Report in English with a Dutch summary (KCE reports 63A)

6 Breast Cancer KCE reports 63
2 METHODOLOGY
2.1 GENERAL APPROACH
As for the clinical practice guidelines (CPGs) for colorectal cancer and testicular cancer,
the present CPG was developed by adapting (inter)national CPGs to the Belgian context
[1]. This approach is currently being structured in a formal methodology by the
ADAPTE group, an international group of guideline developers and researchers [2]. The
ADAPTE methodology generally consists of three major phases:
Set-up Phase: Outlines the necessary tasks to be completed prior to beginning the
adaptation process (e.g., identifying necessary skills and resources).
Adaptation Phase: Assists guideline developers in moving from selection of a topic
to identification of specific clinical questions; searching for and retrieving guidelines;
assessing the consistency of the evidence therein, their quality, currency, content and
applicability; decision making around adaptation; and preparing the draft adapted
guideline.
Finalization Phase: Guides guideline developers through getting feedback on the
document from stakeholders who will be impacted by the guideline, consulting with the
source developers of guidelines used in the adaptation process, establishing a process
for review and updating of the adapted guideline and the process of creating a final
document.
This stepwise approach is currently being validated in an evaluation study using the
(qualitative and quantitative) information from multiple case studies.
2.2 CLINICAL QUESTIONS
The clinical practice guideline addresses the following clinical questions:
1. Which screening strategy is the most effective for the early detection of
breast cancer?
a. < 50 years
b. 50 – 69 years
c. > 70 years
2. What is the ideal follow-up (and treatment) of women with a high familial
and/or genetic risk of developing breast cancer?
3. What diagnostic tests are the most effective to confirm the diagnosis of
breast cancer?
a. Triple test approach: clinical examination / mammography / pathology
b. MRI?
c. MIBI?
4. What diagnostic tests are necessary to investigate the extent of the breast
cancer?
a. Sentinel biopsy
b. X-ray heart/lungs
c. Ultrasonography of the liver
d. Bone scintigraphy
e. Biochemical and tumormarkers; genetic tests
f. CAT scan of the thorax
g. PET scan