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 for the assessment of response to treatment in 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, skeletal scintigraphy, CT, MRI, 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 (as well as men) receiving treatment for 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.)

Yes. Subgroups can be stratified according to origin of cancer and type of treatment.

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 monitoring response to avoid ineffective chemotherapy, and improving the effectiveness of palliative care.

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

False positives from use of chemotherapeutic agents, radiation, costs.

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
• Functional limitations and disability

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. 5-year survival rate drops to 25% with metastasis, changing the intention of therapy from curative to palliative.

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:

The treatment paradigm is changing fast in ways that affect the staging strategy.

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. More focus is needed on research for the smaller subgroups, in particular those with the metastatic disease as opposed to the general population.

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