More on breast cancer guidelines
CMAJ 1998;158:1429
In response to: J. Mahoney; S.C. Brown; C.M. Godfrey; R.L. Reid; M. Rieckenberg; W.R. Ramsay; B.A. Nassar, et al
On behalf of the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer I thank these contributors for their suggestions. The following comments are my own.
In reply to Drs. Mahoney, Brown and Godfrey, I would point out that breast reconstruction and lymphedema were high on the approximately 20 topics first considered by the steering committee. However, 10 had to be chosen, and neither of these made the final list. Both are included among the topics that the steering committee has proposed for the (hoped-for) successor to these guidelines.
Like breast reconstruction and lymphedema, hormone replacement therapy could not be included in the first set of guidelines but is high on the list of topics for the next set. The policy statement of the SOGC will be valuable at that time, and I thank Dr. Reid for drawing it to our attention.
Probably neither Dr. Rieckenberg nor Dr. Ramsay disagrees with the general thrust of the paragraph in question, which can be summarized as follows: (1) The histopathological diagnosis of DCIS is often difficult — even the pathologists of a major clinical trial had difficulty. (2) Experience, in the form of a substantial DCIS caseload, presumably helps interpretation. (3) If there are any pathologists who lack such experience, they should not hesitate to refer specimens to a centre with special expertise. Naturally, it is the pathologist who must determine when expert consultation is needed.
I thank the co-participants of the Maritime Hereditary Cancer Programme for their excellent summary on genetic risk, but ask for their patience with us guidelines writers. We did not include hereditary risk factors among the first 10 topics, although we probably should have. I have little doubt that this topic will be tackled in the second round.
I am grateful for all of these helpful comments and those that were published in an earlier Letters section of CMAJ. I consider this correspondence a continuation of the Canada-wide consultation that was an intrinsic part of the development of the first 10 guidelines. All of these comments will be considered by the steering committee as it starts round 2, and they will all help to further mould a Canadian consensus.
Maurice McGregor, MB, BCh, MD
Chair, Steering Committee on Clinical
Practice Guidelines for the Care and
Treatment of Breast Cancer
Professor of Medicine
McGill University
Montreal, Que.
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