Quality varies across clinical practice guidelines for mammography screening in women aged 40-49 years as assessed by AGREE and AMSTAR instruments

J Clin Epidemiol. 2011 Sep;64(9):968-76. doi: 10.1016/j.jclinepi.2010.12.005. Epub 2011 Mar 21.


Objective: To assess the quality of clinical practice guidelines providing recommendations on the frequency of mammography screening in asymptomatic, average-risk women 40-49 years of age.

Study design and setting: We searched the National Guideline Clearinghouse and MEDLINE for guidelines published from 2005 to 2010. Five independent assessors rated the quality of each guideline and its underlying evidence review using the Appraisal of Guidelines for Research and Evaluation (AGREE) and Assessment of Multiple Systematic Reviews (AMSTAR) instruments, respectively.

Results: Eleven guidelines were appraised. Ten referenced an underlying evidence review; two referenced the same review. Three reviews were rated good, one was moderate, and five were rated poor quality. On overall assessment of the quality of the guidelines, two were strongly recommended, two were recommended with provisos, and seven were either not recommended or the assessors were unsure whether to recommend it. Most guidelines clearly presented their recommendations, but the rigor of development, applicability, and stakeholder involvement varied. Seven guidelines recommended mammography screening as part of a periodic health examination and four recommended individualized screening in the target population. The latter four guidelines were based on good-quality reviews and three were recommended by the assessors.

Conclusion: Guideline users need to be aware of the variability in quality and identify the high-quality guidelines that meet their needs.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adult
  • Breast Neoplasms / diagnostic imaging
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / prevention & control*
  • Early Detection of Cancer / statistics & numerical data
  • Evidence-Based Medicine
  • Female
  • Humans
  • Mammography / statistics & numerical data*
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Practice Guidelines as Topic*
  • Quality Assurance, Health Care / methods*
  • Quality Assurance, Health Care / statistics & numerical data
  • United States / epidemiology