• Holger J Schünemann, Donata Lerda, Nadya Dimitrova, Pablo Alonso-Coello, Axel Gräwingholt, Cecily Quinn, Markus Follmann, Robert Mansel, Francesco Sardanelli, RossiPaolo GiorgiPGAzienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy (P.G.R.)., Annette Lebeau, Lennarth Nyström, Mireille Broeders, Lydia Ioannidou-Mouzaka, Stephen W Duffy, Bettina Borisch, Patricia Fitzpatrick, Solveig Hofvind, Xavier Castells, Livia Giordano, Sue Warman, Zuleika Saz-Parkinson, and European Commission Initiative on Breast Cancer Contributor Group.
• McMaster University Health Sciences Centre, Hamilton, Ontario, Canada (H.J.S.).
• Ann. Intern. Med. 2019 Aug 20; 171 (4): 273-280.

AbstractNeither 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.

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