Top 10 breast cancer topics needing a Cochrane systematic review

Deciding which research topics to focus on in medicine and health depends on many factors. These factors can include the currency of a topic, feedback from people providing or receiving care, and the priorities of funders.

In late 2019, the Cochrane Breast Cancer Group (part of Cochrane’s Cancer Network) conducted a formal priority-setting exercise to help decide which review topics were most needed in the Cochrane Library. The Group did this by circulating a survey listing 25 new or existing review topics to a diverse group of individuals who are part of the international breast cancer community. The survey asked individuals to rank their top 10 topics from the list. Read details about the aims and methods used for this priority-setting exercise, which adhered to the standards outlined in Cochrane’s priority setting guidance note.

What were the top 10 review topics?

Rank

Topic in Cochrane format 

Topic question in lay terms 

1

Omission of whole breast irradiation for postmenopausal women with early breast cancer 

Can radiotherapy be safely omitted in postmenopausal women with early breast cancer? 

2

Platinum-containing regimens for neoadjuvant and adjuvant therapy in triple-negative breast cancer 

What are the benefits and harms of adding platinum chemotherapy to standard therapy for people with triple-negative early breast cancer? 

3

Overdiagnosis due to screening mammography for women aged 40 years and over

In women aged 40 years or older and at average risk, should they have a mammogram? 

4

Post-mastectomy radiotherapy for women with early breast cancer and 1 to 3 positive lymph nodes

For women who have 1 to 3 positive axillary lymph nodes after mastectomy, does radiotherapy to the lymph nodes provide an additional benefit when compared to women who do not have radiotherapy to the lymph nodes?

5

Breast surgery for metastatic breast cancer

What are the benefits and harms of having breast surgery in addition to anti-cancer treatment when breast cancer has spread to another part of the body?

6

Partial breast irradiation for early breast cancer

Can radiotherapy delivered to part of the breast be as effective and safe as radiotherapy delivered to the whole breast for women who have had breast-conserving surgery?

7

Parenteral bone-active agents in adjuvant therapy

What are the benefits and harms of adding bisphosphonate or denosumab to standard anti-cancer treatment in women with early breast cancer?

8

Systemic therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer

Can medications and supplements (such as complementary and alternative medicines) help to reduce the symptoms of aromatase inhibitor-induced muscle pain and stiffness compared to no therapy? 

9

Non-hormonal interventions for hot flushes in women with a history of breast cancer

Can pharmacological agents (such as vitamin E, clonidine, gabapentin) and non-pharmacological therapies (such as meditation, aromatherapy, magnetic therapy) help to reduce the number of hot flushes compared to no therapy in women receiving endocrine therapy for breast cancer treatment, women experiencing menopause with a history of breast cancer or women experiencing menopause due to breast cancer treatment?

10

Hypofractionation radiation therapy for early breast cancer

Can fewer radiotherapy visits (by using a higher radiation dose at each visit) be as effective and safe as conventional radiotherapy treatments for women who have had breast-conserving surgery?


Read about the ranking of the 25 new or existing review topics.

We need your help: call for new author teams

Topics 1 and 9 are available to new author teams. All other topics listed above are already underway with established author teams.

If you are interested in working on topic 1 or 9, please contact us at cochrane@ctc.usyd.edu.au for further details. New author teams need to involve at least two authors – one person with clinical experience in the topic area and another person with methodological and statistical experience who has training in Cochrane methods and has published a systematic review. In line with Cochrane’s principles, new author teams are expected to update review topics as new evidence emerges.

What is next?

Support to author teams
For the top 10 topics, the Cochrane Breast Cancer Group will prioritise these topics during the editorial and peer-review process.

For all breast cancer review topics registered with Cochrane, the Cochrane Breast Cancer Group continues to work on these topics with author teams as these remain important topics. There will be no noticeable change in the support provided to author teams.

Future topics
The Cochrane Breast Cancer Group is open to receiving new topic ideas. If you have suggestions for new topics that are not currently covered in the Cochrane Library, please send your idea to cochrane@ctc.usyd.edu.au.

Repeating this priority-setting exercise
The priority-setting exercise may be repeated every 3 years, depending on resources.

Who responded to the survey?

The survey was circulated to over 800 individuals. Of the 199 people who responded, 90 people (45%) provided complete responses. The respondents were doctors (59%), researchers (18%) and people who had received treatment or currently receiving treatment for breast cancer (14%). Most respondents were from the UK, followed by the USA, Argentina, and India.

How did we calculate the ranking for each review topic?

The average ranking was calculated for each topic. This method is commonly used to determine ranking scores from surveys. This approach considers the number of counts for each ranking on a topic, the weighting of each rank (where a ranking of 1 gets the most weight) and the total number of counts. 

[Cover image: foliage of the Yew tree. Taxanes, a class of chemotherapy drugs, were originally derived from the Yew tree]