Exames de triagem a partir de 50 anos de idade

Doenças da tireoide são relativamente comuns, e mais frequentes em mulheres que em homens.

As opiniões sobre o valor de exames de triagem da tireoide (TSH, T4, T3) variam.

A U.S. Preventive Services Task Force, dos EUA, fez uma revisão em 2004 e não obteve resultados conclusivos sobre benefícios da triagem de adultos assintomáticos.

A American Thyroid Association, dos EUA, recomenda a triagem para pessoas acima de 35 anos de idade, especialmente mulheres, a cada cinco anos, ou em um intervalo menor se a pessoa apresentar sintomas.

A American Association of Clinical Endocrinologists, dos EUA, recomenda a triagem para mulheres a partir de 50 anos de idade, ou mais cedo se houver uma história familiar de doença da tireoide.

Links
American Association of Clinical Endocrinologists (AACE): Thyroid Disease Fact Sheet
AACE: Neck Check Card

Fontes

American College of Physicians. Inactive ACP guidelines. Available on the Internet at http://www.acponline.org/clinical_information/guidelines/past through http://www.acponline.org. Accessed 12 Feb 2008.

Georgetown University Department of Medicine. Thyroid disease: basic thyroid information. Available on the Internet through http://www.medicine.georgetown.edu. Accessed 12 Feb 2008.

National Women’s Health Resource Center. Thyroid disorders. 29 Sep 2002, reviewed 5 Mar 2007. Available on the Internet at http://www.healthywomen.org/healthtopics/thyroiddisorders through http://www.healthywomen.org. Accessed 12 Feb 2008.

American Association of Clinical Endocrinologists. Women’s endocrine health. Available on the Internet at http://www.powerofprevention.com/w_endocrine.php through http://www.powerofprevention.com. Accessed 12 Feb 2008.

American Association of Clinical Endocrinologists. 2004 thyroid awareness campaign encourages patients and physicians to take control of thyroid health (press release). 22 Jan 2004. Available on the Internet at http://www.aace.com/pub/press/release/index.php?r=20040122 through http://www.aace.com. Accessed 21 Jul 2004.

American Association of Clinical Endocrinologists. Facts about thyroid disease. PDF available for download at http://www.aace.com/public/awareness/tam/2005/pdfs/thyroid_disease_fact_sheet.pdf through http://www.aace.com. Accessed 21 Jul 2004 and 12 Feb 2008.

Goldsmith C. Hypothyroidism: easy to treat, often overlooked. 25 Feb 2002. Nurseweek News. Previously available on the Internet at http://www.nurseweek.com/ce/ce153a_print.html through http://www.nurseweek.com. Accessed 21 Jul 2004; document no longer posted.

Ladenson PW, et al, for the American Thyroid Association. American Thyroid Association guidelines for detection of thyroid dysfunction. 12 Jun 2000. Arch Intern Med 60:1573-1575. PDF available for download at http://www.thyroid.org/professionals/publications/documents/GuidelinesdetectionThyDysfunc_2000.pdf through http://www.thyroid.org. Accessed 14 Jul 2004 and 12 Feb 2008.

US Preventive Services Task Force. Screening for thyroid disease: recommendation statement. 20 Jan 2004. Ann Intern Med 140(2):125-127. Available on the Internet at http://www.guideline.gov. Accessed 19 Jul 2004 and 12 Feb 2008.

American Association of Clinical Endocrinologists. Take control of your health: keep your thyroid in balance (patient brochure). PDF previously available for download at http://www.aace.com/pub/tam2004/PatientBrochure.pdf. Accessed 21 Jul 2004; document no longer posted.

National Women’s Health Information Center, Office on Women’s Health, US Department of Health and Human Services. Thyroid disorders. Previously available on the Internet at http://www.4woman.gov/faq/thyroid_disease.htm. Accessed 15 Jul 2004; document no longer posted.

American College of Physicians. Screening for thyroid disease (position paper). 1998. Ann Intern Med 129:141-143. Available on the Internet at http://www.annals.org. Accessed 21 Jul 2004.

Helfand M and Redfern CC, for the American College of Physicians. Screening for thyroid disease: an update. 1998. Ann Intern Med 129:144-158. Available on the Internet at http://www.annals.org. Accessed 21 Jul 2004.

O câncer de mama é uma causa importante de mortalidade em mulheres. Mamografias periódicas podem evitar muitas mortes ao detectar tumores em um a três anos antes que possam ser sentidos.

A partir de 50 anos de idade:

• A American Cancer Society, o American College of Obstetricians and Gynecologists, dos EUA, e outros órgãos recomendam uma triagem anual para mulheres com risco normal, a partir dos 40 anos de idade, incluindo exames das mamas feito por um profissional e mamografia.
• A U.S. Preventive Services Task Force, dos EUA, recomenda que, para mulheres com risco normal e menos de 50 anos de idade, a triagem se baseie na história clínica e em fatores de risco; e, para mulheres com 50 a 74 anos de idade, a triagem inclua uma mamografia anual.

A partir de 75 anos de idade:

• A American Cancer Society, dos EUA, declara que a idade avançada não é uma razão para interromper a triagem de câncer de mama. Mulheres não portadoras de doenças graves devem continuar a rotina de exames das mamas feito por um profissional e mamografia.
• A US Preventive Services Task Force, dos EUA, não encontrou evidências de benefícios adicionais na mamografia a partir de 75 anos de idade, e não faz recomendações específicas para essa faixa de idade.

Essas recomendações se aplicam a pessoas sem fatores de risco conhecidos. Quando são identificados, deve ser iniciado um programa de triagem individual sob orientação médica. O link da American Cancer Society, abaixo, relaciona fatores que podem aumentar o risco de câncer de mama, incluindo predisposição genética e história familiar ou pessoal de câncer de mama.

Links
American Cancer Society: What are the risk factors for breast cancer?
American Cancer Society: Can breast cancer be found early?
To sign up for a personal mammogram scheduling reminder, click here.

Fontes

American Medical Women’s Association. Breast cancer screening. Revised 2000. Available on the Internet at http://www.amwa-doc.org/index.cfm?objectId=0AA0C8F2-D567-0B25-565A679EEA33CD7D through http://www.amwa-doc.org. Accessed 7 Feb 2008.

American Cancer Society. Detailed guide: breast cancer—can breast cancer be found early? Revised 13 Sep 2007. Available on the Internet at http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=5 through http://www.cancer.org. Accessed 7 Feb 2008.

American Cancer Society. Breast cancer: early detection.  Available on the Internet at http://www.cancer.org/docroot/cri/content/2_6x_breast_cancer_early_detection.asp through http://www.cancer.org. Accessed 15 Jul 2004 and 7 Feb 2008.

National Women’s Health Information Center, US Department of Health and Human Services. General screenings and immunizations for women. Material posted as of Nov 2007. Available on the Internet at http://www.4women.gov/screeningcharts/general through http://www.4women.gov. Accessed 4 Feb 2008.

US Preventive Services Task Force. Guide to Clinical Preventive Services, 2007. Available on the Internet at http://www.ahrq.gov/clinic/pocketgd07/gcp2c.htm through http://www.ahrq.gov. Accessed 4 Feb 2008.

American Academy of Family Physicians. Summary of recommendations for clinical preventive services (rev 6.4). 15 Aug 2007. Available on the Internet through http://www.guideline.gov. Accessed 4 Feb 2008.

US Centers for Disease Control and Prevention. Women’s health—facts and stats—selected US national research findings—cancer. 2004. Available on the Internet at http://www.cdc.gov/women/natstat/cancer.htm#breast through http://www.cdc.gov. Accessed 7 Feb 2008.

Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Breast cancer: the most common malignancy in women. Spring 2004. Prevention Report 18(3). Available on the Internet at http://odphp.osophs.dhhs.gov/PUBS/prevrpt/04Volume18/Issue3pr.htm through http://odphp.osophs.dhhs.gov. Accessed 7 Feb 2008.

American College of Radiology. Breast care guidelines (press release). Nov 2000.

US Centers for Disease Control and Prevention. The National Breast and Cervical Cancer Early Detection Program—reducing mortality through screening (2003 program fact sheet). Revised May 2004. Available on the Internet at http://www.cdc.gov/cancer/nbccedp/about.htm through http://www.cdc.gov. Accessed 15 Jul 2004.

US Preventive Services Task Force. Screening for breast cancer: recommendations and rationale (release date Feb 2002). 3 Sep 2002. Ann Intern Med 137(5 Part 1):344-346. Available on the Internet at http://www.ahcpr.gov/clinic/uspstf/uspsbrca.htm through http://www.ahcpr.gov. Accessed 15 Jul 2004 and 7 Feb 2008.

US Centers for Disease Control and Prevention.  Healthy People 2010, increase proportion receiving mammogram objective 3.13. Available on the Internet at http://www.healthypeople.gov/document/html/objectives/03-13.htm through http://www.healthypeople.gov. Accessed 15 Jul 2004 and 7 Feb 2008.

US Centers for Disease Control and Prevention. Table 80: use of mammography for women 40 years of age and over according to selected characteristics: United States, selected years 1987-2000. Health, United States 2003. Available on the Internet at http://www.cdc.gov/nchs/products/pubs/pubd/hus/womens.htm through http://www.cdc.gov. Accessed 6 Aug 2004.

Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. U.S. Preventive Services Task Force. Annals of Internal Medicine. November 17, 2009 vol. 151 no. 10 716-726. Available online at http://www.annals.org/content/151/10/716.full through http://www.annals.org. Accessed November 2009.

A maioria das mortes por câncer do colo do útero (a parte inferior do útero) pode ser evitada com triagens regulares usado o método de Papanicolaou. Esse tipo de câncer, observado em geral em mulheres com mais de 40 anos de idade, é de desenvolvimento lento. Triagens de rotina podem identificar a doença em seus estágios iniciais, quando ele é curável na maior parte dos casos, e até lesões pré-cancerosas, que podem ser removidas com facilidade.

Além do teste de Papanicolaou, recomenda-se a pesquisa de DNA de papilomavírus (HPV). Infecções persistentes com algumas cepas de HPV são um fator de risco importante de câncer de colo do útero. Dois tipos de HPV, 16 e 18, correspondem a cerca de 70% dos casos de câncer cervical nos EUA.

A American Cancer Society, a U.S. Preventive Services Task Force, o American College of Obstetricians and Gynecologists, e a American Academy of Family Physicians, dos EUA, têm recomendações semelhantes para mulheres com mais de 30 anos de idade e com atividade sexual:

• A partir dos 30 anos de idade, mulheres sem fatores de risco conhecidos e com resultados de Papanicolaou e pesquisa de DNA de HPV normais durante três anos sucessivos devem repetir os dois exames a cada três anos.

A frequência dos exames pode ser maior quando há fatores de risco identificados, como exposição ao dietilestilbestrol, comportamento sexual de risco, HIV ou comprometimento do sistema imunológico. Mulheres submetidas a histerectomia em geral devem fazer os exames, porque o colo do útero é preservado na maioria dos casos.

O American College of Obstetricians and Gynecologists, dos EUA, recomenda um exame pélvico anual, mesmo quando não é necessário o teste de Papanicolaou.

Links
To sign up for a personal Pap test scheduling reminder, click here.

Fontes

(December 2009). American College of Obstetricians and Gynecology Practice Bulletin Number 109, Cervical Cytology Screening. PDF available for download at http://journals.lww.com/greenjournal/documents/PB109_Cervical_Cytology_Screening.pdf through http://journals.lww.com. Accessed December 2009.

American Cancer Society. DES Exposure: Questions and Answers. Available online at http://www.cancer.org/docroot/CRI/content/CRI_2_6x_DES_Exposure_Questions_and_Answers.asp through http://www.cancer.org. Accessed September 2008.

American College of Obstetricians and Gynecologists. Cervical cancer screening: testing can start later and occur less often under new ACOG recommendations (press release). 31 Jul 2003. Available on the Internet at http://www.acog.org/from_home/publications/press_releases/nr07-31-03-1.cfm through http://www.acog.org. Accessed 15 Jul 2004 and 18 Jan 2008.

American College of Physicians. New pap guidelines reduce screening, but raise concerns about compliance. Apr 2003. Observer. Available on the Internet at http://www.acponline.org/journals/news/apr03/pap_guides.htm?hp through http://www.acponline.org. Accessed 15 Jul 2004 and 18 Jan 2008.

American College of Obstetricians and Gynecologists. Human papillomaviruses and cancer: questions and answers. 8 Jun 2006. Available on the Internet through http://www.medem.com. Accessed 18 Jan 2008.

American College of Obstetricians and Gynecologists. Cervical cytology screening (practice bulletin 45). Aug 2003.  Available on the Internet at http://www.guideline.gov. Accessed 8 Feb 2008.

American Society for Colposcopy and Cervical Pathology. What women should know about HPV and cervical health. 2003. Available on the Internet at http://www.asccp.org/patient_edu.shtml through http://www.asccp.org. Accessed 17 Jan 2008.

American Academy of Family Physicians. Summary of recommendations for clinical preventive services (rev 6.4). 15 Aug 2007.  Available on the Internet at http://www.guideline.gov. Accessed 4 Feb 2008.

American Cancer Society. American Cancer Society guidelines for the early detection of cancer. 28 Mar 2007.  Available on the Internet at http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp?sitearea=PED through http://www.cancer.org. Accessed 4 Feb 2008.

American Cancer Society. Overview: cervical cancer: What causes cancer of the cervix? Can it be prevented? Available on the Internet at http://www.cancer.org. Accessed 10 Aug 2004; 2006 revision accessed 8 Feb 2008.

American Society for Colposcopy and Cervical Pathology. Descriptions of new FDA-approved HPV DNA tests (clinical update). PDF available for download at http://www.asccp.org/pdfs/consensus/clinical_update_20090408.pdf through http://www.asccp.org. Accessed 11 Jun 2009.

National Cancer Institute. Human papillomaviruses and cancer: questions and answers (fact sheet). Available on the Internet at http://www.cancer.gov/cancertopics/factsheet/Risk/HPV through http://www.cancer.gov. Accessed 9 July 2009.

Smith RA, Cokkinides V, and Eyre HJ, for the American Cancer Society. American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin 53:27-43. Available on the Internet at http://caonline.amcancersoc.org/cgi/content/full/53/1/27 through http://caonline.amcancersoc.org. Accessed 5 Aug 2004 and 8 Feb 2008.

Solomon D, Papillo J, Davey D, on behalf of the Cytopathology Education and Technology Consortium. Statement on HPV DNA Test Utilization. Am J Clin Pathol 2009;131:768-769.

US Centers for Disease Control and Prevention. Basic facts on screening and the Pap test. Oct 2003. PDF available for download at http://www.cdc.gov/cancer/cervical/pdf/cc_basic.pdf through http://www.cdc.gov. Accessed 2 Aug 2004 and 18 Jan 2008.

US Preventive Services Task Force. Screening for cervical cancer (release date Jan 2003). Available on the Internet at http://www.ahcpr.gov/clinic/uspstf/uspscerv.htm through http://www.ahcpr.gov. Accessed 15 July 2004 and 8 Feb 2008.

US Preventive Services Task Force.  Screening for cervical cancer: recommendations and rationale (AHRQ pub. 03-515A). Jan 2003. Available on the Internet at http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm through http://www.ahrq.gov. Accessed 8 Feb 2008.

US Food and Drug Administration. Cervical Cancer Screening. FDA Consumer Magazine. January-February 2004. Available online at http://www.fda.gov/Fdac/features/2004/104_cancer.html through http://www.fda.gov. Accessed September 2008.

Muitas mortes por câncer colorretal poderiam ser evitadas com triagens regulares. Essa doença é a terceira causa mais frequente de morte por câncer no mundo. A triagem permite identificar lesões pré-cancerosas (pólipos, adenomas) e lesões cancerosas iniciais, ainda com uma grande probabilidade de cura.

A maioria das recomendações recomenda a triagem de adultos a partir de 50 anos de idade, mas não há um consenso sobre o método mais indicado. Os que estão disponíveis incluem exames laboratoriais das fezes, exames endoscópicos e radiológicos:

• A pesquisa de sangue oculto nas fezes pode reduzir em 15% a 33% as mortes por câncer colorretal. É feita por métodos químicos ou imunoquímicos em uma ou mais amostras de fezes.
• A pesquisa de DNA nas fezes identifica sequências características de carcinomas nas células que descamam do tubo digestivo. É um exame recente e seu valor na triagem ainda não está determinado.
• A retossigmoidoscopia é um método endoscópico que permite a visualização do reto e da parte terminal do cólon. Durante o exame, lesões pré-cancerosas e cancerosas podem ser identificadas e removidas ou biopsiadas. É necessária a limpeza do cólon antes do exame, usando medicamentos catárticos.
• A colonoscopia difere da sigmoidoscopia porque permite examinar todo o cólon e o reto. É considerada mais sensível para identificar lesões, permitindo também retirada ou biópsia das lesões observadas. É necessário fazer a limpeza do cólon antes do exame, usando medicamentos catárticos. Durante o exame, a maioria dos pacientes recebe alguma forma de sedação.
• A colonoscopia virtual é um método radiológico que envolve o processamento de imagens de tomografia computadorizada para reconstituir todo o trajeto do cólon em imagens a duas e três dimensões, permitindo a identificação de lesões. É necessária a limpeza do cólon antes do exame, usando medicamentos catárticos. As lesões identificadas devem ser retiradas ou biopsiadas em seguida durante uma colonoscopia.
• O clister opaco é outro método radiológico usado para pesquisar lesões no cólon. Após limpeza com catárticos, o cólon é enchido com um contraste de bário e ar. O exame permite detectar de 30% a 50% dos tumores identificados na colonoscopia. As lesões identificadas devem ser retiradas ou biopsiadas em seguida durante uma colonoscopia.

O médico e o paciente devem escolher o método mais conveniente em cada momento. A pesquisa de sangue oculto é um exame simples, que pode ser feito a cada ano ou com mais frequência. A colonoscopia é o mais sensível, mas envolve preparo do intestino, sedação e um custo maior, e pode ser recomendada a cada cinco anos.

Links
MedlinePlus: Colorectal Cancer
Healthwise, Inc. Decision Point: Which test should I have to screen for colorectal cancer?
To use a calculator to determine your risk, click here.
To sign up for a personal colon cancer screening reminder, click here.

Fontes

Bernard L, et al. 5 Mar 2008 (e-pub). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58. Available on the Internet through http://caonline.amcancersoc.org. Accessed 6 Mar 2008.

Boyles, S. 6 Mar 2008. Flat lesions linked to colon cancer: flat lesions can be overlooked during colonoscopies. Available on the Internet at http://www.webmd.com/colorectal-cancer/news/20080306/flat-lesions-linked-to-colon-cancer?src=RSS_PUBLIC through http://www.webmd.com. Accessed 14 Mar 2008.

American Cancer Society. Can colorectal polyps and cancer be found early? American Cancer Society colorectal cancer screening guidelines. Rev 5 Mar 2008. Available on the Internet through http://www.cancer.org. Accessed 14 Mar 2008.

US Centers for Disease Control and Prevention. Colorectal cancer screening guidelines. Reviewed/updated 16 Feb 2007. Available on the Internet at http://www.cdc.gov/cancer/colorectal/basic_info/screening/guidelines.htm through http://www.cdc.gov. Accessed 15 Feb 2008.

Jemal, A, et al. Mar/Apr 2008. Cancer statistics, 2008. CA Cancer J Clin 58:71-96. Available on the Internet at http://caonline.amcancersoc.org/cgi/content/full/58/2/71 through http://caonline.amcancersoc.org. Accessed 14 Mar 2008.

US Centers for Disease Control and Prevention. United States cancer statistics: major facts and findings. Updated/reviewed 24 Sep 2007. Available on the Internet at http://www.cdc.gov/cancer/npcr/uscs/2004/facts_major_findings.htm through http://www.cdc.gov. Accessed 15 Feb 2008.

US Centers for Disease Control and Prevention. A call to action: colorectal cancer (talking points, slides 35 and 37). Available on the Internet at http://www.cdc.gov/cancer/colorctl/caltoaction/slide_index.htm through http://www.cdc.gov. Accessed 3 Aug 2004 and 14 Feb 2008.

Centers for Medicare and Medicaid Services, US Department of Health and Human Services. Colorectal cancer facts for people with Medicare (pub. 11040). PDF available for download at http://www.medicare.gov/publications/pubs/pd/11040.pdf through http://www.medicare.gov. Accessed 3 Aug 2004 and 14 Feb 2008.

US Centers for Disease Control and Prevention. Colorectal cancer: health professionals facts on screening. Available on the Internet at http://www.cdc.gov/cancer/ScreenForLife/fs_professional.htm through http://www.cdc.gov. Accessed 15 Jul 2004 and 14 Feb 2008.

US Centers for Disease Control and Prevention. Colorectal cancer: Screen For Life: basic facts on screening. Available on the Internet at http://www.cdc.gov/cancer/ScreenForLife/fs_basic.htm through http://www.cdc.gov. Accessed 15 Jul 2004 and 14 Feb 2008.

American Gastroenterological Association. Colorectal cancer screening (patient brochure). Previously available on the Internet at http://www.gastro.org/clinicalRes/brochures/cc_screening.html. Accessed 15 Jul 2004; document no longer posted.

Centers for Medicare & Medicaid Services, US Department of Health and Human Services. Colorectal cancer screening for people with Medicare (pub. 11039). 1 Apr 2003 (since revised: Jan 2006). Available on the Internet at http://www.cdc.gov/cancer/colorectal/sfl/print_materials.htm through http://www.cdc.gov. Accessed 3 Aug 2004 and 14 Feb 2008.

American Cancer Society. Guidelines for the early detection of colon cancer (reviewed 2003). PDF available for download at http://www.cancer.org/colonmd/pdfs/guidelines.pdf through http://www.cancer.org. Accessed 15 Jul 2004.

New recommendations by the American College of Gastroenterology call for changes in colorectal cancer screening of African Americans (press release). 21 Mar 2005. Available on the Internet at http://www.acg.gi.org/media/releases/march212005.asp through http://www.acg.gi.org. Accessed 2005 and 14 Feb 2008.

Sirovich BE, Schwartz LM, Woloshin S. Screening men for prostate and colorectal cancer in the United States: does practice reflect the evidence? 19 Mar 2003. JAMA 289:1414-1420.

Stevens T and Burke CA. Colonoscopy screening in the elderly: when to stop? Aug 2003. Amer J Gastroenterol 98;8:1881. Available on the Internet through http://www.amjgastro.com. Accessed 3 Aug 2004; abstract accessed 14 Feb 2008.

US Centers for Disease Control and Prevention. Colorectal cancer test use among persons aged 50 years, United States, 2001. 14 Mar 2003. MMWR 52(10). PDF available for download at http://www.cdc.gov/MMWR/PDF/wk/mm5210.pdf through http://www.cdc.gov. Accessed 3 Aug 2004 and 14 Feb 2008.

US Preventive Services Task Force. Screening for colorectal cancer: recommendations and rationale. 2002. Ann Intern Med 137(2):129-31. Available on the Internet at http://www.ahrq.gov/clinic/3rduspstf/colorectal/colorr.htm through http://www.ahrq.gov. Accessed 15 Jul 2004 and 14 Feb 2008.

Winawer S, et al, for the US Multi-Society Task Force on Colorectal Cancer. Colorectal cancer screening and surveillance: clinical guidelines and rationale, update based on new evidence. Feb 2003. Gastroenterol 124(2):544-560. Available on the Internet at http://www.guideline.gov. Accessed 19 Jul 2004 and 14 Feb 2008.

JournalWatch. "USPSTF Updates Colorectal Cancer Screening Guidelines." Availabe online at http://firstwatch.jwatch.org/cgi/content/short/2008/1007/1?rss=1 through http://firstwatch.jwatch.org. Accessed November 2008.

U.S. Preventive Services Task Force. Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine Volume 149, Issue 9. November 4, 2008. Available online at http://www.annals.org/cgi/content/full/0000605-200811040-00243v1 through http://www.annals.org. Accessed November 2008.

A Organização Mundial de Saúde avalia que pelo menos 171 milhões de pessoas no mundo têm diabetes. No Brasil, são 7,6 milhões. A incidência de diabetes em todo o mundo está aumentando e deve dobrar até 2030. Além disso, existem muitos milhões de pessoas que têm diabetes e não sabem ou que têm pré-diabetes. O diagnóstico de pré-diabetes permite retardar ou impedir o desenvolvimento do diabetes do tipo 2 e suas complicações vasculares, com consequências para os olhos, os rins, os nervos e o coração. Contribuem para a doença a obesidade e a falta de atividade física.

Muitas das orientações atuais de triagem recomendam triagem seletiva para diabetes melito. Por exemplo, o National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK), dos EUA, recomenda a triagem a partir de 45 anos de idade em pessoas que têm peso excessivo e um ou mais fatores de risco (ver abaixo), usando a glicemia em jejum ou a glicemia pós-prandial.

A triagem deve ser repetida a cada três anos, ou mais cedo quando houver peso excessivo ou fatores de risco adicionais.

Fatores de risco

Familiares:

• Parentes próximos com diabetes.

Pessoais:

• Peso acima do normal e vida sedentária.
• Hipertensão arterial, doença cardíaca ou vascular.
• Exames anteriores que sugerem intolerância à glicose.

Em mulheres:

• Diabetes gestacional anterior ou bebê com mais de 4,5 kg ao nascer.
• Síndrome do ovário policístico.

Embora a U.S. Preventive Services Task Force, dos EUA, relatasse, em 2003, que não podia determinar as vantagens da triagem universal, ela recomenda fazer em adultos com hipertensão arterial ou níveis de colesterol altos.

Links
NIDDK: Am I at Risk for Type 2 Diabetes?
NHLBI: Calculate Your Body Mass Index
To sign up for a personal diabetes test scheduling reminder, click here.

Fontes

ACE/AACE Diabetes Road Map Task Force. Road maps to achieve glycemic control in type 2 diabetes mellitus. May/Jun 2007. Endocr Pract 13:260-268. PDF available for doanload at http://www.aace.com/meetings/consensus/odimplementation/roadmap.pdf through http://www.aace.com. Accessed 18 Feb 2008.

American Diabetes Association. Standards of medical care in diabetes—2008 (position statement). Jan 2008. Diabetes Care 31:S12-S54 Available on the Internet through http://www.care.diabetesjournals.org. Accessed 18 Feb 2008.

National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health. National diabetes statistics (NIH pub. 06–3892). Nov 2005. Available on the Internet at http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm#12 through http://diabetes.niddk.nih.gov. Accessed 19 Feb 2008.

U.S. Preventive Services Task Force. Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008 Jun 3; 148:846. [Erratum in: Ann Intern Med 2008 Jul 15; 149:147.]

US Centers for Disease Control and Prevention. Number of Americans with diabetes continues to increase (fact sheet). 26 Oct 2005. Available on the Internet at http://www.cdc.gov/od/oc/media/pressrel/fs051026.htm through http://www.cdc.gov. Accessed 5 Mar 2008.

National Institute for Diabetes and Digestive Kidney Diseases, National Institutes of Health. Am I at risk for type 2 diabetes? (NIH pub. 04-4805). Apr 2004. Available on the Internet at http://www.diabetes.niddk.nih.gov/dm/pubs/riskfortype2/index.htm#4 through http://www.diabetes.niddk.nih.gov. Accessed 19 Jul 2004; revision of Dec 2006 accessed 15 Feb 2008.

American Diabetes Association. Screening for type 2 diabetes. Jan 2004. Diabetes Care 27:S11-14. Brief summary available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004.

National Center for Chronic Disease Prevention and Health Promotion, Diabetes Public Health Resource, US Centers for Disease Control and Prevention. CDC statements on diabetes issues: screening for type 2 diabetes. 18 Jun 2004. Available on the Internet at http://www.cdc.gov/diabetes/news/docs/screening.htm through http://www.cdc.gov. Accessed 19 Jul 2004 and 15 Feb 2008.

Matfin G and Guven S. Diagnosing Diabetes Mellitus: do we need new criteria? Available on the Internet, from the American Association of Clinical Endocrinologists, at http://www.aace.com/clin/fcc/fcc-200001.php through http://www.aace.com. Accessed 19 Jul 2004.

Mayer-Davis EJ, D’Antonia A, Tudor-Locke C. Lifestyle for diabetes prevention. In: Diabetes in the Life Cycle and Research: A Core Curriculum for Diabetes Education (5th ed.). Franz MJ, ed. American Association of Diabetes Educators. 2003; page 3.

US Preventive Services Task Force. Screening for Diabetes Mellitus, adult type 2. Feb 2003. Available on the Internet at http://www.ahrq.gov/clinic/uspstf/uspsdiab.htm through http://www.ahrq.gov. Accessed 19 Jul 2004 and 15 Feb 2008.

Sherwin RS, et al. Prevention or delay of type 2 diabetes. Jan 2004. Diabetes Care 27:S47-S54. Available on the Internet through http://care.diabetesjournals.org. Accessed 19 Jul 2004 from the National Guideline Clearinghouse and 15 Feb 2008.

A partir da infância, colesterol e outras substâncias gordurosas se acumulam nas artérias. Com o tempo, isso forma placas que estreitam as artérias em todo o corpo, em um processo chamado aterosclerose. A principal causa de morte nos países desenvolvidos é a doença coronariana, que está relacionada com os níveis sanguíneos de colesterol.

O National Cholesterol Education Program e a American Heart Association, dos EUA, recomendam a triagem de lipídios no sangue a partir do início da idade adulta:

• A cada 5 anos, todos os adultos com mais de 20 anos de idade devem fazer um perfil lipídico após jejum. Se os níveis estiverem normais diversas vezes, o intervalo entre os exames pode aumentar. Se os resultados forem limítrofes, o intervalo deve diminuir.

Após 9 a 12 horas em jejum, são medidos no sangue: colesterol total, colesterol HDL, colesterol LDL e triglicerídeos. Sem jejum, apenas duas medidas podem ser feitas: colesterol total e colesterol HDL.

Outros órgãos, que são menos rigorosos, recomendam:

• Triagem de distúrbios lipídicos em todos os homens a partir de 35 anos de idade e em todas as mulheres a partir de 45 anos.
• Exames de adultos mais jovens devem ser feitos quando há outros fatores de risco de doença coronariana.

Esses fatores de risco são fumo, hipertensão arterial (140/90 mm Hg ou uso de medicamentos anti-hipertensivos), diabetes, obesidade, história familiar de doença coronariana precoce, nível baixo de colesterol HDL ou nível alto de colesterol LDL. Quem apresenta dois ou mais fatores de risco deve ser acompanhado com maior frequência.

Sobre o limite de idade para o exame, a U.S. Preventive Services Task Force, dos EUA, recomenda:

• Após 65 anos, não há necessidade de fazer exames, porque os níveis de lipídicos não costumam aumentar nessa idade. Entretanto, pessoas que nunca fizeram um exame devem ser testadas pelo menos uma vez.

Links
University of Maryland Heart Center: Heart Disease Risk Calculator
National Heart, Lung, and Blood Institute: What is high blood cholesterol?
American Academy of Family Physicians: Heart disease & Stroke
To sign up for a personal cholesterol test scheduling reminder, click here.

Fontes

American Academy of Family Physicians. Summary of policy recommendations for clinical preventive services. Aug 2007. Available on the Internet through http://www.guideline.gov. Accessed 11 Feb 2008.

American Academy of Pediatrics, Committee on Nutrition. Cholesterol in childhood (policy statement). Jan 1998 (retired 1 May 2006). Pediatrics 101:1;141-147. Available on the Internet through http://aappolicy.aappublications.org. Accessed 10 Aug 2004.

Berg AO, for the US Preventive Services Task Force. Screening for lipid disorders: recommendations and rationale. Apr 2001. Am J Prev Med 20(3S):73-76.

American Heart Association. Get your cholesterol checked. Update of 27 Aug 2007. Available on the Internet at http://www.americanheart.org/presenter.jhtml?identifier=541 through http://www.americanheart.org. Accessed 16 Jul 2004 and 11 Feb 2008.

Grundy SM, et al, for the Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. 13 Jul 2004. Circulation 110:227-239. Available on the Internet through http://www.circ.ahajournals.org. Accessed 5 Aug 2004 and 11 Feb 2008.

American Academy of Family Physicians. Heart disease and heart attacks: what women need to know. Sep 2000, updated Nov 2006. Available on the Internet at http://familydoctor.org/online/famdocen/home/common/heartdisease/risk/287.html through http://familydoctor.org. Accessed 4 Aug 2004 and 11 Feb 2008.

American Academy of Family Physicians. Heart disease: assessing your risk. Sep 2000, updated Nov 2006. Available on the Internet at http://familydoctor.org/online/famdocen/home/common/heartdisease/risk/292.html through http://familydoctor.org. Accessed 16 Jul 2004 and 11 Feb 2008.

National Heart, Lung, and Blood Institute of the National Institutes of Health. High blood cholesterol: what you need to know. Available on the Internet at http://www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm through http://www.nhlbi.nih.gov. Accessed 16 Jul 2004; 2005 rev accessed 11 Feb 2008.

American College of Preventive Medicine. Screening for lipid disorders. Available on the Internet at http://www.acpm.org/cpslipiddisorders.htm through http://www.acpm.org. Accessed 5 Aug 2004 and 11 Feb 2008.

American Academy of Family Physicians. Summary of policy recommendations for periodic health examinations. Aug 2003. Available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004.

National Heart, Lung, and Blood Institute of the National Institutes of Health. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood pressure in adults (Adult Treatment Panel III) (NIH pub. 01-3670). May 2001. Available on the Internet at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm though http://www.nhlbi.nih.gov. Accessed 15 Jul 2004 and 11 Feb 2008.

National Heart, Lung, and Blood Institute of the National Institutes of Health. Update on cholesterol guidelines: more-intensive treatment options for higher risk patients (press release). 12 Jul 2004. Available on the Internet at http://www.nhlbi.nih.gov/new/press/04-07-12.htm through http://www.nhlbi.nih.gov. Accessed 4 Aug 2004 and 11 Feb 2008.

A triagem universal para HIV se tornou rotina nos EUA. Pelo menos de 90% a 95% das pessoas contaminadas produzem anticorpos detectáveis nos exames em três meses após a exposição, e o diagnóstico pode melhorar muito a saúde e a extensão da vida das pessoas infectadas e evita a transmissão para outras. Mulheres grávidas infectadas podem transmitir o vírus para seus bebês.

O Centers for Disease Control and Prevention (CDC), dos EUA, recomenda:

• Triagem de todas as pessoas entre 13 e 64 anos de idade, pelo menos uma vez.
• Triagem de todas as mulheres grávidas.
• Triagem anual de pessoas com atividades que podem disseminar a infecção.

Avaliação de risco

Pessoas nas situações abaixo devem ser testadas logo, mesmo que não apresentem sintomas:

Contatos sexuais:

• Sexo não protegido com duas ou mais pessoas
• Homens que tiveram contato sexuais com homens desde 1975
• Pessoas que trocam sexo por dinheiro ou por drogas
• Sexo com pessoas infectadas, bissexuais ou usuários de drogas injetáveis
• Pessoas em tratamento de doenças transmitidas sexualmente

Outras preocupações:

• Usuários de drogas injetáveis (compartilhamento de agulhas não esterilizadas)
• Receptores de transfusões de sangue entre 1978 e 1985

A frequência da triagem depende dos contatos sexuais e de outras atividades de risco. Por exemplo, pessoas em relações monógamas podem fazer algum teste apenas uma vez. O risco aumenta quando  indivíduo ou seu parceiro tem contato sexual com mais de uma pessoa ou outro comportamento de risco nos últimos meses.

Links
For confidential information, you can call the STDs and HIV/AIDS hotline of the CDC: 800-232-4636.
National Library of Medicine: Online, narrated tutorial on STDs
Mayo Clinic: STD testing - What to know before your appointment

Fontes

Branson BM, et al, for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. 22 Sep 2006. MMWR 55(RR14):1-17. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm through http://www.cdc.gov. Accessed 28 Jan 2008.

US Centers for Disease Control and Prevention. Questions and answers for the general public: revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings. Last modified 22 Jan 2007. Available on the Internet at http://www.cdc.gov/hiv/topics/testing/resources/qa/qa_general-public.htm through http://www.cdc.gov. Accessed 28 Jan 2008.

US Preventive Services Task Force. Guide to Clinical Preventive Services, 2007. Available on the Internet at http://www.ahrq.gov/clinic/pocketgd07 through http://www.ahrq.gov. Accessed 28 Jan 2008.