Cholecystectomy or ultrasound surveillance for chronic typhoid carriers in endemic regions
People who carry the typhoid bacterium in their gallbladder long term have about four times the usual risk of gallbladder cancer. Two meta-analyses suggest offering them gallbladder removal or regular scans; no programme has tried it.
Overview
Chronic Salmonella Typhi carriage carried a pooled odds ratio of 4.28 across 17 studies (Nagaraja and Eslick 2014) and a summary relative risk of 4.6 to 5.0 in the Chilean case-control study and meta-analysis (Koshiol 2016), with the gallbladder as the reservoir of carriage. The carrier state is diagnosable by stool culture or Vi serology and cholecystectomy is also the treatment for carriage itself. A pragmatic programme in a typhoid-endemic, gallbladder-cancer-endemic region (northern India) could randomise identified carriers to cholecystectomy or annual ultrasound and measure cancer incidence, with the added public health benefit of removing a transmission reservoir.
- Prevention we already have is not deployed · Around four in ten cancers are preventable with tools we already own: vaccines, tobacco control, weight, alcohol, sun and infection control.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
Typhoid carriage is one of the few modifiable risk factors for gallbladder cancer. In the UK it is rare, but it matters for people who grew up where typhoid is endemic and for the question of whether chronic carriers should be offered cholecystectomy.
No trial has tested cholecystectomy or surveillance for chronic carriers; the recommendation is expert inference from a fourfold risk. It is one of the prevention ideas on this page.
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