<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1405-0099</journal-id>
<journal-title><![CDATA[Cirujano general]]></journal-title>
<abbrev-journal-title><![CDATA[Cir. gen]]></abbrev-journal-title>
<issn>1405-0099</issn>
<publisher>
<publisher-name><![CDATA[Asociación Mexicana de Cirugía General A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1405-00992016000400217</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[El cirujano y la subdeterminación en el cáncer de mama. La mamografía, del dilema epistémico al dilema bioético]]></article-title>
<article-title xml:lang="en"><![CDATA[The surgeon and underdetermination in breast cancer. The mammogram, from epistemic to moral dilemma]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Campos]]></surname>
<given-names><![CDATA[Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional Autónoma de México Facultad de Medicina ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>10</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>10</month>
<year>2016</year>
</pub-date>
<volume>38</volume>
<numero>4</numero>
<fpage>217</fpage>
<lpage>222</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S1405-00992016000400217&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S1405-00992016000400217&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S1405-00992016000400217&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: Frente a imágenes mamográficas sugestivas de malignidad los cirujanos enfrentan un dilema doble, epistémico y moral. Cuando no encuentran coherencia en las guías de práctica y normas oficiales, toman decisiones en solitario y resuelven ambos dilemas pragmáticamente. Las diferentes organizaciones difieren en los criterios de sus recomendaciones para efectuar mamografías de tamizaje. Dado que la subdeterminación entre teoría y evidencia hace que las tesis de las recomendaciones no puedan ser verificadas aisladamente, estas recomendaciones también se hacen con criterios pragmáticos pero no convincentes. De tal manera, los cirujanos tienen que resolver primero el dilema epistémico y luego el dilema moral, y actúan siguiendo sus intuiciones sin considerar las recomendaciones. Utilizan para ello un razonamiento derrotable, racionalmente convincente pero epistemológicamente inválido. El efecto es que sus acciones pueden ser iatrógenas e ir de lo epistémicamente problemático a lo moralmente problemático.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: When confronted to mammographic images suggestive of malignancy, surgeons face a double dilemma, epistemic and moral. When they do not find coherence in the clinical guides and official norms, they make decisions on their own and solve both dilemmas pragmatically. Different organizations differ in the criteria of the recommendations and guidelines for breast cancer screening mammograms. Given that the underdetermination between theory and evidence makes it impossible for the thesis of these recommendations to be verified in isolation, they are also made using pragmatic but unconvincing criteria. In such a way, surgeons must first solve an epistemic dilemma, then a moral dilemma, and act on their intuitions. They use a defeasible reasoning, rationally convincing but epistemologically invalid. The effect is that their actions can be iatrogenic and go from the epistemically problematic to the morally problematic.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Cáncer de mama]]></kwd>
<kwd lng="es"><![CDATA[mamografía]]></kwd>
<kwd lng="es"><![CDATA[subdeterminación]]></kwd>
<kwd lng="es"><![CDATA[dilema moral]]></kwd>
<kwd lng="es"><![CDATA[bioética]]></kwd>
<kwd lng="en"><![CDATA[Breast cancer]]></kwd>
<kwd lng="en"><![CDATA[mammogram]]></kwd>
<kwd lng="en"><![CDATA[underdetermination]]></kwd>
<kwd lng="en"><![CDATA[moral dilemma]]></kwd>
<kwd lng="en"><![CDATA[bioethics]]></kwd>
</kwd-group>
</article-meta>
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