Justificación - Ministerio de Salud y Protección Social y Publicaciones... · 37 Departament de...
Transcript of Justificación - Ministerio de Salud y Protección Social y Publicaciones... · 37 Departament de...
Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Guía de Atención Integral (GAI) para la detección temprana, atención integral, seguimiento y rehabilitación de pacientes
con diagnóstico de cáncer de mama.
Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Justificación
• Epidemiología
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Incidencia de cáncer de mamaMujeres (Todas las edades) - TAE por 100.000
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Globocan 2008
0 10 20 30 40
Melanoma
Leucemia
Linfomas no Hodgkin
Ovario y otros anexos
Tráquea, bronquios y pulmón
Colon, recto y ano
Estómago
Tiroides
Cuello del útero
Mama
IncidenciaMortalidad
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Incidencia y mortalidad por cáncer en Colombia
Mujeres (Todas las edades) – TAE por 100.000
Nuevos casos por añoMama: 7007
Fuente: Pardo C et al. Incidencia y mortalidad por cáncer en Colombia 2002-2006. INC; 2010
Mortalidad por cáncer de mama en Colombia
Murillo R et al. INC-IGAC; 200415/04/2011
Razones mortalidad/incidencia para países seleccionados de América
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0.00 0.05 0.10 0.15 0.20 0.25 0.30 0.35 0.40 0.45
Canadá
Estados Unidos
Argentina
Chile
Costa Rica
Brasil
Bolivia
Perú
Colombia
Ecuador
México
Cuba
Razón Mortalidad/incidencia
Fuente: Globocan 2008
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Tendencias de mortalidad por cáncer en Colombia
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
Mujeres
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Year
AS
R p
er10
0.00
0
Stomach
Lung
Cervix uteri
Breast
Women
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
Mujeres
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Year
AS
R p
er10
0.00
0
Stomach
Lung
Cervix uteri
Breast
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Year
AS
R p
er10
0.00
0
Stomach
Lung
Cervix uteri
Breast
Women
Murillo R et al. Serie Doc Tec INC 2006; No. 1
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
Mujeres
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Year
AS
R p
er10
0.00
0
Stomach
Lung
Cervix uteri
Breast
Women
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
Mujeres
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Año
TAE
por
100
.000 Estómago
Pulmón
Cuello uterin
Mama
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Year
AS
R p
er10
0.00
0
Stomach
Lung
Cervix uteri
Breast
0
2
4
6
8
10
12
14
16
18
1980 1984 1988 1992 19962000
Year
AS
R p
er10
0.00
0
Stomach
Lung
Cervix uteri
Breast
Women
Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Justificación
• Impacto
• Evidencia
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Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Antecedentes
• Convocatoria
• Alianzas
• Marco metodológico
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Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Objetivo General
• Generar recomendaciones para la detección temprana en mujeres, atención integral, seguimiento y rehabilitación de pacientes con diagnóstico de cáncer de mama en Colombia.
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Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Aspectos sanitarios
Detección temprana, tratamiento, seguimiento y rehabilitación de mujeres con diagnóstico de cáncer de mama.
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Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Población a la que se dirige
• Mujeres de población general susceptibles de ser tamizadas.
• Mujeres con riesgo de tener cáncer de mama.
• Mujeres y hombres con diagnóstico de cáncer de mama en cualquier estadio.
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Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Ámbito asistencial
• Profesionales de la salud que intervengan en el proceso de detección temprana, atención integral, seguimiento y rehabilitación de pacientes con diagnóstico de cáncer de mama. La guía para pacientes se encuentra establecida para mujeres blanco de tamización y pacientes diagnosticados con cáncer de mama.
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Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Preguntas
• Construcción de matriz
• Envío al GDG.
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Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Priorización
• Tamización: 6
• Neoplasia in situ: 7
• Estadíos tempranos: 16
• Estadíos localmente avanzados: 10
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Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Priorización
• Enfermedad metastásica: 7
• Económicas: 7
• Otras: 10
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Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
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# Elaboradores n Título1 American College of Physicians 1 Screening Mammography for Women 40 to 49 Years of Age: A Clinical Practice Guideline from the American College of Physicians
2 American Cancer Society (ACS) 1 American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography
3 American College of Radiology (ACR) 9 ACR Appropriateness Criteria® nonpalpable mammographic findings (excluding calcifications)
4 American College of Radiology (ACR) ACR Practice guideline for the performance of a breast ultrasound examination
5 American College of Radiology (ACR) ACR Practice guideline for the performance of contrast‐enhanced magnetic resonance imaging (mri) of the breast
6 American College of Radiology (ACR) ACR Practice guideline for the performance of screening and diagnostic mammography
7 American College of Radiology (ACR) ACR Practice guideline for the performance of stereotactically guided breast interventional procedures
8 American College of Radiology (ACR) ACR Practice guideline for the performance of ultrasound‐guided percutaneous breast interventional procedures
9 American College of Radiology (ACR) Practice guideline for breast conservation therapy in the management of invasive breast carcinoma
10 American College of Radiology (ACR) Practice guideline for determinants of image quality in digital mammography
11 American College of Radiology (ACR) Practice guideline for the management of ductal carcinoma in‐situ of the breast (dcis)
12 American Society of Breast Disease (ASBD) 1 The Use of Magnetic Resonance Imaging of the Breast (MRIB) for Screening of Women at High Risk of Breast Cáncer
13 American Society of Clinical Oncology (ASCO) 8 American Society of Clinical Oncology 2003 Update on the Role of Bisphosphonates and Bone Health Issues in Women With Breast Cáncer
14 American Society of Clinical Oncology (ASCO) American Society of Clinical Oncology 2006 Update of the Breast Cancer Follow‐Up and Management Guidelines in the Adjuvant Setting
15 American Society of Clinical Oncology (ASCO) American Society of Clinical Oncology 2007 Update of Recommendations for the Use of Tumor Markers in Breast Cáncer
16 American Society of Clinical Oncology (ASCO) American Society of Clinical Oncology Clinical Practice Guideline Update on the Role of Bone‐Modifying Agents in Metastatic Breast Cáncer
17 American Society of Clinical Oncology (ASCO) American Society of Clinical Oncology Clinical Practice Guideline Update on the Use of Pharmacologic Interventions Including Tamoxifen, Raloxifene, and Aromatase Inhibition for Breast Cancer Risk Reduction
18 American Society of Clinical Oncology (ASCO) American Society of Clinical Oncology Clinical Practice Guideline: Update on Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cáncer
19 American Society of Clinical Oncology (ASCO) American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Human Epidermal Growth Factor Receptor 2 Testing in Breast Cáncer
20 American Society of Clinical Oncology (ASCO) American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Immunohistochemical Testing of Estrogen and Progesterone Receptors in Breast Cáncer
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21 British Association of Quirurgical Oncology (BASO) 2 Surgical guidelines for the management of breast cáncer
22 British Association of Quirurgical Oncology (BASO) Oncoplastic breast surgery e ‐ A guide to good practice
23 Cancer Care Ontario (CCO) 13 Adjuvant Ovarian Ablation in the Treatment of Premenopausal Women with Early Stage Invasive Breast Cáncer
24 Cancer Care Ontario (CCO) Adjuvant Taxane Therapy for Women with Early‐stage, Invasive Breast Cancer: A Clinical Practice Guideline
25 Cancer Care Ontario (CCO) Baseline Staging Tests in Primary Breast Cáncer Practice Guideline Report # 1‐14
26 Cancer Care Ontario (CCO) Breast Irradiation in Women with Early Stage Invasive Breast Cáncer Following Breast Conserving Surgery
27 Cancer Care Ontario (CCO) Fulvestrant for Systemic Therapy of Locally Advanced or Metastatic Breast Cancer in Postmenopausal Women: Guideline Recommendations
28 Cancer Care Ontario (CCO) Magnetic Resonance Imaging Screening of Women at High Risk for Breast Cancer: A Clinical Practice Guideline
29 Cancer Care Ontario (CCO) Management of Ductal Carcinoma in Situ of the Breast: A Clinical Practice Guideline
30 Cancer Care Ontario (CCO) Surgical Management of Early‐Stage Invasive Breast Cáncer31 Cancer Care Ontario (CCO) The Role of Aromatase Inhibitors in Adjuvant Therapy for Postmenopausal Women with Hormone Receptor‐positive
Breast Cancer: Guideline Recommendations
32 Cancer Care Ontario (CCO) The Role of Gemcitabine in the Management of Metastatic Breast Cáncer
33 Cancer Care Ontario (CCO) The Role of HER2/neu in Systemic and Radiation Therapy for Women with Breast Cancer: A Clinical Practice Guideline
34 Cancer Care Ontario (CCO) The Role of Trastuzumab (Herceptin®) in the Treatment of Women with HER2/neu‐overexpressing Metastatic Breast Cáncer
35 Cancer Care Ontario (CCO) The Role of Trastuzumab in Adjuvant and Neoadjuvant Therapy in Women with HER2/neu‐overexpressing Breast Cáncer
36 Centro Nacional de Excelencia Tecnológica en Salud CENETEC México 1 Prevención y diagnóstico oportuno de cáncer de mama en el primer nivel de atención ‐ Versión extendida y versión de referencia
37 Departament de Salut de Cataluña 1 Oncoguía de mama Actualización 2008 Guías de práctica clínica en cáncer de Cataluña
38 European Society for Medical Oncology (ESMO) 5 BRCA in breast cancer: ESMO Clinical Recommendations
39 European Society for Medical Oncology (ESMO) Locally recurrent or metastatic breast cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow‐up
40 European Society for Medical Oncology (ESMO) Primary breast cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow‐up
Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
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41 European Society for Medical Oncology (ESMO) Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007
42 European Society for Medical Oncology (ESMO) Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2009
43 Insitute for Clinical Systems Improvement (CSI) 1 Health Care Guideline: Diagnosis of Breast Disease
44 Journal Watch Medicine that matters 1 Women´s Health CLINICAL PRACTICE GUIDELINE WATCH
45 Ministerio de Salud de Chile (MSC) 1 Guía Clínica Cáncer de Mama 200646 National Breast and Ovarian Cáncer Centre and Australian Cáncer Network 1 The pathology reporting of breast cáncer A guide for pathologists, surgeons, radiologists and oncologists
47 National Comprehensive Cáncer Network (NCCN) 1 Breast Cancer VI2010
48 National Guideline Clearinhouse (NGC) Guideline Summary ‐ ACR Appropriateness Criteria® bone metastases.
49 National Guideline Clearinhouse (NGC) Guideline Summary ‐ ACR Appropriateness Criteria® conservative surgery and radiation‐stage I and II breast carcinoma
50 National Guideline Clearinhouse (NGC) Guideline Summary ‐ ACR Appropriateness Criteria® locally advanced breast cáncer
51 National Guideline Clearinhouse (NGC) Guideline Summary ‐ ACR Appropriateness Criteria® palpable breast masses
52 National Guideline Clearinhouse (NGC) Guideline Summary ‐ ACR Appropriateness Criteria® postmastectomy radiotherapy
53 National Guideline Clearinhouse (NGC) Guideline Summary ‐ ACR Appropriateness Criteria® stage I breast carcinoma
54 National Guideline Clearinhouse (NGC) Guideline Summary ‐ Breast cancer. In: Suspected cancer in primary care: guidelines for investigation, referral and reducing ethnic disparities
55 National Guideline Clearinhouse (NGC) Guideline Summary ‐ Breast self‐examination.56 National Guideline Clearinhouse (NGC) Guideline Summary ‐ Hereditary breast and ovarian cancer syndrome
57 National Guideline Clearinhouse (NGC) Guideline Summary ‐ Hormone therapy and breast cancer. In: Menopause and osteoporosis update 2009
58 National Guideline Clearinhouse (NGC) Guideline Summary ‐ Recommendations from the EGAPP Working Group: can tumor gene expression profiling improve outcomes in patients with breast cancer?
59 National Guideline Clearinhouse (NGC) Guideline Summary ‐ Risk assessment and genetic counseling for hereditary breast and ovarian cancer: recommendations of the National Society of Genetic Counselors
Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
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60 National Guideline Clearinhouse (NGC) Guideline Summary ‐ The prophylactic use of filgrastim in patients with breast cáncer
61 National Guideline Clearinhouse (NGC) Guideline Summary ‐ The use of bevacizumab in metastatic breast cáncer
62 National Guideline Clearinhouse (NGC) Guideline Summary ‐ Use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers
63 National Guideline Clearinhouse (NGC) Guideline Summary ‐ Zoledronic acid as adjuvant therapy in combination with adjuvant endocrine therapy for premenopausal women with early‐stage hormone receptor positive breast cáncer
64 National Guideline Clearinhouse (NGC) Guideline Summary ‐The continued use of trastuzumab beyond disease progression in patients with metastatic breast cáncer
65 National Library of Guidelines (NHS) 1 Quality assurance guidelines for surgeons in breast cáncer screening
66 National Insitute of Clinical Excellence (NICE) 4 Familial breast cancer The classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care Update July 2006
67 National Insitute of Clinical Excellence (NICE) NICE clinical guideline 41 (Partial update of NICE clinical guideline 14): Familial breast cáncer
68 National Insitute of Clinical Excellence (NICE) NICE Clinical guidelines CG80 Breast cancer (early & locally advanced): diagnosis and treatment
69 National Insitute of Clinical Excellence (NICE) NICE Clinical guidelines CG81 Advanced breast cancer: diagnosis and treatment
70 New Zealand Guidelines Group (NZGG) 1 Management of early breast cáncer71 Society Obstetricians and Gynaecologists of Canada
(SOGC)1 Progesterone‐Only and Non‐Hormonal Contraception in the Breast Cancer Survivor: Joint Review and
Committee Opinion of the Society of Obstetricians and Gynaecologists of Canada and the Society of Gynecologic Oncologists of Canada.
72 The Breast Health Global Initiative (BGHI) 1 Normas Internacionales Para la Salud de Mama y el Control del Cáncer de Mama
73 U.S. Preventive Service Task Force (USPSTF) 2 Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms
74 U.S. Preventive Service Task Force (USPSTF) Screening for Breast Cáncer: U.S. Preventive Services Task Force (carpeta: guía en cuatro archivos)
Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011Instituto Nacional de Cancerología - E.S.EBogotá – Colombia Marzo de 2011
Gracias.
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