Raichand Smriti, Dunn Adam G, Ong Mei-Sing, Bourgeois Florence T, Coiera Enrico, Mandl Kenneth D
Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia.
Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.
Syst Rev. 2017 May 22;6(1):105. doi: 10.1186/s13643-017-0495-6.
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.
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.
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.
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.
尽管已有大量证据积累，但关于乳腺钼靶检查利弊的争论仍在继续。我们试图量化乳腺钼靶检查系统评价之间的分歧，并确定作者或设计特征是否与支持将乳腺钼靶检查用于常规乳腺癌筛查的结论相关。
我们检索了2000年1月至2015年11月期间发表的乳腺钼靶检查系统评价，并提取了有关证据选择、年龄组、荟萃分析的使用以及作者职业和财务利益冲突披露的信息。如果关于特定年龄组的结论表明存在有意义的益处、乳腺钼靶检查的益处大于危害或危害无关紧要，则将其评为有利。主要结局指标是相对于评价设计和作者特征的有利结论比例。
在50项评价中确定的59条结论中，两名研究者将42%（25/59）评为有利。在临床医生得出的结论中，63%（12/19）被评为有利，而其他作者得出的结论中这一比例为32%（13/40）。在系统评价最为集中的50 - 69岁年龄组中，无财务利益冲突的作者（优势比0.06；95%置信区间0.07 - 0.56）和非临床医生（优势比0.11；95%置信区间0.01 - 0.84）得出的结论被评为有利的可能性较小。在此期间，有利结论的比例没有趋势，并且我们发现评价设计特征与有利结论之间没有显著关联。
乳腺钼靶检查证据的系统评价结论差异持续了15年。我们没有发现有力证据表明设计特征与在常规乳腺癌筛查中更支持乳腺钼靶检查的益处相关。相反，结果表明作者的特定专业知识和利益冲突影响了系统评价的结论。
