Doctors and patients have told Inside Turkey that Turkey’s health system needs to do more to warn women about the dangers of human papillomavirus (HPV) and offer them protection from it.
HPV is a common infection, which affects around 80 per cent of sexually active adults. It is symptomless, but some types of the virus can cause cancer. For women, cervical cancer is a particular risk.
Vaccinating and screening women for HPV during regular cervical smear tests are the two main ways of protecting people against the effects of the virus. But on both counts, say experts, Turkey’s health system is falling short.
Annual smear tests, which check the health of the cervix, are recommended in Turkey as early detection and treatment of abnormalities – including the effects of HPV- can help prevent cervical cancer. Ayla Üçkuyu, an obstetrician-gynaecologist (OB-GYN) based in Antalya, told Inside Turkey that although in many European countries these are run at regular intervals by family practitioners, responsibility for getting tested in Turkey is left to individual women.
What’s more, hospitals do not routinely screen for HPV when giving smear tests. If any abnormalities are detected, then patients are referred to specialist Cancer Early Treatment, Scanning and Information (KETEM) centres for further tests, including HPV screening.
Üçkuyu, who says she warns all her patients about the risks of HPV, believes that the current system for raising awareness doesn’t go far enough.
“I’ve seen as my years in practice went on, that obtaining information through the digital world is more effective than a doctor at a state hospital informing a patient,” she noted.
Currently, KETEM centres are the main sources of public information about HPV, along with public service announcements, explains Ayhan Atıgan, an OB-GYN at the private Davraz Life Hospital in Isparta, western Turkey.
Atıgan said that in his experience, women who are informed about HPV show a willingness to get tested.
“I give all my patients detailed information about HPV as I take a professional interest in it,” he continued, adding that family doctors should be doing more to inform the public about HPV.
“Family practitioners reach all parts of society across the country and are entrusted with preventative treatment, so they carry a bit more of the burden in informing the public of HPV. If every mother who brings their baby in for vaccinations was given information about HPV, the public would be informed much more easily. If pre-marital scans and tests included information about HPV testing, the national vaccination rate would rise,” he concluded.
“I only recently found out that certain types of HPV can cause cancer,” said one young woman, speaking to Inside Turkey on condition of anonymity, after receiving an abnormal smear test result. “I’d had a smear test before, but I didn’t even know what it was for, the doctor didn’t inform me about HPV at all.”
What’s more, when the young woman was referred to a KETEM centre, she found she was too young to qualify for a free HPV test. Currently, KETEM centres only offer free combined smear tests and HPV screening to women between the ages of 30 and 70.
This is because HPV testing becomes more important for women the older they get, noted Üçkuyu. Women under 30 are more likely to be able to fight off the virus, so smear tests usually only start screening for HPV when they reach that age.
With vaccines, however, intervention at a young age is key. The World Health Organisation (WHO) recommends that sexually inactive girls aged nine to 14 should be given priority, followed by boys in the same age group.
As Üçkuyu explained, that’s because the risk of contracting HPV is higher in women who become sexually active younger, when fallopian tube tissue is not yet fully developed.
But while some countries offer mandated HPV vaccine programmes, this isn’t done in Turkey. According to Üçkuyu, the cost of imported vaccines means that the country’s health ministry doesn’t include HPV among its mandatory vaccination programmes. As of July, a dose of one type of HPV vaccine cost 1,858 lira, while a dose of another, more comprehensive type cost 2,575 lira.
In November 2022, health minister Fahrettin Koca announced that the HPV vaccine would soon be offered free of charge, but there has been no progress on the issue to date. Koca’s plan has also attracted criticism from health experts as it envisages free vaccination for over-18s – considerably later than the WHO recommends.
Üçkuyu said that she told her patients that they need to save up for the treatment.
“The vaccine really does require separate budgeting, so I think young women should be prioritised in the vaccination process. For instance, if I’m talking to a 40-year-old patient who has a young daughter, I tell her it’s more beneficial for her daughter to get vaccinated,” she said.
The young woman who told Inside Turkey about her experience of the system added it was unfair for her to have learned about HPV so late in her life.
“I would have definitely got vaccinated and been more careful had I known about HPV sooner. I’m a university student who enjoys researching and reading a variety of topics, and I only recently learned what HPV was. That made me feel so ignorant. Sexually active individuals need to be informed about the virus before they encounter it.”