Citations of scientific results and conflicts of interest: the case of mammography screening

Abstract

IntroductionIn 2001, a Cochrane review of mammography screening questioned whether screening reduces breast cancer mortality, and a more comprehensive review in Lancet, also in 2001, reported considerable overdiagnosis and overtreatment. This led to a heated debate and a recent review of the evidence by UK experts intended to be independent.ObjectiveTo explore if general medical and specialty journals differed in accepting the results and methods of three Cochrane reviews on mammography screening.MethodsWe identified articles citing the Lancet review from 2001 or updated versions of the Cochrane review (last search 20 April 2012). We explored which results were quoted, whether the methods and results were accepted (explicit agreement or quoted without caveats), differences between general and specialty journals, and change over time.ResultsWe included 171 articles. The results for overdiagnosis were not quoted in 87% (148/171) of included articles and the results for breast cancer mortality were not quoted in 53% (91/171) of articles. 11% (7/63) of articles in general medical journals accepted the results for overdiagnosis compared with 3% (3/108) in specialty journals (p=0.05). 14% (9/63) of articles in general medical journals accepted the methods of the review compared with 1% (1/108) in specialty journals (p=0.001). Specialty journals were more likely to explicitly reject the estimated effect on breast cancer mortality 26% (28/108), compared with 8% (5/63) in general medical journals, p=0.02.ConclusionsArticles in specialty journals were more likely to explicitly reject results from the Cochrane reviews, and less likely to accept the results and methods, than articles in general medical journals. Several specialty journals are published by interest groups and some authors have vested interests in mammography screening.

Screening Mammography

“…They evaluated the extent to which three Cochrane reviews on mammography screening that reported considerable overdiagnosis were cited by a general medical and specialty journals. The results for overdiagnosis were accepted by general medical journals in 11% (7 of 63) of articles in contrast to only 3% (3 of 108) (P = .05) ( Table 1) (35). They concluded that several specialty journals are published by interest groups and some authors have vested interests in mammography screening.…”

Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention

“…This is a common occurrence in specialist medical journals rather than in general practitioner journals. The former lower reporting rates of potential harms attributed to preventive initiatives, reflecting possibly a conflict of interest 42 . This makes it difficult to compare group D with groups A + C with regards to the harm/benefits net balance, exposing asymptomatic people to unnecessary harm.…”

Por que reconsiderar a indicação do rastreamento do câncer de mama?

“…Esses últimos são mais explícitos em rejeitar dados de revisões sistemáticas e apresentam, com maior frequência, problemas de conflitos de interesses 55 .…”