ONFERÊNCIA PROTECÇÃO RADIOLÓGICA NA AÚDE 2/Room... · Are we sure it’s worth it? When...
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CONFERÊNCIA: PROTECÇÃO RADIOLÓGICA NA SAÚDE SETEMBRO 2013 Stakeholders and Radiology: What keeps Laço awake at night? www.laco.pt
Transcript of ONFERÊNCIA PROTECÇÃO RADIOLÓGICA NA AÚDE 2/Room... · Are we sure it’s worth it? When...
CONFERÊNCIA: PROTECÇÃO RADIOLÓGICA NA SAÚDE SETEMBRO 2013
Stakeholders and Radiology: What keeps Laço awake at night?
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LAÇO
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Mission Laço is a non-profit association working to significantly improve the prevention, early diagnosis and treatment of breast cancer in Portugal.
WOMEN, BREAST CANCER & RADIOLOGY IN PORTUGAL
¢ Screening
¢ Diagnosis and treatment
¢ Justification, optimization, lowering the dosage – real examples
¢ Regulation and priorities
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WOMEN, BREAST CANCER & RADIOLOGY IN PORTUGAL ¢ Before – organised
mammography screening (assymptomatic women 45/50 - 69; currently available to approximately 50% of eligible women) and opportunistic screening (Lx, Porto)
¢ During – diagnosis (mammography) and treatment (radiotherapy)
¢ After – follow-up (mammography)
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SCREENING – WHAT’S A GIRL TO DO??
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SCREENING – WHAT’S A GIRL TO DO??
¢ Mammograms are NOT Really Saving Lives, Research Says
http://summaries.cochrane.org/CD001877/screening-for-breast-cancer-with-mammography
¢ Mammography is still the best screening tool used today for the early detection of breast cancer.
http://ww5.komen.org/BreastCancer/TheMammographyDebate.html
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SCREENING DOUBTS - ARE WE SURE IT’S WORTH IT?
¢ Mammography screening is expensive, involves radiation exposure and false positives. Are we sure it’s worth it? When perfect, does screening make a difference?
¢ Ethical screening – the need for guaranteed quality follow up – lack of certified Breast Units in Portugal
¢ Lack of feedback - effectiveness can’t yet be shown in Portugal?
¢ Overscreening leading to overtreating- finding DCIS lesions that will never evolve in some women (who cannot yet be identified)
¢ Could we be doing something with more impact with the money from unnecessary screening mammograms?
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PERCEPTIONS OF SCREENING - ANGER
¢ Angry women who think they are being denied services because screening doesn't start at 35 or earlier
¢ Interval cancers – “they missed the cancer”
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PERCEPTIONS OF SCREENING – FALSE PROTECTION
¢ Overscreening - women who go annually or more often (organized + opportunistic)
¢ “Protection” - belief that mammograms confer protection
¢ Consequences - unnecessary radiation exposure, wasted resources
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PERCEPTIONS OF SCREENING – CONFUSION
¢ Causes cancer vs. no risk at all?
¢ Radiation risk? more than using a cell phone? less than standing near a TV? more than flying in an airplane?
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DIAGNOSIS & TREATMENT CONCERNS
¢ Overall lack of quality control ¢ The average age of radiotherapy machines in
Portugal ¢ Lack of equipment leading to unequal access to
radiotherapy, especially through the public system
¢ Lack of qualified technicians ¢ Discrepancies in protocols and doses ¢ Wait times ¢ “Miracle cures” in the media creating false hope
¢ http://www.publico.pt/sociedade/noticia/estudo-destaca-grandes-lacunas-da-radioterapia-em-portugal-1372554
¢ http://expresso.sapo.pt/radioterapia-que-elimina-tumor-numa-so-sessao-chega-a-portugal=f686380
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FOLLOW-UP
¢ Other health problems resulting from radiation damage http://www.nejm.org/doi/full/10.1056/NEJMoa1209825
¢ Continued exposure to radiation through regular mammograms; other options - MRIs?
¢ Doubts about implants and mammograms
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PROBLEMS: JUSTIFICATION
¢ Joana - at 24, she found a lump and was told by her doctor that she was too young for breast cancer so no exams were done, not even an ultrasound
¢ Over a year later she was diagnosed by another doctor with stage 3 breast cancer
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PROBLEMS: OPTIMIZATION
¢ Maria – turned 50 and asked her family doctor at the Centro de Saúde in Lisbon for a mammogram
¢ Poor quality machine and a poorly trained technician at the only clinic she knew of that accepted prescriptions from the SNS (her Centro de Saúde doesn’t do mammograms)
¢ the poor quality mammogram was read by one radiologist who had no previous exams to compare it with and missed the spot that turned out to be cancer
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PROBLEMS: LOWERING THE DOSE
¢ Marta – had childhood cancer treated with thoracic radiotherapy and now has stage 4 breast cancer at the age of 39
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WHERE IS THE BETTER, FASTER, CHEAPER, EASIER AND SAFER WAY TO DETECT BREAST CANCER?
¢ Will tomosynethesis with computer simulated images and CAD lead to:
¢ lower doses ¢ fewer repetitions ¢ less overdiagnosis of DCIS ¢ fewer false positives ¢ fewer false negatives
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THE LEGAL CONTEXT IN PORTUGAL
¢ Lack of legislation and regulation
¢ Lack of enforcement of what does exist
¢ Urgent need for a mammogram certification process – facilities and equipment, technicians and radiologists
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¢ http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorecard/ucm113858.htm
RADIOLOGY& BREAST CANCER: LAÇO’S PRIORITIES FOR PORTUGAL
¢ Regulatory action: mammogram certification process which is independent, competent and transparent
¢ Implementation of the European Recommendations for breast cancer screening, diagnosis and treatment http://www.europarl.europa.eu/sides/getDoc.do?type=TA&reference=P6-TA-2006-0449&language=EN
¢ Continuing information campaigns to increase health literacy so that women understand the benefits and risks and have ways to recognize quality facilities vs unsafe/irregular situations
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