Abstract:
: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. :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. :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.
journal_name
Cad Saude Publicajournal_title
Cadernos de saude publicaauthors
Migowski A,Stein AT,Ferreira CBT,Ferreira DMTP,Nadanovsky Pdoi
10.1590/0102-311X00116317subject
Has Abstractpub_date
2018-06-21 00:00:00pages
e00116317issue
6eissn
0102-311Xissn
1678-4464pii
S0102-311X2018000600501journal_volume
34pub_type
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journal_title:Cadernos de saude publica
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journal_title:Cadernos de saude publica
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journal_title:Cadernos de saude publica
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doi:10.1590/s0102-311x2007000500009
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