Opisthorchiasis with proinflammatory cytokines (IL-1ß and TNF-α) polymorphisms influence risk of intrahepatic cholangiocarcinoma in Thailand: a nested case-control study.

BACKGROUND: Chronic inflammation and repeated infection with Opisthorchis viverrini (O. viverrini) induces intrahepatic cholangiocarcinoma (ICC). Inflammatory cytokines such as interleukin (IL) and tumor necrosis factor (TNF) are substances in the immune system that promote inflammation and causes disease to progress. Genes that help express proinflammatory cytokines can affect an individual's susceptibility to disease, especially in cancer-related chronic inflammation. This study aimed to investigate risk factors for ICC with a focus on opisthorchiasis and polymorphisms of proinflammatory cytokines (IL-1ß and TNF-α). METHODS: This study was a nested case-control study within a cohort study. 219 subjects who developed a primary ICC were identified and matched with two non-cancer controls from the same cohort based on sex and age at recruitment (±3 years). An O. viverrini-IgG antibody was assessed using enzyme linked immunosorbent assay. IL-1ß and TNF-α polymorphisms were analyzed using a polymerase chain reaction with high resolution melting analysis. Associations between variables and ICC were assessed using conditional logistic regression. RESULTS: Subjects with a high infection intensity had higher risk of ICC than those who had a low level (OR = 2.1; 95% CI: 1.2-3.9). Subjects with all genotypes of TNF-α (GG, GA, AA) and high infection intensity were significantly related to an increased risk of ICC (p < 0.05). CONCLUSIONS: Polymorphisms of IL-1ß and TNF-α are not a risk of ICC, but an individual with O. viverrini infection has an effect on all genotypes of the TNF-α gene that might promote ICC. Primary prevention of ICC in high-risk areas is based on efforts to reduce O. viverrini infection.

Human papillomavirus (HPV) infection in a case-control study of oral squamous cell carcinoma and its increasing trend in northeastern Thailand.

Human papillomavirus (HPV) is an independent risk factor for development of oral squamous cell carcinoma (OSCC). This study aimed to investigate the role of HPV infection and the trend in percentage of HPV-associated OSCC over a 5-year period in northeastern Thailand. In this case-control study, 91 exfoliated oral cell samples and 80 lesion cell samples from OSCC cases and exfoliated oral cells from 100 age/gender-matched controls were collected. HPV infection was investigated by PCR using GP5+/GP6+ primers followed by HPV genotyping using reverse line blot hybridization. Quantitative RT-PCR was used to evaluate HPV oncogene transcription. Temporal trends of HPV infection were evaluated in archived formalin-fixed paraffin-embedded (FFPE) OSCC tissues using in situ hybridization. HPV DNA was found in 17.5% (14/80) of lesion samples from OSCC cases and 29.7% (27/91) of exfoliated oral cell samples from the same cases. These values were significantly higher than in exfoliated oral cell samples from controls (13%, 13/100). HPV-16 was the genotype most frequently found in OSCC cases (92.8%, 13/14 infected cases). Interestingly, HPV oncogene mRNA expression was detected and correlated with OSCC cases (P < 0.005). Of 146 archived FFPE OSCC samples, 82 (56.2%) were positive for high-risk HPV DNA and 64 (43.8%) cases were positive for HPV E6/E7 mRNA expression. There was a trend of increasing percentage of HPV-associated OSCC from 2005 to 2010. This was especially so for females with well-differentiated tumors in specific tongue sub-sites. We suggest that HPV infection plays an important role in oral carcinogenesis in northeastern Thailand.

The XRCC 1 DNA repair gene modifies the environmental risk of stomach cancer: a hospital-based matched case-control study.

BACKGROUND: Previous studies have found that polymorphisms of the DNA repair gene X-ray repair cross-complementing group 1(XRCC1) and environmental factors are both associated with an increased risk of stomach cancer, but no study has reported on the potential additive effect of these factors among Thai people. The aim of this study was to investigate whether the risk of stomach cancer from XRCC1 gene polymorphisms was modified by environmental factors in the Thai population. METHODS: Hospital-based matched case-control study data were collected from 101 new stomach cancer cases and 202 controls, which were recruited from2002 to 2006 and were matched for gender and age. Genotype analysis was performed using real-time PCR-HRM. The data were analysed by the chi-square test and conditional logistic regression. RESULTS: The Arg/Arg homozygote polymorphism of the XRCC1 gene was associated with an increased risk of stomach cancer in the Thai population (OR adj, 3.7; 95%CI, 1.30-10.72) compared with Gln/Gln homozygosity. The effect of the XRCC1gene on the risk of stomach cancer was modified by both a high intake of vegetable oils and salt (p = 0.036 and p = 0.014), particularly for the Arg/Arg homozygous genotype. There were, however, no additive effects on the risk of stomach cancer between variants of the XRCC1gene and smoking,alcohol or pork oil consumption. CONCLUSIONS: The effect of the XRCC1 gene homozygosity, particularly Arg/Arg, on the risk for stomach cancer was elevated by a high intake of vegetable oils and salt.

Cohort profile: cholangiocarcinoma screening and care program (CASCAP).

BACKGROUND: Cholangiocarcinoma (CCA) is an extremely aggressive cancer that is usually fatal. Although globally morbidity and mortality are increasing, knowledge of the disease remains limited. The Mekong region of Southeast Asia, and particularly the northeast of Thailand, has by far the highest incidence of CCA worldwide with 135.4 per 100,000 among males and 43.0 per 100,000 among females being reported in Khon Kaen Province. Most patients are first seen during late stage disease with 5-year survival being less than 10%. Starting in 1984, control and prevention strategies have been focused on health education. Although early detection can substantially increase 5-year survival, there are currently no strategies to increase early diagnosis. METHODS/DESIGN: The Cholangiocarcinoma Screening and Care Program (CASCAP) is a prospective cohort study comprising two cohorts- the screening and the patient cohorts. For the screening cohort, ultrasound examination will be carried out regularly at least annually to determine whether there is current bile duct and/or liver pathology so that the optimal screening program for early diagnosis can be established. This cohort is expected to include at least 150,000 individuals coming from high-risk areas for CCA. For the patient cohort, it is estimated that about 25,000 CCA patients will be included during the 5-year recruitment period. All CCA patients will be treated according to routine clinical care and followed so that effective surgical treatment can be formulated. This cohort is indeed a conventional cancer registry. Thus, CASCAP is an ongoing project in which the number of participants changes dynamically. DISCUSSIONS: This is the first project on CCA that involves screening the at risk population at the community level. At the time of preparing this report, a total of 85,927 individuals have been enrolled in the screening cohort, 55.0% of whom have already undergone ultrasound screening, and 2661 CCA cases have been enrolled in the patient cohort. Among the participants of the screening, whose mean age was 53.8±9.8 years, 55.6% were female, 77.5% attained primary school as the highest level of education, 79.9% were farmers, 29.9%, reported having relatives with CCA, 89.1% had eaten uncooked fish, and 42.2% of those who had been tested for liver fluke were found to be infected.

Association of Epstein-Barr virus infection with oral squamous cell carcinoma in a case-control study.

BACKGROUND: Besides the well-known risk factors, Epstein-Barr virus (EBV) might play a significant role in oral squamous cell carcinoma (OSCC). To explore the role of EBV in OSCC, the prevalence of EBV infection in oral exfoliated cells of OSCC cases and controls in northeastern Thailand was investigated, and the association of EBV in tumor lesion cells was further confirmed. METHODS: Oral exfoliated cells were collected from OSCC cases and non-cancer controls. Cells from tumor lesions were taken from OSCC patients for further strong confirmation of the association of EBV with OSCC. EBV DNA was detected by polymerase chain reaction (PCR) using primers specific for EBV DNA polymerase. The EBV DNA positive samples were confirmed further by nested PCR. RESULTS: Epstein-Barr virus was detected in the oral exfoliated cells of 45.05% of OSCC patients and 18.08% of the non-cancer control (P < 0.001). Similarly, EBV was detected in 32.5% of the tumor lesions. Betel quid chewing was statistically significantly associated with EBV prevalence (OR = 2.08), whereas no association with tobacco smoking and alcohol consumption. Alcohol consumption and betel quid chewing were significantly associated with OSCC (OR = 3.05 and OR = 5.05, respectively), but tobacco smoking was not associated. Interestingly, EBV was significantly associated with OSCC (OR = 3.76). CONCLUSIONS: Epstein-Barr virus prevalence is associated with OSCC and seems to be enhanced by betel quid chewing, suggesting that EBV may, together with betel quid chewing, act as an important etiological risk factor of OSCC.

Factors associated with delayed diagnosis of breast cancer in northeast Thailand.

BACKGROUND: We identified factors associated with delayed first consultation for breast symptoms (patient delay), delayed diagnosis after first consultation (doctor delay), and advanced pathologic stage at presentation among 180 women with breast cancer in Thailand. METHODS: In this cross-sectional study 180 patients with invasive breast cancer were interviewed about potential risk factors and markers of delayed presentation. Patient delay was defined as time from onset of symptoms to first consultation with a health care provider, and doctor delay was defined as time from first consultation with a health care provider to diagnosis of breast cancer. Linear regression and logistic regression were used for the data analyses. RESULTS: Among the 180 patients, 17% delayed seeking consultation for longer than 3 months, and 42% reported a doctor delay of longer than 3 months. In multivariate linear analysis, a significant increase in patient delay was associated with higher family income and smoking; factors associated with increased doctor delay were previous breast symptoms, self-treatment, and travel time to the hospital. In multiple logistic regression, doctor delay was related to age at first birth (P = 0.003), previous breast symptoms (P = 0.01), and number of consultations with a surgeon before diagnosis (P = 0.007). Regarding stage of breast cancer, there were significant associations with age at diagnosis (P for trend = 0.04), education (P for trend = 0.01), family income (P for trend = 0.02), time to referral (P = 0.01), and number of consultations with a surgeon before diagnosis (P < 0.01). CONCLUSIONS: Hospital referral from a health care provider was a major contributor to delayed diagnosis. Breast cancer awareness campaigns in Thailand should target individuals in low- and high-income groups, as well as practitioners.

Hormonal contraceptive use and breast cancer in Thai women.

BACKGROUND: Breast cancer is the most common cancer in women worldwide. We investigated the association of hormonal contraceptive use and breast cancer in Thai women. METHODS: A cohort study was conducted in Khon Kaen, Thailand. There were 70 cases of histologically confirmed breast cancer among 11 414 women aged 30 to 69 years who were recruited as participants in the cohort study during the period from 1990 through 2001. The study population was followed-up until December 31, 2011. To identify factors associated with incidence of breast cancer, hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a Cox proportional hazards model. RESULTS: The 11 414 women provided a total observation time of 157 200 person-years. Breast cancer risk among women with a history of hormonal contraceptive use was 1.31 times that of women without such a history, but the difference was not statistically significant (95% CI, 0.65-2.65). No type of hormonal contraceptive was associated with a significant increase in breast cancer risk as compared with women who had never used hormonal contraceptives (oral contraception: HR = 1.35, 95% CI, 0.65-2.78; injection contraception: HR = 1.25, 95% CI, 0.56-2.80), and there was no relationship between duration of hormonal contraceptive use and breast cancer. CONCLUSIONS: There was no association between hormonal contraceptive use and breast cancer; however, this finding should be viewed with caution due to the small number of cases.

Alcohol consumption and mortality: the Khon Kaen Cohort Study, Thailand.

BACKGROUND: The prevalence of alcohol consumption among Thais is high, around 30%. We quantified the relationship between alcohol drinking and mortality in a rural population in the most populous region of Thailand. METHODS: The data were from the Khon Kaen Cohort Study. About 24 000 Thai adults were enrolled between 1990 and 2001, and follow-up for vital status continued until March 16, 2012. Mortality data were obtained from the Bureau of Policy and Strategy, Ministry of the Interior, Thailand. A Cox proportional hazards model was used to analyze the association between alcohol drinking and death, controlling for age, education level, and smoking, and floating absolute risk was used to estimate the 95% confidence intervals of hazard ratios. RESULTS: In total, 18 457 participants (5829 men and 12 628 women) were recruited, of whom 3155 died (1375 men and 1780 women) during a median follow-up period of 13.6 years. Although alcohol drinking was common (64% of men and 25% of women), the amounts consumed were very low (average, 4.3 g/day in men and 0.8 g/day in women). As compared with never drinkers, mortality risk was lower among current drinkers and higher among ex-drinkers. Current drinking was not associated with mortality from cancer or diseases of the circulatory system, although ex-drinkers appeared to have a higher risk of death from the latter. CONCLUSIONS: The leading causes of mortality were not associated with current alcohol drinking at the low consumption levels observed in this population.

Risk factors for colon cancer in Northeastern Thailand: interaction of MTHFR codon 677 and 1298 genotypes with environmental factors.

BACKGROUND: Polymorphisms in methylenetetrahydrofolate reductase (MTHFR), such as MTHFR C677T and A1298C, are associated with several cancers. This study aimed to evaluate the effects of MTHFR polymorphisms on colon cancer risk and possible interactions with environmental factors in a population from northeastern Thailand. METHODS: This hospital-based case-control study was conducted during 2002-2006; 130 colon cancer cases and 130 age- and sex-matched controls were enrolled. Information was collected and blood samples were obtained for assay of MTHFR C677T and A1298C polymorphisms by polymerase chain reaction with restriction fragment length polymorphism techniques. Associations between variables of interest and colon cancer were assessed using conditional logistic regression. RESULTS: Increased risk of colon cancer was associated with alcohol consumption and bowel habits. Alcohol drinkers who consumed < or = 0.50 or >0.50 units of alcohol per day had elevated risks (OR(adj) = 3.5; 95% CI: 1.19-10.25 and OR(adj) = 1.71; 95% CI: 0.74-3.96, respectively). The risk was also higher in subjects with frequent constipation (11.69; 2.18-62.79) and occasional constipation (3.43; 1.72-6.82). An interaction was observed between the MTHFR C677T polymorphism and freshwater fish consumption on colon cancer risk (P value for interaction = 0.031). Interactions were observed between the MTHFR A1298C polymorphism and bowel habits, family history of cancer, alcohol consumption, and beef consumption on colon cancer risk (P-value for interaction = 0.0005, 0.007, 0.067, 0.003, respectively). CONCLUSIONS: In a Thai population, colon cancer risk was associated with alcohol and beef consumption, bowel habits, and family history of cancer. Interactions between MTHFR polymorphisms and environmental factors were also observed.

Incidence of and Risk Factors for Tuberculosis among Cancer Patients in Endemic Area: A Regional Cohort Study.

BACKGROUND AND OBJECTIVE: Cancer is a known risk factor for developing active tuberculosis (TB) disease. The incidence of and risk factors for TB are not known among cancer patients in Thailand. This study aimed to investigate risk factors for TB among cancer patients in an area with endemic TB infections. METHODS: We used the Khon Kaen population-based cancer registry and two TB databases to conduct a retrospective cohort study of cancer patients. From 2001 to 2015, we identified 40,948 eligible cancer patients. Following until 2017, we identified cases of TB diagnosed after cancer diagnosis and analyzed primary cancer site, staging, treatment, and demographic factors. Adjusted incidence rate ratios (adj. IRR) were computed to identify risk factors among a sub-set of cancer types (n = 9,733) using Poisson regression. RESULTS: Among all cancer patients, 472 cases of TB were diagnosed following cancer diagnosis (cumulative incidence = 1.15%, incidence rate = 421.86 cases per 100,000 patients per year). Among the sub-set of cancer types, 206 cases of TB were found (cumulative incidence = 2.11%, incidence rate = 848.26 cases per 100,000 patients per year). Risk factors for TB among cancer patients were sex (p < 0.001) (male adj. IRR  = 1.87, 95% CI: 1.36-2.59), age (p < 0.001) (age >70 adj. IRR  = 2.36, 95% CI: 1.56-3.55, compared to age ≤50) and cancer site (p < 0.001). Compared to thyroid cancer, TB infection was more associated with lung cancer without histopathological confirmation (adj. IRR  = 6.22, 95% CI: 2.57-15.04). Cancer stage and treatment did not show statistically significant trends. CONCLUSION: Old age, male sex, and certain cancer types were independent risk factors for TB in cancer patients. Targeted latent TB screening may be appropriate among high risk groups.

Coffee Consumption and Lung Cancer Risk: A Prospective Cohort Study in Khon Kaen Thailand.

BACKGROUND:   Lung cancer is a major cause of cancer death worldwide. The incidence of lung cancer in Thailand increasing, but risk factors are rarely reported. OBJECTIVE: To investigate the effect of coffee consumption on lung cancer in Thai population. METHODS: Between 1990 and 2001, lifestyle and demographic data were collected from 24,528 participants in the Khon Kaen Cohort Study (KKCS), who were followed through 2016, by linking to the Khon Kaen Population-based Cancer Registry. A total of 12,668 eligible participants (68.8% females, mean age 51.0 years at baseline) having complete datasets (239,488 person-years of follow up with 138 incident cases of lung cancer observed) were analyzed using a multi-variable adjusted Cox proportional hazard models. RESULTS: Coffee consumption was associated with reduced risk for lung cancer (adj. HR = 0.54; 95% CI: 0.35-0.84) after adjusting for age and gender.  Cigarette smoking (adj. HR = 2.76; 95% CI: 1.32-5.78) and family history of cancer (adj. HR = 1.65; 95% CI: 1.10-2.48) were associated with higher risk. CONCLUSION: This study suggests coffee consumption may be a protective factor for lung cancer in among this cohort.
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Factors Associated with Time Intervals for Diagnosis of Colorectal Cancer: A Hospital Based Study in Khon Kaen, Thailand.

BACKGROUND: Colorectal cancer (CRC) is among the five-leading cancers in Thailand. Delayed diagnosis is crucial for undermining the prognosis of the patients. This study aims to evaluate the factors associated with the time interval for diagnosis (TID). METHODS: A cross-sectional analytical study of 191 CRC patients with histological confirmation who were undergoing treatment in the tertiary hospital in Khon Kaen Province was conducted. The data were obtained by interview and retrieving from medical records. The time interval in each diagnostic process is reported in geometric mean. The geometric mean ratio (GMR) used to interpret the results from multiple linear regressions that analyze the relationship between factors and log-transformed TID. RESULTS: Most patients were males (61.78%) with  mean age of 61.28±10.2 years old. The geometric mean of TID was 263.48 days. Two factors were significantly associated with longer TID: first visit at a tertiary hospital (GMR=7.77 relative to secondary hospital; 95%CI=1.95 to 30.57) and distance to tertiary healthcare. Two factors were significantly associated with shorter TID: officer/ state enterprise (GMR=0.53 relative to agriculture; 95%CI=0.28 to 0.98) and cost of traveling to secondary healthcare. CONCLUSIONS: The results showed the occupation, first health care visit, distance and cost were factors associated with TID. Improving the facilities at the secondary healthcare units for diagnosing CRC would be likely to help to reduce the  wasted time in the  healthcare system.

Comprehensive Data of P53 R282 Gene Mutation with Human Papillomaviruses (HPV)-Associated Oral Squamous Cell Carcinoma (OSCC).

Alterations of the P53 gene and human papillomavirus (HPV) infection are associated with development of oral squamous cell carcinoma (OSCC). We aimed to identify mutation of P53 exon 8 codon 282 in OSCC and correlate these with HPV infection as well as histopathological grade of OSCC. Samples of known HPV infection status were studied including oral lesion cells, formalin-fixed paraffin embedded (FFPE) tissues from OSCC and exfoliated oral cells of matched age-sex controls. P53 exon 8 mutation was detected using the polymerase chain reaction (PCR). Mutation of codon 282 was identified by allele-specific oligonucleotide typing (ASO) using EvaGreen real-time PCR. The PCR products were analyzed by gel electrophoresis and melting curve analysis. Mutation of P53 exon 8 was seen in 81.7% and 69.6% of FFPE OSCC tissues and oral lesion cells, respectively. This was significantly higher than in controls (16.7%). Frequency of mutation did not differ between HPV-positive samples (62.5% and 81.8% in oral lesion cells and FFPE tissue samples, respectively) and HPV-negative samples (73.3% and 81.5% in oral lesion cells and FFPE tissue samples, respectively). This finding is similar to P53 codon 282 mutation that was found only in FFPE tissues (35.0%) and oral lesion cells (32.6%) from both HPV-positive and negative OSCC. Interestingly, frequency of mutation was higher in well-differentiated OSCC with HPV-infection (28.1%) than without HPV (14.8%). This result demonstrated a mutation hot spot in P53 associated with oral carcinogenesis and might be useful to guide chemotherapeutic modality for HPV-associated OSCC in northeast Thailand.

Factors associated with breast self-examination among Thai women living in rural areas in Northeastern Thailand.

OBJECTIVE: To identify factors associated with monthly breast self-examination (BSE) performance among Thai women living in rural areas, Northeastern Thailand. MATERIAL AND METHOD: This present cross-sectional study was conducted during April to July 2008. A random sample of 705 women aged 20 to 64 years living in the rural areas of Northeastern region was interviewed using a structured questionnaire seeking information on demography, prior experience of BSE, knowledge (of breast cancer and breast examination techniques) and health belief Logistic regression was performed to identify the potential predictors of monthly BSE performance. RESULTS: Seventy-five percent of women had performed BSE in the last year, and only 49% had performed BSE monthly. Monthly BSE performance was associated with having heard of BSE (OR = 2.8; 95% CI: 1.1-6.9), been taught to perform BSE (OR = 2.4; 95% CI: 1.5-3.7), higher knowledge about breast cancer and BSE procedures (OR = 2.4; 95% CI: 1.7-3.5), and higher confidence in one's ability to perform BSE (OR = 4.4; 95% CI: 3.0-6.4). CONCLUSION: To increase monthly BSE performance among Thai women living in the Northeastern rural areas, health officers should address women levels of accurate knowledge of breast cancer, provide training in BSE procedures, and advocate women' confidence in performing BSE.

Awareness Level about Breast Cancer Risk Factors, Barriers, Attitude and Breast Cancer Screening among Indonesian Women

Background: Globally, breast cancer is the second most common cancer in women and is a leading cause of mortality in Indonesia. Raising awareness of breast cancer is particularly important to help at risk women seek medical treatment for this disease. This study aimed to comprehensively investigate the Indonesian women's level of knowledge about breast cancer risk factors, barriers, attitude and breast cancer screening. Methods: This population-based cross-sectional study administered the breast cancer awareness Indonesian scale (BCAS-I) to 856 Indonesian women. Samples were selected in rural and urban combinations from three provinces by stratified random sampling. The ordinal logistic model was used to investigate the clustering effect of the participant's characteristics in this study. Results: Of the women, 62% lived in rural areas and 38% lived in urban areas. Living in an urban area was significantly associated with a lower knowledge of the risk factors. However, living in an urban area was significantly associated with better attitudes and healthier behaviours related to breast cancer awareness. Women with higher education levels had 70% worse attitudes toward breast cancer awareness. Women living South of Sumatera, women living in Yogyakarta, and unmarried women were 5.03, 3.84, and 1.56 times as likely to have higher perceived barriers, respectively. Conclusion: Urban women had a poorer level of knowledge of breast cancer risk factors compared to women living in more rural areas. The result of this study may reflect inadequate breast cancer awareness campaigns or a lack of breast cancer awareness campaigns. These findings suggest that additional education programs aiming to increase awareness and educate the public are needed.

Factors Associated with Breast Cancer Awareness in Thai Women.

Background: Breast cancer is the most common cancer in women worldwide. In south-east Asia, both the incidence and mortality rates of breast cancer are on the rise, and the latter is likely due to the limited access to large-scale community screening program in these resource-limited countries. Breast cancer awareness is an important tool which may, through increasing breast self-examination and the seeking of clinical examination, reduce breast cancer mortality. Investigating factors associated with breast cancer awareness of women is likely to help identify those at risk, and provide insights into developing effective health promotion interventions. Objective: To investigate factors associated with breast cancer awareness in Thai women. Methods: A cross-sectional sample of Thai women aged 20-64 years was collected during August to October, 2015 from two provinces of southern Thailand (Surat Thani and Songkla). A questionnaire including the Breast Cancer Awareness Scale along with demographic characteristics was administered and Proportional Odds Logistic regression was then used to investigate factors associated with breast cancer awareness. Results: In total, 660 Thai women participated in this study. Factors most often associated with the various breast cancer awareness domains were age and rurality. While rural women had poorer knowledge of breast cancer signs and symptoms, they also had lower levels of perceived barriers and considerably better breast cancer awareness behaviors. Conclusion: Despite lower knowledge of breast cancer risk factors and no evidence of better knowledge of signs and symptoms, we found rural Thai women had considerably better breast cancer awareness behavior. This may be due to these women's lower levels of perceived barriers to breast cancer screening services. Indeed this suggests, at least in Thai women, that interventions aimed at lowering perceived barriers rather than enhancing disease knowledge may be more successful in engaging women with breast cancer screening services and increasing breast self-examination.

Questionnaire Validation of Colorectal Cancer Literacy Scale among Thai People in Northeastern Thailand

Background: Colorectal cancer is an important public health problem worldwide. Although progress in screening and treatment has considerably improved the prognosis in the developed world, in developing countries colorectal cancer mortality rate remains relatively high. Colorectal cancer screening literacy is an important initial step in overcoming this problem. Development of a validated assessment instrument is therefore important for implementation of appropriate health education programs to facilitate early detection. Objectives: This study focused on generation and validation of a colorectal cancer screening literacy scale for Thai people in northeastern Thailand. Methods: This methodological study was carried out in two phases: (1) literature reviews and semi-structured interviews were used to select items, then the content and face validity were checked; and (2) a confirmatory factor analysis (CFA) was conducted to test construct validity and reliability. A self-administered questionnaire was used to collect data from Thai people aged 50- 65 in June 2017. Results: For the total of 400 participants who responded (response rate 100 %), the age ranged from 50 to 65 years old (mean = 57.3, SD = 4.616). The colorectal cancer screening literacy scale was designed to include 6 domains and it was shown to have good internal consistency, and CFA demonstrated the model to fit data adequately (Chi-squared/degree of freedom = 1.079, p = 0.061, CFI = 1.00, GFI = 0.93, AGFI = 0.91, RMSEA = 0.014 and SRMR = 0.036). The final version of its, consisting of 57 items across the 6 domains covering key aspects of colorectal cancer screening literacy, demonstrated good psychometric properties for this population. Conclusions: Use of the colorectal cancer screening literacy scale in Thai people could lead to improved educational programs for optimizing colorectal cancer screening.

Cervical Cancer in Khon Kaen, Thailand: Analysis of 1990-2014 Incidence Data and Prediction of Future Trends

Background: Cervical cancer is the second most common cancer of women in Thailand. There have been no reports of incidence and future in Khon Kaen, a province in northeastern Thailand, where the relatively high prevalence gives evaluation of cervical cancer screening a high priority. Objectives: To determine cervical cancer incidence rates in Khon Kaen for 1990­2014 and predict future trends until 2029. Methods: Cancer incidence data from the Khon Kaen population-based cancer registry were analyzed and age-standardized incidence rates (ASR) were estimated. Joinpoint analysis and age-period-cohort modeling were applied for data from 1990 to 2014 and the Nordpred package was employed to project trends from 2015 to 2029. Results: Between 1990 and 2014, a total of 3,258 cases were diagnosed with ICD-O code C53 (invasive cervical cancer). Before 2005, an annual percentage change (APC) varied widely, with outliers in 1993 and 1999. The APC computed with the Joinpoint software decreased at -2.8% (95% CI;-4.5 to -1.1) per year on average. After 2005, a rise was noted until 2008, after which a drop became apparent with an APC of -8.0% (95% CI; -14.5 to -1.1) per year on average. Both period and cohort effects played a role in shaping the decrease in incidence. The three projection method suggested that incidence rates would continue to decrease in the future. Conclusions: A decreasing trend in incidence of cervical cancer in Khon Kaen was noted from 1990 to 2014 with a prediction of continuous decrease until 2029. Maintenance and improvement of the screening program is advised.

Health Insurance and Colorectal Cancer Survival in Khon Kaen, Thailand.

Background: Evidence from healthcare studies demonstrates that patients' health insurance affects service accessibility and the outcome of treatment. However, assessment on how colorectal cancer survival relates to health insurance is limited. Objective: The study examined the association between health insurance and colorectal cancer survival in Khon Kaen, Thailand. Methods: The retrospective cohort study was conducted with 1,931 colorectal cancer patients from Khon Kaen cancer registry between January 1, 2003 and December 31, 2012, and was followed-up until December 31, 2015. Relative survival was used to estimate the survival rate. Cox proportional hazard regression was used to estimate the relationship between health insurance and colorectal cancer survival, represented with the hazard ratio. Result: Most of the participants were males, and the median age was 62 years. The median survival time was 2.25 years (95% CI: 2.00-2.51). The five-year observed survival rate and relative survival rate were 36.87 (95% CI: 34.66-39.08) and, 42.28 (95% CI: 39.75-44.81), respectively. The factors that showed significant associations with poorer survival after adjustment for gender and age were non-surgical treatments (HRadj=1.88;95%CI=1.45-2.45), advanced stage (III+IV) (HRadj=2.50; 95%CI=2.00-3.12), histological grading in poorly differentiated (HRadj=1.84; 95%CI=1.32-2.56), and Universal Coverage Scheme (HRadj=1.37;95%CI=1.09-1.72). Conclusion: The survival of colorectal cancer patients in the Universal Coverage Scheme was likely to be poorer than in the Civil Servant Medical Benefit Scheme. This indicates an urgent need for a national program for colorectal cancer screening in the general population and access to health insurance.

Association between periductal fibrosis and bile duct dilatation among a population at high risk of cholangiocarcinoma: a cross-sectional study of cholangiocarcinoma screening in Northeast Thailand.

OBJECTIVES: To assess associations between periductal fibrosis (PDF) and bile duct dilatation (BDD) in ultrasonography (US) screening of population at risk of cholangiocarcinoma (CCA) due to residence in an endemic area for Opisthorchis viverrini. CCA survival rates are low, and early identification of risk factors is essential. BDD is one symptom that can identify patients at risk of CCA. Detection of PDF by US can also identify at-risk patients, at an earlier stage of CCA development. Identification of association between PDF and BDD will inform screening practices for CCA risk, by increasing the viability of PDF screening for CCA risk. SETTING: Nine tertiary care hospitals in Northeast Thailand. DESIGN: Cross-sectional study. PARTICIPANTS: Study subjects in the Cholangiocarcinoma Screening and Care Program (CASCAP) in Northeast Thailand. CASCAP inclusion criteria are all residents of Northeast Thailand aged ≥40 years. Participants are recruited through CCA screening centres and through primary healthcare units. So far, 394 026 have been enrolled. METHODS: PDF and BDD were identified through US. PDF was categorised into three groups, PDF1, 2 and 3, depending on their high echo locality in the peripheral, segmental and main bile duct, respectively. Associations between PDF and BDD were determined by adjusted OR and 95% CI using multiple logistic regression. RESULTS: BDD was found in 6.6% of PDF3, 1.7% of PDF2 and 1.4% of PDF1 cases. Among PDF cases, especially in PDF3, BDD was found in men more than in women (8.9% and 4.6%, respectively). Compared with non-PDF, the association between PDF3 and BDD was highly significant (adjusted OR=5.74, 95% CI 4.57 to 7.21, p<0.001). CONCLUSIONS: Our findings reveal that there is a relationship between PDF and BDD, which is associated with CCA. Therefore, PDF can also be an indicator for suspected CCA diagnosis through US.