O paradoxo da popularidade no rastreamento mamográfico e a prevenção quaternária
DOI:
https://doi.org/10.5712/rbmfc18(45)3487Palavras-chave:
Prevenção Quaternária, Atenção Primária à Saúde, Prevenção de Doenças, Câncer de mama, Programas de rastreamento.Resumo
Introdução: Apesar dos sobrediagnósticos (diagnósticos de doenças que não se manifestariam clinicamente) no rastreamento mamográfico terem tornado duvidoso o balanço benefícios-danos, persistem suas recomendações positivas às mulheres (>50 anos) e aos profissionais, o que demanda prevenção quaternária — evitação de danos iatrogênicos e sobremedicalização. Nessa persistência, estão envolvidos expectativas fictícias, cultura moralista preventivista, medicina de vigilância e biocapitalismo (interesses econômicos). Argumentamos que o “paradoxo da popularidade” — expansão paradoxal da popularidade dos rastreamentos alimentada pela produção de seus danos iatrogênicos — tem mais importância nesse contexto do que se tem considerado. Objetivo: Descrever e discutir alguns modos de operação possíveis desse paradoxo nos profissionais de saúde. Métodos: Ensaio baseado em literatura selecionada intencionalmente. Resultados: Para além da síntese desse paradoxo nas populações, sua operacionalidade em profissionais de saúde envolve fatores cognitivos (invisibilidade dos casos sobrediagnosticados, diluição dos casos graves entre os sobrediagnosticados e feedbacks cognitivos apenas positivos na experiência clínica), políticos (interesses corporativos e comerciais poderosos) e psicológicos (significativa recompensa subjetiva de tratar mais pessoas com ótimo resultado e menor desgaste emocional derivado do cuidado aos casos sobrediagnosticados, além de outros comuns vieses psicocognitivos). Conclusões: Os processos discutidos podem ser relevantes para a prevenção quaternária e um melhor manejo clínico e institucional desse rastreamento, que deve envolver os profissionais da Atenção Primária à Saúde e vários outros atores sociais.
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