Meta-analysis in cancer epidemiology.

Meta-analysis has seen increasing use as a tool in epidemiology over the past five years. Although this method is relatively well accepted for use in clinical trials, its use has proved somewhat more controversial in epidemiology. If meta-analysis is viewed as an evolutionary improvement over the review article, it may become more widely acceptable. Meta-analysis should incorporate the concern for study quality and differences in study design seen in classic review articles with the concern for rigor, objectivity, and quantitative precision characteristic of meta-analysis. Available tools for consideration of differences among studies are described with several examples from the literature. The extent to which various methods are used in published meta-analyses is described. Methods for assessing publication bias, and tools for combining dose-response data, are discussed also. Evaluation of risk factors and protective factors for cancer must be based on the weight of the evidence. Tools such as meta-analysis are essential if we are to interpret the vast number of completed studies in cancer epidemiology.