A MODEL FOR USING DATA IN CANCER CONTROL EFFORTS: TURKEY
In order to catalyze efforts to combat cancer, the second cause of death in the country, Turkey has defined and is implementing a national cancer control programme. Following a first phase in 2008-2012, the current national cancer control programme 2013-2018 calls for strategic actions to address the whole cancer continuum in Turkey. This case study aims to highlight the efforts undertaken to scale-up the coverage of population-based cancer registration, and how the availability of essential cancer data contributes to the cancer prevention and control efforts in Turkey.
SPEAKING WITH DATA
Cancer control plans must be evidence-based. A plan should be substantiated with relevant data that is regularly updated, encompasses the entire nation, and internationally vetted. These efforts can create public awareness, inform campaigns for better health, improve funding opportunities, and favorably impact policy. Through the development of data at the outset, reports and factsheets were produced to accompany health messaging organized by the Turkish Ministry of Health. The reach of these messages was vastly improved due to the inclusion of data, which begins the process of behavior change both with the public and within the government.
Opening ceremony of the Turkish national cancer congress
These processes have informed Turkey’s slogan, “Registry is the most important pillar” of our national cancer control programme. The current NCCP was launched in 2013 and actions are coordinated by the Turkish Ministry of Health in addition to several stakeholder ministries under four main pillars: registry, prevention, screening and palliative care. The ultimate aim of the NCCP is to have a decrease at least 5% in cancer incidence rates by the end of 5 years. In addition to the hereby detailed registry programme, Turkey has implemented several prevention programmes such as tobacco control, obesity and diabetes control programmes, promotion of physical activity, reducing salt consumption, as well as asbestos and radon control programmes. With respect to screening, HPV DNA screening has been integrated among 3 national population-based cancer screening programmes (breast, cervical and colorectal cancers) organized by public health centers and family physicians.
For our purposes, knowing the cancer statistics across age groups and by sex afforded our national efforts the opportunity to better plan prevention efforts, target screening and early diagnosis centers, and better distribute investments. Without a relevant registry, our cancer control program planning efforts would not be as robust and would significantly impede the monitoring of existing programmes.
In 2002, Turkey only had two registry centers. By 2012 that grew to nine centers. Within the last two years, given the preceding decade of experience, we have implemented at least one registry center in each city in Turkey. This important scale-up has been made possible largely thanks to modern information technologies services. With 24 active cancer registration centers in 2014, the population coverage is 62%. The objective is to achieve 100% population coverage by 2015 (Hacikamiloglu E, Boztas G, Kav S, Gultekin M and Tuncer M. State of Oncology in Turkey 2013. In: Boyle P, Sullivan R, Zielinski C and Brawley OW (Eds). State of Oncology 2013. iPRI, Lyon, France (2013).
These efforts are also recognized at the international level. In addition to four accredited centers, and with its’ twenty years of experience, the Izmir Registry Center has been designated as an international training hub by the International Agency for Research on Cancer (IARC) in the context of the Global Initiative for Cancer Registry Development (GICR).
Turkish registry data is evaluated for evidence-based policies by national and international bodies. National Cancer Advisory Board, universities and academicians, professional Non-Governmental Organizations, IARC, Middle East Cancer Consortium, and the US National Cancer Institute are the primary stakeholders of Turkish cancer registry data.
Cancer registry centers in 2014
MOVING DATA FORWARD
Data should be continuous, regularly updated, internationally compared, and representative of your population(s) as country disease burdens and priorities change from time to time and from region to region.
Data should be used to depict basic information and current priorities. We have grown our use of data beyond ‘the basics’ and make efforts to use our data to highlight successes and the contextual meaning of those successes for the general public and government. This increases the motivation of all involved stakeholders. For example, by highlighting evidence of a decrease in national cigarette smoking rates from 31,2% in 2008 to 27% in 2012 and a steady rate of lung cancer in the National Tobacco Control Action Plan, we increased the motivation of those working on and supporting Turkey’s National Tobacco Control Program.
As we continue to add to our data and develop our programming, we have targeted questions beyond identifying kinds of cancers, to include region, age and age intervals, and key dates from diagnosis onward. By asking specific questions and recording relevant data we can set the stage for better screening programs throughout Turkey. Future plans include adapting data collection devices and techniques to improve the Obesity Prevention and Control Programme of Turkey, ideally through regular surveying.
SUCCESSES AND CHALLENGES
There are a number of factors that have contributed to the success of using our data for our national cancer control efforts. Using the robust data collected, the national cancer control efforts received strong support from our head directors, policy makers, scientists, and also from non-governmental organizations. The data collected provided evidence of the success of the cancer control policies that had been implemented and led to other positive outcomes. One such result was an increase in budget for screening programs. During a High Economic Council review of the health budget, our team prepared a presentation that addressed the economic benefits of screening versus treatment. Our presentation led to an increased budget, which allowed for a population based breast, cervical, and colorectal cancer screening program to be established.
There have been some significant challenges that we have encountered concerning the use of our data. The most significant challenge faced by our program was the turnover rate of our cancer registrars. We were able to address this issue as we have grown our cancer registry centers throughout the country. Working closely with local health authorities, we look to staff our cancer registrars in different positions in the center so that we are better able to retain institutional memory and grow our data with knowledge staff.
Learn more about cancer control actions in Turkey: www.kanser.gov.tr