Por que reconsiderar a indicação do rastreamento do câncer de mama?

Tesser, Charles Dalcanale; d'Ávila, Thiago Luiz de Campos

doi:10.1590/0102-311x00095914

Cited by 14 publications

(24 citation statements)

References 38 publications

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“…This has enormous implications for public health as recently synthesized by Bulliard & Chiolero 34 . Contrary to the beliefs induced by the natural history model of diseases, there is strong evidence that overdiagnosis is more common than one would have thought, and this is particularly true in cancer screening 35 . Since 2013, international conferences on overdiagnosis and overtreatment are being held to tackle this phenomenon (http:// www.preventingoverdiagnosis.net/).…”

Section: Unsustainable and Dangerous Fusionmentioning

confidence: 70%

“…For example, in cancer screening, wherein the spectrum of harm is very significant in group D, they are commonly not measured in their entirety in clinical trials 41 . Additionally, when they are measured in large systematic reviews and metaanalyses, scientific articles usually do not include such reviews 35 . This is a common occurrence in specialist medical journals rather than in general practitioner journals.…”

Section: Technical and Ethical Considerationsmentioning

confidence: 99%

“…The immense asymmetry between the requirements for recommending preventive interventions and that of clinical care supports this statement. If there is doubt about the net harm/benefit ratio, this should be enough to not recommend any preventive initiative 35 (Table 2).…”

Section: Technical and Ethical Considerationsmentioning

confidence: 99%

See 2 more Smart Citations

Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention

Tesser

Norman

2016

Cad. Saúde Pública

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Section: Unsustainable and Dangerous Fusionmentioning

confidence: 70%

Section: Technical and Ethical Considerationsmentioning

confidence: 99%

See 1 more Smart Citation

Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention

Tesser

Norman

2016

Cad. Saúde Pública

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“…Several additive preventive activities do not stand the test of the PP. We should mention some examples even without detail or discussion, due to space limitations: mammographic screening for breast cancer has an unfavorable 66 or, at least doubtful, harm-benefit ratio in the face of extensive and serious damage 12,[67][68][69] . The same occurs with the case of screening for prostate cancer 70 .…”

Section: The Precautionary Principle Articulated To Additive Preventionmentioning

confidence: 99%

“…Overdiagnosis and overtreatment occur in large proportions in disease screening 11,12 , generating the paradox of popularity 13 : Overdiagnosed and overtreated people believe that they were saved by screening even though they were actually harmed. This context is interpreted as beneficial, i.e., the adverse effects are supposedly offset by the "cure" of the chimerical disease/risk factor.…”

Section: Introductionmentioning

confidence: 99%

Geoffrey Rose e o princípio da precaução: para construir a prevenção quaternária na prevenção

Tesser

Norman

2019

Interface (Botucatu)

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A prevenção tem sido medicalizada gerando danos iatrogênicos frequentes. Isso demanda prevenção quaternária (P4): evitar medicalização/intervencionismo desnecessários e danos iatrogênicos correlatos. Apresentamos, neste artigo, uma articulação conceitual orientadora da P4 na prevenção. Geoffrey Rose distinguiu entre medidas preventivas “redutivas” (reduzem riscos derivados da vida moderna, como sedentarismo e ultraprocessados na alimentação) e “aditivas” (adicionam fatores artificiais protetores, como vacinações, rastreamentos, fármacos hipolipemiantes). O grande potencial de danos das medidas preventivas aditivas exige aplicação sistemática do princípio da precaução. Este orienta que, havendo dúvidas científicas sobre danos potenciais significativos de uma atividade, o Estado deve ativamente evitá-los, por meio de atribuição do ônus da prova de eficácia/segurança da atividade aos proponentes, exploração de alternativas inofensivas e aumento da participação pública na decisão. Tal aplicação, crucial para a P4 na prevenção, amiúde não ocorre em práticas preventivas de alta prevalência e iatrogenia.

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Still Controversial: Early Detection and Screening for Breast Cancer in Brazil, 1950–2010s

Teixeira

Neto

2019

Med. Hist.

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Mammographic screening for breast cancer is a widely used public health approach, but is constantly a subject of controversy. Medical and historical research on this topic has been mainly conducted in Western Europe and North America. In Brazil, screening mammography has been an open topic of discussion and a challenge for health care and public health since the 1970s. Effectively, Brazilian public health agencies never implemented a nationwide population-based screening programme for breast cancer, despite the pressures of many specific groups such as advocacy associations and the implementation of local programmes. This article examines the complex process of incorporating mammography as a diagnostic tool and the debates towards implementing screening programmes in Brazil. We argue that debates about screening for breast malignancies, especially those conducted in the late twentieth and early twenty-first centuries, took place in a context of change and uncertainty in the Brazilian health field. These discussions were strongly affected both by tensions between the public and the private health care sectors during the formative period of a new Brazilian health system, and by the growing role of civil society actors. Our study investigates these tensions and their consequences. We use several medical sources that discussed the topic in Brazil, mainly specialised leading oncology journals published between 1950 and 2017, medical congress reports for the same period, books and theses, institutional documents and oral testimonies of health professionals, patients and associations collected in the framework of the ‘The History of Cancer’ project from the Oswaldo Cruz Foundation and Brazilian National Cancer Institute.

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Por que reconsiderar a indicação do rastreamento do câncer de mama?

Cited by 14 publications

References 38 publications

Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention

Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention

Geoffrey Rose e o princípio da precaução: para construir a prevenção quaternária na prevenção

Still Controversial: Early Detection and Screening for Breast Cancer in Brazil, 1950–2010s

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