Author: Rodger J. Winn MD
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The Mission Statement of every institution, hospital, and medical group declares the professional commitment to provide care that is “the most up-to-date” and “state-of-the-art.” For the most part, this goal is met, but it still must be placed in context. For the year 2002, a search of PubMed under breast cancer, human, English yields 5,496 entries. The daunting task for the oncology team becomes, then, the challenge of reading 15 articles a day, each and every day, and still finding time to keep up with the nonbreast cancer literature.One solution, of course, is the distillation of current knowledge into a clinical practice guideline by a broad panel of experts committed to keeping abreast of the plethora of new advances. Considering the enormous breadth of new information, it comes as no surprise that this JNCCN presents three separate breast cancer-oriented guidelines: treatment, screening and diagnosis, and risk reduction.The second major issue in using guidelines to maintain currency is the schedule of updates. A study of the AHCPR national guidelines showed that guidelines began to loose considerable validity after three years.1 A worrisome finding is that despite the existence of new data, the old guidelines remained in use. For this reason, the NCCN annual review process assures us that the recommendations reflect information of the latest vintage.Each guideline recommendation is built on a body of data and analysis. Many times, the pithy, straightforward recommendation reflects the amassing of a body of data, major debate on its significance, and a...

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Rodger J. Winn is the Editor-in-Chief of JNCCN, as well as chair of the NCCN's Guidelines Steering and Principal Investigators Committees. His past positions include Associate Professor of Clinical Medicine at the University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology.

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    Shakelle PG, Ortiz E, Rhodes S. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: How quickly do guidelines become outdated? JAMA 2001;286:15091511.

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