Potashnik 1999.
Methods | Retrospective cohort. | |
Participants | The study cohort included 1197 subfertile women attending a subfertility clinic in Beer‐Sheba, Israel, between 1960 and 1984, of whom 780 were exposed to fertility treatment. Mean follow‐up, 17.9 years. |
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Interventions | Any drug; clomiphene citrate. Data on dosages and number of cycles were available. | |
Outcomes | Histologically confirmed endometrial cancer was retrieved by linkage of the cohort to the Israel National Cancer Registry through 1994. Incident cases in total cohort, 2; in exposed cohort, 2. | |
Notes | ||
Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Selection bias (comparability) | High risk | Comment: Exclusion of endometrial cancer cases at the beginning of the study was not reported. Comment: Non‐exposed women drawn from the same population as exposed cohort. Quote: "No statistically significant differences were found between the exposed and unexposed groups regarding all types of infertility, ethnic origin, and age at first visit". Comment: No comparability on diabetes mellitus, polycystic ovary syndrome (PCOS), and obesity was ensured. |
Selection bias (confounding) | High risk | Quote: "The standardized incidence ratio was computed as the ratio of observed to expected numbers of cases with 95% confidence interval (CI) estimates". Comment: Analyses inadequately controlling for potential confounding factors. |
Performance bias | High risk | Comment: Exposure to ovary‐stimulation drugs was ascertained by medical records. Blindness regarding the allocated interventions not guaranteed. |
Detection bias | Low risk | Quote: "The study cohort computer file was linked to the Israel National Cancer Registry to identify cancer cases". Comment: Outcome was ascertained by record linkage |
Attrition bias | Low risk | Quote: "Cancer ascertainment during internal verifications was found to be 90%–95% complete" Comment: Follow‐up was expected to be rather complete. |
Selective reporting (reporting bias) | High risk | Comment: Analyses on endometrial cancer by type of subfertility not reported. |
Other bias | High risk | Quote: "The mean (+/‐SD) duration of follow‐up for the study population was 17.9+/‐5.3 years".. Comment: Length of follow‐up was considered adequate. Comment: Non‐RCT study. |