The incidence of gall bladder cancers in females of our population is amongst the highest in the world and in male population it is highest in India. The fatality due to gall bladder cancer is very high in our population, given the fact that almost all the cases are diagnosed in advanced stages.The high morbidity and mortality due to gall bladder cancer is having a significant impact in the efforts for cancer control in this part of the world. The hypothesis is that, if the cases of gall bladder cancers (incidental gall bladder cancers) can be detected at an early stage by a screening hepato-biliary system ultra-sonogram as part of organized population based screening program, the mortality due to gall bladder cancer can be reduced substantially to say the least.
To my knowledge there is no randomized controlled trial that shows an impact of ultrasound on mortality of gall bladder cancer in a population-based screening. Also observational evidence seems to be quite limited. Even if the rationale of such a screening seems to be obvious, effects on mortality have to be shown with high evidence, ideally by a randomized controlled trial. Before implementing such a screening, I would suggest performing a screening trail. But first one should be sure that ultrasound and gall bladder cancer meet the basic criteria for screening of Wilson and Jungner (WHO, 1968), see http://www.who.int/bulletin/volumes/86/4/07-050112/en/l
http://www.who.int/bulletin/volumes/86/4/07-050112/en/l
Thank you Alexander for your suggestions. That was indeed helpful.
When we speak about cancer screening, it must detect the disease at very early stage in which the patient is asymptomatic. But gall bladder cancer usually present in late stage. Yes, in this part of the country, gall bladder cancer incidence is quite high. Cancer Awareness and development of healthy food habit may help in reducing cancer incidence.
Thank you Usha Sarma Ma'am for your suggestions.You have very rightly said that dietary practices needs to evaluated to identify risk for gall baldder cancer, as prevention is ideal. The idea behind hepato-biliary system (HBS) ultrasound screening is to detect incidental cases which are amenable for complete surgical resection, and for now this is the gold standard for cure. USG should be the first step in the early diagnosis of gall bladder cancers radiologicaly in an epidemiologic setting (incidental finding) [1]. Studies have shown that incidental gall bladder cancers produces subtle radiological changes in 47% of such cases and in high risk population prophylactic cholecytectomy is advisable [2,3]. So,detection of incidental cancers will definitely improve survival in the larger context.
The only issue would be start a field trial as advised by Dr.Alexandar, preferably randomized but that may be possible at one go. Also, as I was going through the Wilson and Jungner criteria for screening, it seems reasonable to have a field trial for HBS ultra-sound screening for gall bladder cancer.
References:
1. Rodríguez-Fernández A1, Gómez-Río M, Medina-Benítez A, et al. Application of modern imaging methods in diagnosis of gallbladder cancer. J Surg Oncol 2006;93:650-64.
2.Rammohan A, Cherukuri SD, Sathyanesan J, et al. Incidental gall bladder cancers: Are they truly incidental? World J Gastrointest Oncol 2014; 6:441-3.
3. Mohandas KM, Patil PS. Cholecystectomy for asymptomatic gallstones can reduce gall bladder cancer mortality in northern Indian women. Indian J Gastroenterol 2006;25:147–51.
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