Women’s autonomy confronted with massive screening.

Abstract

Who does decide about systematic screening and how is it confronting the individual autonomy? Mammographic breast cancer screening global controversy is not a new issue. It was installed from more than two decades and Gøtzsche and Olsen paper published on 2000 was the hurricane that caused intense evidence review that has accumulated facts in this important discussion. There is general agreement among researchers to assume that the decline in mortality must be attributed to the improvement of treatments, better access to them and improvement in social conditions, more than to massive breast cancer screening programs. The conclusion is that this “overscreening” does not affect the global incidence of advanced cancer. During 2013 and 2014 BMJ published communications and letters explaining the situation of Uruguayan women. Today, still all Uruguayan female workers between 40 and 59 years are obligated to be screened for breast cancer every two years. When massive screening programs are evaluated from public health perspective, one must assess the balance of concerns and controversies about the efficacy and pertinence of this decision. Ana is a woman that opposed herself to the enforced mammography program. This was exposing her to problems concerning her working license, as she was then not fulfilling the reglamentation of this new law. It would implicate sanctions like salary cessation. Therefore she wrote a book in which one can precisely follow up her fight. She had to fight four years against the government in order to receive an answer: end of September 2016 a superior court spoke in favour of hers. Talking about mammography screening It is not only a scientific or personal position but what is worrying is the situations of all the women out there that today must feel very confused. Thus mandatory and obligatory mammography used to apply massive screening is confronting with the individual autonomy. General practitioners must modulate how to apply general recommendations and guidelines to individuals adapting his resolution with their patients own beliefs and values, in order to orientate a "healthy" decision making process. It is imperative to promote reflection from ethic and practice perspective on how to proceed when the exercise of individual autonomy is been confronted in this way.