Epidemiology of gallbladder cancer in India
India carries about a tenth of the world's gallbladder cancer, concentrated in the north and east, striking younger people than in the West, with gallstones present in four out of five patients and a list of environmental co-factors under suspicion.
Overview
Review from Chandigarh and Lucknow. India contributes about 10 percent of the global gallbladder cancer burden; incidence is high in north, north-east, central and east India and low in the south and west, and is rising in both sexes. Patients typically present in the fifth and sixth decades with advanced disease. Gallstones are present in 80 percent of Indian patients, yet incidence is out of proportion to gallstone prevalence, so co-factors are proposed: age, low socioeconomic status, chronic Salmonella Typhi and Helicobacter pylori infection, pollutants, heavy metals, chemicals, adulterated mustard oil and smoking, plus soil and water contamination. The authors call for large multicentre studies of attributable risk and, meanwhile, vigilance for incidental cancer and better access to gallstone care.
- India contributes about 10 percent of the global gallbladder cancer burden; incidence is highest in the north, north-east, centre and east.
- Gallstones are present in 80 percent of Indian gallbladder cancer patients.
The Indian epidemiology matters to the NHS: people of South Asian heritage make up a large part of several English cities, and Asian ethnicity is a named risk factor in the European polyp guideline.
- Narrative review; attributable fractions for the co-factors are not established.
- Registry coverage in India is partial.
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