MP and former GP challenges Uruguay’s compulsory breast screening programmeBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6624 (Published 08 December 2016) Cite this as: BMJ 2016;355:i6624
Uruguay’s government is being challenged to end its compulsory breast screening programme, after a court ruled that one woman with concerns about possible harms caused by mammography should be exempt.
On 6 December Daniel Radio, a deputy in the opposition Independent party and a former GP, presented a bill to parliament for legislation to ensure that women are asked for their informed consent to undergo screening for breast cancer and are not penalised if they refuse to give it.
Uruguay’s compulsory policy, introduced in 2006 under President Tabaré Vázquez, a practising oncologist, obliges all women aged 40-59 to have a mammogram every two years to obtain the “carné de salud” (health card) required by employers. But many people have concerns about a growing body of international research suggesting that screening leads to many unnecessary interventions and about exposure to x rays increasing the risk of cancer.
“Even if the benefits [of mammography] are greater than the harms, this should not be obligatory,” Radio told The BMJ. “It is incongruous with people’s human rights. People must have the right to consent—or not.”
Ana Rosengurtt, a 55 year old state sector computer engineer who read about global research questioning the benefits of screening,1 won her case in July when a Montevideo court (the tribunal for administrative disputes) found that her right, enshrined in the Uruguayan constitution, to decide what happens to her body, had been ignored and that the government had neglected its obligation to obtain patients’ informed consent.
But the court ruling applied only to that individual case, and the government has made no indication that it will reconsider whether the programme should be compulsory in light of the court’s decision. Requests from The BMJ for comment from the health ministry were not answered.
Rosengurtt is the only person to have challenged the programme’s compulsory nature through the courts. The World Health Organization says that Uruguay, with a population of 3.4 million, has one of the highest rates of breast cancer, and the population has largely embraced the policy. A petition Rosengurtt launched in 2013, calling for the programme to be made optional, has gathered only 2597 signatures.
Uruguay’s society for family medicine has been calling for a rethink of the policy without any success.
“We have been very worried for a few years about overscreening the population,” said Virginia Cardozo, a family doctor and member of the society’s board. “But the population believes in intervention, and the medical system believes in it.
“We are really engaged in a war against cancer, so it’s very difficult to talk about these things.”