Migowski Arn, Dias Maria Beatriz Kneipp, Nadanovsky Paulo, Silva Gulnar Azevedo E, Sant'Ana Denise Rangel, Stein Airton Tetelbom
Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil.
Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil.
Cad Saude Publica. 2018 Jun 25;34(6):e00046317. doi: 10.1590/0102-311X00046317.
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.
本文的目的是介绍巴西实施乳腺癌早期检测新建议面临的主要挑战，并思考障碍以及克服这些障碍的策略。实施循证指南是一项全球性挑战，仅基于传播建议的传统策略已被证明不足以改变现有的临床实践。巴西在遵守乳腺癌早期检测新指南方面面临的一个主要挑战是该国目前使用乳房X光筛查的模式，这种模式经常包括年轻女性且检查间隔时间短。这种对人群健康有害的做法因防御性医疗的逻辑以及错误信息的传播而得到强化，这些错误信息高估了筛查的益处，低估甚至忽略了其危害。此外，缺乏针对有症状病例早期诊断的政策和措施。为克服这些障碍，在初级保健中改变护理监管、融资以及实施共同决策至关重要。审核与反馈、学术指导以及纳入决策辅助工具是一些有助于实施新建议的策略。
