Context.
Breast cancer is the leading cancer among women in Morocco. Since 2010, a national organized early breast cancer detection program has been institutionalized and integrated into all primary healthcare facilities in the Kingdom.
The chosen model is based on screening through clinical breast examination at primary healthcare facilities. Confirmation by mammography is performed at dedicated support centers or by mobile mammography units. Women with suspicious lesions are referred to the oncology center after biopsy and histopathological confirmation. This organization aims to reduce diagnostic delays, improve the detection of lesions at an early stage, and strengthen continuity of care.
Objective
The objective of this study is to analyze the process and outcome indicators of the national early breast cancer detection program after fifteen years of implementation.
Materials and Methods
To analyze the performance of the early breast cancer detection organized program, a secondary analysis of programmatic data was conducted. Data sources included annual reports on breast cancer screening, diagnosis, and management activities. The indicators studied were selected and then analyzed according to the first pillar of the WHO’s Global Breast Cancer Initiative: early detection and its indicator linked to the stages at the time of diagnosis.
The evaluation is based on a comparative analysis of the period 2020–2024, corresponding to the implementation phase of the second PNPCC 2020–2029.
Results
Analysis of the national early breast cancer screening program demonstrates nationwide coverage by early detection activities. 7,300 healthcare professionals – physicians and nurses – offer screening at primary healthcare centers. It currently covers approximately two million women per year, with a detection rate of about 1.2 per 1,000 women screened. Between 2022 and 2024, annual screening coverage of between 53% and 65.5% was achieved, despite some persistent regional disparities. The screening adherence rate is 23%. The referral rate to diagnosis is 2.6%, which is lower than the expected rates of 5–7%. This may be related to the limited sensitivity of clinical breast examination as a breast cancer screening test. The proportion of breast cancers diagnosed at stages I–II is 64%, according to data from the Greater Casablanca Cancer Registry, which is higher than the WHO threshold of 60%.
Conclusion
The organized early breast cancer detection program has helped to structure and institutionalize early detection of this cancer at the national level. However, the impact in terms of early detection remains limited, highlighting the need to improve the quality of screening, streamline the diagnostic process, and enhance coordination between different levels of care, in accordance with the guidelines of the WHO's Global Breast Cancer Initiative.