Acabo de receber um email de um colega radiologista no Portal Lucy Kerr, o qual se dedica exclusivamente à área de ultrassonografia e que desde 2011 acompanha nosso site e lê nossos comentários sobre o uso da mamografia e diz que concorda em diversos aspectos com nossos pontos de vista e gostaria de saber o que eu achava do parecer do CBR sobre a mamografia expresso no link http://cbr.org.br/parecer-uso-da-mamografia-digital-em-todas-as-faixas-etarias/
E respondi a ele enviando uma lista bibliográfica de procedência irretocável, onde os cientistas condenam a mamografia. Todas as referências que passei ao colega e anexo ao final são respaldadas pela Cochrane e por outros pesquisadores seríssimos, sem conflitos de interesses e nenhum destes foi citado no parecer do CBR.
Os trabalhos científicos que apoiam o parecer favorável do CBR foram publicados no AJR e Radiology, que são revistas cientificas dos radiologistas e para os radiologistas, que dificilmente publicam qualquer trabalho que condene a mamografia. Partimos de uma ótica viciada e desvirtuada pelos conflitos de interesse, pois os que emitiram o parecer são radiologistas e ganham ao realizar a mamografia. E o mais absurdo: recomendam o exame a partir de 40 anos, sem nenhum respaldo naquela literatura referendada pela Cochrane.
As referências que estão no parecer CBR são pobres e os pesquisadores fazem parte «da quadrilha da mamografia», pois praticam rotineiramente sérios vícios metodológicos e forçam os resultados desejados«cometendo erros além da imaginação», segundo análise do Dr. Peter Gøtszche, diretor da Cochrane da Dinamarca.
Porque não citaram na bibliografia a melhor e maior revisão sobre a mamografia já realizada, como foi a da Cochrane em 2013, onde os pesquisadores identificaram a ineficácia e malefícios da mamografia? Nessa revisão, após analisarem tudo que já havia sido feito sobre o método até aquela data, além de ter verificado os resultados nas populações rastreadas e não rastreadas, concluiram que o método deveria ser abolido.
É comum dizer-se que o pior cego é o que não quer ver. E eu digo que ninguém é mais burro do que aquele que raciocina com o bolso. E tudo as custa da saúde feminina, mutilando sua sexualidade e seus relacionamentos afetivos. Muito triste!!!
Um amigo meu radiologista e ultrassonografista conceituado, muito antes da Cochrane, me dizia que a mamografia é um exame pouco informativo, cheio de falhas e no qual não acreditava.
Eu tinha mamógrafo e me desfiz dele, pois sabia que estava prejudicando as mulheres com um exame radioativo e sem acuidade diagnóstica em metade das mulheres portadoras de mamas densas. Hoje me dedico a realizar e ensinar o exame tríplice das mamas (US, Doppler e elastografia), sabendo que estou oferecendo uma alternativa confiável e inócua para o rastreio do câncer de mama.
Espero que você como médico também zele pela saúde feminina.
Estou anexando dois grupos de referências: minhas e do último artigo Dr. Peter Gøtzsche
Se achou interessante essa leitura, veja também a minha resposta ao receber um email comentando esse artigo em relação “a pedir ou não pedir mamografia, (…) mesmo o profissional sabendo da ineficácia do método, se a paciente for diagnosticada com câncer e o médico não pediu a mamografia, ele será, com certeza, processado.”
I – Referências dos artigos no site do Portal Lucy Kerr:
- Douek M, Baum M. Mass breast screening: is there a hidden cost? Br J Surg. 2003; 90 (suppl.1): (Abstrat Breast 14)
- Gøtzsche PC. Mammography screening. Truth, lies and controversies. Radcliffe Publishing Inc 2012, 1ªed
- Wall C, Baines CJ, Miller AB Is carcinoma in situ a precursor lesion of invasive breast cancer? Int J Cancer. 2014 Oct 1;135(7):1646-52.
- Dixon JM. Breast screening has increased the number of mastectomies. Breast Cancer Res. 2009; 11 (Suppl. 3): S19
- Tabár L, Duffy SW, Smith RA. Beyond randomized controlled trials. Author’s reply. Cancer. 2002; 94(2):581-3
- Tábar L,Yen MF, Vitak B e col. Mammographic service screening and mortality in breast cancer patients: 20 year follow-up before and after introduction of screening . Lancet.2003; 361 (9367): 1405-10
- Duffy SW, Tábar L,Chen HH e col. The impact of organized mammographic service screening on breast carcinoma mortality in seven Swedish counties: a collaborative evaluation. Cancer. 2002; 95 (3):458-69
- Tabár L. [Screening with mammography contribute substantially to a significant reduction in breast cancer mortality ] [Swedish].
- Zahl PH, Jørgensen KJ, Maehlen J, Gøtzsche PC. Biases in estimates of overdetection due to mammography screening. Lancet Oncol. 2008 Mar;9(3):199-201
- Zahl PH1, Gøtzsche PC, Andersen JM, Maehlen J. Results of the Two-County trial of mammography screening are not compatible with contemporaneous official Swedish breast cancer statistics. Dan Med Bull. 2006 Nov;53(4):438-40.
- Gøtzsche PC. invited response. J Surg Oncol. 2002; 81: 162-3
- Jørgensen KJ, Gøtzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ 2009;339:b2587.
- Morrell S, Barratt A, Irwing L, et al. Estimates of overdiagnosis of invasive breast cancer associated with screening mammography. Cancer Causes Control 2010;21:275–82
- Kalager M, Adami HO, Bretthauer M, et al. Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian screening program. Ann Intern Med2012;156:491–9
- Jørgensen KJ, Klahn A, Gøtzsche PC. Are benefits and harms in mammography screening given equal attention in scientific articles? A cross-sectional study. BMC Med 2007;5:12
- Norris SL, Burda BU, Holmer HK, et al. Author’s specialty and conflicts of interest contribute to conflicting guidelines for screening mammography. J Clin Epidemiol 2012;65:725–33
- Riva C, Biollaz J, Foucras P, et al. Effect of population-based screening on breast cancer mortality.Lancet 2012;379:1296.
- Woloshin S, Schwartz LM. The benefits and harms of mammography screening: understanding the trade-offs. JAMA 2010;303:164–5
- The Annals of Internal Medicine Editors When evidence collides with anecdote, politics, and emotion: breast cancer screening. Ann Intern Med 2010;152:531–2
- Gøtzsche PC, Jørgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013 Jun 4;6:CD001877. Review.
- Gøtzchhe PC. Rational Diagnosis and Treatment: evidence-clinical decision-making. 4th ed. Chichester:Wiley; 2007
II – As Referências do artigo do Peter C Gøtzsche⇑ intitulado Mammography screening is harmful and should be abandoned, do Nordic Cochrane Centre, Rigshospitalet, Dept 7811, Denmark
- Gøtzsche PC,Jørgensen KJ. Screening for breast cancer with mammography.Cochrane Database Syst Rev 2013; 6: CD001877–CD001877. (first published in 2001).
- Humphrey LL,Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002; 137: 347–360.
- Canadian Task Force on Preventive Health Care,Tonelli M, Connor Gorber S,Joffres M, Dickinson J, Singh H, Lewin G, et al. Recommendations on screening for breast cancer in average-risk women aged 40–74 years. CMAJ 2011; 183:1991–2001.
- ↵Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. Lancet 2012; 380:1778–1786.
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- ↵Biller-Andorno N,Jüni P. Abolishing mammography screening programs? A view from the Swiss Medical Board. N Engl J Med 2014; 370: 1965–1967.
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- ↵Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 365:1687–1717.
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- ↵Gøtzsche PC. Relation between breast cancer mortality and screening effectiveness: systematic review of the mammography trials. Dan Med Bull 2011;58: A4246–A4246.
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- ↵Gøtzsche PC. Mammography screening: truth, lies and controversy, London:Radcliffe, 2012.
- ↵Gøtzsche PC,Jørgensen KJ, Zahl PH, Mæhlen J. Why mammography screening has not lived up to expectations from the randomised trials. Cancer Causes Control 2012; 23: 15–21.
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- Autier P,Boniol M, Middleton R, Doré JF,Héry C, Zheng T, et al. Advanced breast cancer incidence following population-based mammographic screening.Ann Oncol 2011; 22: 1726–1735.
- ↵Kalager M,Adami HO, Bretthauer M, Tamimi RM. Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian screening program. Ann Intern Med 2012; 156: 491–499.
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- ↵Bleyer A,Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med 2012; 367: 1998–2005.
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- ↵Jørgensen KJ,Gøtzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends.BMJ 2009; 339: b2587–b2587.
- ↵Jørgensen KJ,Zahl PH, Gøtzsche PC. Breast cancer mortality in organised mammography screening in Denmark: comparative study. BMJ 2010; 340:c1241–c1241.
- ↵Kalager M,Zelen M, Langmark F, Adami HO. Effect of screening mammography on breast-cancer mortality in Norway. N Engl J Med 2010; 363:1203–1210.
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- ↵Autier P,Boniol M, Gavin A, Vatten LJ. Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. BMJ 2011; 343:d4411–d4411.
- ↵Bleyer A. US breast cancer mortality is consistent with European data. BMJ2011; 343: d5630–d5630.
- ↵Jørgensen KJ,Zahl PH, Gøtzsche PC. Overdiagnosis in organised mammography screening in Denmark: a comparative study. BMC Womens Health 2009; 9: 36–36.
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- ↵Zahl PH,Jørgensen KJ, Gøtzsche PC. Overestimated lead times in cancer screening has led to substantial underestimation of overdiagnosis. Br J Cancer2013; 109: 2014–2019.
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- ↵Pharoah PD,Sewell B, Fitzsimmons D, Bennett HS, Pashayan N. Cost effectiveness of the NHS breast screening programme: life table model. BMJ2013; 346: f2618–f2618.
- ↵Baum M . Harms from breast cancer screening outweigh benefits if death caused by treatment is included. BMJ 2013; 346: f385–f385.
- ↵Brodersen J,Siersma VD. Long-term psychosocial consequences of false-positive screening mammography. Ann Fam Med 2013; 11: 106–115.
- ↵Raftery J, Chorozoglou M. Possible net harms of breast cancer screening: updated modelling of Forrest report. BMJ 2011; 343: d7627–d7627.
- ↵Swiss Medical Board. Systematisches Mammographie-Screening. See medicalboard.ch/fileadmin/docs/public/mb/Fachberichte/2013-12-15_Bericht_Mammographie_Final_Kurzfassung_e.pdf(last checked 15 December 2013).
- ↵Jørgensen KJ, Keen JD, Gøtzsche PC. Is mammographic screening justifiable considering its substantial overdiagnosis rate and minor effect on mortality?Radiology 2011; 260: 621–627.CrossRefMedlineOrder article via InfotrieveWeb of ScienceGoogle Scholar