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UADT cancers Interim results. HSFU/UADT cancer CRA Databases: English Databases: Spanish Databases: Chinese Databases searched Search results filtered.

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Presentation on theme: "UADT cancers Interim results. HSFU/UADT cancer CRA Databases: English Databases: Spanish Databases: Chinese Databases searched Search results filtered."— Presentation transcript:

1 UADT cancers Interim results

2 HSFU/UADT cancer CRA Databases: English Databases: Spanish Databases: Chinese Databases searched Search results filtered Papers identified & obtained for full review Data extraction Independent Quality Assessment Cross-checking references & citations Awaited Meta-analysisInterim results only

3 The combined organs and tissues of the respiratory tract and the upper part of the digestive tract (including the lips, mouth, tongue, nose, throat, vocal cords, and part of the esophagus and windpipe).

4 Search strategy “Nasopharynx” OR “nasopharyngeal” OR “NPC” OR “Oropharynx” OR “oropharyngeal” OR “Hypopharynx” OR “hypopharyngeal” OR “pharynx” OR “larynx” OR “laryngeal” OR “paranasal” OR “head and neck” OR “UADT” OR “aerodigestive” OR “upper respiratory” OR “ENT” OR “otorhinolaryngologic*” Cancer OR cancers OR carcinoma OR carcinomata OR neoplasm OR neoplasms OR tumor OR tumors OR tumour OR tumours "IAP" OR "Indoor air" OR "pollution" OR "pollutant" OR "fuel" OR "fuels" OR "dung" OR "agricultural waste" OR "crop waste" OR "crop residue" OR "charcoal" OR "coal" OR "biomass" OR "wood" OR "stove" OR "stoves" OR "chula" OR "chulla" OR "oven" OR "ovens" OR "smoke" OR "smoky" OR heat* OR cook* OR light* OR burn*

5 Databases PubMed (Medline) Embase (Scopus & Ovid) Cochrane Controlled Trials Register CINAHL (Ovid) Global Health (Ovid) DARE (Database of Abstracts of Reviews of Effects) – for reviews LILACS (Latin American and Caribbean literature) Scielo Index Medicus Africanus Chinese databases CNKI – by Ray

6 Search results (English) 11,627 search results 703 abstracts screened 55 full papers reviewed 9 papers with relevant data Did not capture all references from IARC monograph – 2 or 3 additional papers Need to cross-check references and citations plus await results from Chinese databases

7 9 studies 3 China, 1 Singapore, 1 Malaysia, 2 India, 1 Germany, 1 Brazil – 1 kerosene exposure only (not for M/A) – 2 insufficient data for M/A Armstrong 1983, Shanmugaratnam 2000

8 Outcomes Cancer siteStudies Nasopharyngeal cancerZheng 1994, Chelleng 2000, Armstrong 1983, Shanmugaratnam 2000 Nasal cavity, paranasal sinuses and middle ear Zheng 1992 Oral cavity/hypopharynx/ larynx -mainly SCC carcinomas Dietz 1995, Zheng 1992b, Pintos 1998, Sapkota 2008

9 Exposure assessment Indirect assessmentStudy Current use of wood for cookingChelleng 2000, Use of wood as domestic fuel in 1 year preceding diagnosis Zheng 1994; Always use wood for cooking Always use coal for cooking Sapkota 2008 Ever use wood/straw OR coal OR kerosene as cooking fuel Zheng 1992 Main cooking fuel for last ten years – charcoal, firewood, kerosene Shanmugaratnam 2000 (not for M/A) “Exposure to domestic smoke”Armstrong 1983 (not for M/A) Current use wood stove for heating or cookingPintos 1998 Use fossil fuel stove for heating Use fossil fuel stove for cooking Dietz 1995 Ever use kerosene stoveZheng 1992b (not for M/A)

10 Quality issues Quality Issues Shanmugaratnam 2000 Exposure – main cooking fuel (firewood/kerosene /charcoal) used over last ten years but no clear comparison category Only OR and chi2 provided Insufficient data to use for meta- analysis Armstrong 1983 Malaysia “No positive association with domestic smoke” – no data provided Insufficient data to use for meta- analysis Zheng 1992bCrude data for use of kerosene stoveNo other comparable study therefore not included in M/A Dietz 1995 Heidelberg, Germany Use of fossil fuel single stoves for cooking or heating – combines clean and solid fuels Remove in sensitivity analysis Zheng 1992Ever use of wood/straw as cooking fuel No clear comparison fuel Remove in sensitivity analysis Zheng 1994Use of wood as domestic fuel 1 year preceding diagnosis No clear comparison fuel Remove in sensitivity analysis Chelleng 2000: Nagaland, India Cooking fuel used gas vs. wood– 72% of cases were men and a lot of cooking was done outside main home ? Remove in sensitivity analysis Sapkota 2008Always coal or Always wood for cooking vs. modern fuel. But 93% larynx ca and 83% hypopharynx cases men. ? Remove in sensitivity analysis

11 All studies (n=6)

12 Publication Bias Begg's Test adj. Kendall's Score (P-Q) = 20 Std. Dev. of Score = Number of Studies = 12 z = 1.37 Pr > |z| = z = 1.30 (continuity corrected) Pr > |z| = (continuity corrected) Egger's test Std_Eff | Coef. Std. Err. t P>|t| [95% Conf. Interval] slope | bias |

13 NPC (n=2)

14 NPC plus nasal cavity/middle ear n=3

15 Excluding nasopharynx (n=3)

16 Key assumptions/issues Heterogeneous outcomes Combine fuel categories – Fossil fuel stoves Unclear reference categories – Ever wood vs. never wood Cooking as exposure when most of subjects are men


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