Development of the European Commission Initiative on Breast Cancer Guidelines
Authors: Holger J. Schünemann, Pablo Alonso-Coello, Axel Gräwingholt, Cecily Quinn, Markus Follmann, Miranda Langendam, Zuleika Saz-Parkinson
Journal: Annals of Internal Medicine (2020)

Letters7 January 2020Development of the European Commission Initiative on Breast Cancer GuidelinesHolger J. Schünemann, MD, PhD, MSc, Pablo Alonso-Coello, MD, PhD, Axel Gräwingholt, MD, Cecily Quinn, MD, Markus Follmann, MD, MPH, MSc, Miranda Langendam, PhD, and Zuleika Saz-Parkinson, PhDHolger J. Schünemann, MD, PhD, MScMcMaster University Health Sciences Centre, Hamilton, Ontario, Canada (H.J.S.), Pablo Alonso-Coello, MD, PhDIberoamerican Cochrane Centre, Barcelona, Spain (P.A.), Axel Gräwingholt, MDRadiologie am Theater, Paderborn, Germany (A.G.), Cecily Quinn, MDSt. Vincent's University Hospital, Dublin, Ireland (C.Q.), Markus Follmann, MD, MPH, MScGerman Cancer Society, Berlin, Germany (M.F.), Miranda Langendam, PhDUniversity of Amsterdam Medical Centre, Amsterdam, the Netherlands (M.L.), and Zuleika Saz-Parkinson, PhDEuropean Commission, Joint Research Centre, Ispra, Italy (Z.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0621 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Watine incorrectly asserts that the European Guidelines for Breast Cancer Screening and Diagnosis (known as the European Breast Guidelines) do not adhere to the GRADE working group's definitions of strong and conditional recommendations. However, the statements that he cites refer to GRADE's "interpretations" of recommendations, not their "definitions." The GRADE approach states that the strength of a recommendation "is defined as the extent to which one can be confident that the desirable consequences of an intervention outweigh its undesirable consequences" and has "specific implications for patients, the public, clinicians, and policy makers" (1).The European Breast Guidelines ...References1. Andrews J, Guyatt G, Oxman AD, et al; GRADE guidelines: 14.. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol. 2013;66:719-25. [PMID: 23312392] doi:10.1016/j.jclinepi.2012.03.013 CrossrefMedlineGoogle Scholar2. Alonso-Coello P, Schünemann HJ, Moberg J, et al; GRADE Working Group.. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ. 2016;353:i2016. [PMID: 27353417] doi:10.1136/bmj.i2016 CrossrefMedlineGoogle Scholar3. Alonso-Coello P, Oxman AD, Moberg J, et al; GRADE Working Group.. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ. 2016;353:i2089. [PMID: 27365494] doi:10.1136/bmj.i2089 CrossrefMedlineGoogle Scholar4. Schünemann HJ, Lerda D, Quinn C, et al. Breast cancer screening and diagnosis: a synopsis of the European Breast Guidelines. Ann Intern Med. 2020;172:46-56. doi:10.7326/M19-2125 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: McMaster University Health Sciences Centre, Hamilton, Ontario, Canada (H.J.S.)Iberoamerican Cochrane Centre, Barcelona, Spain (P.A.)Radiologie am Theater, Paderborn, Germany (A.G.)St. Vincent's University Hospital, Dublin, Ireland (C.Q.)German Cancer Society, Berlin, Germany (M.F.)University of Amsterdam Medical Centre, Amsterdam, the Netherlands (M.L.)European Commission, Joint Research Centre, Ispra, Italy (Z.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3445. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMethods for Development of the European Commission Initiative on Breast Cancer Guidelines Holger J. Schünemann , Donata Lerda , Nadya Dimitrova , Pablo Alonso-Coello , Axel Gräwingholt , Cecily Quinn , Markus Follmann , Robert Mansel , Francesco Sardanelli , Paolo Giorgi Rossi , Annette Lebeau , Lennarth Nyström , Mireille Broeders , Lydia Ioannidou-Mouzaka , Stephen W. Duffy , Bettina Borisch , Patricia Fitzpatrick , Solveig Hofvind , Xavier Castells , Livia Giordano , Sue Warman , Zuleika Saz-Parkinson , and Development of the European Commission Initiative on Breast Cancer Guidelines Joseph Watine Metrics Cited byBringing two worlds closer together: a critical analysis of an integrated approach to guideline development and quality assurance schemes 7 January 2020Volume 172, Issue 1Page: 72-73KeywordsAge groupsBehaviorBreast cancerBreast cancer screeningDecision makingDisclosureGrading of Recommendations Assessment Development and EvaluationMammographyPrevention, policy, and public healthPublic policy ePublished: 7 January 2020 Issue Published: 7 January 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...