Mortalidade cardiovascular associada ao rastreamento mamográfico
Mortalidade cardiovascular associada ao rastreamento mamográfico
Data
2019
Autores
Migowski, Arn
Nadanovsky, Paulo
Vianna, Cid Manso de Mello
Journal Title
Journal ISSN
Volume Title
Publisher
Revista Brasileira de Cancerologia
Resumo
Introdução: Os danos cardiovasculares do rastreamento mamográfico não têm sido objeto de estudo ou preocupações, inclusive na área de cardio-oncologia. O resultado é uma importante lacuna na literatura a despeito de evidências da grande magnitude do sobrediagnóstico e do sobretratamento no rastreamento e sua ligação com aumento da mortalidade cardiovascular. Objetivo: Apresentar e discutir as principais evidências a respeito das causas de aumento de mortalidade cardiovascular associadas ao rastreamento. Método: Foram realizadas buscas sistemáticas na literatura, por meio de quatro estratégias de busca em duas bases de dados (MEDLINE e LILACS), para identificar as causas de aumento de mortalidade cardiovascular potencialmente associadas ao sobrediagnóstico e ao sobretratamento. Para cada uma das estratégias de busca, os resultados tiveram seu nível de evidência atribuídos de acordo com a classificação do Oxford Centre for Evidence-Based Medicine. Resultados: Dois grandes grupos de causas de aumento da mortalidade cardiovascular foram identificados: o primeiro ligado diretamente ao diagnóstico de câncer de mama; e o segundo ao tratamento do câncer de mama, incluindo cirurgia e radioterapia adjuvante. O aumento de mortalidade cardiovascular incluiu diversos subgrupos de causas, tais como infarto agudo do miocárdio, tromboembolismo pulmonar, insuficiência cardíaca, arritmias, doença orovalvar e acidente vascular encefálico. Conclusão: Existem evidências consistentes sobre mortalidade cardiovascular associada ao diagnóstico e ao tratamento do câncer de mama em situações clinicamente compatíveis com o rastreamento. É provável também que essa seja uma das causas mais importantes da mortalidade relacionada ao rastreamento, em especial aquelas associadas ao sobretratamento com radioterapia adjuvante.
Introduction: Cardiovascular harms of mammographic screening have not been the subject of study or concern, including in the cardio-oncology area of. The result is an important gap in literature despite the evidence of great magnitude of overdiagnosis and overtreatment in screening and its association with increased cardiovascular mortality. Objective: Present and discuss the main evidence regarding the causes of increased cardiovascular mortality associated with screening. Method: Systematic searches were performed in the literature through four search strategies in two databases (MEDLINE and LILACS), to identify the causes of increased cardiovascular mortality potentially associated with overdiagnosis and overtreatment. For each one of the search strategies, it was used the classification of the Oxford Centre for Evidence-Based Medicine to assign the level of evidence of the results.Results: Two major groups of causes of increased cardiovascular mortality were identified: the first linked directly to the diagnosis of breast cancer; and the second to the treatment of breast cancer, including surgery and adjuvant radiotherapy. The increase of cardiovascular mortality included several subgroups of causes such as acute myocardial infarction, pulmonary thromboembolism, heart failure, arrhythmias, heart valve disease and stroke. Conclusion: There are consistent evidence about cardiovascular mortality associated with breast cancer diagnosis and treatment in conditions clinically compatible with screening. It is also likely to be one of the most important causes of mortality related to screening, especially those associated with overtreatment with adjuvant radiotherapy.
Introduction: Cardiovascular harms of mammographic screening have not been the subject of study or concern, including in the cardio-oncology area of. The result is an important gap in literature despite the evidence of great magnitude of overdiagnosis and overtreatment in screening and its association with increased cardiovascular mortality. Objective: Present and discuss the main evidence regarding the causes of increased cardiovascular mortality associated with screening. Method: Systematic searches were performed in the literature through four search strategies in two databases (MEDLINE and LILACS), to identify the causes of increased cardiovascular mortality potentially associated with overdiagnosis and overtreatment. For each one of the search strategies, it was used the classification of the Oxford Centre for Evidence-Based Medicine to assign the level of evidence of the results.Results: Two major groups of causes of increased cardiovascular mortality were identified: the first linked directly to the diagnosis of breast cancer; and the second to the treatment of breast cancer, including surgery and adjuvant radiotherapy. The increase of cardiovascular mortality included several subgroups of causes such as acute myocardial infarction, pulmonary thromboembolism, heart failure, arrhythmias, heart valve disease and stroke. Conclusion: There are consistent evidence about cardiovascular mortality associated with breast cancer diagnosis and treatment in conditions clinically compatible with screening. It is also likely to be one of the most important causes of mortality related to screening, especially those associated with overtreatment with adjuvant radiotherapy.
Description
Palavras-chave
Radiotherapy, Adjuvant, Mammography, Mass Screening, Cardiovascular Diseases/mortality, Breast Neoplasms/diagnosis, Radioterapia adjuvante, Mamografia, Programas de rastreamentos, Doenças cardiovasculares/mortalidade, Neoplasias da mama/diagnóstico, Tomografia Computadorizada por Raios X, Tomografia, Ultra-sonografia, Apendicite, Apendicectomia, Estudos transversais, Diagnóstico, Educação médica continuada, Medicina baseada em evidências
Citação
Migwski A, Nadanovsky P, Vianna CMM. Mortalidade cardiovascular associada ao rastreamento mamográfico. Rev Bras Cancerol. 2019;65(03):e-02335. Doi: 10.32635/2176-9745.RBC.2019v65n3.335.