Cohort profile: cholangiocarcinoma screening and care program (CASCAP)

Area of Science:

• Hepatobiliary Medicine
• Gastroenterology
• Oncology

Background:

• Cholangiocarcinoma (CCA) is a highly aggressive cancer with increasing global incidence, particularly in Southeast Asia.
• Northeast Thailand exhibits the world's highest CCA incidence rates, with late-stage diagnosis leading to poor prognoses.
• Current prevention strategies focus on health education, yet lack early diagnosis methods.

Purpose of the Study:

• To establish an optimal screening program for early diagnosis of Cholangiocarcinoma (CCA).
• To implement community-level screening for individuals at high risk of CCA.
• To gather data for effective surgical treatment formulation in CCA patients.

Main Methods:

• Prospective cohort study design with two arms: screening and patient cohorts.
• Annual ultrasound examinations for the screening cohort (target: 150,000 individuals) to detect bile duct and liver pathology.
• Enrollment of approximately 25,000 CCA patients over 5 years for a conventional cancer registry.

Main Results:

• 85,927 individuals enrolled in the screening cohort; 55.0% received ultrasound.
• 2,661 CCA cases enrolled in the patient cohort.
• Screening participants (mean age 53.8) showed high prevalence of risk factors: 89.1% consumed uncooked fish, 42.2% tested positive for liver fluke.

Conclusions:

• CASCAP is the first community-level CCA screening initiative for at-risk populations.
• The study highlights significant risk factor prevalence, including liver fluke infection and uncooked fish consumption.
• Findings underscore the need for targeted screening and intervention strategies in high-incidence regions.