title: Breast Cancer Screening in Morocco: Performance Indicators During Two Years of an Organized Programme.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Epidemiology and Public Health, Faculty of Medicine, University Sidi Mohammed Ben Abdellah, Fez, Morocco E-mail : elfakirsamira@yahoo.fr.
authors.forename: Samira
authors.initials: S
authors.lastname: El Fakir
authors.forename: Adil
authors.initials: A
authors.lastname: Najdi
authors.forename: Youssef Chami
authors.initials: YC
authors.lastname: Khazraji
authors.forename: Maria
authors.initials: M
authors.lastname: Bennani
authors.forename: Latifa
authors.initials: L
authors.lastname: Belakhel
authors.forename: Loubna
authors.initials: L
authors.lastname: Abousselham
authors.forename: Badiaa
authors.initials: B
authors.lastname: Lyoussi
authors.forename: Rachid
authors.initials: R
authors.lastname: Bekkali
authors.forename: Chakib
authors.initials: C
authors.lastname: Nejjari
mesh_terms: D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009018:Morocco; D010342:Patient Acceptance of Health Care; D010808:Physical Examination; D011237:Predictive Value of Tests; D011320:Primary Health Care; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies