Disentangling policy and generational drivers of breast cancer screening in Türkiye

Background

Despite policies, mammography coverage in Türkiye remains below the 70% national target. Disentangling the interplay of aging, policy changes, and generational behaviors is essential to address gaps. We applied an Age-Period-Cohort-Interaction (APC-I) framework to evaluate lifetime mammography screening patterns and inform targeted public health interventions.

Methods

We analyzed pooled, cross-sectional data from seven Turkey Health Survey waves (2008-2022). The nationally representative sample comprised 31,817 women aged 40-69 years. The outcome was self-reported lifetime mammography (ever-screened). We fitted an adjusted APC-I logistic regression model to estimate age, period, and cohort effects, controlling for education, marital status, and region.

Results

Ever-screening prevalence rose from 25.7% (2005-2009) to 54.1% (2020-2024). Adjusted period effects peaked in 2020-2024 (β = 0.482, p < 0.001). Age effects revealed lower-than-average screening in newly eligible 40-44-year-olds (β=-0.634, p < 0.001), peaking at 50-54 years (β = 0.260, p < 0.001). Cohort effects showed higher odds for women born in 1955-1959 (+8%, p = 0.011) and 1960-1964 (+7%, p = 0.012). Conversely, the 1980-1984 cohort had 19% lower odds (p < 0.001). Intracohort momentum decelerated for women born 1965-1974. Sociodemographic disparities persisted: odds were higher for women with tertiary education (aOR=1.58, 95% CI: 1.49-1.68) and married women (aOR=1.37, 95% CI: 1.29-1.44). Compared to West-Urban, regional odds were lower in the Central region (aOR=0.87, 95% CI: 0.79-0.96).

Conclusions

Türkiye’s policies doubled mammography uptake, yet coverage remains below targets. Deficits among younger women and slower initiation in recent cohorts demand targeted outreach. Public health strategies must move beyond capacity building to address persistent sociodemographic, geographic, and generational barriers.

Key messages

• Lifetime mammography screening in Türkiye doubled (26% to 54%) from 2008-2022 following policy expansions, but overall coverage remains below the 70% national target.

• Age-period-cohort modeling reveals critical screening deficits among newly eligible women and recent birth cohorts, requiring generation-specific outreach strategies.