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Objective: Breakthrough cancer pain (BTcP) is common and has a significant impact on the quality of life of patients with cancer. This review compares current national/international BTcP guidelines in order to identify disparities and priorities for further research., Methods: Relevant guidelines were identified using searches of PubMed, the National Guideline Clearinghouse, the internet (commercial search engines), and correspondence with key opinion leaders and relevant pharmaceutical companies. Identified guidelines were compared, using the Association for Palliative Medicine of Great Britain and Ireland recommendations as the 'reference' guideline., Results: Ten specific BTcP guidelines were identified/reviewed, as well as major international generic cancer pain guidelines. In general, there was good agreement between the specific BTcP guidelines, although there remain some differences in terms of definition, diagnostic criteria and treatment of BTcP. Disparities between the different BTcP guidelines invariably reflect personal opinion rather than research evidence. Generic cancer pain guidelines continue to support the use of oral opioids as rescue medication, while specific BTcP guidelines invariably endorse the use of transmucosal opioids as rescue medication., Conclusion: Current guidelines agree on many aspects of the management of BTcP. However, the evidence to support current guidelines remains low grade, and so more research is needed in this area of care. Moreover, there needs to be an international consensus on the definition and diagnosis criteria of BTcP., Competing Interests: Competing interests: AND has received honoraria for speaking from Angelini, Menarini, ProStrakan, Takeda and TEVA; honoraria for attending advisory boards from Grunenthal, MEDA, Nycomed, ProStrakan and TEVA; and unrestricted research grants from Cephalon, ProStrakan and Takeda. FE has received honoraria for speaking from Grunenthal and TEVA; and honoraria for attending advisory boards from Grunenthal, MEDA, Nycomed, ProStrakan and TEVA. MJF has received honoraria for attending advisory boards from MEDA, Takeda and TEVA. JPS has received honoraria for speaking from TEVA; honoraria for attending advisory boards from TEVA; and support for publication from Takeda. CR has received honoraria for speaking from Angelini and TEVA; and support for publication from Molteni., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)