title: A comparison of international breast cancer guidelines - do the national guidelines differ in treatment recommendations?
abstract: OBJECTIVE
  Clinical practice guidelines (CPG) are an appropriate method to optimise routine clinical care. Numerous CPGs for the diagnosis and treatment of breast cancer have been developed by national health institutions or medical societies. While a comparison of methodological criteria has been undertaken before, it is unknown whether these CPGs differ in their actual treatment recommendations.
  
  
  METHODS
  We included national breast cancer CPGs from the USA, Canada, Australia, the UK, and Germany that satisfy internationally recognised methodological criteria and are in widespread use in daily clinical care. Treatment recommendations for adjuvant invasive breast cancer including surgery, radiation, endocrine therapy, chemotherapy and anti-HER2-therapy were compared.
  
  
  RESULTS
  Recommendations for endocrine therapy show discordances regarding optimal usage of ovarian function suppression for premenopausal patients and aromatase inhibitors for postmenopausal patients. However, most other treatment recommendations exhibit a large degree of congruency. This reflects the fact that they rest on the same evidence base, and that many national guidelines are adopted from other guidelines so that well accepted guidelines are cited within other guidelines.
  
  
  CONCLUSIONS
  Considering that the development of guidelines is a very expensive and resource-intensive task the question arises whether the development of national guidelines in numerous countries is worth the effort since the recommendations differ only marginally.
authors: Department of Mathematics and Computer Science, University of Bremen, Bremen, Germany. rwolters@escience.uni-bremen.de
authors: R
authors: R
authors: Wolters
authors: A C
authors: AC
authors: Regierer
authors: L
authors: L
authors: Schwentner
authors: V
authors: V
authors: Geyer
authors: K
authors: K
authors: Possinger
authors: R
authors: R
authors: Kreienberg
authors: M B
authors: MB
authors: Wischnewsky
authors: A
authors: A
authors: Wöckel
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D035082:Federal Government; D005260:Female; D006801:Humans; D038622:Internationality; D008408:Mastectomy / Q000379:methods / Q000706:statistics & numerical data; D008495:Medical Oncology / Q000331:legislation & jurisprudence* / Q000379:methods*; D060787:Neoplasm Grading; D017410:Practice Guidelines as Topic; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011878:Radiotherapy / Q000706:statistics & numerical data; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors; D014481:United States
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047428:Protein Kinase Inhibitors; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human