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 havean impact on the prevalence of cancer and other non-communicable diseases. For planning control programmes it isnecessary to monitor change over time and the present study was conducted to provide information on stomach andcolorectal cancer incidence rates in Khon Kaen Cancer Registry (KKCR), established in 1984 at the Faculty ofMedicine, Srinagarind Hospital, Khon Kaen University. Objective: To assess trends in urban and rural areas ofKhon 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, wereretrieved and incidence trends were calculated using the Generalized Linear Model method (GLM), which generatesincidence-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. Accordingto the histopathological diagnosis, the most common was adenocarcinoma with over 90 percent. The overall agestandardizedincidence 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 bothurban and rural areas males were affected more frequently than females, although a shift was evident towardsdecrease in the se ratio was evident for colorectal cancers over time. Discussion: The results of this study showedslight increase in the incidence of colorectal cancer in Khon Kaen province, while rates for stomach cancer remainedquite 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 Lymphoma in Khon Kaen,Thailand, 1985-2008

Background: Lymphoma is the second most common of childhood cancer in Thailand, but data on trendsover time are limited. Objective: To perform a statistic assessment of the incidence trend of childhood lymphomain Khon Kaen, Thailand, between 1985 and 2008. Method: All children aged < 15 years newly diagnosed withlymphoma according to International Childhood Cancer Classification (ICCC) during January 1, 1985- December31, 2008 were collected from data base of Khon Kaen Provincial Registry. Aged-adjusted incidence rates (ASRs)were calculated by standard method and trends were calculated using the generalized linear model method, which utilizes incidence-rate-base logarithms. Results: During 1985-2008 there were 72 children (47boys and 25 girls) who were diagnosed with lymphoma in Khon Kaen province. The peak age-group of diseasewas in the 5-9 year olds for both sexes. All cases were pathologically proven. Non-Hodgkin lymphoma (NHL)was more common than Hodgkin disease (ratio 7:1). The overall ASR was 6.04 per million (95%CI: 4.64 to 7.45)and the ASR was 7.64 per million (95%CI: 5.44 to 9.84) in boys and 4.37 per million (95%CI: 2.64 to 6.10) ingirls. Significant increases were observed for boys, since the 2006 to 2008 ASR was 15.3 per million (95%CI:5.73 to 25.0). Trend analyses during 1985 - 2008 showed that incidence among boys for lymphoma increasedby 1.38 percent per year (95%CI:- 4.6-8.3) while the incidence among girl decreased by 2.6 percent per year(95%CI:- 12-6.8). Conclusions: Our data showed that the incidence of childhood lymphoma in Khon Kaenprovince was similar to the one of Thailand but lower than those of western countries. During the past 24 years,the incidence trend seems to be increasing in boys but decreasing in girls. Interpretation is difficult without abetter understanding of what underlies the reported changes.     

Trends in incidence of hepatocellular carcinoma, 1990-2009, Khon Kaen, Thailand

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.     

Incidence and Survival Rates among Pediatric Osteogenic Sarcoma Cases in Khon Kaen,Thailand, 1985-2010

Background: Osteosarcoma is the most common bone cancer in children, responsible for a high rate ofamputation and death. This is the first long-term, population-based, epidemiologic and survival study inThailand. Objective: To study the incidence and survival rates of pediatric osteosarcoma in Khon Kaen.Method: Childhood osteosarcoma cases (0-19 years) diagnosed between 1985-2010 were reviewed. The datawere retrieved from the population-based data set of the Khon Kaen Cancer Registry and medical recordsfrom Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. All cases were censored until the endof April 2012. The age-standardized incidence rate (ASR) was calculated using the standard method. Survivalexperience was analyzed using the standard survival function (STATA 9.0) and presented with a Kaplan-Meiercurve. Results: 58 cases were enrolled. The overall ASR was 14.1 per million. Males and females were equallyaffected. The peak incidence was for 15-19 year-olds in both sexes (ASR=10.4 per million in males and 8.5 infemales). The 5-year overall survival rate was 27.6% (95% CI: 15.8-40.8%). The median survival time was 1.6years (95% CI: 1.2-2.1). In a subgroup analysis, the patients who received only chemotherapy survived longer(5-year survival 45.7%, median survival time 4.1 years, p=0.12). Conclusion: The incidence rate for childhoodosteosarcoma was slightly less than those reported for Western countries. The survival rate was also lower thanreports from developed countries. Further evaluation of the treatment protocol and risk factor stratification isneeded.     

Childhood Cancer Incidence and Survival 1985-2009, Khon Kaen,Thailand

Background: The Khon Kaen Cancer Registry (KKCR) was established in 1984. Previous population-basedincidences and survivals of childhood cancer in Thailand were determined using a short cancer registration period.Materials and Methods: Data were retrieved of all children residing in Khon Kaen, between 0–15 years, diagnosedas having cancer and registered in the KKCR (1985-2009). The follow-up censored date was December 31, 2012.The childhood cancers were classified into 12 diagnostic groups, according to the International Classificationof Childhood Cancer. The incidence was calculated by the standard method. Survival of childhood cancer wasinvestigated using the KKCR population-based registration data and overall survival calculated using the KaplanMeier method. Results: In the study period, 912 newly diagnosed cases of childhood cancer were registered.The respective mean and median age was 6.4 (SD=4.6) and 6 (0-14) years. The age-peak for incidence was 0–4years. The age-standardized rate (ASR) was 83 per million. Leukemia was the most common cancer (N=360,ASR 33.8) followed by neoplasms of the central nervous system (CNS, N=150, ASR 12.8) and lymphoma (N=79,ASR 7.0). The follow-up duration totaled 101,250 months. The death rate was 1.11 per 100 person-months(95%CI: 1.02 -1.20). The 5-year overall survival was 52% (95%CI: 53-56.9) for all cancers. The respective 5-yearoverall survival for (1) acute lymphoblastic leukemia (ALL), (2) acute non-lymphoblastic leukemia (ANLL), (3)lymphoma, (4) germ cell tumors, (5) renal tumors, (6) retinoblastoma, (7) soft tissue tumors, (8) CNS tumors,(9) bone tumors, (10) liver tumors, and (11) neuroblastoma was (1) 51%, (2) 37%, (3) 63%, (4) 74%, (5) 67%,(6) 55%, (7) 46%, (8) 44%, (9) 36%, (10) 34%, and (11) 25%. Conclusions: The incidence of childhood canceris lower than those of western countries. Respective overall survival for ALL, lymphoma, renal tumors, livertumors, retinoblastoma, soft tissue tumors is lower than that reported in developed countries while survival forCNS tumors, neuroblastoma and germ cell tumors is comparable.     

Incidences,Trends and Long Term Outcomes of Retinoblastoma in Three Cancer Registries,Thailand

Background: Retinoblastoma (RB) is rare, albeit the most common primary intraocular malignancy amongchildren. To elucidate the true incidence, trend and survival, we studied incidences and trends of retinoblastomain a large population with long-term follow-up using data from 3 population-based cancer registries. Objective:To describe the incidence, trends and survival of RB between 1990 and 2009 in Khon Kaen, Songkhla and ChiangMai, Thailand. Materials and Methods: We sourced the data from the cancer registries in Khon Kaen, Songkhlaand Chiang Mai on children with retinoblastoma, diagnosed between 1990 and 2009. Retinoblastoma was definedas per the International Classification of Disease for Oncology version 3 using the code 9510/3. Incidence wasanalyzed using the standard method with the criteria of the International Association of Cancer Registries. TheKaplan-Meier method was applied to calculate cumulative survival. Trends were calculated using the log ranktest. Results: We identified 75 cases of children between 0 and 15 years of age diagnosed with RB (Khon Kaen31, Chiang Mai 20, Songkhla 24). Males and females were equally affected. The most common age group was0-4 years. The morphological verification of the disease was 90.7%. The respective ASR in Khon Kaen, ChiangMai and Songkhla was 4.4, 4.0 and 4.6 per million; for which the overall ASR for all 3 areas was 4.3 per million.The respective trend in incidence was 4, 2.8, 5.8 and 5.4 during 1990-4, 1995-9, 2000-4 and 2005-9. Overall,incidence trended gradually upward by 2% annually. The respective survival rate in Khon Kaen, Chiang Maiand Songkhla was 50, 40 and 75% (differences not significantly different at p=0.14) and the overall survival forall centers was 60%. Conclusions: Over the last two decades, the incidence and overall survival of retinoblastomahas increased. The ASRs and survival in Thailand were less than those in resource-rich countries.     

Trends in Liver Cancer Incidence between 1985 and 2009, Khon Kaen,Thailand: Cholangiocarcinoma

Background: 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. Objective: To perform a statistical assessment of the incidence trends between 1985 and 2009 of liver cancer, specifically focusing on cholangiocarcinoma (CHCA). Methods: 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. Results: 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%).Conclusions: 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.     

Squamous cell carcinomas of the head and neck in Norway, 1953-92: an epidemiologic study of a low-risk population

Trends in incidence, five-year relative survival, and mortality among patients in Norway with squamous cell carcinoma of the oral sites, oro-/hypopharynx, and larynx were studied for the period 1953-92. Throughout the first part of the study period, age-adjusted incidence rates (AAIR) of oral cancer remained stable in both genders. Since the end of the 1960s, AAIRs increased by 13 percent per five-year period in males and 12 percent in females. The figures suggest increased male incidence rates of oral cancer in younger age groups. During the same period, AAIRs of cancers of the oro-/hypopharynx in males increased by 19 percent per five-year period. The AAIRs of laryngeal cancer increased steadily from 1953-92 among both males and females by 17 percent and 21 percent per five-year period, respectively. For all sites, changes in AAIRs for males were greater in rural than in urban areas. No improvement in detection of disease at a localized stage was observed for either gender. There are indications of improvements in the five-year relative survival rates for oral and pharyngeal cancer in both genders. For all sites, relative survival was better in younger than in older patients. Only in the case of pharyngeal cancer in males was an increase in disease-specific mortality rates positive for a time trend.     

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 1990’s. 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 105 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.     

Epidemiology of head and neck cancer in Thailand

Cancer is the most common cause of death in Thailand, with the mortality almost doubled during 1998–2011 (from 48.4 to 95.2 per 100 000). The estimated number of new cancer cases in 2011 was 112 392. Our review provides baseline data on the current epidemiological situation with head and neck (HN) cancer in Thailand based on reports of the National Cancer Registry and findings from local and international publications. Collectively, HN cancer approaches age‐standardized rate (ASR) incidence of 15.7 and 10.7 per 100 000 males and females, respectively, and is ranked among the top five dominant cancers in Thailand. The leading HN malignancies in men are oral (ASR incidence 4.6 per 100 000), nasopharyngeal (ASR 2.8) and laryngeal (ASR 2.7) cancers, while the most common cancers in women are thyroid (ASR 5.1) and oral (ASR 3.2) carcinomas. Some local habits (betel quid chewing, traditional cigarette smoking and alcohol intake) are associated with the high incidence of oral cancer in Northeast Thailand. Despite important prognostic significance, the role of human papillomavirus infection in various HN cancers from Thailand has been scarcely addressed. There is a growing incidence of thyroid cancer over the last two decades. The Thai population overall, compared to worldwide rates of HN malignancies, has a lower incidence of laryngeal and thyroid cancers but higher incidence of nasopharyngeal cancer.     

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 Karachi, Pakistan: first results from Karachi Cancer Registry

No cancer incidence data from Pakistan have been published in the 5 decades since independence. Incidence data for the period 1995-1997 from the population of the Karachi South district (1.7 million) are presented here. A total of 4,268 new cancer cases were registered during this period: 2,160 cases in males and 2,108 cases in females. Overall, 95.3% of the incident cases were microscopically verified. The incidence rates for all cancers combined were 80.5 per 100,000 (crude) and 136.7 per 100,000 (age- standardised rates [ASR]) for males and 91.8 (crude) and 163.2 per 100,000 (ASR) for females. In males, lung cancer (ASR 20.3) was the most frequently recorded malignancy followed by oral cavity (ASR 13.8) and larynx cancer (ASR 8.6). In females, breast was the most common site of cancer, accounting for one third of female cancers (ASR 51.7), followed by oral cavity (ASR 14.1) and ovarian cancer (ASR 10.2). Karachi reports the highest incidence of breast cancer for any Asian population, except Jews in Israel. Tobacco smoking is estimated to be responsible for 40% of cancers in males and tobacco chewing for a further substantial proportion of head and neck cancers.     

Health Insurance and Colorectal Cancer Survival in Khon Kaen,Thailand

Background: Evidence from healthcare studies demonstrates that patients’ health insurance affects serviceaccessibility and the outcome of treatment. However, assessment on how colorectal cancer survival relates to healthinsurance is limited. Objective: The study examined the association between health insurance and colorectal cancersurvival in Khon Kaen, Thailand. Methods: The retrospective cohort study was conducted with 1,931 colorectal cancerpatients from Khon Kaen cancer registry between January 1, 2003 and December 31, 2012, and was followed-up untilDecember 31, 2015. Relative survival was used to estimate the survival rate. Cox proportional hazard regression wasused to estimate the relationship between health insurance and colorectal cancer survival, represented with the hazardratio. Result: Most of the participants were males, and the median age was 62 years. The median survival time was2.25 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 withpoorer 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 ofcolorectal cancer patients in the Universal Coverage Scheme was likely to be poorer than in the Civil Servant MedicalBenefit Scheme. This indicates an urgent need for a national program for colorectal cancer screening in the generalpopulation and access to health insurance.     

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 reportsof incidence and future in Khon Kaen, a province in northeastern Thailand, where the relatively high prevalence givesevaluation of cervical cancer screening a high priority. Objectives: To determine cervical cancer incidence rates inKhon Kaen for 1990–2014 and predict future trends until 2029. Methods: Cancer incidence data from the Khon Kaenpopulation-based cancer registry were analyzed and age-standardized incidence rates (ASR) were estimated. Joinpointanalysis and age-period-cohort modeling were applied for data from 1990 to 2014 and the Nordpred package wasemployed to project trends from 2015 to 2029. Results: Between 1990 and 2014, a total of 3,258 cases were diagnosedwith ICD-O code C53 (invasive cervical cancer). Before 2005, an annual percentage change (APC) varied widely, withoutliers 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 decreasein 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 aprediction of continuous decrease until 2029. Maintenance and improvement of the screening program is advised.     

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

Background: Because of the gender disparity in the incidence of thyroid cancer, this study aimed to determinethe association between reproductive factors and thyroid cancer. Methods: A total of 10,767 eligible women fromthe Khon Kaen Cohort, recruited and interviewed between 1990 and 2001, were followed up until 2011. Thedata 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 % werepapillary tumors. The incidence was apparently greater among those with an early age of menarche, nulligravidawomen, and oral contraceptive users. Conlusions: There was a trend for thyroid cancer to develop in relationto longer estrogen exposure. This evidence is inconclusive but warrants further investigation.     

Cancer in the Gambia: 1988-97

We describe the incidence of cancer in The Gambia over a 10-year period using data collected through the Gambian National Cancer Registry. Major problems involved with cancer registration in a developing country, specifically in Africa are discussed. The data accumulated show a low overall rate of cancer incidence compared to more developed parts of the world. The overall age standardized incidence rates (ASR) were 61.0 and 55.7 per 100 000 for males and females, respectively. In males, liver cancer was most frequent, comprising 58% of cases (ASR 35.7) followed by non-Hodgkin lymphoma, 5.4% (ASR 2.4), lung 4.0%, (ASR 2.8) and prostate 3.3% (ASR 2.5) cancers. The most frequent cancers in females were cervix uteri 34.0% (ASR 18.9), liver 19.4% (ASR 11.2), breast 9.2% (ASR 5.5) and ovary 3.2% (ASR 1.6). The data indicate that cancers of the liver and cervix are the most prevalent cancers, and are likely to be due to infectious agents. It is hoped that immunization of children under 1 year against hepatitis B will drastically reduce the incidence of liver cancer in The Gambia.     

Joinpoint Analysis Trends in the Incidence of Colorectal Cancer in Khon Kaen,Thailand (1989 – 2012)

Objective: This study focused on recent changes in the incidence of colorectal cancer (CRC) in Khon Kaen, Thailand. Methods: Data for CRC over the period 1989 to 2012 from the population-based cancer registry of Khon Kaen province were employed. Age-standardized incidence rates (ASR) were calculated and classified into 4 age-groups for comparison. Joinpoint regression analysis was used to detect changes in trends among each line segment and an overall line was generated, whether increasing or decreasing, with annual percent change (APC) and average annual percent change (AAPC). Results: There were 3,364 CRC cases included in the analysis, 72.2% histological confirmed and 53.5% in men. Trends of ASRs generally demonstrated gradual increase over the period 1989 to 2012. For those aged under 45 or 50 years there was slight overall increase, with a somewhat zigzag pattern. From joinpoint analysis, the trends of all aged groups were found to be increasing among both men and women: aged 45 years and older group AAPC=3.40, 2.30 and 3.90, respectively); aged 50 years and older group AAPC=2.90, 2.20 and 3.40; aged under 45 years AAPC=6.30, 6.00 and 6.90; and aged under 50 years (AAPC=5.70, 3.20 and 5.70. Conclusions: ASRs for CRC have been gradually increasing in the northeast region of Thailand. Future studies should consider the subsite distribution.     

A global view on cancer incidence and national levels of the human development index

Socioeconomic factors are associated with cancer incidence through complex and variable pathways. We assessed cancer incidence for all cancers combined and 27 major types according to national human development levels. Using GLOBOCAN data for 184 countries, age‐standardized incidence rates (ASRs) were assessed by four levels (low, medium, high, very high) of the Human Development Index (HDI), a composite index of life expectancy, education, and gross national income. A strong positive relationship between overall cancer incidence and HDI level was observed. When comparing the ASR in very high HDI regions with that in low HDI regions, we observed a positive association ranging from 2 to 14 and 2 to 11 times higher in males and females, respectively, depending on the cancer type. Positive dose–response relationships between the ASR and HDI level were observed in both sexes for the following cancer types: lung, pancreas, leukemia, gallbladder, colorectum, brain/nervous system, kidney, multiple myeloma, and thyroid. Positive associations were also observed for testicular, bladder, lip/oral cavity, and other pharyngeal cancers, Hodgkin lymphoma, and melanoma of the skin in males, and corpus uteri, breast, and ovarian cancers and non‐Hodgkin lymphoma in females. A negative dose–response relationship was observed for cervical and other pharyngeal cancers and Kaposi sarcoma in females. Although the relationship between incidence and the HDI remained when assessed at the country‐specific level, variations in risk within HDI levels were also observed. We highlight positive and negative associations between incidence and human development for most cancers, which will aid the planning of cancer control priorities among countries undergoing human development transitions.     

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

Introduction: Khon Kaen Cancer Registry (KKCR) was established in 1984. KKCR aims to collect allcancer cases in Khon Kaen Province. The poorly qualified data may lead to distort the cancer burden andmisinterpretation of policy maker. Objective: To assess data quality in childhood cancer between 1990 and 2007in Khon Kaen Province, Thailand. Materials and Methods: Data of childhood cancer cases aged less than 20 yearsdiagnosed during 1990-2007 were retrieved from the population-based data set of KKCR. All childhood cancerdata were verified before data entry. Internal consistency, percentage of morphological verification (MV%) andcancer 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 acceptablyqualified which reflects the quality of the whole registration.     

Leads to cancer control based on cancer patterns in a rural population in South India

Objective: Cancer patterns and incidence rates for a rural population (359,674) resident in 384 villages spread over 2058 km² in Palani and Oddanchathram taluks of Dindigul District, Tamil Nadu, in South India, are described in this paper. Methods: A population-based cancer registry was established in 1995 to register incident invasive and in-situ cancers. Cases were found and details abstracted by cancer registry staff visiting 26 data sources, comprising cancer hospitals, tertiary and secondary care hospitals, pathology laboratories and death registration offices. A customized version of CANREG-3 software was used for data entry and analysis. Results: During the period 1996–1998, 783 invasive cancers (310 male and 473 females) were registered, yielding an all-cancer crude incidence rate of 56.8/100,000 males and 88.5/100,000 females; the corresponding age standardized incidence rates (ASR) were 83.3 and 122.3 respectively. In males, mouth cancer (ASR 11.5) was the most frequently recorded malignancy followed by tongue (ASR 8.6), hypopharynx (ASR 7.8), esophagus (ASR 7.8) and larynx (ASR 7.8). Thus head and neck cancers accounted for half of the male cases. In females, cervical cancer (ASR 65.4) accounted for more than half of the cancers followed by breast (ASR 14.2) and mouth (ASR 10.2). Ambillikai Cancer Registry (ACR) reports the second highest incidence of cervical cancer in the world. More than four-fifths of cervical cancer cases were diagnosed in stages II B and III B; a third of these cancer patients either did not have, or did not complete, treatment. Conclusions: The observed cancer patterns in this population establish that measures directed at prevention and early detection (linked with treatment) of cervix and head and neck cancers are of paramount importance for cancer control in this and other rural populations of India where three-fourths of the total population live.