Instrucciones Para LA Mejora DE LA ATENCIÓN DE LA DETECCIÓN Temprana DEL CÁNCER DE Mama, Indicaciones Para Solicitar MAMOGRAFÍA Y Ultrasonido

Objectives

Strengthen timely, high-quality and comprehensive breast-cancer detection and care through a technical consensus on the effectiveness of screening-related programmes, with mammography targeted to women whose clinical presentation or risk profile warrants it.[1]

• Prioritise mammography for women with clinical suspicion of breast cancer.[1]
• Prioritise mammography for women at increased risk, including those with prior thoracic radiotherapy, atypical hyperplasia or lobular carcinoma in situ, previous breast cancer, or specified family histories.[1][2]
• Limit breast ultrasound as a screening modality, as it is not to be used for breast-cancer screening.[1][2]
• Focus screening-related imaging decisions on clinical need and risk stratification; the source does not specify broader population-screening targets, timeframes, outcome indicators or equity objectives.[1][2]

Implementation

Implement the instructions immediately and mandatorily throughout the Costa Rican Social Security Fund's regional management, health-service networks, hospitals, clinics and health areas, under monitoring by the Medical Management Directorate and with technical recommendations from the Institutional Oncology Council.[1][2]

• Apply mammography according to clinical priority, particularly for women with symptoms or elevated risk.[1][2]
• Avoid using breast ultrasound as a breast-cancer screening test.[1][2]
• Require a previous mammogram that expressly identifies the need for ultrasound when referring asymptomatic women for that examination.[2]
• Include the patient's characteristics, clinical condition and reason for referral in ultrasound requests for symptomatic women.[2]
• Provide clinically relevant information in all mammography and ultrasound requests so radiology services can prioritise appointments; do not process requests that lack the specified information.[2]
• Coordinate delivery through the Medical Management Directorate, while drawing on the Institutional Oncology Council's technical recommendations.[1][2]
• Monitor implementation and compliance through the Medical Management Directorate.[2]
• Note that the source does not specify formal performance indicators, reporting cycles, evaluation methods, budgets, funding sources, staffing arrangements or resource allocations.[1][2]

Monitoring & Evaluation

Implementation oversight rests with the Medical Management Directorate, which is responsible for monitoring compliance with the mandatory instructions on breast-imaging referrals and service delivery.[2]

• Monitor implementation and adherence across the Costa Rican Social Security Fund’s relevant management, service-network and care-provider structures.[1][2]
• Support referral-quality control by declining to process mammography or ultrasound requests that lack the required clinically relevant information.[2]
• Apply prioritisation information in radiology requests to support appointment management according to clinical need.[2]
• Note that the source does not specify formal performance indicators, targets, reporting intervals, data systems, independent evaluation arrangements, surveillance mechanisms or sanctions beyond monitoring and non-processing of incomplete requests.[2]

Costing & Financing

No costing or financing framework is specified for implementation of the breast-imaging instructions.[1][2]

• Not specify programme costs, capital expenditure, operating budgets, funding sources, resource allocations, funding gaps or economic assumptions.[1][2]
• Not quantify the financial implications of prioritising mammography, managing ultrasound referrals, monitoring compliance or coordinating implementation through the Medical Management Directorate and Institutional Oncology Council.[1][2]