Diagnostic and Management Issues in Gallbladder Carcinoma

Drs. Abi-Rached and Neugut have presented a comprehensive review of the natural history and epidemiologic characteristics of patients who develop carcinoma of the gallbladder. They correctly point out that this tumor is a rare neoplasm, with the annual incidence in the United States being quite low; the number of patients dying from gallbladder cancer in 1978 was estimated to be 2,469, representing only .3% to 1.0% of total cancer deaths in the United States [1]. Since incidence rates vary significantly by geographical area, the risk factors associated with this tumor are of interest. For example, in Chile, cancer of the gallbladder and bile ducts accounts for 5.25% of cancer deaths [2]. Among Jews in Israel, the incidence appears to be higher in patients of European birth compared with those born in Asia [3]. Incidence also appears to be higher in Native Americans and Mexican-Americans born in the United States than in other population groups in the United States [4]. For instance, gallbladder cancer is the most common gastrointestinal malignancy among Southwestern Native Americans [5].