domingo, febrero 09, 2014

Tener la autoridad de la "palabra precisa" desde un lugar de poder puede ser complicado y perjudicial.

Fotos Virginia González / fotocomposición Miguel Pizzanelli
Verdes de Caleta Gonzalo, Enero 2014.

Estimados: en la nota que comparto a continuacion 
(http://www.espectador.com/salud/284193/alvaro-luongo-inca-somos-de-los-paises-que-hemos-reflejado-mayor-diagnostico-y-menor-mortalidad-en-casos-de-cancer(http://www.espectador.com/salud/284193/alvaro-luongo-inca-somos-de-los-paises-que-hemos-reflejado-mayor-diagnostico-y-menor-mortalidad-en-casos-de-cancer)
es una entrevista de un medio de prensa al Dr Luongo, director del INCA (instituto nacional del cáncer . Hace declaraciones sobre los datos que ha comunicado la OMS sobre la situación del cáncer en el mundo y en particular en Uruguay.

Mas allá de los posicionamientos personales y científicamente fundados que tengamos sobre la aplicación racional de programas de tamizaje para cáncer de mama con mamografìas, discrepo con su posición sobre una serie de información que llega a la opinión pública ,sobre otros asuntos que están zanjados a nivel internacional desde hace ya mucho tiempo.

Que quede claro que no estamos en contra, apriori, de los "tamizajes en la población sana", sino que queremos que se racionalice el uso de las tecnologías para detección de enfermedades crónicas y cáncer de un modo que respete la epidemiología del país, pero que tambien respete la cuantiosa evidencia internacional que se ha ido acumulando a lo largo del tiempo sobre estos asuntos.

Sobre la nota queremos  destacar algunos aspectos:

1/ El mas grave el argumentar a favor sobre la utilidad del uso de PSA para el cribado o tamizaje del cáncer de próstata. No existe casi evidencia que apoye esto.

PREGUNTO AQUI A TODOS LOS PROFESIONALES EXTRANJEROS A MODO DE ENCUESTA Y COMO FORMA DE MITIGAR NUESTRA POSIBLE INGNORACIA PARTICULAR Y ESENCIAL: ¿en que países se sostiene en este momento los cribados sistemáticos en población sana con PSA y en cuales NO? (AGRADECEMOS RESPUESTAS)






2/ La argumentación tan fuerte sobre la recomendación de la realización sistemática del autoexamen mamario que esta en revisión total, a lo largo y ancho de todo el mundo:

Breast Self examination

Randomized Trial of Breast Self-Examination in
Shanghai: Final Results
David B. Thomas, Dao Li Gao, Roberta M. Ray, Wen Wan Wang, Charlene J.
Allison, Fan Liang Chen, Peggy Porter, Yong Wei Hu, Guan Lin Zhao, Lei Da
Pan, Wenjin Li, Chunyuan Wu, Zakia Coriaty, Ilonka Evans, Ming Gang Lin,
Helge Stalsberg, Steven G. Self

JNCI J Natl Cancer Inst (2002) 94(19): 1445-1457. doi: 10.1093/jnci/94.19.1445
http://jnci.oxfordjournals.org/content/94/19/1445.full.pdf+html


Routinely Teaching Breast Self-Examination is Dead. What Does This Mean?
Russell Harris, Linda S. Kinsinger
JNCI J Natl Cancer Inst (2002) 94(19): 1420-1421.doi: 10.1093/jnci/94.19.1420
http://jnci.oxfordjournals.org/content/94/19/1420.full.pdf+html


Breast self examination does not improve cancer survival 
Deborah Josefson Nebraska
http://www.bmj.com/highwire/filestream/384688/field_highwire_article_pdf/0/793.1
Teaching women breast self examination is not cost effective, nor does it lead to improvements in survival from breast cancer, according to a large, 10 year, randomised observational study conducted in Shanghai, China (J Natl Cancer Inst 2002;94:1445-57).
Breast self examinations did, however, lead to earlier detection of breast lesions and increased the number of biopsies for benign breast lumps. 
David Thomas and Roberta Ray and colleagues from the Fred Hutchinson Cancer Research Center in Seattle, Washington, in conjunction with Dao Li Goa and colleagues from the Shanghai Textile Industry Bureau in Shanghai, China, conducted a study to examine the efficacy of breast self examination in reducing breast cancer mortality.
The study group was a cohort of  266 064 female factory workers drawn from 519 textile factories in Shanghai between October 1989 and October 1991. The women were followed up until December 2000. A total of 132 979 women were randomly assigned to be instructed in intensive self examination and 133 085 women were assigned to a control group that did not receive any instruction. 
Performing breast self examination did not lead to significant gains in survival. At the 10 year follow up point 154 women (0.12%) in the self examination group and 158 (0.12%) in the control group developed breast cancer and died. Of these deaths, 135 in the instruction group and 131 in the control group were deemed to be caused by the breast cancer itself. The number of breast cancers diagnosed overall was 1747, of which 864 were in the self examination group and 890 inthe control group. 
The cumulative risk ratio for women in the instruction group relative to the control group was 1.04 (95% confidence interval 0.82 to 1.33).  
The number of breast biopsies performed for benign disease was considerably higher in  the self examination group than in the control group: 2761 compared with 1505. 
Treatment patterns were similar in the two groups. About 24% of women with breast cancer in each group were given radiation treatment, while 84% in the self examination group and 82% in the control group were treated with tamoxifen.
Single and multiagent chemotherapy rates were also similar in the two groups: 6.1% and 7.1% for single agents and 80% and 81% for multiple agents. About 30% of each group used traditional Chinese medicines. 
The authors concluded that, in general, teaching breast self examination is a waste of money—in developed countries and  in more disadvantaged areas. In countries where mammography is available it is far superior and more specific in picking up cancerous lesions, they say. “In developing countries, where mammography screening is not available, it would not seem to be a good use of limited funds available for preventive services to promote the practice [of breast self examination],” they add. 
Currently the US Preventive Health Services Task Force recommends neither for nor against self examination. The American Cancer Society still promotes the practice. 
Advice to women to undertake breast self examination was abandoned over 10 years ago in the United Kingdom.

Cololario

Evidentemente la búsqueda del bien común enturbia las mentes "hiperclaras y progresistas" de los tomadores de decisiones que el gobierno de izquierda elije como portavoces. Esto nos pone en un camino de control despótico del Estado sobre la voluntad y el cuerpo de los demás,  preocupante, irreflexivo, paternalista, autoritario y perjudicial a los derechos de los usuarios. Este proceder no admite diálogo posible con "otros saberes" y con otras formas de proceder, que las hay. Mucho para reflexionar en momentos de posibles cambios.


Miguel Pizzanelli
(las opiniones vertidas aquí son totalmente personales y asumo todas las consecuencias de lo dicho)