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

What is the comparative effectiveness of imaging techniques (e.g. sonography, CT, MRI) for the locoregional staging of 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, sentinel node imaging, FDG-PET/CT

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 recently diagnosed breast cancer undergoing imaging for locoregional staging.

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 outcomes such as mortality and reduction of metastases, number of surgeries, and mastectomy rate.

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 comparative diagnostic accuracy across imaging techniques in identifying lesions within as well as near the breast, for example, in the lymph nodes.

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. Long-term risk of local recurrence is 0.5% to 1% per year.

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:

New technologies introduce uncertainty for clinicians who are determining the best technique for staging breast cancer. Policy-makers making determinations about the best coverage decisions need to be guided by evidence examining all current technologies in clinical practice use.

Potential Impact

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

The answer(s) to this research question will be disseminated by the Effective Health Care Program to clinical providers and policy makers who will be able to use this information to make more informed treatment recommendations and coverage decisions.

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

As soon as possible in order to evaluate newer techniques.

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)

The answer(s) to this research question will be disseminated by the Effective Health Care Program to clinical providers and policy makers who will be able to use this information to make more informed treatment recommendations and coverage decisions.

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