ORGANIZING EARLY DIAGNOSIS AND SCREENING PROGRAMS FOR BREAST CANCER IN TURKEY "The report of Breast Cancer Early Detection and Screening Sub-Committee, National Cancer Advisory Board, The Ministry of Health of Turkey"

Background: Breast cancer is the most commonly seen and cause of cancer deaths in women in most of the developed and developing countries. Breast cancer awareness and organized population based screening programmes have resulted in early diagnosis, reduction in mortality, and breastconserving surgery. Therefore, body image of women suffered from breast cancer has been protected, and overall survival rate has increased. Eighty-four KETEM's (Cancer Early Detection and Screening Center) in 81 provinces in Turkey has been founded by Cancer Control Department of The Ministry of Health of Turkey. Opportunistic screening has been performed in these centers; however there are no available data regarding the effect of opportunistic screening on breast cancer mortality. Population based organized screening programmes should be implemented to reach this aim. Aim: The aim is to organize national early diagnosis and screening programs consistent with the conditions of country, that are necessary for early diagnosis and treatment of breast cancer which is the most frequently seen female cancer with gradually increasing incidence in our country. Methods: National Cancer Advisory Board, Breast Cancer Early Detection and Screening Sub-Committee organized three meetings in Ankara in 2008. In addition to those three-day workshops, a fourth one was performed in January 22-24, 2009 to provide reports from those studies. In these meetings, expert panelists selected by The Ministry of Health, National Cancer Advisory Board, and National Federation of Breast Societies shared their experiences and knowledge on early detection and screening of breast cancer in Turkey. Two representatives from the World Health Organization also attended to the third meeting. During those meetings, targets and strategies for early detection and screening for breast cancer had been evaluated. Possible barriers to screening, their eliminations, methods of follow up the prepared programme step by step had also been discussed. Results: To reach the success with early detection and screening programs is not possible without community awareness about the importance of early detection and especially high-level awareness of the target population. For this reason, education of women and increasing breast cancer awareness should be the first step. Health care providers (physicians, nurses, midwives etc.) and their administrators (health administrators, chief of staff in hospital etc.) should also be trained and included in those programs. A realistic budget for screening projects should be prepared and carried out. There should be a high-level coordination and a comprehensive organization among study groups, screening centers, and institutions. Social, cultural, and other possible regional barriers against the implementation of projects should be explored and eliminated. Activities, performance status and available data should be controlled, evaluated and published periodically. Targets, strategies, activities, criteria relationships with other related organizations should be re-evaluated, and performance should be monitored regularly. Conclusions: Organizing and implementing breast cancer early detection and screening programmes could be possible only with comprehensive, planned in details, and well determined studies. Resources should be used carefully and timely whenever necessary. As a result of this, downstaging of breast cancer and reduction in mortality rate in community could be possible.