Evaluation of performance indicators of a national breast cancer screening program in Casablanca, Morocco

Morocco's national breast cancer screening program (NBCSP) was launched in 2010 in response to rising breast cancer incidence. The program comprises clinical breast examination (CBE) and diagnostic mammography and aims to improve early diagnosis and breast cancer management. This study evaluated key performance indicators of the NBCSP for the Casablanca-Settat region from 2018 to 2021.

Aggregated regional data on screening and diagnostic activities under the NBCSP were extracted from a health information system. Annual screening coverage, participation, CBE-positivity, and breast cancer detection rates for the region were then calculated. Screening numbers and CBE positivity rates were compared by year and sub-region using one-way ANOVA and Bonferroni multiple-comparison tests. Trends in breast cancer screenings were also compared using Pearson's correlation coefficients and statistical trend tests.

From 2018 to 2021, a total of 846,692 women in the Casablanca-Settat region were screened under the NBCSP, and 21,476 referred for a positive CBE to a designated secondary referral center for diagnostic mammography. Annual screening coverage rates of eligible women ranged from 10.4 to 28.8% during the study period. Only two out of nine administrative sub-regions in Casablanca-Settat achieved a desired 40% screening coverage threshold. Overall, annual participation among the target population from 2018 to 2021 decreased by 44.8%. Annual CBE positivity rates remained stable between 2.2 and 2.7%, though notable variations were observed at the sub-regional level. Over one-third (36.4%, n = 7,808) of CBE-positive women sought consultations at designated secondary referral centers in the region. Compliance to further diagnostic testing at these centers increased overtime, from 24.2% in 2018 to 61.9% in 2021. Breast cancer detection rates in the region from 2018 to 2021 were: 0.7, 0.8, 1.0, to 1.1 per 1000 women screened, respectively.

The NBCSP fell short of achieving its desired performance benchmarks in the Casablanca-Settat region from 2018 to 2021, notably in screening coverage, participation, and CBE positivity rates. Annual breast cancer detection rates under the program also remained low. Additional interventions are needed to increase screening participation, standardize CBE training, and establish linkages between health facilities to limit the underestimation of breast cancer under the NBCSP.