One of the important ways in which this guidance is used reflects a greater concern with implementation. Recommendations from the original breast guidance were incorporated into the NHS cancer standards for both England6 and Wales. 7 These standards have in turn been used to help improve services in various ways (including national peer review in England), and have informed reviews of cancer services carried out by the Commission for Health Improvement and Audit Commission. The task of producing the update has been greater than anticipated because of the scale of the evidence reviews required – although in reality, much of the updated evidence substantiated the validity of existing recommendations, rather than.
