Author's specialty and conflicts of interest contribute to conflicting guidelines for screening mammography

Objective: To examine the relationship between guideline panel members' conflicts of interest and guideline recommendations on screening mammography in asymptomatic, average-risk women aged 40-49 years. Study Design and Setting: We searched the National Guideline Clearinghouse and MEDLINE for relevant guidelines published between January 2005 and June 2011. We examined the disclosures and specialties of the lead and secondary authors of these guidelines, as well as the publications of the lead authors. Results: Twelve guidelines were identified with a total of 178 physician authors from a broad range of specialties. Of the four guidelines not recommending routine screening, none had a radiologist member, whereas of the eight guidelines recommending routine screening, five had a radiologist member (comparison of the proportions, P = 0.05). A guideline with radiologist authors was more likely to recommend routine screening (odds ratio = 6.05, 95% confidence interval = 0.57-∞, P = 0.14). The proportion of primary care physicians on guideline panels recommending routine vs. nonroutine screening was significantly different (38% vs. 90% of authors; P = 0.01). The odds of a recommendation in favor of routine screening were related to the number of recent publications on breast disease diagnosis and treatment by the lead guideline author (P = 0.02). Conclusion: Recommendations regarding mammography screening in this target population may reflect the specialty and intellectual interests of the guideline authors.