In most countries, women are free to make up their minds about whether to get mammograms. Incredibly, that is not the case in Uruguay.
After posting my last column, “Do Mammograms Kill More Women Than They Save?”, I heard from a woman named Ana Rosengurtt. “I am an Uruguaian woman of 54 years old,” she emailed, who is “litigating against a decree in my country which requires a mammogram each 2 years in order to get the health card for working, studying and getting the driver license.”
In 2012, Rosengurtt, a state-employed computer engineer, sued the government, demanding that the decree be overturned. Rosengurtt sent me a 2013 news story in the BMJ (British Medical Journal) that provided information on her case. Here are excerpts, in italics:
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…
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 tumors 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 [Rosengurtt], 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.
Rosengurtt’s case is still pending. Because she refuses to be screened for breast cancer, she receives a government health card that lasts for only six months. “So every 6 months I must undergo all the medical tests which includes sugar blood screening, cholesterol screening, sight control, teeth control.”
“In an effort to raise public awareness,” she writes, “I've set up a petition that calls for an end to mandatory screening in my country: https://secure.avaaz.org/es/petition/MAMOGRAFIA_OBLIGATORIA_EN_URUGUAY_UN_PROBLEMA_CIENTIFICO_Y_UN_ABUSO_ETICO/. You may have it translated with Google translator or double right click mouse on the text.”
Uruguay’s decree, Rosengurtt asserts, violates UNESCO’s Universal Declaration on Bioethics and Human Rights. It states: “Any preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information.”
Coercing women to undergo mammograms is medicine at its most Kafkaesque.