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Pongnikorn D, Phinyo P, Patumanond J, Daoprasert K, Phothong P, Siribumrungwong B. Individualized Prediction of Breast Cancer Survival Using Flexible Parametric Survival Modeling: Analysis of a Hospital-Based National Clinical Cancer Registry. Cancers (Basel) 2021; 13:1567. [PMID: 33805407 PMCID: PMC8037061 DOI: 10.3390/cancers13071567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
Prognostic models for breast cancer developed from Western countries performed less accurately in the Asian population. We aimed to develop a survival prediction model for overall survival (OS) and disease-free survival (DFS) for Thai patients with breast cancer. We conducted a prognostic model research using a multicenter hospital-based cancer clinical registry from the Network of National Cancer Institutes of Thailand. All women diagnosed with breast cancer who underwent surgery between 1 January 2010 and 31 December 2011 were included in the analysis. A flexible parametric survival model was used for developing the prognostic model for OS and DFS prediction. During the study period, 2021 patients were included. Of these, 1386 patients with 590 events were available for a complete-case analysis. The newly derived individualized prediction of breast cancer survival or the IPBS model consists of twelve routinely available predictors. The C-statistics from the OS and the DFS model were 0.72 and 0.70, respectively. The model showed good calibration for the prediction of five-year OS and DFS. The IPBS model provides good performance for the prediction of OS and PFS for breast cancer patients. A further external validation study is required before clinical implementation.
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Affiliation(s)
- Donsuk Pongnikorn
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand;
- Cancer Registry Unit, Lampang Cancer Hospital, Lampang 52000, Thailand;
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Musculoskeletal Science and Translational Research (MSTR) Cluster, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | | | - Pachaya Phothong
- Policy and Strategy Unit, Lampang Cancer Hospital, Lampang 52000, Thailand;
| | - Boonying Siribumrungwong
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand;
- Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
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2
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Lakha F, Suriyawongpaisul P, Sangrajrang S, Leerapan B, Coker R. Breast cancer in Thailand: policy and health system challenges to universal healthcare. Health Policy Plan 2020; 35:1159-1167. [PMID: 33212481 DOI: 10.1093/heapol/czaa063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/14/2022] Open
Abstract
Thailand has successfully implemented Universal Health Coverage (UHC) and embedded the 2030 Agenda for Sustainable Development into its Thailand 4.0 policy. Breast cancer is a growing challenge in Thailand, as it is globally. It serves as a perfect medium through which to interrogate UHC and demonstrate areas of the health system which require further strengthening if UHC is to be sustainable in the longer term. We conducted a situation analysis and used a Systemic Rapid Assessment (SYSRA) framework to examine the challenges posed to UHC through the lens of breast cancer. We identified a number of challenges facing UHC including (1) continued political commitment; (2) the need for coordinated scale-up of strategic investments involving increased financing and fine-tuning of the allocation of resources according to health needs; (3) reducing inequities between health insurance schemes; (4) investing in innovation of technologies, and more critically, in technology transfer and capacity building; (5) increasing capacity, quality and confidence in the whole primary healthcare team but especially family medicine doctors. This would subsequently increase both efficiency and effectiveness of the patient pathway, as well as allow patients wherever possible to be treated close to their homes, work and family; (6) developing and connecting information systems to facilitate understanding of what is working, where needs are and track trends to monitor improvements in patient care. Our findings add to an existing body of evidence which suggest, in light of changing disease burden and increasing costs of care, a need for broader health system reforms to create a more enabling platform for integrated healthcare as opposed to addressing individual challenging elements one vertical system at a time. As low- and middle-income countries look to realize the 2015 Sustainable Development Goals and sustainable UHC this analysis may provide input for policy discussion at national, regional and community levels and have applicability beyond breast cancer services alone and beyond Thailand.
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Affiliation(s)
- Fatim Lakha
- Department of Global Health and Development, Communicable Disease Policy Research Group, London School Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | - Suleeporn Sangrajrang
- Cluster of Health System Development, National Cancer Institute, Bangkok 10400, Thailand
| | | | - Richard Coker
- Department of Global Health and Development, Communicable Disease Policy Research Group, London School Hygiene and Tropical Medicine, London WC1E 7HT, UK
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3
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Vianna FSL, Giacomazzi J, Oliveira Netto CB, Nunes LN, Caleffi M, Ashton-Prolla P, Camey SA. Performance of the Gail and Tyrer-Cuzick breast cancer risk assessment models in women screened in a primary care setting with the FHS-7 questionnaire. Genet Mol Biol 2019; 42:232-237. [PMID: 31170278 PMCID: PMC6687344 DOI: 10.1590/1678-4685-gmb-2018-0110] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022] Open
Abstract
Breast cancer (BC) risk assessment models base their estimations on different aspects of a woman's personal and familial history. The Gail and Tyrer-Cuzick models are the most commonly used, and BC risks assigned by them vary considerably especially concerning familial history. In this study, our aim was to compare the Gail and Tyrer-Cuzick models after initial screening for familial history of cancer in primary care using the FHS-7 questionnaire. We compared 846 unrelated women with at least one positive answer to any of the seven FHS-7 questions (positive group) and 892 unrelated women that answered negatively (negative group). Concordance between BC risk estimates was compared by Bland-Altman graphics. Mean BC risk estimates were higher using the Tyrer-Cuzick Model in women from the positive group, while women from the negative group had higher BC risk estimates using the Gail model. With increasing estimates, discordance also increased, mainly in the FHS-7 positive group. Our results show that in women with a familial history of cancer, the Gail model underestimates risk and the Tyrer-Cuzick seems to be more appropriate. FHS-7 can be a useful tool for the identification of women with higher breast cancer risks in the primary care setting.
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Affiliation(s)
- Fernanda Sales Luiz Vianna
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Laboratório de Medicina Genômica, Centro de Pesquisa Experimental do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Luciana Neves Nunes
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maira Caleffi
- Associação Hospitalar Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Patricia Ashton-Prolla
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Laboratório de Medicina Genômica, Centro de Pesquisa Experimental do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Suzi Alves Camey
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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4
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Knight SR, Ots R, Maimbo M, Drake TM, Fairfield CJ, Harrison EM. Systematic review of the use of big data to improve surgery in low- and middle-income countries. Br J Surg 2019; 106:e62-e72. [PMID: 30620075 PMCID: PMC6590290 DOI: 10.1002/bjs.11052] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 12/16/2022]
Abstract
Background Technological advances have led to the generation of large amounts of data, both in surgical research and practice. Despite this, it is unclear how much originates in low‐ and middle‐income countries (LMICs) and what barriers exist to the use of such data in improving surgical care. The aim of this review was to capture the extent and impact of programmes that use large volumes of patient data on surgical care in LMICs. Methods A PRISMA‐compliant systematic literature review of PubMed, Embase and Google Scholar was performed in August 2018. Prospective studies collecting large volumes of patient‐level data within LMIC settings were included and evaluated qualitatively. Results A total of 68 studies were included from 71 LMICs, involving 708 032 patients. The number of patients in included studies varied widely (from 335 to 428 346), with 25 reporting data on 3000 or more LMIC patients. Patient inclusion in large‐data studies in LMICs has increased dramatically since 2015. Studies predominantly involved Brazil, China, India and Thailand, with low patient numbers from Africa and Latin America. Outcomes after surgery were commonly the focus (33 studies); very few large studies looked at access to surgical care or patient expenditure. The use of large data sets specifically to improve surgical outcomes in LMICs is currently limited. Conclusion Large volumes of data are becoming more common and provide a strong foundation for continuing investigation. Future studies should address questions more specific to surgery.
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Affiliation(s)
- S R Knight
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - R Ots
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - M Maimbo
- Department of General Surgery, Kitwe Teaching Hospital, Kitwe, Zambia
| | - T M Drake
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - C J Fairfield
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - E M Harrison
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
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Luangxay T, Virachith S, Hando K, Vilayvong S, Xaysomphet P, Arounlangsy P, Phongsavan K, Mieno MN, Honma N, Kitagawa M, Sawabe M. Subtypes of Breast Cancer in Lao P.D.R.: A Study in a Limited-Resource Setting. Asian Pac J Cancer Prev 2019; 20:589-594. [PMID: 30806064 PMCID: PMC6897003 DOI: 10.31557/apjcp.2019.20.2.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The purpose of this study is to evaluate the prevalence of the immunohistochemical subtypes of breast cancer among Lao women by using immunohistochemistry (according to the St. Gallen 2017 guidelines) and to study their correlation to clinicopathological features in order to help guide better treatment plans for patients. Materials and methods: Formalin-fixed and paraffin embedded tissue blocks of 76 cases of primary invasive breast cancer were retrieved from the University of Health Sciences, Vientiane, Lao PDR, from 2013 to 2016. Patients’ information and previous histological reports were reviewed. Immunohistochemistry was done using antibodies against estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2/neu) and Ki-67 (MIB-1). Results: The mean age of the patients was 49 years, and the major histologic type was invasive ductal carcinoma, NOS (90.7%). The proportion of each subtype was hormone receptor-positive and HER2-negative, 44.7%; hormone receptor-positive and HER2-positive, 3.9%; hormone receptor-negative and HER2-positive, 13.2%; and triple-negative, 38.2%. ER was positive in 40.8% of the cases, while PR was positive in 47.4%. More than half of the cases were poorly differentiated cancer (65.8%), followed by moderately differentiated (34.2%). Tumors presented with pT2 (60.5%), followed by pT3 (25.0%) and pT4 (7.9%). Conclusion: Breast cancer among Lao women is characterized by a large percentage of the triple-negative subtype that is less susceptible to hormonal treatments. The empirical treatment with tamoxifen should be reconsidered since it would be less effective to these patients. More importantly, basic pathology services should be the first requirement in Lao PDR in order to provide adequate care.
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Affiliation(s)
- Thitsamay Luangxay
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Cancer Center, Mittaphab Hospital, Vientiane, Laos.
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6
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Virani S, Chindaprasirt J, Wirasorn K, Sookprasert A, Somintara O, Vachirodom D, Koonmee S, Srinakarin J, Kamsa-Ard S, Suwanrungruang K, Rozek LS, Sriplung H, Wiangnon S. Breast Cancer Incidence Trends and Projections in Northeastern Thailand. J Epidemiol 2018; 28:323-330. [PMID: 29760320 PMCID: PMC6004364 DOI: 10.2188/jea.je20170045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The northeast has the lowest incidence of breast cancer of all regions in Thailand, although national rates are increasing. The heterogeneity in subnational trends necessitates a comprehensive evaluation of breast cancer incidence trends and projections to provide evidence for future region-specific strategies that may be employed to attenuate this growing burden. METHODS Joinpoint regression and age-period-cohort modeling were used to describe trends from 1988-2012. Data was projected from three separate models to provide a range of estimates of incidence to the year 2030 by age group. RESULTS Age-standardized rates (ASRs) increased significantly for all women from 1995-2012 by 4.5% per year. Rates for women below age 50 increased by 5.1% per year, while women age 50 years and older increased by 6% per year from 1988-2012. Projected rates show that women age 50 years and older have the largest projected increase in ASRs by 2030 compared to younger women and all women combined. CONCLUSIONS Breast cancer trends in Khon Kaen are presently lower than other regions but are expected to increase and become comparable to other regions by 2030, particularly for women ages 50 years and older.
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Affiliation(s)
- Shama Virani
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University
| | - Jarin Chindaprasirt
- Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Khon Kaen University
| | - Kosin Wirasorn
- Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Khon Kaen University
| | - Aumkhae Sookprasert
- Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Khon Kaen University
| | | | | | - Supinda Koonmee
- Department of Pathology, Faculty of Medicine, Khon Kaen University
| | | | - Supot Kamsa-Ard
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University
| | | | | | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University
| | - Surapon Wiangnon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University
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7
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Pongnikorn D, Daoprasert K, Waisri N, Laversanne M, Bray F. Cancer incidence in northern Thailand: Results from six population-based cancer registries 1993-2012. Int J Cancer 2018; 142:1767-1775. [PMID: 29226335 DOI: 10.1002/ijc.31203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
Rapid changes in social and economic development have led to cancer becoming a major cause of national morbidity and mortality in Thailand. Cancer registries have been critical in documenting subnational cancer patterns and transitions in the country; with the establishment of six registries in northern Thailand, a comprehensive assessment of the scale and profile of cancer is now possible in the region. Cancers of the liver, lung, colorectum, breast and cervix were the major cancers 2008-2012, although variations in the profiles of cancer were observed, with a very high incidence of liver cancer seen among males in Phrae, corresponding to one in 11 men developing the disease in a lifetime. Based on data from Lampang and Chiang Mai 1993-2012, rates of lung and cervical cancer incidence have declined, while liver, colorectal and breast cancer incidence have been increasing up to 2012. A more detailed investigation of the incidence trends for specific cancer sites and subtypes at the local level are crucial to the monitoring and evaluation of the cancer control interventions implemented within the Thai national cancer control programme (NCCP). Priority should be given to extend the capacity of the new registries in northern Thailand, ensuring improvement in quality and utilization of the data to drive epidemiologic research and cancer control.
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Affiliation(s)
| | | | - Narate Waisri
- Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mathieu Laversanne
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
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Virani S, Sriplung H, Bilheem S, Sripan P, Maneesai P, Waisri N, Chitapanarux I. Effect of the national screening program on malignancy status of cervical cancer in Northern Thailand. Int J Public Health 2018; 63:377-385. [PMID: 29362857 DOI: 10.1007/s00038-018-1077-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/07/2017] [Accepted: 01/11/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Cervical cancer has posed a serious problem in Thailand for decades. In 2002, a systematic screening program was implemented under universal healthcare coverage for all Thai women. However, there has been little research on how screening affected particular aspects of cervical cancer, such as stage distribution. This screening program has a target group; therefore, it is necessary to assess stage and incidence trends by age of those within and outside the screening target group. METHODS Using trend analysis, we assess in situ and malignant cervical cancers in Northern Thailand to measure changes after implementation of the national screening program. RESULTS While incidence of malignant cancers is decreasing and incidence of in situ tumors is increasing across all age groups, women above age 60 still experience a high incidence of malignant tumors. CONCLUSIONS The screening program is successful in the target group at downshifting the stage distribution of malignant tumors and reducing incidence of malignant tumors with in situ cases being captured. However, the high incidence of malignant tumors in women over age 60 will continue to be clinically relevant for cervical cancer management until younger generations undergoing screening enter this age group.
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Affiliation(s)
- Shama Virani
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.,Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Surichai Bilheem
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Patumrat Sripan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, 110 Intrawarorose road, Chiang Mai, 50200, Thailand.,Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Puttachart Maneesai
- Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narate Waisri
- Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, 110 Intrawarorose road, Chiang Mai, 50200, Thailand. .,Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. .,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Virani S, Bilheem S, Chansaard W, Chitapanarux I, Daoprasert K, Khuanchana S, Leklob A, Pongnikorn D, Rozek LS, Siriarechakul S, Suwanrungruang K, Tassanasunthornwong S, Vatanasapt P, Sriplung H. National and Subnational Population-Based Incidence of Cancer in Thailand: Assessing Cancers with the Highest Burdens. Cancers (Basel) 2017; 9:E108. [PMID: 28817104 PMCID: PMC5575611 DOI: 10.3390/cancers9080108] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 12/20/2022] Open
Abstract
In Thailand, five cancer types-breast, cervical, colorectal, liver and lung cancer-contribute to over half of the cancer burden. The magnitude of these cancers must be quantified over time to assess previous health policies and highlight future trajectories for targeted prevention efforts. We provide a comprehensive assessment of these five cancers nationally and subnationally, with trend analysis, projections, and number of cases expected for the year 2025 using cancer registry data. We found that breast (average annual percent change (AAPC): 3.1%) and colorectal cancer (female AAPC: 3.3%, male AAPC: 4.1%) are increasing while cervical cancer (AAPC: -4.4%) is decreasing nationwide. However, liver and lung cancers exhibit disproportionately higher burdens in the northeast and north regions, respectively. Lung cancer increased significantly in northeastern and southern women, despite low smoking rates. Liver cancers are expected to increase in the northern males and females. Liver cancer increased in the south, despite the absence of the liver fluke, a known factor, in this region. Our findings are presented in the context of health policy, population dynamics and serve to provide evidence for future prevention strategies. Our subnational estimates provide a basis for understanding variations in region-specific risk factor profiles that contribute to incidence trends over time.
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Affiliation(s)
- Shama Virani
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand.
- Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Surichai Bilheem
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand.
| | - Wasan Chansaard
- Cancer Registry Unit, Surat Thani Cancer Hospital, Surath Thani 84100, Thailand.
| | - Imjai Chitapanarux
- Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
| | | | | | - Atit Leklob
- Cancer Unit, Lopburi Cancer Center, Lopburi 15000, Thailand.
| | - Donsuk Pongnikorn
- Cancer Registry Unit, Lampang Cancer Hospital, Lampang 52000, Thailand.
| | - Laura S Rozek
- Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | | | - Krittika Suwanrungruang
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
| | | | - Patravoot Vatanasapt
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand.
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