Las recomendaciones preventivas de los médicos de familia estadounidenses

La American Academy of Family Physicians ha actualizado sus recomendaciones preventivas en la práctica clínica. Son una adaptación de la U.S. Preventive Services Task Force (USPSTF). Estas recomendaciones son un excelente ejemplo de organización y evaluación de la efectividad y evidencia de la recomendaciones. Por ejemplo:

Cáncer de mama: La AAFP recomienda que en la mujer de 40 años y más se deberá realizar un despistaje del cáncer de mama con mamografía cada 1 o 2 años tras escuchar el consejo de su médico de familia acerca de los potenciales riesgos y beneficios de este procedimiento.

Las consideraciones en www.ahrq.gov/clinic/uspstf/uspsbrca.htm:

The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older.

Rating: B recommendation

Rationale: The USPSTF found fair evidence that mammography screening every 12-33 months significantly reduces mortality from breast cancer. Evidence is strongest for women aged 50-69, the age group generally included in screening trials. For women aged 40-49, the evidence that screening mammography reduces mortality from breast cancer is weaker, and the absolute benefit of mammography is smaller, than it is for older women. Most, but not all, studies indicate a mortality benefit for women undergoing mammography at ages 40-49, but the delay in observed benefit in women younger than 50 makes it difficult to determine the incremental benefit of beginning screening at age 40 rather than at age 50.
The absolute benefit is smaller because the incidence of breast cancer is lower among women in their 40s than it is among older women. The USPSTF concluded that the evidence is also generalizable to women aged 70 and older (who face a higher absolute risk for breast cancer) if their life expectancy is not compromised by comorbid disease. The absolute probability of benefits of regular mammography increase along a continuum with age, whereas the likelihood of harms from screening (false-positive results and unnecessary anxiety, biopsies, and cost) diminish from ages 40-70. The balance of benefits and potential harms, therefore, grows more favorable as women age. The precise age at which the potential benefits of mammography justify the possible harms is a subjective choice. The USPSTF did not find sufficient evidence to specify the optimal screening interval for women aged 40-49