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Uruguay’s mandatory breast cancer screening for working women aged 40-59 is challenged

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1907 (Published 21 March 2013) Cite this as: BMJ 2013;346:f1907
  1. Sophie Arie
  1. 1London

A woman in Uruguay is challenging the obligation for working women aged between 40 and 59 years to be screened for breast cancer every two years.

A decree issued in 2006 by the then president, Tabaré Vázquez, an oncologist, made biennial screening for breast cancer a part of a series of regular, state funded health checks that female employees must complete to get the “health card” that all workers need.

A 52 year old state sector computer engineer is the first person known to have refused screening. She recently began legal proceedings to seek an exemption from the country’s health ministry.

“I read about the international debate about the risks of mammograms,” the woman, who wanted to be known by her initials, AR, told the BMJ. “I couldn’t believe that in my country there has been no public discussion about this. There is a lot of fear of cancer here. I think most women think it can only be good to have more checks.”

Uruguay has the highest cancer mortality in Latin America and is in the top 10 countries worldwide, World Health Organization data show. Theories for the country’s high incidence of cancer range from high levels of pollution to the national diet, which is high in beef and fat and low in fruit and vegetables.

But international research has raised concern over the potential dangers of mammography, because it can lead to treatment for minor tumours that would never have threatened the woman’s health. A raised risk of cancer from exposure to x rays is another concern.

“I was shocked when I heard about the policy [in Uruguay],” said Juan Gérvas, a Spanish GP and expert on public health with an interest in the risks of breast cancer screening. “It’s the only country in the world with this sort of mandatory screening. And there is absolutely no scientific basis for applying this to women between 40 and 50.”

“It’s strange that nobody has questioned this decree until now—not women nor practitioners,” Gérvas told the BMJ. “It’s an ethical problem. Women should be allowed to give their informed consent.” Gérvas is backing a campaign by AR, who has begun collecting signatures for a petition calling for an end to mandatory screening.

Uruguay’s health ministry was not able to provide figures before the BMJ went to press but suggested in an email that screening and diagnosis may not have increased much as a result of the 2006 decree, because many women at risk of breast cancer were already having regular mammography before then by choice.

An official indicated that all disease prevention policies would be reviewed to take into account new scientific evidence. Vázquez, who is expected to run for president again next year, could not be reached in time for this article.

Notes

Cite this as: BMJ 2013;346:f1907