Prof.Dr.Vahit \u00d6zmen
\nIstanbul T\u0131p Fak\u00fcltesi \u00d6\u011fretim \u00dcyesi
\nT\u00fcrkiye Meme Hastal\u0131klar\u0131 Dernekleri Federasyonu Ba\u015fkan\u0131 (2009-2011)
\nvozmen@istanbul.edu.tr
\nwww.vahitozmen.com <\/p>\n
3 Ekim 2015<\/p>\n
MAMOGRAF\u0130 \u0130LE TARAMA MEME KANSER\u0130NDEN \u00d6L\u00dcMLER\u0130 AZALTMAKTA VE MEMEN\u0130N KORUNMA \u015eANSI VERMEKTED\u0130R<\/p>\n
Her tan\u0131 ve tarama y\u00f6nteminin kendine ait avantajlar\u0131 ve dezavantajlar\u0131 vard\u0131r. Bug\u00fcn mamografi, meme kanserinden \u00f6l\u00fcmleri azaltt\u0131\u011f\u0131 bilinen tek \u00f6nemli tarama y\u00f6ntemidir. Mevcut olan a\u015fa\u011f\u0131da da belirtti\u011fim dezavantajlar\u0131, sa\u011flad\u0131\u011f\u0131 yararlar (erken tan\u0131 ile \u00f6l\u00fcmleri azaltmas\u0131 ve memenin korunmas\u0131na yard\u0131mc\u0131 olmas\u0131) yan\u0131nda ihmal edilebilir. Bu nedenle, ABD\u2019de 50 y\u0131ldan beri, Bat\u0131 Avrupa\u2019da 40 y\u0131ldan beri toplum tabanl\u0131 tarama y\u00f6ntemi olarak kullan\u0131lmakta ve kullan\u0131lmaya devam edilmektedir. Mamografi aleyhinde yaz\u0131lan makaleler, leyhine yaz\u0131lanlar kar\u015f\u0131s\u0131nda olduk\u00e7a az say\u0131dad\u0131r. Bunlar\u0131 detayl\u0131 olarak incelemeden ve kar\u015f\u0131la\u015ft\u0131rmadan mamografi zararl\u0131d\u0131r, \u00e7ektirmeyin demek, \u00fclkemizde s\u0131kl\u0131\u011f\u0131 giderek artan ve fark\u0131ndal\u0131\u011f\u0131 zay\u0131f olan meme kanserinde tan\u0131da gecikmelere ve \u00f6l\u00fcmlerin artmas\u0131na neden olacakt\u0131r. A\u015fa\u011f\u0131da da belirtti\u011fim gibi, yapt\u0131\u011f\u0131m\u0131z ara\u015ft\u0131rmada g\u00f6rsel ve yaz\u0131l\u0131 bas\u0131n meme kanseri konusunda toplumu en fazla uyaran, bilgilendiren kaynaklar\u0131n ba\u015f\u0131nda gelmektedir. Medyan\u0131n mamografiyi olumsuz, zararl\u0131 bir tan\u0131 y\u00f6ntemi olarak g\u00f6stermesi, kad\u0131nlar\u0131m\u0131z\u0131n bu y\u00f6nteme olan g\u00fcvenini azaltacakt\u0131r.<\/p>\n
1.Geli\u015fmi\u015f \u00fclkelerden daha az s\u0131kl\u0131kta g\u00f6r\u00fclmesine ra\u011fmen, meme kanseri g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 \u00fclkemizde h\u0131zla artmaktad\u0131r. Bu art\u0131\u015f\u0131n en \u00f6nemli nedenleri, ortalama ya\u015fam s\u00fcresinin uzamas\u0131, kay\u0131tl\u0131 hasta say\u0131s\u0131n\u0131n artmas\u0131, mamografiye ve hekime ula\u015fman\u0131n kolayla\u015fmas\u0131 sonucu taraman\u0131n artmas\u0131 ve ya\u015fam tarz\u0131n\u0131n (beslenme, do\u011furganl\u0131k, hormon kullan\u0131lmas\u0131, s\u00fct verme vs.) bat\u0131ya benzemesi olarak s\u0131ralanabilir. Bizim Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 ile yapt\u0131\u011f\u0131m\u0131z \u00e7al\u0131\u015fmalarda, \u00fclkemizde meme kanseri g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 son 20 y\u0131lda 2 kat\u0131ndan fazla artm\u0131\u015ft\u0131r.<\/p>\n
2.T\u00fcrkiye\u2019de federasyonumuzca olu\u015fturulan ve yakla\u015f\u0131k 20.000 meme kanserli hastay\u0131 i\u00e7eren \u201cUlusal Meme Kanseri Veri Taban\u0131\u2019n\u0131na g\u00f6re, hastalar\u0131m\u0131z\u0131n sadece %27\u2019sinde hastal\u0131k sadece memede lokal iken b\u00f6lgesel lenf nod\u00fcllerine yay\u0131lmadan farkedilebilmekte, di\u011fer hastalar\u0131m\u0131zda daha ge\u00e7 evrede tan\u0131 konulmaktad\u0131r. Bunun en \u00f6nemli nedeni, t\u00fcm \u00fclkemize y\u00f6nelik yayg\u0131n toplum tabanl\u0131 organize mamografik taraman\u0131n azl\u0131\u011f\u0131 ve kad\u0131nlar\u0131n bu hastal\u0131\u011f\u0131n fark\u0131nda olmamas\u0131 olarak s\u0131ralanabilir. Bizim yapt\u0131\u011f\u0131m\u0131z bir ara\u015ft\u0131rmada, kad\u0131nlar\u0131n bu hastal\u0131\u011f\u0131 \u00f6\u011frenmelerinde en \u00f6nemli fakt\u00f6rlerin ba\u015f\u0131nda televizyon ve gazetelerde bu konuda verilen haberler gelmektedir.
\n2.Meme kanserindeki art\u0131\u015fa ra\u011fmen, \u00fclkemizde tan\u0131 i\u00e7in mamografi \u00e7ektiren kad\u0131nlar\u0131n oran\u0131 d\u00fc\u015f\u00fckt\u00fcr. \u0130stanbul Bah\u00e7e\u015fehir\u2019de 1000 kad\u0131nda yapt\u0131\u011f\u0131m\u0131z ve ge\u00e7ti\u011fimiz y\u0131l ABD\u2019de yay\u0131mlanan \u00e7al\u0131\u015fmam\u0131zda, sosyo-k\u00fclt\u00fcrel d\u00fczeyi nispeten iyi bir y\u00f6re olmas\u0131na ra\u011fmen burada ya\u015fayan 40-69 ya\u015f aras\u0131 kad\u0131nlar\u0131n ancak yar\u0131s\u0131 ya\u015fam\u0131nda bir kez mamografi \u00e7ektirmi\u015ftir. Bu oran geli\u015fmi\u015f \u00fclkelerde %100\u2019e yak\u0131nd\u0131r.<\/p>\n
3.\u0130stanbul\u2019daki Belediyelerin \u00e7o\u011fu Aile-Kad\u0131n Sa\u011fl\u0131\u011f\u0131 Merkezleri kurarak, \u00fccretsiz muayene ve mamografi yapmakta ve bunu uzmanlarla payla\u015fmaktad\u0131r. Kad\u0131nlar\u0131m\u0131z\u0131n bir uzman taraf\u0131ndan muayene edildikten sonra filmlerinin \u00e7ekildi\u011fini ve daha sonra ilgili uzmanlara y\u00f6nlendirildiklerini g\u00f6zlemlemekteyiz. Bunlar\u0131n kontrols\u00fcz, geli\u015fig\u00fczel bir g\u00f6rev yapt\u0131klar\u0131n\u0131 sanm\u0131yorum. Aksine, meme kanseri konusunda fark\u0131ndal\u0131\u011f\u0131 art\u0131rarak erken tan\u0131 sa\u011flayaca\u011f\u0131na inan\u0131yorum.<\/p>\n
4.Mamografinin yarar ve zararlar\u0131na gelince; bu konuda \u00e7ok say\u0131da ara\u015ft\u0131rma yap\u0131lmaktad\u0131r. Yap\u0131lan ara\u015ft\u0131rmalar\u0131n sonu\u00e7lar\u0131, mamografinin yararlar\u0131n\u0131n getirdi\u011fi zararlardan \u00e7ok fazla oldu\u011fu i\u00e7in tarama y\u00f6ntemi olarak uygulanmaya devam edilmesini \u00f6nermektedir.
\nMamografi radyasyon yayarak kanser yap\u0131yor kayg\u0131s\u0131na gelince, yap\u0131lan bir \u00e7al\u0131\u015fmada; 100.000 kad\u0131na 40 ya\u015f\u0131ndan itibaren her y\u0131l mamografi \u00e7ektirilirse, ancak 86 kad\u0131nda radyasyona ba\u011fl\u0131 kanser ortaya \u00e7\u0131kma ihtimali vard\u0131r ve bu d\u00fc\u015f\u00fck bir olas\u0131l\u0131kt\u0131r. D\u00fczenli mamografi \u00e7ekildi\u011fi zaman 4.5 kat daha fazla ya\u015fam kurtarmakta, 9.5 y\u0131l daha fazla ya\u015fam \u015fans\u0131 vermektedir. Mamografi ile gereksiz biyopsiler, tedaviler, kayg\u0131lar artmaktad\u0131r bu do\u011fru bir sonu\u00e7tur. Ancak, bug\u00fcn hi\u00e7 bir tan\u0131 ve tarama y\u00f6ntemi baz\u0131 yan etkileri olmadan uygulanamaz.
\nMamografi konusunda yap\u0131lan t\u00fcm ele\u015ftirilere ra\u011fmen, mamografi bug\u00fcn tarama y\u00f6ntemi olarak Amerikan Kanser Derne\u011fi, Amerikan Kanser Enstit\u00fcs\u00fc, Amerikan Radyoloji Derne\u011fi taraf\u0131ndan 40 ya\u015f\u0131ndan itibaren ve y\u0131lda bir kez \u00f6nerilmektedir. ABD\u2019de 1963 y\u0131l\u0131nda ba\u015flat\u0131lan mamografi ile meme kanseri tarama \u00e7al\u0131\u015fmalar\u0131 halen devam etmektedir.<\/p>\n
5.Baz\u0131 yaz\u0131larda, son senelerde bir\u00e7ok \u00fclkede meme kanserinden \u00f6l\u00fcmlerin azalmas\u0131n\u0131n taramalardan de\u011fil, \u201ctedavi ve sa\u011fl\u0131k hizmetlerindeki iyile\u015fmeden kaynakland\u0131\u011f\u0131n\u0131\u201d belirten bir\u00e7ok \u00e7al\u0131\u015fma oldu\u011fu belirtilmektedir. Ancak, kanserde tarama ile erken tan\u0131 konulamaz ise, etkin tedavinin ba\u015far\u0131 \u015fans\u0131 d\u00fc\u015f\u00fck maliyeti de y\u00fcksek olur. ABD\u2019nin en se\u00e7kin dergilerinden olan New England Journal of Medicine\u2019da yay\u0131mlanan bir makalede, \u201cTaraman\u0131n meme kanserinden \u00f6l\u00fcmleri %28 ila %65 oran\u0131nda (ortalama %46) azaltt\u0131\u011f\u0131, geriye kalan oranlarda ise di\u011fer tedavilerin yard\u0131mc\u0131 oldu\u011funu belirtmektedir. <\/p>\n
6.\u00dclkemiz ko\u015fullar\u0131na gelince, Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Kanserle Sava\u015f Dairesi, Avrupa Birli\u011fi ile uyum \u00e7er\u00e7evesinde 50 ya\u015f\u0131ndan itibaren 2 y\u0131lda bir mamografi \u00e7ekilmesini \u00f6nermektedir. Ancak, \u00fclkemiz n\u00fcfusunun gen\u00e7 olmas\u0131 ve 50 ya\u015f alt\u0131 meme kanserli kad\u0131nlar\u0131m\u0131z\u0131n t\u00fcm meme kanserlerinin yar\u0131s\u0131n\u0131 olu\u015fturmas\u0131 (bu oran geli\u015fmi\u015f \u00fclkelerde %25 kadard\u0131r), \u00fclkemizde mamografik tarama ya\u015f\u0131n\u0131n 40\u2019a indirilmesini d\u00fc\u015f\u00fcnd\u00fcrmektedir. Bu konuya \u0131\u015f\u0131k tutmas\u0131 a\u00e7\u0131s\u0131ndan, 2008 y\u0131l\u0131nda Bah\u00e7e\u015fehir ve \u00e7evresindeki mahallelerde ya\u015fayan 40-69 ya\u015f aras\u0131ndaki yakla\u015f\u0131k 7.500 kad\u0131n\u0131 kapsayan \u201cBah\u00e7e\u015fehir Mamografik Tarama Proje\u2019si\u2019ni\u201d ba\u015flatt\u0131k. Mamografi sayesinde meme kanseri tan\u0131s\u0131 koydu\u011fumuz kad\u0131nlar\u0131m\u0131z\u0131n %82\u2019sinde hastal\u0131k hi\u00e7 yay\u0131lmadan \u00e7ok erken yakalanm\u0131\u015ft\u0131r. Bu proje, Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Kanserle Sava\u015f Dairesi, \u0130stanbul ve Marmara T\u0131p Fak\u00fcltesi , The Breast Health Global Initiative, International Atomic Agency taraf\u0131ndan da desteklenmektedir. Bu projenin ilk sonu\u00e7lar\u0131na g\u00f6re bug\u00fcne kadar taramaya kat\u0131lan 5.400 kad\u0131n\u0131n %56\u2019s\u0131, erken meme kanseri tan\u0131s\u0131 konulan 40 kad\u0131n\u0131n ise %60\u2019\u0131 40-49 ya\u015f grubundad\u0131r. Bu sonu\u00e7lar, bizim de ABD gibi 40 ya\u015f\u0131ndan itibaren mamografik taramaya ba\u015flamam\u0131z gerekti\u011fini g\u00f6stermektedir.
\nSonu\u00e7 olarak, g\u00fcn\u00fcm\u00fczde mamografinin meme kanseri \u00f6l\u00fcmlerini %40 kadar azaltt\u0131\u011f\u0131n\u0131 biliyoruz. Elde edilen yararlar, bu tarama y\u00f6nteminin getirece\u011fi zararlardan \u00e7ok daha fazlad\u0131r ve 40 ya\u015f\u0131ndan itibaren d\u00fczenli olarak yap\u0131lmas\u0131n\u0131 gerektirmektedir.<\/p>\n
Kaynaklar:<\/p>\n
1.Ozmen V. Breast cancer in Turkey and in the world. The Journal of Breast Health 4:6-12, 2014.<\/p>\n
2.Ozmen V, Anderson BO. The Challenge of Breast Cancer in Low- and Middle-income Countries\u2014Implementing the Breast Health Global Initiative Guidelines. US Oncology 2008, 76-79.<\/p>\n
3.Ozmen V, Ozcinar V, Karanlik H, Cabioglu N, Tukenmez M, Disci R, Ozmen T, Igci A, Muslumanoglu M, Kecer M, Soran A. Breast cancer risk factors in Turkish women \u2013 a University Hospital based nested case control study. World J Surg Oncol. 2009; 8;7:37.<\/p>\n
4.Ozmen V. \u0130nvaziv duktal karsinom. In T\u00fcrk Cerrahi Derne\u011fi Temel ve Klinik Cerrahi Kitab\u0131, Cem Terzi (Ed). http:\/\/www.tcdcerrahi.org\/fulltext.php?id=340<\/p>\n
5.Yip CH, Smith RA, Anderson BO, Miller AB, Thomas DB, Ang ES, Caffarella RS, Corbex M, Kreps GL, McTiernan A, Anyanwu S, Cabioglu N, Caffarella R, Corbex M, Kovtun A, Kreps G, McTiernan A, Murillo R, Myakynkov V, Nystr\u00f6m L, Ozmen V, Remennick L, Russell C, Sener SF, Sepulveda C, Shastri S, Smith RA.; Breast Health Global Initiative Early Detection Panel. Guideline implementation for breast healthcare in low- and middle-income countries: early detection resource allocation. Cancer. 2008 Oct 15;113(8 Suppl):2244-56.<\/p>\n
6. Ozmen V, Nilufer Ozaydin A, Cabioglu N, Gulluoglu BM, Unalan PC, Gorpe S, Oner BR, Aribal E, Thomas DB, Anderson BO. Survey on a mammographic screening program in Istanbul, Turkey.
\nBreast J. 2011 May-Jun;17(3): 260-7.<\/p>\n
7.Warner E. Clinical practice. Breast-cancer screening. N Engl J Med. 2011 Sep 15;365(11):1025-32.<\/p>\n","protected":false},"excerpt":{"rendered":"
Prof.Dr.Vahit \u00d6zmen Istanbul T\u0131p Fak\u00fcltesi \u00d6\u011fretim \u00dcyesi T\u00fcrkiye Meme Hastal\u0131klar\u0131 Dernekleri Federasyonu Ba\u015fkan\u0131 (2009-2011) vozmen@istanbul.edu.tr www.vahitozmen.com 3 Ekim 2015 MAMOGRAF\u0130 \u0130LE TARAMA MEME KANSER\u0130NDEN \u00d6L\u00dcMLER\u0130 AZALTMAKTA VE MEMEN\u0130N KORUNMA \u015eANSI VERMEKTED\u0130R Her tan\u0131 ve tarama y\u00f6nteminin kendine ait avantajlar\u0131 ve…<\/span><\/p>\n