Turkey Cancer Control Programme

Objectives

Türkiye’s National Cancer Control Programme provides a comprehensive, multidisciplinary and cost-effective framework to reduce the cancer burden through prevention, early diagnosis, organised screening, cancer registration, diagnosis, treatment, palliative care, supportive care and rehabilitation, adapted to national resources and regional differences.[1][2]Phase III is intended to evaluate and report results from the first two programme phases while ensuring continuity of services.[3][4]

• Reduce exposure to modifiable cancer risks, including tobacco, alcohol, unhealthy diet, obesity, insufficient physical activity, infectious agents, occupational and environmental carcinogens, air pollution, ionising and ultraviolet radiation.[5][6]
• Strengthen primary prevention through healthy nutrition, weight control, physical activity, tobacco control, alcohol regulation, vaccination and protection from environmental hazards.[7][8][9]
• Maintain population-based screening for breast, cervical and colorectal cancers to support earlier diagnosis, improve survival and quality of life, and reduce morbidity and mortality.[3][7][10]
• Expand breast, cervical and colorectal screening participation, capacity, technical quality and public awareness, with planned improvements to be completed by December 2023.[11]
• Strengthen cancer registration as the evidence base for measuring incidence, survival, geographical distribution and service quality, and for guiding prevention, research and national policy.[12][13]
• Provide palliative and supportive care throughout the cancer pathway to relieve pain and other symptoms and improve the quality of life of patients and families.[1]
• Increase public awareness, health literacy and use of prevention, screening, early-diagnosis, treatment and rehabilitation services.[14][15]

The programme also prioritises action on specific environmental risks. The Turkey Asbestos Control Strategic Plan uses phased assessment and remediation, while the Turkey Radon Mapping and National Radon Control Programme seeks to identify high-risk areas and initiate remediation, ventilation, awareness and education where measurements exceed World Health Organization standards.[16][17][18]

Screening policy is framed as a continuous, quality-assured pathway rather than a single test. It should identify eligible asymptomatic people, invite them, conduct suitable tests, ensure diagnostic confirmation, staging and effective treatment after abnormal findings, and evaluate outcomes.[19][10]Breast screening targets women aged 40–69 through biennial mammography, cervical screening uses primary human papillomavirus testing for women aged 30–65 every five years, and colorectal screening covers women and men aged 50–70 using faecal occult blood testing every two years and colonoscopy every 10 years.[20][21][22]

Implementation

Implementation combines Ministry-led policy, community-based prevention and screening, referral-based diagnostic care, cancer registry development, professional training and international collaboration. The Ministry of Health, through the General Directorate of Public Health Cancer Department, leads the programme with contributions from universities, oncology centres, hospitals, clinical specialists and relevant public-health departments.[3][4][23]

• Deliver breast, cervical and colorectal screening through Cancer Early Diagnosis, Screening and Training Centres, Healthy Life Centres, Community Health Centres and family medicine services, supported by mobile screening and outreach where needed.[24][22][11]
• Integrate Family Medicine into screening, improve screening-centre equipment and technical capacity, expand screening centres and mobile vehicles, and conduct public awareness and education campaigns.[11]
• Refer people with positive or suspicious screening findings to equipped diagnostic and treatment services and maintain follow-up across screening, diagnosis and treatment.[22][25]
• Maintain 173 referral centres for post-screening cases and provide specialist diagnostic capacity for breast and cervical cancer, while the detailed colorectal-centre requirements are not specified.[26]
• Develop active cancer registration in all 81 provinces through provincial engagement, administrative support, standardised data collection, registrar training, digital management and quality-control procedures.[13][27]
• Coordinate tobacco control through national programmes, action plans, provincial tobacco control boards, the Department of Combating Tobacco and Substance Addiction, the ALO 171 Smoking Cessation Advice Line and international tobacco-control instruments.[28]
• Implement asbestos and radon actions with provincial health authorities, municipalities, governorships, universities, the Turkish Atomic Energy Agency and relevant Ministry departments.[16][18]

Operational governance for screening assigns the Head of the Department of Cancer responsibility for planned service expansion, working with Ministry departments, provincial health directorates, public, private, foundation and university hospitals, non-governmental organisations, the Social Security Institution, related ministries and the World Health Organization and International Agency for Research on Cancer.[11]Provincial Cancer Control Units coordinate colorectal screening registration and follow-up, while participating institutions report monthly through Health Directorates to the General Directorate of Public Health Cancer Department.[22]

Quality assurance and monitoring rely on cancer registries, screening information systems, referral tracking and defined service standards. Registry quality is assessed through completeness, validity, timeliness, comparability, consistency checks, staff certification and participation in Cancer Incidence in Five Continents and CONCORD studies.[29][30][31]Screening monitoring includes participation, early-stage detection, diagnostic completion, treatment access and cancer outcomes; the 2023 screening action tracks annual participation, early-stage cancers and expected versus actual cancer deaths.[10][11]

Cervical screening requires information systems and legal arrangements that link population, screening, cancer and death registries, calculate participation, compliance, quality and impact indicators, and provide feedback to professionals, stakeholders and health authorities.[32]The programme also calls for regular publication of screening performance results.[33]Breast screening uses the National Screening Mammography System and a teleradiology reporting system with independent double reading and third-reader resolution where radiologists disagree.[24]

International cooperation supports capacity development, evidence use and surveillance. Türkiye collaborates with the World Health Organization, International Agency for Research on Cancer, International Association of Cancer Registries, Union for International Cancer Control, European Network for Cancer Registries and other partners.[1][13]The İzmir Cancer Registry Centre serves as an International Agency for Research on Cancer regional hub, providing training, technical support and consultancy to registry organisations in 30 countries.[34]

Monitoring & Evaluation

The programme establishes cancer registration, organised screening and action-plan monitoring as its principal evaluation mechanisms, but does not provide a single consolidated national indicator framework, reporting timetable or accountability system for all cancer-control components.[3][35][11]

• Expand population-based active cancer registration to all 81 provinces and use registry data to measure incidence, geographic distribution, survival, diagnosis, treatment and nursing-care quality.[36][12][27]
• Apply data-quality assurance through International Agency for Research on Cancer methods, assessing comparability, completeness, validity, source coverage, case-detail completeness, reporting accuracy and interpretation.[29][30]
• Require provincial registry examination and evaluation reports covering staffing, data, physical conditions and quality-control analyses, and report archive and data-reliability findings to registry centres.[30]
• Use international benchmarking and quality assessment through Cancer Incidence in Five Continents and CONCORD survival studies, with qualifying Turkish registry-centre data included in these publications.[37][13]
• Monitor registry coverage annually, with active reporting increasing from 13 provinces and 47.5% population coverage in 2013 to 14 provinces and 50.3% coverage in 2017.[38]
• Use the Public Health Management System, the 2019 Cancer Registration Circular and provincial reporting to support cancer surveillance and reporting.[39]
• Evaluate Phase III by reviewing and reporting results from the first two phases of the Cancer Control Programme.[3][4]
• Track breast, cervical and colorectal screening through participation, referral, diagnostic confirmation, treatment access and routine pathway evaluation.[19][10]
• Measure annual increases in screening participation, increases in early-stage cancer detection, and expected versus actual cancer death rates; assign the Head of the Department of Cancer responsibility for this action-plan area, with completion planned for December 2023.[11]
• Monitor cervical screening through informatics systems that calculate participation, compliance, quality and impact indicators, record cancers detected during or after screening, and publish performance results for decision-makers, providers, participants and the public.[32][33]
• Assess breast screening through participation, cancers detected, stage distribution, breast-conserving surgery and survival outcomes; the Bahçeşehir programme recorded approximately 85% participation and 96.9% ten-year survival among screen-detected cases.[40]
• Address gaps in mammography follow-up data, as final outcomes were unknown for 85.4% of BI-RADS 0 cases, 65.6% of BI-RADS 4 cases and 35.5% of BI-RADS 5 cases in the reported dataset.[41]
• Monitor colorectal screening through monthly reporting by participating institutions to Provincial Health Directorates and onward transmission to the General Directorate of Public Health Cancer Department, with coordination by Provincial Cancer Control Units.[22]
• Assess radon activities through numbers trained and post-training awareness questionnaires, and registry action plans through training, certification, data-flow, completeness, validity and timeliness measures.[18][42][31]
• Use tobacco-control strategy and action plans, provincial tobacco-control boards and national coordination mechanisms, although detailed cancer-specific indicators and reporting cycles are not specified.[28]

Costing & Financing

Cost-effectiveness is an explicit principle for prevention and screening, but the programme does not provide an overall budget, costed workplan, domestic allocation, funding-gap analysis or resource-mobilisation target.[1][43][11]

• Use European Union donation funds to support the introduction of Cancer Early Diagnosis, Screening and Training Centres in 11 provinces in 2004.[36]
• Provide screening mammography free of charge under a Ministry of Health legal regulation, while no national screening budget or financing plan is specified.[44]
• Provide faecal occult blood test kits free of charge to colorectal-screening participants, without stating the total programme cost or funding allocation.[22]
• Finance the Şanlıurfa reproductive-health and cervical-screening project through the European Union via the Ministry of Health programme, without disclosing a monetary value.[45]
• Prioritise organised population-based cervical screening because it is presented as more cost-effective than opportunistic screening, while requiring reasonable test costs and adequate information-system, diagnostic and treatment capacity.[32][33]
• Apply screening economic assessments that consider affordability, cost-effectiveness, cases detected, treatment benefits, false-positive harms and the consequences of not screening.[46][43][19]
• Recognise that early diagnosis may reduce treatment costs and invasive-treatment needs, while advanced diagnostic modalities such as magnetic resonance imaging and digital dermoscopy are described as relatively expensive or resource constrained.[47][48][49]
• Record a breast-screening economic evaluation in which the Bahçeşehir programme’s incremental cost-effectiveness ratio was 1,897 United States dollars per additional life-year, below the reported 2014 gross domestic product per capita of 10,650 United States dollars.[50]
• Note that the source identifies resource requirements for referral centres, specialist personnel, diagnostic equipment, registry training, radon measurement and asbestos remediation, but does not quantify their costs or funding needs.[25][18][42][17]