{"entity":{"id":"idea-gbc-prophylactic-cholecystectomy-targeted-and-evaluated","kind":"idea","name":"Redesign Chile's prophylactic cholecystectomy programme around risk, and evaluate it properly","aka":[],"tldr":"Chile has paid for preventive gallbladder removal in 35 to 49 year olds with stones since 2006 without a design that can show whether it prevents cancer deaths. Targeting the operation by region, ancestry and risk score, with an evaluation built in, would answer the question the world's only such programme has left open for twenty years.","summary":"The GES programme has issued 284,139 notifications since 2006. Standardised gallbladder cancer mortality has fallen, but was falling before the programme, and the 2019 analysis found the targeted age group's mortality decline doubled (4 to 8 percent per period) without a national break in trend. High-incidence areas do not receive proportionally more operations. Genetic work shows Mapuche ancestry raises risk independently of stones and body mass index, and exome studies show Chilean tumours carry the lowest mutation burden of five countries studied. A risk-based redesign (region, ancestry-informed score, sex, typhoid history) with a stepped-wedge or regression-discontinuity evaluation would make the programme both more efficient and, for the first time, measurable.","asOf":"2026-09-24","links":[{"label":"Samaniego et al.: is it time to modify the GES programme (Rev Med Chile 2024)","url":"https://europepmc.org/article/MED/40052976"},{"label":"Zollner et al.: Mapuche ancestry and gallbladder cancer risk, instrumental variable analysis (Cancers 2023)","url":"https://europepmc.org/article/MED/37627062"}],"tags":["gallbladder-evidence"],"related":[],"cancers":["gallbladder"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["falp-chile","nci"],"pathways":[],"terms":["prophylactic-cholecystectomy","screening"],"trials":[],"people":[],"bottlenecks":["b-prevention-adoption","b-real-world-evidence"],"keyPapers":["paper-samaniego-chile-ges-programme-evaluation-rev-med-chile-2024","paper-mardones-frenz-chile-ges-mortality-rev-med-chile-2019","paper-cid-chile-programme-gallbladder-cancer-mortality-am-j-epidemiol-2024","paper-garate-calderon-gallbladder-cancer-worldwide-exome-ebiomedicine-2026"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Reallocating GES cholecystectomy capacity to a validated risk score rather than an age band will reduce gallbladder cancer mortality per operation performed by at least 30 percent, and a built-in stepped-wedge rollout will detect that effect within ten years.","rationale":"The programme's marginal benefit is highest where incidence and individual risk are highest; current allocation by age alone ignores both.","test":"Stepped-wedge rollout of the risk-based allocation across health service regions, with gallbladder cancer mortality and incidence from national statistics as primary outcomes and operations per prevented death as the efficiency measure.","maturity":"being-tested-at-scale","actor":"policy","cost":"large","horizonYears":10},"route":"/ideas/idea-gbc-prophylactic-cholecystectomy-targeted-and-evaluated/","neighbours":{"cancer":[{"id":"gallbladder","kind":"cancer","name":"Gallbladder cancer","route":"/cancers/gallbladder/"}],"institution":[{"id":"falp-chile","kind":"institution","name":"Fundación Arturo López Pérez","route":"/institutions/falp-chile/"},{"id":"nci","kind":"institution","name":"National Cancer Institute (NIH)","route":"/institutions/nci/"}],"term":[{"id":"prophylactic-cholecystectomy","kind":"term","name":"Prophylactic (preventive) cholecystectomy","route":"/terms/prophylactic-cholecystectomy/"},{"id":"screening","kind":"term","name":"Screening","route":"/terms/screening/"}],"bottleneck":[{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"},{"id":"b-real-world-evidence","kind":"bottleneck","name":"Weak real-world evidence and registries","route":"/bottlenecks/b-real-world-evidence/"}],"paper":[{"id":"paper-mardones-frenz-chile-ges-mortality-rev-med-chile-2019","kind":"paper","name":"Changes in gallbladder cancer mortality and hospital discharges due to preventive cholecystectomy in Chile","route":"/key-papers/paper-mardones-frenz-chile-ges-mortality-rev-med-chile-2019/"},{"id":"paper-cid-chile-programme-gallbladder-cancer-mortality-am-j-epidemiol-2024","kind":"paper","name":"Gallbladder cancer mortality in Chile: has the government program targeting young gallstone patients had an impact?","route":"/key-papers/paper-cid-chile-programme-gallbladder-cancer-mortality-am-j-epidemiol-2024/"},{"id":"paper-samaniego-chile-ges-programme-evaluation-rev-med-chile-2024","kind":"paper","name":"Gallbladder Cancer: Is It Time to Modify the Explicit Health Guarantees (GES) Program?","route":"/key-papers/paper-samaniego-chile-ges-programme-evaluation-rev-med-chile-2024/"},{"id":"paper-garate-calderon-gallbladder-cancer-worldwide-exome-ebiomedicine-2026","kind":"paper","name":"Geographic and genetic diversity in gallbladder cancer mutation profiles: insights from a worldwide exome analysis","route":"/key-papers/paper-garate-calderon-gallbladder-cancer-worldwide-exome-ebiomedicine-2026/"}],"roadmap":[{"id":"gallbladder-cancer-roadmap","kind":"roadmap","name":"Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials","route":"/roadmaps/gallbladder-cancer-roadmap/"}]}}