The Canadian Practice Guidelines for the Care and Treatment of Breast Cancer, first published in 1998, were developed to reduce variation in the way that breast cancer was being treated. To determine whether the guidelines have influenced practice, Steven Latosinsky and colleagues performed a population-based study, supported by the CancerCare Manitoba Foundation, that included women living in Manitoba in whom breast cancer was diagnosed from 1995 to 2003.
By examining 4 measures of care, they found that there was clinically significant variation in the province-wide rates of all measures studied and that introduction of the guidelines in 1998 did not affect either the province-wide rates or variations in these rates between surgeons.
Their findings suggest that the Canadian breast cancer guidelines are not meeting their objective.
In a related commentary, Eva Grunfeld discusses the implications of this finding and asks the million dollar question — are guidelines effective? She notes that publication is only one component among many that affects adoption of guidelines into clinical practice and concludes that the Canadian breast cancer guidelines are as effective as possible under the circumstances.
p. 771 Canadian breast cancer guidelines: Have they made a difference?
S. Latosinksky et al
http://www.cmaj.ca/pressrelease/pg771.pdf
p. 785 Canadian breast cancer guidelines are as effective as possible under the circumstances
E. Grunfeld
http://www.cmaj.ca/pressrelease/pg785.pdf
Canadian Medical Association Journal