The European Commission developed guidelines on breast cancer screening and diagnosis based on scientific evidence. Because research continuously produces new evidence, the Commission has also developed an updating strategy to permit the consideration and potential inclusion of this new evidence.


The updating strategy aims to ensure that the guidelines continue to be based on the latest available scientific findings, thereby remaining a valid tool for healthcare providers, policymakers and citizens. The strategy is designed as a transparent and reproducible process.


The updating process allows considering if new evidence may impact the content of each recommendation developed. The process is a modular, subdivided in successive phases to assess the specific updating need of each recommendation.


The workflow of the updating strategy consists of four phases:

  1. prioritisation
  2. surveillance
  3. updating
  4. publication

Each recommendation can pass through one or more phases depending on the new evidence available. 

Development phases

In 2018, 7 recommendations went through the process of testing the updating strategy. At the end of the exercise, 2 recommendations have been updated and modified.


  • Martínez García L. et al. Development of a prioritisation tool for the updating of clinical guideline questions: the UpPriority Tool protocol, BMJ Open 2017 Aug 3;7(8)
  • Martínez García L. et al. The validity of recommendations from clinical guidelines: a survival analysis, CMAJ. 2014;186(16):1211-9
  • Alonso-Coello P. et al. GRADE Working Group. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction, BMJ. 2016 Jun 28;353
  • Vernooij R.W. et al. Checklist for the Reporting of Updated Guidelines (CheckUp), PLoS Med. 2017 Jan 10;14(1)