Le Matin: Cervical cancer: what is the situation in Morocco and what are the main causes?
Pre Kouhen Fadila : I would first like to point out that cervical cancer is a disease that is largely preventable through effective prevention measures, such as vaccination and routine screening. However, despite the availability of these tools, cervical cancer continues to affect thousands of women, particularly in low-income countries. This highlights the challenges faced in effectively implementing these prevention strategies, such as limited access to care, socioeconomic disparities, and gaps in awareness and health education. In Morocco, cervical cancer ranks fourth among the most common female cancers, after breast, thyroid and colorectal cancers. It represents 6.5% of cancer cases in women. According to data from the Greater Casablanca registry for the period from 2018 to 2021, this cancer affects approximately 8.7 women per 100,000 each year. Nationally, there are around 3,300 new cases each year and nearly 2,500 deaths linked to this disease. Cervical cancer develops in the cells of the cervix, the lower part of the uterus that opens into the vagina. The majority of cases are caused by persistent infection with certain types of human papillomavirus (HPV), a very common virus transmitted through sexual contact. Although most HPV infections are mild and transient, some high-risk strains, such as HPV 16 and 18, can cause precancerous lesions that, if left untreated, can progress to cancer.
What are the symptoms that should alert you and what treatments are available today?
Cervical cancer is often asymptomatic in its early stages, making early detection all the more crucial. However, certain signs should alert women, such as abnormal vaginal bleeding outside of menstruation, after sexual intercourse or after menopause, unusual vaginal discharge, often smelly or tinged with blood, and persistent pelvic pain, especially during sex. If abnormalities are detected during the clinical or paraclinical examination, targeted biopsies must be performed in order to confirm the presence of cancer cells and establish a precise diagnosis. Treatment for this disease varies depending on the stage and may include surgery, radiation therapy, and chemotherapy, often combined for optimal effectiveness. However, these treatments remain invasive, are often accompanied by significant side effects and represent a significant financial burden for health systems. For example, in France, the average cost of treatments varies from 9,164 euros for stage I to 26,886 euros for stage IV. These figures highlight the importance of investing in effective prevention strategies. Among these, early detection occupies a central place, offering the possibility of identifying precancerous lesions at a stage where interventions are less invasive, more effective and significantly less expensive.
-Indeed, visual inspection of the cervix with application of acetic acid (IVA) is used in Morocco for the early detection of cervical cancer, mainly in women aged 30 to 49 years. This simple, inexpensive and effective method makes it possible to identify precancerous lesions in health centers and reproductive health centers across the country. However, although IVA is favored for its ease of application, the cervical-vaginal smear (VCF) remains the gold standard method for detecting cellular abnormalities. Current recommendations call for FCV screening for women aged 25 to 65 years, with initial follow-up including three consecutive annual examinations. If the results are normal, screening every three years is then recommended. In the event of abnormal results, rapid treatment and close follow-up are necessary to avoid progression to invasive cancer. Alongside screening, primary prevention through vaccination against human papillomavirus (HPV) plays a vital role. Since October 2022, Morocco has integrated the quadrivalent HPV vaccine into its national immunization program. This vaccine, administered free of charge in health centers, mainly targets young girls aged 11, particularly those in school, with a two-dose schedule spaced six months apart. By combining regular screening programs with systematic vaccination of young girls, Morocco is equipping itself with powerful means to reduce the incidence of this disease and improve public health.
Globally, the World Health Organization (WHO) has set an ambitious goal: to eliminate cervical cancer as a public health problem by 2030. This vision is based on the “90 -70-90”, which aims to:
- Vaccinate 90% of girls against HPV before the age of 15.
- Screen 70% of women before age 35, then a second time before age 45.
- Ensure that 90% of women diagnosed receive adequate treatment.
This initiative could prevent more than 40% of new cases and save 5 million lives by 2050. To achieve this goal, it is imperative to strengthen political commitment, mobilize sufficient resources and intensify awareness campaigns , particularly in low- and middle-income countries, where cervical cancer remains a major public health problem. In this month of January, awareness month dedicated to this disease, it is therefore essential to recall the importance of these actions combining vaccination, screening and treatment to effectively fight against preventable cancer and save lives.
