Seguimento pós-tratamento de pacientes com câncer da mama
quando e como orientar?
Palabras clave:
neoplasias mamarias, seguimentosResumen
A necessidade e a forma de seguimento de pacientes com câncer da mama é assunto controverso. Há enorme variação, entre profissionais, sobre quais exames solicitar e periodicidade das consultas. Alguns procedimentos, hoje feitos de rotina, não têm o suporte da evidência científica. Do ponto de vista de controle loco-regional, orientar a paciente para autoexame das mamas e consultas a cada 4 a 6 meses com mamografia anual, formam um conjunto de orientações bastante consensual e eficiente. O aspecto menos definido refere-se à pesquisa, de rotina, de metástases hematogênicas em pacientes assintomáticas e tratadas com intenção curativa. Este assunto tem sido recentemente discutido com opiniões bem antagónicas. Aparentemente a solicitação de vários exames de laboratório e radiológicos, de rotina, possibilita fazer diagnóstico de falha a distância um pouco mais precocemente, mas não há evidências que isso mude a sobrevida global. Pelo enorme número de pacientes, a solicitação de exames de rotina tem um alto custo. Além disso, em geral, estes exames deixam as pessoas ansiosas. Pelo menos dois estudos prospectivos e randomizados europeus, comparando a sobrevida de pacientes assintomáticas seguidas com exames usuais de rotina, versus seguimento mais orientado por queixas, mostram igualdade de sobrevida. O mesmo cabe para os atuais marcadores inespecíficos. Para pacientes que não participam de estudos prospectivos, o que significa a maioria dos casos, seguimento com exame clínico e solicitação de exames basicamente quando os sintomas exigirem, é uma boa alternativa quando se considera custo/benefício.
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