title: Organization and evaluation of a pilot cervical cancer screening program in Morocco.
abstract: OBJECTIVE
  To evaluate a pilot program for early detection of cervical cancer using visual inspection with acetic acid (VIA) and the loop electrosurgical excision procedure (LEEP) in one region of Morocco.
  
  
  METHODS
  A descriptive analysis of the screening outcome measures of 43 participating primary care units and one reference center for LEEP was conducted in Meknès-Tafilalet between January 1, 2011, and December 31, 2013. Data on the number of participants, VIA results, colposcopy, and treatment were used in analyses.
  
  
  RESULTS
  Of the 308 197 women in the target age group (30-49 years), 18 586 (6.0%) were screened by VIA. Positive screening test results were recorded for 1628 (8.8%) women, of whom 1144 (70.3%) received diagnostic confirmation by colposcopy. Of the 87 (7.6%) women with cervical intraepithelial neoplasia, only 16 (18.4%) underwent LEEP; three cases of invasive cervical cancer were diagnosed.
  
  
  CONCLUSIONS
  Issues with implementation of the screening program were found, including low compliance and a low treatment rate of cervical intraepithelial neoplasia by LEEP. By contrast, high rates of colposcopy referral were observed. Screen-and-treat by ablative methods (e.g. thermocoagulation) should be considered to increase treatment rates at national scale-up.
authors.affiliation: Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain; Department of Scientific Research, Continuous Training and Cooperation, Higher Institute of Nursing Professions and Techniques of Health of Rabat, Rabat, Morocco.
authors.forename: Farida
authors.initials: F
authors.lastname: Selmouni
authors.affiliation: Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France. Electronic address: sauvagetc@iarc.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sauvaget
authors.affiliation: Department of Scientific Research, Continuous Training and Cooperation, Higher Institute of Nursing Professions and Techniques of Health of Rabat, Rabat, Morocco.
authors.forename: Latifa
authors.initials: L
authors.lastname: Belakhel
authors.affiliation: Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Lucas
authors.affiliation: Department of Infrastructure and Provincial Ambulatory Actions, Regional Direction of Health Meknès-Tafilalet, Meknès, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khouchoua
authors.affiliation: Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
mesh_terms: D019342:Acetic Acid; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery; D003127:Colposcopy / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods*; D004598:Electrosurgery / Q000379:methods; D005260:Female; D006801:Humans; D007202:Indicators and Reagents; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D009018:Morocco; D010808:Physical Examination / Q000379:methods; D010865:Pilot Projects; D015397:Program Evaluation; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000601:surgery
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid
keywords: Cervical cancer; Early detection; Evaluation; Morocco; National screening program; Pilot program