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Department of radiotherapy. University Hospital Ibn Rochd Casablanca –
Morroco
Cancer Control Resources in Maghreb countries
Pr. BENIDER
Marrakech June 19th 2010
Maghreb map
MAGHREBEpidemiologic transition - Demographic transition
- Transformations of the environment
- Change of the way of life
Non transmissible chronic diseases
Health priorities
Cancer = Major problem of public health
INTRODUCTION
• 1929: Bergonié Centre -Casablanca
Ibn Rochd Oncology Center
Historical •1929-1980
1947: Casablanca Mayor inaugurating the hospitalization of the Bergonié center
Historical •1929-1980
New cases Radium treatments External beam radiotherapy
1939 1940 1941 1942 1943 1944 1945 1946 1947 1948
139 150 228 219 187 170 209 236 336 313
69 58 75 88 59 47 48 44 186 123
88 85 189 89 140 182 204 396 308 384
total 2187 797 2075
•Treated cancers in Cancer Centre bergonié
• 1980: First two radiotherapy specialists (Pr.Gueddari -
Pr.Kahlain)
• 1985: National Institute of Oncology-Rabat
• 1989: First private center - Casablanca
Historical •1980-2005
• 2005: Lalla Salma Association Against Cancer
• 2010: Cancer Plan (2010 - 2019)
•After 2005
Epidemiological Data
Cancer Standardized Incidence In Maghreb
All SitesMale FemaleMOROCCO (Casablanca*) 100,3 104,2
ALGERIA (Alger**) 148,6
151,3
TUNISIA (Tunis***) 133,2 101,4
LYBIA (Benghazi****) 116,92 95,11
•* Registre des Cancers de la région du Grand Casablanca Edition 2004
•** Registre des tumeurs d’Alger Edition 2003
•*** Registre des Cancers de Nord Tunisie 1999-2003
•**** Benghazi Cancer Registry 2004
Cancer Standardized Incidence In Maghreb
All SitesMale FemaleMOROCCO (Casablanca*) 100,3 104,2
ALGERIA (Alger**) 148,6
151,3
TUNISIA (Tunis***) 133,2 101,4
LYBIA (Benghazi****) 116,92 95,11
USA (New Jersey) 566,2 439,2
France (Loire) 422,7 256
CANADA 398,5 308,3
COMMONLY CANCERS IN MALE
MOROCCO(Casablanca
*)
ALGERIA(Alger**)
TUNISIA(Tunis***)
LYBIA(Benghazi****
)
Lung Lung Lung Lung
Prostate Colon/Rectum
Bladder Colon/Rectum
Colon/Rectum
Bladder Colon/Rectum
Head Neck
NHL Stomach Prostate Bladder
Larynx Prostate Skin Prostate
•* Registre des Cancers de la région du Grand Casablanca Edition 2004
•** Registre des tumeurs d’Alger Edition 2003
•*** Registre des Cancers de Nord Tunisie 1999-2003
•**** Benghazi Cancer Registry 2004
COMMONLY CANCERS IN FEMALE
MOROCCO(Casablanca
*)
ALGERIA(Alger**)
TUNISIA(Tunis***)
LYBIA(Benghazi****
)
Breast Breast Breast Breast
Cervix uteri Colon/Rectum
Colon/Rectum
Colon/Rectum
Thyroid Cervix uteri Skin Corpus uteri
Colon/Rectum
Thyroid Cervix uteri NHL
Ovaries Ovaries Thyroid Cervix uteri
•* Registre des Cancers de la région du Grand Casablanca Edition 2004
•** Registre des tumeurs d’Alger Edition 2003
•*** Registre des Cancers de Nord Tunisie 1999-2003
•**** Benghazi Cancer Registry 2004
Breast CancerComparison of standardized
incidence of other countries
Country Incidence
MOROCCO (Casablanca)
35,04
ALGERIA (Alger) 44,5
TUNISIA (Tunis) 29,6
USA (New Jersey) 129,4
FRANCE (Loire) 109,8
CANADA 95,5
Health facilities
Cancer facilities in Morocco
• Casablanca Public (1)
Private (2)
• Rabat Public (1) Military (1)
Private (2)
• Oujda Public (1)
• Total: 8 cancer centers
Al houceima
•Before 2005
Cancer facilities in Morocco
Functional• Casablanca (4)• Rabat (4)• Agadir (1)• Oujda (1)• Al Houceima (1)• Marrakech (2*)• Fes (1/1*)• Total: 12 (3*) cancer
centersPlanned• Tanger• Meknes (2)• Safi• Laayoune
Al houceima
•After 2005
*Functional soon
Cancer facilities in Algeria
•ALGERIA
•Constantine•Algiers
•Ain-Naadja•BlidaAin
Misserghin
Oran
•6 centers
... . ..
Cancer facilities in Tunisia
•- 3 functional centers:
Tunis
Sousse
Sfax
•Jendouba
- 3 planned centers:
Gafsa
Gabes
Jendouba
Radiation Therapy Equipment in Morocco Before 2005
Linac 10
Cobalt 7
Simulator (CT) 3
Brachy LDR 16
Brachy HDR 2
TPS 10
After 2005
22 (2*)
6
5 (7*)
16
7
28 (14*)
•* Planned
Radiation Therapy Equipment in Algeria
Linac 9
Cobalt 6
Brachy 4
Radiation Therapy Equipment in Tunisia
Public Private Total
LINAC 1/4* 1/1* 2/5*
Cobalt 4 5 9
Simulator 3 2/1* 5/1*
TPS 3 3
•* Planned
Comparison of Radiation Therapy Equipment in Maghreb countries
Morocco Algeria Tunisia
Linac 22(2*) 9 2(5*)
Cobalt 6 6 9
Simulator (CT)
5(7*) - 5(1*)
Brachy LDR 16 4 -
Brachy HDR 7 - -
TPS 28(14*) - 3
•* Planned - No data available
2222
Human resources in cancer centers in Morocco
•Radiotherapy
Specialists: 82
Residents: 61
Medical Oncology
Specialists: 20
Residents: 51
Surgical Oncology
Specialists: 16
Total:
Specialists: 118
Residents : 112
2323
Human resources in cancer centers in Algeria
Medical Oncologists: 250
Radiation Oncologists: 50
Surgeons: 100
2424
Public Private Total
Surgical Oncology
Specialists 11 4 15
Residents 13 - 13
Radiotherapy
Specialists 15 4 19
Residents 19 - 19
Medical Oncology
Specialists 20 12 32
Residents 32 - 32
Total
Specialists 46 18 64
Residents 64 - 64
Human resources in cancer centers in Tunisia
2525
Morocco Algeria Tunisia
Surgical Oncology
Specialists 16 100 15
Residents - - 13
Radiotherapy
Specialists 82 50 19
Residents 61 - 19
Medical Oncology
Specialists 20 250 32
Residents 51 - 32
Comparison of Human resources in cancer centers in Maghreb countries
- No data available
Moroccan cancer Plan 2010-2019Conceptual Framework
National and international mobilization
Prevention
Early diagnosisDetection
Diagnosis and treatment
Palliative cares
Legislation
Research / TrainingSocial support
Communication
Moroccan cancer Plan 2010-2019Health facilities organization
•Level 1: Basic health centers,
General practionners
•Level 2: Provincial hospitals Diagnosis centers
Clinics
•Level 3: University hospitals, Regional cancer centers Private cancer centers
Tunisian cancer Plan 2006-2010
In collaboration with the Institut National Français du Cancer (INCa)
Piloting comittee and sub-commissions :
- Formation/Research
- Epidemiology
- Primary Prevention
- Screening/Early Diagnosis
- Management
Recommendations
International Resources Standards in Radiotherapy
EQUIPMENT
• 1 device / 250 000 - 500 000 inhabitants.
OMS/AIEA recommendations for developing
countries :
1 device for 1 million inhabitants.
International Resources Standards in Radiotherapy
HUMAN RESOURCES
• 1 Radiation Oncologist / 300 - 400 annual treatments
• 1 Radiation Physicist / 350 - 500 annual treatments
• 2 therapy radiographers / each treatment device
• At least 1 therapy radiographer / simulator
• At least 1 dosimetrist.
Moroccan equipment Requirement in Radiotherapy (cancer Plan 2010-
2019) For each cancer center
2 LINACs with MLC
1 Simulation system (standard or CT)
1 TPS with network link
HDR Brachytherapy
Moroccan Human Resources Requirement in Radiotherapy
(cancer Plan 2010-2019) For each cancer center
At least 2 radiation oncologists, and above depending on the
center activity: 1 radiation oncologist / 400 - 500 patients treated
per year
At least 2 Radiation Physicists , and above depending on the center
activity: 1 radiation Physicist / 600 - 700 patients treated per year
At least 12 radiation therapy radiographers
At least 2 Brachytherapy radiographers
At least 1 dosimetrist, and above depending on the center activity
Conclusion
Cooperation Governments - NGOs would
allow:
* Cancer prevention
* Cancer treatment
* Palliative care
* Better quality of life
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