Cancer registration in north Africa Mokhtar Hamdi Cherif

Importance of Cancer Registration in North Africa Cancer is becoming a major problem of public health in North Africa cancer registries have become indispensable tools for information system and planning Now the three Maghreb countries have national strategic plans against cancer

Cancer registries in North Africa 5 10 Alger Blida Medea Boumerdes Setif Batna CNE Bejaia Jijel Annaba Biskra BBA Guelma El Tarf 4 Oran Tlemcen Saida Mostaganem

Materiel and Method -The Three Maghreb Cancer Registries use the CANREG 5 software, provided and updated by IARC The Data collection is done by active mode -In Algeria The Setif Cancer Registry uses for the The Data Analysis (SEER * Stat) provided by the National Institute of Cancer of the USA. for Analysis of temporal trends cancer Join Point

Algeria

New Challenge National Cancer Registration In Algeria, The New Challenge National Cancer Registration

Implementation of national network OF cancer registries National Cancer Plan 2015-2019 Strategic axis 6 Institutionalization of cancer registries Presidential Project Ministry of Health

Main Objective Cover 50 % of valited cancer registration in the national population at 31th December 2014.

Intermediate objectives Implementation of new departmental cancer registries Consolidate existing registries Establishment of a network of cancer registries by region Establishment of a national coordination of regional networks Periodic evaluation of registration activities annual publication of local ,regional and national incidence data Promote publications in CI5 Feed back information to different data sources

Preliminary Results of the East region network CANCER registries Target population: 15 799 103 inhabitants Covered Population Covered Rate implemented registries 14 224 482 inhabitants 88% validated registries 8 919 706 inhabitants 57%

Preliminary results of the Western region network CANCER registries Target population: 9 344 951 inhabitants Covered Population Covered Rate implemented registries 7 663 058 inhabitants 82 % validated registries 3 560 963 inhabitants 38%

Preliminary results of the Central Region network CANCER registers Target population: 13 555 946 inhabitants Covered Population Covered Rate implemented registries 10 161 371 inhabitants 75 % validated registries 7 744 175 inhabitants 57 %

Preliminary Results of national network cancer registries Target population: 38 700 000 inhabitants . Covered Population Covered Rate implemented registries 32 048 911 inhabitants 52 % validated registries 20 224 844 inhabitants 82 %

National estimation based on validated registries at December 31, 2014   Number of cases Crude rate ASR Men 16 748 100.2 109.2 Women 25 122 111.8 119.8 Total 41 870 106 114.5

Incidence of the Main Sites in Algeria, in men, 2014 Crude Rate /100,000 ASR (WR)/100,000 Median age Lung and Bronchus 16.9 25.8 61 Colo-rectum 10.3 14.3 65 Bladder 9.4 13.9 67 Prostate 8.2 11.8 71 Stomach 4,7 6,1 NPC 4.5 5.9 43 Non-Hodgkin Lymphoma 4,3 5,4 57 Larynx 3,0 63 Leukaemia 2,8 3,8 41

Incidence of the Main Sites in Algeria, in women, 2014   Sites Crude Rate /100,000 ASR (WR)/100,000 Median age Breast 54.4 65.2 47 Colo-rectum 12.2 16.5 56 Cervix 6.7 10.2 57 Thyroid 5.2 8.1 54 Non-Hodgkin Lymphoma 4.1 4.9 43 Stomach 3,7 4,7 gallbladder 3.5 4.5 Leukaemia 3,1 4,2 39

Setif Cancer Registry, Algeria Trend of the main sites 1986-2014 Setif Cancer Registry, Algeria

Trends of the main sites man 1986-2014, Setif,Algeria

Trends of the main sites women 1986-2014, Setif,Algeria IC-95%= (2,0; 3,3)

Annual projections of the number of cancer cases in Algeria

TUNISIA

TunisiA Cancer registries Target Population: 10 982 754 Inhabitants Covered Population: 6 546 466 Inhabitants Covered rate : 60% Rates / 100 000 Inhabitants Crude Rate ASR Male 122,5 129,9 Female 98,4 99,7

MORoCCO

Morocco Cancer registries Target Population: 33 848 242 Inhabitants Covered Population: 4 270 750 Inhabitants Covered rate : 18% Rates /100 000 Inhabitants Crude Rate ASR Male 112,5 132,8 Female 119,8 121,9

libya cancer registry Rates /100 000 Inhabitants Crude Rate ASR Target Population: 6 597 960 Inhabitants Covered Population: 1 478 783 Inhabitants Covered rate : 22 % Rates /100 000 Inhabitants Crude Rate ASR Male 74,8 138,5 Female 71 110

Comparison of COVERED population by CANCER REGISTRATION IN north africa country General Population covered Population Covered rate Algeria 38 700 000 32 048 911 82 % tunisia 10 982 754 6 546 466 60 % Morocco 33 848 242 6 243 436 18 % Libya 6 597 960 1 478 783 22 %

Comparison of ASR in North Africa Algeria Tunisia Morocco Lybia Men   Algeria Tunisia Morocco Lybia Men 109.2 129,9 132,8 138,5 Women 119.8 99,7 121,9 110,0 Total 114.5 114,8 127,4 124,3

Comparison OF ASR(WR)/100,000 of main sites in Men in North Africa Algeria (National Network) Tunisia (North) Morocco (Casablanca) Libya (Benghazi) Lung and Bronchus 25.8 30,6 25,9 27,8 Colo-rectum 14.3 10,5 8,1 13,8 Bladder 13.9 12,9 8,7 14,9 Prostate 11.8 11,4 13,5 14,7 Stomach 6,1 5,8 4,8 4,9 NPC 5.9 3,5 4,2 2,8 Non-Hodgkin Lymphoma 5,4 5,7 7,2 Larynx 4,3 6,0 5,5 Leukaemia 3,8 3,6 2,7

Comparison OF ASR(WR)/100,000 of main sites in Women in North Africa Algeria (National Network) Tunisia (North) Morocco (Casablanca) Libya (Benghazi) Breast 65.2 30,9 36,4 22,9 Colo-rectum 16.5 9,2 5,8 12,3 Cervix 10.2 4,6 15 4,5 Thyroid 8.1 3,3 6,7 3,8 Non-Hodgkin Lymphoma 4.9 4,7 4,3 Estomac 3,2 2,7 3,0 Gallbladder 4.5 2,6 1,9 Leukaemia 4,2 2,8 2,0 4,8

Registries validated by IARC with publication in CI5 (Cancer Incidence in Five Continents) In north africa Volumes CI5 VI CI5 VII CI5 VIII CI5 IX CI5 X Total Algeria Setif Algiers 5 Tunisia Sousse North 2 Morocco Libya Benghazi 1

Hope Algeria

Conclusion Cancer registration in North Africa has become a priority for Health Systems in Algeria, Morocco and Tunisia Cancer registries are now formalized and institutionalized The coverage of cancer registration is clearly increasing in North Africa we begin to have a completeness and good quality of cancer incidence data the incidence data for Maghreb countries compared with industrialized countries remain relatively low ,but have increased significantly over the last years Comparison of the incidence data in the three Maghreb countries does not show large differences