Breast cancer is the leading cause of cancer mortality in Brazilian women. The new Brazilian guidelines for early detection of breast cancer were drafted on the basis of systematic literature reviews on the possible harms and benefits of various early detection strategies. This article aims to present the recommendations and update the summary of evidence, discussing the main controversies. Breast cancer screening recommendations (in asymptomatic women) were: (i) strong recommendation against mammogram screening in women under 50 years of age; (ii) weak recommendation for mammogram screening in women 50 to 69 years of age; (iii) weak recommendation against mammogram screening in women 70 to 74 years of age; (iv) strong recommendation against mammogram screening in women 75 years or older; (v) strong recommendation that screening in the recommended age brackets should be every two years as opposed to shorter intervals; (vi) weak recommendation against teaching breast self-examination as screening; (vii) absence of recommendation for or against screening with clinical breast examination; and (viii) strong recommendation against screening with magnetic resonance imaging, ultrasonography, thermography, or tomosynthesis alone or as a complement to mammography. The recommendations for early diagnosis of breast cancer (in women with suspicious signs or symptoms) were: (i) weak recommendation for the implementation of awareness-raising strategies for early diagnosis of breast cancer; (ii) weak recommendation for use of selected signs and symptoms in the current guidelines as the criterion for urgent referral to specialized breast diagnosis services; and (iii) weak recommendation that every breast cancer diagnostic workup after the identification of suspicious signs and symptoms in primary care should be done in the same referral center.

The objective of the current article is to present the main challenges for the implementation of the new recommendations for early detection of breast cancer in Brazil, and to reflect on the barriers and the strategies to overcome them. The implementation of evidence-based guidelines is a global challenge, and traditional strategies based only on disseminating their recommendations have proven insufficient for changing prevailing clinical practice. A major challenge for adherence to the new guidelines for early detection of breast cancer in Brazil is the current pattern in the use of mammographic screening in the country, which very often includes young women and a short interval between tests. Such practice, harmful to the population's health, is reinforced by the logic of defensive medicine and the dissemination of erroneous information that overestimates the benefits of screening and underestimates or even omits its harms. In addition, there is a lack of policies and measures focused on early diagnosis of symptomatic cases. To overcome these barriers, changes in the regulation of care, financing, and implementation of shared decision-making in primary care are essential. Audit and feedback, academic detailing, and the incorporation of decision aids are some of the strategies that can facilitate implementation of the new recommendations.

Objetivo: Analisar a produção de procedimentos quimioterápicos e radioterápicos registrados nos sistemas de informação referentes ao tratamento de crianças e adolescentes menores de 19 anos com câncer, considerando o tipo de habilitação oncológica dos estabelecimentos de saúde no Sistema Único de Saúde (SUS). Método: Estudo descritivo utilizando a base de dados do sistema de informação ambulatorial do SUS (SIA-SUS), a partir dos procedimentos de quimioterapia e de radioterapia registrados no ano de 2014, e análise das normativas existentes para tratamento oncológico pediátrico. Resultados: Dos 283 estabelecimentos habilitados em oncologia no SUS, 71 eram habilitados em oncologia pediátrica, entretanto 213 informaram realizar quimioterapia e 138 radioterapia em crianças e adolescentes. Os habilitados em oncologia pediátrica realizaram 75,1% do total de quimioterapia e 52,6% dos campos de radioterapia registrados. Houve variação na distribuição etária de quimioterapia segundo tipo de habilitação do estabelecimento. Serviços isolados de radioterapia informaram 34,4% dos campos irradiados em menores de um ano. Conclusão: Os procedimentos não foram realizados, em sua totalidade, em estabelecimentos preconizados conforme orientações existentes.

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