Keywords: preventive medicine, primary care, screening, healthcare services, national survey

Background:

National cancer screening programs are essential for reducing mortality. In Türkiye, primary care is the backbone of screenings for breast, cervical, and colorectal cancers. While guidelines are established, long-term participation trends and the specific role of primary care visits in adherence require updated evidence to improve preventive strategies in family medicine.

Research questions:

What are the participation trends in cancer screenings among Turkish women between 2008 and 2022, and which sociodemographic or health-related factors are most strongly associated with screening adherence in the primary care setting in 2022?

Method:

This is a quantitative, retrospective study using microdata from the Türkiye Health Surveys (2008–2022). The study included women in national target age groups for breast (40–69), cervical (30–65), and colorectal (50–70) screenings. Data from seven survey cycles were analysed (sample sizes: 7,366 to 13,922). Outcomes included screening rates at recommended intervals. Analysis used descriptive statistics and correlation to identify associations between screenings and healthcare utilization factors for 2022 data.

Results:

Participation at recommended intervals significantly increased from 2008 to 2019: Mammography rose from 18.1% to 32.2%, Pap smear from 16.6% to 45.0%, and Fecal Occult Blood Test (FOBT) from 2.6% to 31.6%. However, 2022 data showed a post-pandemic decline across all types: Mammography 23.2%, Pap smear 37.3%, and FOBT 24.9%. In focus to 2022, strong positive correlations were found between different screening types, notably Mammography and Pap smear (rho=0.512, p<0.001). Screening adherence was significantly associated with older age, presence of chronic diseases, and a higher frequency of family physician visits (p<0.001) in 2022.

Conclusions:

Screening participation improved for a decade but declined after the pandemic, consistent with a disruption in preventive care delivery continuity. The large national sample provides robust evidence for Turkish health policy. These findings urge family physicians to refocus on proactive screening invitations to regain lost momentum.

Points for discussion:

Screening rates dropped in 2022 following the pandemic. What do you think the main reason for this decline is, and how can family doctors ensure that these preventive services are protected during future health crises?

In what ways could a logistic regression model help us to identify the single most important factor on which family doctors should focus? How would you use dichotomous variations? 'Other versus appropriate timeframe' or 'never versus ever'?

Can family doctors use "physical activity" or “active minutes per week” as a simple marker to identify patients who might also be more likely to follow other preventive health advice?