Guidelines for early detection of breast cancer in Brazil. II - New national recommendations, main evidence, and controversies

• Autor(a) principal: Arn Migowski
• Data de Publicação: 2018
• Outros Autores: Gulnar Azevedo e Silva, Maria Beatriz Kneipp Dias, Maria Del Pilar Estevez Diz, Denise Rangel Sant’Ana, Paulo Nadanovsky
• 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/6616
• topic: 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

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.