Jinekolojik Kanserlerde Tarama ve Erken Tanı-1
Özet
Jinekolojik kanserler, tüm dünyada kadını etkileyen önemli sağlık sorunlarındandır ve Türkiye'de en sık görülen türü uterus kanseridir. Kanserle mücadelede risk faktörlerinin eliminasyonu, tarama stratejileri ve erken tanı temel amaçtır. Bu süreçte primer, sekonder, tersiyer ve dördüncül korunma yaklaşımları uygulanmaktadır. Tarama programlarında Wilson ve Jungner kriterleri esas alınırken, jinekolojik kanserler içinde bu kriterleri en çok karşılayan tür servikal kanserdir. Servikal kanserin en önemli nedeni, vakaların neredeyse tamamında saptanan onkojenik HPV enfeksiyonudur. Hastalığın uzun bir kanser öncesi döneme sahip olması erken tanıyı kolaylaştırmaktadır. Günümüzde taramada servikal sitoloji (Pap test) ve daha yüksek sensitiviteye sahip HPV testleri tek başına veya kombine olarak kullanılmaktadır. Türkiye, 30-65 yaş grubundaki kadınlara KETEM'lerde ücretsiz olarak uygulanan 5 yıl aralıklı HPV bazlı primer tarama stratejisini benimsemiştir. Tarama sonucu HPV 16 veya 18 pozitif çıkanlar ile diğer yüksek riskli HPV tiplerine sahip olup sitolojisi anormal olan hastalar doğrudan kolposkopiye yönlendirilmektedir. Diğer taraftan, vulva ve vajina kanserleri daha nadir görülmekte olup, bu türler için henüz rutin bir tarama yöntemi bulunmamaktadır. Ancak HPV aşılarının bu lezyonlara karşı etkili olduğu kanıtlanmıştır.
Gynecological cancers are significant health problems affecting women worldwide, with uterus cancer being the most common type in Turkey. The primary goals in combating cancer are the elimination of risk factors, development of screening strategies, and early diagnosis. In this process, primary, secondary, tertiary, and quaternary prevention approaches are applied. While Wilson and Jungner criteria are based upon for screening programs, cervical cancer best meets these criteria among gynecological malignancies. The most crucial cause of cervical cancer is oncogenic HPV infection, detected in almost all cases. The long pre-cancerous period of the disease facilitates early diagnosis. Currently, cervical cytology (Pap test) and HPV tests with higher sensitivity are utilized individually or combined for screening. Turkey has adopted a 5-year interval HPV-based primary screening strategy for the 30-65 age group, conducted free of charge at KETEMs. Patients testing positive for HPV 16 or 18, and those with other high-risk HPV types who have abnormal cytology, are referred directly to colposcopy. Conversely, vulvar and vaginal cancers occur more rarely, and there is no routine screening method established for them yet, though HPV vaccines have proven effective against these lesions.
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