Review Literatur dan Telaah Jurnah

1. PICO
Sarah berusia 50 tahun, dia selalu melakukan SADARI setiap hari dirumah dia datang pada
anda untuk menanyakan lebih efektif mana melakukan sadari atau dengan tes momografi
untuk deteksi dini kanker payudara.
P : Semua wanita
I : Melakukan SADARI
C : melakukan momografi
O : Kanker payudara
Pertanyaan : bagi semua wanita, apakah melakukan tes momografi cukup efektif
dibandingkan dengan melakukan SADARI untuk mendeteksi dini kanker payudara?
2. Penelusuran jurnal melalui Pubmed

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3. Telaah jurnal berdasarkan kriteria RAMBOo
 R : Rekrutmen
a. Apakah subjek mewakili populasi target? (ya)
b. Cara terbaik perekrutan subjek :
 secara acak
 kriteria ekslusi dan inklusi :
 wanita berusia 50 sampai 75 tahun
 wanita tanpa riwayat prosedur atau perawatan bedah payudara yang baru
dilalui
 wanita yang dapat melakukan kompresi diri
 Diantara 549 wanita secara acak, 548 menyelesaikan uji coba, dari jumlah
tersebut, 275 (usia (SD) rata-rata, 61,rata-rata, 61,35 (6,34)tahun) diacak
kelengan kompresi diri dan 273 (usia (SD)rata-rata, 60,84 (6,41) tahun) kelengan
kompresi standar.

 A : Alokasi
a. Apakah kelompok penelitian sebanding? (ya)
b. Antara kelompok kasus dan control sebanding? (ya, matching)

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  M : Maintenance
Tidak ada perbedaan yang dilaporkan dalam skor kualitas gambar dari 2 kelompok
atau dalam jumlah tampilan tambahan yang dilakukan (median (QR) pandangan
ekstra, 2 (2-2)vs 2 (2-3)pandangan ekstra P = 0,64), apapun indikasinya, termasuk
kualitas gambar tidak mencukupi (29 (16,8 %) vs 27 (15,0%) pandangan kualitas tidak
memadai : P = 0,65) tidak ada efek samping atau rasa sakit yang dilaporkan oleh
peserta setelah kompresi diri mammography.

 Pengukuran
Double bling yaitu identitas mereka yang Menerima intervensi disembunyikan dari
administrator dan subjek sampai setelah tes selesai.
Pengukuran bersifat objektif.

4. Carilah makna dari hasil penelitian tersebut (ARR, RR, RRR, NNT)
Angka kesakitan pada kompresi standar (control) adalah 0,64 sedangkan angka kesakitan
pada kompresi diri (perlakuan) adalah 0,009
Outcome biner :
 RR = Resiko outcome dalam kelompok perlakuan dibagi resiko kejadian dalam
kelompok control.
RR = 0,009/0,64 = 0,01 (RR <1 = perlakuan dalam menurunkan)
 ARR = resiko kejadian dalam kelompok control dikurang resiko kejadian dalam
kelompok perlakuan.
ARR = 0,64 – 0,009 = 0,6 atau 60%
Keuntungan mutlak dari perlakuan adalah pengurangan sebesar 60% angka kesakitan
(yaitu terdapat 60% kesakitan lebih sedikit dalam kelompok perlakuan dibandingkan
dengan kelompok kontrol)
 RRR = ARR dibagi resiko kejadian dalam kelompok control atau 1 – RR
ARR/kelompok Kontrol = 0,6/0,64 = 0,94 (94%) atau 1 – RR = 1 – 0,01 = 0,99
(99%)
Perlakuan dapat menurunkan kesakitan sebanyak 94% atau 99% dibandingkan
kelompok kontrol.
 NNT = 1/ARR = 1/0,6 = 1,67
Kita akan membutuhkan perlakuan pada 1 samapai 2 orang untuk mencegah satu
angka kesakitan.

5. Kesimpulan
Kompresi diri tampaknya tidak kalah dengan mammography kompresi standar dalam
mencapai ketebalan payudara minimal tanpa rasa sakit yang meningkat atau

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menurunkan kualitas gambar. Teknik ini bias menjadi pilihan efektif bagi wanita yang
ingin terlibat dalam pemeriksaan payudara mereka.

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 LAMPIRAN JURNAL

https://jamanetwork.com/journals/jamainternalmedicine/article- abstract/2723076

Self-compression Technique vs Standard Compression in Mammography.

A Randomized Clinical Trial
Philippe Henrot, MD1 Martine Boisserie-Lacroix, MD2 Véronique Boute, MD3
; ; ; et

alPhilippe Troufléau, MD1; Bruno Boyer, MD1; Grégory Lesanne, MD1; Véronique Gillon, PharmD1; Emmanuel Desandes, MD1; Edith Netter, MD4; Maryam
Sa adate, MD4 Anne Tardivon, MD5 Christine Grentzinger, MD6 Julia Salleron1 Guillaume Oldrini, MD, PhD1
; ; ; ;
Author Affiliations
JAMA Intern Med. 2019;179(3):407-414. doi:10.1001/jamainternmed.2018.7169
Key Points
Question Could self-compression of the breast be used by women during mammography?
Findings In this randomized clinical trial that included 549 women in France, self-compression
mammography was found to be noninferior to the standard compression approach in achieving
minimal breast thickness. The compression force was higher in the self-compression group
compared with the standard compression group without increasing pain or compromising
image quality.
Meaning Self-compression may be an effective mammography technique for women who want
to take an active role in their own breast examination.
Abstract
Importance Many women dread undergoing mammography, and some may not attend or
reattend breast cancer screening because of the discomfort or pain induced by breast
compression.
Objective To evaluate the noninferiority of the self-compression mammography technique for
reducing breast thickness compared with standard compression.
Design, Setting, and Participants This prospective, parallel-group, noninferiority randomized
clinical trial was conducted from May 7, 2013, to October 26, 2015, at 6 cancer care centers in
France. Participants were women aged 50 to 75 years, without a history of recent breast

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surgical procedure or treatment, and who could perform self-compression. Analyses were
performed on intention-to-treat basis from January 27, 2017, to March 30, 2018.
Interventions Patients were randomized 1:1 to the self-compression group or the standard
compression group.
Main Outcomes and Measures Primary end point was breast thickness expressed as the
mean of 4 views: right and left craniocaudal and right and left mediolateral oblique. The
predefined noninferiority margin was a difference of 3 mm, with a 1-sided 95% CI. Secondary
end points included compression force, image quality, requirement for additional views, pain,
and patient satisfaction and radiographer assessment questionnaires.
Results Among the 549 women randomized, 548 (97.3%) completed the trial. Of these, 275
(48.8%) (mean [SD] age, 61.35 [6.34] years) were randomized to the self-compression arm
and
273 (48.5%) (mean [SD] age, 60.84 [6.41] years) to the standard compression arm. The
difference in the mean thickness between the 2 arms was lower than the noninferiority margin,
with an upper 1-sided 95% CI less than 3 mm (–0.17; 95% CI,−∞ to 1.89 mm; P < .05).
Compression force was higher in the self-compression group compared with the standard
compression arm for the 4 mammographic views. Pain was statistically significantly lower in
the self-compression group (n = 274) compared with the standard compression group (n = 269)
(median [interquartile range (IQR)] score, 2 [1-5] vs 3 [1-5]; P = .009). No difference was
reported in the image quality scores of the 2 groups or in the number of additional views
performed (median [IQR] extra views, 2 [2-2] vs 2 [2-3] extra views; P = .64), whatever the
indication, including insufficient image quality (29 [16.8%] vs 27 [15.0%] insufficient quality
views; P = .65). No adverse effects or pain were reported by the participants after the self-
compression mammography.
Conclusions and Relevance Self-compression does not appear to be inferior to standard
compression mammography in achieving minimal breast thickness without increasing pain or
compromising image quality; this technique may be an effective option for women who want
to be involved in their breast examination.
Trial Registration ClinicalTrials.gov identifier: NCT02866591

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