Mamografia: infraestrutura, cobertura, qualidade e risco do câncer radionduzido em rastreamento oportunístico no estado de Goiás
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Data
2012-04-10
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Universidade Federal de Goiás
Resumo
Among the available methods for the diagnosis and early detection of breast
cancer, the most indicated for mass screening is the mammography. To
guarantee its effectiveness, this exam needs to be performed using high quality
standards and the lowest radiation dose possible. Therefore, the present
research aimed to assess the infrastructure and performance of the equipments
available at the mammography services in the state of Goiás, regarding
coverage, quality, and radiological protection (dose) of patients, in order to
provide early detection of breast cancer by an opportunistic screening. A
prospective study was carried out, from 2007 to 2010, to observe the diagnostic
imaging services which perform mammography, initially for the Brazilian Unified
National Health System (SUS) and, in 2010, the services of the private system
were included. Data collection was divided into two phases: the first, to collect
information on infrastructure and the second, to apply tests in order to evaluate
the performance characteristics of equipment and materials used. We calculated
the conformity of the assessed items in terms of quality of image and equipment
performance and estimated the average dose in glandular tissue and the risk of
radioinduced carcinogenesis, as well as the risk of mortality by radioinduced
tumors. The results were presented in four articles. In the first, we showed that
mammography coverage in the state of Goiás in 2008 was 66% among women
in the 50 69-year age group, considering biennial mammography. In the second
article, we concluded that the implementation of the Mammography Quality
Control Program was effective to achieve better quality mammography in SUS
services. In the beginning of our research, only 2.9% of SUS services were
within the desired range of quality and, after two interventions (2008 and 2009),
20% of them reached it. The results of the third article, in which we verified the infrastructure and quality of services performing mammography, both for SUS
and private systems, showed no difference in quality of exams between them.
However, the evaluation between types of technology used showed difference
between radiation doses (p < 0.001) applied during mammography. In the fourth
article, we estimated the benefit risk balance of screening mammography
carried out in the state of Goiás in 2010. The excess absolute risk of
radioinduced cancer and the lifetime risk presented significant difference for
types of technology (p < 0.001) and types of health system (p < 0.019)
according to the age group of screening. The ratio lives saved/lives lost was
75.5/1 for screening at the 40 70-year age group and 166.5/1 at the 50 70-year
age group. The results showed that coverage of the 50 69-year age group in
the state of Goiás is near the recommended standards for the beginning of
organized screenings. However, when assessed per regional health unit,
coverage was non-uniform, presenting high concentration of equipments and
exames at the Central Regional. The initial evaluation of equipment performance
indicated the need to implant actions for controlling mammography quality and
risk. The actions of the Mammography Quality Control Program proved to be
effective to enhance the quality of mammography, although the same does not
remain true for the radiation dose used in mammography. These doses are
lower in conventional mammography equipments than in those coupled to image
digitization systems. Regarding radiological protection, screening women who
are 50 70 years old, when performed biennially using conventional
mammography equipments, presented more benefit.
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Citação
CORRÊA, Rosangela da Silveira. Mammography: infraestructure, coverage, quality and risk of radioinduced cancer in an opportunistic screening in the state of Goiás. 2012. 214 f. Tese (Doutorado em Ciencias da Saude) - Universidade Federal de Goiás, Goiânia, 2012.