Increasing gall‐bladder cancer mortality rate during the last decade in Chile, a high‐risk area

Abstract

Increasing gall-bladder cancer mortality rate during the last decade in Chile, a high-risk areaGall-bladder cancer presents 01 large geographic variation in mortality rates (Diehl, 1980). The highest mortalities are found in Chile (Strom, 1984), Bolivia (Rios-Dalenz et al., 1983), North American Indians (Black et al., 1977), Mexicans (Alborez-Saavedra et al., 1980) and North-eastern Europeans (Strom, 1984). In contrast, gall-bladder cancer mortality rates are very low in Spain, in black Americans (Ditphl, 1980) and in Maoris from New Zealand (Fraumeni, 1975). Data from the Chilean National Institute of Statistics show a con.rtant increment of extra-hepatic biliary cancer mortality rates during the last 18 years (Serra et al., 1990). Identified risk factors for this cancer are gall-stones, age and sex (with a high female to male ratio) both in Chile (Nervi et al., 1988), and elsewhere (Strom, 1984). Large geographic variations in incidence strongly suggest the action of specific etiologic factors in the development of gall-bladder cancer. The principal risk factor is gall-stone disease in Chile and other countries. Potential environmental risk factors are primarily related to gall-stone formation (Bull and Nervi, 1987). Further evidence linking gall-stone disease and gall-bladder cancer has been the finding of a reciprocal relationship between cholecystectomy rates and mortality from gall-bladder cancer (Diehl and Beral, 1981).Cholesterol gall-stones are exrremely common in Chile, approximately 45% of women and 20% of men older than 20 years having gall-stone disease (Covarrubias et al., 1984). Cholecystectomy for gall-stone disease is the most frequent surgical procedure of the abdomen in Chile. It represents the second cause of hospitalization ajler obstetrical indications (Ministerio de Salud, 1988). More than 35% oj"cho1ecystectomies are performed because of acute cholecystitis in Chile (Paz et al., 1986).Mortality rates of extra-hepatic biliary tract cancer in Chile have consistently increased during the last decade from 7.841 100,000 in I980 to 9.96/100,00t3 in 1988, as shown in Table I . In contrast, mortality of hepatoma has remained essentially constant during the same period We tested the hypothesis that the increment in mortality rates from gall-bladder cancer may be the consequence of a reciprocal change in the number of cholecystectomies performed during the previous year(s). The assumption was made that increasing the number of gall-bladders at risk by decreasing the number of cholecystectomies carried out would increase the risk of gull-bladder cancer.As shown in Figure I , we found a striking, significant reciprocal correlation between the 2 variables. It is apparent from the data that the marked reduction of cholecystectomy rates between 1980 and 1988 in Chile may have increased the number of gall-bladders at risk for cancer. 'There is no evidence that the prevalence of gall-stone disease has changed in the last 20 years. Prevalence figures of autopsy material from 1966-1 970 (MarinoviC et al.,...

Preneoplastic lesions in gallbladder cancer

“…Gallstones [21][22][23], the presence of chronic inflammation [11], the existence of adenomas [24,25], pancreaticobiliary maljunction [26,27], and the rate of cholecystectomies [28,29] and other risk factors such as sex, age, obesity, parity [23,30], are considered to be the most important risk factors in the development of gallbladder cancer. Gallbladder cancer is largely asymptomatic until advanced stages of the disease, gallstones, and chronic inflammation being the most commonly associated clinical manifestations [8,31].…”

Mitochondrial DNA Mutation at the D310 (Displacement Loop) Mononucleotide Sequence in the Pathogenesis of Gallbladder Carcinoma

“…In Chile, this neoplasm is the leading cause of cancer deaths in females, and there has been a striking and consistent increase in incidence during the last few decades (2). GBC is a highly malignant neoplasm, usually diagnosed at advanced stages of the disease (1).…”

Gallstones in spinal cord injury (SCI): a late medical complication?

“…9 Additionally, there is also a greater prevalence of cancer of the biliary tract among the Chilean population. 10,11 …”