• Asian Pacific Journal of Cancer Prevention
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• v.16 no.8
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• pp.3499-3503
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• 2015

Background: Cancer has become an epidemic disease. Nearly ten million new cancer cases are diagnosed annually in the world and out of these about half are from the developing world. To appropriately plan for treatment, management and prevention of the disease, it becomes necessary to study the trends about morbidity caused by cancers. Materials and Methods: Data for patients diagnosed with any form of gastrointestinal (GI) cancers was extracted from records maintained in the outpatient department registers of the Oncology Department of Government Medical College and Hospital in Chandigarh from 1999 to 2012. Trends were analysed for different categories of GI cancers for the period of 12 years. Results: In present study GI cancers accounted for 23 % of all registered cases (n-9603) of carcinomas. Males predominated for all GI cancers except in the gall bladder. Gastrointestinal cancers as a proportion of total cancers increased from 21% in 1999 to 25.9% in 2012 with a significant increasing trend in our series (${\chi}^2$ for linear trend=9.36, p<0.003). Cancers of the tonsil, oral cavity and pharynx taken together showed an increasing trend over the years (${\chi}^2$ for trend=55.2, p<0.001) whereas cancers of the lower GI (${\chi}^2=19.6$, p<0.0001) and gall bladder (${\chi}^2=19.5$, p<0.0001) showed a declining trend in our series. Conclusions: GI cancers form a significant proportion of all cancers reporting to our data. In depth studies to ascertain the reasons for the changing trends are required to design intervention programs. Further information is necessary from cancer registries and from the hospital records of oncology departments.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.22
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• pp.9731-9737
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• 2014

Large scale secular registry or surveillance systems have been accumulating vast data that allow mathematical modeling of cancer incidence and mortality rates. Most contemporary models in this regard use time series and APC (age-period-cohort) methods and focus primarily on predicting or analyzing cancer epidemiology with little attention being paid to implications for designing cancer registry, surveillance or evaluation initiatives. This research models age-specific cancer incidence rates using logistic growth equations and explores their performance under different scenarios of data completeness in the hope of deriving clues for reshaping relevant data collection. The study used China Cancer Registry Report 2012 as the data source. It employed 3-parameter logistic growth equations and modeled the age-specific incidence rates of all and the top 10 cancers presented in the registry report. The study performed 3 types of modeling, namely full age-span by fitting, multiple 5-year-segment fitting and single-segment fitting. Measurement of model performance adopted adjusted goodness of fit that combines sum of squred residuals and relative errors. Both model simulation and performance evalation utilized self-developed algorithms programed using C# languade and MS Visual Studio 2008. For models built upon full age-span data, predicted age-specific cancer incidence rates fitted very well with observed values for most (except cervical and breast) cancers with estimated goodness of fit (Rs) being over 0.96. When a given cancer is concerned, the R valuae of the logistic growth model derived using observed data from urban residents was greater than or at least equal to that of the same model built on data from rural people. For models based on multiple-5-year-segment data, the Rs remained fairly high (over 0.89) until 3-fourths of the data segments were excluded. For models using a fixed length single-segment of observed data, the older the age covered by the corresponding data segment, the higher the resulting Rs. Logistic growth models describe age-specific incidence rates perfectly for most cancers and may be used to inform data collection for purposes of monitoring and analyzing cancer epidemic. Helped by appropriate logistic growth equations, the work vomume of contemporary data collection, e.g., cancer registry and surveilance systems, may be reduced substantially.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6227-6231
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• 2013

In the past, hepatitis B virus (HBV) infection was endemic in the general Korean population. The association of HBV infection with the occurrence of liver cancer has been well demonstrated in several epidemiologic studies. While the mortality rates of liver cancer in Korea have decreased steadily over the last decade, the presence of hepatitis B surface antigen (HBsAg) in mothers remains high at 3-4%, and 25.5% of these HBsAg positive mothers are positive for hepatitis B e antigen (HBeAg). HBV infection caused almost a quarter of hepatocellular carcinoma (HCC) cases and one-third of deaths from HCC. These aspects of HBV infection prompted the Korean government to create a vaccination program against HBV in the early 1980s. In 1995, the Communicable Disease Prevention Act (CDPA) was reformed, and the government increased the number of HBV vaccines in the National Immunization Program (NIP), driving the vaccination rate up to 95%. In 2000, the National Health Insurance Act (NHIA) was enacted, which provided increased resources for the prevention of perinatal HBV infection. Then in 2002, the Korean government, in conjunction with the Korean Medical Association (KMA), launched an HBV perinatal transmission prevention program. The prevalence of HBsAg in children had been high (4-5%) in the early 1980s, but had dropped to below 1% in 1995, and finally reached 0.2% in 2006 after the NIP had been implemented. After the success of the NIP, Korea finally obtained its first certification of achievement from the Western Pacific Regional Office of the World Health Organization (WPRO-WHO) for reaching its goal for HBV control. An age-period-cohort analysis showed a significant reduction in the liver cancer mortality rate in children and adolescents after the NIP had been implemented. In addition to its vaccination efforts, Korea launched the National Cancer Screening Program (NCSP) for 5 leading sites of cancer, including the liver, in 1999. As a consequence of this program, the 5-year liver cancer survival rate increased from 13.2% (1996-2000) to 23.3% (2003-2008). The development of both the primary and secondary prevention for liver cancer including HBV immunization and cancer screening has been of critical importance.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.7
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• pp.4319-4323
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• 2013

Background: Hookah smoking has been referred to as a global tobacco epidemic by public health officials. This study aimed to investigate the characteristics, behaviour and perceptions related to hookah smoking among the youth smokers in Pune. Methods: Two hundred and eighty established hookah smokers participated in this study. Data was collected using a 29-item questionnaire, constructed using three main domains: Characteristics (socio-demographic and personal), behaviour and perceptions (about harmful effects in comparison to cigarette smoking). Results: The results indicated that the mean age of starting hookah smoking was 17.3 years; 75% of participants did not have parental acceptance; light-headedness, dizziness and headache were most common reported nicotine effects, post hookah smoking. Hookah smoking on a daily basis was reported by 24.6% participants. The mean time of hookah session was 1 hour and 19 minutes. 68.2% participants were reported to smoke hookah in hookah-cafes and 35.7% participants were found to share the hookah. Some 66.7% participants had no intention to quit. Most of them (71-80%) had misperception about the safety of hookah smoking over cigarette smoking and 54-82% participants were unaware of health effects. Conclusions: Educational intervention is urgently needed to create awareness among the youth about the harmful effects of hookah smoking.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.14
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• pp.5741-5747
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• 2015

Purpose: To understand the epidemiology of different upper gastrointestinal (UGI) tract related abnormalities through endoscopic data analysis. Materials and Methods: A retrospective study of three years from January 2009 to December 2011 was conducted with data from endoscopic surveillance of upper GI tract problems, collected from the Gastroenterology Unit, Osmania General Hospital, Hyderabad. MS excel and Medcalc software (comparison of proportions) were used for data analysis. Results: A total of 10,029 (6,468 in males and 3,561 in females) endoscopies were performed during this three-year period. The male to female ratio was 1.8:1. Overall, ~30% of endoscopies evaluated showed patients with acid peptic disorders, 13.6% with vascular-related abnormalities, 10.6% showed structural abnormalities, followed by 6.3% with malignancies. Burden of malignancies was mostly observed in the older age group (60-69 years). Esophageal cancer cases decreased (p=0.0001) whereas stomach cancers increased over this period (p=0.0345). We also observed an increased incidence of acid peptic disease (APD) (p=0.0036) and gastroesophageal reflux disease (GERD) (p=0.0002) cases during this period. Conclusions: Endoscopic diagnosis is useful for early detection of UGI anomalies and helpful for physicians to manage and treat varied kinds of UGI disorders. Analysis of data revealed changing trends in the incidence of various pathologies of the UGI tract. Functional dyspepsia and GERD definitely reduce the quality of life of the individual. The role of our diverse dietary habits and lifestyle associated with these problems have not yet been established, though there have been reports on the effect of coffee, spicy food, wheat-based diet, screening of UGI pathologies along with collection of complete personal and medical history details, can h elp in correlating the patients' condition with various aspects of lifestyle and diet.

• Journal of Nutrition and Health
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• v.38 no.9
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• pp.786-792
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• 2005

With dramatic transitions from a traditionally food-insecure to a food-sufficient society, over weight and/or obesity are an increasing health concern in Korea. In 2000, $35.9\%$ of Korean adults were over weight (BMI>25) with increasing trends. It is well known that obesity is highly correlated with chronic diseases, such as diabetes, hypertension, cardiovascular disease, cancer and high cholesterol. In 2003, the social cost of obesity is estimated at $529.5\~799.3$ billion won (direct cost) and at $1,200\~1,817$ billion won (including indirect cost). The share of the direct cost is estimated at $2.6\~3.9\%$ of total medical bill 20,742 billion won. These costs are underestimated and would surely be higher if the expenditures outside of the official medical insurance system of Korea were included. Based on the rapid increase of obesity rate among the Korean youth, it is crucial to develop and implement appropriate policies to curb the obesity epidemic.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7237-7241
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• 2013

Background: Smokeless tobacco use in South Asia is believed to be a significant contributor to morbidity and mortality. In India, only a few studies involving health educational intervention by health care providers have demonstrated reduction in smokeless tobacco usage. In the present study we assessed the cessation efforts towards smokeless tobacco by physicians in two high tobacco prevalence states of India. The study also identified opportunities and barriers for integration of tobacco cessation services in routine practices of physicians. Materials and Methods: This mixed method study involved qualitative (phase I) and quantitative research study (phase II). In phase I, 59 in-depth interviews with physicians were conducted. In phase II, a quantitative study conducted among 238 physicians. An inductive approach was followed to analyze qualitative data using ATLAS. Ti software. The Chi-square test was employed to test the association between different variables of interest using SPSS version 17. Results: The majority of physicians related only respiratory problems and cancer with smokeless tobacco. Other major health effects like cardio-vascular problems, oral diseases, and effects on reproductive and neonatal health were recognized only by a few physicians. The age-group of 10-19 years was identified as most vulnerable to smokeless tobacco use. Less than one-third of physicians reported recording smokeless tobacco history of all patients. Findings indicated that less than half of physicians provided information on harmful health effects of smokeless tobacco with regard to specific diseases. Conclusions: The study revealed a low level of knowledge of physicians about harmful effects of tobacco and their suboptimal engagement in tobacco control practices. The study indicates the need of capacity building initiatives to equip physicians with skills in tobacco cessation.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7075-7080
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• 2013

Background: Oral submucosal fibrosis (OSMF) is one of the most prevalent premalignant conditions in India which is easy to diagnose but difficult to manage. At present it is considered as irreversible and incurable. It has also been referred to as an epidemic in India. Aims and Objectives: To correlate the frequency and duration of habits with clinical staging, functional staging and histopathological grading and to correlate the clinical and functional staging with histopathological grading. Materials and Methods: The study included a total of 90 subjects, 80 with OSMF in the experimental group and 10 patients in the control group. Patient personal history was recorded with chewing habits, including frequency and duration of chewing. The site of keeping the quid, time duration and whether he/she swallows it or spits it were also noted. Clinical staging was done on the presence of palpable fibrous bands. Functional staging was accomplished by measuring mouth opening. Incisional biopsy was done for all the patients for histopathological examination. Histopathological grading was according to Pindborg and Sirsat. Results: The experimental group comprised 71 males and 9 females, the majority of which were in the age group of 21-30 years. Correlation of habits with clinical staging, functional staging and histopathological grading were significant (p<0.05). Clinical and functional staging did not correlate with histopathological grading, but the correlation of clinical and functional staging was highly significant (p<0.01). Conclusions: The widespread habit of chewing gutkha is a major risk factor for OSMF, especially in the younger age group. In this study, it was found that with increase in the duration and frequency of the habit the severity of the disease increased.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.9
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• pp.3659-3665
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• 2015

Background: Waterpipe tobacco smoking has becoming popular especially among young people worldwide. Smokers are attracted by its sweeter, smoother smoke, social ambience and the misconception of reduced harm. The objective of this study was to systematically review the effects of waterpipe tobacco policies and practices in reducing its prevalence. Materials and Methods: A systematic review was conducted electronically using the PubMed, OVID, Science Direct, Proquest and Embase databases. All possible studies from 1980 to 2013 were initially screened based on titles and abstracts. The selected articles were subjected to data extraction and quality rating. Results: Three studies met the inclusion criteria and were eligible for this review. Almost all of the waterpipe tobacco products and its accessories did not comply with the regulations on health warning labelling practices as stipulated under Article 11 of WHO FCTC. In addition, the grisly new warning labels for cigarettes introduced by Food and Drug Administration did not affect hookah tobacco smoking generally. Indoor air quality in smoking lounges was found to be poor and some hookah lounges were operated without smoke shop certification. Conclusions: Our findings revealed the availability of minimal information on the practices in controlling waterpipe smoking in reducing its prevalence. The lack of comprehensive legislations or practices in controlling waterpipe smoking warrants further research and policy initiatives to curb this burgeoning global epidemic, especially among the vulnerable younger population.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.1
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• pp.45-50
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• 2016

Background: The tobacco epidemic is a heralding health menace, particularly among college students. Tobacco usage among young can have an especially devastating effect as they can be exposed for longer periods. Data to estimate the prevalence of tobacco use in young adults will be a valuable addition to the existing resources. Materials and Methods: An analytical cross-sectional study was therefore carried out in Mangalore city using a pre-tested, self-administered questionnaire adapted from the Global Youth Tobacco Survey (GYTS) with a representative sample of 720 students aged 18-20 years selected from degree colleges by multi-stage random sampling. Results: Prevalence of 'ever users' and 'current users' of smoking were 20.4% and 11.4%, respectively. The mean age at initiation of cigarette smoking was 16 years and the majority (31 %) smoked in public places. Interestingly, 84% of them knew about the harmful effects of cigarette smoking. About one half of smokers had some or most of their friends smoking. Multivariate analysis revealed gender (OR=8.585: CI-3.26-22.5), pocket money (OR=4.165; CI=1.76-9.82) and peer's smoking habit (OR= 5.15; CI-2.21-11.9) have higher odds as correlates of tobacco usage among college students. Conclusions: It is of prime importance to highlight the role of prevention of smoking initiation rather than subsequently trying to stop the habit. Comprehensive interventions embracing family, friends and social milieu are needed to reduce tobacco use among students in India.