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ABSTRACT: Liver cancer is the most frequent cancer among Thais especially people in northeastern Thailand, but there has as yet been no assessment of trend. The data of all cancers in Khon Kaen can be retrieved from data base of the Khon Kaen Cancer Registry (KKCR) which was established in 1984.
To assess the incidence trend of hepatocellular carcinoma in Khon Kaen, Thailand, between 1990 and 2009.
Population-based cases of liver cancer registered between 1985 and 2009 were retrieved from the KKCR data base and cases with diagnosis of hepatocellular carcinoma (HCC) with the coding C22.0 according to ICD-O were selected. Incidence trends were calculated using the Jointpoint analysis.
There were 7,859 cases of HCC during the study period. Males were affected two times more frequently than females. The most common age group of cases was 50 and 69 years (60.3%). Most patients were diagnosed based on radiology imaging (40.6%) while the morphology verification was 7%. The age-standardized rates (ASR) were 13.1 to 49.8 per 100,000 among males and 4.8 to 38.4 per 100,000 among females depending on year of diagnosis since 1985. Remarkably, the ASRs were clearly low during first few years of starting the registration. The overall ASRs of HCC were 30.3 per 100,000 in males (95% CI: 25.9 to 34.6) and 13.1 per 100,000 (95% CI: 10.4 to 15.8) in females. During 1990-2009, the trends in incidences have been decreasing significantly with the annual percent change (APC) of 6.2% per year (95% CI: -7.6 to -4.8) in males and by 6.5% per year in females (95% CI: -8.4 to -4.9).
The incidence trends have been decreasing in both sexes. The recent decline in incidence may represent a falling risk.
Asian Pacific journal of cancer prevention: APJCP 01/2012; 13(3):1065-8. · 0.66 Impact Factor
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ABSTRACT: The ability and behaviour of the capture-recapture method using a virtual three-source model for evaluation of the level of completeness of case ascertainment requires exploration.
Cancer cases obtained from 9 population-based cancer registries in Thailand during 2003 to 2007 were applied for capture-recapture using a model based on clinical, pathological and mortality data. These three virtual sources were derived from three actual items common to all cancer registries: the basis of diagnosis, ICD-O morphology code, and last known patient status. Poisson regression models were fit to the data to estimate parameters which were then transformed into demographic values. A linear model was used to determine the predictors and estimated percentage of completeness (EPC) in case ascertainment among the cancer registries.
The EPC was greater than 97% in 5 and less than 90% in 4 registries. The worst had an EPC of 70%. The percentage death certificate only (%DCO) and the interaction between %DCO and morphological verification (MV) were significantly associated with EPC. Other factors intrinsic to registries also exerted influence on the EPC.
In addition to other standard indicators to monitor completeness of cancer registries, the present virtual three-source capture-recapture model can be routinely used to estimate the level of completeness of case ascertainment in cancer registries.
Asian Pacific journal of cancer prevention: APJCP 01/2011; 12(1):173-8. · 0.66 Impact Factor
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ABSTRACT: The Khon Kaen Cancer Registry (KKCR), having both hospital and population-based registration, was established in 1984 at the Faculty of Medicine, Khon Kaen University. Liver cancer is the most frequent malignancy among Thais from northeastern Thailand, but there has hitherto been no assessment of trends over time.
To perform a statistical assessment of the incidence trends between 1985 and 2009 of liver cancer, specifically focusing on cholangiocarcinoma (CHCA).
Cases of CHCA, registered between 1985 and 2009, were retrieved from the KKCR and all those with a specific ICD-O-3rd diagnosis with a coding of C22.1, C24.0, C24.8 and C24.9 were selected. Incidence trends were calculated using the generalized linear model method (GLM), which generates incidence rate based logarithms. Jointpoint analysis was used to identify the best fitting model.
Of the 18,589 cases of liver cancer 42% (7,859) were hepatocellular carcinoma and 58% (10,731) were CHCA. Among persons with CHCA, males were affected two times more frequently than females. Three-quarters of the cases were between 55 and 69 years of age. Morphology verified through a cytological or histological examination of tissue from the primary site (%MV) was only 10.8 % (1,141). The respective overall Age Standardized Rate (ASR) for CHCA from 1985 to 2009 was 16.8 to 62.0 per 100,000 among males and 4.8 to 25.6 per 100,000 among females. The respective, overall, ASR of CHCA among males vs. females was 44.3 per 100,000 (95% CI: 38.9 to 49.7) vs. 17.6 (95% CI: 14.5 to 20.7). Among males vs. females, the respective incidence from 1990 to 2009 has been significantly decreasing by -0.7% per year (Annual Percent Change, APC: -0.7%, 95%CI: -2.1% to +0.8%) vs. -0.4% per year (APC: -0.4%, 95% CI: -2.1% to +1.4%).
The rate increase in the first 5 to 6 years may be due to improved completeness of the registry, since in the subsequent 10 to 12 years there is a rather stable rate. It may be, however, that the recent decline in incidence represents a real fall in risk.
Asian Pacific journal of cancer prevention: APJCP 01/2011; 12(9):2209-13. · 0.66 Impact Factor
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ABSTRACT: This study was aimed to describe incidence, trends, and survival of oral and pharyngeal cancers in Khon Kaen, the province situated in the northeast of Thai-land.
Data on oral and pharyngeal cancer cases diagnosed during 1985 - 2001 were retrieved from the population-based cancer registry of Khon Kaen. The final status of the patients was verified by database linkage and follow-up using postcards.
Of 1,038 cases, 62.6% were female and 37.4% were male, with a mean age of 63 years. The age-standardized incidence rate (ASR) in females (6.2 per 100 000; 95%CI 5.7-6.7) was significantly higher than in males (3.9 per 100 000; 95%CI 3.5-4.4). Annual percent changes in ASR were 1.7 in females (p<0.05), but 1.2 in males. Lip and buccal cancers were the most common sites respectively; however, the incidence of tongue cancer was increasing in the last period. Eighty five percent of all cases were diagnosed in advanced stage (stage III and IV). The overall five-year relative survival was 43.1%. We found stage distribution and survival did not change during the study period.
The considerably high incidence in female suggests a need for research on specific risk factors. Moreover, attempts should be made to detect oral cancers earlier in order to improve the outcomes of cancer control.
Asian Pacific journal of cancer prevention: APJCP 01/2011; 12(10):2505-8. · 0.66 Impact Factor
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ABSTRACT: The magnitude of differences in mortality incidence (M:I) ratios derived from the national mortality source and those derived from cancer registry (CR) databases may be used to determine associated factors.
All information on cancer incidence cases and mortality cases from January 1, 2003 to December 31, 2007 were retrieved from 5 population-based cancer registries in four regions of Thailand. Two sources of mortality were used: death cases within the cancer registries and mortality statistics obtained from the Ministry of Public Health (MOPH). Plots of percentage M:I ratios from cancer registry databases and from national mortality sources against 1 minus 5 years relative survival (1-5yrRS) were used to visualize the correlation between the two mortality sources. A Poisson regression model was used to determine the influence of cancer sites and registries on the M:I ratio/[1-5yrRS].
There was high variability between the standard M:I ratio derived from national mortality compared with 1-5 year RS. The factors affecting M:I ratios are sources of mortality data and misclassification of topographic site as the cause of death.
Use of the M:I ratio is not recommended to evaluate completeness of cancer registry data when the quality of mortality data is poor.
Asian Pacific journal of cancer prevention: APJCP 01/2011; 12(12):3283-8. · 0.66 Impact Factor
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Rengaswamy Sankaranarayanan,
Rajaraman Swaminathan,
Hermann Brenner,
Kexin Chen,
Kee Seng Chia,
Jian Guo Chen,
Stephen C K Law,
Yoon-Ok Ahn,
Yong Bing Xiang,
Balakrishna B Yeole, [......],
Bhagwan M Nene, Krittika Suwanrungruang,
Padmavathiamma Jayalekshmi,
Rajesh Dikshit,
Henry Wabinga,
Divina B Esteban,
Adriano Laudico,
Yasmin Bhurgri,
Ebrima Bah,
Nasser Al-Hamdan
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ABSTRACT: Population-based cancer survival data, a key indicator for monitoring progress against cancer, are not widely available from countries in Africa, Asia, and Central America. The aim of this study is to describe and discuss cancer survival in these regions.
Survival analysis was done for 341 658 patients diagnosed with various cancers from 1990 to 2001 and followed up to 2003, from 25 population-based cancer registries in 12 countries in sub-Saharan Africa (The Gambia, Uganda), Central America (Costa Rica), and Asia (China, India, Pakistan, Philippines, Saudi Arabia, Singapore, South Korea, Thailand, Turkey). 5-year age-standardised relative survival (ASRS) and observed survival by clinical extent of disease were determined.
For cancers in which prognosis depends on stage at diagnosis, survival was highest in China, South Korea, Singapore, and Turkey and lowest in Uganda and The Gambia. 5-year ASRS ranged from 76-82% for breast cancer, 63-79% for cervical cancer, 71-78% for bladder cancer, and 44-60% for large-bowel cancers in China, Singapore, South Korea, and Turkey. Survival did not exceed 22% for any cancer site in The Gambia; in Uganda, survival did not exceed 13% for any cancer site except breast (46%). Variations in survival correlated with early detection initiatives and level of development of health services.
The wide variation in cancer survival between regions emphasises the need for urgent investments in improving awareness, population-based cancer registration, early detection programmes, health-services infrastructure, and human resources.
Association for International Cancer Research (AICR; St Andrews, UK), Association pour la Recherche sur le Cancer (ARC, Villejuif, France), and the Bill & Melinda Gates Foundation (Seattle, USA).
The lancet oncology 12/2009; 11(2):165-73. · 14.47 Impact Factor
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ABSTRACT: Fifty seven cases of cancer of the cervix were identified within a cohort of 16,648 women enrolled in a cohort study of lifestyle and cancer in a rural population of Northeast Thailand. They were compared with 228 matched controls from the same cohort, with respect to demographic, behavioural and reproductive factors potentially associated with risk of the disease. Number of pregnancies and age at having first child were associated with the risk of cervical cancer, but in contrast to studies elsewhere, age at having first sexual intercourse, number of sexual partners and sexually-transmitted infections were not associated with risk. The lack of effect may be simply due to the small size of the study. But it is also likely that these aspects of female sexual behaviour are not very relevant in a relatively conservative rural population. These aspects may be investigated further in future, as new incident cancers are accrued into the cohort.
Cancer Detection and Prevention 02/2004; 28(5):334-9. · 2.52 Impact Factor
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ABSTRACT: The incidence of gastric cancer in the countries of South East Asia is variable, ranging from age-standardized rates of 20.9/105 (men) and 10.4/105 (women) in Hanoi, Vietnam to 4.1/105 (men) and 2.1/105 (women) in Khon Kaen, Thailand. The reasons for these differences are unknown. Possible explanations are differences in dietary habits, alcohol drinking, smoking and/or the prevalence of infection with Helicobacter pylori (H. pylori). A case-control study was conducted in Khon Kaen, Thailand, to study the role of these factors in gastric cancer carcinogenesis. 131 gastric cancer cases and 262 matched controls were recruited for the study. Information on dietary habits, alcohol drinking and smoking were collected by a structured questionnaire. Blood samples were available from 111 cases and 232 controls for H. pylori assay. Using an unconditional logistic regression model controlling for age and sex, we assessed the effects of dietary habits, alcohol drinking, smoking and H. pylori infection on the risk of gastric cancer. A high intake of salt (OR=1.8; 95%CI 1.1-3.0) and fermented foods (OR=1.9; 95%CI 1.1-3.3) was found to be associated with an increased risk. Preference for spicy food was not associated with gastric cancer risk in this population. Although there were negative associations between gastric cancer and vegetable and fruit intake, they were rather weak (OR 0.8 for both) and non significant. There were also weak (non-significant) associations with smoking and alcohol consumption, and no association with H. pylori infection (OR=0.6; 95%CI 0.4-1.0). Infection of H. pylori was associated with various indicators of crowding.
Asian Pacific journal of cancer prevention: APJCP 02/2002; 3(4):345-352. · 0.66 Impact Factor
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ABSTRACT: The life styles of Thai people are changing with westernization and this would be expected to have an impact on the prevalence of cancer and other non-communicable diseases. For planning control programmes it is necessary to monitor change over time and the present study was conducted to provide information on stomach and colorectal cancer incidence rates in Khon Kaen Cancer Registry (KKCR), established in 1984 at the Faculty of Medicine, Srinagarind Hospital, Khon Kaen University.
To assess trends in urban and rural areas of Khon Kaen province during 1985 - 2004.
Data for stomach and colorectal cancer with an ICD-O diagnosis (coding C16 , C18 - C20) from the population-based cases of the KKCR, registered between 1985 and 2004, were retrieved and incidence trends were calculated using the Generalized Linear Model method (GLM), which generates incidence-rate-based logarithms.
The study population comprised 2,530 cases, 721 of stomach (males 449, females 272) and 1809 of colorectal (males 976, females 833) cancer. Most cases were aged 35-75 years. According to the histopathological diagnosis, the most common was adenocarcinoma with over 90 percent. The overall age-standardized incidence rates (ASR) for stomach cancer were 4.5 and 1.4 per 100 000 in males and females, respectively, during 1985-1989, 3.7 and 2.0 during 1990-1994, 3.0 and 2.2 during 1995-1999 and 3.6 and 1.8 during 2000-2004 . The respective figures for colorectal cancer were 3.3 and 2.6, 4.6 and 3.1, 5.4 and 3.5 and finally 5.8 and 5.3. In both urban and rural areas males were affected more frequently than females, although a shift was evident towards decrease in the se ratio was evident for colorectal cancers over time.
The results of this study showed slight increase in the incidence of colorectal cancer in Khon Kaen province, while rates for stomach cancer remained quite stable. The findings indicate a need for continuing research in stomach and colorectal cancer epidemiology, with subdivision into particular sites within these two sections of the gut.
Asian Pacific journal of cancer prevention: APJCP 7(4):623-6. · 0.66 Impact Factor
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ABSTRACT: The Khon Kaen Cancer Registry (KKCR), providing both hospital and population-based registration, was established in 1984 in the Faculty of Medicine, Khon Kaen University. Leukemia is the most common cancer among Thai children in Thailand, including both curable and preventable types, but no assessment of trends has hitherto been performed.
To perform a statistical assessment of the incidence trend of childhood leukemia in Khon Kaen, Thailand, between 1985 and 2002.
Population-based cases of childhood leukemia registered between 1985 and 2002 were retrieved from the KKCR and cases with an ICD-O diagnosis (coding C42) in children under 15 were selected. Incidence trends were calculated using the Generalized Linear Model method (GLM), which generates incidence-rate-based logarithms.
Of the 277 cases of leukemia, boys were affected two times more frequently than girls and half of the cases were 0-4 years of age. Most diagnoses were histologically- or cytologically-proven and the most common type (affecting two-thirds, 65.7%) was acute lymphoblastic leukemia (ALL). The overall, age-standardized rate (ASR) for leukemia was 31.9 per million (95%CI: 28.1 to 35.7); 40.3 per million (95%CI: 34.2 to 46.4) in boys and 27.0 (95%CI: 21.8 to 32.2) in girls. Incidence has been increasing by 2.4% per year in boys (95% CI: -0.5 to 5.3) and 4.1% per year in girls (95% CI: 1.1 to 7.2).
This incidence-rate-based logarithm indicates that childhood leukemia has been increasing, suggesting further epidemiological research on causes and possible prevention is needed.
Asian Pacific journal of cancer prevention: APJCP 7(1):75-8. · 0.66 Impact Factor
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ABSTRACT: The incidence of colorectal cancer is variable around the world. Hiroshima, Japan had the highest incidence in men in 1997 with an age-standardized rate of 86.7 per 100,000 and New Zealand had the highest, at 40.6 per 100,000, in women. The incidence of colorectal cancer in Thailand is rather low and the latest figures for Northeast of Thailand are 7.1 per 100,000 for men and 4.7 for women. The reasons for these differences between countries are possibly due to variation in dietary habits, alcohol drinking or other cofactors.
A case-control study was conducted in Khon Kaen, Northeast Thailand during 2002-2006 to study risk factors for colorectal cancer in a low risk area. Totals of 253 colorectal cancer cases (males 135, females 118) and 253 age- and sex-matched controls were recruited. Information on dietary habits, alcohol drinking, smoking and other information were collected by a structured questionnaire. Blood samples were collected for further study. Both univariate and multivariate analyses were carried out.
In the final model of multivariate analysis, the significant risk factors for colorectal cancer were a family history of cancer (OR=1.9 95%CI=1.2-2.9) and meat consumption (OR=1.0 95%CI=1.0007-1.0026). For BMI, subjects with higher BMI unexpectedly had a lower risk of colorectal cancer (OR=0.5 95%CI=0.3-0.8).
Our study confirmed risk factors for colorectal cancer i.e. meat consumption and cancer in the family (genetic problem). However, the results for BMI are the reverse of expected, underlining one limitation of hospital-based case-control studies, in which cases are ill and admitted to the hospital at late stage.
Asian Pacific journal of cancer prevention: APJCP 8(4):573-7. · 0.66 Impact Factor
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ABSTRACT: Cervical cancer is the most common cancer in Thai women and as yet screening programmes are minimally effective. The Pap smear is the test accepted to be most appropriate for cervical cancer screening so far. One of the main reasons why women do not come to have Pap smear done is "shyness", which weakens compliance with recommendations to undergo Pap smear with pelvic examination. The self-administered device by the Kato method was established to overcome this problem and the present study was carried out to confirm the adequacy of the specimens obtained with this technique in comparison with specimens collected by gynecologists. Two hundred women were invited to participate in the study voluntarily. Each was allocated to have a Pap smear conducted by a gynecologist and then instructed to produce a self-obtained smear using Kato's device. The cytology results of Pap smears from both methods were compared to test for agreement using Kappa statistics. There was agreement between the adequacy of smears collected by gynecologists and those self-sampled with the percentage agreement of 96.5% and a Kappa score of 0.43 (95% CI 0.33-0.54, P<0.001). There were 8 cases detected as epithelial cell abnormalities from the cervical cells collected by gynecologists and also with the self-administered technique. Good agreement for detection of cellular changes was found with a percentage of 78.0% and the Kappa's score was 0.61 (95% CI 0.46-0.76, P<0.001). The results from this study provide convincing evidence that the self-administered device can be an alternative choice for women who are too shy to undergo pelvic examination or even for those who have limited time to visit health care centers or doctors to have a Pap smear test.
Asian Pacific journal of cancer prevention: APJCP 4(2):99-102. · 0.66 Impact Factor
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ABSTRACT: Cervical cancer is a common cancer in Thai women and one of the only cancers that can be readily cured if early detection is successful. The Pap smear is an accepted as an appropriate means for cervical cancer screening at present. However, there are still some management problems with early detection programmes. Since data showing how many women have been screened by Pap smear are limited in Thailand, the present study was conducted with the aim of determining coverage in a defined population in the sample area, Thakaserm sub- district in Nampong district, Khon Kaen province, Thailand. The investigation was carried out during June-August 2000 to collect information on history of screening for cervical cancer using questionnaires. All women aged 20 and above were asked to answer the set of questionnaires a total of 1199 women responded. There were 66.9% that reported having received a Pap smear test for screening for cervical cancer at least once. However, there were 33.1 % that had never undergone a Pap smear in their life. It is important to find a strategy to increase the coverage of cervical cancer screening programme for this population.
Asian Pacific journal of cancer prevention: APJCP 4(2):103-5. · 0.66 Impact Factor
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ABSTRACT: As part of an ongoing project involving a large cohort in the Khon Kaen Province in the North-east of Thailand, a total of 236 women who had tested positive for a Pap smear at the initial recruitment and advised to seek medical attention were followed up after a mean period of 3.1 years. The 204 individuals who could be contacted were interviewed to determine treatments received and underwent a further Pap smear as well as colposcopy in 179 of the cases. On clinical advice, biopsies were also taken from 32 of these. Only 15% of the total of 204 had actually received therapy, the majority undergoing surgery (self-reported). Possible positive Pap smear results were obtained for 23.5%, with 6.4% having high grade squamous intraepithelial lesions (HGSILs) or squamous cell carcinoma (SCC) (one case). Comparison of the different testing modalities demonstrated 5.6% false negatives and 16.2 false positives for the Pap smear with colposcopy as the gold standard. Compared with biopsy findings, there were 21.8% and 40.6% false positives with Pap and colposcopy, respectively, but no false negatives. The present results point to good efficacy for the initial screening, since only 0.5% of the total population developed an SCC. However, judgement as to therapy should depend on a biopsy since there were considerable false positives with the other two modalities employed.
Asian Pacific journal of cancer prevention: APJCP 8(1):135-6. · 0.66 Impact Factor
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ABSTRACT: The incidence of cancer of the cervix uteri in Khon Kaen Province is moderately high (age-standardised rate 16.8 per 100 000 person-years), with about a two-fold variation in incidence between different districts. Stage at presentation is considerably more advanced than in the United States and Europe, and there has been little change in incidence over the last 15 years. Currently, control of cervix cancer is through early detection and treatment. Screening programmes have, to date, been opportunistic, but a new national plan anticipates that all women will be screened six times during their lifetime. The results from Khon Kaen provide a benchmark against which the success of this policy can be evaluated.
Asian Pacific journal of cancer prevention: APJCP 4(4):312-8. · 0.66 Impact Factor
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ABSTRACT: This descriptive study was carried out to test the acceptability of a self-administered device for cervical cancer screening and assess certain risk factors in relation to the cancer in two districts of Khon Kaen province in Northeast Thailand.
A total of 354 women from the villages were selected (including 143 teachers from secondary and primary schools; 24 health officers from the rural health centres, and 37 nurses from the University Hospital, Khon Kaen University). The Kato device was introduced and used by the women, who were then asked to give their opinion on its usage.
The Kato device was generally well accepted by the women. However, many of those with a higher educational background were more sceptical towards the device than their counterparts from the villages.
A suitable approach to strengthen the control of cervical cancer in the rural areas of Thailand might be to introduce the Kato device as an integral part of primary health care. The introduction of the device should go along with health education on the importance of avoiding infection with the papilloma viruses. This message should be transmitted to both females and males.
Asian Pacific journal of cancer prevention: APJCP 5(2):144-50. · 0.66 Impact Factor
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ABSTRACT: Stomach cancer is not common in Thailand but the life styles of the Thai population are changing to become more Western so that information for planning control programme of stomach cancer is necessary. The highest incidence rates of this neoplasm are found in Eastern Asia, ranging from age-standardized rates of 95.5/105 (men) and 40.1/105 (women) in Yamagata, Japan to 4.1/105 (men) and 2.1/105 (women) in Khon Kaen, Northeast of Thailand. In Thailand, the estimated age-standardized incidence rates in 1993, 1996 were 4.9/105, 4.1/105 in men and 3.0/105 , 2.6/105 in women. Risk factors for stomach cancer in Thai population are unclear, but possibly include low intake of vegetables and fruits, alcohol drinking, tobacco smoking and high intake of salt.
To investigate various aspects of dietary factors, smoking, and alcohol drinking in determining risk of stomach cancer in Thai population.
A case-control study was conducted in Khon Kaen, Thailand during 2002-2006, to study the role of these factors in stomach cancer. 101 stomach cancer cases and 202 matched controls (case : control = 1:2) by sex, age (? 3 years) and region were recruited from Srinagarind Hospital and Khon Kaen Regional Hospital, in Khon Kaen Province. All of cases were histologically confirmed. Controls had a variety of diseases, the main ones being disease of the eye. Information on dietary habits, alcohol drinking and smoking were collected by a structured questionnaire, blood samples were collected for further study.
The distribution of the general characteristics by case-control status, the distribution of age and sex were similar in cases and controls. In the final analysis, the factors that found to be higher risk but not statistically significant were long-term filter cigarette smoking (OR=1.9, 95%CI: 0.85-4.50), long-term alcohol consumption (OR=1.2, 95%CI: 0.51-2.60) and low intake of vegetables and fruits (OR=1.2, 95%CI: 0.74-1.96). A high intake of vegetable oil (OR=4.5, 95%CI: 1.00.-20.17) was found to be associated with increased risk, and similar tendencies were noted for pork oil (OR=1.4, 95%CI: 0.63-3.01) and jeaw prik (mainly chilly with plara broth) (OR=1.2, 95%CI: 0 .76- 2.01).
Our study confirmed protective effects of a high intake of fruits and vegetables against stomach cancer development and showed a high intake of sauces to increase risk of stomach cancer as in other countries in Asia.
Asian Pacific journal of cancer prevention: APJCP 9(1):71-5. · 0.66 Impact Factor
