Lifestyle-related risk factors for stomach cancer in northeast Thailand.

BACKGROUND: 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. OBJECTIVE: To investigate various aspects of dietary factors, smoking, and alcohol drinking in determining risk of stomach cancer in Thai population. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Risk factors for colorectal cancer in northeast Thailand: lifestyle related.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Pap smear, colposcopy and biopsy findings at follow-up of Pap smear positive women in North-east Thailand.

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.

Trends in incidences of stomach and colorectal cancer in Khon Kaen, Thailand 1985-2004.

BACKGROUND: 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. OBJECTIVE: To assess trends in urban and rural areas of Khon Kaen province during 1985 - 2004. METHODS: 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. RESULTS: 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. DISCUSSION: 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.

Trends in incidence of childhood leukemia, Khon Kaen, Thailand, 1985-2002.

BACKGROUND: 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. OBJECTIVE: To perform a statistical assessment of the incidence trend of childhood leukemia in Khon Kaen, Thailand, between 1985 and 2002. METHODS: 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. RESULTS: 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). CONCLUSIONS: This incidence-rate-based logarithm indicates that childhood leukemia has been increasing, suggesting further epidemiological research on causes and possible prevention is needed.

Experience with a self-administered device for cervical cancer screening by Thai women with different educational backgrounds.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Cervix cancer in Khon Kaen, northeast Thailand, 1985-1999.

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.

A comparison of cytology with Pap smears taken by a gynecologist and with a self-sampling device.

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.

The coverage of cervical cancer screening in Khon Kaen, northeast Thailand.

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.