A interpretação das novas diretrizes para a detecção precoce do câncer de mama no Brasil

Migowski, Arn

doi:10.1590/0102-311x00111516

Cited by 5 publications

(6 citation statements)

References 5 publications

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“…Although the 2004 consensus did not recommend teaching breast self-examination, it maintained the traditional recommendation of annual screening with clinical breast examination in women 40 years or older 6 . Although the evidence for this recommendation is very weak 11 , other similar recommendations are found in the guidelines of developing countries in Latin America, Africa, and Asia 3,10,12,13 , generally including women under 50 years in the target population. Indirect criteria, such as a younger population age structure than in Europe and North America, less access to mammography, and lower accuracy of this exam in young women, as well as habitually later tumor detection in these countries, are the justifications usually presented for this recommendation of annual screening with clinical examination.…”

Section: History Of Government Recommendations For Early Detection Ofmentioning

confidence: 71%

“…The methodological option here was to consider breast cancer-specific mortality as the critical outcome and penalize the quality of evidence, given the possibility of biases. This penalization and the borderline balance between the risks and benefits of mammographic screening 11 were the two factors that resulted in the weakly favorable recommendations for screening, even in the 50 to 69-year target population. For women in other brackets, the imprecision of the effect estimates (wide confidence intervals) in the meta-analyses resulted in further penalizing the quality of the evidence.…”

Section: Implications For the Chosen Methodsmentioning

confidence: 99%

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Diretrizes para detecção precoce do câncer de mama no Brasil. I - Métodos de elaboração

et al. 2018

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Clinical guidelines are traditionally drafted by expert consensus. The benefits of mammographic screening have been questioned in recent years, owing to biases detected in the clinical trials that popularized its widespread use. Meanwhile, growing body of evidence on harms associated with mammographic screening also required a new approach, taking into account the uncertainties on the benefits and a balance between the gains and possible harms from screening. This article discusses the development of the new guidelines for early detection of breast cancer in Brazil, with details on the drafting methods and implications for the new recommendations. The new methodology features systematic literature reviews, assessment of the validity of the evidence, and the balance between each intervention's risks and benefits, ensuring greater transparency, reproducibility, and validity in the drafting process. The new guidelines also include recommendations for cases with suspicious signs and symptoms. The authors provide a detailed discussion of the advantages of the approach as compared to the traditional expert consensus model, as well as the methods' limitations and disadvantages. They also address the implications of various decisions, such as choices on study designs, screening effectiveness outcomes, definition of overdiagnosis, and methods for calculation.

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Section: History Of Government Recommendations For Early Detection Ofmentioning

confidence: 71%

Section: Implications For the Chosen Methodsmentioning

confidence: 99%

Diretrizes para detecção precoce do câncer de mama no Brasil. I - Métodos de elaboração

et al. 2018

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“…Contudo, é importante destacar que o aumento da detecção desses casos mais iniciais via programas de rastreamento, não necessariamente está ligado à redução da mortalidade pela doença. Ao invés disto, há evidências de que ele pode aumentar a incidência de câncer, pois, casos que talvez nunca viessem a apresentar manifestações clínicas da doença passam a ser tratados, e contribuem artificialmente para o aumento da sobrevida 31,32 . Nos Estados Unidos, por exemplo, de 1976 a 2008, Bleyer e Welch 32 verificaram que após excluir o aumento transitório da incidência de câncer de mama associado ao uso da terapia de reposição hormonal, e após ajustar para as tendências da incidência de câncer em mulheres com menos de 40 anos de idade, tumores que foram detectados em virtude do rastreamento, e que poderiam nunca vir a apresentar manifestações clínicas, foram diagnosticados em 31% dos casos de câncer de mama no período 32 .…”

Section: Discussionunclassified

“…Além disso, os resultados do presente estudo devem ser interpretados com cautela, uma vez que, apesar de a sobrevida ser considerada um desfecho tradicional na área de oncologia, a existência de métodos de rastreamento disponíveis, como ocorre com o câncer de mama, pode levar a um aumento espúrio da sobrevida relacionado ao viés de tempo de antecipação, de tempo de duração e de sobrediagnóstico 31 . A validade externa dos dados também deve ser considerada com precaução, uma vez que as mulheres avaliadas foram usuárias do Sistema Único de Saúde.…”

Section: Discussionunclassified

Sobrevida em 10 anos em mulheres com câncer de mama: coorte história de 2000-2014

Ayala¹,

Anjos

Cassol

et al. 2019

Ciênc. saúde coletiva

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Resumo O câncer de mama é um problema de saúde pública por sua elevada incidência, morbidade e mortalidade. A análise de sobrevida dessa doença contribui para a descrição do comportamento e dos fatores prognósticos. O objetivo deste artigo é investigar a sobrevida em 10 anos após o diagnóstico, e os fatores prognósticos de mulheres com câncer de mama admitidas no Serviço de Mastologia do Sistema Único de Saúde em Joinville, Santa Catarina, entre 2000-2014. Estudo de coorte histórica com dados dos prontuários e das declarações de óbito de 1.321 mulheres, sendo que 471 foram consideradas elegíveis nos critérios tempo de acompanhamento mínimo de 10 anos (n = 288), e/ou óbito antes deste período (n = 183). Análise de sobrevida realizada pelo modelo de Kaplan-Meier, Teste de Log-Rank e Regressão de Cox. A sobrevida global em 10 anos foi 41,0% (IC95% 36,1% 45,0%). O risco de mortalidade em 10 anos estratificado pelo estadiamento tumoral foi maior entre as mulheres com invasão linfática e estadiamento II, e com 60 anos ou mais e estadiamento III. Os achados sugerem que a presença de invasão linfática,idade avançada e estadiamento intermediário/avançado da doença podem ser considerados indicadores de pior prognóstico para o câncer de mama.

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“…Some highly influential examples, predominantly from the United States, are the guidelines of the National Comprehensive Cancer Network 18 and the old versions of the guidelines of the American Cancer Society 19 and the American College of Obstetricians and Gynecologists 20 . The 2004 guidelines of the Brazilian Ministry of Health recommended screening with clinical breast examination starting at 40 years 10 , did not clearly explain the reason for not recommending mammographic screening before 50, and did not discuss the risks and possible benefits (or lack thereof), which could have indirectly encouraged the introduction of mammographic screening and left room for many to interpret the target population's recommendation as a mere prioritization of the age bracket 21 . Evidence shows that guidelines recommending routine mammographic screening in women 40 to 49 years suffer from quality problems and lack of rigor in the methods for their development 22 .…”

Section: Challenges and Barriers To Implementation Of The New Guidelinesmentioning

confidence: 99%

Diretrizes para detecção precoce do câncer de mama no Brasil. III - Desafios à implementação

et al. 2018

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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.

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A interpretação das novas diretrizes para a detecção precoce do câncer de mama no Brasil

Cited by 5 publications

References 5 publications

Diretrizes para detecção precoce do câncer de mama no Brasil. I - Métodos de elaboração

Diretrizes para detecção precoce do câncer de mama no Brasil. I - Métodos de elaboração

Sobrevida em 10 anos em mulheres com câncer de mama: coorte história de 2000-2014

Diretrizes para detecção precoce do câncer de mama no Brasil. III - Desafios à implementação

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