A scoping review characterizing "Choosing Wisely®" recommendations for breast cancer management

Abstract

Purpose Choosing Wisely (CW)® was created by the American Board of Internal Medicine (ABIM) to promote patient-physician conversations about unnecessary medical interventions. Similarly, other countries created their own panels of experts called "CW® campaigns" which review recommendations submitted by that country's oncology societies. We performed a scoping review to consolidate CW® recommendations from different groups with respect to breast cancer care. Methods A systematic search of Medline and Embase was designed by an information specialist for publications presenting CW® recommendations for breast cancer care practices from 2011-2020. We also reviewed the websites of all CW® campaigns and reference sections of each CW® recommendation. Two reviewers independently screened studies for inclusion and performed data extraction. Findings were summarized narratively. Results Review of ABIM CW® recommendations showed 19 breast cancer-related recommendations pertaining to; screening (n = 4), radiological staging (n = 2), treatment (n = 10), surveillance (n = 2), and miscellaneous (genetic testing; n = 1). Of 22 countries with CW® campaigns, 10 published recommendations for breast cancer. Over half (57%) of recommendations were supported by more than one country. No recommendations were refuted between campaigns. Two campaigns developed 3 novel recommendations on new topics, including chemotherapy in ductal carcinoma in situ (Italy) and comparison of screening imaging modalities (Portugal). Conclusions CW® recommendations focus on reducing overutilization of investigations and treatments. There was a high rate of consensus between different CW® campaigns. As health care systems globally move attention to reduce low-value care, further studies are required to address adherence to these current recommendations and develop new recommendations.

Omission of sentinel node biopsy for breast cancer: Historical context and future perspectives on a modern controversy

“…After reviewing the evidence, the American Board of Internal Medicine's Choosing Wisely (CW) health educational campaign now recommends omission of all forms of axillary surgery, including SNB, for clinically nodenegative patients aged 70 years or older with early stage, ER-positive, HER-2-negative, invasive breast cancer. 33,34 Moreover, as part of the CW campaign, the Society of Surgical Oncology advises surgeons not to routinely use sentinel lymph node surgery in women older than 70 years who have hormone receptor-positive breast cancer. 34,35 The CW campaign's objectives are to recommend clinical management strategies with a high benefit-torisk ratio and to promote patient-physician conversations about unnecessary medical interventions.…”

The COVID-19 pandemic: An opportunity to rethink and harmonise the frequency of follow-up visits for patients with early stage breast cancer

“…While the National Institute for Health and Care Excellence (NICE) recommends avoidance of routine follow-up in asymptomatic patients [13], other national and international practice guidelines recommend regular follow-up with health care providers, sometimes as often as every 3-6 months, for several years (Table 1) [1,[14][15][16][17][18]. Given the importance of providing evidence-based follow-up care during the COVID-19 pandemic, this systematic review was performed to provide up-to-date evidence around optimal recommendations in terms of both frequency and duration of follow-up care.…”