240 abridged version. In 2006 and 2008, the second and third edi- tion of the KBCCPG included more detailed content, rein- forced via systematic literature reviews and consensus built in a multidisciplinary manner. The third KBCCPG was devel- oped with financial assistance from the department of medical resource of the welfare administration body, in cooperation with the Korean Academy of Medicine (KAM). The KBCS has sought to improve the CPG developmental process by widen- ing the multidisciplinary approach, via the use of external review. The evolutionary process leading to the development of the fourth KBCCPG, in which the KAM participates, included an online survey of 96 members of the KBCS, which corresponded to approximately 13% of all KBCS members. These 96 members were asked to complete a questionnaire revealing the practical utility of the third KBCCPG in real-life daily practice in breast cancer clinics. The purpose of our survey was to apply this valu- able feedback to the construction of the fourth KBCCPG. Seven academic societies related to breast cancer mana- gement collaborated to produce the third edition of the KBCCPG. The collaborating groups were the Korean Society for Therapeutic Radiology & Oncology, the Korean Society of Pathologists, the Korean Society of Plastic and Reconstructive Surgeons, the Korean Society of Radiology, the Korean Soci- ety of Nuclear Medicine, KBCS, and KAM. Development of the third edition of the KBCCPG was officially supported by the Korean Ministry of Health & Welfare. During the developmental process, the Guidelines Com- mittee organized a task force team (TFT), all members of which had the workshop training for systematic literature searches and evidence grading before initiating the guideline develop- ment. The Guidelines Committee requested that members of the TFT to systematically review the literature cited on web- sites; which included the National Comprehensive Cancer Network (NCCN) guidelines [2,3], the Cochrane database [4], EMBASE, and PubMed. The strength of any recommendation is important to permit informed clinical decision-making; any suggestion is effec- tively a judgment of the benefits, risks, harm, and cost of ad- herence. The quality of evidence reflects the extent to which a guideline panel has confidence that the study of a particular aspect of a disease is adequate to support a particular recom- mendation [5,6]. We performed the present survey to ascertain the utility and practical use of the third edition of the KBCCPG, and the appli- cation of these guidelines in the daily practice of KBCS mem- bers working in breast cancer clinics. The data will be used to guide drafts of the fourth edition of the KBCCPG. In Addition, we reevaluated key grade of recommendations and level of evidences of the third KBCCPG; we will seek to update these http://ejbc.kr Geumhee Gwak, et al. guidelines in the fourth KBCCPG. The fourth Korean Breast Cancer Society Guideline Com- mittee (KBCSGC) was composed of five subgroups (one be- nign breast disease committee; four breast cancer committees) that prepared guidelines. A questionnaire was developed by TFT formed from subgroups of the KBCSGC and contained 19 general questions exploring the utility of the third KBCCPG and 81 specific questions (1 on benign disease, 12 on non- invasive breast cancer, 26 on early-stage breast cancer [EBC], 24 on locally advanced breast cancer, and 19 on metastatic breast cancer). We amended the draft of the questionnaire between the 1st December 2009 and 25th February 2010, and delivered the final version to all members of the KBCS and partners within the multi-disciplinary teams containing KBCS members. We e-mailed the questionnaire three times between 26th February 2010 and 16th March 2010. Among 270 mem- bers of the KBCS who downloaded the e-mailed questionnaire file sent by an online survey company (Oz-survey, Seoul, Korea) under contract with the KBCS, a total of 96 members sent us responses. We analyzed all completed questionnaires and presented the results of our online survey at a symposium conducted by the fourth KBCSGC group, held on 30th March 2010. The demographic characteristics of surveyed respondents were representative of those from surgeons in university hos- pitals in Korea. Although the third KBCCPG was rated as the first preferred reference material in daily practice, most respon- dents simultaneously referred to the NCCN guidelines, the St. Gallen Oncology Conference guidelines, and the American Society of Clinical Oncology (ASCO) guidelines. About 80% of members are satisfied with the third edition of the KBCCPG, but fewer than 5% are deeply satisfied. The use of a multidisci- plinary approach, the publication of a well-organized booklet, and the utility of the booklet in terms of the education of train- ees have been advanced and considered strengths of the third KBCCPG; whereas a lack of data on various preclinical condi- tions, on metastatic and recurrent breast cancer, and on life- long care after cancer treatment, are recognized weaknesses. One of the most important issues is the novel content re- quested for the fourth KBCCPG. Most respondents chose atypical duct hyperplasia, papillary neoplasm, and non-can- cerous lesions, as deserving of special attention. Thus, the committee has added these topics as appendices to the fourth KBCCPG. NON-INVASIVE BREAST CANCER In real practice, when ductal carcinoma in situ (DCIS) pa- tients exhibit negative margins in frozen intraoperative sec- http://dx.doi.org/10.4048/jbc.2012.15.2.239