*Seda Kansu Founder Member Pembe Hanım – *Beril Koparal, Vice President Pembe Hanım
* Cengiz MD Gemici Dr Lutfi Kirdar Kartal Training and Research Hospital Department of Oncology – * Hasan Fevzi Batirel MD Marmara University Medical FacultyDepartment of Thoracic Surgery – *Rıza Çetingöz

MD.Professor in Medicine Turkish Lung Cancer Society President – *Ahmet Özet MD.Professor in Medicine Turkish Medical Oncology Society President
• Pembe Hanım Cancer Patients Society
• Turkish Society of Medical Oncology
• Turkish Lung Cancer Society
• Dr Lutfi Kirdar Kartal Training and Research Hospital Department of Oncology
• Marmara University Medical FacultyDepartment of Thoracic Surgery

The incidence of cancer in Turkey is 267 and 186 in a hundred thousand in men and women respectively. Lung cancer is the number one cause of cancer death in men in Turkey and its incidence is increasing in women in recent years as well. It is the fifth common cause cancer after breast, colon, thyroid and gynecologic malignancies in women in Turkey.The number of cancer cases directly related with smoking is expected to be 31.000. The incidence of lung cancer in men and women is 21.9 and 5.3 in a hundred thousand respectively. Namely there are 50.000 lung cancer patients in Turkey. And each year a new 30.000 patients are added to this number. Between 2009-2013,the incidence of lung cancer among men has decreased from 56 to 51 in a hundred thousand. However the number has increased from 16 to 18 in a hundred thousand among women. This decrease among men is the positive result of effective smoking cessation campaigns as the main cause of lung cancer in Turkey is smoking. The second reason is air pollution in workplaces.
Lung cancer is diagnosed generally at late stages in Turkey as well as in the west, and more than 50% of the patients present with metastatic disease at diagnosis. Only minority, less than 20% present with localized disease and these cases are generally detected incidentally for other health reasons. Curative surgery can be offered to only 15% of the patients. There is no effective prevention other than smoking cessation and screening which is becoming more popular for certain risk groups in the west but it is not a proposed method actually in Turkey.

Treatment decisions in high volume centers are taken by multidisciplinary way including radiologists, pathologists, nuclear medicine specialists, surgeons, medical and radiation oncologists. Surgery is the primary treatment modality in early stages of disease, and lung cancer surgeons are well experienced throughout the country being able perform all sort of surgical techniques including robotic one with high success. Cancer chemotherapy and radiotherapy are well developed in the country with the availability of recent FDA approved targeted drugs and immunotherapeutic agents as well. Certain centers in Turkey are also included in multinational studies involving new agents in treatment of this disease. Radiation oncology centers are equipped with high technology radiotherapy machines being able to perform image guided intensity modulated radiotherapies and stereotactic radiotherapies in treatment of lung cancer.

For the last years prevention programs in Turkey has increased. Two main actions for this are smoking cessation and fight against air pollution. The effectiveness of early diagnosis programs in lung cancer has not been proved. There has been an initiation of screening programs by low dose BT in high-risk patients. The diagnosis and treatment of lung cancer is in line with global standards considering surgery, radiotherapy and chemotherapy. The global improvements in lung cancer is closely followed by oncologists and scientists in Turkey and rapidly integrated into clinical practice by means of prevention, diagnosis, treatment and follow-up. However the patient care in terminal stage should be improved. The set up of Turkish Cancer Institute has been initiated and targets for 2023 are the determination of molecular genetic targets for diagnosis and the treatment of lung cancer, the identification of cellular therapies and immunotherapy and other targeted therapy modalities.

In Turkey it is not possible to talk about early diagnosis. But we can talk about early stage diagnosis. The rate of early stage lung cancer patients in Turkey is less than 1/5. Unfortunately population based screening programs for lung cancer has not been approved by Ministry of Health yet. With a screening program a tumor of 1 cm can be diagnosed. However a patient with symptoms being diagnosed has a tumor of 3 cm and the rate of cure between these patients is really different. 5 year survival for a patient with a tumor of 1 cm is 100% and a patient with a tumor of 3cm is 65-70%. Under screening programs for high- risk patients, the risk of death from lung cancer decreases 20%.

On the patient organization side Pembe Hanım Association has made the first attempt in Turkey to raise awareness in the public for lung cancer. For four years a Project called “MegaLung” has reached many people talking about the prevention, diagnosis and treatment of lung cancer. This was the first and only project about lung cancer. “MegaLung” had its place in many organizations open to public to reach as many people as possible as lung cancer is a wide range cancer and it has a preventable cause namely smoking.
At the moment with the collaboration of members of Pembe Hanım Association, mainly Seda Kansu and Turkish Lung Cancer Society, a patient organization for lung cancer called “Nefes (Breath)” is being set up with the aim of raising awareness among public and lung cancer patients about the all the issues related with lung cancer.

* As Pembe Hanım Cancer Patients Society we would like to thank Turkish Society of Medical Oncology,Turkish Lung Cancer Society, Dr Lutfi Kirdar Kartal Training and Research Hospital Department of Oncology and Marmara University Medical FacultyDepartment of Thoracic Surgery for their valuable support.