A Medical Anthropology Assessment of Community Liver Cancer Risks: Qualitative Comparisons of Communities with Different Risk Profiles in Thailand.

Background: Thailand has the highest incidence rate of cholangiocarcinoma (CCA) in the world, and a high rate of hepatocellular carcinoma. Although risk factors for these two types of liver cancer have been identified, gaps persist in models for prevention. This qualitative study examined community awareness of liver cancer risk factors and prevention in rural Thailand.

Methods: Qualitative interviews were conducted with two groups from two villages in the north of Thailand. Village A (5 participants) has a high prevalence of CCA, while Village B (10 participants) has low prevalence. Open-ended questions were asked about social structures, farming practices, drinking water, diet, health care, and attitudes towards health promotion. Responses were tabulated and common themes were discerned, then stratified by village to examine their similarities and differences.

Results: In Village A, respondents were ethnic Thai with large families engaged in low-income farming and applying pesticides in unsafe manners. Village B was populated by the Mian ethnic group, where family sizes were smaller and higher incomes were derived from cash crops like coffee. Risky pesticide application practices were commonly reported. Diets were similar, except for intakes of freshwater crabs and crab paste in Village A (absent in Village B). However, the crabs had potentially high contamination of pesticide residues. Village A relied on surface water contaminated with pesticide runoff, in contrast to Village B that was upstream of point-source contamination. Furthermore, Village B emphasized healthy lifestyles and promoted the overall health of the community, supported by a network of social workers. Very few people there had ever experienced cancer. In contrast, Village A suffered from many liver cancer deaths and lacked a social worker network.

Conclusions: These results inform community-tailored interventions in Thailand to promote safer pesticide practices, healthier diets, safer drinking water, and supportive community health for CCA prevention.