Algunas consideraciones teóricas sobre la pesquisa activa <span class="so-article-trans-title" dir="auto"> Translated title: Some theoretical considerations on the active inquiry </span>

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Abstract

En el presente trabajo se exponen algunas consideraciones de los autores sobre la pesquisa activa. Se tratan los antecedentes en nuestro país, el concepto de pesquisa activa, sus dimensiones técnica, económica y ética, y se analizan los principios éticos de toda pesquisa. Se presentan los diferentes tipos de pesquisas y las características que debe tener toda prueba o examen de pesquisa, así como la interrelación de esta con el diagnóstico temprano. Se presentan los criterios que debe reunir una enfermedad para ser sometida a un programa de pesquisa. También se exponen los problemas de salud que reúnen los requisitos necesarios para ser pesquisados. Por último, se hacen las conclusiones sobre la aplicación de pesquisas, y se insiste en que estas deben descansar fundamentalmente en la exploración clínica, así como estar integradas o formar parte de los programas de salud vigentes y ser congruentes con las evidencias científicas disponibles. Se realizan también recomendaciones sobre los principios que deben regir en las pesquisas basadas en investigaciones paraclínicas.

Translated abstract

In present paper are exposed some authors considerations on the active inquiry. Included are the backgrounds in our country, the concept on active inquiry, its technical, economic, and ethical dimension and the inquiry ethical principles are analyzed. Authors present the different criteria of the inquiries as well as the features related to all test or examination of the inquiry and its interrelationship with the early diagnosis. Also are exposed the health problems fulfilling the requirement necessary to be inquired. Finally, we conclude on inquiries applications, and it is emphasized that they must to be based mainly in clinical exploration, as well as its integration or be part of health programs in use and to be consistent with available scientific evidences. We recommend on principles essential in inquiries based on paraclinical researches

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Screening for breast cancer.

Katrina Armstrong, Alison W Fletcher, Joann G Elmore … (2005)

Breast cancer screening in community practices may be different from that in randomized controlled trials. New screening modalities are becoming available. To review breast cancer screening, especially in the community and to examine evidence about new screening modalities. English-language articles of randomized controlled trials assessing effectiveness of breast cancer screening were reviewed, as well as meta-analyses, systematic reviews, studies of breast cancer screening in the community, and guidelines. Also, studies of newer screening modalities were assessed. All major US medical organizations recommend screening mammography for women aged 40 years and older. Screening mammography reduces breast cancer mortality by about 20% to 35% in women aged 50 to 69 years and slightly less in women aged 40 to 49 years at 14 years of follow-up. Approximately 95% of women with abnormalities on screening mammograms do not have breast cancer with variability based on such factors as age of the woman and assessment category assigned by the radiologist. Studies comparing full-field digital mammography to screen film have not shown statistically significant differences in cancer detection while the impact on recall rates (percentage of screening mammograms considered to have positive results) was unclear. One study suggested that computer-aided detection increases cancer detection rates and recall rates while a second larger study did not find any significant differences. Screening clinical breast examination detects some cancers missed by mammography, but the sensitivity reported in the community is lower (28% to 36%) than in randomized trials (about 54%). Breast self-examination has not been shown to be effective in reducing breast cancer mortality, but it does increase the number of breast biopsies performed because of false-positives. Magnetic resonance imaging and ultrasound are being studied for screening women at high risk for breast cancer but are not recommended for screening the general population. Sensitivity of magnetic resonance imaging in high-risk women has been found to be much higher than that of mammography but specificity is generally lower. Effect of the magnetic resonance imaging on breast cancer mortality is not known. A balanced discussion of possible benefits and harms of screening should be undertaken with each woman. In the community, mammography remains the main screening tool while the effectiveness of clinical breast examination and self-examination are less. New screening modalities are unlikely to replace mammography in the near future for screening the general population.

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Computed tomography screening and lung cancer outcomes.

Jeffrey J Swensen, Colin Begg, B Bach … (2007)

Current and former smokers are currently being screened for lung cancer with computed tomography (CT), although there are limited data on the effect screening has on lung cancer outcomes. Randomized controlled trials assessing CT screening are currently under way. To assess whether screening may increase the frequency of lung cancer diagnosis and lung cancer resection or may reduce the risk of a diagnosis of advanced lung cancer or death from lung cancer. Longitudinal analysis of 3246 asymptomatic current or former smokers screened for lung cancer beginning in 1998 either at 1 of 2 academic medical centers in the United States or an academic medical center in Italy with follow-up for a median of 3.9 years. Annual CT scans with comprehensive evaluation and treatment of detected nodules. Comparison of predicted with observed number of new lung cancer cases, lung cancer resections, advanced lung cancer cases, and deaths from lung cancer. There were 144 individuals diagnosed with lung cancer compared with 44.5 expected cases (relative risk [RR], 3.2; 95% confidence interval [CI], 2.7-3.8; P<.001). There were 109 individuals who had a lung resection compared with 10.9 expected cases (RR, 10.0; 95% CI, 8.2-11.9; P<.001). There was no evidence of a decline in the number of diagnoses of advanced lung cancers (42 individuals compared with 33.4 expected cases) or deaths from lung cancer (38 deaths due to lung cancer observed and 38.8 expected; RR, 1.0; 95% CI, 0.7-1.3; P = .90). Screening for lung cancer with low-dose CT may increase the rate of lung cancer diagnosis and treatment, but may not meaningfully reduce the risk of advanced lung cancer or death from lung cancer. Until more conclusive data are available, asymptomatic individuals should not be screened outside of clinical research studies that have a reasonable likelihood of further clarifying the potential benefits and risks.