Tunisia Program - Working Meeting on Comprehensive Cervical Cancer Prevention and Control

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Rim Ben Aissa (ONFP), Leila Joudane (UNFPA Co) - Tunisia Program - Working Meeting on Comprehensive Cervical Cancer Prevention and Control

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Tunisia Program - Working Meeting on Comprehensive Cervical Cancer Prevention and Control

  1. 1. WORKING MEETING ON COMPREHENSIVE CERVICAL CANCER PREVENTION AND CONTROL TUNISIA Program Dr Rim Ben Aissa (ONFP) Dr Leila Joudane (UNFPA Co) Antalya, Turkey 18-20 May 2011CSB/UNFPA
  2. 2. MAGNITUDE AND BURDEN OF CERVICAL CANCER IN TUNISIA  2nd female cancer in Tunisia after Breast cancer  According to the North Tunisia cancer registry 2005 , incidence of cervical cancer remained stable from 1994 to 2003 , with an annual age-standardized incidence rate of 6 cases per 100,000 women.  250 new cases per year  Invasive cancer rare before 35 years ( 2.9% of cases of cancer)  Average age of invasive cancer 55 years versus 42.2 years for carcinoma in situ  Adenocarcinoma is rare ( 5.3 %)CSB/UNFPA
  3. 3. MAGNITUDE AND BURDEN OF CERVICAL CANCER IN TUNISIAMost of women are diagnosed at late stage disease• carcinoma in situ :7.2:%• Local extension:13.6%• Regional extension :52.9%• Metastasis: 3.9%CSB/UNFPA
  4. 4. CERVICAL CANCER SCREENING PROGRAMME• Population of Tunisia is about 10 millions habitants• Number of women eligible for the program is about 2millions 2000 primary health care centers – 24 reproductive health centers (one /governorate) offering gynecologyst services/colposcopy One cytology unit per region; each region cover 4 governorates Referral services (surgery,radiotherapy) available on the 3 main governorates CSB/UNFPA
  5. 5. CERVICAL CANCER SCREENING PROGRAM: DESCRIPTIONTARGET:ONE PAP SMEAR DURING LIFE, AT LEAST, FORWOMEN VISITING REPRODUCTIVE HEALTHCENTERS AND HEALTH CARE CENTERS ANDBETWEEN 35-59 YEARS1 PAP SMEAR EVERY 3 YEARS: FOR HIGH RISKWOMEN (WOMEN EXPOSED TO HIGH RISK OFSTI, HAVING MULTIPLE PARTNERS WITHOUTUSING ANY PROTECTION) CSB/UNFPA
  6. 6. CERVICAL CANCER SCREENING PROGRAMME - DESCRIPTION The cervical screening program is based on Pap smears performed mostly by midwifes (1 mide wife per 800 women from 15-49 years) Pap smears are transported to cytology units and readen by cytologists Quality control system : anatomopathologists ensure second reading of 10% of pap smears at random and all abnormal pap smears Colposcopy performed by gynecologist in the reproductive health center for every positive pap smear Referral for treatment of every cervical cancer diagnosed CSB/UNFPA
  7. 7. CERVICAL SCREENING PROGRAMME: RESULTS• COVERAGE RATE : 14% out of 2 millions target women was screened in 5 years,• 54% of pap smears are normal• 17,5% are inflammatory• 0,02% high grade• 0,06% low grade CSB/UNFPA
  8. 8. SCREENING AND TREATMEN PROGRAMME CHALLENGES AND ACTIONS TAKENCHALLENGES ACTIONS TAKEN Low rate of coverage (14%) because of the  Sensitize target population especiallylimited number of cytologists most at risk womenDelay to deliver result to women: only 50%  Training of health care providers on papof women has their results by the end of the smear technicalmonth Advocacy for recruiting 45 cytologists tolow knowledge about the program: 20% of cover 60% of eligible populationtarget population have never heard about theprogram  Improve the referral system, M&E system Over treatment of low grade lesions Delay for treatment monitoring and evaluation system weakEstimation cost of the program to cover60% of the target population: 10 millions $ CSB/UNFPA
  9. 9. SCREENING AND TREATMENT PROGRAMME WAY FORWARD  Sensitize target population to screening and STI prevention  Sensitize health care provider to screening  Improve health care providers training  Develop a comprehensive information , monitoring and evaluation system  Develop cytology units Develop HPV testing as primary screening ? Low HPV prevalence Make vaccine more affordable ? Low prevalence of HPV 16 & 18CSB/UNFPA
  10. 10. Prévalence de l’ADN des HPVs dans la population étudiée Nombre de sujets %HPV- 94 92HPV+ 8 7,84Total 102 100 10
  11. 11. Types d’HPV observésType d’HPV Nombre de virus Bas risque 5HPV 6 1HPV11 3HPV42 1CP6108 2Risque intermédiaire 2 ( 25%)HPV 56 1HPV73 1Haut risque 3HPV16 3HPV18 0HPV31 0 11
  12. 12. THANKS FOR YOUR ATTENTIONCSB/UNFPA

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