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APPENDIX B 141 EXAMPLE 2 AMERICAN COLLEGE OF PHYSICIANS Screening for Breast Cancer The guideline on screening for breast cancer, approved April 1989, is a product of the Clinical Efficacy Assessment Project (CEAP), an internally funded practice evaluation activity of the American College of Physicians. This project has evaluated laboratory tests, other technologies, and medical procedures and practices and made recommendations in the form of statements or guidelines. A procedures manual for the project, published in 1986, describes 10 elements involved in the CEAP's guidelines development process: identification of technologies as candidates for evaluation, criteria for selecting technologies to be evaluated, selection of consultants, evaluation process, definition of terms, development of statement, review of statement, ratification process, dissemination of statement, and reconsideration of previously approved statements. The primary audience is the College's 68,000 members, who are specialists in internal medicine. The ACP publishes guidelines in freestanding form as shown below and also has published some sets of related guidelines in manual form. Eventually, the College will publish a comprehensive volume of guidelines, background papers, and other relevant materials. As the guideline shown below illustrates, the freestanding guidelines do not describe the CEAP process, nor do they cite the extensive scientific background papers that are a key element in the evaluation process. For the breast cancer screening guideline, the background paper was prepared by David M. Eddy and published (as are many such papers) in 1989 in the Annals of Internal Medicine.
