Development of the European guidelines

Important advances in breast cancer screening and treatment, and changes in the way guidelines are developed, from expert consensus-based to evidence-based, led to the need for new European guidelines on breast cancer screening and diagnosis.

The objective of the European guidelines is to improve the prevention and diagnosis of breast cancer.

The European guidelines are developed using GRADE (Grading of Recommendations Assessment, Development and Evaluation), and internationally recognised and transparent process to develop evidence-based recommendation. In particular, they are developed using the GRADEpro Guideline Development Tool (GRADEpro GDT).

The recommendations are drafted and voted in a structured way by the members of the Guidelines Development Group (GDG), which includes healthcare professionals, epidemiologists, guideline developers and patients. 

The procedure consists of the following essential steps: 

1. The GDG prioritises a set of healthcare questions from a broader list that included questions coming from a public consultation carried out among different stakeholders. 
2. The GDG frames each question using the PICO format - Population under study (for example women of certain age); Intervention (for example a medical examination); Comparator (other main options such as an alternative medical examination); and Outcomes (results). 
3. An external and independent team, with specific expertise in the field, carries out systematic reviews for each question. 
4. The GDG assesses the quality of the evidence retrieved and use GRADE Evidence to Decision (EtD) frameworks to decide on the recommendation and its strength. The GRADE EtD framework systematically assess 12 different criteria, including the balance between desirable and undesirable effects, the certainty of the evidence, people’s values, cost-effectiveness, and feasibility. 
5. If a recommendation is not adequate for a formal certainty of evidence rating according to GRADE, a good practice statement can be developed. 
6. Recommendations are updated as new evidence becomes available, following a regular and systematic updating process.  

Recommendations are updated as new evidence arises.

Healthcare authorities and professionals can adopt the European breast cancer guidelines or adapt them to their local context.

• EtD: Evidence to Decision
• GDG: Guidelines Development Group
• GRADE: Grading of Recommendations Assessment, Development and Evaluation
• PICO: Population, Intervention, Comparator, Outcome