CERVICAL SCREENING IN MOROCCO : CURRENT STATUS & FUTURE

Transcription

1 CERVICAL SCREENING IN MOROCCO : CURRENT STATUS & FUTURE Zaki El Hanchi Pr Gynecology, National Institute of Oncology Rabat International Symposium about Ovarian and Cervical Cancer, April 6-7th 2018, Marrakech/Morocco

2 Lead Group Log Introduction Cervical cancer is a big public health problem in Morocco : High frequence ; High Mortality ; Delay in diagnosis in more 2/3 cases.

3 Lead Group Log Epidemiological data of cervical cancer in Morocco [Casablanca Registry ] 2 th cancer of women % of women cancers. Incidence : 14,8 / women. ¾ cases advanced stage (2 et 3).

4 Lead Group Log Cervical cancer repartition / age [RCGC ] 32% of cases between 2008 et 2012 : years old

5 Lead Group Log Before 2010 NO strategy After 2010 Strategy of organised screening endorsed

6 Lead Group Log In Morocco STRONG WILL TO FIGHT CANCER LEADERSHIP HIGHNESS PRINCESS LALLA SALMA FLCC (Lalla Salma Fondation against cancer)

7 Lead Group Log Practitioners Gynecologists Surgeons Radiologists Pathologists.. Administrator Decision Makers NGO rs

8 Lead Group Log GAOLS To Reduce Mortality and Morbidity of cervical cancer To Reduce the Incidence of cervical cancer

9 Lead Group Log National Plan Against Cancer Prevention Early Detection Diagnosis Treatement palliative care Social back Communication & social mobilization Follow up and evaluation

10 Lead Group Log Screening of cervical cancer TARGET : Women aged : years old TEST : VIA at primary health structure Repeat : every three years

11 Lead Group Log Cervical cancer screening steps Women Invitation Screening by VIA L E V E L I Abnormal Results Normal Results Invitation after 3 years Complementary evaluation Colposcopy Biopsy Histology Intra-epith. Lesion : DLR L E V E L II Management of cancer L III

12 Lead Group Log Strategic orientations Fonction Actions Assurance Quality Norms Structures Suffisant number of health center I Activity in public health system Humans Ressources Personnel in charge of screening in suffisant number, skill Obligatory training with certification; verification of individual performance; reorientation Equipement and laboratory Availability and maintenance equipement; use of standard shape for creation of repports; proper quality of tests Process of quality control conducted by medical physicists ; Quality control of Laboratories Information System Suitable System to collect data, analysis and repports; follow of women with abnormal results Update of registries or computerized register Direction Chief identified to manage of changes, improve of quality and manage of incidents Coordinator of the program is mandatory

13 Lead Group Log System of information Register and information technology Health Center I Reference Feed Back Reference Center II Data of all H.C. I Health Ministry National Institut Oncology Maternity III

14 Lead Group Log Quality Assurance Evaluation Structure Indicators Norms Process Indicators Norms Results Indicators Norms Improve the quality

15 Lead Group Log Principal implementations

16 Lead Group Log Improvement of service s availability Construction of Reference Centers Aquirement of necessary equipements

17 Lead Group Log Reference Centers 7 30 centers functioning 4 sooner 10 in project

18 Strategy of training Elaboration guide; Training of teachers ; Training of 3000 personnels; Training in Communication and Counseling; Training in matters of management and follow up of program; Including the early detection in nurses school, lspits (2015)

19 Communication about the program Breast cancer : Annual campaign ; Plans of regional communication ; Supports (posters and folds); NGO Cervical cancer : Regions : yes National : Not yet

20 Follow up / Evaluation First evaluation of the whole activity : 2016 Fondation LC, IARC commission Accompaniment et oversight of activities.

21 Studies and research Prospective study about patient circuit ( ) ; Global study of the program (2013); Study about profile, reasons and the becoming of women lost after being screened for cervical cancer ( ); Retrospective study about the becoming women screened for cervical cancer ( );

22 Indicators of performance

23 Screening test results 250, , , , , ,000 50, ,421 8 % 5,3 % 19,230 8,518 9, % participants VIA - VIA per year

24 Participation rate evolution % 8.00% 7.00% 6.00% 6.60% 7.80% 5.00% 4.00% 3.00% 2.00% 1.00% 1.60% 3.20% 3.50% 4.70% 0.00% 0.00%

25 Colposcopy VIA + colposcopy

26 Results of colposcopy 6,000 5,413 5,399 5,000 4,386 4,000 3,000 2,000 colposcopy CIN cancer 1,

27 CIN and cervical cancer 20.00% 18.00% 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% 12.20% 8.80% 1.30% 1.30% 1.80% % CIN cancer

28 Results of cervical cancer screening program evaluation in Morocco Low coverage rate : No campaign about cervical cancer Screening no available every where Positif VIA test is high and variable Low rate of colposcopy : Number of gynecologist is not sufficient Low rate of diathermic loop excision : Number of gynecologist is not sufficient Not all gynecologist have the skill of ER or have fear to do it at the Reference Center.

29 Challenge and perspectives To reinforce the AVAILABILITY of structures and equipements all around the country ; To INCREASE the rate of participants ; To ensure the DIAGNOSIS of all women with positive VIA; TO ensure the TREATMENT of all women with CIN or cervical cancer

30 Challenge and perspectives To be sure that every participant return every 3 years ; To implement an efficient information technology in order to follow up all participant in every steps. To reinforce the evaluation of the program.

31 How to be sure that every woman with a positive VIA could have a colposcopy? Training more caregivers in coposcopy : Gynecologists General practitionners ++++ To organize a certified training Good accompaniment

32 Vaccine Quadrivalent Vaccine : Prevention of CIN 2/3 Cervical cancer VIN 2/3 VaIN 2/3 Genital wart Bivalent Vaccine : Prevention of CIN 2/3 Cervical cancers Individual vaccination Available in Morocco since 2008

33 Conclusion Evolution very good of the program : Successful partnership between Health Ministry and LS Fondation ; Commitment and involvement of all collaborators.

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