Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Do patients with small (<1.0 cm) invasive breast cancers need to undergo radiation therapy and/or chemotherapy?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Surgery (adequate) +/- hormonal therapy vs. surgery plus radiation and/or chemotherapy (both of which are very expensive and associated with significant side effects).

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Women with small invasive breast cancers.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Invasive breast cancers (without associated high grade DCIS)<1.0 cm. in size.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

High cure rate Cost savings Efficiency of treatment (in regard to time) Lack of side effects

Describe any health-related risks, side effects, or harms that you are concerned about.

Significant side effects related to both radiation therapy and chemotherapy

High cost

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

None

AHRQ Priority Populations

None

Federal Health Care Program

None

Importance

Describe why this topic is important.

There is a strong tendency to overtreat small breast cancers which have a very high (>95%) cure rate with surgery alone.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Attempt to find cost-effective solutions to this common disease.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Overtreatment is so wide spread that it has become the standard of practice in most areas.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It would not necessarily help me or my group but it would help my patients and the health care system by lowering costs and morbidity without adversly affecting outcome.

Describe the timeframe in which an answer to your question is needed.

As soon as practical. The longer the wait, the more patients who will be treatd inappropriately and the higher the costs to an already over-burdoned health care system.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

none known

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

It would not necessarily help me or my group but it would help my patients and the health care system by lowering costs and morbidity without adversly affecting outcome.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

None