Diretrizes para detecção precoce do câncer de mama no Brasil. II - Novas recomendações nacionais, principais evidências e controvérsias

Abstract

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.

Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment

“…In agreement with present results, a recent Mexican study associated diagnostic delay with increased number of HCP, used before admission to a specialized health care centre (Unger-Saldaña et al, 2018). According to the INCA and the Ministry of Health, women who experience breast cancer symptoms should visit a primary HCP for clinical breast examination (Migowski et al, 2018). From this primary service, patients should be referred to diagnostic mammography and an anatomic-pathological exam.…”

“…Private HCP can perform diagnostic services and they are financed by the SUS. After diagnostic confirmation of breast cancer, patients should then be referred to units or centres with high complexity of cancer treatment (Unidades/Centros de Alta Complexidade Oncológica; UNACON/CACON; Migowski et al, 2018). Diagnostic mammography and anatomic-histopathological exams are often not offered by the same HCP.…”

Biological and histological variability of breast cancer

“…Este es el tratamiento sugerido por las normas internacionales y con el que se cuenta en el hospital ya que se ha convertido en un centro de referencia oncológica en especial para el cáncer de cuello uterino y cáncer de mamas. Por lo tanto al ser declarado centro de referencia para estas patologías el Ministerio de Salud provee al hospital de los recursos mínimos necesarios para este tratamiento (1,2) . Tomando en cuenta específicamente la clasificación molecular, tanto en nuestro estudio como en literaturas siguen en frecuencia el luminal B, Her2 y el triple negativo (5) .…”

“…(Itauguá) 2019;11 (2):41-50 10.18004/rdn2019.0011.02.041-050 pasará de unos 6 millones a 10 millones. El cáncer de mama es una patología presente desde tiempos inmemoriales, que en la actualidad es unos de los canceres más estudiados y del cual se conocen con mayor exactitud su fisiopatología, su funcionamiento molecular y los mecanismos que los regulan favorecen a un tratamiento oncológico desarrollado especialmente para cada paciente (1,2) .…”

Mortalidade Cardiovascular Associada ao Rastreamento Mamográfico

“…É sabido que o rastreamento do câncer de mama com mamografia aumenta o diagnóstico de casos de câncer de mama que nunca iriam se manifestar clinicamente (sobrediangóstico) [1][2][3] e que esse aumento de casos diagnosticados também resulta em tratamento oncológico desnecessário (sobretratamento) 4 . Esse aumento de tratamento é contraintuitivo na medida em que se esperava que, com o rastreamento, haveria redução da morbidade.…”