title: Cohort profile: cholangiocarcinoma screening and care program (CASCAP).
abstract: BACKGROUND
  Cholangiocarcinoma (CCA) is an extremely aggressive cancer that is usually fatal. Although globally morbidity and mortality are increasing, knowledge of the disease remains limited. The Mekong region of Southeast Asia, and particularly the northeast of Thailand, has by far the highest incidence of CCA worldwide with 135.4 per 100,000 among males and 43.0 per 100,000 among females being reported in Khon Kaen Province. Most patients are first seen during late stage disease with 5-year survival being less than 10%. Starting in 1984, control and prevention strategies have been focused on health education. Although early detection can substantially increase 5-year survival, there are currently no strategies to increase early diagnosis.
  
  
  METHODS
  The Cholangiocarcinoma Screening and Care Program (CASCAP) is a prospective cohort study comprising two cohorts- the screening and the patient cohorts. For the screening cohort, ultrasound examination will be carried out regularly at least annually to determine whether there is current bile duct and/or liver pathology so that the optimal screening program for early diagnosis can be established. This cohort is expected to include at least 150,000 individuals coming from high-risk areas for CCA. For the patient cohort, it is estimated that about 25,000 CCA patients will be included during the 5-year recruitment period. All CCA patients will be treated according to routine clinical care and followed so that effective surgical treatment can be formulated. This cohort is indeed a conventional cancer registry. Thus, CASCAP is an ongoing project in which the number of participants changes dynamically.
  
  
  CONCLUSIONS
  This is the first project on CCA that involves screening the at risk population at the community level. At the time of preparing this report, a total of 85,927 individuals have been enrolled in the screening cohort, 55.0% of whom have already undergone ultrasound screening, and 2661 CCA cases have been enrolled in the patient cohort. Among the participants of the screening, whose mean age was 53.8±9.8 years, 55.6% were female, 77.5% attained primary school as the highest level of education, 79.9% were farmers, 29.9%, reported having relatives with CCA, 89.1% had eaten uncooked fish, and 42.2% of those who had been tested for liver fluke were found to be infected.
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand. nkhuntikeo@gmail.com.|Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. nkhuntikeo@gmail.com.
authors.forename: Narong
authors.initials: N
authors.lastname: Khuntikeo
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand.|Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Nittaya
authors.initials: N
authors.lastname: Chamadol
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand.|Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Puangrat
authors.initials: P
authors.lastname: Yongvanit
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand.|Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Watcharin
authors.initials: W
authors.lastname: Loilome
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand.|Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Nisana
authors.initials: N
authors.lastname: Namwat
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand.|Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Paiboon
authors.initials: P
authors.lastname: Sithithaworn
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand.|Faculty of Medicine, St Mary's Campus, Imperial College, London, United Kingdom.
authors.forename: Ross H
authors.initials: RH
authors.lastname: Andrews
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand.|Department of Ecology and Parasitology, Karlsruhe Institute of Technology, 76131, Karlsruhe, Germany.
authors.forename: Trevor N
authors.initials: TN
authors.lastname: Petney
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand.|Department of Epidemiology, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Supannee
authors.initials: S
authors.lastname: Promthet
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand.|Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Kavin
authors.initials: K
authors.lastname: Thinkhamrop
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand.|Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Chaiwat
authors.initials: C
authors.lastname: Tawarungruang
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, 40002, Thailand. bandit@kku.ac.th.|Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand. bandit@kku.ac.th.
authors.forename: Bandit
authors.initials: B
authors.lastname: Thinkhamrop
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D018281:Cholangiocarcinoma / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013785:Thailand