How familiar are you with the slogan “Early diagnosis saves lives”? Do you regularly visit health institutions for yearly check-ups? When did you last visit your family practitioner? Did you hear about the KETEM centres in Turkey, and more importantly, did you know that they offer free screenings for some cancer types?
Turkey’s “Cancer Early Diagnosis, Screening and Education Centres” –known as KETEM’s- are primary care centres operating under the National Ministry of Health. Their main objective is to reach healthy people that are not yet diagnosed with any type of cancer, and to diagnose a possible cancer as early as they can. The earlier a cancerous formation is identified, the higher the chance of a successful treatment. This fact should never be underestimated, for obvious reasons, as well as the conclusion part of an article published in early February. The study proclaims that cervical cancer might be completely eradicated in Australia, thanks to an effective screening and vaccination program carried out for the past 9 years.
Every city in Turkey has at least one KETEM, offering same technological opportunities and equipment. They are currently trying to standardise breast cancer screenings with the countrywide installation of new mammography devices. In addition to these, they are trying to reach everyone with the help of their mobile cancer screening vehicles called “Pink Princesses”.
Working in close collaboration with family practitioners, KEREM’s offer screening and early diagnosis services for three types of cancer: breast, cervical, and colon. The reasons for choosing these cancers is 1) they are in easily accessible body parts, 2) they are not very invasive cancers that spread relatively slower, and 3) techniques required for their screening are easy, simple, fast and cost-effective. Some other types of cancer can be quite invasive and spread aggressively fast. Diagnosis of some can be very costly or may require techniques such as CT scans that expose the body to high amounts of radiation, and needless to say, these scans should be made very frequently in order to diagnose aggressive cancers –which means repeated exposure to that high radiation. The amount of radiation your body receives in a mammography, on the other hand, is almost the same amount you’re exposed to during an international flight. When the subject is human health, health care professionals always consider a profit/loss equilibrium. Hence, the selected types of cancer are the most suitable candidates by all means. Women can have a cervical screening for every five years if they are over 30, a screening for breast cancer every two years if they are over 40, and both and men over 50 can have a screening for colon cancer every two years.
Just had a blood test, I’m as sound as a barrel!
Despite all their efforts, recognition of KETEM’s is below the expected rate; although their presentations in schools, meetings, public displays and brochures. The major reasons for this is the fact that healthy people simply believe they do not “need” such screenings, or they neglect it even though their family practitioners referral, and sometimes they just prefer private doctors or hospitals. One of the most common factors is the horribly erroneous thought of “Just had a blood test recently, with all my values perfect, so I cannot possibly have a health problem.” Unless there is a cancer type that directly effects blood cells, a cancer lurking in your body cannot be detected from a complete blood count.
Number one culprit of cervical cancer: HPV
Human papilloma virus (HPV) is the most common sexually transmitted disease and is the sole cause of the majority of cervical cancers (about 70-90 per cent according to different sources). HPV is transmitted mainly by skin-to-skin contact and can sometimes reveal itself by the occurrence of genital warts, while it may also not display any symptoms for years. So, even sexual encounter with a single person carries the risk of transmission. The virus is known to cause cancers not only around cervix, but also in other body parts including anus and throat.
Men are also under the threat of cancers caused by HPV, with a very high incidence rate. Although there is currently no identification method for men, there are tests for women. The usual practice of PCR after a “Pap-smear” may not always be reliable enough, as it involves human intervention. Involuntary mistakes during staining and scanning stages may lead to the overlooking of cervical cancer cells. The Hybrid Capture (HC) test applied in KETEM’s is a different technique with a very high reliability ratio of 97 per cent. The test identifies the types of HPV by directly looking for its DNA. It is a simple and very cost-effective technique that is valid for 5 years. Why 5 years? Because HPV related cancers advance very slowly and the process takes a minimum duration of 5 to 10 years.
If your result comes put positive for HPV, the next step involves examining cells for any changes. Not all HPV carriers necessarily get cancer, as there are over 100 different strains of HPV. Some do not cause cancers at all, and may eventually be eliminated from the body thanks to your immune system. However, at least 13 strains are recognised as having a “high risk” of developing cancer. Consequently, it is much wiser to be cautious and well-guarded against HPV.
Can HPV be treated?
Sorry, bad news here. There is sadly no medication to entirely eliminate HPV from the body. A successful cancer treatment may clear the virus itself off the body, but the risk continues as long as its negative effects on the DNA of cells persist. Only in cases of dysplasia, when cancer-prone cells showing abnormal growth are limited to the epithelial tissue, the risk of recurrence declines if the surgical borders can be entirely cleaned.
How can we protect ourselves?
Vaccines. There are vaccines to protect you against the most risky HPV strains (HPV 16 and 18). Another thing you should do is not to skip your regular screenings. The significance of an easy, painless test with a 5-year validity is quite obvious. Besides, it’s for free!
These vaccines protect you against the types with the highest risk. Both boys and girls over nine years can be vaccinated, but experts in Turkey usually suggest and prefer vaccinating between the ages 12-13 because this is when the body gives a much better immune response to the vaccine. The main goal is to immunise the body before the first sexual intercourse. These vaccines have an impressively high efficacy (97-100 per cent) and are sometimes recommended in treating warts in order to decrease frequency of recurrence. In case the cancer is diagnosed at a very early stage (dysplasia) and is entirely cleared form the body, vaccination may be recommended to avoid the virus from re-entering the body. However, if the cancer is diagnosed for certain, the vaccine cannot protect you even after a successful treatment. The only thing to do then, is screening as frequently as your doctor recommends.
What should I do to go for a screening?
If you are living in Turkey, you may directly go to a KETEM near you or ask your family practitioner for a “Cancer Early Diagnosis Request Form”. You do not need an appointment except for the mammography. Your Turkish ID number, or a temporary ID number is enough for an early diagnosis. And a bit of awareness, of course, you should not think “I am perfectly healthy, so why would I need a screening?” Plus, all these screenings are free of charge. You will only have to pay for your transportation. So, it is time to stop being ignorant and carefree. Do yourself and your loved ones a favour, and go to a KETEM.
Our sincerest thanks to Dr. Hatice Yüksel of İzmir-Karşıyaka, Health Centre No.1, for providing information and brochures during our visit for a screening; and Gynaecologist Dr. Aslı Kaleli Yücetürk for answering our questions about HPV.
- 1. http://kanser.gov.tr/
- 2. http://www.who.int/mediacentre/factsheets/fs380/en/
- 3. https://www.cdc.gov/std/hpv/stdfact-hpv.htm
- 4. https://ecdc.europa.eu/en/human-papillomavirus/factsheet
- 5. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet
- 6. https://academic.oup.com/jid/advance-article-abstract/doi/10.1093/infdis/jiy075/4841780?redirectedFrom=fulltext