La mamografía como método de tamizaje para el cáncer de seno en Colombia
Palabras clave:
Mamografía, análisis costo-beneficio, neoplasmas de la mama, autoexamén de la mamaResumen
El Instituto Nacional de Cancerología, en conjunto con el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia, recientemente organizaron un consenso nacional para responder a la pregunta “¿cuál es el mejor método de tamizaje para el cáncer de mama en países en desarrollo?” dentro de su política de revisión de las guías de práctica clínica en enfermedades oncológicas (1). El instituto es una entidad estatal del orden nacional adscrita al Ministerio de la Protección Social, que entre una de sus funciones hace recomendaciones en políticas de salud sobre el diagnóstico y tratamiento del cáncer; sin embargo, no es el único ente con esta responsabilidad. Dada la característica de la pregunta, ésta también interesa a la Sociedad Colombiana de Radiología, que por razones de la Ley 657 de 2001, también es organismo consultor respecto a las decisiones relacionadas con la radiología, y a la Asociación Colombiana de Sociedades Científicas en general y a las asociaciones de Mastología, Oncología, Cirugía y demás que abordan el diagnóstico o tratamiento del cáncer mamario. Igualmente, compromete a los actores del Sistema Nacional de Seguridad Social en Salud y por último y la más importante de todas, a las mujeres en edades de riesgo para desarrollar cáncer de mama. Por tal razón, y ante la poca publicidad para esta importante discusión, es necesario hacer pública la información existente respecto a este tema, para que todos los involucrados tengan los elementos de juicio necesarios para discutir y aportar a ella.
Es evidente que esta pregunta tiene dos partes: una se refiere a la efectividad de un método de tamizaje (¿Cuál es el mejor método de tamizaje para cáncer de seno?) y la otra explora la aplicación de dicho método en ciertas condiciones económicas (la de los países en desarrollo), entre los que se cuenta Colombia.
El presente documento pretende responder no sólo estas dos preguntas, sino también tratar de dar una visión general del problema del cáncer de seno en Colombia y los peligros que se ciernen sobre el diagnóstico temprano de esta enfermedad, y quizá sobre los demás cánceres, cuya decisión depende de las conclusiones que se alcancen en este consenso.
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Referencias bibliográficas
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2. Shapiro S. Periodic screening for breast cancer: the HIP Randomized Controlled Trial. Health Insurance Plan. J Natl Cancer Inst Monogr 1997; 27-30.
https://doi.org/10.1093/jncimono/1997.22.27
3. Chu KC, Smart CR, Tarone RE. Analysis of breast cancer mortality and stage distribution by age for the Health Insurance Plan Clinical Trial. J Natl Cancer Inst 1988; 80: 1125-1132.
https://doi.org/10.1093/jnci/80.14.1125
4. Habbema JD, van Oortmarssen GJ, van Putten DJ, Lubbe JT, van der Maas PJ. Age-specific reduction in breast cancer mortality by screening: an analysis of the results of the Health Insurance Plan of Greater New York study. J Natl Cancer Inst 1986; 77: 317-320.
5. Andersson I, Janzon L. Reduced breast cancer mortality in women under age 50: updated results from the Malmo Mammographic Screening Program. J Natl Cancer Inst Monogr 1997; 63-7.
https://doi.org/10.1093/jncimono/1997.22.63
6. Garne JP, Aspegren K, Balldin G, Ranstam J. Increasing incidence of and declining mortality from breast carcinoma. Trends in Malmo, Sweden, 1961-1992. Cancer 1997; 79: 69-74.
https://doi.org/10.1002/(SICI)1097-0142(19970101)79:1<69::AID-CNCR10>3.0.CO;2-4
7. Andersson I, Aspegren K, Janzon L, et al. Mammographic screening and mortality from breast cancer: the Malmo Mammographic Screening Trial. BMJ 1988; 297: 943-948.
https://doi.org/10.1136/bmj.297.6654.943
8. Alexander FE, Anderson TJ, Brown HK, et al. 14 years of follow-up from the Edinburgh Randomized Trial of Breast-Cancer Screening. Lancet 1999; 353: 1903-1908.
https://doi.org/10.1016/S0140-6736(98)07413-3
9. Alexander FE. The Edinburgh Randomized Trial of Breast Cancer Screening. J Natl Cancer Inst Monogr 1997; 31-35.
https://doi.org/10.1093/jncimono/1997.22.31
10. Alexander FE, Anderson TJ, Brown HK, et al. The Edinburgh Randomized Trial Of Breast Cancer Screening: results after 10 years of follow-up. Br J Cancer 1994; 70: 542-548.
https://doi.org/10.1038/bjc.1994.342
11. Roberts MM, Alexander FE, Anderson TJ, et al. Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet 1990; 335: 241-246.
https://doi.org/10.1016/0140-6736(90)90066-E
12. Warwick J, Tabar L, Vitak B, Duffy SW. Time-dependent effects on survival in breast carcinoma: results of 20 years of follow-up from the Swedish Two-County Study. Cancer 2004; 100: 1331-1336.
https://doi.org/10.1002/cncr.20140
13. Tabar L, Vitak B, Chen HH, et al. The Swedish Two-County Trial twenty years later. Updated mortality results and new insights from long-term follow-up. Radiol Clin North Am 2000; 38: 625-651.
https://doi.org/10.1016/S0033-8389(05)70191-3
14. Tabar L, Chen HH, Fagerberg G, Duffy SW, Smith TC. Recent results from the Swedish Two-County Trial: the effects of age, histologic type, and mode of detection on the efficacy of breast cancer screening. J Natl Cancer Inst Monogr 1997; 43-47.
https://doi.org/10.1093/jncimono/1997.22.43
15. Tabar L, Fagerberg G, Chen HH, et al. Efficacy of breast cancer screening by age. New results from the Swedish Two-County Trial. Cancer 1995; 75: 2507-2517.
https://doi.org/10.1002/1097-0142(19950515)75:10<2507::AID-CNCR2820751017>3.0.CO;2-H
16. Tabar L, Fagerberg G, Duffy SW, Day NE, Gad A, Grontoft O. Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am 1992; 30: 187-210.
17. Frisell J, Lidbrink E. The Stockholm Mammographic Screening Trial: risks and benefits in age group 40-49 years. J Natl Cancer Inst Monogr 1997; 49-51.
https://doi.org/10.1093/jncimono/1997.22.49
18. Frisell J, Lidbrink E, Hellstrom L, Rutqvist LE. Followup after 11 years-update of mortality results in the Stockholm mammographic screening trial. Breast Cancer Res Treat 1997; 45: 263-270.
https://doi.org/10.1023/A:1005872617944
19. Bjurstam N, Bjorneld L, Warwick J, et al. The Gothenburg Breast Screening Trial. Cancer 2003; 97: 2387-2396.
https://doi.org/10.1002/cncr.11361
20. Bjurstam N, Bjorneld L, Duffy SW, et al. The Gothenburg Breast Cancer Screening Trial: preliminary results on breast cancer mortality for women aged 39-49. J Natl Cancer Inst Monogr 1997; 53-55.
https://doi.org/10.1093/jncimono/1997.22.53
21. Bjurstam N, Bjorneld L, Duffy SW, et al. The Gothenburg Breast Screening Trial: first results on mortality, incidence, and mode of detection for women ages 39-49 years at randomization. Cancer 1997; 80: 2091-2099.
https://doi.org/10.1002/(SICI)1097-0142(19971201)80:11<2091::AID-CNCR8>3.0.CO;2-#
22. Miller AB, To T, Baines CJ, Wall C. The Canadian National Breast Screening Study-1: breast cancer mortality after 11 to 16 years of follow-up. A randomized screening trial of mammography in women age 40 to 49 years. Ann Intern Med 2002; 137: 305-312.
https://doi.org/10.7326/0003-4819-137-5_Part_1-200209030-00005
23. Miller AB, To T, Baines CJ, Wall C. Canadian National Breast Screening Study-2: 13-year results of a randomized trial in women aged 50-59 years. J Natl Cancer Inst 2000; 92: 1490-1499.
https://doi.org/10.1093/jnci/92.18.1490
24. Miller AB, To T, Baines CJ, Wall C. The Canadian National Breast Screening Study: update on breast cancer mortality. J Natl Cancer Inst Monogr 1997; 37-41.
https://doi.org/10.1093/jncimono/1997.22.37
25. Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. CMAJ 1992; 147: 1477-1488.
26. Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years. CMAJ 1992; 147:1459-1476.
27. Miller AB. Commentary: a defence of the Health Insurance Plan (HIP) study and the Canadian National Breast Screening Study (CNBSS). Int J Epidemiol 2004; 33: 64-65.
https://doi.org/10.1093/ije/dyh015
28. Black WC, Haggstrom DA, Welch HG. All-cause mortality in randomized trials of cancer screening. J Natl Cancer Inst 2002; 94: 167-173.
https://doi.org/10.1093/jnci/94.3.167
29. Fenton JJ, Elmore JG. Balancing mammography's benefits and harms. BMJ 2004; 328: E301-302.
https://doi.org/10.1136/bmj.328.7453.E301
30. Garber JE. Breast cancer screening: a final analysis? CA Cancer J Clin 2003; 53: 138-140.
https://doi.org/10.3322/canjclin.53.3.138
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2005-09-20
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Sanabria, Álvaro; Romero, J. La mamografía Como método De Tamizaje Para El cáncer De Seno En Colombia. Rev Colomb Cir 2005, 20, 158-165.
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