Module

Uitkomst raming

Toelichting

Screeningsmodaliteiten mammacarcinoom

geen financiële gevolgen

Uit de toetsing volgt dat de aanbeveling(en) niet breed toepasbaar zijn (<5.000 patiënten) en daarom naar verwachting geen substantiële financiële gevolgen zal hebben voor de collectieve uitgaven.

GRADE

Definitie

Hoog

• er is hoge zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• het is zeer onwaarschijnlijk dat de literatuurconclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Redelijk

• er is redelijke zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• het is mogelijk dat de conclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Laag

• er is lage zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• er is een reële kans dat de conclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Zeer laag

• er is zeer lage zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• de literatuurconclusie is zeer onzeker.

Implicaties van sterke en zwakke aanbevelingen voor verschillende richtlijngebruikers

Sterke aanbeveling

Zwakke (conditionele) aanbeveling

Voor patiënten

De meeste patiënten zouden de aanbevolen interventie of aanpak kiezen en slechts een klein aantal niet.

Een aanzienlijk deel van de patiënten zouden de aanbevolen interventie of aanpak kiezen, maar veel patiënten ook niet.

Voor behandelaars

De meeste patiënten zouden de aanbevolen interventie of aanpak moeten ontvangen.

Er zijn meerdere geschikte interventies of aanpakken. De patiënt moet worden ondersteund bij de keuze voor de interventie of aanpak die het beste aansluit bij zijn of haar waarden en voorkeuren.

Voor beleidsmakers

De aanbevolen interventie of aanpak kan worden gezien als standaardbeleid.

Beleidsbepaling vereist uitvoerige discussie met betrokkenheid van veel stakeholders. Er is een grotere kans op lokale beleidsverschillen.

Cluster/richtlijn: NVRO Late effecten na hodgkinlymfoom

Uitgangsvraag/modules: UV5.2 Op welke wijze zouden risicogroepen van 5-jaarsoverlevers van hodgkinlymfoom en diffuus grootcellig B-cellymfoom gescreend moeten worden voor mammacarcinoom?

Database(s): Embase.com, Ovid/Medline

Datum: 6 augustus 2024

Periode: vanaf 2010

Talen: geen restrictie

Literatuurspecialist: Alies Oost

Rayyan: https://rayyan.ai/reviews/1115107

BMI-zoekblokken: voor verschillende opdrachten wordt (deels) gebruik gemaakt van de zoekblokken van BMI-Online https://blocks.bmi-online.nl/

Deduplication: voor het ontdubbelen is gebruik gemaakt van http://dedupendnote.nl:9777/

Toelichting:

Voor deze vraag is gezocht op de elementen:

• hodgkinlymfoom/ diffuus grootcellig B-cellymfoom overlevers/ behandeld met radiotherapie/ chemotherapie
• Screening mammacarcinoom (d.m.v. mammografie/ MRI)

De sleutelartikelen worden gevonden met deze search, m.u.v. die van Chiarelli (Performance measures of magnetic resonance imaging plus mammography in the high risk ontario breast screening program) en Geuzinge (Cost-effectiveness of Breast Cancer Screening with Magnetic Resonance Imaging for Women at Familial Risk). Er blijkt niet in titel/abstract/trefwoord dat er is gekeken naar hodgkinlymfoom/ diffuus grootcellig B-cellymfoom. Na overleg met de adviseur is besloten dat deze niet met de search hoeven te worden gevonden.

Te gebruiken voor richtlijntekst:

In de databases Embase.com en Ovid/Medline is op 6 augustus 2024 systematisch gezocht naar systematische reviews, RCTs en observationele studies vanaf 2010 over het screenen voor mammacarcinoom bij overlevers van hodgkinlymfoom en diffuus grootcellig B-cellymfoom. De literatuurzoekactie leverde 273 unieke treffers op.

EMBASE

OVID/MEDLINE

Ontdubbeld

SR

36

14

40

RCT

42

25

55

Observationele studies

176

82

178

Totaal

254

121

273*

No.

Query

Results

#1

('hodgkin disease'/exp OR hodgkin*:ti,ab,kw OR (((lymphogranuloma* OR granuloma*) NEAR/3 malign*):ti,ab,kw) OR lymphogranulomatos*:ti,ab,kw OR 'reed sternberg':ti,ab,kw OR 'diffuse large b cell lymphoma'/exp OR dlbcl:ti,ab,kw OR ((('large b cell' OR 'diffuse large cell' OR immunoblast* OR plasmablast* OR centroblast* OR 'double hit' OR 'double expressor' OR histiocytic) NEAR/3 lymphoma*):ti,ab,kw)) AND ('survival'/exp OR 'cancer survivor'/exp OR 'childhood cancer survivor'/exp OR 'survivor'/de OR 'survivorship'/exp OR 'remission'/exp OR surviv*:ti,ab,kw OR remission:ti,ab,kw OR caya:ti,ab,kw OR (((late OR long) NEAR/3 (effect* OR risk* OR sequelae*)):ti,ab,kw) OR (((after OR following) NEXT/3 hl):ti,ab,kw) OR 'radiotherapy'/exp OR 'stereotactic radiotherapy'/exp OR 'radical radiotherapy'/exp OR 'proton radiation'/exp OR 'radiosurgery'/exp OR 'radiation injury'/de OR 'radiation exposure'/de OR radiotherap*:ti,ab,kw OR radiotreatment*:ti,ab,kw OR radiat*:ti,ab,kw OR irradiat*:ti,ab,kw OR sbrt:ti,ab,kw OR sabr:ti,ab,kw OR inrt:ti,ab,kw OR isrt:ti,ab,kw OR imrt:ti,ab,kw OR vmat:ti,ab,kw OR chemoradi*:ti,ab,kw OR 'chemo radi*':ti,ab,kw OR radiosurg*:ti,ab,kw OR 'radi* surg*':ti,ab,kw OR ((volumetric NEAR/3 modulat* NEAR/3 arc):ti,ab,kw) OR (((radio* OR roentgen OR rontgen OR 'x ray') NEAR/3 (therap* OR treatment*)):ti,ab,kw) OR (((proton OR photon) NEAR/3 (therap* OR beam OR irradiat* OR recoil OR radiat* OR radio*)):ti,ab,kw) OR ((bucky NEAR/3 (ray OR radi* OR therap* OR treatment*)):ti,ab,kw) OR 'neoadjuvant therapy'/exp OR 'chemotherapy'/exp OR chemo:ti,ab,kw OR 'chemotherap*':ti,ab,kw OR chemoimmuno*:ti,ab,kw OR 'cytostatic agent'/exp OR 'cytostatic*':ti,ab,kw OR 'anthracycline antibiotic agent'/exp OR anthracyclin*:ti,ab,kw OR 'alkylating agent'/exp OR alkylat*:ti,ab,kw OR 'doxorubicin'/exp OR 'doxorubicin*':ti,ab,kw OR adriamycin*:ti,ab,kw OR doxil*:ti,ab,kw OR 'mitoxantrone'/exp OR 'mitoxantron*':ti,ab,kw OR novantron*:ti,ab,kw OR 'epirubicin'/exp OR 'epirubicin*':ti,ab,kw OR 'procarbazine'/exp OR 'procarbazin*':ti,ab,kw OR natulan:ti,ab,kw) OR (((after OR following) NEXT/3 (hodgkin* OR lymphoma* OR dlbcl)):ti,ab,kw)

105937

#2

(((breast* OR mamma*) NEAR/3 (screen* OR monitor* OR surveillanc*)):ti,ab,kw) OR (((surveillanc* OR screen*) NEAR/3 (imag* OR scan* OR strateg*)):ti,ab,kw) OR (('screening'/exp OR 'monitoring'/exp OR 'long term care'/exp OR screen*:ti,ab,kw OR monitor*:ti,ab,kw OR surveillanc*:ti,ab,kw) AND ('mammography'/exp OR mammograph*:ti,ab,kw OR 'mammo graph*':ti,ab,kw OR mammogram*:ti,ab,kw OR 'mammo gram*':ti,ab,kw OR mamilloscop*:ti,ab,kw OR mammilloscop*:ti,ab,kw OR mastograph*:ti,ab,kw OR echomammograph*:ti,ab,kw OR galactograph*:ti,ab,kw OR scintimammograph*:ti,ab,kw OR xeromammograph*:ti,ab,kw OR (('breast'/exp OR 'breast tumor'/exp OR 'thorax'/exp OR breast*:ti,ab,kw OR chest:ti,ab,kw OR thorax:ti,ab,kw OR thoracic:ti,ab,kw) AND ('nuclear magnetic resonance imaging'/exp OR 'mri scanner'/exp)) OR (((breast* OR mamma* OR chest OR thorax OR thoracic) NEAR/4 (imag* OR mri OR mris OR nmr OR mra OR mras OR tomograph* OR ct OR zeugmatograph* OR 'mr tomograph*' OR 'mr imag*' OR 'proton spin' OR fmri OR fmris OR rsfmri)):ti,ab,kw)))

145282

#3

#1 AND #2 NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) AND [2010-2024]/py

486

#4

'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab

1050726

#5

'clinical trial'/exp OR 'randomization'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp OR 'placebo'/exp OR 'prospective study'/exp OR rct:ab,ti OR random*:ab,ti OR 'single blind':ab,ti OR 'randomised controlled trial':ab,ti OR 'randomized controlled trial'/exp OR placebo*:ab,ti

4080750

#6

'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti)

8344767

#7

'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab)))

15288566

#8

#3 AND #4 - SR

36

#9

#3 AND #5 NOT #8 - RCT

42

#10

#3 AND (#6 OR #7) NOT (#8 OR #9) - observationeel

176

#11

#8 OR #9 OR #10

254

#

Searches

Results

1

((exp Hodgkin Disease/ or hodgkin*.ti,ab,kf. or ((lymphogranuloma* or granulomatos*) adj3 malign*).ti,ab,kf. or lymphogranulomatos*.ti,ab,kf. or 'reed sternberg'.ti,ab,kf. or exp Lymphoma, Large B-Cell, Diffuse/ or dlbcl.ti,ab,kf. or (('large b cell' or 'diffuse large cell' or immunoblast* or plasmablast* or centroblast* or 'double hit' or 'double expressor' or histiocytic) adj3 lymphoma*).ti,ab,kf.) and (exp Survival/ or Survivors/ or exp Cancer Survivors/ or exp Survivorship/ or surviv*.ti,ab,kf. or remission.ti,ab,kf. or caya.ti,ab,kf. or ((late or long) adj3 (effect* or risk* or sequelae*)).ti,ab,kf. or ((after or following) adj3 hl).ti,ab,kf. or exp Radiotherapy/ or exp Radiation Injuries/ or exp Radiation Exposure/ or radiotherap*.ti,ab,kf. or radiotreatment*.ti,ab,kf. or radiat*.ti,ab,kf. or irradiat*.ti,ab,kf. or sbrt.ti,ab,kf. or sabr.ti,ab,kf. or inrt.ti,ab,kf. or isrt.ti,ab,kf. or imrt.ti,ab,kf. or vmat.ti,ab,kf. or chemoradi*.ti,ab,kf. or 'chemo radi*'.ti,ab,kf. or radiosurg*.ti,ab,kf. or 'radi* surg*'.ti,ab,kf. or (volumetric adj3 modulat* adj3 arc).ti,ab,kf. or ((radio* or roentgen or rontgen or 'x ray') adj3 (therap* or treatment*)).ti,ab,kf. or ((proton or photon) adj3 (therap* or beam or irradiat* or recoil or radiat* or radio*)).ti,ab,kf. or (bucky adj3 (ray or radi* or therap* or treatment*)).ti,ab,kf. or exp Neoadjuvant Therapy/ or exp Chemoradiotherapy/ or exp Chemotherapy, Adjuvant/ or exp Consolidation Chemotherapy/ or exp Induction Chemotherapy/ or exp Maintenance Chemotherapy/ or exp Antineoplastic Combined Chemotherapy Protocols/ or chemo.ti,ab,kf. or 'chemotherap*'.ti,ab,kf. or chemoimmuno*.ti,ab,kf. or exp Cytostatic Agents/ or 'cytostatic*'.ti,ab,kf. or exp Anthracyclines/ or anthracyclin*.ti,ab,kf. or exp Antineoplastic Agents, Alkylating/ or alkylat*.ti,ab,kf. or exp Doxorubicin/ or 'doxorubicin*'.ti,ab,kf. or adriamycin*.ti,ab,kf. or doxil*.ti,ab,kf. or exp Mitoxantrone/ or 'mitoxantron*'.ti,ab,kf. or novantron*.ti,ab,kf. or exp Epirubicin/ or 'epirubicin*'.ti,ab,kf. or exp Procarbazine/ or 'procarbazin*'.ti,ab,kf. or natulan.ti,ab,kf.)) or ((after or following) adj3 (hodgkin* or lymphoma* or dlbcl)).ti,ab,kf.

53791

2

(((breast* or mamma*) adj3 (screen* or monitor* or surveillanc*)) or ((surveillanc* or screen*) adj3 (imag* or scan* or strateg*))).ti,ab,kf. or ((Mass Screening/ or exp Population Surveillance/ or screen*.ti,ab,kf. or monitor*.ti,ab,kf. or surveillanc*.ti,ab,kf.) and (exp Mammography/ or mammograph*.ti,ab,kf. or 'mammo graph*'.ti,ab,kf. or mammogram*.ti,ab,kf. or 'mammo gram*'.ti,ab,kf. or mamilloscop*.ti,ab,kf. or mammilloscop*.ti,ab,kf. or mastograph*.ti,ab,kf. or echomammograph*.ti,ab,kf. or galactograph*.ti,ab,kf. or scintimammograph*.ti,ab,kf. or xeromammograph*.ti,ab,kf. or ((exp Breast/ or exp Breast Neoplasms/ or exp Thorax/ or breast*.ti,ab,kf. or chest.ti,ab,kf. or thorax.ti,ab,kf. or thoracic.ti,ab,kf.) and exp magnetic resonance imaging/) or ((breast* or mamma* or chest or thorax or thoracic) adj4 (imag* or mri or mris or nmr or mra or mras or tomograph* or ct or zeugmatograph* or 'mr tomograph*' or 'mr imag*' or 'proton spin' or fmri or fmris or rsfmri)).ti,ab,kf.))

66918

3

(1 and 2) not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/)

242

4

limit 3 to yr="2010 -Current"

175

5

meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf.

765859

6

exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw.

2760882

7

Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies]

4795359

8

Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.))

5754693

9

4 and 5 - SR

14

10

(4 and 6) not 9 - RCT

25

11

(4 and (7 or 8)) not (9 or 10) - observationeel

82

12

9 or 10 or 11

121