Risk factors for gallbladder cancer. An international collaborative case–control study

Authors

  • Brian L. Strom M.D., M.P.H,

    Corresponding author
    1. The Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, and the Division of General Internal Medicine of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
    • M.P.H., 824 Blockley Hall, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021
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  • Roger D. Soloway M.D,

    1. The Division of Gastroenterology, University of Texas Medical Branch at Galveston, Galveston, Texas
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  • Jaime L. Rios-Dalenz M.D,

    1. Facultad de Medicina, Universidad Mayor de San Andres, La Paz, Bolivia
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  • Hector A. Rodriguez-Martinez M.D,

    1. Hospital General de Mexico, Unidad de Patologia, Mexico
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  • Suzanne L. West Ph.D,

    1. The Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, and the Division of General Internal Medicine of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
    2. University of North Carolina School of Public Health, Chapel Hill, North Carolina
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  • Judith L. Kinman M.A,

    1. The Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, and the Division of General Internal Medicine of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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  • Marcia Polansky Ph.D,

    1. Hahnemann University, Philadelphia, Pennsylvania
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  • Jesse A. Berlin Sc.D

    1. The Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, and the Division of General Internal Medicine of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Abstract

Background. Gallbladder cancer has an unusual geographic and demographic distribution, suggesting many possible etiologies.

Methods. A case-control study was undertaken at four hospitals in La Paz, Bolivia, and at one hospital in Mexico City, Mexico. Eighty-four patients with newly diagnosed, histologically confirmed gallbladder cancer were compared with 126 control subjects without stones and with 264 control subjects with cholelithiasis or choledocholithiasis without cancer. All study subjects underwent abdominal surgery. Study subjects were interviewed regarding demographic characteristics, medical history, family history, diet, and exposure to agents presumed to be risk factors for biliary cancer.

Results. Virtually all subjects in Mexico were judged to be mestizos (i.e., persons of mixed ancestry). In contrast, race was a very strong risk factor for gallbladder cancer in Bolivia. Relative to mestizos who spoke neither language, the odds ratio (95% confidence interval [CI]) for cases versus control subjects without stones for those who spoke Aymara well was 15.9 (CI, 1.9–179), whereas it was 1.4 (CI, 0.2–8.2) for those who spoke Quechua well. An increased risk was also noted for elevated maximum body mass index (P = 0.03), family history of gallstones (odds ratio [OR] = 3.6 [CI, 1.3–11.4]), and physician-diagnosed typhoid (OR = 12.7 [CI, 1.5-598]). An increased risk was also seen with elevated maximum body mass index; compared with those with a body mass index less than 24 kg/m2, those with an index of 24–25 kg/m2, 26–28 kg/m2, and greater than 28 kg/m2 had odds ratios of 1.6 (CI, 0.4–7.6), 1.3 (CI, 0.3–5.6), and 2.6 (CI, 0.5–18.6), respectively (asymptotic test for trend, P = 0.03). Finally, a number of associations were noted with certain dietary and cooking habits.

Conclusions. Patients with gallbladder cancer differed from control subjects in race, body mass, physician-diagnosed typhoid, and certain dietary patterns. These findings may provide useful clues to the pathogenesis of gallbladder cancer, but given the number of analyses performed, additional cases need to be studied. Cancer 1995:76:1747–56.

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