳房 X 光摄影重复使用的干预措施已得到评估，但这些干预措施的效果尚不清楚。
我们于 2009 年 8 月 15 日检索电子数据库，并提取数据以计算未调整的效应估计值（比值比[OR]和 95%置信区间[CI]）。合格的研究报告了干预组和对照组的重复筛查估计值。我们检验了同质性并计算了汇总比值比。为了探索异质性的可能原因，我们进行了分层分析，检查了 15 个先验解释变量的元回归模型，并进行了影响分析。我们使用漏斗图和不对称检验评估发表偏倚。统计检验为双侧。
25 项合格研究（27 项效应估计值）存在统计学显著的异质性（Q = 69.5，I² = 63%，P<.001）。尽管在 15 个解释变量的某些类别中有同质亚组，但分层后异质性仍然存在。对于除一个解释变量外的所有变量，亚组汇总比值比相似，置信区间重叠。唯一观察到的八个仅提醒的异质性研究的汇总比值比最大（OR = 1.79，95%CI = 1.41 至 2.29），且显著大于使用教育/动机或咨询更强化策略的同质组的汇总比值比（P(diff) =.008）（OR = 1.27，95%CI = 1.17 至 1.37）。然而，仅提醒的研究仍然存在统计学显著的异质性，而被归类为教育/动机或咨询的研究则具有同质性。同样，在元回归模型中，干预效果大小的唯一具有统计学意义的预测因子是干预策略（仅提醒与其他两种策略相结合作为参照）。未发现发表偏倚。
观察到的异质性排除了汇总效果估计。我们也不能得出仅提醒干预策略比其他策略更有效的结论。需要进一步的研究来确定可以增加重复乳房 X 光摄影的方法或策略。
