Mortality Attributable to Second Hand Smoking in Morocco: 2012 Results of a National Prevalence Based Study

Tachfouti, Nabil,Najdi, Adil,Lyoussi, Badiaa,Nejjari, Chakib Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.6

Purpose: To estimate the number of deaths attributable to second hand smoking (SHS) in Morocco in 2012. Materials and Methods: prevalence based study focusing on mortality from ischaemic heart disease (IHD) and lung cancer among non-smokers aged 35 and over. Prevalence of SHS among never smokers was gathered from a national cross sectional survey on tobacco and population attributable risk (PAR) was calculated by applying PARs to mortality. The analyses were stratified by sex, age and area of exposure. Results: Rates for exposure to SHS among men aged 35-64 years ranged from 20.0% at home to 57.4% at work. Among non-smoking Moroccans aged 35 and over, 233 (IC: 147 - 246) deaths were attributable to exposure to SHS; 156 (IC: 100 - 221) in women and 77 (IC: 44 -125) in men. A total of 173 (122 - 222) deaths were estimated to have been caused by exposure only at home, 34 (9 - 76) by exposure only at the work place and 26 (15 - 58) by exposure both at home and work places. Exposure to SHS could be responsible for 182 (128 - 237) deaths from IHD and 51 (19 - 109) from lung cancer. Conclusions: These data confirm that SHS needs urgent attention in Morocco.

Direct Costs of Cervical Cancer Management in Morocco

Berraho, Mohamed,Najdi, Adil,Mathoulin-Pelissier, Simone,Salamon, Roger,Nejjari, Chakib Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.7

Background: For cervical cancer the epidemiological profile is poorly known in Morocco and no data is available concerning the direct medical costs. The purpose of this work is to estimate the direct cost of medical management of invasive cervical cancer during the first year after diagnosis in Morocco. Methods: The estimation of direct costs of medical management of invasive cervical cancer during the first year after diagnosis in Morocco is based on the estimation of individual cost in each stage which covers diagnosis, treatment and follow-up during first year. The cost was estimated per patient and whole cycle-set using the costs for each drug and procedure as indicated by the Moroccan National Agency for Health Insurance. Extrapolation of the results to the whole country was used to calculate the total annual cost of cervical cancer treatments in Morocco. Results: Overall approximately 1,978 new cases of cervical cancer occur each year in Morocco. The majority (82.96%) of these cases were diagnosed at a late stage (stageII or more). The cost of one case of cervical cancer depends on stage of diagnosis, the lowest cost is $382 for stageCis followed by the cost of stageIA1 for young women (< 40 years) which is $2,952. The highest cost is for stageIV, which is $7,827. The total cost of cervical cancer care for one year after diagnosis is estimated at $13,589,360. The share allocated to treatment is the most important part of the global care budget with an annual sum of $13,027,609 whereas other cost components are represented as follows: $435,694 for annual follow-up activity and $126,057 for diagnosis and preclinical staging. Conclusion: This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of health facilities in Morocco.

Cervical Cancer in Morocco: Epidemiological Profile from Two Main Oncological Centers

Berraho, Mohamed,Bendahhou, Karima,Obtel, Majdouline,Zidouh, Ahmed,Benider, Abdellatif,Errihani, Hassan,Nejjari, Chakib Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.7

Background: In Morocco, the epidemiological profile of cervical cancer is not well established. The focus of the present study was both epidemiological and pathological characteristics. Methods: For all cases of cervical cancer treated between 2003 and 2007 in the National Institute of Oncology and the Oncology Department of the IbnRochd hospital (Casablanca), 900 cases were randomly selected. Results: The mean age was $52.1{\pm}11.8$ years. The most (90.5%) represented histological type was squamous cell carcinoma. For more than 57.0% cases the mean distance between patient's origin and center of treatment was greater than 100km. According to the FIGO classification, only 17.2% of patients were identified as being in early stages (0 and I). For 72.2% patients the follow-up did not exceed 2 years. At 1 year of following-up 55.8% of patients were alive and 43.4% were lost to following-up. Conclusion: Our study addressed the issue of the burden of cervical cancer in Morocco. The result provides a basis for decision-makers for the development of strategic measures to implement the fight against cervical cancer in Morocco.

Female Breast Cancer Incidence and Mortality in Morocco: Comparison with Other Countries

Khalis, Mohamed,El Rhazi, Karima,Charaka, Hafida,Chajes, Veronique,Rinaldi, Sabina,Nejjari, Chakib,Romieu, Isabelle,Charbotel, Barbara Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.12

Background: Breast cancer is the most frequently diagnosed malignancy and the leading cause of cancer death among women worldwide. In Morocco, there have been few recent descriptive studies on female breast cancer. The aim of this study was to describe the latest available incidence and mortality rates of breast cancer among Moroccan women and to compare them with rates in other regional and Western countries. Methods: For this descriptive study, Moroccan incidence data were obtained from the most recent reports of the cancer registries of Casablanca and Rabat. Information on breast cancer incidence for different countries were obtained primarily from publicly available cancer registries and Cancer Incidence in Five Continents, Volume X. Mortality data were extracted from the GLOBOCAN 2012 published by the International Agency for Research on Cancer. Results: The age-standardized incidence (World) rate of breast cancer in Moroccan women increased from 35.0 to 39.0 per 100,000 women between 2004 and 2008, showing an annual increase of 2.85 %. The highest incidence rates were registered in the age groups of 45-49, 50-54 and 55-59 years (106.1, 108.2 and 108.5 respectively). Sixty-nine percent of female breast cancer cases were diagnosed at stages II and III. In 2012, the estimated number of women who died of breast cancer in Morocco was 2,878. The crude, age-standardized (World) mortality rates were 17.3 and 18.0 per 100,000, respectively. Conclusion: Although the incidence of female breast cancer in Morocco is lower than in Western countries, evidence shows that the rate is rising. This increase of breast cancer incidence has been observed in parallel with changes in reproductive behavior and adoption of a Western lifestyle. Prevention policies need to be implemented.

First Data On Direct Costs of Lung Cancer Management in Morocco

Tachfouti, N.,Belkacemi, Y.,Raherison, C.,Bekkali, R.,Benider, A.,Nejjari, C. Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.4

Background: Lung cancer is the leading cause of cancer morbidity and mortality. Its management has a significant economic impact on society. Despite a high incidence of cancer, so far, there is no national register for this disease in Morocco. The main goal of this report was to estimate the medical costs of lung cancer in our country. Methods: We first estimated the number of annual new cases according to stage of the disease on the basis of the Grand-Casablanca-Region Cancer Registry data. For each sub-group, the protocol of treatment was described taking into account the international guidelines, and an evaluation of individual costs during the first year following diagnosis was made. Extrapolation of the results to the whole country was used to calculate the total annual cost of treatments for lung cancer in Morocco. Results: Overall approximately 3,500 new cases of lung cancer occur each year in the country. Stages I and II account for only 4% of cases, while 96% are diagnosed at locally advanced or metastatic stages III and IV. The total medical cost of lung cancer in Morocco is estimated to be around USD 12 million. This cost represents approximately 1% of the global budget of the Health Department. According to AROME Guidelines, about 86% of the newly diagnosed lung cancer cases needed palliative treatment while 14% required curative intent therapy. The total cost of early and advanced stages lung cancer management during the first year were estimated to be 4,600 and 3,420 USD, respectively. Conclusion: This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of health facilities in Morocco. A substantial proportion of the burden of lung cancer could be prevented through the application of existing cancer control knowledge and by implementing tobacco control programs.

Organization and Evaluation of Performance Indicators of a Breast Cancer Screening Program in Meknes-Tafilalt Region, Morocco

Charaka, Hafida,Khalis, Mohamed,Elfakir, Samira,Khazraji, Youssef Chami,Zidouh, Ahmed,Abousselham, Loubna,El Rhazi, Karima,Lyoussi, Badiaa,Nejjari, Chakib Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.12

Objective: The benefits of screening and early detection of breast cancer, including reduced morbidity and mortality, have been well-reported in the literature. In 2011, a breast cancer screening program was launched in Meknes-Tafilalt region of Morocco. The aim of this study was to evaluate the early performance indicators of this program. Materials and Methods: This retrospective evaluative study was conducted between April 2012 and December 2014, in Meknes-Tafilalt region of Morocco. Several performance indicators of the breast cancer screening program were calculated: the compliance rate, the positivity rate, the referral rate, the cancer detection rate and the organizational indicators. Results: During 2012-2014, a total of 184,951 women participated in the breast cancer screening program. The compliance rate was 26%, the positive rate was 3.3%, the referral rate was 36.7%, and the cancer detection rate was 1.2 per 1,000 women. The median time between the date of clinical breast examination and the date of biopsy (or cyto-puncture) was 36 days. The median time between the date of positive mammography and the date of biopsy (or cyto-puncture) was 6 days. The median time between the date of clinical breast examination and the date of the first received treatment was 61 days. Conclusions: The program needs better monitoring, as well as implementation of quality assurance tools to improve performance in our country.

Health-Related Quality of Life among Breast Cancer Patients and Influencing Factors in Morocco

El Fakir, Samira,El Rhazi, Karima,Zidouh, Ahmed,Bennani, Maria,Benider, Abdelatif,Errihani, Hassan,Mellass, Nawfel,Bekkali, Rachid,Nejjari, Chakib Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.12

Background: Breast cancer is the most common cancer among women in most countries of the world. It is ranked first in females in Morocco (accounting for 33.4% of the total cancer burden) and more than 60% of cases are diagnosed at stage III or IV. During the last decade, health-related quality of life (HRQOL) has become an important aspect of breast cancer treatment. The objective of this study was to describe self-reported HRQOL in patients with breast cancer and to investigate its associations with sociodemographic and clinical variables. Methods: A prospective study was carried out in the main oncology centers in Morocco. Quality of life was measured using the Moroccan Arabic versions of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C 30 (EORTC QLQ C30) and the Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23). Statistical analyses were performed using descriptive statistics and multivariate analyses. Results: A total of 1463 subjects were included in the study, with a mean age of 55.6 (SD. 11.2) years, 70% being married. The majority had stage II (45.9%) and a few cases stage IV (12.9%) lesions. The participants' global health mean score was 68.5 and in "functional scales", social functioning scored the highest (Mean 86.2 (SD=22.7)). The most distressing symptom on the symptom scale was financial difficulties (Mean 63.2 (SD=38.2)). Using the disease specific tool, it was found that future perspective scored the lowest (Mean 40.5 (SD=37.3)). On the symptom scale, arm symptoms scored the highest (Mean 23.6 (SD=21.6)). Significant mean differences were noted for many functional and symptom scales. Conclusion: Our results emphasized that the general HRQOL for our study population is lower than for corresponding populations in other countries. This study provided baseline information on the quality of life for a large sample of Moroccan women diagnosed with breast cancer.

Breast Cancer Screening in Morocco: Performance Indicators During Two Years of an Organized Programme

Fakir, Samira El,Najdi, Adil,Khazraji, Youssef Chami,Bennani, Maria,Belakhel, Latifa,Abousselham, Loubna,Lyoussi, Badiaa,Bekkali, Rachid,Nejjari, Chakib Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.15

Background: Breast cancer is commonly diagnosed at late stages in countries with limited resources. In Morocco, breast cancer is ranked the first female cancer (36.1%) and screening methods could reduce the proportion presenting with a late diagnosis. Morocco is currently adopting a breast cancer screening program based on clinical examination at primary health facilities, diagnosis at secondary level and treatment at tertiary level. So far, there is no systematic information on the performance of the screening program for breast cancer in Morocco. The aim of this study was to analyze early performance indicators. Materials and Methods: A retrospective evaluative study conducted in Temara city. The target population was the entire female population aged between 45-70 years. The study was based on process and performance indicators collected at the individual level from the various health structures in Tamara between 2009 and 2011. Results: A total of 2,350 women participated in the screening program; the participation rate was 35.7%. Of these, 76.8% (1,806) were married and 5.2% (106) of this group had a family history of breast cancer. Of the women who attended screening, 9.3% (190) were found to have an abnormal physical examination findings. A total of 260 (12.7%) were referred for a specialist consultation. The positive predictive value of clinical breast examination versus mammography was 23.0%. Forty four (35.5%) of the lesions found on the mammograms were classified as BI-RADs 3; 4 or 5 category. Cancer was found in 4 (1.95%) of the total number of screened women and benign cases represented 0.58%. Conclusions: These first results of the programme are very encouraging, but there is a need to closely monitor performance and to improve programme procedures with the aim of increasing both the participation rate and the proportion of women eligible to attend screening.