El mito del diagnóstico precoz del cáncer de mama

TORONTO – El diagnóstico por imágenes del cáncer de mama (screening) ha sido considerado desde hace mucho tiempo como una de las herramientas más importantes para reducir la mortalidad como consecuencia de la enfermedad. Es por eso que las dudas recientes sobre su efectividad -intensificadas por la publicación en febrero pasado del seguimiento durante 25 años del Estudio Nacional Canadiense de Screening de Mama- causaron tanta sorpresa. ¿Cómo puede ser que el diagnóstico por imágenes del cáncer de mama, que facilita una detección temprana de la enfermedad, no impida que se produzcan muertes como consecuencia de la misma?

Entender las limitaciones del diagnóstico por imágenes exige, ante todo, entender el proceso. Se le practica una mamografía (rayos X de la mama) a gente ostensiblemente saludable para detectar una enfermedad insospechada. Si se detecta alguna anormalidad, se realiza una prueba de diagnóstico para confirmar la presencia de la enfermedad. Si los resultados son positivos, empieza el tratamiento.

La primera limitación del diagnóstico por imágenes del cáncer de mama es obvia: donde no existe un diagnóstico y un tratamiento efectivo, el diagnóstico por imágenes no puede tener ningún impacto. Pero hay algo más vinculado a la cuestión -concretamente, saber si el screening cumple, en definitiva, con su objetivo previsto de reducir las tasas de mortalidad por cáncer de mama.

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