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Search Strategy

Literature searches were conducted in Pubmed, CINAHL, and the Cochrane Library, using keywords “breast” and “neoplasms” and “selective estrogen modulators” and “primary prevention” OR “risk reduction” and “tamoxifen” and/or “raloxifene”.

Guideline searches were also carried out on the websites of the world’s most highly respected cancer organizations and agencies. All selected literature articles and source guidelines were in English and dated after the year 2000 (unless the selection was an earlier landmark study) up to the March 2011.

The inclusion/exclusion process consisted of selecting guidelines from reputable cancer organizations with preference given to those from Canadian sources where possible. Twelve source guidelines were identified but only five were chosen to be reviewed due to currency of content (22-33).

The five identified source guidelines (29-33) were put through the ADAPTE process (34) with an AGREE II assessment (35), and the Alberta Health Services (AHS) “risk reduction and surveillance strategies for individuals at high genetic risk for breast and ovarian cancer” guideline was chosen to be adapted for use in our guideline (32). The AHS guideline was selected as the optimal choice due to its applicability, quality and currency of content.
There has been much debate but no consensus on the ‘grading of evidence’ in Canada. Presently, Canadian experts in the field of guideline development are involved in an ongoing in-depth analysis of the functionality of grading. Until such time as a report is released of their findings, and a consensus reached on whether to assign a grade of recommendation to a guideline, this group has decided to forgo the use of grading.

No competing or conflicts of interest were declared.


Updated Jul 12, 2012