{"id":1371,"date":"2026-02-02T16:31:48","date_gmt":"2026-02-02T14:31:48","guid":{"rendered":"https:\/\/gynaikologos-komotini.gr\/gynaika\/"},"modified":"2026-04-08T14:40:29","modified_gmt":"2026-04-08T11:40:29","slug":"gynaika","status":"publish","type":"page","link":"https:\/\/gynaikologos-komotini.gr\/tr\/gynaika\/","title":{"rendered":"Kad\u0131n"},"content":{"rendered":"\t\t
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Kadin<\/h1>\t\t\t\t<\/div>\n\t\t\t\t
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Rahim a\u011fz\u0131 kanseri - PAP testi - HPV testi <\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Jinekolojik muayenenizi ihmal etmeyin!<\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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Rahim a\u011fz\u0131 kanseri taramas\u0131 <\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Rahim a\u011fz\u0131 kanseri, d\u00fcnya \u00e7ap\u0131nda \u00f6nemli bir sa\u011fl\u0131k sorunu olmaya devam etmektedir. Kaynaklar\u0131n s\u0131n\u0131rl\u0131 oldu\u011fu \u00fclkelerde, invaziv rahim a\u011fz\u0131 kanserinin (genellikle kad\u0131nlarda en s\u0131k g\u00f6r\u00fclen kanser t\u00fcr\u00fc) y\u00fcksek insidans\u0131 \u00f6nemli bir sorundur; kaynaklar\u0131n yeterli oldu\u011fu \u00fclkelerde ise vurgu, n\u00fcfusu kontrol etmenin en uygun y\u00f6ntemi ve yeterli kapsama alan\u0131n\u0131n nas\u0131l sa\u011flanabilece\u011fi \u00fczerine yo\u011funla\u015fmaktad\u0131r. \u00d6rne\u011fin, ABD’deki kad\u0131nlar\u0131n %80’inden fazlas\u0131 son 3 y\u0131l i\u00e7inde Pap smear testi yapt\u0131rm\u0131\u015f olsa da, rahim a\u011fz\u0131 skuam\u00f6z h\u00fccreli kanseri olanlar\u0131n \u00e7o\u011fu, toplu tarama kapsam\u0131nda yak\u0131n zamanda kontrol edilmemi\u015ftir.<\/p>

Geleneksel olarak, rahim a\u011fz\u0131 taramas\u0131, Pap smear testi ( ) ile e\u015f anlaml\u0131d\u0131r. Ancak bu tarama y\u00f6ntemi, baz\u0131 eksikliklere sahiptir ve bu da onu bu \u00f6zel tarama i\u00e7in ideal testten uzakla\u015ft\u0131rmaktad\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Bu yetersizlik \u015funlara ba\u011fl\u0131d\u0131r:<\/p>

  1. %50 civar\u0131nda nispeten d\u00fc\u015f\u00fck duyarl\u0131l\u0131k (kaynaklar\u0131 s\u0131n\u0131rl\u0131 \u00fclkelerde daha da d\u00fc\u015f\u00fck), oysa s\u0131v\u0131 sitolojide %70’e varan daha y\u00fcksek bir duyarl\u0131l\u0131k mevcuttur.<\/li>
  2. \u00a0Yukar\u0131dakilerin bir sonucu olarak, tekrarlanan \u00f6rnek al\u0131mlar\u0131na duyulan ihtiya\u00e7.<\/li>
  3. \u00a0Kad\u0131nlar\u0131n sonu\u00e7lar\u0131 i\u00e7in tekrar \u00e7a\u011fr\u0131lmas\u0131.<\/li>
  4. \u00a0Geni\u015f bir deneyime sahip bir laboratuvar\u0131n varl\u0131\u011f\u0131 gereklili\u011fi.<\/li>
  5. \u00a0Pozitif vakalarda klinik kolposkopi, de\u011ferlendirme ve tedaviye ihtiya\u00e7 duyulmas\u0131.<\/li>
  6. \u00a0N\u00fcfus taramas\u0131 i\u00e7in bir sitolojik program\u0131n y\u00fcksek maliyeti.<\/li><\/ol>

    Yukar\u0131daki zorluklar\u0131n bir sonucu olarak, asetik asit uygulamas\u0131 – VIA veya Lugol iyot uygulamas\u0131 (VILI), kolposkopi, trahilografi, papilloma vir\u00fcs\u00fc (HPV) testi, spektroskopi ve yeni biyokimyasal belirte\u00e7ler gibi bir\u00e7ok alternatif tarama y\u00f6ntemi ara\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. Bunlar\u0131n hi\u00e7biri Pap smear testinin yerini almay\u0131 ba\u015faramam\u0131\u015f olsa da, t\u0131p camias\u0131, rahim a\u011fz\u0131n\u0131n semptom \u00f6ncesi taramas\u0131 i\u00e7in kullan\u0131labilecek y\u00f6ntemler olarak HPV testine ve daha az \u00f6l\u00e7\u00fcde VIA’ya odaklanm\u0131\u015ft\u0131r. Bu durum, rahim a\u011fz\u0131 neoplazisi konusunda, bir kad\u0131n\u0131n ya\u015fam\u0131 boyunca sadece bir veya birka\u00e7 kontrol ziyareti ile yetinilen yeni bir d\u00f6nemin yakla\u015f\u0131p yakla\u015fmad\u0131\u011f\u0131 sorusunu g\u00fcndeme getirmektedir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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    Rahim a\u011fz\u0131 kanseri taramas\u0131n\u0131n ilkeleri. \nTarama, hastal\u0131\u011f\u0131n birincil ve ikincil \u00f6nlenmesini i\u00e7erir.\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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    Birincil \u00f6nleme<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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    Hastal\u0131\u011f\u0131 olmayan ki\u015filerde risk fakt\u00f6rlerini belirlemeyi ama\u00e7lar. Risk fakt\u00f6rlerinin ortadan kald\u0131r\u0131lmas\u0131yla, hastal\u0131\u011f\u0131n g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 azalacakt\u0131r. Rahim a\u011fz\u0131 kanserleri durumunda, HPV’nin yay\u0131lmas\u0131n\u0131 \u00f6nlemek i\u00e7in birincil \u00f6nleme, cinsel e\u011fitim ve tek e\u015flili\u011fi hedeflemelidir. B\u00f6ylece, kontrol daha \u00e7ok rahim a\u011fz\u0131 kanseri geli\u015fimi i\u00e7in risk fakt\u00f6rlerini i\u00e7eren bir ya\u015fam tarz\u0131na sahip kad\u0131nlara odaklanacakt\u0131r. Bu kad\u0131nlar daha sonra bilgilendirilecek ve ya\u015fam tarzlar\u0131n\u0131 de\u011fi\u015ftirmeleri i\u00e7in te\u015fvik edilecektir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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    \u0130kincil \u00f6nleme<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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    \u0130kincil \u00f6nlemde, g\u00f6r\u00fcn\u00fc\u015fte sa\u011fl\u0131kl\u0131 ki\u015filerde yap\u0131lan topluluk taramas\u0131 ile, hastal\u0131\u011f\u0131n \u00f6l\u00fcmc\u00fcl bir sonuca (\u00f6l\u00fcm) do\u011fru ilerlemesi, hastal\u0131\u011f\u0131n erken a\u015famada tespit edilmesi ve tedavisi yoluyla durdurulmal\u0131d\u0131r. Pap smear testi, ikincil \u00f6nlemeyi ama\u00e7layan taraman\u0131n klasik bir \u00f6rne\u011fidir. B\u00f6ylece erken evre kanserlerin kansere d\u00f6n\u00fc\u015fmesi engellenir.<\/p>

    Geli\u015fmi\u015f \u00fclkelerde, do\u011fum kontrol\u00fcn\u00fcn ba\u015fl\u0131ca y\u00f6ntemi Pap testi’dir. Ancak son y\u0131llarda, HPV testi, daha y\u00fcksek duyarl\u0131l\u0131\u011f\u0131 ve rahim a\u011fz\u0131 kanserinin ana nedeni olan HPV vir\u00fcs\u00fcn\u00fc tespit etmesi nedeniyle pop\u00fclerlik kazanm\u0131\u015ft\u0131r. Farkl\u0131 \u00fclkelerin farkl\u0131 k\u0131lavuzlar\u0131 vard\u0131r; Avrupa \u00fclkelerindeki k\u0131lavuzlar birbirine benzemekte ve ABD’dekilerden biraz daha muhafazak\u00e2rd\u0131r.\u00a0Bununla birlikte, t\u00fcm \u00fclkeler, y\u00fcksek risk alt\u0131ndaki kad\u0131nlar\u0131n (Pap smear testi sonucu anormal \u00e7\u0131kanlar dahil) ileri ya\u015flara kadar (genellikle \u00f6m\u00fcr boyu) her y\u0131l tarama yapt\u0131rmas\u0131 gerekti\u011fi konusunda hemfikirdir. Her ne kadar histerektomi ge\u00e7irmi\u015f kad\u0131nlarda tarama \u00f6nerilmese de, rahim a\u011fz\u0131nda neoplazi \u00f6yk\u00fcs\u00fc olan veya histerektomi \u00f6rne\u011finde neoplazi saptanan kad\u0131nlar taramaya devam etmelidir.<\/p>

    HPV testinin duyarl\u0131l\u0131\u011f\u0131 Pap smear testinden daha y\u00fcksektir (%50’ye kar\u015f\u0131 %70), ancak bunun sonucunda ilk testte daha fazla yanl\u0131\u015f pozitif sonu\u00e7 (hastal\u0131k belirtisi g\u00f6stermeyen kad\u0131nlarda vir\u00fcs\u00fcn saptanmas\u0131) ortaya \u00e7\u0131kmaktad\u0131r. Y\u00fcksek pozitif sonu\u00e7lara \u00f6rnek olarak, bir kad\u0131nda y\u00fcksek riskli HPV vir\u00fcs\u00fc saptanmas\u0131na ra\u011fmen sitolojik incelemenin negatif \u00e7\u0131kmas\u0131 (hatta kolposkopinin de negatif olmas\u0131) verilebilir. Ancak bu kad\u0131n rahatlayamaz, dikkatle izlenmelidir.\u00a0<\/strong><\/p>

    HPV testinin (sitolojik inceleme olsun ya da olmas\u0131n) son derece y\u00fcksek duyarl\u0131l\u0131\u011f\u0131, \u00e7ok y\u00fcksek bir pozitif prediktif de\u011fer vaat eder, ancak bu, sitolojik inceleme de dikkate al\u0131nd\u0131\u011f\u0131nda %95’in alt\u0131nda olan testin \u00f6zg\u00fcll\u00fc\u011f\u00fcne ba\u011fl\u0131d\u0131r. . Bununla birlikte, spesifiklik, istenen %95 standard\u0131na ula\u015fmasa da, y\u00fcksek bir pozitif prediktif de\u011fer sa\u011flamak i\u00e7in yeterlidir (%60-90).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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    Rahim a\u011fz\u0131 kanseri riski y\u00fcksek olan kad\u0131nlar\u0131, hangi tarama testi kullan\u0131l\u0131rsa kullan\u0131ls\u0131n, d\u00fc\u015f\u00fck riskli kad\u0131nlardan ayr\u0131 olarak tespit etmek zordur. \u00d6rne\u011fin ABD’de, her y\u0131l rahim a\u011fz\u0131 kanseri te\u015fhisi konulan kad\u0131nlar\u0131n %50’si hi\u00e7 sitoloji testi yapt\u0131rmam\u0131\u015ft\u0131r. Bu nedenle, geli\u015fmi\u015f \u00fclkelerde, hi\u00e7 tarama yapt\u0131rmam\u0131\u015f veya nadiren tarama yapt\u0131ran kad\u0131nlar aras\u0131nda n\u00fcfus kapsam\u0131n\u0131 art\u0131rmak i\u00e7in \u00f6zel \u00e7aba g\u00f6sterilmelidir. Bir\u00e7ok \u00fclkede kapsama oran\u0131 d\u00fc\u015f\u00fckt\u00fcr, yakla\u015f\u0131k %50 civar\u0131ndad\u0131r; bu \u00f6rnekler aras\u0131nda %48 ile \u00c7ek Cumhuriyeti ve %47 ile Bel\u00e7ika (Limburg eyaleti) say\u0131labilir. Bununla birlikte, etkili ulusal tarama programlar\u0131yla tan\u0131nan \u0130skandinav \u00fclkeleri, %90 gibi y\u00fcksek bir kapsama oran\u0131na sahiptir. Rahim a\u011fz\u0131 kanseri prevalans\u0131, ABD’de 100.000 kad\u0131nda 6,5 (2006) ve Hollanda’da 100.000 kad\u0131nda 6,9 olarak hesaplanmaktad\u0131r. Kanser \u00f6ncesi lezyonlar olan CIN 2 ve 3’\u00fcn prevalans\u0131 %1,1 ile %2,8 aras\u0131nda de\u011fi\u015fmektedir. G\u00fcney Afrika’da yap\u0131lan bir \u00e7al\u0131\u015fmada (n = 1286) (ortalama ya\u015f 34), CIN 2 ve 3’\u00fcn toplam prevalans\u0131 %7,4 idi. Bu nedenle, preinvaziv hastal\u0131\u011f\u0131n prevalans\u0131 d\u00fc\u015f\u00fck de\u011fildir ve dolay\u0131s\u0131yla yanl\u0131\u015f pozitif sonu\u00e7lar \u00f6nemli bir sorun te\u015fkil etmemektedir.<\/p>

    Buna kar\u015f\u0131l\u0131k, pop\u00fclasyon taramas\u0131nda yanl\u0131\u015f negatif bir sonucun sonu\u00e7lar\u0131, rahim a\u011fz\u0131 kanseri durumunda ciddi olabilir.\u00a0Bu nedenle, Pap smear testine HPV testinin eklenmesi, \u00f6zellikle 30 ya\u015f ve \u00fcst\u00fc kad\u0131nlarda, ilk testin yanl\u0131\u015f negatif sonu\u00e7lar\u0131n\u0131 azaltmak i\u00e7in anlaml\u0131d\u0131r. Geli\u015fmi\u015f \u00fclkelerde, n\u00fcfus taramas\u0131 i\u00e7in uygun ko\u015fullar mevcut oldu\u011fundan Pap smear testinin uygulanmas\u0131 m\u00fckemmeldir. HPV testi i\u00e7in de, \u00e7ok daha pahal\u0131 olmas\u0131na ra\u011fmen, uygulama iyidir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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    Hem Pap smear testi hem de HPV testi, t\u0131p camias\u0131nda ve genel n\u00fcfus aras\u0131nda iyi bir kabul g\u00f6rmektedir. N\u00fcfus taramas\u0131na kat\u0131lan kad\u0131nlar \u00e7o\u011funlukla 20 ile 50 ya\u015flar\u0131 aras\u0131nda oldu\u011fundan, bu testin uygulanmas\u0131yla ya\u015fam beklentisi \u00f6nemli \u00f6l\u00e7\u00fcde artm\u0131\u015ft\u0131r. Pap smear testi, geli\u015fmi\u015f \u00fclkelerde yeterince de\u011ferlendirilmi\u015ftir. \u00d6rne\u011fin ABD’de, son 30 y\u0131lda rahim a\u011fz\u0131 kanseri g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 %50’den fazla azalm\u0131\u015ft\u0131r. Bu, rahim a\u011fz\u0131 sitolojik muayenesinin yayg\u0131nla\u015fmas\u0131na ba\u011fl\u0131d\u0131r. Bu nedenle, geli\u015fmi\u015f \u00fclkeler rahim a\u011fz\u0131 kanseri i\u00e7in topluluk tarama programlar\u0131n\u0131 do\u011fru bir \u015fekilde uygulam\u0131\u015ft\u0131r.<\/p>

    Bununla birlikte, baz\u0131 s\u0131n\u0131rlamalar da tespit edilmi\u015ftir:<\/p>

    (1) Pap smear testi, \u00f6zellikle s\u0131n\u0131rl\u0131 duyarl\u0131l\u0131\u011f\u0131 nedeniyle ideal de\u011fildir ve (2) bir\u00e7ok \u00fclkede kapsama oran\u0131 %80 standard\u0131n\u0131n olduk\u00e7a alt\u0131ndad\u0131r ve bu nedenle rahim a\u011fz\u0131 kanseri taramas\u0131 ve kanserden kaynaklanan \u00f6l\u00fcmlerin kontrol\u00fc s\u0131n\u0131rl\u0131d\u0131r.<\/p>

    HPV testi, y\u00fcksek duyarl\u0131l\u0131\u011f\u0131 sayesinde semptom \u00f6ncesi tarama programlar\u0131nda daha fazla kullan\u0131lmal\u0131d\u0131r ve en iyi se\u00e7enek, 30 ya\u015f\u0131n \u00fczerindeki kad\u0131nlarda rahim a\u011fz\u0131 sitolojisi ile birle\u015ftirilmesi gibi g\u00f6r\u00fcnmektedir. Ayr\u0131ca, t\u00fcm geli\u015fmi\u015f \u00fclkeler n\u00fcfusun %80’inden fazlas\u0131n\u0131 kapsayacak \u015fekilde \u00e7al\u0131\u015fmal\u0131d\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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    HPV (\u0130nsan papilloma vir\u00fcs\u00fc) testi<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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    Bu testin amac\u0131, rahim a\u011fz\u0131 kanseri geli\u015fimi ile yak\u0131ndan ili\u015fkili olan y\u00fcksek riskli HPV DNA su\u015flar\u0131n\u0131 tespit etmektir. Pozitif test oran\u0131, kad\u0131n\u0131n ya\u015f\u0131na ve test edilen su\u015f say\u0131s\u0131na ba\u011fl\u0131 olarak \u00f6nemli \u00f6l\u00e7\u00fcde de\u011fi\u015fir. Hassasiyeti %82,8 ile %100 aras\u0131nda, \u00f6zg\u00fcll\u00fc\u011f\u00fc ise %62,5 ile %99,3 aras\u0131nda de\u011fi\u015fmektedir. D\u00fc\u015f\u00fck pozitif prediktif de\u011feri (%8,9) ve y\u00fcksek negatif prediktif de\u011feri (%99,7) daha \u00f6nceden bilinmekteydi. Testin kullan\u0131m\u0131, uyguland\u0131\u011f\u0131 kad\u0131nlarda CIN 2 vakalar\u0131nda %73’l\u00fck bir azalmaya yol a\u00e7m\u0131\u015ft\u0131r. Ne yaz\u0131k ki, bu test y\u00fcksek teknoloji gerektirdi\u011fi i\u00e7in pahal\u0131d\u0131r. Bununla birlikte, kolayca uygulanabilen d\u00fc\u015f\u00fck maliyetli bir HPV testi \u00fcretim a\u015famas\u0131ndad\u0131r.<\/p>

    HPV testlerinin sitolojik muayeneye k\u0131yasla avantajlar\u0131 \u015funlard\u0131r: (1) testin objektifli\u011fi, (2) s\u00fcrecin neredeyse tamamen otomatikle\u015ftirilebilmesi, (3) kalite kontrol s\u00fcre\u00e7lerine entegre olmas\u0131, (4) baz\u0131 pop\u00fclasyonlarda HPV DNA’s\u0131n\u0131 saptamak i\u00e7 ‘e y\u00f6nelik kendi kendine numune alma imkan\u0131 (sa\u011fl\u0131k tesisleri ve i\u015fg\u00fcc\u00fc k\u0131s\u0131tlamalar\u0131yla birlikte; duyarl\u0131l\u0131kta bir miktar kay\u0131p ile) ve (5) 30 ya\u015f ve \u00fcst\u00fc kad\u0131nlarda y\u00fcksek dereceli skuam\u00f6z intraepiteliyal lezyonlar\u0131n saptanmas\u0131nda daha y\u00fcksek bir duyarl\u0131l\u0131k. Kontrol aral\u0131klar\u0131n\u0131n uzat\u0131lmas\u0131yla etkinlik art\u0131\u015f\u0131 sa\u011flanabilir ve b\u00f6ylece bir kad\u0131n\u0131n ya\u015fam\u0131 boyunca ge\u00e7irdi\u011fi toplam kontrol say\u0131s\u0131 azal\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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    <\/div>\n\t\t\t\t\t\t<\/div>
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    Y\u00fcksek standartlarda t\u0131bbi hizmetler Komotini’deki Kad\u0131n Hastal\u0131klar\u0131 ve Do\u011fum Uzman\u0131 Alexandros Maina taraf\u0131ndan.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

    \n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t<\/path><\/svg>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\tDoktorla randevu al\u0131n <\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

    Kadin Rahim a\u011fz\u0131 kanseri – PAP testi – HPV testi Jinekolojik muayenenizi ihmal etmeyin! Rahim a\u011fz\u0131 kanseri taramas\u0131 Rahim a\u011fz\u0131 kanseri, d\u00fcnya \u00e7ap\u0131nda \u00f6nemli bir sa\u011fl\u0131k [\u2026]<\/span><\/p>\n","protected":false},"author":1,"featured_media":-1,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"open","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-1371","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"\nKad\u0131n | Alexandros Mainas MD, PhD<\/title>\n<meta name=\"description\" content=\"Rahim a\u011fz\u0131 kanseri, kad\u0131nlar i\u00e7in \u00f6nemli bir sa\u011fl\u0131k sorunudur. 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