Bringing an end to mandatory breast cancer screening in UruguayBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g390 (Published 21 January 2014) Cite this as: BMJ 2014;348:g390
- Hazel Thornton, honorary visiting fellow, Department of Health Sciences, University of Leicester1
Mammographic screening is increasingly in the spotlight as evidence accumulates that the potential for harm is greater than that for providing benefit.1 Thanks to intensive international research efforts, and updated systematic reviews,2 this compelling evidence is increasingly acknowledged and accepted, not only by policy makers and providers, but also by citizens, at least in the UK.
But different cultures face different problems, as described by Arie.3 The presidential republic of Uruguay, a democracy since 1984, faces a more serious problem—population mammographic screening. A decree issued in 2006 by the then president, Dr Tabaré Vásquez, an oncologist, made biennial screening for breast cancer part of a series of regular, state funded health checks that female employees must complete to get the health card that all workers need.3
Screening is a medical intervention: it is unethical to impose it without seeking the participant’s consent. Without question in the UK, “a screening participant’s valid consent is paramount in the provision of a successful screening service.”4 5 Realisation by an under-informed public that women need to consent to the NHS Breast Screening Programme’s invitation was slow in dawning, even with considerable media exposure. But in Uruguay there has been no public discussion and no provision of good quality information, only exacerbation of the fear of cancer. In an effort to raise public awareness, a petition has been set up that calls for an end to mandatory screening (https://secure.avaaz.org/es/petition/MAMOGRAFIA_OBLIGATORIA_EN_URUGUAY_UN_PROBLEMA_CIENTIFICO_Y_UN_ABUSO_ETICO/).
In our international medical community, surely something else can be done to bring an end to this unacceptable state of affairs?
Cite this as: BMJ 2014;348:g390
Competing interests: None declared.