Food and social background of Nasopharyngeal cancer patients in Jakarta
This article has been retracted: Med J Indones. 1998. DOI: http://dx.doi.org/10.13181/mji.v7i1.1216
Vol 6. No 1- October - Decenhs I 997
Nasophary,sedlCancu 249
Food and Social Background of Nasopharyngeal Cancer Patients in Jakarta
Averdi Roezin
Abstrak
BerbaEai Jaktot Elah dibuktikan s.baqai wnJehab dan ttetlisp.sisi tihbulhya ka iiona atofdrinE 6NF) sepefli Vire
Epstei, Batt ( EB ), dakahan, je^b kelanin. Ecrctik , sosbl ekDno i, likgkugan.lan laia laih. ScIaM t0 bulaa dori Jonwti sahpai
Oktobet 1996 di Bagiu THT FKUIRIiUPN Dt. Cipto Mangutkusuno lakrtta diddpatkan 81 kas6 batu katsbma MefatiaE .Lm
dibandihS*'n .lenEan E 1 kasus buNnn katsinoM natujarihE yanE datanq berobat yats diahbil secara acdk dalatu waktu ydag sana.
Penderita ldki laki lebih baryak dari \|dnita (61,201a : 3 5,6OEa) denEat unut rata-rata 45 tahun padd krlonpok KNF de 34,13 tahs
pada kelotsrok han-KN F. Diszlid*i pula pendidikdn, penghasilan sebulm. berat ba.!an, aergi untuk tuen&dk sutuber air ninm,
dan Lliddpatkan bahwd kelonpok KNF mmaw betusal dai Eolaryan berpaghasilan tetut& Ditnukan pula bahwa secaft betuk@
ikan asih yahg dikonsumsi sehari hdti okh kelotupok KNF lebih banyak diba bskaa pada kelonpok non KNF, juEa kebbsam
merokok du linskunsan JokE tloluti.f lebih banrak pdda petdetita KNF.
Many factoB hare been prcr.n as the etinLoqicaL @d pre.lispottus fadots oJ a6opharrngeat cdrcet sch 6 EB viw, diet,
senetics, social economr, earironment and othea. Duting 10 oaths fron Janrary to Ocnabet 1996 in the Depl hett ol
OtorhinoldrynEalos, Medicdl Faculry, Unitercirt al hdonesi4 ve found 8t ne|9 c6es oJ naephartttgedt cancet and coq,arcd rtem
eith 8l cases aJ aoh NPC pdtiens in the sane tihe. Male patients vere norc lrequeat than feML (61.20Ea : 35.80%): the ayerage
aee was 45 yedts in NPC aad J4.13 lears il flon NPC Etoup. Edacation, na hl! inco e, bodr weiSht, eneryy
Jot cookin| Mr! eatet
saurces wete studied. We fomd that the NPC patierts cahe lrom a lower ia@me 8roup. The protninent e"ideace w6 that the
cansunption oJ sabed fsh as a ptut.in sa rce was hiEher ih the NPC .onpated to the ao, NpC gtoup G 3.3 3Ea and I 3.58%), and
this dtlfercnc. was stuIisticaLu siBtiJiaat. Polutcd en'iroMeht ds weII as wkins habit wrc dl:o hisher in the NpC .ohpdted b
sa
Kelwo
ls: salt.dfish, shokinI habit.
It's nearly definilive thal EB-virus (EBV) is rhe eriology of nasopharyngeal cancer (NPC). But EBV is not
runnjng alonc: there aresome ext€mal factorsthatplay
a role in the appearins of NPC. Those factors are
genetics. age, sex, diet, geography, social economy.
culture and habit, polution, infection and many others.
Environm€ntal polution is still thought by many. espc
cially in lay Inan. as a major cause of many forms of
cancer. However. intcnsive research in the last 3
decades has shown that lbis concepr is incorrect. Lifestyle ot liiestyle-related behavior can promote and
cause the d€velopment of various cancer found in
human. Thc etiological factors are ofren complex and
need carelul analysis and evaluation.
De pafl h e n t oJ O ra r hin o I arynsolo I y, F acul ry.J M e dXine,
Universit! of lndon.sid/ Dr. Cipto ManEnkusuno Haqital
In nasopharyngeal carcinoma, many authors had m€n,
tioned EB virus, genetics and diet to be the main
etiological factom. The enviromcntal factors and/or
diet factors can react with genetic malerial. such as
DNA and should be rhe rmponanr one in causins
NPC,l
Ho2 first proposed that Chirese salted fish, apopular
food in Southem China, especially favourcd by the
Cantonese. was apossible factor in the devclopm€nt of
IJPC. This theory was based on rhe+acfthaHhehighcst
incidence of NPC occurs in the fisher folk of Hong
Kong, whose di€t contains a high proponion ofsaltcd
fish and a deficient intake of vitamin-rich fresh
vegelables and fruhs. In Indonesia, there was no siudy
lo prool thar salred ftsh (onsumprion, social economic
condition, culture and habit, and polution play a role
in rhe NPC. even lhough lndanesian pcople hav€ inre'
mediate to high susceptibility to NPC.
'wl
250
Me.! J Indones
Therefore, during I 0 months, from January to October
1996 in the Department of Otorhinolaryngology.
Medical Faculty, Universjty of Indonesia we studicd
81 new cases of NPC and comparcd thcm to anolher
81 patients of non NPC. This study was focuscd on
food and social background ofthe NPC and non NPC
Table 1- Age distribunon ofNPC and non-NPC patients
(N = 8l)
NPC q,
2.4',7
20 -29
30
39
40-49
50-59
METHODS
60
This study was hcld in thc Dcparhenl of Otorbino
Iaryngology, Medical Faculty. Univcrsity of In
donesia.IDr. Cipto Mangunkusumo Hospilal. Jakarta,
bctween January I to October 31, 1996. During that
time were found 81 new cases of nasopharyngeal canwhich consist of 52 males and 29 females. The
diagnosis was based on the anamnesis, clinical examination, radiological examination - CTScan, biopsy
cer-
and histopathological finding of nasopharyngeal cancer. The control group ofnon NPC patienls wcr€ also
consist of 52 males and 29 females suffeing from
various diseases and normal one. The conlrol group
cases werc taken randomized on the samc day after
each caseofNPC was diagnosed. The criteriato be the
control group were an adult patient and has the same
sex with the NPC paiient. The exclusion ofNPC was
colftrmcd by rhe anamnesis. clinical e\amin0rion.
conventional radiological €xamination. biopsy and
bjstopathological examination if suspiciously there
was atumor a d demonstrable signs and symptoms of
nasopharyngeal cancer. In thi s control group included
any kinds of diseases of ihe ear, nose and throat and
neoplasms of the ear, nose and throat, except
nasopharyngeal cancer.In both groups food and social
background were studied including age, sex, occupa!ion, education, monthly income, body weight. main
food, protein soDrces, other supplemen t lood, smoking
babit, energy for cooking, drinking water sources and
housing.
RESULTS
69
SD
Non'NPC % (N)
0',1)
9.88 (8)
38.29 (31)
23.47 (19)
12.35 (t 0)
8.64 (7)
2.47 12)
4.94 (4)
\2)
9.88 (8)
25.92 (2t)
25.92 250
58.03 (47)
17.28 (14)
6.17 (5)
120.78
There are 4 kinds of protein sources taken by most
Indonesian in their meals. Meat (beef, mutton, pork
and fresh fish), taofu or soya bean cu.d, soya bean
cake and saltcd fish. Th€ lastthree were earen in daily
meal of most low income people in Indonesia.
In the NPC group meat, taofu, soya bean cake, and
salted fish was taken by 45.69Vo, 95.O67o, a2;72Vo
and 33.3370 of patients respectivcly at least twic€ a
week in their menu. In the oth€r $oup, meat, taofu,
soya bean cake was takcn by 6'7.90Eo, 24.O'7qo and
?1-6070
olftetwo sroups N= 8l
NPC 70
with 42.21% in the NPC group and this difference was
statislically not significant (P = 0.1098).
of
rdken by
patients rcspectively, butsalted fish was
58d. of the cases (Table 4).
only I I
Non NPC % (N)
12.34
17.28
(0)
Tablc 4. Protcin sour@s in botb group of patients
(t4)
NPC%(N)
18.28 (3 r)
14.42lt2)
17.28
(t4)
135.21
+ 80:12
Body weisht
Most of the NPC group paticnts have body weight
below normal (58.027o), while tbe percentage of normal and above normal body weishi was 20,99% and
20.99% respectivcly. Normal body weight = 90% (H
- 100) kg (H = height in cenlimeter).
In non NPC group, cascs having below normal. nor
mal and above normdl body weight were 50-627r,
l1 1]e, and Io.oso; respe,'rvrly. There wi. no.ig,
nificant difierence of body weight ligures between
both groups (P = 0.0217).
Food
Ricerras themain stapleinboth grorps as wcll as most
of Indonesian pcople. All of the NPC group ate rice
two or three times aday (1007,) and only one (1.237.)
in the non-NPC group are srgo rs mJrn rood
Salted
*
fish*
Vcgetables an d fru irs are eaten hy '14 .01Eo alrd 62.96q.
of the NPC group, and hy 16.54E, aDd 59.26Ea in the
nor NPC group respcclivcly. However, only 21.161L
drank milk every day in the non-NPC group conpared
81)
Non-NPC % (N)
45.68 (37)
95.06 (77)
82.72 (6t)
67.90 (55)
74.07 (60)
71.60 (58)
3333
13.58(11)
(n)
'flre salred fishjntakeas a prctein source was statislically
significdtly diffe.ent between the two groups (P 100
4.94 (4)
4.94 (4)
34.57 (28)
29.58 (21)
SD
+27 70
J 31.?6
-19
80-89
99
t7.28
2.46 (2)
r.70 (3)
63.?0mz
The house s rizeotthe two g.ouPs wds not stalistically
significmt (P = 0.1109).
1989 also had the same figure
i.e.
Most of thc cases in the NPC group were Primary
School graduates, but in the non NPC group most of
them were High School graduates- There were more
University graduates in the non-NPC than intheNPC
groDp. As a whole, the non-NPC group was more
educared than Ihe \Pc group. Th€ monlhly income
revealed that the NPC patients came from the Iower
income people compared to the non_NPC patients.
Norrnal and below normal body weight in the two
groups showcd nearly the same figure; 79.01 inthe
NPC and 83.957, in non-NPC group.
oflh€.ubjerls rn Ihe l\ o grouts ate rice
day
as
well as most of Indonesian people, only
every
rn
lhe
non
NPC group ale sago as lhe main (drone
source.
In some people in east part of Inbohydrate
donesiasagois the main carbohydrate source and some
other people in lbat region took com as the main food.
Almosr all
ln Jakarta, the meat price is much higher
Combined factors
The combinalion ofall factors above showed lhat sex.
age. body weight. salted fish consumption, smoking
habit, sources ofcnergy (wood and kcrosene). water
sources and housing. in logistic regression test had an
ORof2lS
DISCUSSION
Sex ratio between male and female in this study was
1.8 : l. I1's a bit djfferent with the figure nentioned by
Shanmugaratnam who sludied the epidemiology of
NPC (2-3 : l).r
h
Thc hrlhe r rncrdence ol NPC r. in lhe 4 ,lr' "d" "
)
hlc
NPC.c, ur.d mo.r lrcqurnrly drou'rJ rhc l.urrh
(t 8 tinet
than taofu and soya bean cake, and the price of salted
fish is about 807o of meat prico. In this study the
.ubjecls com.umed sahcd fish only 50 Lo 75 gram. rn
each meal because they ate much more rice than salted
fish.
In thl3 NPC group they ate meat less in frequency and
quantily compared tothe ncn NPCgroup(45.68% and
67.9070); in g€ncral, this showed that thc NPC group
came from Iower €conomic class comparcd to the non
NPC group. However, they ate more satted fish than
the non-NPC group (33.33% and 13.587,),1nd this
diflerence is statistically significant supposing lhe
role ofsaltcd 6sh in predisposing NPC in this study
The consumption ofsalted fish in Indonesian was very
much diffcrent than people in China or Hong Kong.In
VaL6. No 4-Octabet -
D.r.nbcr
Cbina or Hongkong, they are
a lot of salled fish in cach
meal, every day for years sinc€ the weaning. A case
control study in Hong Kong on cases under 35 years of
age found a positive association of NPC with the
conrumplion ol srlled fi\h ar any lirne. bul lhi\ ds\ociation was particularly strong for the consumplion during
childhood. There was a relaiive increase in risk of
neariy 40 fold for the consumption of saited fish once
or more rime\ a week ar agc ot 10. rn cnmparison ro
rare consumpnon.' somc crfer rmenral :unpfl lor rhis
association was provided by the study of Yu and
Henderson in which rats f€d salted fish developed
tumors in lhc nasal cavity.8
Vegetables and frDits were consumed by both groups
wirh abou' Inc samc pcr(cnrage. Hnwever. it wr'
much different
NdsoPhary\seatctncer 251
1997
in
drinking rnilk which percentage
was higher in the NPC group becausethey believe that
nilk could increase their body resistance against cdnThere was difference between smoking habji in thc
NPC group (49.38%) comparedto thenonNPC group
(32.107.). Even it's not sradstically sigrificanl, but
lhe O.R. showed thatthe smokers have 2 timcs highcr
risk lt) have nasopharyngeal cancer than the non
Wood andkcrosene wereusedmorc frequent as energy
source in the NPC comparcd with the non-NPC group,
though those figures are statistically not significant.
Both energy sources give more polutior and are
usuaily used by lower income group. In the non-NPC
group they used more gas and electricity as energy
sources compared to the NPC group. As a whole the
NPC group lived in more poluied environment than
statistically significant, il showed that the NPC group
had larger house than the non-NPC group.
Thecombined factors i.e. age, sex, body weight, smoking habit, salled fish consumption, souces of energy
(wood and kerosene), water sources and housins
showed that the NPC group had 2.18 times the risklo
have nasopharyngeal caJcjnoma tban non NPC group.
The other factor that was never proved before as an
important risk factor ofNPC in Indonesiawas salted
fish. However, thjs study revealed that salted fish
played a role in increasing the risk ofNPC.
CONCLUSION
Male is more frequent to have nasopharyngeal cancor
than female and the age average ofNPC patients was
45 years (between 40 to 50 years). Most of the NPC
pilienls (ame lrom lower income srarus, I've rn more
poluted cnvironment caused by smoking habit and
energy sourc€ in daily used; as a whole tbe quality of
life was less wealthy
Males in the 4th decadeoflife who atesalted fish more
than twjce a week, had a smoking habitand with alow
social economic condition had 2.18 times the possibility to have nasopharyngeal cancer than other
pcoplc with better social economic and do not have
salted fish in tbeir meal.
REFERENCES
1.
WeisblrserJH, HornCL. Tne Causes ol Cdcer. tn:Holleb
AI, Fink DB. Murahy cP, Edito6. Clinical Oncolosy
2.
Ho JC. An Epidcmiologic and Clinical Study ol
non NPC group.
Ground watcr are used by mosi of IndoDesian people
as water sourcc for drink and olher nccessity. But
some people in big city used water from clean water
lacilities provided by the goverment.
Ground water wcrc morc uscd by thc NPC (70.107.)
compared to 62.909, in Don NPC sroup, bu1 water
supply by govemmcnl wcrc used more in non NPC
(3'7.049a) than in NPC sroup (28.4070). Thc clcan
waterfascil;1ies by govclncnt arcDot found iD allparts
ofJakarta. but thc ijgures showcd lhat rhc non NPC
g.oup was morc wcalthy !haD NPC group.
r:i .r/. r\ Jr.c Jl
l1
he 'lrl.\
rl,J p.rJmcrer
rcir. l.uu.e .r,,e in NP. wr' / 4R"l L .^r1 ,.(d r.
63.70 n2 in non-NPC group. EvDnthough il s not
Hn
compared to the non-NPC
patients.
Ar flican
Cr!er
Soc
er) Arlanrdl40z.P4-lt,F
Nrsopharyngcal Carcinona. In: Vad Ha$eit CA, Gibb AC,
editos. Nasopharyngeal Carcinoma. Hong Kong: The
r.
.!.
'
Chinese
Unive6ity P.es, l99l123-4.
I Na\ophdryngrdt .d , inomd
Epidcmiology and Aetiology. Pro.eedings or Nasopharyn
gedl Cdcer Seninar I 988, April 16; Semarang. Sendang:
FK IINDIP 1988:1-15
Roezin A. Managcmcnt of NPC in In.lonesia. Asim J of
Su.gery l99.li l6(4):274'9.
\ ''.l lr.o D. tl ./rn A RrJ\i N \dopharyngeal ' drL rnom"
in Cipt{r Mangunkusuno Gcneral HosPital, Jakdta, ln
ilonesia. AbsLncl ol The XV Wodd Con8rcs of Otor
hiDol..yngology Head & Neck Suraeryi 1993, June 20 25i
Istanbul, 'lu.kiye Istdbul: Organizing Comntnk of rhc
Sh"rnuCarrrnam
(bngres,
6
199.1:296.
Roezin A. Prisojo D. Side effccr of ddiofierapy in NPC
psLients.I.donesia I Oncol 1993-,4 (tl:23 30
Med J ln'dohes
Yu MC, Ho JHC, Lar SH, Hqderson BE. Cantonese stvle
salted fish as a cause of NPC: Report of a ca5e control shrdv
ir Hong Kong. Cmce. Res 1986:46:956_61
8. Yu MC. Heddeson BE. Intake of C-antonse stvle salted nsh
as a caNe ofNPC. tn : Tomatis L. Aitio A, Dav NE, Heseltine
7.
E, Kaldor J, Miller AB, et al, edito6. Cancer: Causes, Oc_
curen@ ud Conirol.IARC Scientific Publication No.l00
Lyon:IARC, 1990i 214.
{
I
:
I
Vol 6. No 1- October - Decenhs I 997
Nasophary,sedlCancu 249
Food and Social Background of Nasopharyngeal Cancer Patients in Jakarta
Averdi Roezin
Abstrak
BerbaEai Jaktot Elah dibuktikan s.baqai wnJehab dan ttetlisp.sisi tihbulhya ka iiona atofdrinE 6NF) sepefli Vire
Epstei, Batt ( EB ), dakahan, je^b kelanin. Ecrctik , sosbl ekDno i, likgkugan.lan laia laih. ScIaM t0 bulaa dori Jonwti sahpai
Oktobet 1996 di Bagiu THT FKUIRIiUPN Dt. Cipto Mangutkusuno lakrtta diddpatkan 81 kas6 batu katsbma MefatiaE .Lm
dibandihS*'n .lenEan E 1 kasus buNnn katsinoM natujarihE yanE datanq berobat yats diahbil secara acdk dalatu waktu ydag sana.
Penderita ldki laki lebih baryak dari \|dnita (61,201a : 3 5,6OEa) denEat unut rata-rata 45 tahun padd krlonpok KNF de 34,13 tahs
pada kelotsrok han-KN F. Diszlid*i pula pendidikdn, penghasilan sebulm. berat ba.!an, aergi untuk tuen&dk sutuber air ninm,
dan Lliddpatkan bahwd kelonpok KNF mmaw betusal dai Eolaryan berpaghasilan tetut& Ditnukan pula bahwa secaft betuk@
ikan asih yahg dikonsumsi sehari hdti okh kelotupok KNF lebih banyak diba bskaa pada kelonpok non KNF, juEa kebbsam
merokok du linskunsan JokE tloluti.f lebih banrak pdda petdetita KNF.
Many factoB hare been prcr.n as the etinLoqicaL @d pre.lispottus fadots oJ a6opharrngeat cdrcet sch 6 EB viw, diet,
senetics, social economr, earironment and othea. Duting 10 oaths fron Janrary to Ocnabet 1996 in the Depl hett ol
OtorhinoldrynEalos, Medicdl Faculry, Unitercirt al hdonesi4 ve found 8t ne|9 c6es oJ naephartttgedt cancet and coq,arcd rtem
eith 8l cases aJ aoh NPC pdtiens in the sane tihe. Male patients vere norc lrequeat than feML (61.20Ea : 35.80%): the ayerage
aee was 45 yedts in NPC aad J4.13 lears il flon NPC Etoup. Edacation, na hl! inco e, bodr weiSht, eneryy
Jot cookin| Mr! eatet
saurces wete studied. We fomd that the NPC patierts cahe lrom a lower ia@me 8roup. The protninent e"ideace w6 that the
cansunption oJ sabed fsh as a ptut.in sa rce was hiEher ih the NPC .onpated to the ao, NpC gtoup G 3.3 3Ea and I 3.58%), and
this dtlfercnc. was stuIisticaLu siBtiJiaat. Polutcd en'iroMeht ds weII as wkins habit wrc dl:o hisher in the NpC .ohpdted b
sa
Kelwo
ls: salt.dfish, shokinI habit.
It's nearly definilive thal EB-virus (EBV) is rhe eriology of nasopharyngeal cancer (NPC). But EBV is not
runnjng alonc: there aresome ext€mal factorsthatplay
a role in the appearins of NPC. Those factors are
genetics. age, sex, diet, geography, social economy.
culture and habit, polution, infection and many others.
Environm€ntal polution is still thought by many. espc
cially in lay Inan. as a major cause of many forms of
cancer. However. intcnsive research in the last 3
decades has shown that lbis concepr is incorrect. Lifestyle ot liiestyle-related behavior can promote and
cause the d€velopment of various cancer found in
human. Thc etiological factors are ofren complex and
need carelul analysis and evaluation.
De pafl h e n t oJ O ra r hin o I arynsolo I y, F acul ry.J M e dXine,
Universit! of lndon.sid/ Dr. Cipto ManEnkusuno Haqital
In nasopharyngeal carcinoma, many authors had m€n,
tioned EB virus, genetics and diet to be the main
etiological factom. The enviromcntal factors and/or
diet factors can react with genetic malerial. such as
DNA and should be rhe rmponanr one in causins
NPC,l
Ho2 first proposed that Chirese salted fish, apopular
food in Southem China, especially favourcd by the
Cantonese. was apossible factor in the devclopm€nt of
IJPC. This theory was based on rhe+acfthaHhehighcst
incidence of NPC occurs in the fisher folk of Hong
Kong, whose di€t contains a high proponion ofsaltcd
fish and a deficient intake of vitamin-rich fresh
vegelables and fruhs. In Indonesia, there was no siudy
lo prool thar salred ftsh (onsumprion, social economic
condition, culture and habit, and polution play a role
in rhe NPC. even lhough lndanesian pcople hav€ inre'
mediate to high susceptibility to NPC.
'wl
250
Me.! J Indones
Therefore, during I 0 months, from January to October
1996 in the Department of Otorhinolaryngology.
Medical Faculty, Universjty of Indonesia we studicd
81 new cases of NPC and comparcd thcm to anolher
81 patients of non NPC. This study was focuscd on
food and social background ofthe NPC and non NPC
Table 1- Age distribunon ofNPC and non-NPC patients
(N = 8l)
NPC q,
2.4',7
20 -29
30
39
40-49
50-59
METHODS
60
This study was hcld in thc Dcparhenl of Otorbino
Iaryngology, Medical Faculty. Univcrsity of In
donesia.IDr. Cipto Mangunkusumo Hospilal. Jakarta,
bctween January I to October 31, 1996. During that
time were found 81 new cases of nasopharyngeal canwhich consist of 52 males and 29 females. The
diagnosis was based on the anamnesis, clinical examination, radiological examination - CTScan, biopsy
cer-
and histopathological finding of nasopharyngeal cancer. The control group ofnon NPC patienls wcr€ also
consist of 52 males and 29 females suffeing from
various diseases and normal one. The conlrol group
cases werc taken randomized on the samc day after
each caseofNPC was diagnosed. The criteriato be the
control group were an adult patient and has the same
sex with the NPC paiient. The exclusion ofNPC was
colftrmcd by rhe anamnesis. clinical e\amin0rion.
conventional radiological €xamination. biopsy and
bjstopathological examination if suspiciously there
was atumor a d demonstrable signs and symptoms of
nasopharyngeal cancer. In thi s control group included
any kinds of diseases of ihe ear, nose and throat and
neoplasms of the ear, nose and throat, except
nasopharyngeal cancer.In both groups food and social
background were studied including age, sex, occupa!ion, education, monthly income, body weight. main
food, protein soDrces, other supplemen t lood, smoking
babit, energy for cooking, drinking water sources and
housing.
RESULTS
69
SD
Non'NPC % (N)
0',1)
9.88 (8)
38.29 (31)
23.47 (19)
12.35 (t 0)
8.64 (7)
2.47 12)
4.94 (4)
\2)
9.88 (8)
25.92 (2t)
25.92 250
58.03 (47)
17.28 (14)
6.17 (5)
120.78
There are 4 kinds of protein sources taken by most
Indonesian in their meals. Meat (beef, mutton, pork
and fresh fish), taofu or soya bean cu.d, soya bean
cake and saltcd fish. Th€ lastthree were earen in daily
meal of most low income people in Indonesia.
In the NPC group meat, taofu, soya bean cake, and
salted fish was taken by 45.69Vo, 95.O67o, a2;72Vo
and 33.3370 of patients respectivcly at least twic€ a
week in their menu. In the oth€r $oup, meat, taofu,
soya bean cake was takcn by 6'7.90Eo, 24.O'7qo and
?1-6070
olftetwo sroups N= 8l
NPC 70
with 42.21% in the NPC group and this difference was
statislically not significant (P = 0.1098).
of
rdken by
patients rcspectively, butsalted fish was
58d. of the cases (Table 4).
only I I
Non NPC % (N)
12.34
17.28
(0)
Tablc 4. Protcin sour@s in botb group of patients
(t4)
NPC%(N)
18.28 (3 r)
14.42lt2)
17.28
(t4)
135.21
+ 80:12
Body weisht
Most of the NPC group paticnts have body weight
below normal (58.027o), while tbe percentage of normal and above normal body weishi was 20,99% and
20.99% respectivcly. Normal body weight = 90% (H
- 100) kg (H = height in cenlimeter).
In non NPC group, cascs having below normal. nor
mal and above normdl body weight were 50-627r,
l1 1]e, and Io.oso; respe,'rvrly. There wi. no.ig,
nificant difierence of body weight ligures between
both groups (P = 0.0217).
Food
Ricerras themain stapleinboth grorps as wcll as most
of Indonesian pcople. All of the NPC group ate rice
two or three times aday (1007,) and only one (1.237.)
in the non-NPC group are srgo rs mJrn rood
Salted
*
fish*
Vcgetables an d fru irs are eaten hy '14 .01Eo alrd 62.96q.
of the NPC group, and hy 16.54E, aDd 59.26Ea in the
nor NPC group respcclivcly. However, only 21.161L
drank milk every day in the non-NPC group conpared
81)
Non-NPC % (N)
45.68 (37)
95.06 (77)
82.72 (6t)
67.90 (55)
74.07 (60)
71.60 (58)
3333
13.58(11)
(n)
'flre salred fishjntakeas a prctein source was statislically
significdtly diffe.ent between the two groups (P 100
4.94 (4)
4.94 (4)
34.57 (28)
29.58 (21)
SD
+27 70
J 31.?6
-19
80-89
99
t7.28
2.46 (2)
r.70 (3)
63.?0mz
The house s rizeotthe two g.ouPs wds not stalistically
significmt (P = 0.1109).
1989 also had the same figure
i.e.
Most of thc cases in the NPC group were Primary
School graduates, but in the non NPC group most of
them were High School graduates- There were more
University graduates in the non-NPC than intheNPC
groDp. As a whole, the non-NPC group was more
educared than Ihe \Pc group. Th€ monlhly income
revealed that the NPC patients came from the Iower
income people compared to the non_NPC patients.
Norrnal and below normal body weight in the two
groups showcd nearly the same figure; 79.01 inthe
NPC and 83.957, in non-NPC group.
oflh€.ubjerls rn Ihe l\ o grouts ate rice
day
as
well as most of Indonesian people, only
every
rn
lhe
non
NPC group ale sago as lhe main (drone
source.
In some people in east part of Inbohydrate
donesiasagois the main carbohydrate source and some
other people in lbat region took com as the main food.
Almosr all
ln Jakarta, the meat price is much higher
Combined factors
The combinalion ofall factors above showed lhat sex.
age. body weight. salted fish consumption, smoking
habit, sources ofcnergy (wood and kcrosene). water
sources and housing. in logistic regression test had an
ORof2lS
DISCUSSION
Sex ratio between male and female in this study was
1.8 : l. I1's a bit djfferent with the figure nentioned by
Shanmugaratnam who sludied the epidemiology of
NPC (2-3 : l).r
h
Thc hrlhe r rncrdence ol NPC r. in lhe 4 ,lr' "d" "
)
hlc
NPC.c, ur.d mo.r lrcqurnrly drou'rJ rhc l.urrh
(t 8 tinet
than taofu and soya bean cake, and the price of salted
fish is about 807o of meat prico. In this study the
.ubjecls com.umed sahcd fish only 50 Lo 75 gram. rn
each meal because they ate much more rice than salted
fish.
In thl3 NPC group they ate meat less in frequency and
quantily compared tothe ncn NPCgroup(45.68% and
67.9070); in g€ncral, this showed that thc NPC group
came from Iower €conomic class comparcd to the non
NPC group. However, they ate more satted fish than
the non-NPC group (33.33% and 13.587,),1nd this
diflerence is statistically significant supposing lhe
role ofsaltcd 6sh in predisposing NPC in this study
The consumption ofsalted fish in Indonesian was very
much diffcrent than people in China or Hong Kong.In
VaL6. No 4-Octabet -
D.r.nbcr
Cbina or Hongkong, they are
a lot of salled fish in cach
meal, every day for years sinc€ the weaning. A case
control study in Hong Kong on cases under 35 years of
age found a positive association of NPC with the
conrumplion ol srlled fi\h ar any lirne. bul lhi\ ds\ociation was particularly strong for the consumplion during
childhood. There was a relaiive increase in risk of
neariy 40 fold for the consumption of saited fish once
or more rime\ a week ar agc ot 10. rn cnmparison ro
rare consumpnon.' somc crfer rmenral :unpfl lor rhis
association was provided by the study of Yu and
Henderson in which rats f€d salted fish developed
tumors in lhc nasal cavity.8
Vegetables and frDits were consumed by both groups
wirh abou' Inc samc pcr(cnrage. Hnwever. it wr'
much different
NdsoPhary\seatctncer 251
1997
in
drinking rnilk which percentage
was higher in the NPC group becausethey believe that
nilk could increase their body resistance against cdnThere was difference between smoking habji in thc
NPC group (49.38%) comparedto thenonNPC group
(32.107.). Even it's not sradstically sigrificanl, but
lhe O.R. showed thatthe smokers have 2 timcs highcr
risk lt) have nasopharyngeal cancer than the non
Wood andkcrosene wereusedmorc frequent as energy
source in the NPC comparcd with the non-NPC group,
though those figures are statistically not significant.
Both energy sources give more polutior and are
usuaily used by lower income group. In the non-NPC
group they used more gas and electricity as energy
sources compared to the NPC group. As a whole the
NPC group lived in more poluied environment than
statistically significant, il showed that the NPC group
had larger house than the non-NPC group.
Thecombined factors i.e. age, sex, body weight, smoking habit, salled fish consumption, souces of energy
(wood and kerosene), water sources and housins
showed that the NPC group had 2.18 times the risklo
have nasopharyngeal caJcjnoma tban non NPC group.
The other factor that was never proved before as an
important risk factor ofNPC in Indonesiawas salted
fish. However, thjs study revealed that salted fish
played a role in increasing the risk ofNPC.
CONCLUSION
Male is more frequent to have nasopharyngeal cancor
than female and the age average ofNPC patients was
45 years (between 40 to 50 years). Most of the NPC
pilienls (ame lrom lower income srarus, I've rn more
poluted cnvironment caused by smoking habit and
energy sourc€ in daily used; as a whole tbe quality of
life was less wealthy
Males in the 4th decadeoflife who atesalted fish more
than twjce a week, had a smoking habitand with alow
social economic condition had 2.18 times the possibility to have nasopharyngeal cancer than other
pcoplc with better social economic and do not have
salted fish in tbeir meal.
REFERENCES
1.
WeisblrserJH, HornCL. Tne Causes ol Cdcer. tn:Holleb
AI, Fink DB. Murahy cP, Edito6. Clinical Oncolosy
2.
Ho JC. An Epidcmiologic and Clinical Study ol
non NPC group.
Ground watcr are used by mosi of IndoDesian people
as water sourcc for drink and olher nccessity. But
some people in big city used water from clean water
lacilities provided by the goverment.
Ground water wcrc morc uscd by thc NPC (70.107.)
compared to 62.909, in Don NPC sroup, bu1 water
supply by govemmcnl wcrc used more in non NPC
(3'7.049a) than in NPC sroup (28.4070). Thc clcan
waterfascil;1ies by govclncnt arcDot found iD allparts
ofJakarta. but thc ijgures showcd lhat rhc non NPC
g.oup was morc wcalthy !haD NPC group.
r:i .r/. r\ Jr.c Jl
l1
he 'lrl.\
rl,J p.rJmcrer
rcir. l.uu.e .r,,e in NP. wr' / 4R"l L .^r1 ,.(d r.
63.70 n2 in non-NPC group. EvDnthough il s not
Hn
compared to the non-NPC
patients.
Ar flican
Cr!er
Soc
er) Arlanrdl40z.P4-lt,F
Nrsopharyngcal Carcinona. In: Vad Ha$eit CA, Gibb AC,
editos. Nasopharyngeal Carcinoma. Hong Kong: The
r.
.!.
'
Chinese
Unive6ity P.es, l99l123-4.
I Na\ophdryngrdt .d , inomd
Epidcmiology and Aetiology. Pro.eedings or Nasopharyn
gedl Cdcer Seninar I 988, April 16; Semarang. Sendang:
FK IINDIP 1988:1-15
Roezin A. Managcmcnt of NPC in In.lonesia. Asim J of
Su.gery l99.li l6(4):274'9.
\ ''.l lr.o D. tl ./rn A RrJ\i N \dopharyngeal ' drL rnom"
in Cipt{r Mangunkusuno Gcneral HosPital, Jakdta, ln
ilonesia. AbsLncl ol The XV Wodd Con8rcs of Otor
hiDol..yngology Head & Neck Suraeryi 1993, June 20 25i
Istanbul, 'lu.kiye Istdbul: Organizing Comntnk of rhc
Sh"rnuCarrrnam
(bngres,
6
199.1:296.
Roezin A. Prisojo D. Side effccr of ddiofierapy in NPC
psLients.I.donesia I Oncol 1993-,4 (tl:23 30
Med J ln'dohes
Yu MC, Ho JHC, Lar SH, Hqderson BE. Cantonese stvle
salted fish as a cause of NPC: Report of a ca5e control shrdv
ir Hong Kong. Cmce. Res 1986:46:956_61
8. Yu MC. Heddeson BE. Intake of C-antonse stvle salted nsh
as a caNe ofNPC. tn : Tomatis L. Aitio A, Dav NE, Heseltine
7.
E, Kaldor J, Miller AB, et al, edito6. Cancer: Causes, Oc_
curen@ ud Conirol.IARC Scientific Publication No.l00
Lyon:IARC, 1990i 214.
{
I
:
I