Ersin Nazlıcan

Cervical cancer screening in Turkey: a community-based experience after 60 years of pap smear usage.

Cervical cancer is the second most common cancer in females in the World with around 500,000 new cases occurring annually, but the first in the developing countries with a high mortality if not diagnosed early. Papanicolau (Pap) smear is a cheap, easy-to-apply and widely accepted test which has been long used to detect cervical cancer at very early stages. However, despite being available for nearly 60 years, the test can hardly be considered to have become successfully applied in many communities. We aimed in this study to present the results of a screening survey for cervical cancer which targeted a women population aged between 35 and 40 living in a semi-rural area in the province of Hatay, located in the eastern Mediterranean region of Turkey, with specific aims of increasing early diagnosis, education and raising population awareness about cancers. This community-based descriptive study covered 512 women between 35 and 40 years of age living at Armutlu with a mean age of 37.6±1.7. Gynecologic examinations revealed cervical erosion in 8 (1.6%), vaginitis in 193 (37.7%) and normal findings in 311 (60.7%); pathological evaluation reports of the smears were negative in 290 (56.6%), inflammation in 218 (42.6%) and ASC-US in 4 (0.8%), according to the 2001 Bethesda classification. It can be concluded that Pap smear test - proven to be a very valuable test at the clinical level- should also be widely used at the community level to detect cervical cancer at very early stages to reduce both the mortality and morbidity among healthy people. The need for continuous community-based cervical cancer screening programs is strongly suggested.

Evaluation of Depression in Newly Diagnosed Breast Cancer Cases in Hatay Province of Turkey in 2011

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females in Turkey. The main problems experienced by women with breast cancer are physical losses, emotional distress and degradation in family, work and social roles. The purpose of this cross-sectional retrospective study was to investigate the socio-demographical characteristics and depressive symptoms of 125 newly diagnosed cases with breast cancer reported to cancer control department of Hatay provincial health directorate in 2011. To evaluate the depressive symptoms the Beck Depression Inventory (BDI) was used. All 125 cases who participated in the study were female. The mean age was 49.2 ± 11.9. The mean BDI score of the cases was 17.5 ± 10.6. The number of cases whose BDI scores were 17 and above was 65 (52.0%), and the number of cases whose BDI scores were under 17 was 60 (48.0%). The most striking finding in our study was that only 4 of the cases were receiving psychological help and support. The rate of depression was found high in our study and psychological support is a must for patients with a life threatening disease such as cancer.

Cervical Cancer Screening in an Early Diagnosis and Screening Center in Mersin, Turkey.

Cancer is a major public health problem due to the jeavy disease burden, fatality and tendency for increased incidence. Of all cancer types, cervical cancer is reported to be the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases worldwide in 2012. It features a long preclinical phase with slowly progressing precancerous lesions such as CIN 2 and 3 and adenocarcinoma in situ. Therefore, screening programs such as with Pap smear tests may play an important role in cervical cancer prevention. The purpose of this study was to present results of a Pap smear screening survey for cervical cancer targeting women living in an urban area in the province of Mersin, located in the Mediterranean region of Turkey. This community- based descriptive study included women living at Akdeniz county of Mersin province. A total of 1,032 screened women between 30 and 65 ages within the routine screening programme constituted the study population. The mean age of the participants was 43.8 ± 8.6 (min. 30, max. 65) years. The percentage of the participants who had previously undergone smears was 40.6%. Epithelial cell changes were found in 26 (2.5%) participants, with ASC-US in 18 (1.7%), ASC-H in 2 (0.2%), LSIL in 5 (0.5%) and HSIL in 1 (0.1%). The most common clinical presentation together with epithelial changes was abnormal vaginal discharge. Taking into account the presence of women who had never undergone Pap test; it should be offered at primary level of health care in the form of a community-based service to achieve reduced morbidity and mortality rates.

Knowledge, attitudes and behaviours of women regarding breast and cervical cancer in Malatya, Turkey

The aim of this study is to gather information about the knowledge, attitudes and behaviours of women regarding breast and cervical cancer, to increase the knowledge level of the relevant age group and to begin including the relevant age group in screening programs. This cross-sectional study is composed of 6910 women aged 30–69 years in Malatya, Turkey. The study aimed to reach 1782 women with a survey, and all of them were reached. The questionnaire form was completed with face-to-face interview. For statistical analysis, data were evaluated as number and percentage distributions. The average age of the women was 45.6±11.4. Nearly half of the women (46.4%) did not know that scans for early detection of breast and cervical cancers were free. Only 22.2% of women knew that breast cancer could be diagnosed early by mammography. 72.7% had never received a mammogram. One third (31.6%) of women did not know it was possible to recognize cervical cancer early, and two thirds (64.5%) of women had not received a Pap smear test. It has been determined that Turkish women do not have adequate knowledge about cancer diagnosis, early cancer diagnosis, and screening.

Haemoglobinopathy Awareness among Young Students in Turkey: Outcomes of a City-Wide Survey

The success of prevention programs demonstrated the importance of raising awareness about haemoglobinopathies since the lack of knowledge and awareness about the disorders may serve as barriers to prevention, disclosure of disease status as well as to testing for haemoglobinopathies. The aim of this study is to investigate the knowledge and attitudes of middle and high school students towards haemoglobinopathies in Hatay, where the disorders are prevalent. This cross-sectional study was conducted on 8th and 9th grade students across Hatay including all sub provinces. From May 2012 to December 2012, a total of 1925 students filled the questionnaires which query the knowledge level and attitudes of students by face to face method. Among questions regarding students’ knowledge about haemoglobinopathies, the lowest correct response rate was observed in “How do these diseases transmit?” with 31.8%, meaning most of the students did not know that the diseases are transmitted by heredity. Significant differences were observed between the correct answer rates of the students and their status of being previously informed. Students who had a diseased person around were having a 2.597-fold (95%CI = 1.886–3.575); students possessing at least one parent at secondary education level or above were having a 1.954-fold higher probability of being previously informed (95%CI = 1.564–2.443). Due to the lack of knowledge about haemoglobinopathies in middle and high school students, we suggest health education programs including informative lectures particularly about the genetic basis of the disorders especially in the regions where the disorders are prevalent.

Evaluation of married haemoglobinopathic carrier couples for prevention of haemoglobinopathic births.

BACKGROUND Abnormal haemoglobins (Hb) and thalassaemias are some of the most frequently observed hereditary disorders in the world, but especially in the Mediterranean region where Turkey is located. Hatay province is one of the largest provinces in the region, suggested as a target area to be selected for preventive programs after studies by three Turkish universities, i.e. Çukurova, Akdeniz and Hacettepe Universities in Turkey. AIMS The aim of this study was to determine demographic and family characteristics of all haemoglobinopathy carrier married couples registered in the Hatay Provincial Health Directorate registry and to educate the target population about pregnancy, births, prenatal diagnosis and genetic counselling with the particularly emphasised scope of eliminating all haemoglobinopathic births. STUDY DESIGN Descriptive cross-sectional and intervention study. METHODS 1065 couples both being haemoglobinopathic carriers, registered in the Hatay Provincial Health Directorate registry were investigated for socio-demographic characteristics, obstetrical status and especially for a present pregnancy, the presence of any haemoglobinopathic patients or carrier children in the family. RESULTS Among women with a history of pregnancy, 47.3% reported that they had never had any prenatal testing, while 33.1% had got received testing in each of their pregnancies. The most frequent reason for not having the test was declared as unawareness of the test (66.0%), followed by economic insufficiencies (17.1%), destiny/religious reasons (9.1%) and family interference (7.8%). After a series of descriptive analyses, the results of the final binary logistic regression model constructed to find out the risk factors significantly affecting the presence of a sick child in the family were grouped as risk increasing factors like age (95%CI between 1.002 and 1.122), marriage before 1994 (95%CI=1.081-4.161), and risk decreasing factors like family willingness for screening (95%CI=0.167-0.854), rate of prenatal testing (95%CI=0.147-0.414), age at first pregnancy (95%CI=0.469-0.882); while the frequency of births was found to have no significant effect (p>0.05). CONCLUSION Besides all legal regulations and applications, time is still needed for real success against such a diffuse and congenitally transferred disease. The education of the target populations appears to be crucial. Official applications should be forced based upon present or future laws.

Kahramanmaraş İl Merkezindeki Lise Son Sınıf Öğrencilerinde Madde Kullanımı ve Etkileyen Faktörler

Amac: Bu calisma Kahramanmaras il merkezindeki lise son sinif ogrencilerinin Maras otu ve madde kullanma durumlarini belirleyip etkileyen faktorleri saptamak amaci ile yapildi. Yontem: Kesitsel tipte yapilan arastirmanin evrenini Kahramanmaras il merkezindeki 7632 lise son sinif ogrencisi olusturmaktadir. Toplam 47 lisenin isimleri bir torbaya konularak basit rastgele yontem ile ogrenci sayisi 1541’i bulana kadar torbadan lise isimleri cekildi. Orneklemin tamamina ulasilarak calisma tamamlandi. 1541 ogrenciye 59 sorudan olusan sosyodemografik ozellikler Maras otu ve madde ile ilgili anket formu uygulandi. Bulgular: Calismaya katilan ogrencilerin % 57.2’si erkek, % 42.8’i kiz ogrenciydi. Kahramanmaras il merkezindeki lise son sinif ogrencilerinde Maras otu kullanma prevalansi % 16.1, madde kullanma prevalansi ise % 6.1 olarak belirlendi. Ogrenciler en cok sirasiyla; ucucu maddeler (% 32.3), esrar (% 30.1), bonzai (% 8.6), eroin (% 6.5) ve ecstasy (% 4.3) kullanmaktaydi. Madde bagimlilarinin aile bireylerinde ve yakin arkadaslarinda da psikoaktif maddelerin sik kullanildigi belirlendi. Maras otu kullananlarda madde bagimliligi daha yuksek orandaydi (p<0,001). Sonuc: Ogrencilerde Maras otu ve madde kullanim duzeyi yuksek oranda bulundu. Ogrencilerin buyuk cogunlugu kullandiklari maddelere ulasmakta zorlanmadiklarini belirtti. Madde kullaniminin zararlari konusunda ogrencileri bilgilendirmek icin toplum tabanli calismalar yapilmalidir.

Adana genelevinde çalışan seks işçilerinin serviks kanseri hakkındaki bilgi, tutum ve davranışları

Amac: Serviks kanseri kadinlarda 2012 yilinda dunya capinda tahmini olarak 528.000 yeni vaka ile en yaygin gorulen dorduncu, genel olarak yedinci kanserdir. Cinsel temas ile seks iscilerinin HPV gecisinde katkida bulunmasi nedeniyle bu populasyonda serviks kanseri prevalansi yuksektir. Bu calismanin amaci seks iscilerinin serviks kanseri hakkindaki bilgi duzeyleri tutum ve davranislarinin belirlenmesidir. Gerec ve Yontem: Bu calisma Turkiye’de, Adana Genelevlerinde calisan seks iscilerine yapilan tanimlayici bir calismadir. Seks iscilerinin serviks kanseri hakkinda farkindaligini belirlemek icin 21 sorudan olusan anket veri toplama araci olarak kullanilmistir. Anketler Deri ve Zuhrevi Hastaliklar Dispanserinde rutin muayene esnasinda 103 seks iscisine arastirmacilar tarafindan yuz yuze gorusme teknigi ile uygulanmistir. Bulgular: Katilimcilarin yaslari ortalama 43.8±8.6 idi. Seks iscilerinin, % 57.3’u serviks kanseri icin yapilan tarama testini biliyordu, % 89.3’u daha once smear yaptirmisti. % 41.8’i smearin 18 yasindan sonra yapilmasi gerektigini belirtirken, %35.9’u da smearin yilda bir siklikla yapilmasi gerektigini belirtmistir. Birden fazla partnerin serviks kanseri riskini arttirdigini bilen 18-49 yas arasi seks iscilerinin smear yaptirma durumlari 49 yas ustu seks iscilerine gore anlamli derecede yuksek bulundu. Sonuc: S erviks kanserine yonelik , aktif tarama ve ulusal servikal kanser onleme programlari, oncelikle bu kadinlar icin uygulanmalidir. Seks iscilerinin bu konuda bilgi duzeylerinin yukseltilmesi ve genc yas grubundaki seks iscileri icin asinin etkili kullanimlarini ogretmek ve etkin bir HPV ve serviks kanseri sikligini azaltabilir.