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CERVIX CANCER EPIDEMIOLOGY IN MOROCCO
AND IN THE WORLD
N. BENJAAFAR; M.A. TAZI; H. ELKACEMI
INTRODUCTION
• The second most common cancer in women worldwide:500000/year
• Cervical cancer is a major public health concern in developing countries: 83%
• the leading cause of cancer deaths: 85% • Second female cancer in Morocco and North Africa• First female cancer in most sub-Saharan countries• Natural history very long, HPV the main cause• screening is efficient• Vaccination?
Population Distribution
Rabat Morocco
3
633001 inhabitants in 2005
0-4
05-09
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75 et +Hommes
Femmes
200000 100000 0 100000 200000
Population Distribution
Grand Casablanca3 615 903
CERVIX CANCER IN MOROCCO
• Second female cancer since 1995 in hospital registries and actually in population based
• It occurs commonly at younger ages
• Most cases are diagnosed at advanced stages
• No planned screening for Women at risk
DATA FROM HOSPITAL REGISTRIES
• INO: National cancer centre, 35% cases
• COIR, Military Hospital, Oujda, Agadir
• Alkindy, Littoral, Alazhar, Nakhil
• 16000 patients/ year
CERVIXCERVIX CANCER,CANCER, INO : % of total number of INO : % of total number of
patients from 2000 to 2006patients from 2000 to 2006
Total numberCancerscervix cancer /%total
20004968481054811%
20015175505959511,5%
20024895470558511,9%
20034994478858211,6%
20045099490260011,7%
20054944473257011,5%
20065310506873813,9%
Evolution of Breast and Cervix cancer at INO : from 1985 to 2006
0
200
400
600
800
1000
1200
1985 1987 1989 1991 1993 1995 1997 1999 2000 2001 2002 2003 2004 2005
Sein Col utérin Poumon Colo-rectum Cavum
0
200
400
600
800
1000
1200
Sein Col utérin
Sein6563 Col utérin
4378 Colorectum
OvaireLymphomes
ThyroideCavumUterusPeauEstomac
SNCT.mous
LarynxPoumon
0 1000 2000 3000 4000 5000 6000 7000
Cancer distribution from : 2000 to 2006
female
Distribution urban/ruralDistribution urban/rural
Urbain 67%
rural 33%
AgeAge
median Age = 50 years
Minimum : 23 years
Maximum : 93 years
Year2000200120022003200420052006
Median age(years)
50505050504949
AgeNumberPourcentage
Âge≤25ans170,5%
25<âge≤30ans451%
30<âge≤35ans2275,4%
35<âge≤40ans43110,2%
40<âge≤45ans65615,5%
45<âge≤50ans81119,2%50<âge≤55ans57713,7%
55<âge≤60ans48011,4%
60<âge≤65ans3789%
65<âge≤70ans3087,3%
70<âge≤75ans1714%
âge<75ans1172,8%
Age group distributionAge group distribution
Age group distribution Age group distribution
0,5% 1%
5,4%
10,2%
15,5%
19,2%
13,7%
11,4%
9%7,3%
4%2,8%
0,00%
2,00%4,00%
6,00%8,00%
10,00%12,00%
14,00%16,00%
18,00%
20,00%
≤25ans 30à35 40à45 50à55 60à65 70à75
PathologyPathology
Sc Carcinoma : 90%
Adenocarcinoma : 5%
Sarcoma : 0,5%
Others : 4,5%
Staging
2003 and 2005
20032005
St X5%3%
Cis1%1,5%
St I13,5%12%
St IIa6,5%4%
St IIb28%33,5%
St IIIa0,5%0%
St IIIb28%30%
St IIIu11,5%7%
St IV5%9%
Staging
2003 and 2005
5% 3%1%
1,5%
13,5% 12%
6,5%
4%
28%
33,5%
0,5%
28%30%
11,5%
7%
5%
9%
0,00%
5,00%
10,00%
15,00%
20,00%
25,00%
30,00%
35,00%
St X Cis St I St IIa St IIb St IIIa St IIIb St IIIu St IV
2003
2005
Other national hospital registries
Breast/Cervix
Rabat, 20051,93
Casablanca, 20081,52
Oujda, 20083,01
Agadir, 2007-20081,94
DATA FROM POPULATION REGISTRIES
• Casablanca, 2004 and Rabat, 2005• Breast cancer is The leading female cancer and
overall: Rabat: ASR: 35.8/100000 33.5% in female
Median age: 48 years Casablanca: ASR:35.0/100000
36.1% Median age: 48 years
Data from population registries
• Cervix cancer, 2nd female cancer Rabat: ASR:15.4/100000
13.5% Median age: 54 years
Casablanca: ASR: 13.5/100000 12.82% Median age: 53.5 years
All anatomical
sites
Females
20
Principales localisations cancéreuses chez la femme-RCRC 2004.
36,1%
12,8%
5,3%
5%
4%
2,8%
2,7%
2,5%
2,3%
2,2%
1,7%
1,6%
1,2%
1,1%
16,7%
Sein
Col
Thyroide
Ovaires
LNH
Rectum
Corps utérin
Estomac
Peau
Colon
Poumon
LH
Vésicule biliaire
Œsophage
Autres
Data from population registries
• Cumulative risk 0-74 years
Rabat : 1.9%
Casablanca: 1.5%
• Pathology
Rabat: SCC: 90.2%, Adenocarc: 7.8%
Casablanca: SCC: 79%, Adenocarc: 4.7%
Data from population registriesRabat
• 93% are invasive, 7% in situ carcinoma
• Median age invasive, 54y and in situ, 46y
• 12% aged less 40y, Incidence10.7/100000
• The incidence increases with age to a maximum between 65-74years: 90/100000
• 92% were collected from cancer centres
• More than 67% are stage II or higher
Uterine cervix cancer, Rabat ASR: Age group Distribution
Age 24
Data from population registriesRabatStaging
Uterine cervix cancer
Comparison
With other
registries
ASR
Zimbabwe, Harare )1998-2002(47,3
Brazil, Brasilia37,7
Maroc, Rabat (2005)15,4
Maroc, Casablanca (2004)13,5
Algeria, Setif (1998-2002)11,6
Japan, Nagazaki )1998-2002(10,9
France, Bas-Rhin )1998-2002(8,3
Sweden )1998-2002(7,0
Italy, Modena )1998-2002(6,4
Tunisia, North (1995-1998)6,1 USA, SEER )9(: Blancs )1998-2002(6,0
Geneva )1998-2002(4,0
Libya, Benghazi (2004)3,5
China, Shanghai )1998-2002(2,826
CERVIX CANCER IN THE WORLD
Age-standardized Incidence and Mortality Rates for Cervix Uteri Cancer.
Data shown per 100,000
Cervix cancer in North Africa
%ASRCumulative risk
Gharbiah,Egypt )1999-2002(
1,82,8-
Benghazi, Libya )2004(
1,53,50,32 %
North Tunisia )1998-2002(
6,66,10,69 %
Setif, Algeria )1998-2002(
10.211,6-
Rabat,Morocco (2005)
13,515,41,9 %
Casablanca, Morocco (2004)
12,813,51,5 %
CONCLUSION
• Cancer du col utérin peut etre évité par un comportement sain et une bonne hygienne
• Le dépistage chez les femmes à risque est efficace sur la mortalité et sur l’incidence
• Informer la population pour avoir un diagnostic précoce seul garant d’une curabilité
Thank You for your attention
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