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EBM CRITICAL APPRAISAL PROGNOSIS IN WOMAN WITH INTERVAL BREAST CANCER: POPULATION BASED OBSERVATIONAL COHORT STUDY

Disusun oleh : Deniswari Rahayu 1102010065

Indah Kusumo Wardani P. 1102010129

Dosen Pembimbing : dr. Yulia Suciati, M.Kes

FAKULTAS KEDOKTERAN UNIVERSITAS YARSI APRIL 2013

EBM Nama : Deniswari Rahayu / Indah Kusumo Wardani P. NIM : 1102010065 / 1102010129

TUGAS EVIDENCE BASED MEDICINE Skenario Perempuan berusia 53 tahun datang ke rumah sakit dengan keluhan pembesaran payudara kanan dan teraba benjolan. Satu tahun yang lalu pasien pernah menjalani pemeriksaan mamogram dan didapatkan hasil normal. Dokter menyarankan untuk melakukan pemeriksaan mamogram lanjutan dan diagnosis sementara adalah kanker payudara. Pasien menanyakan kemungkinan kesembuhan penyakitnya, apakah pemeriksaan mammogram sebelumnya telah mempengaruhi penyakitnya tersebut? Pertanyaan (foreground question) Adakah perbedaan prognosis kanker payudara pada pasien yang telah terpapar radiasi alat radiologi (mamogram) dan yang belum terpapar radiasi alat radiologi? PICO Population : Pasien perempuan dewasa dengan keluhan pembesaran dan benjolan pada payudara kanan. Intervention : Menilai perbaikan pembesaran dan benjolan pada payudara yang telah terpapar radiasi. Comparisson : Menilai perbaikan pembesaran dan benjolan pada payudara yang belum terpapar radiasi. Outcome : Paparan radiasi pemeriksaan mamogram tidak dapat digunakan untuk memprediksi prognosis penyakit. Pencarian bukti ilmiah Alamat website : http://www.ncbi.nlm.nih.gov/pubmed/ Kata kunci : interval women breast cancer AND prognosis AND mammogram Limitasi : Januari 2007- Januari 2013 Hasil Pencarian : 53 Dipilih artikel berjudul: Prognosis in Women with Interval Breast Cancer: Population Based Observational Cohort Study.

REVIEW JURNAL Pendahuluan To compare the prognosis in women with interval breast cancer (cancer detected after a normal screening mammogram and before the next scheduled mammogram) with breast cancer detected among women not yet invited to mammography screening (non-screened). Jenis Penelitian Population based observational study. Setting Waktu dan Tempat Norwegian breast cancer screening programme, implemented in different counties from 1996 to 2005. Peserta 7116 women with a diagnosis of breast cancer at age 50 to 72 years; 1816 had interval breast cancer and 5300 had a diagnosis of breast cancer but had not yet been invited to screening. Penilaian Utama Characteristics of the breast tumours, and survival of the women using Kaplan Meier curves and multivariable Cox proportional hazard models. Hasil Although interval cancers on average were slightly larger than the cancers in women not invited to screening, the histological type or status of axilliary lymph nodes did not differ noticeably between the two groups. Among interval cancers, there were no appreciable trends in size, nodal status, grade, or hormone receptor positivity associated with time since the last normal mammogram as a marker of growth rate. After 10 years of follow-up, the survival rates were 79.1% (95% confidence interval 75.4% to 82.3%) among women with interval cancers and 76.8% (75.3% to 78.2%) among women in the non-screened cancer group (hazard ratio 0.98, 95% confidence interval 0.84 to 1.15; P=0.53). Analyses stratified by time since last normal mammogram, age at diagnosis, or screening round showed similar results. Kesimpulan The prognosis of women with interval breast cancers was the same as that of women with breast cancers diagnosed without mammography screening.