Development of the European Guidelines on breast cancer screening and diagnosis.

Article type
Authors
Saz-Parkinson Z1, Parmelli E1, Janusch-Roi A1
1European Commission; Joint Research Centre
Abstract
Background: The European Breast Guidelines on screening and diagnosis are evidence-based guidelines developed within the European Commission Initiative on Breast Cancer. They have been developed by a multidisciplinary group (GDG) of experts in the field, as well as patients, using the GRADE approach and its Evidence to Decision frameworks.
Objectives:Present the results of the development process of the European Breast Cancer Guidelines.
Methods:The European Commission selected, via an open call, a multidisciplinary GDG who voluntarily participate in the Guideline development process. The European Commission´s Joint Research Centre (JRC) is responsible for the scientific coordination, overarching planning and budgeting of the Guidelines, ensuring conflict of interest management and transparently reporting the guideline process. Systematic reviews externally conducted by Cochrane Iberoamerica support each recommendation developed using GRADE´s evidence to decision (EtD) frameworks, which are updated as new evidence becomes available according to our updating strategy (https://healthcare-quality.jrc.ec.europa.eu/discover-ecibc/methodologies/guidelines-updating)
Results: During the 4.5 years since start of ECIBC, 16 in presence meetings have taken place (39 total days) with approximately 27 GDG panel experts. Recommendations have gradually been published during this period, as they were finalised, in a dedicated webpage.The following recommendations have been developed: 21 recommendations on breast cancer screening, 19 on breast cancer diagnosis, 31 relating to communication issues around screening and diagnosis and 2 on training of professionals involved in breast cancer screening and diagnosis. Additionally, we have also developed three good practice statements on training and communication issues and 13 indicators have been developed to monitor breast cancer screening. In 2019, 2 recommendations were updated and in 2020, 6 were updated and a new one was developed as a result of the updating process.
With regards to the strength of the recommendations in the European Breast Cancer Guidelines, 61 are conditional and 12 are strong recommendations (requiring at least 80% agreement among GDG members). There is low or very low certainty evidence for 48 of the recommendations and only high certainty evidence for 2.
Conclusions: The development of the European Breast Cancer Guidelines has been a rapid learning process for all those involved, using the experience gained to improve and streamline processes in order to be able to achieve a development rate of approximately 1.5 recommendations per month. All lessons learned are helping design the new European Commission Initiative on Colorectal Cancer.
Finally, transparent reporting of EtDs is allowing countries to rapidly adapt or adopt these recommendations to their specific healthcare contexts (Bulgaria, Italy, Spain, Tunisia, China and Chile, among others)
Patient or healthcare consumer involvement: Three patient members of GDG are fully involved in development and updating process.