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Editorials |16 April 2019

A Guide to a Guidance Statement on Screening Guidelines

Joann G. Elmore, MD, MPH; Christoph I. Lee, MD, MS

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 9 April 2019.
  • David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (J.G.E.)
    University of Washington School of Medicine, Seattle, Washington (C.I.L.)

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0726.

    Corresponding Author: Joann G. Elmore, MD, MPH, Department of Medicine, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue, Suite 900, Los Angeles, CA 90024; e-mail, JElmore@mednet.ucla.edu.

    Current Author Addresses: Dr. Elmore: Department of Medicine, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue, Suite 900, Los Angeles, CA 90024.

    Dr. Lee: University of Washington School of Medicine, 1144 Eastlake Avenue East, LG-200, Seattle, WA 98109.

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In this issue, the American College of Physicians (ACP) Clinical Guidelines Committee presents its assessment of the quality and content of 7 English-language guidelines for breast cancer screening (1). The results of the assessment are 4 guidance statements that provide clarity and simplicity amidst the chaos of diverging guidelines. ACP guidance statements represent convergence across differing recommendations while highlighting important points for physicians to consider in shared decision-making conversations with their patients about routine breast cancer screening.
Variability in the interpretation of medical data has long been studied (2) and is a known phenomenon in breast cancer screening, both in radiologists' subjective interpretation of mammograms (3) and in objective interpretation of data from randomized clinical trials. Indeed, there is also marked variability in the makeup of screening guideline bodies, and research has shown conflict-of-interest issues related to authors' clinical specialties in earlier mammography guidelines (4). Of note, even among the members of the ACP Clinical Guidelines Committee, assessment and quality ratings varied considerably. These ACP guidance statements were developed after review of guidelines familiar to most screening stakeholders, including guidance from the U.S. Preventive Services Task Force, American Cancer Society, American College of Radiology, American College of Obstetricians and Gynecologists, Canadian Task Force on Preventive Health Care, National Comprehensive Cancer Network, and the World Health Organization.
The Committee ultimately agreed on 4 general guidance statements: First, in average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast...
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Elmore JG, Lee CI. A Guide to a Guidance Statement on Screening Guidelines. Ann Intern Med. 2019;170:573–574. doi: 10.7326/M19-0726

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Published: Ann Intern Med. 2019;170(8):573-574.

DOI: 10.7326/M19-0726

Published at www.annals.org on 9 April 2019

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2019 American College of Physicians
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