Epidemiology and Molecular Pathology of Gallbladder Cancer

Authors

  • Dr. Eduardo C. Lazcano-Ponce MD, PhD,

    1. Lazcano-Ponce is Director, Epidemiology Department, Population Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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  • Dr. J. F. Miquel MD,

    1. Miquel is Associate Professor, Gastroenterology Department, Catholic University of Chile, Santiago, Chile
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  • Dr. Nubia Muñoz MD,

    1. Muñoz is Consultant, International Agency for Research on Cancer, Lyon, France
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  • Dr. Rolando Herrero MD, PhD,

    1. Herrero is Consultant, International Agency for Research on Cancer, Lyon, France, and Costa Rica Cancer Institute, San José, Costa Rica
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  • Dr. Catterina Ferrecio MD,

    1. Ferrecio is Assistant Professor, Public Health Department, Catholic University of Chile, Santiago, Chile
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  • Dr. Ignacio I. Wistuba MD,

    1. Wistuba is Associate Professor, Pathology Department, Catholic University of Chile, Santiago, Chile
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  • Dr. Patricia Alonso de Ruiz MD,

    1. Alonso de Ruiz is Head of Cytopathology Laboratory, Autonomous National University of Mexico, Mexico General Hospital, Mexico City, DF
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  • Dr. Gerardo Aristi Urista MD,

    1. Aristi Urista is Assistant Professor, Cytopathology Laboratory, Autonomous National University of Mexico, Mexico General Hospital, Mexico City, DF
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  • Dr. Flavio Nervi MD

    1. Nervi is Professor Titular, Gastroenterology, Public Health and Pathology Departments, Catholic University of Chile, Santiago, Chile
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    • Original studies performed in Chile and referenced herein were supported by a grant from Elliot Marcus, and institutional grants number 1000739 from the Fondo Nacional Científico y Tecnológico (FONDECYT), and 1091/G224/ICU/CHILE from the Italian Ministry of Foreign Affairs.

    • This study was partially funded by the Mexican National Council of Science and Technology and the Mexican National Institute of Public Health. The preparation of this manuscript was undertaken during the period when Dr. Eduardo Lazcano-Ponce was a visiting scientist at the International Agency for Research on Cancer in Lyon, France.


Abstract

Gallbladder cancer is usually associated with gallstone disease, late diagnosis, unsatisfactory treatment, and poor prognosis. We report here the worldwide geographical distribution of gallbladder cancer, review the main etiologic hypotheses, and provide some comments on perspectives for prevention. The highest incidence rate of gallbladder cancer is found among populations of the Andean area, North American Indians, and Mexican Americans. Gallbladder cancer is up to three times higher among women than men in all populations. The highest incidence rates in Europe are found in Poland, the Czech Republic, and Slovakia. Incidence rates in other regions of the world are relatively low. The highest mortality rates are also reported from South America, 3.5–15.5 per 100,000 among Chilean Mapuche Indians, Bolivians, and Chilean Hispanics. Intermediate rates, 3.7 to 9.1 per 100,000, are reported from Peru, Ecuador, Colombia, and Brazil. Mortality rates are low in North America, with the exception of high rates among American Indians in New Mexico (11.3 per 100,000) and among Mexican Americans.

The main associated risk factors identified so far include cholelithiasis (especially untreated chronic symptomatic gallstones), obesity, reproductive factors, chronic infections of the gallbladder, and environmental exposure to specific chemicals. These suspected factors likely represent promoters of carcinogenesis. The main limitations of epidemiologic studies on gallbladder cancer are the small sample sizes and specific problems in quantifying exposure to putative risk factors. The natural history of gallbladder disease should be characterized to support the allocation of more resources for early treatment of symptomatic gallbladder disease in high–risk populations. Secondary prevention of gallbladder cancer could be effective if supported by cost–effective studies of prophylactic cholecystectomy among asymptomatic gallstone patients in high–risk areas.

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