Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation

• Autor(a) principal: Arn Migowski
• Data de Publicação: 2018
• Outros Autores: Maria Beatriz Kneipp Dias, Paulo Nadanovsky, Gulnar Azevedo e Silva, Denise Rangel Sant’Ana, Airton Tetelbom Stein
• 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/6615
• topic: Breast Neoplasms; Early Detection of Cancer; Mass Screening; Mammography; Health Plan Implementation; Neoplasias de Mama; Detecção Precoce de Câncer; Programa de Rastreamento; Mamografia; Implementação de Plano de Saúde

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.