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A Case Control Study of Eating Habit as A Risk Factor Of Lung Cancer In Johor , Malaysia

A Case Control Study of Eating Habit as A Risk Factor Of Lung Cancer In Johor , Malaysia. A. Akashah , Shamsul A.S. 25 Nov 2009. 1-INTRODUCTION.

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A Case Control Study of Eating Habit as A Risk Factor Of Lung Cancer In Johor , Malaysia

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  1. A Case Control Study of Eating Habit as A Risk Factor Of Lung Cancer In Johor, Malaysia A. Akashah, Shamsul A.S. 25 Nov 2009

  2. 1-INTRODUCTION

  3. 10 countries have highest incidence rates of lung cancer in the world – Hungary (81.6 per 100 000), Poland, Kazakhstan, Croatia, Russia, Estonia, Chezh. Rep., Latvia, Lithuania, Australia (Goodman et al. 2002) • USA – IR 48.7 in 100 000 for male (16th in world) and 26.8 per 100 000 for female (2nd in world) in 2002 (Jemal et al. 2006)

  4. In Malaysia, 5 common cancer in 2004 (Breast, Lung, Colorectal, Cervix and Leukemia) (NCC report 2004) • Lung cancer is number 9/10 found in cancer cases in male aged >60 year old and number 3/10 among major disease in Malaysia in 2000 (National Burden of disease, MOH 2004)

  5. Number 1 /10 cause of cancer among male in Malaysia (Lung, nasopharynx, stomach, urinary bladder, rectum, non-Hodgkin’s lymphoma, larynx, liver, colon and esophagus) (Kasri 1997) • IR in Malaysia is 13.4 cases per 100 000 in 2003 (National Cancer Registry 2003)

  6. Lung cancer caused 8.6% of cases of cancer in Malaysia in 2002 (NCR 2002) • Ratio male to female was 2.7:1 and commonly found after the age 40 y.o in Msia in 2002 (NCR 2002) • There are 130 cases of lung cancer cases in Johor in 2007(Chest clinic census 2008) • There are 43 cases of patients (33.1%) aged less than 60 years old and 87 cases (66.9%) aged ≥60 years old

  7. 23.8% (31 cases) are female patients while 76.2% (99 cases) are male, resulting in a male:female ratio of 3.2:1 – Johor (2007) • The IR for the state of Johor in the year 2007 was 4.1 cases over a population of 100 000 (HSAJB Chest Clinic Census 2008)

  8. 2- Scope of the study

  9. Occupational exposure factors Food frequency intake factors LUNG CANCER INCIDENCE Behavioural factors Environment exposure factors Medical factors Socio-demographic factors

  10. Sample frame for case Sample frame for control Randomly select a control from sample frame Randomly select a case from sample frame Case selected only with inclusion criteria Control selected only with inclusion criteria and matched with case (1:1) Questionnaires to cases and control selected with consent Risk factors calculated by McNemar Calculator (Graphpad.com)) Analysis by SPSS 15.0 (descriptive and multivariate) Risk factors and the association were determined Calculation of ARP and PARP

  11. 1) General objective - To determine the risk factors of lung cancer -To determine the association between the risk factors and lung cancer

  12. 2) Specific objectives i) To make a comparison of a socio-demographic characteristics between lung cancer cases and non-lung cancer cases according to; - work status - income status - married status

  13. ii) To determine the risk factors of lung cancer according to; a) Socio-demographic factors - level of education - income status b) Behavioural factors - Smoking - Alcohol intake c) Occupational exposure - Exposure to dust : wood, iron and sand dust - Exposure to chemical : cement and pesticides

  14. d) Environmental exposure - Expose to the polluted place - Expose/ staying with pets in same home - Expose/ staying near to livestock (animal farm) e) Medical factors - blood group: O, A, B and AB - Past history of medical disease (Hypertension, Hypercholestrolemia, DM) - Past history of respiratory disease (Pneumonia, Chronic bronchitis, BA,Tuberculosis) - Family history of cancer

  15. f) Food frequency intake factors - Taste of food : high sweet, salty, sour and spicy - Style of cook : steamed, fried and grilled - Fruit and vegetables - Drinks : milk, red/black tea and coffee

  16. iii) To measure the association between the determined risk factors and lung cancer iv) To measure the attributable risk percent and population attributable risk percent of the determined risk factors of lung cancer.

  17. 3. Hypothesis i) There is no difference between lung cancer cases and non-lung cancer according with their socio-demographic characteristics. ii) There is high of risk in the factors of; - low education level - low income status - smoking - alcohol consumed - have family history of lung cancer

  18. - Have history of any respiratory disease : Pneumonia,Tuberculosis, Chronic bronchitis and BA - Have history of medical disease : Hypertension, DM and Hypercholestrolemia - Exposed to occupational dust : wood, iron and sand - Exposed to occupational chemical substance : cement and pesticide

  19. - Exposed to polluted area - Exposed / staying with pets at same house - Exposed / staying near with livestock (animal farm) - High frequency intake of food : high salty food, sweet food and sour food - High frequency intake of food : fried food, grilled food - High frequency intake of drink : coffee and red/black tea

  20. iii) There is low of risk in the factors of; - high frequency intake of food : spicy - high frequency intake of food : steamed food - high frequency intake of food : vegetables and fruits - high frequency intake of drink :milk

  21. 3- RESEARCH METHODOLOGY

  22. 1. Research location and time of study • Chest clinic, Sultanah Aminah Hospital, Johor Bahru, Johor, Malaysia (lung cancer cases) – Centre of referral for lung dz from all over Johor, Malaysia • Control (ward or clinic in SAHJB) • From 1st of June 2007 until 31st May 2008

  23. 2. Design of study • Matched case control study

  24. 3. Sample of study • Sample population a) Case – Lung cancer primer diagnosed through Chest X-ray and Histopathology (ICD-10:C33-C34) at chest clinic not less than 1 year before the period of study. Criteria not fit for cases - dementia - bed ridden - deaf and mute - language difficulty - non Malaysian - Psychiatric problem

  25. b) Control – Any patient who registered and have treatment at SAHJB who has not diagnosed as lung cancer through Chest X-Ray (inpatient or outpatient) - Criteria not fit for control same with cases - Control were matched with cases by - Age (10 years range) - Sex (male and female) - Race (Chinese, Malay and Indian)

  26. 4. Size of sample - Based on the study of Axelsson G et al. 1996 and with formula by Hennekens et al. 1987 Sample size =(PoQo +P1Q1)(Zα/2 + Zβ)2 (P1-Po)2 = 120 pair = 162 pair (sample in the study)

  27. 6- Data collection • Structured Questionnaires (pretest) • 2 parts: a) Personal information b) Food Frequency Technique (Axelsson G. et al 1996) (based on standardized FFQ) – 4 blocks of food intake (36 items) with adaptation of local type of food

  28. 7- Data analysis - SPSS 15 version (SPSS.Inc 2007) - McNemar calculator (Graphpad.com) was used for the calculation of the OR as an univariate analysis (McNemar OR). - For multivariate analysis (SPSS), the conditional logistic regression was used to get the adjusted OR.

  29. - ARP (Attributable Risk Percent) and PARP (Population Attributable Risk Percent) was calculated based on the formula; (Kaelin & Bayona 2004) AR = Ie – Iu PAR = Ip - Iu AR% = AR/Ie x 100 PAR% = PAR/Ip x 100

  30. 4- RESULT AND DISCUSSION

  31. Distribution of Case and Control By Age

  32. The difference of socio-demographic factors (job status) between case and control

  33. The differences of socio-demographic factors (income status) between case and control

  34. The difference of socio-demographic factors (married status) between case and control

  35. There is no difference between the case and control in socio-demographic background (fit for matched case control study)

  36. Mc Nemar OR and Adjusted OR of significant risk factors

  37. MV analysis - Model Fitting Information to find an association between frequency of food intake and lung cancer Mc Fadden = 65.8% (mod. association) Goodness of Fit = p > 0.05

  38. Atrributable risk and AR%

  39. Salty food… • High frequency intake have increase the risk of lung cancer (Axelsson G. et al. 1996) (Lei Y.X. et al. 1996) • High salty food contained nitrosamine (nitrate and nitrite in origin) that formed from the reaction between high conc. of salt in the food. This nitrosamine is carcinogen to many organ (e.g lung) (Kansas state univesity 1992)

  40. Spicy food… • High frequency intake have reduce the risk of lung cancer (USMS swimmer 2007) • Spicy food contained high capsaicin. It prevent the activities of tNOX in any cancer cell. This will inhibit the growth of cancer cell and causes apoptosis (destruction of cancer cell) (Purdue and Arizona Uni. USA 2000)

  41. Fruit… • High frequency intake have reduce the risk of lung cancer (Balder et al. 1986 with OR 0.78-0.89, Hind et al. 1984 with OR 0.4, Axelsson G. et al. 1996 with OR 0.37-0.79, Marchand et al. 1993 with OR 0.5) • Fruit contained high Vitamin C which have anti-oxidant function to inhibit carcinogenesis • Anti-oxidant protect cell from free-radical in blood (causes carcinogenesis by changing the DNA structure in cell) (Kansas Uni. 1992)

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