5 research outputs found
Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines
Description: The European Commission Initiative for Breast Cancer
Screening and Diagnosis guidelines (European Breast Guidelines) are
coordinated by the European Commission's Joint Research Centre. The
target audience for the guidelines includes women, health professionals,
and policymakers.
Methods: An international guideline panel of 28 multidisciplinary
members, including patients, developed questions and corresponding
recommendations that were informed by systematic reviews of the evidence
conducted between March 2016 and December 2018. GRADE (Grading of
Recommendations Assessment, Development and Evaluation) Evidence to
Decision frameworks were used to structure the process and minimize the
influence of competing interests by enhancing transparency. Questions
and recommendations, expressed as strong or conditional, focused on
outcomes that matter to women and provided a rating of the certainty of
evidence.
Recommendations: This synopsis of the European Breast Guidelines
provides recommendations regarding organized screening programs for
women aged 40 to 75 years who are at average risk. The recommendations
address digital mammography screening and the addition of hand-held
ultrasonography, automated breast ultrasonography, or magnetic resonance
imaging compared with mammography alone. The recommendations also
discuss the frequency of screening and inform decision making for women
at average risk who are recalled for suspicious lesions or who have high
breast density
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Breast Cancer Management During the COVID-19 Pandemic: The Senologic International Society Survey
Objective: In early 2020, the spread of coronavirus disease-2019 (COVID-19) led the World Health Organization to declare this disease a pandemic. Initial epidemiological data showed that patients with cancer were at high risk of developing severe forms of COVID-19. National scientific societies published recommendations modifying the patients' breast cancer (BC) management to preserve, in theory, quality oncologic care, avoiding the increased risk of contamination. The Senology International Society (SIS) decided to take an inventory of the actions taken worldwide. This study investigates COVID-19-related changes concerning BC management and analyzes the will to maintain them after the pandemic, evaluating their oncological safety consequences. Materials and Methods: SIS network members participated in an online survey using a questionnaire (Microsoft® Forms) from June 15th to July 31st, 2020. Results: Forty-five responses from 24 countries showed that screening programs had been suspended (68%); magnetic resonance imagines were postponed (73%); telemedicine was preferred when possible (71%). Surgeries were postponed: reconstructive (77%), for benign diseases (84%), and in patients with significant comorbidities (66%). Chemotherapy and radiotherapy protocols had been adapted in 28% of patients in both. Exception for telemedicine (34%), these changes in practice should not be continued. Conclusion: The SIS survey showed significant changes in BC's diagnosis and treatment during the first wave of the COVID-19 pandemic, but most of these changes should not be maintained. Indeed, women have fewer severe forms of COVID-19 and are less likely to die than men. The risk of dying from COVID-19 is more related to the presence of comorbidities and age than to BC. Stopping screening and delaying treatment leads to more advanced stages of BC. Only women aged over 65 with BC under treatment and comorbidities require adaptation of their cancer management
Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative.
BACKGROUND: Predicting the risk of recurrence and response to chemotherapy in women with early breast cancer is crucial to optimise adjuvant treatment. Despite the common practice of using multigene tests to predict recurrence, existing recommendations are inconsistent. Our aim was to formulate healthcare recommendations for the question "Should multigene tests be used in women who have early invasive breast cancer, hormone receptor-positive, HER2-negative, to guide the use of adjuvant chemotherapy?" METHODS: The European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group (GDG), a multidisciplinary guideline panel including experts and three patients, developed recommendations informed by systematic reviews of the evidence. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision frameworks were used. Four multigene tests were evaluated: the 21-gene recurrence score (21-RS), the 70-gene signature (70-GS), the PAM50 risk of recurrence score (PAM50-RORS), and the 12-gene molecular score (12-MS). RESULTS: Five studies (2 marker-based design RCTs, two treatment interaction design RCTs and 1 pooled individual data analysis from observational studies) were included; no eligible studies on PAM50-RORS or 12-MS were identified and the GDG did not formulate recommendations for these tests. CONCLUSIONS: The ECIBC GDG suggests the use of the 21-RS for lymph node-negative women (conditional recommendation, very low certainty of evidence), recognising that benefits are probably larger in women at high risk of recurrence based on clinical characteristics. The ECIBC GDG suggests the use of the 70-GS for women at high clinical risk (conditional recommendation, low certainty of evidence), and recommends not using 70-GS in women at low clinical risk (strong recommendation, low certainty of evidence)
Monitoring and evaluation of breast cancer screening programmes: selecting candidate performance indicators
Background: In the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection. Methods: The indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries. Results: A total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers > 20 mm, cancers ≤10 mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate. Conclusion: This systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality
Methods for Development of the European Commission Initiative on Breast Cancer Guidelines Recommendations in the Era of Guideline Transparency
Neither breast cancer prevention and early-detection programs, nor their
outcomes, are uniform across Europe. This article describes the
rationale, methods, and process for development of the European
Commission ( EC) Initiative on Breast Cancer Screening and Diagnosis
Guidelines. To be consistent with standards set by the Institute of
Medicine and others, the EC followed 6 general principles. First, the EC
selected, via an open call, a panel with broad representation of areas
of expertise. Second, it ensured that all recommendations were supported
by systematic reviews. Third, the EC separately considered important
subgroups of women, included patient advocates in the guidelines
development group, and focused on good communication to inform women's
decisions. Fourth, EC rules on conflicts of interest were followed and
the GRADE ( Grading of Recommendations Assessment, Development and
Evaluation) Evidence to Decision frameworks were used to structure the
process and minimize the influence of competing interests. Fifth, it
focused its recommendations on outcomes that matter to women, and
certainty of the evidence is rated for each. Sixth, the EC elicited
stakeholder feedback to ensure that the recommendations remain up to
date and relevant to practice. This article describes the approach and
highlights ways of disseminating and adapting the recommendations both
within and outside Europe, using innovative information technology
tools