RISK FACTORS FOR GALL BLADDER CANCER IN KARACHI
AbstractBackground: Frequency of gallbladder cancer in Karachi has been reported to be 8% and that from other parts of Pakistan varies between 6-7%. This is very high as compared with the Western studies. With this in mind a case control study was designed to identity risk factors responsible for gallbladder cancer. Methods: This case control study included 107 histologically proven cases of gall bladder cancer from Jinnah Postgraduate Medical Centre, Civil Hospital and two private hospitals of Karachi. Age and sex matched controls were of two types. Those with and without cholelithiasis screened sonographically. Demographic, socio-economic factors, life-style, dietary habits and dietary intake were recorded on a proforma. The cases and controls were compared for various factors using odds Ratio. Results: Among 107 cancer cases 27 were males and 80 females (M:F=1:3). Mean age of males was 59 years (range 35-82 years) and females 53years (range 31-70 years). One hundred and five (98%) had associated choleliathiasis. Important risk factors appeared to be gallstones, high parity, young age at first delivery, low fiber and Vitamin A intake (p<0.01), high fat intake (p<0.01), prolonged fasting hours/habit of missing dinner(OR:6.8), using repeatedly boiled or improperly stored ghee or oil(OR:2.6). Conclusions: According to this case-control study major risk factors for gall bladder cancer were gallstones, dietary mal practices and poorly balanced diet. Poorly stored/ processed food acts as a promoter in the presence of gall stones and may favour cancer development.Key words: Gallbladder carcinoma, choleliathiasis, diet, dietary habits.
Scott TE, Carroll M, Cogliano FD, Smith BF, Lamorte WW. A case–control assessment at risk factors for gallbladder carcinoma. Dig Dis Sci 1999;44:1619-25.
Hamrick RE Jr, Liner FJ, Harsting PR, Cohn I Jr. Primary carcinoma of the gall bladder. Ann surg 1982;195:270-73.
Mehta A, Bahadur AK, Aranya RC, Jain AK. Role of radiation therapy in carcinoma of the gallbladder – a preliminary Indian experience. Trop Gastroenterol 1996;17:22-5.
Sox JC, Edge SS. Laparoscopic cholecystectomy and unsuspected gallbladder carcinoma. Semin Surg Oncol 1999;16:327-31.
Hassan TJ, Zuberi SJ, Maqsood R. Carcinoma of gallbladder. J Pak Med Assoc 1978;28:33-4.
Mubarik A, Ahmed M, Khan AH, Mansoor A. Carcinoma of gallbladder - A study of 112 consecutive cases. Pak Armed Forces Med J 1990;43:1-7.
Yaqin HU, Parmar BK. A comparative study of biliary tract disease in Karachi (Pakistan) and Aylesbury (England). J Pak Med Assoc 1976;26(8):162-4.
Adson MA. Carcinoma of the gallbladder, symposium on surgery of the biliary tract. Surg Clin North Am 1973;53:1203-16.
Khan ZR, Neugut AI, Ahsan H, Chabot JA. Risk factors for biliary tract cancers. Am J Gastroenterol 1999;94:149-52.
Nervi F, Duarte I, Gomez G, Rodriguez G, Del Pino G, Ferrerio O, et al. Frequency of gallbladder cancer in Chile, a high risk area. Int J Cancer 1988;41:657-60.
Zatonski WA, La Vechia C, Przewozniak K, Maisonneuve P, Lowenfels AB, Boyle P. Risk factors for gallbladder cancer. a Polish case–control study. Int J Cancer 1992; 51: 707-11.
Aretxabala X, Roa I, Burgos L, Araya JC, Fonseca L, Wistuba I. Gallbladder cancer in Chile. A report on 54 potentially resectable Tumours. Cancer 1992;69:60-5.
Chen A, Huminer D. The role of estrogen receptors in the development of gall stones and gallbladder. Cancer Med Hypothesis 1991;36:259-60.
Tominaga S, Kata I. Diet and cancer. Asian Med J 1987;30:268-74.
Strom BL, Soloway RD, Rios–Dalenz JL, Rodriguez-Martinez HA, West SL, Kinman JL, et al. Risk factors for gallbladder cancer. An International Collaborative case-control study. Cancer 1995;76:1747-56