Background Development of a high-quality Clinical Practice Guideline (CPG) involves spending a significant amount of resources. Frequently, similar strategies are used around the world to achieve similar results. A method to utilise resources in a more efficient manner and to avoid the unnecessary duplication of efforts is to adapt existing guidelines. However, the methodological diversity of CPGs, specific regional conditions, and difficulties in the implementation of recommendations, impose a systematic approach for its adaptation that constitute an important methodological challenge, that must take into account the similarities between a de novo development and an adaptation of guidelines. The process of adaptation requires systematic and transparent activities that disclose the considerations made to adjust the recommendations to a specific context.

Methods The development of the GPC for breast cancer follows the steps proposed in the Methodological Guideline for the development of GPCs in the Colombian Health System.

Results The systematic search retributed 176 GPCs, 48 (27%) of which were qualified with the DELBI instrument as “highly recommended”. The Guideline Development Group (GDG) elaborated 41 questions, 30 (73%) were adapted following the methodology proposed by the ADAPTE collaboration. The remaining 11 (27%) developed de novo; 12,000 titles and publication summaries have been reviewed, of which 130 have been included and qualified with the system proposed for GRADE Working Group. The results take into account the challenges implied in the CPG adaptation processes.