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RASTREIO DE CANCRO DA MAMA: MAMOGRAFIA, PARA QUEM E COM QUE FREQUÊNCIA? Opinião do clínico

RASTREIO DE CANCRO DA MAMA: MAMOGRAFIA, PARA QUEM E COM QUE FREQUÊNCIA? Opinião do clínico. J. Abreu de Sousa Clínica de Mama IPO PORTO. Mamografia de Rastreio !. Depois de 50 anos,. 600.000 mulheres incluídas…. 10 Estudos Prospectivos Randomizados ,. Com 10 anos de follow-up ….

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RASTREIO DE CANCRO DA MAMA: MAMOGRAFIA, PARA QUEM E COM QUE FREQUÊNCIA? Opinião do clínico

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  1. RASTREIO DE CANCRO DA MAMA:MAMOGRAFIA, PARA QUEM E COM QUE FREQUÊNCIA?Opinião do clínico J. Abreu de Sousa Clínica de Mama IPO PORTO

  2. Mamografia de Rastreio!

  3. Depois de 50 anos, 600.000 mulheres incluídas… 10 Estudos Prospectivos Randomizados, Com 10 anos de follow-up…

  4. Radiação ionizante Dor Ansiedade Stress ? Riscos

  5. The Real Problem With Mammograms: They're Too Good at Finding Things We Don't Understand by Kate Dailey November 17, 2009 While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.

  6. When NOT to screen for cancer? WhenanOunceofPreventionisWorth a PoundofHarm

  7. Sobrevivência do Carcinoma da Mama Invasivo por TamanhoSwedishTwo-CountyTrialofBreastScreening Surg Oncol Clin N Am 14(2005) 671-697

  8. Rastreio do Cancro da Mama com MamografiaEvidência Científica

  9. Risco Relativo de Mortalidade nos RCT de Rastreio de Cancro da Mama SurgOncolClin N Am 14(2005) 671-697

  10. Consultas Subsequentes 5919 Estereotáxia Ecografia Primeiras Consultas 3351 Estereotáxia Ecografia

  11. Probabilidade de Falsos Positivos na Mamografia, Necessidade de Biópsias e Diagnóstico de Cancro da Mama, em 1000 mulheres que realizaram Mamografia durante 10 anos Taxa de Falsos Positivos : 6,5%

  12. Probabilidade de Cancro da Mama, em 1000 mulheres que realizaram Mamografia durante 10 anos

  13. Modernas Técnicas de Imagem »» Sobrediagnóstico? Rastreio: Detecção de CDIS e Sobre-diagnóstico?

  14. Rastreio de Prevalência: 37% CDIS não progressivos • Rastreio de Incidência: 4% CDIS não progressivos • Ainda que o sobrediagnóstico seja um elemento a ter a conta no rastreio, o fenómeno tem uma pequena dimensão, tanto em termos relativos como absolutos

  15. Taxa de Falsos Negativos

  16. 20% dos cancros detectados em mulheres rastreadas

  17. CATEGORIAS DE DENSIDADE MAMOGRÁFICA BreastImagingReport Data System (BI-RADS) AmericanCollegeofRadiology, 4th Edition BI-RADS 4 >75% Glandular BI-RADS 1 <25 Glandular BI-RADS 2 25-50% Glandular BI-RADS 3 51-75% Glandular

  18. 587.369 mulheres » 1.349.027 mamografias » 14.090 Ca Mama • Risco de Cancro / 5 anos » Densidade, Idade, Menopausa, THS • Risco de Ca Mama / 5 anos: BIRADS 1, SEM THS – 0.8% • Risco de Ca Mama / 5 anos: BIRADS 1, COM THS – 0.9% • Risco de Ca Mama / 5 anos: BIRADS 4, SEM THS – 2.4% • Risco de Ca Mama / 5 anos: BIRADS 4, COM THS – 4.2%

  19. Rastreio na Mulher Idosa? Mulheres > 65 anos: 12% população (2010) Mulheres > 65 anos: 35% população (2035)

  20. Probabilidade de desenvolver Cancro da Mama por Idade

  21. 87 anos c T2 N0 M0 ECOG: 1 ASA: 3 79 anos c T1 N0 M0 ECOG: 0 ASA:2

  22. Reduzir a Mortalidade 25% Mamografia 2/2 anos dos 50-69 anos

  23. American Cancer Society Guidelines for the Early Detection of Cancer The American Cancer Society recommends these screening guidelines for most adults. Breast cancer Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s. The American Cancer Society recommends that some women -- because of their family history, a genetic tendency, or certain other factors -- be screened with MRI in addition to mammograms. (The number of women who fall into this category is small: less than 2% of all the women in the US.) Talk with your doctor about your history and whether you should have additional tests at an earlier age. For more information, call the American Cancer Society and ask for our document,

  24. The Myth of the Mammogram Why many American women are resolutely rejecting the new mammogram recommendations, despite mixed reaction in the medical community. by Pat Wingert November 20, 2009 "We spent 20 years telling women to be afraid, be very afraid, of breast cancer, and that they could save their lives through early detection," says Cindy Pearson, executive director of the National Women’s Health Network. But in fact, the evidence has been mounting since 1992, when a Canadian National Breast Cancer Studyconcluded that mammograms had no effect on mortality for premenopausal women 40 to 50 years old. The initial recommendation to begin mammograms at age 40, made in 1983 by the American Cancer Society, was based on a documented rise in breast-cancer rates, not because of compelling data that mammograms were highly effective for the younger age group.

  25. The U.S. Preventive Services Task force (USPSTF), funded by the Agency for Healthcare Research and Quality, published its recommendations in Annals of Internal Medicine; its decision was based on an analysis of existing trials that looked at the impact of mammography on breast-cancer deaths. The task force further recommended that women between ages 50 and 74 get screened every two years instead of annually, and that doctors no longer urge women to conduct monthly breast self-exams, since the practice does not appear to significantly reduce the risk of death from breast cancer. Opinião Pública !!! PanelUrgesMammogramsat 50, Not 40 Published: November 16, 2009 Mostwomenshouldstart regular breastcancerscreeningat age 50, not 40, according to newguidelinesreleasedMondaybyaninfluentialgroupthatprovidesguidance to doctors, insurancecompaniesandpolicymakers.

  26. 40-49 anos • Necessário rastrear 1900 mulheres • + de 20.000 visitas para mamografia • + de 2.000 falso-positivos • Para prevenir 1 morte durante 11 anos de follow-up • 60-69 anos • Necessário rastrear 400 mulheres • + de 5.000 visitas para mamografia • + de 400 falso-positivos • Para prevenir 1 morte durante 11 anos de follow-up Valor da Mamografia Sobrestimado ?

  27. 44 € 53 €

  28. CUSTO BENEFÍCIO

  29. Medida de que inclui a qualidade e a quantidade de vida • Usado para medir o valor de uma intervenção médica • Baseado no número de anos acrescentados por uma intervenção • Análise de Custo/Utilidade, para calcular o Custo/QALY salvo (incremental costeffectiveness ratio "ICER") para uma intervenção determinada QALY(Quality-AdjustedLifeYear)

  30. Modelo de Relação Risco-Benefício para Decisões Individuais

  31. A interpretação da evidencia clínica é um exercício científico A aplicação da evidencia , na elaboração de uma norma, é um exercício social

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