Abstract A84: Risk factors for lung cancer in Nepal
Authors: Hashibe Mia , Siwakoti Bhola , Thakur Binay Kumar , Pun Chin Bahadur , Shrestha Bhakta Man , Burningham Zachary , Sapkota Amir 
Published: December 2010

Over 672,000 lung cancer patients, half of all cases in the world, are diagnosed in low-and middle-income countries (LMC) each year, yet the majority of epidemiologic studies on cancer have been conducted in high-income countries. Cancer is already a major burden in LMCs, and the burden is expected to increase in the next decades. Nepal is one of the poorest countries in the world, with a gross domestic product per capita of $470 in 2009. Lung cancer is the most common cancer among men and the third most common cancer among women in Nepal, where cancer patients remain among the most severely medically underserved. Primary exposures of concern in Nepal with regard to lung cancer are indoor air pollution from solid fuels and smoking tobacco including local tobacco products such as choor and kankat. We have initiated a case-control study of lung cancer in Nepal, with the aims to study the lung cancer risk factor profile in a LMC and estimate attributable fractions and to identify genetic susceptibility factors for lung cancer in Nepal. The lung cancer cases are being recruited from the main cancer hospital in Nepal, the B.P. Koirala Memorial Cancer Hospital (BPKMCH). We aim to recruit 600 lung cancer cases and 600 controls, who will undergo a face-to-face interview on tobacco consumption, occupational history, residential history, type of fuel used for cooking, reproductive factors (for women only), dietary and other lifestyle habits. Biosample collection will include blood, toenail clippings, hair, urine, blood spots and tumor tissue for cases. Thus far we have recruited 103 lung cancer cases and 156 controls. Approximately 46.6% (n=48) of lung cancer patients were females and the largest proportion of cases were in the 60-69 year age group (35.0%). The proportion of never-smokers among controls was more (39%) compared to lung cancer cases (14%), as expected. Among men, 10.9% of cases and 28.5% of controls were never smokers. Among women, 16.7% of cases and 70% of controls were never smokers. The most common type of tobacco smoked was cigarettes without filters (61.2% of cases and 34.0% of controls). The odds ratio adjusted for age, sex, education and ethnicity were 3.96 (95%CI=1.71-9.22) for subjects who currently smoked cigarettes without filters and 1.94 (95%CI=0.96-3.92) for subjects who formerly smoked cigarettes without filters. The majority of subjects lived in rural areas for all of their lives (79.9%) and used wood for cooking and heating in the home (78.2%). Approximately 65.4% of subjects had been exposed to involuntary smoking in the home and 48.4% had ever consumed alcohol. As more subjects are recruited, we will analyze the data further for risk factors. In the future, we would like to evaluate clinical management, quality of life and survival among lung cancer patients in Nepal, and to conduct cost utility analysis for primary and tertiary prevention efforts against lung cancer in Nepal. Our study will generate crucial data needed to formulate more effective cancer care and control policies in Nepal, to improve the situation for this severely medically underserved population.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A84.