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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