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

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.

Family history of gallstones and the risk of biliary tract cancer and gallstones: A population‐based study in Shanghai, China

“…A case-control study of gallbladder cancer in Bolivia and Mexico reported that a family history of gallstones was associated with a 3.6-fold risk of gallbladder cancer. 12 The mechanisms are unclear, but it is possible that some yet unidentified susceptibility mechanism may further elevate the risk of biliary tract cancer associated with stones.To investigate the rapid rise in incidence rates of biliary tract cancers in Shanghai, we conducted a large population-based study in Shanghai between 1997 and 2001. In this report, we examined whether a family history of gallstones is an independent risk factor for biliary tract cancer and whether it augments the risk associated with the presence of gallstones.…”

“…A case-control study of gallbladder cancer in Bolivia and Mexico reported that a family history of gallstones was associated with a 3.6-fold risk of gallbladder cancer. 12 The mechanisms are unclear, but it is possible that some yet unidentified susceptibility mechanism may further elevate the risk of biliary tract cancer associated with stones.…”

Obesity and the risk of gallbladder cancer: a meta-analysis

“…We identified eight cohort studies Wolk et al, 2001;Calle et al, 2003;Samanic et al, 2004Samanic et al, , 2006Engeland et al, 2005;Kuriyama et al, 2005;Oh et al, 2005) and four case -control studies (Zatonski et al, 1992(Zatonski et al, , 1997Strom et al, 1995;Serra et al, 2002) that reported results on overweight/obesity and risk of gallbladder cancer. One case -control study (Zatonski et al, 1992) was excluded because this study was included in a multicentre case -control study (Zatonski et al, 1997); the multicentre casecontrol study was included in this meta-analysis.…”

Incidence differences for gallbladder cancer between occupational groups suggest an etiological role for alcohol

“…Gallstones are a recognized risk factor for gallbladder cancer. 1,2 The effect of alcohol consumption on gallbladder cancer risk remains controversial throughout the published literature. 3,4 In Sweden, people in different occupations have been shown to have different levels of alcohol intake.…”