ABSTRACT
Introducción: La mamografía es el método de elección para el diagnóstico de cáncer de mama, sin embargo en senos con tejidos densos, su rendimiento disminuye. El objetivo del presente estudio fue establecer el valor de la mamografía y la ecografía para el tamizaje de cáncer de mama en mujeres con tejidos glandulares densos. Metodología: Se realizó un estudio transversal, que incluyó por conveniencia 97 casos consecutivos de mujeres con tejido glandular denso en mamografía, al que se realizó estudio ecográfico complementario, atendidas entre 1-01-2017 al 31-12-2019 en el servicio de Imágenes del hospital Teodoro Maldonado Carbo. Se incluyeron aquellas que poseían estudio de lesión de mama por biopsia y/o de anatomía patológica. Para el análisis de método se calcularon sensibilidad, especificidad, valores predictivos positivos y negativos, cocientes de probabilidad positivos y negativos y porcentaje de exámenes correctamente realizado. Resultados: La prevalencia de Cáncer de mama en la muestra fue 95%. Para el BIRADS mamográfico el rendimiento diagnóstico fue: DC 12.37%, S 7.61%, E 98.13%, VPP 98.68% VPN 5.56%, CPP nv, CPN 0.92. Para el BIRADS ecográfico fue de DC 43.30%, S 41.30%, E 80%, VPP 97.44, VPN 6.90%, CPP 2.07, CPN 0.73. Para el criterio del ecografista fue de DC 86.60%, S 91.30%, E 8.00%, VPP 94.38, VPN 5.56%, CPP 0.91, CPN nv. Conclusión: La mamografía tuvo un bajo desempeño. En ecografía la utilización de BIRADS mejora el rendimiento. El criterio emitido por un ecografista experimentado logra el mayor desempeño para el diagnóstico de neoplasia maligna de mama en mujeres con tejido fibroglandular denso.
Introduction: Mammography is the method of choice for diagnosing breast cancer; however, its performance in breasts with dense tissues decreases. The present study aimed to establish the value of mammography and ultrasound for breast cancer screening in women with dense glandular tissues. Methodology: A cross-sectional study was carried out, which included, for convenience, 97 consecutive cases of women with dense glandular tissue on mammography, to which a complementary ultrasound study was performed, attended between 01-01-2017 and 12-31-2019 in the Imaging service of the Teodoro Maldonado Carbo Hospital. Those who had a study of breast lesions by biopsy and pathology were included. For method analysis, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and the percentage of tests correctly performed were calculated. Results: The prevalence of breast cancer in the sample was 95%. For the mammographic BI-RADS, the diagnostic yield was DC 12.37%, S 7.61%, E 98.13%, PPV 98.68%, NPV 5.56%, CPP NV, and CPN 0.92. For the ultrasound BI-RADS, it was DC 43.30%, S 41.30%, E 80%, PPV 97.44, NPV 6.90%, CPP 2.07, and CPN 0.73. The sonographer's criteria were DC 86.60%, S 91.30%, E 8.00%, PPV 94.38, NPV 5.56%, CPP 0.91, and CPN NV. Conclusion: Mammography had poor performance. In ultrasound, the use of BIRADS improves performance. The criterion issued by an experienced sonographer achieves the best performance for diagnosing breast malignancy in women with dense fibroglandular tissue.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Breast Neoplasms , Mammography , Ultrasonography , Diagnostic ServicesABSTRACT
Objetivo: Avaliar o acesso e a adesão da população feminina, atendida pelo Sistema Único de Saúde (SUS), à Diretriz Brasileira de Detecção Precoce do Câncer de Mama, em duas cidades de médio porte de uma região metropolitana do estado de São Paulo, Brasil. Métodos: Estudo transversal. Os dados foram coletados no Sistema de Informação do Câncer (Siscan) e nas Secretarias Municipais de Saúde no período de 01/01 a 31/12 de 2017. Resultados: Em Santa Bárbara d'Oeste, foram realizadas 3.106 mamografias: 2.931 (94,4%) BI-RADS® 1-2; 21 (0,7%) BI-RADS® 3; 12 (0,4%) BI-RADS® 4-5; 142 (4,5%) BI-RADS® 0. A maioria dos exames (1.855 59,7%) foi realizada em mulheres de 50 a 69 anos. A cobertura mamográfica na população de risco foi de 11,2%. O envelhecimento foi relacionado ao BI-RADS® 4-5 (p = 0,005). A idade jovem esteve relacionada ao maior número de BI-RADS® 0 (p = 0,03). Em Vinhedo, foram realizadas 1.996 mamografias: 1.835 (91,9%) BI-RADS® 1-2; 9 (0,45%) BI-RADS® 3; 7 (0,35%) BI-RADS® 4-5; 145 (7,3%) BI-RADS® 0. A maioria dos exames (975 48,8%) foi realizada em mulheres de 50-69 anos. A população coberta pela mamografia foi de 17%. Reunindo ambas as análises populacionais, evidenciou-se que o envelhecimento esteve relacionado ao maior número de casos suspeitos (p = 0,007). Conclusão: A maioria das mamografias foi realizada em mulheres de 50-69 anos. A cobertura mamográfica ficou aquém da encontrada no Brasil e recomendada pela Organização Mundial da Saúde.
Objective: To evaluate the access and adherence of the female population, assisted by Health Unic System (SUS), to Brazilian Breast Cancer Early Detection Guideline in two medium-sized cities of a metropolitan region in the State of São Paulo, Brazil. Methods: Cross-sectional study. Data were collected from the Cancer Information System (Siscan) and from the Municipal Health Secretariats between 01/01 to 12/31, 2017. Results: In Santa Bárbara d'Oeste 3,106 mammograms were performed: 2,931 (94.4%) BI-RADS® 1-2; 21 (0.7%) BI-RADS® 3; 12 (0.4%) BI-RADS® 4-5; 142 (4.5%) BI-RADS® 0. Most of the exams (1,855 59.7%) among women aged 50-69 years. The mammographic coverage at risk population was 11.2%. Aging was related to BI-RADS® 4-5 (p = 0.005). The young age was related to the highest number of BI-RADS® 0 (p = 0.03). In Vinhedo 1,996 mammograms were performed: 1,835 (91.9%) BI-RADS® 1-2; 9 (0.45%) BI-RADS® 3; 7 (0.35%) BI-RADS® 4-5; 145 (7.3%) BI-RADS® 0. Most of the exams (975 48.8%) among women aged 50-69 years. The population covered by mammography was 17%. Gathering both population analysis, it was shown that aging was related to the highest number of suspected cases (p = 0.007). Conclusion: Most mammograms were performed between 50-69 years. Mammographic coverage fell short of that found in Brazil and recommended by the World Health Organization.
Subject(s)
Humans , Female , Breast Neoplasms/mortality , Breast Neoplasms/epidemiology , Breast Neoplasms/diagnostic imaging , Mammography/statistics & numerical data , Unified Health System , Health Services Coverage , Brazil/epidemiology , Cross-Sectional StudiesABSTRACT
Resumen: Introducción: en Uruguay el cáncer de mama (CM) ocupa el primer lugar en incidencia y mortalidad por cáncer en la mujer. Objetivo: conocer la implementación del tamizaje del CM en la práctica clínica habitual y el grado de adhesión a las recomendaciones planteadas en el año 2015 por el Ministerio de Salud Pública (MSP) para la detección temprana del CM entre los médicos del primer nivel de atención. Material y métodos: se trata de un estudio observacional descriptivo y transversal. Se aplicó una encuesta dirigida a médicos del primer nivel de atención, de carácter anónimo. Resultados: se incluyeron 169 médicos, 89,4% (151) considera que el uso de la mamografía de tamizaje disminuye la mortalidad por CM, 54,4% (92) indica la mamografía a partir de los 40 años de edad y 38,5% (65) a partir de los 50 años. El 56,8% (96) indica la mamografía cada 2 años en la población de mujeres que se encuentran entre 50 y 69 años. El 65,7% de los encuestados (111) conoce la guía nacional y 47,9% (81) la utiliza, mientras que el 18,9% (32) utiliza recomendaciones de otras sociedades científicas. Conclusión: el presente estudio evidenció que los médicos del primer nivel de atención hacen un uso correcto de las distintas herramientas de tamizaje del CM. Se necesitan medidas activas para desarrollar programas educativos para el personal de salud, que podrían permitirles difundir conocimientos e influir positivamente en las actitudes de los pacientes.
Summary: Introduction: in Uruguay, breast cancer (BC) is the leading cause of cancer incidence and mortality in women. Objective: to understand the implementation of BC screening among primary care physicians in routine clinical practice and the degree of adherence to the recommendations put forward in 2015 by the Ministry of Public Health (MPH) for the early detection of BC. Materials and methods: this was a descriptive, cross-sectional, observational study. An anonymous survey was administered to physicians working in primary care. Results: 169 physicians were included, 89.4% (151) consider the use of screening mammography decreases mortality from BC, 54.4% (92) indicate mammography from 40 years of age and 38.5% (65) from 50 years of age. The majority (56.8%, 96) indicate mammography every 2 years in the population of women aged 50-69 years. Of the respondents, 65.7% (111) were aware of the national guidelines and 47.9% (81) followed them, while 18.9% (32) followed recommendations from other scientific bodies. Conclusion: this study showed that primary care physicians make correct use of the different BC screening tools. Active measures are needed to develop educational programs for healthcare personnel, which may enable them to disseminate knowledge and positively influence patients' attitudes.
Resumo: Introdução: o câncer de mama (CM) ocupa o primeiro lugar em incidência e mortalidade por câncer em mulheres no Uruguai. Objetivo: conhecer a implementação do rastreamento do CM na prática clínica de rotina e o grau de adesão às recomendações de 2015 do Ministério da Saúde Pública para detecção precoce do CM entre os médicos do primeiro nível de atenção. Material e métodos: trata-se de um estudo observacional descritivo e transversal. Foi aplicada uma pesquisa anônima destinada aos médicos do primeiro nível de atenção. Resultados: foram incluídos 169 médicos; 89,4% (151) consideram que o uso da mamografia de rastreamento diminui a mortalidade por CM, 54,4% (92) indicam mamografia a partir dos 40 anos e 38,5% (65) a partir dos 50 anos; 56,8% (96) indicam mamografia a cada 2 anos na população de mulheres entre 50 e 69 anos. 65,7% dos respondentes (111) conhecem o guia nacional e 47,9% (81) o utilizam, enquanto 18,9% (32) utilizam recomendações de outras sociedades científicas. Conclusão: este estudo mostrou que os médicos do primeiro nível de atenção fazem uso correto das diferentes ferramentas de rastreamento do CM. São necessárias medidas ativas para desenvolver programas educacionais para os profissionais de saúde, que possam permitir que eles disseminem o conhecimento e influenciem positivamente as atitudes dos pacientes.
Subject(s)
Humans , Male , Female , Physicians/statistics & numerical data , Breast Neoplasms/diagnosis , Health Knowledge, Attitudes, Practice , Mass Screening , Primary Health Care , Mammography , Cross-Sectional Studies , Surveys and Questionnaires , Guideline AdherenceABSTRACT
Em relação à última diretriz brasileira do Instituto Nacional do Câncer/Ministério da Saúde sobre a detecção precoce do câncer de mama, destacamos as incertezas sobre a tomada de decisão compartilhada relativas a benefícios e riscos do rastreamento mamográfico. Este artigo expressa as percepções de usuárias de serviços de Atenção Primária à Saúde sobre a decisão compartilhada nesse cenário, sendo resultado de uma pesquisa qualitativa que utilizou grupos focais, como instrumentos de produção de dados, e análise de conteúdo temática, para a sistematização de resultados. As participantes revelaram não participarem dedecisão compartilhada no rastreamento mamográfico, o que nos leva a ressaltar a importância de nortear os cuidados em saúde com base em tecnologias leves, ou seja, tecnologias relacionais, e a valorizar, também, a necessidade de implementação de certos aspectos conceituais e de princípios fundamentais, que precisam ser discutidos e realçados para que a decisão compartilhada seja implementada.
According to the latest Brazilian guidelines from the National Cancer Institute/Ministry of Health on early detection of breast cancer, we highlight the uncertainties about shared decision-making concerning the benefits and risks of mammographic screening. This article expresses the perceptions of users of Primary Health Care services concerning shared decision-making in this scenario. As a result of qualitative research, it used focus groups as an instrument for data production and thematic content analysis to systematize the results. The participants revealed that there is no shared decision-making concerning mammographic screening, which leads us to emphasize that health care guidelines should be based on light technologies,that is, relational technologies. They should also discuss and highlight related conceptual aspects and fundamental principles so that shared decision-making can be implemented.
Subject(s)
Humans , Female , Primary Health Care , Breast Neoplasms/diagnosis , Mammography , Mass Screening , Decision Making, Shared , Focus Groups , Qualitative Research , Early Detection of CancerABSTRACT
Introducción: En Uruguay el cáncer de mama (CM) ocupa el primer lugar en incidencia y mortalidad por cáncer en mujeres. Objetivo: Evaluar el conocimiento de mujeres uruguayas sobre el tamizaje de cáncer de mama. Material y métodos: Se trata de un estudio observacional descriptivo y transversal. Se aplicó una encuesta dirigida a mujeres, que fue difundida mediante las redes sociales. El consentimiento informado se solicitó al inicio de la encuesta, como requisito excluyente para poder realizar la misma. Se mantuvo el anonimato de las pacientes en el análisis estadístico y se contó con la aprobación del Comité de Ética del Hospital de Clínicas. Resultados: Participaron 1859 mujeres. El 75.1% (1396) de las encuestadas reconoce el CM como el de mayor mortalidad en mujeres. El 52% (967) cree que 3 de cada 10 mujeres tienen riesgo de desarrollar CM, y 18.4% (342) desconoce su prevalencia. El 60.2% (1119) reconoce a la mamografía como prueba que ha logrado disminuir la mortalidad por CM. El 64.2% (1193) cree que se realiza a partir de los 40 años. Sobre la frecuencia, el 60.5% (1125) considera que se realiza de forma anual. Los factores de riesgo para desarrollar CM mayormente considerados fueron tabaquismo (60.9%, 1132), obesidad (57.%, 1060) y sedentarismo (56.8%,1056). Conclusiones: Nuestros resultados evidencian que las encuestadas están informadas de manera adecuada sobre la importancia del CM y de realizar el tamizaje mamográfico para prevenirlo; sin embargo, el 74.3% (1381) cree que el mismo, debe comenzar a hacerse a los 40 años.
Introduction: In Uruguay, breast cancer (BC) has the highest incidence and mortality of all cancer in women. Objectives : To assess the knowledge of Uruguayan women about breast cancer screening for the early detection of BC. Material and Methods : This is a descriptive and observational study. A survey was applied to woman, it was disseminated through social networks. Informed consent was requested at the beginning of the survey as an exclusive requirement to be able to carry it out. In the statistical analysis, the anonymity of the patients was maintained and the approval of the Ethics Committee of the Hospital de Clínicas was obtained. Results : 1859 women participated. 75.1% (1396) of those surveyed recognize BC as the one with the highest mortality in women. 52% (967) believe that 3 out of 10 women are at risk of developing BC, and 18.4% (342) do not know its prevalence. 60.2% (1119) recognize mammography as a test that has managed to reduce mortality from BC. 64.2% (1193) believe that it is done after 40 years of age. Regarding the frequency, 60.5% (1125) consider that it is carried out annually. The most considered risk factors for developing BC were smoking (60.9%, 1132), obesity (57%, 1.060) and sedentary lifestyle (56.8%, 1056). Conclusions : Our results show that the respondents are adequately informed about the importance of CM and the performance of screening mammography.
Introdução : No Uruguai, o câncer de mama (CM) tem a maior incidência e mortalidade de todos os cânceres em mulheres. Objetivos: Avaliar o conhecimento de mulheres uruguaias sobre o rastreamento do câncer de mama para a detecção precoce do CM. Material e Métodos : Trata-se de um estudo descritivo e observacional. Foi aplicado um questionário às mulheres, divulgado através das redes sociais. O consentimento informado foi solicitado no início da pesquisa como requisito exclusivo para poder realizá-la. Na análise estatística, foi mantido o anonimato dos pacientes e obtida a aprovação do Comitê de Ética do Hospital de Clínicas. Resultados: participaram 1859 mulheres. 75.1% (1396) dos pesquisados ââreconhecem o CB como o de maior mortalidade em mulheres. 52% (967) acreditam que 3 em cada 10 mulheres estão em risco de desenvolver CM e 18.4% (342) não conhecem sua prevalência. 60.2% (1119) reconhecem a mamografia como um exame que tem conseguido reduzir a mortalidade por CM. 64.2% (1.193) acreditam que é feito após os 40 anos. Em relação à frequência, 60.5% (1125) consideram que é realizado anualmente. Os fatores de risco mais considerados para desenvolver CM foram tabagismo (60.9%, 1132), obesidade (57%, 1.060) e sedentarismo (56.8%, 1056). Conclusões: Nossos resultados mostram que as entrevistadas estão adequadamente informadas sobre a importância do MC e a realização da mamografia de rastreamento.
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Breast Neoplasms/prevention & control , Health Knowledge, Attitudes, Practice , Uruguay , Mammography/statistics & numerical data , Cross-Sectional Studies , Risk Factors , Health Surveys , Ultrasonography, Mammary/statistics & numerical data , Breast Self-Examination/statistics & numerical data , Educational Status , Information Seeking Behavior , OctogenariansABSTRACT
Objetivos. Documentar cuantitativamente el grado de concordancia con las recomendaciones del Instituto Nacional del Cáncer (INC) de los mensajes institucionales emitidos en redes sociales de Argentina durante octubre de 2019, en el contexto de las campañas de prevención del cáncer mamario, y analizar cualitativamente los elementos icónicos y textuales que conforman sus piezas de difusión. Materiales y métodos. Análisis cuantitativo y cualitativo de 171 piezas de difusión emitidas durante octubre de 2019 por 54 instituciones, a partir de la evaluación de su concordancia con las recomendaciones del INC, la descripción de las principales recomendaciones discordantes (análisis cuantitativo) y el análisis cualitativo de 30 piezas. Resultados. Ninguno de los mensajes emitidos mencionó potenciales daños del tamizaje. Solamente los del Ministerio de Salud de la Nación fueron totalmente concordantes con las recomendaciones del INC, mientras que los restantes recomendaban realizar mamografías a edades más tempranas o a intervalos más breves. El autoexamen mamario fue la recomendación más frecuente entre las discordantes. Predominaron las imágenes de cuerpos femeninos vinculadas con los estereotipos predominantes de género y belleza, y los discursos paternalistas que apelan al miedo y a la culpa. Conclusiones. Los mensajes emitidos en las piezas de difusión analizadas no fueron concordantes con las recomendaciones del INC, a pesar de que estas últimas están respaldadas por evidencia científica. Por otro lado, los mensajes refuerzan los estereotipos de género y belleza, la culpa y el modelo médico-hegemónico.
Objectives. To quantitatively document the degree of compliance of institutional messages broadcast on social networks with the recommendations of the National Cancer Institute (INC) in Argentina during October 2019, in the context of breast cancer prevention campaigns, and to qualitatively analyze the pictorial and textual elements that make up their dissemination pieces. Materials and methods. Quantitative and qualitative analysis of 171 dissemination pieces issued during October 2019 by 54 institutions, based on the evaluation of their compliance with INC recommendations, the description of the main discordant recommendations (quantitative analysis) and the qualitative analysis of 30 pieces. Results. None of the issued messages mentioned potential screening harms. Only the messages of the National Ministry of Health complied completely with the INC recommendations, while the remaining ones recommended mammograms at younger ages or at shorter intervals. Breast self-examination was the most frequent recommendation among those who didn't comply. The images of female bodies linked to common stereotypes of sex and beauty, and paternalistic discourses appealing to fear and guilt were predominant. Conclusions. The messages broadcasted in the analyzed diffusion pieces did not comply with the INC recommendations, despite the fact that the latter are supported by scientific evidence. On the other hand, the messages reinforce sex and beauty stereotypes, guilt and the medical-hegemonic model.
Subject(s)
Humans , Female , Middle Aged , Aged , Breast Neoplasms , Social Networking , Awareness , Mammography , Mass Screening , Communications Media , Information DisseminationABSTRACT
Breast cancer is a severe illness that often has fatal consequences. Adherence to the recommendations for breast cancer surveillance is poorly practiced among African American women. The study aimed to identify barriers to preventative screening for breast cancer among African American women (AAW) using a qualitative research design. We explored the influence of personal barriers,stereotypes, socioeconomic status, culture, attitudes, and beliefs on African American women's behavior regarding breast cancer screening. Fourteen African American women were interviewed. Data analysis was completed with Interpretative Phenomenology Approach (IPA). This study's findings demonstrated that African American women perceived the barriers to breast cancer screening include lack of information about available resources, belief that screening cannot change genetic predisposition, embarrassment from exposing the breast for a mammogram, fear of mammograms, and fear of a positive result. These findings may be used to develop interventions to increase AAW's participation in breast cancer screening. (Afr J Reprod Health 2022; 26[7]: 22-28).
Subject(s)
Humans , Female , Breast Neoplasms , Mammography , Women , Black or African American , Blood-Testis Barrier , Preventive Medicine , Early Detection of CancerABSTRACT
Varizes mamárias bilaterais e simétricas são entidades raras, que são geralmente decorrentes de síndrome da veia cava superior. O mecanismo desta síndrome é a obstrução crônica do fluxo sanguíneo da veia cava superior para o átrio direito. Este é o relato do caso de uma paciente idosa que apresentava varizes em ambas as mamas e que apresentou câncer de mama bilateral. Várias peculiaridades chamam a atenção neste caso. Uma delas é que as varicosidades limitaram a visualização de pelo menos um dos nódulos pela mamografia, e podem ter contribuído para a demora do seu diagnóstico. Outra foi o desenvolvimento do câncer de mama bilateral, que tem uma incidência bem menor do que o unilateral. E, por último, houve o desenvolvimento de trombose venosa nas varizes de ambas as mamas. A trombose venosa é uma possível complicação de vários tipos de neoplasias, porém sua associação ao câncer de mama é rara. Não encontramos na literatura científica descrição de trombose localizada nas mamas em pacientes com câncer
Bilateral and symmetrical breast varices are rare entities and usually result from superior vena cava syndrome. This syndrome develops due to chronic obstruction of blood flow from the superior vena cava to the right atrium. This article reports a case of an elderly patient who had varicose veins in both breasts, and who had bilateral breast cancer. This case has several peculiarities. One of them is that varicosities limited the visualization of at least one of the nodules on mammography, and may have contributed to the delay in its diagnosis. Another one was the development of bilateral breast cancer, which has a much lower incidence than unilateral. And finally, there was the development of venous thrombosis in the varicose veins of both breasts. Venous thrombosis is a possible complication of several types of neoplasms, but its association with breast cancer is rare. We could not find in scientific literature descriptions of breast thrombosis in patients with cancer.
Subject(s)
Humans , Female , Aged, 80 and over , Breast Neoplasms/diagnosis , Varicose Veins , Mammography , Venous ThrombosisABSTRACT
Resumo Buscou-se identificar fatores que interferem na suspeita do câncer de mama (CM) pela atenção primária à saúde (APS) que impulsionam o encaminhamento para a atenção especializada (AE) nos municípios de São Paulo e Campinas. Foram entrevistadas 664 mulheres (353 paulistanas e 311 campineiras) diagnosticadas com CM, encaminhadas para AE pela APS. Utilizou-se a análise de regressão logística multinível para a identificação das associações entre a suspeita do CM pela APS, variáveis socioeconômicas e atenção ao câncer. Mostraram associação significativa: nível superior de escolaridade (RC = 0,59; IC 95% = 0,35-0,98); pagamento de consulta médica para atendimento relacionado ao câncer (RC = 0,59; IC 95% = 0,36-0,96), continuou atendimento na APS após início do tratamento na AE (RC = 0,62; IC 95% = 0,41-0,95); mama examinada na APS (ECM) antes do encaminhamento para a AE (RC = 1,61; IC 95% = 1,10-2,34) e primeira mamografia solicitada na APS (RC = 2,81; IC 95% = 1,95-4,00). A solicitação da mamografia e o ECM são ações que têm sido incorporadas na APS para a detecção precoce do CM nos municípios. Continuar o atendimento na APS e melhores condições socioeconômicas, como ter nível superior de escolaridade e capacidade de pagar por atendimento, reduzem a chance da suspeita.
Abstract We aimed to identify factors that interfere in breast cancer (BC) suspected cases detected in Primary Health Care (PHC) that drive the referral to Specialized Care (SC) São Paulo and Campinas, Brazil. We interviewed 664 women (353 from São Paulo and 311 from Campinas) diagnosed with BC, referred to SC from PHC. Multilevel logistic regression analysis was used to the identification of associations between BC suspected cases by PHC and the socioeconomic and cancer care variables. The following showed a significant association: higher schooling level (OR = 0.59; 95% CI = 0.35-0.98); medical visit payment for cancer-related care (OR = 0.59; 95% CI = 0.36-0.96), continued attendance at PHC after beginning treatment at SC (OR = 0.62; 95% CI = 0.41-0.95); breast examined in PHC before referral to SC (OR = 1.61; 95% CI = 1.10-2.34) and first mammography requested in PHC (ECM) (OR = 2.81; 95% CI = 1.95-4.00). The request for mammography and the clinical breast examination is incorporated into the PHC for the early detection of BC in the cities. Continuing the care at the PHC and better socioeconomic conditions, such as having a higher education level and capacity to pay for care, can reduce the likelihood of suspected cases.
Subject(s)
Humans , Female , Breast Neoplasms , Breast Neoplasms/therapy , Primary Health Care , Brazil , Mammography , Mass ScreeningABSTRACT
Resumo Objetivo identificar e analisar a acessibilidade e o acesso de mulheres brasileiras com lesão medular para a realização de exames preventivos do câncer de mama e colo de útero. Método estudo quantitativo e transversal desenvolvido em plataforma virtual. Realizadas análises estatísticas descritivas e de associação entre as variáveis qualitativas por meio do teste exato de Fisher. Quando identificada a associação (p<0,05), foi realizada a regressão logística. Resultados participaram 120 mulheres brasileiras com lesão medular com idades entre 25 e 67 anos; 85,83% foram ao ginecologista após a lesão medular, 79,17% realizaram a citologia e 52,50%, a mamografia. Observou-se que as mulheres que utilizavam a saúde suplementar apresentaram maior probabilidade de terem ido ao ginecologista do que as usuárias do serviço público. Aquelas com companheiro e as de maior idade apresentaram maior probabilidade de terem realizado o exame de citologia. Para a mamografia, aquelas de maior idade e que utilizavam a saúde suplementar apresentaram maiores chances de terem realizado o exame de mamografia após a lesão medular. Conclusão mulheres com lesão medular buscam a realização de exames de rastreamento. Entretanto, encontram dificuldades relacionadas à estrutura física, aos equipamentos, transporte, profissionais da saúde, assim como dificuldades sociodemográficas e quanto ao serviço de saúde utilizado.
Resumen Objetivo este estudio tuvo como objetivo identificar y analizar la accesibilidad y el acceso de mujeres brasileñas con lesión medular para la realización de exámenes preventivos de cáncer de mama y de cuello uterino. Método se desarrolló un estudio cuantitativo y transversal, realizado en un entorno virtual. Los análisis estadísticos descriptivos y la asociación entre variables cualitativas se realizaron mediante la prueba exacta de Fisher, cuando se identificó una asociación se realizó una regresión logística. Resultados participaron 120 mujeres brasileñas con lesión medular, la edad de las participantes varió de 25 a 67 años. Con relación al rastreo, el 85,83% de las mujeres acudió al ginecólogo tras la LM, el 79,17% se sometió a citología y el 52,50% a mamografía. Se observó que las mujeres que utilizaban un seguro médico privado tenían más probabilidades de haber visto a un ginecólogo que las usuarias del servicio público. Las que tenían pareja y mayores tenían más probabilidades de someterse a citología oncótica. Para la mamografía, las que eran mayores y que usaban un seguro médico privado tenían más probabilidades de someterse al examen después de la LM. Conclusión las mujeres con LM buscan pruebas de detección. Sin embargo, enfrentan dificultades relacionadas con la estructura física, equipamientos, transporte, profesionales de la salud, así como dificultades sociodemográficas relacionadas con el tipo de servicio de salud utilizado.
Abstract Objective to identify and analyze the accessibility and accessibility of Brazilian women with spinal cord injury to preventive examinations for breast and cervical cancer. Method quantitative and cross-sectional study developed in a virtual platform. Descriptive statistical analysis was performed, as well as association analysis between qualitative variables using Fisher's exact test. When identified the association (p<0.05), logistic regression was performed. Results a total of 120 Brazilian women with spinal cord injury, aged between 25 and 67 years participated in the study; 85.83% visited a gynecologist after the spinal cord injury, 79.17% underwent cytology and 52.50% underwent mammography. It was observed that women who used the supplementary health plan were more likely to have visited a gynecologist than those who used the public service. Those who had a partner and were older were more likely to have undergone the cytology exam. For mammography, those who were older and who used supplementary health care were more likely to have had mammography exams after the spinal cord injury. Conclusion women with spinal cord injury seek screening tests. However, they encounter difficulties related to the physical structure, equipment, transportation, health professionals, as well as socio-demographic difficulties and difficulties regarding the health service used.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Bone Marrow/injuries , Mass Screening , Women's Health/statistics & numerical data , Disabled Persons , Social Determinants of Health , Health Services Accessibility , Neoplasms/prevention & control , Physical Examination , Unified Health System , Breast/cytology , Breast Neoplasms/prevention & control , Mammography , Uterine Cervical Neoplasms/prevention & control , Cervix Uteri/cytology , Cross-Sectional StudiesABSTRACT
Introducción: El carcinoma de mama bilateral sincrónico se define por la aparición de tumores simultáneos en ambas mamas. Estudios indican que la frecuencia de estos carcinomas oscila entre 1,4 y 11,8 %. Actualmente, la ecografía mamaria y la mamografía constituyen los métodos de cribado aconsejables para detectar lesiones iniciales. Objetivo: Presentar un caso infrecuente de carcinoma bilateral simultáneo. Presentación de caso: Se trata de una mujer de 67 años de edad, sin antecedentes personales ni familiares de cáncer de mama, que acude a consulta de mastología por aumento de volumen focal en la mama derecha. En mamografía digital se identifican imágenes nodulares espiculadas de alta densidad en ambas mamas, con clasificación BIRADS-5. Se completó el estudio con citología por aguja fina y biopsia posoperatoria con el resultado de carcinoma ductal bilateral con metástasis al ganglio axilar derecho. Conclusiones: El carcinoma bilateral de mama, a pesar de ser una entidad de aparición excepcional, se puede identificar en estadios clínicos avanzados en pacientes sin antecedentes familiares, por lo que es importante la evaluación de ambas mamas en los estudios de imagen, para descartar lesiones sincrónicas con las pertinentes biopsias bilaterales para su conclusión histopatológica.
Introduction: Synchronous bilateral breast cancer is defined by some authors as the simultaneous appearance of tumors in both breasts. Studies indicate that the frequency of these carcinomas range from 1.4 to 11.8%. Currently, breast ultrasound and mammography are the recommended screening methods to detect initial lesions. Objective: To describe a rare simultaneous bilateral breast carcinoma case. Case report:We present the case of a 67-year-old woman, with no personal or family history of breast cancer, who attended a mastology consultation due to focal volume increase in the right breast. Digital mammography was performed, identifying high-density spiculated nodular images in both breasts with BIRADS-5 classification. A study was completed with fine-needle cytology and postoperative biopsy, obtaining the result of bilateral ductal carcinoma with metastasis to the right axillary node.Conclusions: Bilateral breast carcinoma, despite being an entity of exceptional appearance, can be identified in advanced clinical stages in patients with no family history, so it is important to evaluate both breasts in imaging studies, to rule out synchronous lesions, requesting the relevant bilateral biopsies for histopathological conclusion.
Subject(s)
Carcinoma, Ductal, Breast , Breast Neoplasms , MammographyABSTRACT
Introdução: A neoplasia mamária constitui a primeira causa de óbito por câncer em mulheres brasileiras. Dados sobre o real impacto da pandemia na política de rastreamento e diagnóstico do câncer de mama no Brasil ainda são desconhecidos. Objetivo: Avaliar o efeito da pandemia da covid-19 no número de mamografias realizadas no Sistema Único de Saúde (SUS). Método: Estudo epidemiológico, quantitativo e de delineamento transversal. Foram selecionadas mamografias mensais realizadas no SUS após consulta ao Departamento de Informática do SUS (DATASUS). Foi avaliado o volume histórico, de janeiro de 2017 a março de 2020, mês seguinte ao primeiro caso de covid-19 diagnosticado no Brasil, para se construir um modelo de previsão das mamografias esperadas de março de 2020 até dezembro de 2021. Resultado: No ano de 2020, 1.705.475 mamografias deixaram de ser realizadas no Brasil em relação ao ano anterior, segundo o DATASUS. O modelo de previsão, com base nos valores históricos, mostrou um déficit de 1.635.42 mamografias. Em maio de 2020, ocorreu a maior queda na realização dos exames, representando apenas 20,69% das mamografias realizadas no mesmo mês do ano anterior. Conclusão: A detecção precoce do câncer de mama foi uma das áreas médicas impactadas pela política de restrição e isolamento impostos no ano de 2020. Nesse sentido, esforços governamentais futuros serão necessários para oferecer tratamento a eventuais pacientes com diagnóstico tardio de câncer de mama, além das mamografias que não puderam ser realizadas
Introduction: Breast cancer is the leading cause of death by cancer in Brazilian women. Data on the real impact of the pandemic on breast cancer screening and diagnosis policy in Brazil are still unknown. Objective: Evaluate the effect of the COVID-19 pandemic on the number of mammograms performed in the Brazilian Unified Health System (SUS). Method: Epidemiological, quantitative, cross-sectional study. Monthly mammograms performed at SUS through the Department of Informatics of the SUS (DATASUS) were selected. The historical volume from January 2017 to March 2020, the month following the first case of COVID-19 diagnosed in Brazil, was evaluated to build a forecast model of expected mammograms from March 2020 to December 2021. Result: In 2020, 1,705,475 mammograms were not performed compared to the previous year, according to DATASUS. The prediction model, based on historical values, showed a deficit of 1,635,420 mammograms. In May 2020, there was the biggest drop of the exams, representing only 20.69% of mammograms performed in the same month of the previous year. Conclusion: Early detection of breast cancer was one of the medical areas impacted by the restrictions and social distance policy imposed in 2020. In this sense, future government efforts will be needed to offer treatment to potential patients with late diagnosis of breast cancer, in addition to the mammograms that were not done
Introducción: El cáncer de mama es la principal causa de muerte por cáncer en las mujeres brasileñas. Aún se desconocen los datos sobre el impacto real de la pandemia en la política de tamizaje y diagnóstico de cáncer de mama en Brasil. Objetivo: Evaluar el efecto de la pandemia de covid-19 en el número de mamografías realizadas en el Sistema Único de Salud (SUS). Método: Estudio epidemiológico, cuantitativo y transversal. Se seleccionaron mamografías mensuales realizadas en el SUS a través del Departamento de Informática del SUS (DATASUS). Se evaluó el volumen histórico, de enero de 2017 a marzo de 2020, el mes siguiente al primer caso de covid-19 diagnosticado en Brasil, para construir un modelo de predicción de mamografías esperadas, de marzo de 2020 a diciembre de 2021. Resultado: En 2020, se dejaron de realizar 1.705.475 mamografías en Brasil en comparación con el año anterior, según DATASUS. El modelo de predicción, basado en valores históricos, mostró un déficit de 1.635.420 mamografías. En mayo de 2020, hubo la mayor caída en los exámenes, totalizando solo el 20,69% de las mamografías realizadas en el mismo mes del año anterior. Conclusión: La detección temprana del cáncer de mama fue una de las áreas médicas impactadas por la política de restricción y aislamiento impuesta en 2020. En este sentido, serán necesarios futuros esfuerzos gubernamentales para brindar el tratamiento de eventuales pacientes con diagnóstico tardío de cáncer de mama, además las mamografías mamografías que no se pudieron realizar
Subject(s)
Humans , Female , Unified Health System , Breast Neoplasms , Mammography/statistics & numerical data , COVID-19 , Health PolicyABSTRACT
Resumen: Introducción: se han producido múltiples avances tecnológicos en la historia de la mamografía. En los años más recientes surge la mamografía digital directa con tomosíntesis con mayores capacidades para detectar el cáncer. Objetivo: evaluar el efecto de la nueva tecnología en el desempeño de la mamografía, en la Unidad de Diagnóstico Mamario del Hospital Británico. Material y métodos: se compara el desempeño de la mamografía durante los años 2019-2020 en relación con los años 2010-2018. En el año 2019 se sustituyó la tecnología anterior por un mamógrafo digital directo con tomosíntesis, Hologic modelo Selenia Dimensions. Resultados: en los años 2019 a 2020 se realizaron 10.725 mamografías. Se detectaron 84 cánceres y la tasa de detección de cáncer fue de 8/1.000. El VPP fue de 35%. En los años 2010 a 2018 se realizaron 45.438 mamografías. Se detectaron 229 cánceres y la tasa de detección de cáncer fue de 5/1.000. EL VPP fue de 40%. En relación a las manifestaciones imagenológicas, se destaca el aumento de las microcalcificaciones en el período 2019-2020, que pasaron de ser 7% de los casos, a ser 19% de los casos. Las distorsiones aumentaron de 11% a 13%. En relación a los tipos histológicos de cáncer, se destaca el porcentaje del carcinoma ductal in situ (CDIS) que fue 4 veces superior en el período 2019-2020 en relación al anterior (17% de todos los casos detectados). Conclusiones: con la incorporación de la tomosíntesis aumentó 60% la tasa de detección de cáncer y el porcentaje de CDIS aumentó 4 veces.
Abstract: Introduction: significant technological progress has been made in the history of mammography. Recently, direct digital mammography plus tomosynthesis arrived and improved breast cancer screening. Objective: to evaluate the effects of new technology in the performance of mammography, at the Breast Diagnostic Service of the British Hospital. Method: mammography performance during 2019- 2020 was compared to that between 2010 and 2018. In 2019 the previous tehcnology was substituted by a direct digital mammogram with tomosynthesis, Hologic, Selenia Dimensions model. Results: 10.725 mammographies were done in 2019-2020. Cancer was detected in 84 cases and the cancer detection rate was 8 per 1000 persons. PPV was 35%. 45.438 mammographies were done in 2010-2018. Cancer was detected in 229 cases and the cancer detection rate was 5 per 1.000 persons. PPV was 40%. As to images, it is worth pointing out an increase in microcalcifications between 2019 and 2020, when they grew from 7% of cases to 19% of cases and distortions increased from 11% to 13%. DCIS was 4 times greater in 2019-2020 when compare to the previous period of time (17% of all detected cases). Conclusions: the integration of tomosynthesis increased 60% the cancer detection rate and the DCIS was 4 times greater.
Resumo: Introdução: a história da mamografia registra vários avanços tecnológicos. Nos anos mais recentes, a mamografia digital direta com tomossíntese surgiu com uma maior capacidade de detectar a presença de câncer. Em 2019 a Unidade de Diagnóstico de Mama (UDM) do Hospital Britânico no Uruguai, incorporou um mamógrafo digital direto com tomossíntese, Hologic modelo Selenia Dimensions. Objetivo: avaliar desempenho do mamógrafo digital direto com tomossíntese na UDM. Material e métodos: faz-se uma comparação dos resultados das mamografias durante dois períodos 2019-2020 e 2010-2018. Resultados: no período 2019 a 2020 foram realizadas 10.725 mamografias; 84 cânceres foram detectados com una taxa de detecção de 8/1000. O valor preditivo positivo (VPP) foi de 35%. No período 2010-2018, foram realizadas 45.438 mamografias, 229 cânceres foram detectados com una taxa de detecção de 5/1000. O VPP foi de 40%. Em relação às manifestações de imagem, destaca-se o aumento das microcalcificações no período 2019-2020, que passou de 7% para 19% dos casos. As distorções aumentaram de 11% para 13%. Em relação aos tipos histológicos de câncer, destaca-se a porcentagem de carcinoma ductal in situ (CDIS), que foi quatro vezes maior no período 2019-2020 do que no anterior (17% do total de casos detectados). Conclusões: com a incorporação da tomossíntese, a taxa de detecção de câncer aumentou 60% e a porcentagem de CDIS aumentou quatro vezes.
Subject(s)
Breast Neoplasms/diagnostic imaging , Mammography , Breast Neoplasms/prevention & controlABSTRACT
La evaluación de la densidad mamaria (DM) es un componente importante del informe de mamografía de detección y transmite información a los médicos remitentes sobre la sensibilidad mamográfica y el riesgo relativo de desarrollar cáncer de mama. La densidad mamaria se refiere a la cantidad de tejido fibroglandular en relación con el tejido adiposo. Entendiendo el tema y conociendo las categorías de densidad, se puede, potencialmente, salvar vidas. Mi interés sobre este tópico cobró personalidad al conocer a Nancy M. Cappello, Ph.D., quién podría ser llamada la fundadora del movimiento de educación sobre la densidad mamaria en los Estados Unidos. Cappello, una sobreviviente de cáncer de mama, falleció el 15 de noviembre de 2018 a causa de un síndrome mielodispástico secundario (MDS), un cáncer de médula ósea que fue una complicación de sus agresivos tratamientos anteriores contra el cáncer de mama avanzado al momento del diagnóstico.
Subject(s)
Female , Breast Neoplasms , Mammography , Biomarkers , Breast DensityABSTRACT
Background: Cancer is a public health problem among women, but preventive actions are effective. Aim: To outline the reasons and factors associated with abstention from pap smears and mammography examinations among women. Material and Methods: Using official databases of the WHO and the Ministry of Social Development of Chile, inferential statistical analyses and modeling of abstention through binomial logistic regression were carried out. Results: Breast and cervical cancer had the highest incidence and mortality among women over 35 years old in Chile, even when there are effective screening methods for their early detection. Abstention is conditioned by personal reasons such as low risk perception. There is a high concomitance of abstention for pap smears and mammography. Conclusions: Health promotion actions should encourage women to undergo preventive actions for breast and cervical cancer.
Subject(s)
Humans , Female , Adult , Early Detection of Cancer , Papanicolaou Test , Mammography , Chile/epidemiology , PrevalenceABSTRACT
Introducción: El cáncer de mama se ha convertido en un verdadero desafío a la calidad y expectativa de vida de la población mundial, con un aumento considerable en su incidencia y prevalencia. Cuba cuenta, desde 1987, con un Programa de Control de Cáncer Mamario. Objetivo: Ejemplificar el estudio de un caso con linfoma no Hodgkin primario de la mama, su cuadro clínico y los medios diagnósticos utilizados. Caso clínico: Paciente femenina de 70 años de edad, color de la piel negra, que acudió al Consultorio Médico de la Familia por presentar malestar general, molestias y aumento de volumen en la mama derecha. Se le remitió a consulta de cirugía y se le realizaron estudios complementarios. Se detectó nódulo de mediana densidad, contornos parcialmente definidos, distorsión del tejido vecino, otros nódulos de menos tamaño y densidad en el cuadrante inferior interno, calcificaciones vasculares en ambas mamas. Una biopsia corrobora linfoma no Hodgkin difuso de células grandes de alto grado. Conclusiones: El linfoma primario no Hodgkin de mama es muy raro y de difícil diagnóstico clínico porque no se dispone de signos, síntomas o criterios de imagen específicos para ello. El autoexamen de mama continúa siendo el principal método de diagnóstico del cáncer de mama y aunque el examen clínico, el ultrasonido de mama y la mamografía apoyan la presunción, es la biopsia quien solo brinda la confirmación diagnóstica precisa(AU)
Introduction: Breast cancer has become a real challenge to the quality of life and to life expectancy of the world population, with a considerable increase in its incidence and prevalence. Cuba has, since 1987, a breast cancer control program. Objective: To present a case with primary non-Hodgkin's lymphoma of the breast in a 70-year-old patient, its clinical picture and the diagnostic means used. Clinical case: 70-year-old female patient, with black skin, who came to the family medical office due to malaise, discomfort and increased volume in her right breast. She was referred to surgery and complementary studies were performed. Nodule of medium density was identified, with partially defined contours, distortion of the neighboring tissue, together with other nodules of less size and density in the lower internal quadrant, and vascular calcifications in both breasts. A biopsy confirms diffuse high-grade large-cell non-Hodgkin's lymphoma. Conclusions: Primary non-Hodgkin's lymphoma of the breast is very rare and difficult to diagnose clinically because there are no specific signs, symptoms or imaging criteria for it. Breast self-examination continues to be the main method of diagnosis for breast cancer and, although clinical examination, breast ultrasound and mammography support such diagnostic presumption, it is the biopsy that only provides the precise diagnostic confirmation(AU)
Subject(s)
Humans , Female , Biopsy/methods , Breast Neoplasms/prevention & control , Breast Neoplasms/epidemiology , Mammography/methods , Ultrasonography/methods , Breast Self-Examination/methods , Lymphoproliferative Disorders , CubaABSTRACT
Resumen Introducción: Promover la detección de cáncer de mama (CaMa) en mujeres mediante mastografía es una estrategia viable para disminuir los diagnósticos en fases clínicamente avanzadas y la mortalidad. Objetivos: Describir los resultados reportados por estudios de mastografía en mujeres realizados a nivel nacional durante 2013-2017 y analizar la tendencia espaciotemporal de categorías BIRADS (Breast Imaging Reporting and Data System) sugestivas de malignidad por Estado. Método: Diseño analítico longitudinal que incluyó información sobre estudios de mastografía de mujeres según grupo de edad (< 40 e ≥ 40), valoradas en unidades de la Secretaría de Salud, México, durante 2013-2017. Se estimó la frecuencia de categorías según BIRADS, tasa estandarizada sugestiva de malignidad (categorías 4 y 5) en mujeres ≥ 40 años y se utilizó estadística espacial para analizar la tendencia por Estado. Resultados: Se analizaron 3,659,151 mastografías, el 98.5 % en mujeres ≥ 40 años. La tasa sugestiva de malignidad disminuyó de 38.3 (2013) a 31 (2017) por 100 mil mujeres ≥ 40 años; sin embargo, el riesgo de detección aumentó hasta 13 veces en diez Estados. Conclusiones: Aunque el riesgo de detección en categorías sugestivas de malignidad disminuyó a nivel nacional, algunos Estados requieren reforzar la aplicación de programas de detección del CaMa mediante mastografía e incrementar la participación de la población blanco.
Abstract Introduction: Promoting breast cancer (BC) detection in women by means of mammography is a viable strategy to reduce the number of diagnoses at clinically advanced stages and mortality. Objectives: To describe the results reported by mammography studies in women, carried out nationally during 2013-2017, and to analyze the spatiotemporal trend of Breast Imaging Reporting and Data System (BIRADS) categories suggestive of malignancy by State. Method: Longitudinal, analytical design that included information on mammography studies of women according to age group (< 40 and ≥ 40), evaluated in units of the Ministry of Health of Mexico during 2013-2017. The frequency of BIRADS categories and a standardized rate suggestive of malignancy (categories 4 and 5) were estimated in women aged ≥ 40 years, and spatial statistics were used to analyze the trend by State. Results: A total of 3,659,151 mammograms were analyzed, 98.5 % in women aged ≥ 40 years. The malignancy-suggestive rate decreased from 38.3 (2013) to 31 (2017) per 100,000 women aged ≥ 40 years; however, the risk of detection increased up to 13 times in ten States. Conclusions: Although the risk of detection in categories suggestive of malignancy decreased at the national level, some States need to reinforce the application of BC detection programs through mammography and increase the participation of the target population.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Breast Neoplasms/diagnostic imaging , Mammography/statistics & numerical data , Spatio-Temporal Analysis , Patient Participation/statistics & numerical data , Breast Neoplasms/classification , Breast Neoplasms/epidemiology , Mammography/classification , Linear Models , Space-Time Clustering , Age Factors , Mexico/epidemiologyABSTRACT
El cáncer de mama Triple Negativo es un subtipo molecular que se caracteriza por ausencia de expresión de receptores de estrógeno, progesterona y proteína HER2. Representa el 10 % a 15 % de todos los subtipos de cáncer de mama con impacto en el pronóstico y en las líneas de tratamiento; siendo negativo para receptores hormonales y HER2, la terapéutica hormonal y anti-HER2 no cuentan para su manejo. Aún no se dispone de productos dirigidos a blancos específicos para esta categoría.(AU)
The Triple Negative breast cancer is a molecular subtype characterized by no expression of the estrogen, the progesterone and the HER2 protein receptors. They represents 10 % to 15 % of all the breast cancer subtypes with an impact on the prognosis and in the treatment lines; is negative for the hormone receptors and for the HER2, hormonal and the anti-HER2 therapeutics do not count for the management of them. The products targeting specific to this category are not yet available(AU)
Subject(s)
Humans , Female , Biomarkers, Tumor , Anthracyclines/therapeutic use , Taxoids/therapeutic use , Triple Negative Breast Neoplasms/pathology , Triple Negative Breast Neoplasms/epidemiology , Mammography , Drug Therapy , Medical OncologyABSTRACT
Resumen | Introducción. La calidad de la mamografía está directamente relacionada con la capacidad para detectar anormalidades y, por ello, es necesario el control de calidad en los centros de imágenes diagnósticas. Objetivo. Evaluar la calidad de la imagen, la lectura y el servicio de mamografía de algunos centros de imágenes diagnósticas en Manizales, Colombia. Materiales y métodos. Cuatro centros participaron de forma voluntaria y bajo acuerdos de confidencialidad en el estudio. De las 520 mujeres atendidas en ellos, a 318 se les hicieron mamografías. A partir de una inspección visual del servicio, se evaluaron la infraestructura, la tecnología y el personal de la unidad. Un radiólogo experto en lectura e interpretación clínica de imágenes mamarias evaluó la calidad de la imagen y la de su lectura. El análisis estadístico se hizo utilizando un anova y determinando el índice kappa y el porcentaje de desacuerdo. Resultados. Se encontró falta de calidad de las imágenes obtenidas, principalmente, por presencia de artificios en el 75 % de ellas, e identificación y rotulación deficientes; además, en la toma de la proyección oblicua medio-lateral, se encontró falta de visualización del ángulo inframamario. El grado de concordancia en el reporte BI-RADS fue bajo en los cuatro centros, con diferencias importantes en el informe y la descripción de los hallazgos. Conclusión. Los centros de imágenes diagnósticas evaluados están habilitados para el funcionamiento, pero se encontraron deficiencias importantes en la calidad de las imágenes y en su lectura, lo que pone de manifiesto la necesidad de establecer estándares de calidad y mejorar los aspectos que se puedan mejorar.
Abstract | Introduction: Mammography quality is directly related to the ability to detect an abnormality and, therefore, quality control is necessary for diagnostic imaging centers. Objective: To evaluate image quality, reading, and mammography service in some diagnostic imaging centers in Manizales, Colombia. Materials and methods: Four diagnostic imaging centers participated voluntarily in the study under confidentiality agreements. Out of 520 women attending the centers, 318 had a mammography. The infrastructure, technology, and human resources of each unit were evaluated based on visual inspections. A radiologist expert in reading and clinical interpretation of mammary images evaluated the quality of the image and the reading. We made the statistical analysis using anova, the kappa index, and the percentage of disagreement. Results: We found images of diminished quality mainly due to the presence of artifacts in 75 % of those evaluated, as well as non-compliance with identification criteria and image labeling. There were difficulties in taking the lateral median oblique projection given the absence of the inframammary. The level of agreement in the BI-RADS reporting was low in the four centers with important differences in the report and description of findings. Conclusion: The city's diagnostic centers under evaluation are authorized for their operation. However, there are important deficiencies in image quality and reading, which highlights the need to seek quality standards starting from those aspects that can be improved upon.