title: Overview of cervical cancer screening practices in the extended Middle East and North Africa countries.
abstract: National Organized Cervical Cancer Screening (NOCCS) programs are lacking in most of the "Extended Middle East and North Africa" (EMENA) countries. Consequently, most cervical cancers are diagnosed late and are associated with high mortality. In fact, in most of these countries, national mortality data are unknown due to the absence of population-based mortality registries. Most countries of the EMENA practice more or less limited opportunistic, cytology-based, screening tests, which often lack quality assurance and follow-up care. A few countries, within the initiation of a National Cancer Control Plan, have just started to implement organized screening programs using, for cervical cancer detection, visual inspection with acetic acid (Morocco) or cytology (Turkey). Moreover, most countries of the EMENA lack national guideline, as well as resources for the management of abnormal cytologic screening (or any other screening test). The main obstacle for the implementation of NOCCS is a lack of political understanding to support such public health programs and provide the necessary resources. Other obstacles that hinder the participation of women in cervical screening include a lack of knowledge of the disease, socio-religious and cultural barriers, and geographic and economic difficulties in accessing medical services. These countries are already convinced that prevention of cervical cancers in women who have cervical intraepithelial neoplasia is possible through various screening and treatment algorithms, but most countries still need to invest in well organized programs that can reduce cervical cancer incidence and mortality in women. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Extended Middle East and North Africa Region" Vaccine Volume 31, Supplement 6, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
authors: Montpellier University, France, Epidaure, CRLC Val d'Aurelle, Parc Euromédecine, Montpellier, France. Electronic address: helene.sancho-garnier@montpellier.unicancer.fr.
authors: Hélène
authors: H
authors: Sancho-Garnier
authors: Project Manager, Cervical Screening Program, Rabat, Morocco.
authors: Youssef Chami
authors: YC
authors: Khazraji
authors: Registre des cancers de Sétif, Algeria.
authors: Moktar Hamdi
authors: MH
authors: Cherif
authors: Laboratoire Santé Environnement, Université de Sétif, Algeria.
authors: Abbes
authors: A
authors: Mahnane
authors: National Institute of Public Health, Tunis, Tunisia.
authors: Mohamed
authors: M
authors: Hsairi
authors: Department of Obstetrics and Gynecology, Ain Shams University, Abbassia, Cairo, Egypt.
authors: Amr
authors: A
authors: El Shalakamy
authors: Department of Cancer Control, The Turkish Ministry of Health, Ankara, Turkey.
authors: Nejat
authors: N
authors: Osgul
authors: Department of Cancer Control, The Turkish Ministry of Health, Ankara, Turkey.
authors: Murat
authors: M
authors: Tuncer
authors: Independent Consultant, Seattle, WA, USA.
authors: Aisha O
authors: AO
authors: Jumaan
authors: Department Obstetrics and Gynecology, Gynecologic Oncology, American University of Beirut, Medical Center, Beirut, Lebanon.
authors: Muhieddine
authors: M
authors: Seoud
mesh_terms: D000352:Africa, Northern / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D006291:Health Policy; D006298:Health Services Administration / Q000191:economics; D006801:Humans; D008877:Middle East / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology*
keywords: Extended Middle East; Gulf countries; HPV; Middle East; North Africa; Yemen; cervical cancer screening