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Topic Suggestion Description

Date submitted: November 10, 2017

Describe your topic.
1. What is the effectiveness of breast cancer screening in reducing breast cancer mortality in asymptomatic high-risk women? 2. What is the effectiveness of breast cancer screening in reducing breast cancer incidence in asymptomatic high-risk women? 3. What are the harms of breast cancer screening in asymptomatic high-risk women? Interventions: mammography, MRI as an adjunct to mammography screening, ultrasonography as an adjunct to mammography or as an alternative to MRI when it is not tolerated, digital breast tomosynthesis, and clinical breast examination. Outcomes: breast cancer mortality, breast cancer incidence (cancer detection rates), harms (false positives, unnecessary biopsy, psychological harms), diagnostic accuracy Contextual question: What is the most optimal definition of high-risk for breast cancer? Defining high-risk beyond using an arbitrary cut-off of a risk calculator or those at very high genetic risk (i.e., BRCA mutation, first degree relative of BRCA mutation carrier, or multiple first/second degree relatives with breast cancer) has been difficult provided additional screening may occur, and not be necessary, for those above average-risk (e.g., one first-degree relative with breast cancer, women with a history of chest radiation, women with a personal history of DCIS).
Describe why this topic is important.
Health care organizations screen women at various breast cancer risk levels, however, there are too few recent systematic reviews and clinical practice guidelines that provide guidance for breast cancer screening in high-risk women.
Tell us why you are suggesting this topic.
To inform our clinical practice guidelines on breast cancer screening
Target Date.
Describe what you are doing currently and what you are hoping will change because of a new evidence report.
We are currently updating our clinical practice guideline on breast cancer screening and conducting an in-house rapid review to address the evidence on breast cancer screening in high-risk women. A new evidence report would ensure comprehensiveness when we update the guideline in 2 years.
How will you or your group use the information from a new evidence report?
Inform our clinical practice guideline.
How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
Electronic dissemination of our clinical practice guidelines across our program nationally.
Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
Health care organizations and delivery systems
Information About You: (optional)
Provide a description of your role or perspective.
Guideline developer
If you are you making a suggestion on behalf of an organization, please state the name of the organization.
Kaiser Permanente Care Management Institute
Please tell us how you heard about the Effective Health Care Program.