Cancer Control Resources in
Maghreb countries
Pr. BENIDER
Department of radiotherapy. University
Hospital Ibn Rochd Casablanca – Morroco
Marrakech June 19th 2010
Maghreb map
INTRODUCTION
MAGHREB
Epidemiologic transition
- Demographic transition
- Transformations of the environment
- Change of the way of life
Non transmissible chronic diseases
Health priorities
Cancer = Major problem of public health
Historical
•1929-1980
• 1929: Bergonié Centre -Casablanca
Ibn Rochd Oncology Center
1947: Casablanca Mayor inaugurating the hospitalization of the Bergonié center
Historical
•1929-1980
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
total
New cases
Radium treatments
External beam radiotherapy
139
150
228
219
187
170
209
236
336
313
69
58
75
88
59
47
48
44
186
123
88
85
189
89
140
182
204
396
308
384
2187
797
2075
•Treated cancers in Cancer Centre bergonié
Historical
•1980-2005
• 1980: First two radiotherapy specialists (Pr.Gueddari - Pr.Kahlain)
• 1985: National Institute of Oncology-Rabat
• 1989: First private center - Casablanca
•After 2005
• 2005: Lalla Salma Association Against Cancer
• 2010: Cancer Plan (2010 - 2019)
Epidemiological Data
Cancer Standardized Incidence In Maghreb
All Sites
Male
Female
MOROCCO (Casablanca*)
100,3
104,2
ALGERIA (Alger**)
148,6
151,3
TUNISIA (Tunis***)
133,2
101,4
LYBIA (Benghazi****)
116,92
95,11
•*
Registre des Cancers de la région du Grand Casablanca Edition 2004
•**
Registre des tumeurs d’Alger Edition 2003
•***
Registre des Cancers de Nord Tunisie 1999-2003
•**** Benghazi Cancer Registry 2004
Cancer Standardized Incidence In Maghreb
All Sites
Male
Female
MOROCCO (Casablanca*)
100,3
104,2
ALGERIA (Alger**)
148,6
151,3
TUNISIA (Tunis***)
133,2
101,4
LYBIA (Benghazi****)
116,92
95,11
USA (New Jersey)
France (Loire)
566,2
422,7
439,2
256
CANADA
398,5
308,3
COMMONLY CANCERS IN MALE
MOROCCO
(Casablanca*)
Lung
ALGERIA
(Alger**)
Lung
TUNISIA
(Tunis***)
Lung
LYBIA
(Benghazi****)
Prostate
Colon/Rectum
Bladder
Colon/Rectum
Colon/Rectum
Bladder
NHL
Stomach
Prostate
Bladder
Larynx
Prostate
Skin
Prostate
Lung
Colon/Rectum Head  Neck
•*
Registre des Cancers de la région du Grand Casablanca Edition 2004
•**
Registre des tumeurs d’Alger Edition 2003
•***
Registre des Cancers de Nord Tunisie 1999-2003
•**** Benghazi Cancer Registry 2004
COMMONLY CANCERS IN FEMALE
MOROCCO
(Casablanca*)
Breast
Cervix uteri
ALGERIA
(Alger**)
Breast
TUNISIA
(Tunis***)
Breast
LYBIA
(Benghazi****)
Breast
Colon/Rectum Colon/Rectum Colon/Rectum
Thyroid
Cervix uteri
Skin
Corpus uteri
Colon/Rectum
Thyroid
Cervix uteri
NHL
Ovaries
Ovaries
Thyroid
Cervix uteri
•*
Registre des Cancers de la région du Grand Casablanca Edition 2004
•**
Registre des tumeurs d’Alger Edition 2003
•***
Registre des Cancers de Nord Tunisie 1999-2003
•**** Benghazi Cancer Registry 2004
Breast Cancer
Comparison of standardized incidence of
other countries
Country
MOROCCO (Casablanca)
Incidence
35,04
ALGERIA (Alger)
44,5
TUNISIA (Tunis)
29,6
USA (New Jersey)
129,4
FRANCE (Loire)
109,8
CANADA
95,5
Health facilities
Cancer facilities in Morocco
•Before 2005
•
Casablanca
Public (1)
Private (2)
•
Rabat
Public (1)
Military (1)
Private (2)
•
Oujda
Public (1)
•
Total: 8 cancer centers
Al houceima
Cancer facilities in Morocco
Functional
• Casablanca (4)
• Rabat (4)
• Agadir (1)
• Oujda (1)
• Al Houceima (1)
• Marrakech (2*)
• Fes (1/1*)
•After 2005
• Total: 12 (3*) cancer centers
Planned
• Tanger
• Meknes (2)
• Safi
• Laayoune
*Functional soon
Al houceima
Cancer facilities in Algeria
.
Oran
Ain
.
Misserghin
. .•Algiers
. .•Constantine
•Blida
•Ain-Naadja
•ALGERIA
•6 centers
Cancer facilities in Tunisia
•- 3 functional centers:
Tunis
Sousse
Sfax
- 3 planned centers:
Gafsa
Gabes
Jendouba
•Jendouba
Radiation Therapy Equipment in Morocco
Before 2005
After 2005
Linac
10
22 (2*)
Cobalt
7
6
Simulator (CT)
3
5 (7*)
Brachy LDR
16
16
Brachy HDR
2
7
TPS
10
28 (14*)
•* Planned
Radiation Therapy Equipment in Algeria
Linac
9
Cobalt
6
Brachy
4
Radiation Therapy Equipment in Tunisia
Public
Private
Total
LINAC
1/4*
1/1*
2/5*
Cobalt
4
5
9
Simulator
3
2/1*
5/1*
TPS
3
•* Planned
3
Comparison of Radiation Therapy
Equipment in Maghreb countries
Morocco
Algeria
Tunisia
Linac
22(2*)
9
2(5*)
Cobalt
6
6
9
Simulator
(CT)
Brachy LDR
5(7*)
-
5(1*)
16
4
-
Brachy HDR
7
-
-
TPS
28(14*)
-
3
•* Planned
- No data available
Human resources in cancer centers in
Morocco
•Radiotherapy
Specialists: 82
Residents:
61
Total:
Specialists: 118
Medical Oncology
Specialists:
20
Residents:
51
Residents : 112
Surgical Oncology
Specialists:
16
22
Human resources in cancer centers in
Algeria
Medical Oncologists: 250
Radiation Oncologists: 50
Surgeons: 100
23
Human resources in cancer centers in
Tunisia
Public
Private
Total
Specialists
11
4
15
Residents
13
-
13
Specialists
15
4
19
Residents
19
-
19
Specialists
20
12
32
Residents
32
-
32
Specialists
46
18
64
Residents
64
-
64
Surgical Oncology
Radiotherapy
Medical Oncology
Total
24
Comparison of Human resources in cancer
centers in Maghreb countries
Morocco
Algeria
Tunisia
Specialists
16
100
15
Residents
-
-
13
Specialists
82
50
19
Residents
61
-
19
Specialists
20
250
32
Residents
51
-
32
Surgical Oncology
Radiotherapy
Medical Oncology
- No data available
25
Moroccan cancer Plan 2010-2019
Conceptual Framework
Communication
Palliative
cares
Social support
Prevention
National and
international
mobilization
Diagnosis and
treatment
Legislation
Early diagnosis
Detection
Research / Training
Moroccan cancer Plan 2010-2019
Health facilities organization
•Level 1: Basic health centers,
General practionners
•Level 2: Provincial hospitals
Diagnosis centers
Clinics
•Level 3: University hospitals,
Regional cancer centers
Private cancer centers
Tunisian cancer Plan 2006-2010
In collaboration with the Institut National
Français du Cancer (INCa)
Piloting comittee and sub-commissions :
- Formation/Research
- Epidemiology
- Primary Prevention
- Screening/Early Diagnosis
- Management
Recommendations
International Resources Standards in
Radiotherapy
EQUIPMENT
• 1 device / 250 000 - 500 000 inhabitants.
OMS/AIEA recommendations for developing countries :
1 device for 1 million inhabitants.
International Resources Standards in
Radiotherapy
HUMAN RESOURCES
• 1 Radiation Oncologist / 300 - 400 annual treatments
• 1 Radiation Physicist / 350 - 500 annual treatments
• 2 therapy radiographers / each treatment device
• At least 1 therapy radiographer / simulator
• At least 1 dosimetrist.
Moroccan equipment Requirement in
Radiotherapy (cancer Plan 2010-2019)
For each cancer center
2 LINACs with MLC
1 Simulation system (standard or CT)
1 TPS with network link
HDR Brachytherapy
Moroccan Human Resources Requirement in
Radiotherapy (cancer Plan 2010-2019)
For each cancer center
At least 2 radiation oncologists, and above depending on the center
activity: 1 radiation oncologist / 400 - 500 patients treated per year
At least 2 Radiation Physicists , and above depending on the center
activity: 1 radiation Physicist / 600 - 700 patients treated per year
At least 12 radiation therapy radiographers
At least 2 Brachytherapy radiographers
At least 1 dosimetrist, and above depending on the center activity
Conclusion
Cooperation Governments - NGOs would allow:
* Cancer prevention
* Cancer treatment
* Palliative care
* Better quality of life