Table 1 Contextual differences between the source (ECIBC) and adoloped (Tunisian) guidelines
Guideline Item | ECIBC Guideline | Tunisian Guideline | Rationale for change by Tunisian panel |
|---|---|---|---|
Perspective | Population | Individual | Organized mammography screening programs not available in Tunisia |
Scope | Screening and diagnosis | Screening | Feasibility considerations; first ADOLOPMENT experience |
Prioritized questions | 9* | 6 | 3 questions on screening using tomosynthesis were dropped, as tomosynthesis is not used in Tunisia as a screening tool |
Rating of outcome importance | ‘All-cause mortality’ important;‘overdiagnosis’ critical | ‘All-cause mortality’ not important;‘overdiagnosis’ important | Change in perspective (from population to individual) |
Baseline risks | Breast cancer incidence and breast cancer mortality rate from the meta-analysis control arm data | Lower breast cancer incidence, higher breast cancer mortality rate | Overall, the baseline risk of breast cancer mortality in Tunisia was assumed to be similar to that in Europe |
Indirectness of the evidence | Judgment of indirectness made in the source guideline | Judgment of no (further) rating down of certainty of evidence for indirectness | Based on the consideration of how the characteristics of the populations or the interventions in the Tunisian setting compare to the setting of the source guideline |