WHO DID DECIDED WHEN THE SYSTEM CONFRONT MASS SCREENING AGAINST INDIVIDUAL AUTONOMY AND DECISION MAKING?

Objective: Discuss mandatory mammography for breast cancer screening confronting the exercise of individual autonomy in Uruguay. Method: bibliographic systematic review and analysis from the quaternary prevention focus. Results: Gøtzsche and Olsen paper published on 2000 was the hurricane that caused intense evidence review about mammographic breast cancer screening. In breast cancer facts are revealing all over the world that meanwhile overdiagnosis and cumulative false positives are the rule, mortality is stable or decreasing. There is general agreement to assume that the decline in mortality would be attributed to the improvement in treatments and access to treatments, improvement is social development, more than to massive breast cancer screening programs. And screening is not decreasing the incidence of advanced cancer. During 2013 and 2014 were published communications and letters explaining the situation of Uruguayan working women between 40 and 59 years obligated to be screened for breast cancer every two years. When we consider mandatory mammography programs there are many ethic issues for example the exercise of individual autonomy and the need to provide information for informed consent oriented to a decision making process. Conclusions: From 2016 Uruguay developed a new guideline for breast cancer early detection. Fortunately the recommendations were changed not suggesting systematic screening for women aged 40 to 49 years and 70 to 74. From 50 to 69 is suggested mammography every two years. However we are facing a conflict between the new guideline and the 2006 president decree that oblige female employees to screen every two years to get the health card that is essential to comply.