By Mehmet Artac, MD
Selcuk University, Meram Faculty of Medicine
Konya, Turkey
2006 International Development and Education Award recipient
It was my great pleasure to receive an
International Development and Education Award (IDEA) and to attend the ASCO Annual Meeting in 2006. Until I arrived at the Meeting in Atlanta, I did not realize the value of the award and the influence it would have on my career. My experiences there changed my perception as I discovered that the IDEA program was indeed a potential cornerstone of my career in oncology. One of the most useful and meaningful aspects of the program was the opportunity for each recipient to interact with a mentor. The experience I had with my mentor, Philip A. Philip, MD, PhD, FRCP from the Karmanos Cancer Institute, has been a lasting and beneficial one. Following the 2006 Annual Meeting, I visited Dr. Philip and the Karmanos Cancer Institute in Detroit, Michigan for a week. It was an opportunity for me to learn about the organization of a large National Cancer Institute (NCI)-designated comprehensive cancer center in the United States. While at Karmanos, I was able to meet with different faculty members and have a close look at the center’s multidisciplinary approaches to cancer treatment. These interactions helped me to develop my thoughts about my own cancer center and future career as I was preparing to move to Konya for a faculty position in oncology. For me, the timing was perfect.
The history of oncology in Turkey dates back to before World War II. Dr. Hamdi Suat Aknar established the country’s first cancer laboratory in 1929. The Turkish Association for Cancer Research and Control was founded in 1947. Dr. Frat Dincer established the first medical oncology unit in Turkey at Hacettepe University in 1972. Today, there are approximately 200 medical oncologists and 400 radiation oncologists in Turkey. Most of the cancer specialists are based in large cities like Istanbul, Ankara, and Izmir. However, new oncology services are becoming available in other parts of the country as well.
The population of Turkey is about 70 million, and there are approximately 100,000 doctors. The available statistical data are insufficient to estimate the exact cancer incidence in Turkey. Although cancer has been designated as one of the Ministry of Health’s “Reportable Diseases,” many health care professionals do not comply with the required reporting process. Based on the 2000 census, we can estimate that there are approximately 100,000 newly diagnosed patients with cancer per year. Based on hospital statistics, cancers of the respiratory system constituted almost one-third of all reported cancers in men. In women, breast cancer comprised more than a quarter of reported cancers and was the second leading cause of cancer deaths for women. Carcinoma of the lung is the leading cause of cancer deaths for both men and women. Gastric cancer is the second leading cause of cancer death in men and the third in women. Our hope is that population—and hospital-based cancer registries—will improve in the coming years and these statistics will depict cancer in Turkey more accurately.
Oncology training in Turkey is quite rigorous. After six years of medical school, radiation oncology residency takes about five years. In contrast, medical oncology fellowships begin after five years of internal medicine training and last for about three years. After medical school and the completion of training, the Turkish government requires up to 20 months of compulsory service. Currently there are approximately 6,500 internists in Turkey.
There are few surgical oncologists in Turkey, and general surgeons perform most cancer operations. Pathology departments are working hard to cope with the very large demand from clinicians and some are in the process of improving their operations.
Chemotherapy drugs are available and most patients have insurance coverage provided by the state. Recently, the Turkish government approved funding that will help pay for new targeted therapies for patients with cancer in Turkey. We can therefore prescribe trastuzumab, erlotinib, sunitinib, rituximab, imatinib, and other drugs once they have been approved in our country.
The organization of oncology in Turkey is not controlled by a government agency such as NCI. The Cancer Unit in the Ministry of Health handles registration issues, and our cancer registry system continues to improve.
The government supports one cancer hospital and transplant center in Ankara and an oncology center in Istanbul. Other medical oncology and radiation oncology units are located in 15 university hospitals across the country. There are three cancer institutes in Ankara, Istanbul, and Izmir. Cancer control, prevention, and screening programs are units of public hospitals and many are undergoing a process of improvement. Active cancer organizations in Turkey include the Turkish Association for Cancer Research and Control, the Turkish Oncology Group (TOG), the Medical Oncology Society, and the Turkish Radiation Oncology Society.
Although cancer research is mostly based on translational studies, there are several regulatory, organizational, and procedural challenges to conducting clinical trials in Turkey. I hope that my experiences in the IDEA program and my relationship with Dr. Philip will help me conduct quality clinical research despite these challenges.
After the IDEA program, Dr. Philip and I continued to communicate. He was always willing to review my projects or give valuable advice about some of my patients. In August 2008, I invited Dr. Philip to Konya for an educational event about gastrointestinal cancers sponsored by the Turkish Medical Oncology Society.
I have informed Dr. Philip of the potential to develop oncology in Turkey, especially in my hometown of Konya. I introduced him to several of my associates during their visits to the United States, and these interactions have created the potential for future educational and research collaborations between our institutions.
As a junior oncologist in Konya, where we are only now starting to expand our oncology practice and research, I feel that the opportunity that the IDEA program provided to me was invaluable. The long-lasting relationship I have developed with ASCO, my mentor, Dr. Philip, and his institution is a tremendous resource for me and my department in Konya. As a result of these connections, we strongly sense that ASCO has a genuine interest in reaching out to our developing countries to improve the lives of people with cancer.
ASCO is collaborating with the South and East Mediterranean College of Oncology (SEMCO) to present a Multidisciplinary Cancer Management Course in Izmir, Turkey, on November 20-21, 2008. For more information, please send an e-mail to
mcmc@asco.org.
