Comparison of International Breast Cancer Guidelines: Are We Globally Consistent? Cancer Guideline AGREEment

Background: Evidence-based guidelines are used in health care systems throughout the world to aid in treatment decisions and to ensure quality and consistency in patient care. In breast oncology, guidelines for care are published by several internationally recognized organizations, including those from the United States, Canada, and the United Kingdom. The present study compared clinical breast cancer guidelines from the American Society of Clinical Oncology (asco, United States), Cancer Care Ontario (cco, Canada), and the National Institute for Health and Clinical Excellence (nice, United Kingdom) to determine the quality and consistency of content across international organizations. Methods: We searched for breast cancer guidelines published by asco, cco, and nice. Guidelines on the same theme were identified across organizations and appraised by 4 independent reviewers using the Appraisal of Guidelines for Research and Evaluation (agree) instrument. Content of each guideline was also scored for consistency in overall recommendations across organizations and for consistency in cited evidence. Results: The quality of breast cancer guidelines produced by the targeted organizations was consistently good in the areas of Scope and Purpose, Rigor of Development, and Clarity and Presentation, but variable in the domains of Stakeholder Involvement, Applicability, and Editorial Independence. The content of the guidelines varied slightly in the strength of their recommendations. Conclusions: Our review demonstrated consistency in quality and content for breast cancer practice guidelines published by various organizations. Future guidelines developed by these organizations should focus on how to implement and measure uptake of a guideline.