NCI/AHCPR CO-FUNDING OF BREAST CANCER SCREENING CLINICAL GUIDELINE

NCI/AHCPR CO-FUNDING OF BREAST CANCER SCREENING CLINICAL GUIDELINE was approved by the National Cancer Institute's Division of Cancer Control and Prevention (DCPC) Board of Scientific Counselors at an Oct. 13-14 meeting in Bethesda, Maryland. The board approved a project under which the development and dissemination of a breast cancer screening guideline by the Agency for Health Care Policy and Research will be co-funded by the National Cancer Institute. AHCPR released a separate clinical on mammography quality determinants on Oct. 19.

"There are clearly different recommendations about the use of mammography," DCPC's Marc Manlcy, public health applications research branch chief, stated in his presentation to the board. "Statements or guidelines from different organizations have differed on the appropriateness of this screening," he added, especially for women aged 40-49. "This is just one area where there seems to be insufficient information necessary to make a good, solid judgment," Manley said. "There are other issues such as...the role of breast exams and the role of self-exams."

As a result of the ongoing debate and discussions that have taken place in the last year between NCI Director Samuel Broder and former AHCPR Director Jarrett Clinton, a proposal was drafted "to proceed with a collaborative effort to define core positions and find exactly where the differences of opinion arc occurring, why, and what these differences mean for individual patients. This concept is a result of that discussion," Manley explained.

Modifications of NCI's mammography screening recommendations, with particular focus on younger women, was urged in a recent House Government Operations Committee report ("The Gray Sheet" Oct. 10, p. 11). NCI's current policy, which was changed in December 1993 by the institute's executive committee, states that randomized screening clinical trials have not demonstrated a "statistically significant reduction in mortality" for women under 50 years of age.

Funded through an interagency agreement, the screening guideline program is expected to cost $2 mil. NCI and AHCPR will divide the amount evenly. According to a "concept" document, the "development of the guideline will bring experts with differing opinions into a structured and deliberate consensus process which will clarify points of agreement and disagreement. The dissemination of the guidelines will inform clinicians and the public of these distinctions."

As described in the concept document, AHCPR will convene "multidisciplinary, private sector panels of experts and health care consumers," or will contract a nonprofit organization to appoint a panel to evaluate the current data relating to screening mammography for younger women. Each panel will consist of approximately 15 members and two co-chairs.

After identifying the "major questions" that need to be addressed, the subsequent course of action will include: reviewing and analyzing the available information, soliciting public comments through a Federal Register notice, holding an open meeting for public comments, and submitting a draft guideline "to peer review and to pilot review in actual use by clinicians and other experts."

At the end of the anticipated 18-month process, the final clinical practice guideline will be released in several versions tailored to various audiences. The guideline information will also be made available on-line through the National Library of Medicine, the National Technical Information Service and other electronic information sources.

"AHCPR has an established and very defensible public process for developing clinical guidelines," Manley declared before the board. "Breast cancer and breast cancer screening remain a top priority for the NCI. Few other issues in medical care are of greater importance in terms of providing clarity for both health care providers and patients," he stressed.