Incidence of hepatocellular carcinoma in children in Khon Kaen before and after national hepatitis B vaccine program.

BACKGROUND: Hepatitis B virus infection is one of the most important risk factors for hepatocellular carcinoma. Hepatitis B vaccination has been obligatory in the Expanded Program on Immunization (EPI) in Khon Kaen since 1990. OBJECTIVE: To compare the incidence of hepatocellular carcinoma in children in Khon Kaen province before and after the introduction of national hepatitis B vaccination program. METHODS: Cases of liver tumors in children under 18, diagnosed during 1985-2007, were retrieved from the population-based cancer registry of Khon Kaen. Patients were divided into 2 groups, vaccinated and non-vaccinated with hepatitis B vaccine regarding the year of birth before or after 1990. Patients with diagnosis of liver cancer from any basis of diagnosis in population-based registration, except hepatoblastoma, were included. Patients without verified histology were assumed as having hepatocellular carcinoma if the age at diagnosis was over 10. Age-standardized incidence rates (ASRs) were analyzed and expressed as numbers per 1,000,000 population. RESULTS: Fifteen patients aged 13 to 18 years were included in this study. The mean and median ages at diagnosis were 15.7 and 15 years respectively. Four children had a verified histology (age 14 to 18 years, median and mean = 16). The remaining 11 patients were diagnosed based on history and physical examination, radiology and death certificate, at the aged of 13 to 18 years. The ASRs for liver cancer in children over 10 years of age of non-vaccinated and vaccinated children were 0.88 and 0.07 per million respectively (p = 0.039). When calculated by including children at or older the 5 years of age, the ASRs for non-vaccinated and vaccinated cases were 0.97 and 0.24 per million respectively (p = 0.007). CONCLUSIONS: The incidence of hepatocellular carcinoma is significantly lower in Thai children who receive hepatitis B vaccine at birth.

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.

Result of video-education on "genetic transmission in thalassemia" to thalassemic patients and their parents.

OBJECTIVE: To determine the degree of knowledge improvement and retention after a single viewing of a video CD presentation on the genetic transmission of thalassemia among patients with thalassemia and their parents. MATERIAL AND METHOD: The present research was approved by Khon Kaen University Ethics Review Board A video CD on the genetic transmission of thalassemia was created as an educational tool for improving knowledge and retention. The validity and the informative usefulness of the video CD was evaluated, adapted and approved by a thalassemia expert. Between November 1, 2002 and September 30, 2005, 61 subjects (thalassemic patients and their parents, both groups were in reproductively active ages) at the Pediatric Outpatient Unit, Srinagarind Hospital, Khon Kaen, consented to participate. Their ages ranged between 17 and 50 years (mean +/-SD = 36.5 +/- 9.4; median = 38.0) and 44.3% completed elementary while 26.2% completed secondary school. Their occupations varied. Mothers, fathers, and thalassemic patients comprised 68.9%, 21.3%, and 9.8% of participants, respectively. In a quiet room in the Unit, each subject watched a single viewing of the video. A validated questionnaire (Cronbach's alpha coefficient = 0.79) with 40 true/false items was used to evaluate baseline knowledge on the genetic transmission of thalassemia. Knowledge was retested four times: immediately after the viewing, then at the 4th, 12th, and 24th week. The scores for each test were skewed toward high scores; therefore, non-parametric tests were used for the statistical evaluation. RESULTS: The running time for the video CD was 20 minutes. The baseline knowledge on genetic transmission was high. Immediately after a single viewing of the video, the knowledge level increased significantly (p = 0.000, 95% CI = 4.0-7.0) and was maintained up to the 12th week, after which (at the 24'h week) there was a significant drop (p = 0.020, 95% CI = -2.0 to 0) compared to the immediate post-test. CONCLUSION: The authors' video CD presentation effectively provided knowledge on the genetic transmission of thalassemia to patients with thalassemia and their parents. Post-viewing knowledge increased significantly and was retained for at least 12 weeks. Thereafter a refresher should be taken.

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.

Cancer incidence trends in Thailand, 1989-2000.

Through 2004, five cancer registries in Thailand have collected data for more than ten years. Three-year cancer incidence in Thailand covering the years 1989-1997 has been regularly reported in three volumes of 'Cancer in Thailand. Since the data for the last decade of the 20th century have been collected, the trends in incidence of some cancer sites were analyzed. Data sources were registry data from Chiang Mai, Lampang, Khon Kaen, Bangkok, and Songkhla, which are representative of the four major geographic regions of Thailand. The data drawn in 2002 covered the years 1989 to 1997 for Bangkok, the other four registries drew data from 1989 to 2000. The population denominators were estimated from the two censuses in 1990 and 2000. Only cancers of the liver, lung, colon-rectum, female breast, uterine cervix, and all cancer sites were analyzed since cancers of these sites may have major public health impacts. Age-specific incidence rates of different 5-year age groups were projected through the period 2007-2009 using a linear regression model if the rates were increasing, and a log-linear model to prevent prediction of a negative rate if the rates were decreasing. During the past decade, colorectal and breast cancers showed a statistical significant increasing trend, while the trend was generally stable for cancer of other sites. The number of new cancer cases of all sites is expected to be approximately 125,000 by the year 2008, compared with 81,000 in 1999. However, the accuracy of projections depends very much on the quality of the cancer registries' data. The Bangkok registry significantly improved case ascertainment in recent years, while the Chiang Mai registry had a consistent drop in incidence of cancer at many sites. In-depth investigation of some cancer sites and age period cohort modeling are required for better understanding of cancer trends in Thailand.

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.

Cancer incidence in Thailand, 1995-1997.

There are five population-based cancer registries in Thailand in different regions of the country. Four of them (Chiang Mai, Khon Kaen, Bangkok, and Songkhla) have been operating since 1988 and the other (Lampang) since the early 1990s. These registries have published regular 3-year cancer incidence reports since the first in 1993 for the period 1989-1991. The objective of this article is to summarize the figures of cancer incidence in Thailand during 1995-1997. The population of Thailand in 1996, at the middle of the period, was 27 million males and 27.5 million females. Information of cancer cases residing in the five provinces was collected and abstracted from different sources. Age-standardized incidence rate (ASR) of cancer in males and females was calculated for each registry and that for the whole country was estimated using the five registries as representatives for the four geographical regions of Thailand. The estimated number of new cancer cases in 1996 for the whole country was 35,539 men and 38,476 women and the ASRs were 149.2 and 125.0 per 10(5) population in men and women respectively. Cancer incidences greatly differed from region to region. Lung cancer was the commonest in Chiang Mai and Lampang in the Northern region in both sexes. The incidence of liver cancer in Khon Kaen in the Northeastern region outnumbered all the others in both sexes; cholangiocarcinoma was the major type of liver cancer. In Bangkok, lung cancer was the most important cancer in males and breast cancer was in females. Though it was lung and cervix uteri cancer that ranked the first in men and women in Songkhla, the rate of oral and pharyngeal cancer was exceptionally higher than in other registries. The geographical variability in cancer patterns in Thailand reflects exposure of the population to different risk factors unique to the different regions. In the study as a whole, there are some methodological weak points in estimating the ASRs and number of cancer cases for the whole country, but the results are the most reliable cancer statistics from Thailand at the moment. In conclusion, both a country-wide and region-specific cancer control programmes are needed for Thailand. The national one would be for the cancers common to all regions, and the provincial-level emphasis should be on cancers which are the major problems in the area.

Surveying the prevalence of asthma, allergic rhinitis and eczema in school-children in Khon Kaen, Northeastern Thailand using the ISAAC questionnaire: phase III.

This is the second survey of schoolchildren in Khon Kaen, Northeastern Thailand, using the Thai version of the ISAAC questionnaire to examine the trend in the prevalence of asthma, allergic rhinitis and eczema, and to compare the results with the ISAAC Phase I data. We analyzed 5,075 questionnaires comprising 2,119 six- to seven- and 2,956 thirteen- to fourteen-year-old children (48 and 42 percent male, respectively). The cumulative vs. 12-month prevalence according to the written questionnaires were: 14.3 vs. 9.8% for wheezing, 42.6 vs. 33.3% for rhinitis and 13.5 vs. 11.2% for eczema, respectively. The cumulative vs. 12-month prevalence for the wheezing module, based on the video questionnaire, was 9.2 vs. 6.3%, respectively. Most Phase III prevalence was significantly lower than the first survey except for the steady, 12-month prevalence of wheeze. Our study confirms the high prevalence of allergic diseases among school-children in Northeastern Thailand; albeit, prevalence has not increased in recent years. The Thai version of the English-language ISAAC questionnaire needs to be validated before further use in epidemiological research.

Childhood cancer in Thailand: 1995-1997.

The incidences of childhood cancers in Thailand between 1995 and 1997 were determined from cancer registrations collected at five locations around the kingdom and compared with similar analyses performed at cancer registries in Asia, Europe and the USA. The incidence in Thailand was found to be lower than in some Asian and Western countries. Between 1988-1994 and 1995-1997, the incidence of childhood cancer rose 32.5%. As elsewhere in the world, leukemias, brain tumors and lymphomas comprised two-thirds of all childhood cancers. The age-peak for incidence was between 2 and 5 years, particularly for acute lymphoblastic leukemia. Carcinomas were rare. Several features of the cancer pattern correspond to other Asian populations, in particular the low incidence of Hodgkin s disease, Wilms tumor and Ewing s sarcoma. Neuroblastoma was more common than in neighboring Southeast Asian countries.

Pleuropulmonary blastoma in a child presenting with spontaneous pneumothorax.

The authors described a 27-month-old boy with the diagnosis of pleuropulmonary blastoma who presented with spontaneous pneumothorax. The child was admitted to our hospital with the chief complaint of respiratory distress for 8 months. Initial chest X-ray revealed tension pneumothorax on the right side. After chest tube insertion to the right side, a repeated chest X-ray showed minimal pleural effusion and a mass-like lesion at the right lower lung field. Computed tomography (CT) of the chest showed a cavity with intramural mass confined in the right lower lung accompanied with hydropneumothorax. The surgery revealed a cystic and solid mass occupying the right pleural space medially displacing the right lower lung. Total removal of the mass was performed, the histopathologic findings revealed a mixed cystic and solid type of pleuropulmonary blastoma which was composed of primitive blastema with multidirectional differentiation. Combination chemotherapy consisting of vincristine, cyclophosphamide, doxorubicin and dactinomycin was administered two weeks after surgery. The child has been well for almost 6 months since the surgery, without any signs of metastasis or recurrence.