1. CERVIX CANCER EPIDEMIOLOGY IN MOROCCO AND IN THE WORLD N. BENJAAFAR; M.A. TAZI; H. ELKACEMI

2. 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?

3. Population Distribution Rabat Morocco 3 633001 inhabitants in 2005

4. Population Distribution Grand Casablanca 3 615 903

5. 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

6. DATA FROM HOSPITAL REGISTRIES INO: National cancer centre, 35% cases COIR, Military Hospital, Oujda, Agadir Alkindy, Littoral, Alazhar, Nakhil 16000 patients/ year

7. CERVIXCANCER,INO : % of total number of patients from 2000 to 2006 CERVIX CANCER, INO : % of total number of patients from 2000 to 2006 Total numberCancers cervix cancer %/total 20004968481054811% 20015175505959511,5% 20024895470558511,9% 20034994478858211,6% 20045099490260011,7% 20054944473257011,5% 20065310506873813,9%

8. Evolution of Breast and Cervix cancer at INO : from 1985 to 2006

9. Cancer distribution from : 2000 to 2006 female

10. Distribution urban/rural

11. Age median Age = 50 years Minimum : 23 years Maximum : 93 years Year2000200120022003200420052006 Median age (years) 50 49

12. AgeNumberPourcentage Âge25ans170,5% 25<âge30ans451% 30<âge35ans2275,4% 35<âge40ans43110,2% 40<âge45ans65615,5% 45<âge50ans811 19,2% 50<âge55ans57713,7% 55<âge60ans48011,4% 60<âge65ans3789% 65<âge70ans3087,3% 70<âge75ans1714% âge>75ans1172,8% Age group distribution

14. Pathology Sc Carcinoma : 90% Adenocarcinoma : 5% Sarcoma : 0,5% Others : 4,5%

15. 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%

16. Staging 2003 and 2005

17. Other national hospital registries Breast/Cervix 1,93Rabat, 2005 1,52Casablanca, 2008 3,01Oujda, 2008 1,94Agadir, 2007-2008

18. 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

19. Data from population registries Cervix cancer, 2 nd 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

20. All anatomical sites Females 20

21. 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

22. 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%

23. Data from population registries Rabat 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

24. Uterine cervix cancer, Rabat ASR: Age group Distribution Age 24

25. Data from population registries Rabat Staging

26. 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)2,8 26

27. CERVIX CANCER IN THE WORLD Age-standardized Incidence and Mortality Rates for Cervix Uteri Cancer. Data shown per 100,000

28. Cervix cancer in North Africa Cumulative riskASR% -2,81,8 Gharbiah,Egypt (1999-2002) 0,32 %3,51,5 Benghazi, Libya (2004) 0,69 %6,16,6 North Tunisia (1998-2002) -11,610.2 Setif, Algeria (1998-2002) 1,9 %15,413,5 Rabat,Morocco (2005) 1,5 %13,512,8 Casablanca, Morocco (2004)

29. 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 lincidence Informer la population pour avoir un diagnostic précoce seul garant dune curabilité

30. Thank You for your attention 30