Presentation on theme: "Dr. Mohamad Nizam Bin Subahir MD (USU), M.Comm.Med(Epid & Stat)(UKM)"— Presentation transcript:
1Dr. Mohamad Nizam Bin Subahir MD (USU), M.Comm.Med(Epid & Stat)(UKM) RISK FACTORS OF PROSTATE CANCER IN UNIVERSITI KEBANGSAAN MALAYSIA MEDICAL CENTRE: A CASE-CONTROL STUDYDr. Mohamad Nizam Bin SubahirMD (USU), M.Comm.Med(Epid & Stat)(UKM)
2INTRODUCTION Prostate Cancer Distribution Worldwide prostate cancer incidence is per 100,000 populations (Nelen V. 2007).In Malaysia, Incidence rate was 10.3 per 100,000 population (NCR 2003).Expected to increase in the future with an increasing ageing population.
3INTRODUCTIONEtiology: remain poorly understood but many evidence correlate the incidence of prostate cancer with multiple factors such as genetic, occupation, diet, hormonal disturbances, sexual activity and sexual transmitted disease (O’Reilly 1999)Justification: This study is important because this is the first time for this kind of study done in Malaysia to recognize the risk factors for prostate cancer.
5Study Objective General Objective To determine the relationship between risk factors and prostate cancer patients who came for treatment at Universiti Kebangsaan Malaysia Medical Centre (UKMMC).
6METHODOLOGY Consent Form Control Case Histopatologically confirmed diagnose primer prostate cancerQualifiedQuestionnaireScreening based on IPSS (Int. Prostate Symptom Score)Normal PSA (0-4ng/ml)Has symptomNot QualifiedNo symptomResultsStatistic testNot Normal PSA (>4ng/ml)Already undergone biopsy and proven not has malignancy cell
7Statistical AnalysisStatistical significance was considered if p< 0.05.The relation between risk factors and prostate cancer was examined using software of McNemar Calculator to calculate the (ORM).For conditional logistic regression using the software SPSS version 12.0 to calculate the adjusted odds ratio.
9The ethnic group and age distribution among patient in this study group is almost similar to that of the second report of National Cancer Registry (NCR 2003).When men become older, prostate is the most pathologically transform organ (Groven & Martin 2002)
10McNemar Odds Ratio (ORM) Table 1 till 5 will illustrates the McNemar Odds Ratio (ORM) and related 95% CI for prostate cancer with sociodemographic, lifestyle, diet, medical problem and occupational exposure with different frequency.
11In term of sociodemographic (education, income & married), no significant risk were found with prostate cancer.
12Table 2: McNemar analysis for significant lifestyle factor VariableCasesControlORMP value(+) (-)(95% CI)Freq. Sexual IntercourseLow (+)High (-)0.46( )0.007*ExerciseNot Frequent (+)Frequent (-)220.41( )0.03*Daily Works ActivitySedentary (+)Strenuous (-)440.55( )0.02** significant at p< 0.05
13Table 3: McNemar analysis for significant medical factor VariableCasesControlORMP value(+) (-)(95% CI)Family CaYes (+)No (-)202.87( )0.02** significant at p< 0.05
14Table 4: McNemar analysis for significant occupational factor VariableCasesControlORMP value(+) (-)(95% CI)PesticideYes (+)No (-)24692.400.03** significant at p< 0.05
15Table 5: McNemar analysis for study variable of diet CasesControlORMP value(+) (-)(95% CI)VegetablesFrequent (+)Not Frequent (-)40.21( )0.004*Fruits80.36( )0.018*TomatoesFrequent (+)Not Frequent (-)130.41( )0.007*Meat465.75( )0.001*Fish50.42( )0.15* significant at p< 0.05
16Multivariate Analysis Table 6, 7 & 8 will shows the adjusted odds ratio from conditional logistic regression model for prostate cancer.
17Table 6: Conditional Logistic Regression model for prostate cancer Risk FactorsßWaldPPesticideNoYes1.7188.4190.004*Family History Ca1.3275.1540.023*MeatNot FrequentFrequent2.51118.2420.001*OR(95% CI)1.05.572( )3.768( )12.232( )* significant at p< 0.05
18Histories of exposed to pesticide with prostate cancer consistent with other studies (Meyer et al. (2006) and Alavanja et al. (2003)Pesticide content such as glyphosate isopropylamine and paraquat are not yet proven as carcinogens but have potential.Family history of other cancer was found increase risk for prostate cancer also consistent with other studies (Villeneuve et al. 1999; Freindenreich et al. 2004)
19Table 7: Conditional Logistic Regression model for prostate cancer VegetablesNot FrequentFrequent-2.1204.5600.033*Tomatoes-1.0394.4700.035*Sexual Int. FrequencyLowHigh-0.8324.2170.040*1.00.120( )0.354( )0.435( )* significant at p< 0.05
20Frequent intake of vegetables & tomatoes reduced risk consistent with other studies. Frequent SI was found to be associated with prostate cancer gave protective effect till 57%.Leitzman et al.(2004) found that frequent ejaculation equal or more 21 times per month compared to those who had only 4-7 times will significantly reduced risk for prostate cancer with MRR 0.67 (95%CI: ).
21Table 8: Conditional Logistic Regression model for prostate cancer FruitsNot FrequentFrequent0.1080.0240.876Exercise-0.2050.1060.745Daily Works ActivitySedentaryStrenuous-0.4401.5460.2141.01.114( )0.815(0.644( )
22RecommendationsScreening with PSA before age 50 & repeat if necessary.Encourage public since school age to frequent intake of vegetables, fruits and tomatoes and limit intake of meat.Encourage public do more exercise.Population-based matched case control study.Cross-sectional study (eg; M’sian diet habit)KAP study to worker (eg; use of PPE).
23CONCLUSIONThe present study suggests that some life style and occupation factors are strong predictors of the occurrence of prostate cancer.More importantly, with the identification of the potentially modifiable risk factors, proper public health intervention can be improved.
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