} The last 50 years has seen a better understanding of the causes and treatments of cancer.

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1 Pr K EL RHAZI

2 } The last 50 years has seen a better understanding of the causes and treatments of cancer. } Hence, early detection and technolgy has improved the prognosos of cancer patients to an unprecedented level. } Exposure to a wide variety of natural and manufactured substances in the environment accounts for at least two-thirds all cancer cases.

3 These environmental factors include lifestyle choices such as Cigarette smoking, Excessive alcohol consumption, Poor diet, Lack of exercise, Excessive sunlight exposure, and Sexual behavior that increases exposure to certain viruses. Other factors include exposure to certain medical drugs, hormones, radiation,

4 The environmental factors include also environmental chemicals possibly present in the air, water, food, and workplace. In workplace, occupational groups have higher exposures to environmental chemicals than does the general population. have More cancer risks associated with these many environmental chemicals than does the general population.

5 } Cancer statistics new cases of disease are recorded each year Incidence is rising Public Health problem } What are the contributing factors to the incidence of cancer in Morocco?

6 } To investigate the prevalence of main life style cancer risk factors in Moroccan population } To estimate the prevalence of occupational risk factors among susceptible populations

7 Cross sectional studies, May 2008 Behavioral risk factors study: Nationwide, population-based study 2896 subjects aged 18 years and above Occupational risk factors study: Target population: crafts (wood, pottery, leather, copper), public works building and agriculture 400 subjects in each: crafts and public works building and agriculture

8 Data Collection: Questionnaire appropriated to each study Anthropometrics measurements Statistical analysis Data description Statistical models are used to examine the relationships between the variables

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11 } Sexe ratio M/W : 0.98 } Mean age : 41.57±15.3 years } Origin urban : 58.3% rural : 41.7% } Educational level Illiterates : 43.4% Primary school : 20.4% Secondary : 19.8% High : 7.6% informeleducation : 3% Coranic school: 5.8% 11

12 Socio demographic Informa1ons (3) } Marital status Single : 23,2% Married : 69,2% Divorced : 2,2% Widowed : 5,5% } Housing luxuorious : 3,4% modern : 12,3% New medina : 14,7% Old medina : 19,2% Slums: 9% Rural housing :41,5%. } Profession Active Population : 43,6% Retired : 6% Housewives: 38,9% Students : 4,1% Unemployed : 7,4% } Average family income <2000 MAD : 52,5% MAD : 25,7% MAD : 5,7% MAD : 3,2% 12

13 Behavioral factors 13

14 Obesity (1)

15 Obesity (2)

16 } Smoking prevalence in men: 30 % in women: 0.7 % } The most exposed age range years in men: 39,3% years in women: 0,9%

17 } In partner Among general population: 17.2 % Among no smokers: 22.5 % } In close family Among general population : 16.3% Among no smokers : 18.4% } In workplace Among general population : 6.6% Among no smokers : 4.1%

18 } Alcohol consumption during last12 months before study In men: 6.8% In women: 0.0% } In men who consume Daily consumption: 6.1 % 5 to 6 days per week: 4.0% 1 to 4 days per week: 38.4% 18

19 Dietary habits* Mediterranean Diet adherence was measured according to a modified MeDi score based on the weekly frequency of intake of eight food groups (vegetables, legumes, fruits, cereal or potatoes, fish, red meat, dairy products and olive oil) Greater MeDi adherence was characterized by higher intake of vegetables, fresh fruits, legumes, cereals, fish and olive oil and by lower intake of red meat and dairy products Low MeDi adherence: 29.9 % In women: 28.6% In men: 31.5% In urban area: 27.3% In rural area: 33.3% * Under review in BMC Public Health 19

20 Table 4. Multivariate logistic regression analysis of factors associated with low MeDi adherence (score 1-4). Sample of adult Moroccan population without missing data, (N=2183) Adjusted OR 95% CI p Gender 0.37 Women Men 1 Place of residence 0.04 Rural Urban 1 Marital status <0.001 Married Single/Divorced/Widowed 1 Housing 0.03 Luxurious or modern New medina Poor housing or slums Old medina 1 Tobacco consumption 0.14 Current smoker Ex-smoker Never smoker 1 BMI class (Kg/m2) <25 1 Occupation 0.70 Active/student Retired/unemployed/ Housewife 1

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26 Leather Potery Wood Copper

27 BPW Agriculture

28 n Monograph from the International Agency for Research on Cancer (IARC) classified occupational exposure Group 1: The agent is carcinogenic to humans. Group 2A: The agent is probably carcinogenic to humans. Group 2B: The agent is possibly carcinogenic to humans. Group 3: The agent is not classifiable as to carcinogenicity to humans. Group 4: The agent is probably not carcinogenic to humans.

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30 Age m (SD) Crafts PBW Agriculture wood leather copper pottery 33.1 (12.5) 37.7 (14.3) 34.2 (12.3) 28 (11.7) 31.2 (10.8) 37.9 (11.1) Illiterates (%) <2000MAD (%) Slums (%) Current Smokers (%) Alcohol consumption(%) subjec t 7.8

31 Wood N=100 Copper N=100 Craft Leather N=100 Potery N=100 PBW N=300 wood dust gasoline paint painting Chrome 8 Salt 100 Ethanol 17.3 sulfuric acid 8.4 Nickel Sulfate 4.9 Plomb 21

32 Substances Actives % d exposition Classification cancérogène Deltaméthrine Manebe Malathion Zirame Thirame Dicofol 4 3 Dicofol+Tetradifon : dicofol ND : tetradifon Mineral oil

33 Impervious gloves Crafts PBW Agriculture wood leather copper pottery mask Protection glasses boots ventilation of the working environment

34 } } } The prevalence of life style and occupational risk factor of cancer is high. These results contributed to elaboration of the national plan for prevention and control against cancer. To curb the progression of life style and occupational risk factor in Morocco: intervention strategies should be implemented in the general population but also a target group identified by the } study. Others studies are necessary in others population in industry Several studies are currently underway to evaluate cancer program prevention and detection and to best understand some others contributing factors.

35 Thank you for your attention