Association between Smoking and Mortality: Khon Kaen Cohort Study, Thailand

Kamsa-ard, Siriporn,Promthet, Supannee,Lewington, Sarah,Burrett, Julie Ann,Sherliker, Paul,Kamsa-ard, Supot,Wiangnon, Surapon,Parkin, Donald Maxwell Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.4

Background: Despite anti-smoking campaigns, smoking prevalence among Thai males aged 30 or older is high, at around 50%. The purpose of this study was to determine the relationship between smoking and mortality in a rural Thai community. Materials and Methods: Subjects enrolled into the Khon Kaen cohort study between 1990 and 2001 were followed up for their vital status until $16^{th}$ March 2012. The death resource was from the Bureau of Policy and Strategy, Ministry of Interior, Thailand. A Cox proportional hazards model was used to analyse the association between smoking and death, controlling for age, education level and alcohol drinking, and confidence intervals were calculated using the floating risk method. Results: The study recruited 5,962 male subjects, of whom 1,396 died during a median 13.5 years of follow-up. Current smokers were more likely to die than never smokers after controlling for age, education level and alcohol drinking (HR, 95%CI: 1.41, 1.32-1.51), and the excess mortality was greatest for lung cancer (HR, 95%CI: 3.51, 2.65-4.66). However, there was no increased risk with increasing dose of tobacco, and no difference in risk between smokers of yamuan (hand-rolled cigarettes) and manufactured tobacco. Conclusion: Mortality from cancer, particularly lung cancer, and from all causes combined is dependent on smoking status among men in rural Thailand, but the relative risks are lower than have been reported from studies in high income countries, where the tobacco epidemic is more established.

Association between Praziquantel and Cholangiocarcinoma in Patients Infected with Opisthorchis viverrini: A Systematic Review and Meta-Analysis

Kamsa-Ard, Supot,Laopaiboon, Malinee,Luvira, Vor,Bhudhisawasdi, Vajarabhongsa Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.11

Background: The liver fluke, Opisthorchis viverrini, and the associated incidence of subsequent cholangiocarcinoma (CCA) are still a public health problem in Thailand, and praziquantel (PZQ) remains the antihelminthic drug of choice for treatment. Evidence in hamsters shows that repeated infection and PZQ treatments could increase the risk of CCA. However, the existing evidence in humans is inconclusive regarding increased risk of CCA with frequency of PZQ intake. Objectives: To investigate the relationship between number of repeated PZQ treatments and CCA in patients with O viverrini infection. Materials and Methods: The reviewed studies were searched in EMBASE, MEDLINE, ProQuest, PubMed and SCOPUS from inception to October, 2012 using prespecified keywords. The risk of bias (ROB) of included studies was independently assessed by two reviewers using a quality scale from the Newcastle-Ottawa Scale (NOS). Risk effect of PZQ was estimated as a pooled odds ratio (OR) with its 95% confidence interval (95%CI) in the random-effects model using DerSimonian and Laird's estimator. Results: Three studies involving 637 patients were included. Based on the random effects model performed in two included studies of 237 patients, the association between PZQ treatments and CCA was not statistical significant with a pooled OR of 1.8 (95%CI; 0.81 to 4.16). Conclusions: The present systematic review and meta-analysis provides inconclusive evidence of risk effect of PZQ on increasing the risk of CCA and significant methodological limitations. Further research is urgently needed to address the shortcomings found in this review, especially the requirement for histological confirmation.

Association between Pesticide Use and Cholangiocarcinoma

Jeephet, Kornthip,Kamsa-ard, Siriporn,Bhudhisawasdi, Vajarabhongsa,Kamsa-ard, Supot,Luvira, Varisara,Luvira, Vor Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.8

Background: Thailand remains a primarily agricultural country and Thai farmers are heavy users of pesticides. Coincidentally the incidence of cholangio carcinoma (CCA) is high in parts of the country, but no previous study has examined any association between the two. Materials and Methods: The present matched, case-control study covered patients admitted to Srinagarind Hospital, Khon Kaen University, Thailand. The case group comprised 210 cases diagnosed with CCA and the control group 840 diagnosed with other diseases. Cases and controls were matched for sex, age within five years, and date of admission within three months. Multiple conditional logistic regression was used for the analysis. Results: After adjusting for potential confounders, pesticide use as compared with never used pesticide was not associated with CCA (ORadj=1.11, 95% CI: 0.77, 1.60) and neither was there any significant relationship between CCA and duration of pesticide use, type or number of types pesticide use. Conclusions: The current study thus found no association between pesticide use and CCA.

Trends in Incidence of Hepatocellular Carcinoma, 1990 - 2009, Khon Kaen, Thailand

Wiangnon, Surapon,Kamsa-Ard, Supot,Suwanrungruang, Krittika,Promthet, Supannee,Kamsa-Ard, Siriporn,Mahaweerawat, Suwannee,Khuntikeo, Narong Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.3

Background: 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. Objective: To assess the incidence trend of hepatocellular carcinoma in Khon Kaen, Thailand, between 1990 and 2009. Methods: 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. Results: 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). Conclusions: The incidence trends have been decreasing in both sexes. The recent decline in incidence may represent a falling risk.

Retrospective Appraisal of Cancer Patients from Vientiane Capital City, Lao People's Democratic Republic (PDR), Seeking Treatment in Thailand

Chaleunvong, Kongmany,Kamsa-ard, Supot,Suwanrungruang, Krittika,Wiangnon, Surapon,Sychareun, Vanphanom,Alounlangsy, Phetsamone,Durham, Jo,Promthet, Supannee Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.9

Background: Recent estimates suggest that in the Lao People's Democratic Republic (Lao PDR) the burden of cancer in terms of DALYs lost is amongst the highest in South East Asia. As such, increasingly cancer is becoming an important public health concern in the country. Lao PDR however has no population-based cancer registry and only one hospital-based registry. Cancer treatment within the country is extremely limited. Patients who can, may travel to neighboring countries for treatment, but little information about this is available in the country. The aim of this study was to estimate some of the otherwise largely unknown parameters of the cancer burden in Lao PDR. Materials and Methods: This is a retrospective, descriptive study based on the records of 847 Lao cancer cases treated with surgery, radiation and chemotherapy at Srinagarind Hospital, Khon Kaen University, in Thailand between 1988 and 2010. Results: The annual rate of registration of Lao cancer cases fluctuated, but showed an increasing trend. Most cancers were diagnosed by histology (65.2%), and a combination of endoscopy and radiology (15.6%). In most cases (70.2%) the stage of cancer at diagnosis could not be determined. In those whose stage could be identified, 54.0% were at the final stage (Stage IV). Among males, the commonest cancer sites were the liver (16.1%), blood (12.3%) and nasopharynx (10.6%). Those in female patients were the cervix (22.2%), breast (14.6%) and blood (8.1%). Conclusions: This study indicates that despite some fluctuations, the number of Lao cancer patients presenting at Srinagarind Hospital, Khon Kaen, gradually increased between 1988 and 2010. The unfavorable pattern of late-stage cancer diagnosis among male and female patients suggests a need for cancer control interventions and the establishment of cancer registration and treatment facilities within Lao PDR.

Data Quality of Childhood Cancer in Khon Kaen, Thailand, 1990-2007

Suwanrungruang, Krittika,Kamsa-ard, Supot,Wiangnon, Surapon Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.18

Introduction: Khon Kaen Cancer Registry (KKCR) was established in 1984. KKCR aims to collect all cancer cases in Khon Kaen Province. The poorly qualified data may lead to distort the cancer burden and misinterpretation of policy maker. Objective: To assess data quality in childhood cancer between 1990 and 2007 in Khon Kaen Province, Thailand. Materials and Methods: Data of childhood cancer cases aged less than 20 years diagnosed during 1990-2007 were retrieved from the population-based data set of KKCR. All childhood cancer data were verified before data entry. Internal consistency, percentage of morphological verification (MV%) and cancer cased of the basis of diagnosis by death certificate only (DCO%) were evaluated. The age-adjusted rate (ASR) was calculated by standard method. Results: The data of childhood cancer from KKCR is acceptably qualified which reflects the quality of the whole registration.

Survival Rates of Breast Cancer: A Hospital-Based Study from Northeast of Thailand

Poum, Amornsak,Kamsa-Ard, Supot,Promthet, Supannee Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.3

A retrospective cohort study was carried out with 340 female breast cancer at a teaching university in northeast of Thailand recruited and followed-up until the end of 2006. Survival probabilities were estimated using the Kaplan-Meier method. 161 cases were alive after five years and 58 patients were lost to follow-up. The overall observed survival rates at 1, 3 and 5 years were 83.3%, 59.9% and 42.9%, respectively. When analysis was conducted for stage combined into 2 groups, early (stage I, II and unknown) and late (stage III and IV), the 5-year survival rate for early stage (60%; 95%CI: 0.51-0.67), was higher than for late stage (27%; 95%CI: 0.19-0.34) with high statistical significance (p<0.001). The hazard ratio of patients with stage IV was 11.6 times greater than for stage I (p=0.03). The findings indicate that the different stages of breast cancer markedly effect the overall survival rate.

Proximity of Health Care Center and Cervical Cancer Screening Uptake in Thailand

Polrit, Kornnika,Kamsa-ard, Siriporn,Jirapornkul, Chananya,Promthet, Supannee Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.7

Background: Cervical cancer is one of the most common cancers among women worldwide, and in Thailand is the second most common cancer among women. In 2008, a national cervical cancer screening programme was implemented in Thailand, but coverage remains relatively low. Objectives: The purpose of the study was to investigate whether cervical cancer screening uptake is associated with the area of residency in Thailand. Materials and Methods: A case-control study was carried out in women aged 30 to 60 year-old, who live in Sikhiu district, Nakhon Ratchasima province, Thailand. Structured-questionnaires were used to interview 226 women (cases) who had attended cervical cancer screening in the last five years and 226 women (controls) who had not. Multiple logistic regression was used to investigate the association between the area of residency and cervical cancer screening uptake. Results: After controlling for parity, marital status and duration of hormonal contraceptive use, an association between the area of residence and cervical cancer screening uptake could not demonstrated ($OR_{adj}$ 1.27, 95%CI: 0.79, 2.04). Conclusions: We found no evidence to suggest remoteness to health care center led to lower cervical cancer screening uptake.

Reproductive Risk Factors for Thyroid Cancer: A Prospective Cohort Study in Khon Kaen, Thailand

Sungwalee, Wararat,Vatanasapt, Patravoot,Kamsa-ard, Siriporn,Suwanrungruang, Krittika,Promthet, Supannee Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.9

Background: Because of the gender disparity in the incidence of thyroid cancer, this study aimed to determine the association between reproductive factors and thyroid cancer. Methods: A total of 10,767 eligible women from the Khon Kaen Cohort, recruited and interviewed between 1990 and 2001, were followed up until 2011. The data were linked to the Khon Kaen Population-Based Cancer Registry to detect thyroid cancer cases. Results: There was 17 thyroid cancer cases detected, an incidence of 11.2 per 100,000 person-years, of which 70.6 % were papillary tumors. The incidence was apparently greater among those with an early age of menarche, nulligravida women, and oral contraceptive users. Conlusions: There was a trend for thyroid cancer to develop in relation to longer estrogen exposure. This evidence is inconclusive but warrants further investigation.

Relationship Between the Body Mass Index and Abnormal Pap Smears

Prompakay, Russameekae,Promthet, Supannee,Kamsa-ard, Siriporn,Suwanrungruang, Krittika,Wiangnon, Surapon,Bradshaw, Peter Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.9

This cross-sectional analytic study aimed to investigate any relationship between the body mass index (BMI) and an abnormal Pap smear. The subjects were 7,720 women aged 30-69 years who lived in Khon Kaen Province, Thailand, and had been recruited as participants in the Khon Kaen Cohort Study during 1990-2001. All had received Pap smear screening for cervical cancer. The data were analyzed using descriptive and inferential statistics. Multiple logistic regression was used to determine the relationship between body mass index and an abnormal Pap smear. The mean BMI was $24.53kg/m^2$ (SD=3.98), and 2.14% had abnormal Pap smears. Compared with the reference group of women with a BMI ${\leq}22.9kg/m^2$, those with a body mass index of $23.0-24.9kg/m^2$ had a reduced risk of an abnormal smear (ORadj=0.92, 95%CI: 0.57-1.47), but women with a BMI $25.0-29.9kg/m^2$ were found to have an approximately 1.24 times higher risk ($OR_{adj}=1.24$, 95%CI: 0.86-1.80), and those with a BMI ${\geq}30.0kg/m^2$ had an approximately 1.63 times higher risk ($OR_{adj}=1.63$, 95%CI: 0.98-2.69). The results indicated that the risk of Pap smear abnormalities is increased in women who have a higher than normal body mass index, but this finding was not statistically significant. Nevertheless, public health personnel should encourage women to maintain their BMI in the normal range to reduce the possible future risk of cervical cancer.