E-poster Presentation 2014 World Cancer Congress

Evaluation of cervical cancer screening program using VIA testing in Morocco (#1174)

Farida Selmouni 1 , Latifa Belakhel 1 , Rachid Bekkali 2 , Maria Bennani 2 , Youssef Chami Khazraji 2
  1. Heath Ministry, Rabat, Morocco
  2. Fondation Lalla Salma prévention et traitement des cancers, Rabat, Morocco

Background:

The cervical cancer is the second most common cancer in women after the breast cancer in Morocco. Recorded 14,3/100 000P-Yrs, it’s diagnosed generally in very late stages, therefore delaying and complicating their therapeutic care. To cope this problem, Morocco undertook progressively a screening program using visual inspection of the cervix with acetic acid as a screening tool in primary health centers, by trained doctors, midwifes, and nurses. Colposcopy and/or directed biopsy were performed on VIA positive Women in specialized centers named reference center for reproductive health. Treatment by loop electrosurgical excision procedure was offered to those with cervical intraepithelial neoplasia. This program initiated towards the end of 2010-early 2011 in only one region in the country and scaled up to 6 regions by 2014.

Aim:

The aim of this paper is to document the process and the result of a VIA screening program in the province of Meknes, Morocco from 2011 to 2013.

Methods:

A retrospective study was carry out in 43 health centers and the reference center for reproductive health of the province, based in the following of VIA positive women detected in primary health centers. The data were extracted from the women records and the registry of the program.

Results:

During this period, 18 586 women underwent VIA screening, which represents 6 % of participation rate. Among them, 1743 (9,3%) women were positive, of whom 539 (31%) received colposcopy. 64 women were diagnosed with TAG1-2 and one woman with invasive cancer. 23% the women with TAG1/2 lesions had treatment.

Conclusions:

This result highlights VIA screening program is useful alternative in low-resource setting, but requires careful and continuous monitoring and implementation of quality assurance. We need also to develop a strategy of community awareness, to increase access to the test and/or treatment.

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Cervical cancer, screening program, visual inspection with acetic acid, Morocco

  1. GLOBOCAN 2012 database, International Agency for Research on Cancer, World Health Organization. Available at http://globocan.iarc.fr/ last accessed January 30, 2014.
  2. Berraho M, Obtel M, Bendahhou K, Zidouh A, Errihani H, Benider A, Nejjari C. Sociodemographic factors and delay in the diagnosis of cervical cancer in Morocco. Pan Afr Med J. 2012;12:14.).
  3. IARC, World Health Organization. IARC handbooks of cancer prevention: cervix cancer screening, vol 10. Lyon, France: IARC, 2005.
  4. Sankaranarayanan R, Nene BM, Dinshaw KA, Mahe C, Jayant K, Shastri SS, Malvi SG, Chinoy R, Kelkar R, Budukh AM, Keskar V, Rajeshwarker R, Muwonge R, Kane S, Parkin DM, Chauhan MK, Desai S, Fontaniere B, Frappart L, Kothari A, Lucas E, Panse N; Osmanabad District Cervical Screening Study Group. A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India. Int J Cancer. 2005 Sep 10;116(4):617-23.
  5. Sankaranarayanan R, Esmy PO, Rajkumar R, et al. Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial. Lancet. 2007;370:398Y406.
  6. Sherris J, Wittet S, Kleine A, et al. Evidence-based, alternative cervical cancer screening approaches in low-resource settings. Int Perspect Sex Reprod Health. 2009;35:147Y154
  7. Sauvaget C, Fayette JM, Muwonge R et al. Accuracy of visual inspection with acetic acid for cervical cancer screening. Int J Gynaecol Obstet 2011; 113: 14–24.
  8. Ministère de la santé du Maroc. Guide de détection précoce des cancers du sein et du col de l’utérus, 2011. Disponible au :http://srvweb.sante.gov.ma/Documents/Guide_Pratique_v3.pdf. Accédé le 14 mai 2014
  9. World health organization. Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy. A demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania, and Zambia, 2012. Available at: http://screening.iarc.fr/doc/9789241503860_eng.pdf. Accessed April 22, 2014
  10. Basu P, Nessa A, Majid M, Rahman JN, Ahmed T. Evaluation of the National Cervical Cancer Screening Programme of Bangladesh and the formulation of quality assurance guidelines. J Fam Plann Reprod Health Care. 2010 Jul;36(3):131-4.
  11. Nessa A, Hussain MA, Rahman JN, Rashid MH, Muwonge R, Sankaranarayanan R. Screening for cervical neoplasia in Bangladesh using visual inspection with acetic acid. Int J Gynaecol Obstet. 2010 Nov;111(2):115-8.
  12. Ahmed T, Ashrafunnessa, Rahman J. Development of a visual inspection programme for cervical cancer prevention in Bangladesh. Reprod Health Matters. 2008 Nov;16(32):78-85.
  13. Isaac R, Finkel M, Olver I, Annie IK, Prashanth HR, Subhashini J, Viswanathan PN, Trevena LJ. Translating evidence into practice in low resource settings: cervical cancer screening tests are only part of the solution in rural India. Asian Pac J Cancer Prev. 2012;13(8):4169-72.
  14. Bradley J, Barone M, Mahé C, Lewis R, Luciani S. Delivering cervical cancer prevention services in low-resource settings. Int J Gynaecol Obstet. 2005 May;89 Suppl 2:S21-9.