Guidelines for early detection of breast cancer in Brazil. I - Development methods
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng por |
Título da fonte: | Cadernos de Saúde Pública |
Texto Completo: | https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608 |
Resumo: | 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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Guidelines for early detection of breast cancer in Brazil. I - Development methodsDiretrizes para detecção precoce do câncer de mama no Brasil. I - Métodos de elaboraçãoBreast NeoplasmsEarly Detection of CancerMass ScreeningMammographyPractice Guidelines as TopicNeoplasias da MamaDetecção Precoce de CâncerProgramas de RastreamentoMamografiaGuias de Prática Clínica como AssuntoClinical 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.Tradicionalmente, las directrices clínicas se elaboran a partir del consenso de opiniones de especialistas. En los últimos años, la magnitud de los beneficios del rastreo mamográfico ha sido cuestionada, debido a los sesgos detectados en los ensayos clínicos que popularizaron la propagación de esta práctica. Paralelamente, el creciente cuerpo de evidencias sobre daños asociados al rastreo mamográfico también demandaba un nuevo enfoque que considerase las incertidumbres sobre los beneficios y un balance entre ventajas y posibles daños. Este artículo tiene como objetivo presentar el proceso de elaboración de las nuevas directrices para la detección precoz del cáncer de mama en Brasil, detallando los métodos utilizados, así como sus implicaciones para las nuevas recomendaciones. El nuevo enfoque metodológico presenta como pilares la realización de revisiones sistemáticas de la literatura, la evaluación de la validez de las evidencias y el balance entre riesgos y beneficios de cada intervención, garantizando una mayor transparencia, reproductibilidad y validez en el proceso de elaboración. Otra innovación de las nuevas diretrices es la presencia de recomendaciones dirigidas a casos con signos y síntomas sospechosos. Las ventajas del enfoque adoptado, frente al modelo tradicional de consenso por parte de los especialistas, se discute en detalle, así como los límites y desventajas de los métodos utilizados. Asimismo, se discuten las implicaciones de diversas decisiones, como las decisiones en relación con diseños de estudio, resultados sobre efectividad del rastreo, así como la definición de sobrediagnóstico y forma de cálculo.Tradicionalmente, diretrizes clínicas são elaboradas a partir do consenso de opiniões de especialistas. Nos últimos anos, a magnitude dos benefícios do rastreamento mamográfico vem sendo questionada em função dos vieses detectados nos ensaios clínicos que popularizaram a disseminação dessa prática. Paralelamente, o crescente corpo de evidências sobre danos associados ao rastreamento mamográfico também demandava uma nova abordagem que considerasse as incertezas sobre os benefícios e um balanço entre ganhos e possíveis danos. O presente artigo tem por objetivo apresentar o processo de elaboração das novas diretrizes para detecção precoce do câncer de mama no Brasil, detalhando os métodos utilizados, bem como suas implicações para as novas recomendações. A nova abordagem metodológica apresenta como pilares a realização de revisões sistemáticas da literatura, a avaliação da validade das evidências e o balanço entre riscos e benefícios de cada intervenção, garantindo maior transparência, reprodutibilidade e validade no processo de elaboração. Outra inovação das novas diretrizes é a presença de recomendações dirigidas a casos com sinais e sintomas suspeitos. As vantagens da abordagem adotada frente ao modelo tradicional de consenso de especialistas são discutidas com detalhes, bem como os limites e desvantagens dos métodos utilizados. Também são discutidas as implicações de diversas decisões, como escolhas sobre desenhos de estudo, desfechos sobre efetividade do rastreamento, além da definição de sobrediagnóstico e forma de cálculo.Reports in Public HealthCadernos de Saúde Pública2018-06-21info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmltext/htmlapplication/pdfapplication/pdfhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608Reports in Public Health; Vol. 34 No. 6 (2018): JuneCadernos de Saúde Pública; v. 34 n. 6 (2018): Junho1678-44640102-311Xreponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZengporhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608/14210https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608/14211https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608/14212https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608/14213Arn MigowskiAirton Tetelbom SteinCamila Belo Tavares FerreiraDaniele Masterson Tavares Pereira FerreiraPaulo Nadanovskyinfo:eu-repo/semantics/openAccess2024-03-06T15:29:26Zoai:ojs.teste-cadernos.ensp.fiocruz.br:article/6608Revistahttps://cadernos.ensp.fiocruz.br/ojs/index.php/csphttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/oaicadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2024-03-06T13:07:34.199204Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)true |
dc.title.none.fl_str_mv |
Guidelines for early detection of breast cancer in Brazil. I - Development methods Diretrizes para detecção precoce do câncer de mama no Brasil. I - Métodos de elaboração |
title |
Guidelines for early detection of breast cancer in Brazil. I - Development methods |
spellingShingle |
Guidelines for early detection of breast cancer in Brazil. I - Development methods Arn Migowski Breast Neoplasms Early Detection of Cancer Mass Screening Mammography Practice Guidelines as Topic Neoplasias da Mama Detecção Precoce de Câncer Programas de Rastreamento Mamografia Guias de Prática Clínica como Assunto |
title_short |
Guidelines for early detection of breast cancer in Brazil. I - Development methods |
title_full |
Guidelines for early detection of breast cancer in Brazil. I - Development methods |
title_fullStr |
Guidelines for early detection of breast cancer in Brazil. I - Development methods |
title_full_unstemmed |
Guidelines for early detection of breast cancer in Brazil. I - Development methods |
title_sort |
Guidelines for early detection of breast cancer in Brazil. I - Development methods |
author |
Arn Migowski |
author_facet |
Arn Migowski Airton Tetelbom Stein Camila Belo Tavares Ferreira Daniele Masterson Tavares Pereira Ferreira Paulo Nadanovsky |
author_role |
author |
author2 |
Airton Tetelbom Stein Camila Belo Tavares Ferreira Daniele Masterson Tavares Pereira Ferreira Paulo Nadanovsky |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Arn Migowski Airton Tetelbom Stein Camila Belo Tavares Ferreira Daniele Masterson Tavares Pereira Ferreira Paulo Nadanovsky |
dc.subject.por.fl_str_mv |
Breast Neoplasms Early Detection of Cancer Mass Screening Mammography Practice Guidelines as Topic Neoplasias da Mama Detecção Precoce de Câncer Programas de Rastreamento Mamografia Guias de Prática Clínica como Assunto |
topic |
Breast Neoplasms Early Detection of Cancer Mass Screening Mammography Practice Guidelines as Topic Neoplasias da Mama Detecção Precoce de Câncer Programas de Rastreamento Mamografia Guias de Prática Clínica como Assunto |
description |
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. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-06-21 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608 |
url |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608 |
dc.language.iso.fl_str_mv |
eng por |
language |
eng por |
dc.relation.none.fl_str_mv |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608/14210 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608/14211 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608/14212 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6608/14213 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html text/html application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
Reports in Public Health Cadernos de Saúde Pública |
publisher.none.fl_str_mv |
Reports in Public Health Cadernos de Saúde Pública |
dc.source.none.fl_str_mv |
Reports in Public Health; Vol. 34 No. 6 (2018): June Cadernos de Saúde Pública; v. 34 n. 6 (2018): Junho 1678-4464 0102-311X reponame:Cadernos de Saúde Pública instname:Fundação Oswaldo Cruz (FIOCRUZ) instacron:FIOCRUZ |
instname_str |
Fundação Oswaldo Cruz (FIOCRUZ) |
instacron_str |
FIOCRUZ |
institution |
FIOCRUZ |
reponame_str |
Cadernos de Saúde Pública |
collection |
Cadernos de Saúde Pública |
repository.name.fl_str_mv |
Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ) |
repository.mail.fl_str_mv |
cadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br |
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1798943385705250816 |