The lack of breast cancer screening in low and middle‐income countries results in later stage diagnosis and worsened outcomes for women. A cluster randomized trial was performed in Bogotá, Colombia between 2008 and 2012 to evaluate effects of opportunistic breast cancer screening. Thirteen clinics were randomized to an intervention arm and 13 to a control arm. Physicians in intervention clinics were instructed to perform clinical breast examination on all women aged 50–69 years attending clinics for non‐breast health issues, and then refer them for mammographic screening. Physicians in control clinics were not explicitly instructed to perform breast screening or mammography referrals, but could do so if they thought it indicated (“usual care”). Women were followed for 2‐years postrandomization. 7,436 women were enrolled and 7,419 (99.8%) screened in intervention clinics, versus 8,419 enrolled and 1,108 (13.1%) screened in control clinics. Incidence ratios (IR) of early, advanced and all breast cancers were 2.9 (95% CI 1.1–9.2), 1.0 (0.3–3.5) and 1.9 (0.9–4.1) in the first (screening) year of the trial, and the cumulative IR for all breast cancers converged to 1.4 (0.7–2.8) by the end of follow‐up (Year 2). Eighteen (69.2%) of 26 women with early stage disease had breast conservation surgery (BCS) versus 6 (42.5%) of 14 women with late‐stage disease (p = 0.02). Fifteen (68.2%) of 22 women with breast cancer in the intervention group had BCS versus nine (50.0%) of 18 women in the control group (p = 0.34). Well‐designed opportunistic clinic‐based breast cancer screening programs may be useful for early breast cancer detection in LMICs.
Objetivo: validar en Colombia la escala abreviada de síntomas representativos de neoplasias mieloproliferativas para su posterior uso en investigación y aplicación en el ámbito clínico. Materiales y métodos: se realizó la adaptación transcultural de la escala MNP-SAF-TSS (por sus siglas en inglés: Mieloproliferative Neoplasm Symptom Assesment Form-Total Sympton Score) a español y al contexto colombiano, con análisis estadísticos de validez y con abilidad con un tamaño de muestra determinado para cada propiedad psicométrica. Resultados: con base en las propiedades psicométricas se logró veri car la confiabilidad y la estructura interna de la escala con alfa de Cronbach de 0,8552, lo que denota una buena consistencia interna; se obtuvo un coeficiente de correlación de concordancia de Lin de 0,765 que muestra una buena confiabilidad. El análisis factorial mostró múltiples valores de coeficiente de correlación por encima de 0,3, lo que indica que las variables de la escala miden factores comunes; la validez de criterio concurrente determina que la escala mide lo que debe medir con un adecuado coeficiente de correlación de Spearman de -0,71 y -0,73 al confrontarla con las escalas facit-Fatigue y Fact-Lym, respectivamente. Conclusión: la escala MNP-SAF-TSS adaptada a español y al contexto colombiano es un instrumento válido para la evaluación de síntomas en pacientes con neoplasias mieloproliferativas y puede ser utilizado en la práctica clínica o en estudios clínicos por sus adecuadas propiedades psicométricas.
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