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

What is comparative effectiveness of various imaging techniques for the surveillance/follow-up after the treatment of non-metastatic breast cancer?

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:

For example, sonography, CT, MRI

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 (as well as men) who are in stable remission after non-metastatic breast cancer.

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

None at this time.

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

Improvements in primary outcomes such as mortality and recurrence of breast cancer.

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

There is a risk of missed diagnosis inherent in any imaging modality. Of particular interest would be the comparison of false positive rates across imaging techniques in patients who are in breast cancer remission. We should also consider the effects of radiation.

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)

• Cancer

AHRQ Priority Populations

• Women

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Breast cancer represents a significant disease burden because of its relatively high prevalence. In particular, overtreatment and early diagnosis are of concern. Moreover a focus on the impact of treatment (eg. scarring or radiation effects) is important. Despite major progress in treatment modalities tumor recurrence remains a

major problem (7–30%) and 5-year survival drops to 21–36%.

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.)

This topic was recommended by a diverse panel of stakeholders as a high priority question for an evidence review.

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:

Potential Impact

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

N/A

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

None

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

Breast cancer carries a lifetime risk of 12.15 percent, the highest of any cancer category identified in the Topic Identification Project.

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)

N/A

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

Organization

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