Directrices Europeas sobre Mamas

Discusión 

Al desarrollar las Directrices Europeas sobre Mamas, la ECIBC utilizó un enfoque riguroso para producir recomendaciones sobre detección y diagnóstico de cáncer de mama para mujeres. Las pautas incluyen recomendaciones que abordan el uso de varias pruebas, incluyendo DBT, MRI, ABUS y HHUS, para mujeres que tienen lesiones sospechosas en mamografía o quienes tienen tejido mamario denso.

El uso de algunas pruebas, como DBT, en mujeres con alta densidad mamaria no se aborda en esta sinopsis, pero actualizaciones que incorporan evidencia pertinente emergente y recomendaciones relacionadas están en camino.

Los puntos fuertes de las pautas incluyen su adherencia a los requisitos para un desarrollo confiable4, 6, 98, incluida la exhibición pública y transparente de todas las pruebas, consideraciones y juicios para uso de mujeres, profesionales de la salud, formuladores de políticas e investigadores (https://ecibc.jrc.ec.europa.eu/recommendations). 

Anteriormente describimos las limitaciones de nuestras pautas relacionadas con la falta de evidencia de alta certeza para algunas recomendaciones, la ausencia de modelado formal, y conflictos de intereses y problemas de proceso7.

Creemos que estas limitaciones están equilibradas por la transparencia de las recomendaciones que permite el discurso científico y la comparación con otras pautas.

Nuestras recomendaciones clave sobre tamizaje en mujeres menores de 50 años en general están de acuerdo con las pautas del American College of Obstetricians and Gynecologists99, el American College of Physicians100, y la American Cancer Society101, que sugieren una toma de decisiones compartida.

Sin embargo, nuestras recomendaciones son menos fuertes y favorecen intervalos de detección más amplios que el American College of Radiology102 y el National Comprehensive Cancer Network103.

Para los otros grupos de edad, las recomendaciones concuerdan con las de la Organización Mundial de la Salud104 y la U. S. Preventive Services Task Force105 pero no con las de la Canadian Task Force for Preventive Health Care (CTFPHC)106.

El CTFPHC también utilizó enfoque GRADE EtD, lo cual permite una exploración más detallada de las diferencias. La diferencia clave es la recomendación del CTFPHC contra la detección en mujeres hasta los 49 años y después de los 69 años.

Creemos que esto es el resultado de que el CTFPHC atribuye un valor más alto a daños potenciales más preocupaciones sobre el riesgo de sesgo, lo que lleva a una menor certeza de la evidencia, y mayor importancia atribuida a los resultados para los cuales había menos información disponible. Esto a su vez llevó al CTFPHC a asignar en general menor certeza.

El GDG de ECIBC ha analizado cuidadosamente los datos existentes y complementó los ECA cuando estuvieron disponibles con estudios observacionales y no tuvo graves preocupaciones sobre el riesgo de sesgo en los ensayos en general (véanse las explicaciones en el perfil de evidencia en http://bit.ly/ 2qNKE91).

En contraste con el CTFPHC, los ECIBC GDG tampoco tenían preocupaciones sobre la inconsistencia en resultados de la prueba, lo que hace que el GDG tenga más confianza en la recomendación para mujeres de 50 a 69 años.

(Lea También: Aspirina para la Prevención Primaria de la Enfermedad Cardiovascular en Mujeres)

La viabilidad de implementar una recomendación, la aceptabilidad de esa recomendación, los recursos requeridos y los valores asociados a menudo son contextualmente dependientes.

Algunos países han comenzado o tienen la intención de adaptar o adoptar recomendaciones específicas en Europa (Bulgaria, República Checa, Dinamarca, Estonia, Alemania, Italia, Noruega y Eslovaquia) y fuera de Europa (Bahrein, Chile, China y Túnez) usando los marcos EtD y el GRADO-ADOLOPMENT (GRADO EtD, para la adopción de metodología, adaptación y desarrollo de novo de recomendaciones confiables)107.

En resumen, esta sinopsis presenta y resume la justificación de 15 recomendaciones clave de la European Breast Guidelines.

From McMaster University, Hamilton, Ontario, Canada (H.J.S.); European Commission, Joint Research Centre, Ispra, Italy (D.L., E.P., Z.S.); St. Vincent’s University Hospital, Dublin, Ireland (C.Q.); German Cancer Society, Berlin, Germany (M.F.); Iberoamerican Cochrane Center, Barcelona, Spain (P.A.); Azienda Unitá Sanitaria Locale-IRCCS di Reggio Emilia, Reggia Emilia, Italy (P.G.R.); Private Group Practice for Pathology, Lübeck, Germany (A.L.);

Umeå University, Umeå, Sweden (L.N.); Radboud University Medical Centre, Nijmegen, the Netherlands (M.B.); University of Athens Medical School, Athens, Greece (L.I.); Queen Mary University of London, London, United Kingdom (S.W.D.); University of Geneva, Geneva, Switzerland (B.B.); National Screening Service, Dublin, Ireland (P.F.); Cancer Registry of Norway, Oslo, Norway (S.H.); IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain (X.C.); CPO-Piedmont – AOU Cittá della Salute e della Scienza, Torino, Italy (L.G.); Iberoamerican Cochrane Centre, Barcelona, Spain (C.C.); Langford, North Somerset, United Kingdom (S.W.); Cardiff University, Cardiff, United Kingdom (R.M.); Universitá degli Studi di Milano, Milan, Italy (F.S.); and Radiologie am Theater, Paderborn, Germany (A.G.).

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