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ASSOCIATION BETWEEN MOSQUITO COILS USE WITH NASOPHARYNGEAL CARCINOMA
JOURNAL ARTICLE
Submitted in partial fulfillment of the requirement for a Bachelor Degree at The Faculty of Medicine
Universitas Padjadjaran
WITRI SEPTIANI 130110120050
UNIVERSITAS PADJADJARAN FACULTY OF MEDICINE
BANDUNG 2016
ASSOCIATION BETWEEN MOSQUITO COILS USE WITH NASOPHARYNGEAL CARCINOMA
JOURNAL ARTICLE
WITRI SEPTIANI 130110120050
This is to certify that we have examined this copy of journal article by thecandidate named above and have found that it is complete and satisfactory in all respect, to be submitted in partial fulfillment of the requirement for a Bachelor Degree at the Faculty of Medicine, Universitas Padjadjaran, and that any and all revisions required by the supervisors and
examiners have been made.
Bandung, January 2016 Supervisor I Yussy Afriani Dewi, dr., SpTHT-KL(K)., M.Kes, FICS NIP. 19750413 200012 2 002
Supervisor II Irvan Afriandi, dr., MPH, Dr.PH
NIP. 19710417 199702 1 002
DECLARATION OF ORIGINALITY
OF NOT COMMITTING PLAGIARISM AND/OR UTILIZING FABRICATED DATA IN THE WRITING OF MINOR
THESIS AT THE FACULTY OF MEDICINE UNIVERSITAS PADJADJARAN
I hereby declare that the journal article with the following title:
ASSOCIATION BETWEEN MOSQUITO COILS USE WITH NASOPHARYNGEAL CARCINOMA
is purely a report of a research that I have performed.
1) This article contains no work or arguments previously written or published elsewhere unless explicitly written in the article in the form of citation and acknowledged in the reference list.
2) This letter of statement is sincerely written and should there be dishonesty and inaccuracy associated with this statement discovered in the future, I declare that I will comply with academic sanctions in the form of revocation of academic title awarded to me on the basis of the above- mentioned journal article and other sanctions as regulated by the norms of the university.
Bandung, January 2016
Sincerely,
WITRI SEPTIANI 130110120050
This journal article has been defended by the author in a minor thesis seminar held at the Faculty of Medicine, Universitas Padjadjaran on Wednesday, 6th January 2016
and was attended by the following faculty members:
Pembimbing I : Yussy Afriani Dewi, dr., SpTHT-KL(K)., M.Kes, FICS
Pembimbing II : Irvan Afriandi, dr., MPH, Dr.PH
Ketua Sidang : Ine Kuswardinah, Dra.Apt., M.Kes
Sekretaris : Bonny Wiem Lestari, dr., M.Sc
Anggota : Gartika Sapartini, dr., Sp.A, M.Kes
Association between Mosquito Coils Use with Incidence of Nasopharyngeal
Carcinoma
Witri Septiani1, Yussy Afriani Dewi2, Irvan Afriandi3 1Faculty of Medicine, 2Department of Otorhinolaryngology-Head and Neck Surgery,
3Department of Public Health Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital
Bandung, Indonesia
1. Witri Septiani
Faculty of Medicine, Universitas Padjadjaran Jalan Raya Bandung-Sumedang Km. 21 Jatinangor, Sumedang, West Java, Indonesia Phone: +62 81912765883 Email: [email protected]
2. Yussy Afriani Dewi, dr., SpTHT-KL(K)., M.Kes, FICS Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicne, Universitas Padjadjaran Jalan Prof. Eijkman No. 38 Bandung, West Java, Indonesia Phone: +62 8112272773 Email: [email protected]
3. Irvan Afriandi, dr., MPH, Dr.PH Department of Public Health Faculty of Medicne, Universitas Padjadjaran Jalan Prof. Eijkman No. 38 Bandung, West Java, Indonesia Phone: +62 81320395588 Email: [email protected]
Association between Mosquito Coils Use with Nasopharyngeal Carcinoma
Witri Septiani1, Yussy Afriani Dewi2, Irvan Afriandi3
1Faculty of Medicine, 2Department of Otorhinolaryngology-Head and Neck Surgery, 3Department of Public Health
Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung, Indonesia
Abstract Background: Nasopharyngeal carcinoma (NPC) is malignancy of squamous cells on nasopharyngeal epithelial layer and is the most common otorhinolaryngology malignancy found in Indonesia. Etiology of NPC is multifactorial including food, environment, genetics, and Epstein-Barr virus infection. Mosquito coils contain volatile carcinogens, such as formaldehyde and acetaldehyde which may cause malignancy on upper respiratory tract epithelial cells. The study aimed to understand the association between mosquito coils use with incidence of nasopharyngeal carcinoma. Methods: This was a hospital-based unmatched case control study design involving 80 patients on Oncology Clinic of Department of Otorhinolaryngology-Head and Neck Surgery Dr. Hasan Sadikin General Hospital from September to October 2015. The questionnaire about NPC risk factor exposure including history of mosquito coil use was applied as study instrument. Statistical analysis used chi-square test to acquire the association between two categoriscal variables and was considered significant if p value is <0,05. Result: Percentage of mosquito coil users in case group (52.7%) was higher than in control group (30%). Statistical analysis using chi-square test revealed p = 0.041 with OR (CI 95%) equals to 2.58 (1.03-6.45). This result showed that mosquito coil use might increase risk of nasopharyngeal carcinoma incidence by 2.58 fold. Conclusion: There is an association between mosquito coils use with of nasopharyngeal carcinoma. Keywords: Mosquito coil; nasopharyngeal carcinoma; risk factor
Hubungan Penggunaan Obat Nyamuk Bakar dengan Kejadian Karsinoma
Nasofaring
Witri Septiani1, Yussy Afriani Dewi2, Irvan Afriandi3 1Fakultas Kedokteran, 2Departemen Ilmu Kesehatan THT-KL, 3Departemen Ilmu
kesehatan Masyarakat Fakultas Kedokteran, Universitas Padjadjaran/Rumah Sakit Umum Pusat Hasan
Sadikin Bandung, Indonesia
Abstrak Latar Belakang: Karsinoma nasofaring (KNF) adalah keganasan sel skuamosa pada lapisan epitel nasofaring dan merupakan keganasan THT-KL paling banyak di Indonesia. Etiologi KNF multifaktoral diantaranya makanan, lingkungan, genetik, dan virus Epstein-Barr. Obat nyamuk bakar mengandung karsinogen yang mudah menguap, diantaranya formaldehida dan acetaldehyde yang dapat menyebabkan keganasan sel epitel saluran pernapasan. Berkaitan dengan hal tersebut, dilakukan penelitian untuk mengetahui hubungan penggunaan obat nyamuk bakar dengan kejadian karsinoma nasofaring. Metode: Penelitian desain studi kasus kontrol unmatched melibatkan 80 pasien yang datang ke Poli Onkologi Ilmu Kesehatan THT-KL RSUP Dr. Hasan Sadikin Bandung pada bulan September sampai Oktober 2015. Instrumen penelitian berupa kuesioner tentang paparan faktor risiko KNF termasuk riwayat penggunaan obat nyamuk bakar. Uji chi-square digunakan untuk mengetahui hubungan antara dua variabel kategorik dan dinyatakan bermakna jika nilai p <0,05. Hasil: Persentase pengguna obat nyamuk bakar pada kelompok kasus (52,7%) lebih tinggi dibandingkan dengan kelompok kontrol (30%). Analisis statistik dengan uji chi-square diperoleh nilai p =0,041 dengan OR (IK 95%) sebesar 2,58 (1,03-6,45). Hasil ini menunjukkan penggunaan obat nyamuk bakar dapat meningkatkan risiko terjadinya karsinoma nasofaring sebesar 2,58 kali lipat. Kesimpulan: Terdapat hubungan antara penggunaan obat nyamuk bakar dengan kejadian karsinoma nasofaring. Kata Kunci: Faktor risiko; Karsinoma nasofaring; KNF
1
Introduction
Nasopharyngeal carcinoma (NPC) is a malignancy of squamous cells on
nasopharyngeal epithelial layer.1 The prevalence of NPC in Indonesia is 6.2 per
100,000 residents per year or around 12,000 cases per year and is the most commonly
found otolaryngology malignancy in Indonesia.2 There are 692 (43,7%) NPC patients
in Hasan Sadikin General Hospital, Bandung within 2010-2014 with more male
patients (65.7%) and occur most in the 46-55 age group (29.6%).3 The etiology of
NPC is multifactorial; food (salt-preserved fish consumption) , environmental (mosquito
coil, sawdust, and insecticide exposure), genetic, and Epstein-Barr infection have
been proven as risk factors for NPC.4, 5
Some research has found that gas phase of mosquito coils contain some
carbonyl compounds, such as formaldehyde and acetaldehyde, which may irritate
upper respiratory tract.6 Formaldehyde is proven to have carcinogenic effect towards
humans and nasal part of mice. International Agency for Research on Cancer (IARC)
has proven formaldehyde and acetaldehyde are significantly associated with
occurrence of NPC. Acetaldehyde-bound cells will undergo replication problems and
oncogenic mutation.7,8 Basic Health Research in 2013 shows Indonesia mosquito coil
use is 48.4%, followed by mosquito net bed canopy (25.9%), mosquito repellent
(16.9%), insecticide (12.2%) and window mosquito mesh (8.0%).9 Based on these
regards, a study is conducted to understand the association between mosquito coils
use with incidence of NPC.
2
Methods
Hospital-based unmatched case control study design were used in this
research. Data collection was started from obtaining the outcome or dependent
variable, the case group, which was NPC patients presented to Oncology Clinic of
Otorhinolaryngology-Head and Neck Surgery Department of Hasan Sadikin General
Hospital, Bandung diagnosed based on histopathology result; and control group,
which were patients with other malignancies other than NPC presented to the clinic
of Department of Otorhinolaryngology-Head and Neck Surgery Hasan Sadikin
General Hospital, Bandung. Anamnesis was done on both groups using questionnaire
adapted from Head and Neck Surgery Oncology Study Group, Indonesian
Otorhinolaryngology-Head & Neck Surgery Society to recognize sample behavior in
using mosquito coil and assess risk factors of NPC, which include alcohol
consumption, sawdust exposure, routine insecticide exposure, family history,
smoking history and consuming salt-preserved fish since childhood. This study has
been approved by Hasan Sadikin General Hospital ethical committee and informed
consent has been done to all respondents.
Unpaired comparative analysis formula was used to calculate sample size
with alpha standard deviation Zα = 1.96 and beta standard deviation Zβ = 0.84; value
of P1 = 0.79 and P2 = 0.49; thus, sample size was calculated as 40 for each case and
control group, or 80 people in total. Non probability consecutive sampling was done
3
to select sample; patients presented to Oncology Clinic of Otorhinolaryngology-Head
and Neck Surgery Department of Hasan Sadikin General Hospital, Bandung within
September to October 2015 were appointed as samples on this study. Collected data
were selected based on the inclusion criteria, which was NPC patients diagnosed
based on histopathology result; and the exclusion criteria, which was patients with
multiple malignancies.
Chi square test was used to test association between two categorical
variables. Significance of the test result was determined by p value, should p < 0.05,
the result was considered significant or that there was relation between the two
variables. Excess risk was measured by calculating odds ratio (OR) and confidence
interval (CI) 95%.
4
Results
There were 83 data obtained using non probability consecutive sampling
technique. Among the 83 data, 3 were excluded due to incomplete data. From the
remaining data, there were 40 data for each case and control group, thus made total
80 data.
5
Table 1 Characteristics of Research Subjects
Characteristic Case Group
Control Group p value OR (CI 95%)*
n = 40 (%) n = 40 (%) Sex 0.044 Male 26 (65) 17 (42.5) 2.51 (1.02-6.19) Female 14 (35) 23 (57.5)
Age (Years) 0.478 < 20 1(2.5) 5(12.5) Reference 20-29 6(15) 5(12.5) 0.67 (0.14-1.93) 30-39 5(12.5) 8(20) 0.32 (0.03-3.60) 40-49 9(22.5) 7(17.5) 0.16 (0.02-1.65) 50-59 12(30) 7(17.5) 0.12 (0.01-1.21) ≥60 7(17.5) 8(20) 0.23 (0.02-2.46)
Alcohol Consumption 0.432** Yes 5 (12.5) 2 (5) 2.71 (0.49-14.90) No 35 (87.5) 38 (95)
Sawdust Exposure 0.723 Yes 4 (10) 5 (12.5) 0.78 (0.19-3.14) No 36 (90) 35 (87.5)
Routine Insecticide Exposure 1.000 Yes 6 (15) 6 (15) 1.00 (0.29-3.41) No 34 (85) 34 (85)
Family History of Cancer 1.000** Yes 4(10) 5(12.5) 0.778 (0.19-3.14) No 36(90) 35(87.5)
Smoking History 0.730 Non-smoker 10 (25) 12 (30) Reference Passive 10 (25) 13 (32.5) 1.08 (0.33-3.51) < 10 years 3 (7.5) 1 (2.5) 0.27 (0.02-3.10) >10 years 17 (42.5) 14 (35) 0.68 (0.22-2.05)
Salt-Preserved Fish Consumption 0.013
Yes 28 (70) 17 (42.5) 3.15 (1.26-7.94) No 12 (30) 23 (57.5)
*) OR (CI 95%): Odds Ratio (Confidence Interval 95%) **) Fisher’s Exact Test: used on variables which have cells with expected value (E) less than 5
6
On this research, most case group respondents were male (65%), while in
control group were female (57.5%). In terms of age, most case group respondents
were aged 50-59 years (30%), while in control group most were aged 30-39 years and
≥60 years, which is 20% for each age group. Most respondents, 85.5% on case group
and 95% on control group, were not consuming alcohol. There were more
respondents (85% of each case and control group) not exposed to sawdust than the
exposed ones.
In terms of family history, most respondents (90% of case group and 87.5%
of control group) did not have family history of cancer. Most respondents had more
than 10 years of smoking history; 42.5% of the case group and 35% of the control
group. More respondents (70%) of the case group routinely consumed salt-preserved
fish. Meanwhile, more respondents (57.5%) of the control group did not routinely
consume salt-preserved fish.
Table 2 Association between mosquito coils use with NPC
Characteristic Case Group
Control Group p value OR (CI 95%)*
N = 40 (%) N = 40 (%) Mosquito coil use 0.041**
Yes 21 (52,5) 12 (30) 2.58 (1.03-6.45) No 19 (47,5) 28 (70)
*) OR (CI 95%): Odds Ratio (Confidence Interval 95%) **) Chi-square test
Percentage of mosquito coil use was higher in case group (52%) compared
to control group (30%). Statistical analysis using chi-square test between the
7
variables mosquito coils use and NPC incidence resulted in p value <0.05 with OR
2.58. This showed a significant test result between two variables; mosquito coil use
might increase risk of nasopharyngeal carcinoma incidence by 2.58 fold.
After mosquito coil user data were obtained, sub analysis was done to
identify association between amounts of mosquito coils used with incidence of
nasopharyngeal carcinoma (Table 3) and association between duration of mosquito
coils use with incidence of nasopharyngeal carcinoma (Table 4).
Table 3 Association between amounts of mosquito coils used with NPC
Characteristic Case Group
Control Group p value OR (CI 95%)*
(n = 21) (n = 12) Amount of mosquito
coils used 0.523** Less (≤1 piece) 19 (90.5)* 12 (100) 0.312 (0.01-7.57) Medium (2-4 pieces) 2 (9.5) 0 (0)
*) OR (CI 95%): Odds Ratio (Confidence Interval 95%) **) Fisher’s Exact Test: used on variables which have cells with expected value (E) less than
5
Most respondents (90.5% of case group and 100% of control group) used
less amount of mosquito coils. Statistical analysis using chi-square test revealed p
value >0.05 with OR 0.312 which was achieved by adding 0,5 in every cells. This
showed an insignificant test result between both variables, or that there was no
association between the amounts of mosquito coils used with the incidence of NPC.
8
Table 4 Association between duration of mosquito coil use with NPC
Characteristic Case Group
Control Group p value OR (CI 95%)*
(n = 21) (n = 12) Duration of mosquito
coil use (hour) 0.010* 1-4 hours 6 (28.6) 9 (75.0) 7.50 (1.49-37.66) ≥ 5 hours 15 (71.4) 3 (25.0)
*) OR (CI 95%): Odds Ratio (Confidence Interval 95%) **) Chi-square test
Most respondents of case group use mosquito coil for ≥ 5 hours every night
(71.4%), while in control group the users of mosquito coil for 1-4 hours every night
were higher (75.0%). Statistical analysis using chi-square test revealed p value <0.05
with OR 7.50. This showed a significant test result between both variables, or that
there was association between the duration of mosquito coils use with the incidence
of NPC.
Discussions
This study showed that there were association between gender and
nasopharyngeal carcinoma. Table 1 showed p value <0.05 for sex variable and OR
2.51, which meant male had 2.51 fold higher risk of having nasopharyngeal
carcinoma compared to female. This result was parallel to previous research
conducted by Adham et al. in Indonesia that showed NPC patients male to female
ratio was 2.4:1.2 The ratio differences might occur because of a protective role of
estrogen in women.17
9
Study result about association between age and nasopharyngeal carcinoma
did not reveal significant result. NPC group was dominated with people from 50-59
age group, this corresponded with previous hospital-based research held by Chang et
al. in the United States that showed the peak age of NPC patients was from the 50-59
age group and the prevalence was declining on older age, this occurred due to higher
carcinogen exposures on younger age.10
There were no correlation between alcohol consumption, sawdust exposure,
routine insecticide exposure, family history of cancer, and smoking history with the
incidence of NPC. This result suited with a previously held hospital-based research
by Polesel J et al. in Italy that each alcohol consumption and smoking history was not
associated with the incidence of NPC.11 However, this result did not correspond with
a case control study conducted by Ji Xuemei et al. in China that showed smoking
history and family history had significant association with the incidence of NPC.
Uncertain association between those risk factors with incidence of NPC was probably
due to multifactorial NPC etiology, thus effects of those factors might be
overwhelmed by other risk factors such as salt-preserved fish consumption and
mosquito coil use.12
This research showed that routine salt-preserved fish consumption and
incidence of nasopharyngeal carcinoma were associated; that routinely consuming
salt-preserved fish might increase risk of NPC incidence by 3.15 fold. This suited
preceding research by Tabuchi et al. in Japan which stated that people who routinely
consume salt-preserved fish had higher risk of having NPC.13 The reason behind this
10
statement was because salt-preserved fish contained nitrosamine which might cause
carcinogenesis on nasopharyx epithelial cells.12
Analysis test result on Table 2 showed that mosquito coil use and NPC were
associated. This result meant that mosquito coil use might increase risk of NPC
incidence by 2.58 fold. This result corresponded with an earlier research conducted
by Moore MA et al. in Indonesia and Malaysia which stated that mosquito coils had
been proven to be a risk factor of NPC.14 This was possible because of the presence
of carcinogenic substance contained on the mosquito coil smoke which was proven to
be a risk factor of lung cancer and NPC in some countries, such as Taiwan and
Philippines.15 IARC had also proven that formaldehyde, which composed mosquito
coils, had a significant association with incidence of nasopharyngeal carcinoma.7
Formaldehyde and acetaldehyde, which were constituents of mosquito coil smoke,
might bind with intracellular proteins thus disturbing DNA replication process and
causing oncogenic mutation, and eventually caused morphological, cell function and
immunological reaction abnormalities on nasopharynx epithelial cells.8 In vivo
experiment on mammals had been done by Seithz et al. and had proven that
acetaldehyde might cause mutagenic lesions in DNA. IARC stated that formaldehyde
and acetaldehyde were proven to be carcinogenic based on animal trials.7,8
There was no significant association between amounts of mosquito coil used
with incidence of NPC. This did not correspond with prior research conducted by
Shaltamer et al. which stated that even small concentration of formaldehyde (0.2-0.3
ppm) might cause irritation to the nasopharynx.16 This unsuitability might be resulted
11
from the number of respondent which is smaller on this research, thus reducing the
precision of the study and did not elaborate well the condition of the population.
Analysis test result on Table 4 showed that duration of mosquito coil use and
NPC were associated. There hadn’t been studies conducted to explain this
phenomenon, but it was assumed to happen because prolonged exposure could cause
more severe irritation to epithelial layer of the nasopharynx.
Mosquito coil use might increase the incidence of nasopharyngeal
carcinoma. Limitation of this research was that partial restriction in subject selection
which aimed to increase precision and research efficiency (matching) was not done
on case group, since this was a hospital-based research, hence it needed less number
of respondents. Besides, questionnaire was used on this research, hence recall bias,
which was false information given by the respondents while trying to recall the
experienced risk factor exposures, might occur thus decreased the data accuracy.
With the knowledge of association between mosquito coil use with incidence of NPC,
this research humbly suggested health care professionals and health care services
should focus on preventing NPC since this disease could be prevented by avoiding its
risk factors.
12
Acknowledgement
The author would like to thank Dr. Ratna Anggraeni S. Poerwana, dr., Sp.THT-
KL(K)., M.Kes as the head of Otorhinolaryngology-Head and Neck Surgery
Department of Hasan Sadikin General Hospital, Bandung from which the author
obtained the data.
13
REFERENCES
1. Lu J, He M-L, Wang L, Chen Y, Liu X, Dong Q, et al. MiR-26a inhibits cell
growth and tumorigenesis of nasopharyngeal carcinoma through repression
of EZH2. Cancer research. 2011;71(1):225-33.
2. Adham M, Kurniawan AN, Muhtadi AI, Roezin A, Hermani B,
Gondhowiardjo S, et al. Nasopharyngeal carcinoma in Indonesia:
epidemiology, incidence, signs, and symptoms at presentation. Chinese
journal of cancer. 2012;31(4):185.
3. Madani DZ NA, Permana AD. Prevalence of Nasopharyngeal Carcinoma
Patients at Departement of Otorhinolaryngology-Head and Neck Surgery
DR. Hasan Sadikin General Hodpital, Bandung, Indonesia in 2010-2014.
Indonesia: Universitas Padjadjaran; 2015.
4. Lee AW, Ng W, Chan Y, Sze H, Chan C, Lam T. The battle against
nasopharyngeal cancer. Radiotherapy and Oncology. 2012;104(3):272-8.
5. Anghel I, Anghel A, Dumitru M, Soreanu C. Nasopharyngeal carcinoma--
analysis of risk factors and immunological markers. Chirurgia (Bucur).
2012;107(5):640-5.
6. Pauluhn J, Mohr U. Mosquito coil smoke inhalation toxicity. Part II:
Subchronic nose-only inhalation study in rats. Journal of Applied
Toxicology. 2006;26(3):279-92.
14
7. Sharma TD, Singh TT, Laishram RS, Sharma L, Sunita A, Imchen LT.
Nasopharyngeal carcinoma-a clinico-pathological study in a regional cancer
centre of northeastern India. Asian Pac J Cancer Prev. 2011;12(6):1583-7.
8. Seitz HK, Stickel F. Acetaldehyde as an underestimated risk factor for
cancer development: role of genetics in ethanol metabolism. Genes &
nutrition. 2010;5(2):121-8.
9. Kesehatan D, RI KK. Riset Kesehatan Dasar. Jakarta: Badan Penelitian dan
Pengembangan Kesehatan Departemen Kesehatan Republik Indonesia. 2013.
10. Chang ET, Adami H-O. The enigmatic epidemiology of nasopharyngeal
carcinoma. Cancer Epidemiology Biomarkers & Prevention.
2006;15(10):1765-77.
11. Polesel J, Franceschi S, Talamini R, Negri E, Barzan L, Montella M, et al.
Tobacco smoking, alcohol drinking, and the risk of different histological
types of nasopharyngeal cancer in a low-risk population. Oral oncology.
2011;47(6):541-5.
12. Ji X, Zhang W, Xie C, Wang B, Zhang G, Zhou F. Nasopharyngeal
carcinoma risk by histologic type in central China: impact of smoking,
alcohol and family history. International Journal of Cancer.
2011;129(3):724-32.
13. Tabuchi K, Nakayama M, Nishimura B, Hayashi K, Hara A. Early detection
of nasopharyngeal carcinoma. International journal of otolaryngology.
2011;2011.
15
14. Moore MA, Manan A, Chow KY, Cornain SF, Devi C, Triningsih F, et al.
Cancer epidemiology and control in peninsular and island South-East Asia-
past, present and future. Asian Pac J Cancer Prev. 2010;11(Suppl 2):81-98.
15. Shu-Chen C, Ruey-Hong W, Li-Jie S, Ming-Chih C, Huei L. Exposure to
mosquito coil smoke may be a risk factor for lung cancer in Taiwan. Journal
of epidemiology. 2008;18(1):19-25.
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environment. Chemical Reviews. 2010;110(4):2536-72.
17. Xie S-H, Yu IT-S, Tse L-A, Mang OW-k, Yue L. Sex difference in the
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Cancer. 2013;49(1):150-5.
Appendix 1 Letter of Study Approval
Appendix 2 Ethical Clearance
Appendix 3 Questionnaire
DATAKARSINOMANASOFARING
No.Penelitian
DATAUMUM
Namapemeriksa
……………………………………………….
TanggalRegistrasi
(hari/bulan/tahun)
NomorMedrekPasien
NamaPasien
Umur
……………………………………………….
JenisKelamin
1.Laki-laki2.Perempuan
TanggalLahir(hari/bulan/tahun)
Pendidikan
1.S2/S32.D3/S13.SMA4.SMP
5.SD6.Tidaksekolah7.Lainnya…………
DirujukOleh1.Sendiri4.DirujukDokterSpesialisTHT-KL2.DokterUmum5.Lainnya………………………..3.DokterSpesialisLain
AlamatRumah
Pekerjaan
1.PNS2.Swasta3.Wiraswasta
4.TNI/Polri5.Pensiunan6.Lainnya:…………………………….
Telephone
Telplainyangdapatdihubungi
Ras
1=PapuaMelanesoid2=Negroid3=Wedoid
4=MelayuMongoloid6=Lainnya:………………………………………
FAKTORRISIKO
: :
: :
KonsumsiAlkohol
1. Ya2. Tidak
Terpapardebukayu
1. Ya2. Tidak
Pemakaianobatnyamukbakar
1. Ya2. Tidak
Lamapenggunaanobatnyamukbakardalamsatuhari
1. 1-4Jam2. ≥5Jam
Jumlahobatnyamukbakardalamsatuhari
1. Sedikit(≤1buah)2. Sedang(2-4buah)3. Banyak(≥5buah)
Riwayatmerokok
1. <10tahun2. >10tahun3. Pasif4. Tidakada
Konsumsiikanasin(rutin)sejakkecil
1. Ya2. Tidak
Riwayatkeluargamenderitakanker
1. Karsinomanasofaring
2. Lainnya,sebutkan………………………………..
3. TidakadaTerpaparinsektisida(rutin)lebihdari1tahun
1. Ya2. Tidak
Appendix 4 Statistical Analysis
Jumlah Obat Nyamuk Bakar * KNF Crosstabulation
KNF
Total 1 2
Jumlah Obat Nyamuk Bakar
1 Count 19 12 31
% within KNF 90.5% 100% 93.9%
2 Count 2 0 2
% within KNF 9,5% 0% 6.1%
Total Count 21 12 33
% within KNF 100.0% 100.0% 100.0%
Lama Penggunaan Obat Nyamuk Bakar * KNF Crosstabulation
KNF
Total 1 2
Lama Penggunaan Obat Nyamuk Bakar
1 Count 6 9 15
% within KNF 28.6% 75.0% 45.5%
2 Count 15 3 18
% within KNF 71.4% 25.0% 54.5%
Total Count 21 12 33
% within KNF 100.0% 100.0% 100.0%
1. LuJ,HeM-L,WangL,ChenY,LiuX,DongQ,etal.MiR-26ainhibitscellgrowthandtumorigenesisofnasopharyngealcarcinomathroughrepressionofEZH2.Cancerresearch.2011;71(1):225-33.2. AdhamM,KurniawanAN,MuhtadiAI,RoezinA,HermaniB,GondhowiardjoS,etal.NasopharyngealcarcinomainIndonesia:epidemiology,incidence,signs,andsymptomsatpresentation.Chinesejournalofcancer.2012;31(4):185.3. DeasyZMadaniNA,AgungDinastiPermana.PrevalenceofNasopharyngealCarcinomaPatientsatDepartementofOtorhinolaryngology-HeadandNeckSurgeryDR.HasanSadikinGeneralHodpital,Bandung,Indonesiain2010-2014.Indonesia:UniversitasPadjadjaran;2015.4. LeeAW,NgW,ChanY,SzeH,ChanC,LamT.Thebattleagainstnasopharyngealcancer.RadiotherapyandOncology.2012;104(3):272-8.5. AnghelI,AnghelA,DumitruM,SoreanuC.Nasopharyngealcarcinoma--analysisofriskfactorsandimmunologicalmarkers.Chirurgia(Bucur).2012;107(5):640-5.6. PauluhnJ,MohrU.Mosquitocoilsmokeinhalationtoxicity.PartII:Subchronicnose-onlyinhalationstudyinrats.JournalofAppliedToxicology.2006;26(3):279-92.
