With plans strongly supported by the Ministry of Public Health, the NCCP envisages integration into the health care system in 6 strategic areas: 1 cancer informatics; 2 primary prevention; 3 early detection; 4 treatment; 5 palliative care; and 6 cancer control research. Cancer registration is a high priority, with The overall prevalence of chewing tobacco or snuffing was 4.
In S2-level screening at local sub-district health centers, 88, individuals participated with a dropout rate of From this population, a total of individuals with abnormal or doubtful lesions were identified and further referred for S3-level screening Figure 3. The histopathological reports of the cancerous lesions along with patient demographics are summarized in Table 4.
The northeastern region of Thailand comprises 20 provinces with a total population of 22,, This pilot study focused on four neighboring provinces and included a total of 13 districts with a cumulative population of , individuals. On the contrary, the use of smokeless tobacco was more prevalent in females.
Considering the regional data, the overall prevalence of tobacco use in the northeastern region was second only to the southern region [ 19 ]. The association between oral cancer and tobacco smoking, alcohol consumption, and betel quid chewing has been well established [ 20 ]. Betel quid is traditionally prepared by wrapping areca nut with fresh or fermented betel leaf with lime, tobacco, or other regional additives [ 21 ].
Although primarily consumed for its psychostimulant properties, reca alkaloids arecoline and arecaidine present in areca nut can be a major source of toxicity [ 7 ]. Betel nut consumption and smoking was reported to increase the risk of developing oral premalignant lesion by eight- to nine-fold than those who refrained [ 16 ].
Most of the individuals in the northeastern region of Thailand rely on agriculture for their livelihood and are exposed to prolonged durations of sunlight, increasing their overall risk of cancer [ 22 ].
Alcohol consumption, smoking, betel quid consumption, and long durations of sun exposure were the most prevalent risk factors among the individuals who appeared for the initial S1 screening in our study. These data also agreed with a previous report by the National Statistics Office, which reported a prevalence rate of Comparatively, a higher prevalence of betel quid consumption Furthermore, both past and current users or experiences were grouped as one in our analysis of the risk factors.
In general, the prevalence of smokeless tobacco consumption in Thailand remains low 3. The screening of a large group of individuals for early detection of oral cancer can be challenging due to the required resources, capable personnel, and facilities. Opportunistic screening of oral cancer can be performed when individuals visit dental professionals.
This method of screening is considered cost effective to identify potential lesions [ 25 ]; however, in developing countries the number of individuals who regularly visit dental clinics is low, and it is still questionable whether these individuals represent the general population. Self-examination of the oral mucosa by the individuals themselves may prove difficult, as they may not be able to differentiate between normal and abnormal mucosa without appropriate education or visual media [ 26 ].
Therefore, to improve the overall effectiveness of this study, we first considered identifying high-risk individuals from the general population and then visually screening them for abnormalities. Several large-population-based oral cancer screening programs have been conducted with various levels of success. In a study carried out in Gujrat, India, trained village healthcare workers screened 2,, individuals and referred individuals to tertiary care centers, among which Similarly, in a study conducted in Kannur, Kerala, 1,, individuals were surveyed by volunteers who identified patients, out of which attended subsequent screenings, and 13 were identified with oral cancer and with precancerous lesions [ 28 ].
A study by Chuang et al. A questionnaire-based interview was followed up by visual examination by trained dentists. Out of 2,, individuals who took part in the study, 16, were identified with suspicious lesions, among which 11, were identified with premalignant lesions and were identified with oral cancer. Subsequent evaluations during follow-up led to the identification of an additional lesions [ 29 ].
Besides initial screening, subsequent follow-ups of individuals, especially those with potentially pre-malignant lesions, play a pivotal role in the success of oral cancer studies.
Thailand has an existing extensive network of , [ 30 ] active VHVs, who are overseen by the Department of Health Service Support to provide basic health-related information at the local grassroots level. Many of them can speak local dialects and can encourage villagers to seek medical consultation through discussion and informal conversations. This could have been due to the rural backdrop, where individuals cannot spare their daily wage or traveling time to visit a distant healthcare facility for health issues that may not be of importance to them.
At the final S3 screening, individuals were treated and were placed under observation. Biopsy results revealed 25 cancerous lesions in 21 individuals and OPMD lesions. Although the cancer lesions were mostly prevalent in the fifth to eighth decade of life, one third occurred in the seventh decade, which was in conjunction with a previous multicenter histopathological study of oral malignant lesions [ 4 ]. This has been so far the largest documented observation of malignant and pre-malignant lesions in Thailand.
In a similar community-based oral cancer study carried out in five districts of Roi-et province in Thailand, 57, adults were sent self-screening forms and questionnaires, out of which responded positively and were subsequently examined by dental nurses.
Only out of who were referred appeared for their appointment with dentists. Ninety-nine patients were then referred to an oral and maxillofacial surgeon at a provincial hospital. Although 88 appeared, only 10 individuals accepted biopsy, and the results showed 1 cancerous lesion and 6 PMDs [ 17 ].
Compared to the Roi-et study, this study utilized a three-tier screening process, which improved the workflow by reducing redundant steps both for the patient and treatment team. It allowed the hospitals and dentists to focus on diagnosis and treatment rather than screening. Treatments such as medication, biopsy, laser therapy, removal of irritation, and minor surgery were performed at district hospitals with visiting treatment teams from central or regional hospitals, which also created opportunities for learning, collaboration, and knowledge sharing among the teams.
Only patients with advanced cancerous lesions were referred for proper treatment at the central or regional hospital. Cost utility analysis compares the cost of an intervention to its effectiveness measured in natural health units.
In context with Thailand, a report established the ceiling threshold of cost effectiveness at THB , for each quality-adjusted life year QALY gained [ 32 ]. Similarly, Kumdee et al. These results are indicative of a highly effective intervention, and a detailed report is in progress. For future implementation, it is suggested to adjust the criteria for S1 screening for efficient identification of high-risk individuals from the others and to lessen the workload on S2-level screening.
One method of attaining effective recruitment would be to segregate the risk factors into major and minor risk factors, and to only recruit individuals with risk factors that have the highest association with oral cancer and OPMDs, such as alcohol consumption, tobacco smoking, use of smokeless tobacco, and betel quid chewing. Exposure to multiple risk factors can also be considered during recruitment into S2, as synergistic effects among risk factors were observed in our previous study [ 34 ].
Although the accessibility of the system was greatly improved via internet-enabled terminals, it was also prone to human error. To improve the effectiveness of the study, data entry should be strictly implemented.
Even though oral cancer screening by visual examination is considered to have high specificity and sensitivity [ 35 ], some potentially harmful lesions could have been missed at the S2 level. Moreover, the study identified individuals with OPMDs, which showed the necessity for a robust follow-up system for early detection of malignant transformations.
In order to reduce dropouts and to improve the compliance of patients under the surveillance program and follow-ups, an automated module is currently under development that would send digital text-based reminders SMS to the patients and treatment team regarding their appointments [ 36 ]. However, its results, comparisons to conventional telephone-based reminders, and implications are yet to be determined. Our oral screening program aimed for complete management, where individuals with cancerous or premalignant lesions were screened, diagnosed, treated, and followed up with using standard protocols.
The results of this pilot model have created one of the largest oral cancer databases in Thailand and showed that a community-based screening model utilizing VHVs, dental auxiliaries, and dentists with a digital database management could be effective in oral cancer screening of a large population. The model also has the potential to be applied for the screening of other forms of cancer. Objectives: This study characterized the cervical cancer incidence trends in Songkhla in southern Thailand using joinpoint and age period cohort APC analysis to observe the effect of cervical cancer screening activities in the past decades, and to project cervical cancer rates in the province, to Materials and methods: Invasive and in situ cervical cancer cases were extracted from the Songkhla Cancer Registry from through Age standardized incidence rates were estimated.
Take note : The above prices are valid until 31 December as advertised by the hospital. We would encourage policyholders to check with their insurer or hospital to see whether they would be able to reimburse the cost of screening.
For more information, contact the Oncology Center :. For decades Pattaya has been known as the city devoted to its population of expats. The coastal city offers endless possibilities when it comes to entertainment, food, and lifestyle. But it is also a center for medical services like the nearby Samitivej Sriracha Hospital. Samitivej is a private hospital that has won many accolades in the last few years. For expats looking for a reputable hospital, Samitivej Sriracha makes one of the top 5 hospitals in this region of Thailand.
The hospital offers the following important cancer screenings :. The main thing that all top private hospitals in Thailand have in common is that they have close working relationships with many of the local and global health insurance companies in Thailand. As an intermediary firm, Pacific Prime Thailand also works closely with many of these health insurance companies to provide clients with impartial advice across a range of plans, including:. Jimmy is a content writer who helps simplify insurance for readers interested in international private medical insurance.
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