Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation
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/6615 |
Resumo: | 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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Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementationDiretrizes para detecção precoce do câncer de mama no Brasil. III - Desafios à implementaçãoBreast NeoplasmsEarly Detection of CancerMass ScreeningMammographyHealth Plan ImplementationNeoplasias de MamaDetecção Precoce de CâncerPrograma de RastreamentoMamografiaImplementação de Plano de SaúdeThe 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.El objetivo del presente artículo es presentar los principales desafíos para la implementación de las nuevas recomendaciones en la detección precoz del cáncer de mama en Brasil, así como reflexionar sobre las barreras y estrategias para su superación. La implementación de directrices, basadas en evidencias, es un desafío en todo el mundo, y las estrategias tradicionales basadas sólo en la propagación de las mismas son comprobadamente insuficientes para generar cambios en la práctica clínica vigente. Un gran desafío para la adhesión a las nuevas directrices para la detección precoz del cáncer de mama en Brasil es el actual patrón de uso del rastreo mamográfico en el país, que incluye a menudo a mujeres jóvenes e intervalo corto entre los exámenes. Esta práctica perjudicial para la salud de la población es reforzada por la lógica de la medicina defensiva y por la difusión de información equivocada, que sobrestiman los beneficios del rastreo y subestiman o incluso omiten sus riesgos. Asimismo, existe una carencia de políticas y acciones dirigidas al diagnóstico precoz de casos sintomáticos. Para superar estas barreras, son imprescindibles cambios relacionados con la regulación de la asistencia, financiación y la implantación del proceso de decisión compartida en la atención primaria. Algunas de las estrategias que pueden facilitar el proceso de implementación de las nuevas recomendaciones son: auditoría con retroalimentación, detalle académico e incorporación de herramientas de apoyo a la decisión son algunas de las estrategias que pueden facilitar el proceso de implementación de las nuevas recomendaciones.O objetivo do presente artigo é apresentar os principais desafios à implementação das novas recomendações para a detecção precoce do câncer de mama no Brasil, bem como refletir sobre as barreiras e estratégias para a sua superação. A implementação de diretrizes baseadas em evidências é um desafio em todo o mundo, e estratégias tradicionais baseadas apenas na disseminação de seu texto são comprovadamente insuficientes para gerar mudanças na prática clínica vigente. Um grande desafio à adesão às novas diretrizes para a detecção precoce do câncer de mama no Brasil é o atual padrão de uso do rastreamento mamográfico no país, que acaba incluindo muito frequentemente mulheres jovens e intervalo curto entre os exames. Essa prática danosa à saúde da população é reforçada pela lógica da medicina defensiva e pela difusão de informações equivocadas, que superestimam os benefícios do rastreamento e subestimam ou mesmo omitem seus riscos. Além disso, há carência de políticas e ações voltadas para o diagnóstico precoce de casos sintomáticos. Para superar essas barreiras, mudanças relacionadas à regulação da assistência, financiamento e a implantação do processo de decisão compartilhada na atenção primária são essenciais. Auditoria-feedback, detalhamento acadêmico e incorporação de ferramentas de suporte à decisão são algumas das estratégias que podem facilitar o processo de implementação das novas recomendações.Reports in Public HealthCadernos de Saúde Pública2018-06-25info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmltext/htmlapplication/pdfapplication/pdfhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6615Reports 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/6615/14230https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6615/14231https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6615/14232https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6615/14233Arn MigowskiMaria Beatriz Kneipp DiasPaulo NadanovskyGulnar Azevedo e SilvaDenise Rangel Sant’AnaAirton Tetelbom Steininfo:eu-repo/semantics/openAccess2024-03-06T15:29:26Zoai:ojs.teste-cadernos.ensp.fiocruz.br:article/6615Revistahttps://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:2024-03-06T13:07:34.661387Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)true |
dc.title.none.fl_str_mv |
Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation Diretrizes para detecção precoce do câncer de mama no Brasil. III - Desafios à implementação |
title |
Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation |
spellingShingle |
Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation Arn Migowski 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 |
title_short |
Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation |
title_full |
Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation |
title_fullStr |
Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation |
title_full_unstemmed |
Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation |
title_sort |
Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation |
author |
Arn Migowski |
author_facet |
Arn Migowski Maria Beatriz Kneipp Dias Paulo Nadanovsky Gulnar Azevedo e Silva Denise Rangel Sant’Ana Airton Tetelbom Stein |
author_role |
author |
author2 |
Maria Beatriz Kneipp Dias Paulo Nadanovsky Gulnar Azevedo e Silva Denise Rangel Sant’Ana Airton Tetelbom Stein |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Arn Migowski Maria Beatriz Kneipp Dias Paulo Nadanovsky Gulnar Azevedo e Silva Denise Rangel Sant’Ana Airton Tetelbom Stein |
dc.subject.por.fl_str_mv |
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 |
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 |
description |
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. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-06-25 |
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/6615 |
url |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6615 |
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/6615/14230 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6615/14231 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6615/14232 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6615/14233 |
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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1798943385720979456 |