Epidemiology of Gallbladder Cancer in the Unites States

A Population-Based Study

Motasem Alkhayyat; Mohannad Abou Saleh; Thabet Qapaja; Mohammad Abureesh; Ashraf Almomani; Emad Mansoor; Prabhleen Chahal


Chin Clin Oncol. 2021;10(3):25 

In This Article

Abstract and Introduction


Background: Gallbladder cancer (GBC) is the most common neoplasm of the biliary tract with the lowest rates of survival. Most GBCs are adenocarcinomas that arise from the epithelial lining of the gallbladder. There are limited data in the literature regarding the epidemiology of GBC. Using a large database, we aim to describe the epidemiology using a US population database.

Methods: A multi-institutional database (Explorys Inc., Cleveland, OH, USA) was surveyed. A cohort of patients with a primary malignant neoplasm of gallbladder between 1999–2019 was identified. The prevalence rate was calculated and age-, race-, and sex-based distributions were described. Multivariate analysis was done to evaluate underlying associations.

Results: Of the 56,197,690 individuals in the database, 4,790 individuals with GBC were identified with a prevalence rate of 8.5 per 100,000. Asian race has the highest prevalence of GBC (13.6/100,000). Patients with GBC were also more likely to be smokers, have a history of alcohol abuse, obesity, diabetes, cholelithiasis, chronic cholecystitis, primary sclerosing cholangitis (PSC), and chronic viral hepatitis.

Conclusions: This is one of the largest US population studies to date evaluating the epidemiology of GBC. The 20-year period prevalence rate of GBC was 8.5 per 100,000. Patients with GBC were more likely to be elderly, females, obese, diabetic, and have chronic hepatobiliary disorders.


Gallbladder cancer (GBC) is a rare malignancy, ranking 22nd and 17th among cancers worldwide in incidence and mortality respectively.[1] Nevertheless, it is the most common neoplasm of the biliary tract, accounting for 80–95% of all neoplasms of the biliary tract system.[2] Most GBCs are adenocarcinomas that arise from the epithelial lining of the gallbladder and its carcinogenesis follows a progression through a metaplasia-dysplasia-carcinoma sequence. It is an aggressive tumor that usually presents late with metastasis; hence carrying a poor prognosis with a mean overall survival of 6 months after the diagnosis.[2,3] In current practice, there is a lack of screening tests for GBC.[4]

Current literature shows that unlike other gastroenterological malignancies, GBC is more common in women compared to men.[5] It is also more common in older individuals with 72 years old being the average age of diagnosis in the US.[6] It is more prevalent in certain ethnicities and regions of the world compared to others which is attributed to different environmental exposures and genetic predisposition.[5,7] Interestingly, the global distribution of GBC and gallbladder stones—the most commonly cited risk factor—is found to be related.[5] Other risk factors reported in the literature include a family history of GBC,[8] gallbladder polyps,[9] primary sclerosis cholangitis,[10] chronic infections with Salmonella[11] and H. pylori,[12] congenital biliary cysts,[13] abnormal pancreaticobiliary junction,[14] hormonal therapy in postmenopausal women,[15] cigarette smoking,[16] heavy alcohol drinking,[16,17] and obesity.[18]

There are very few population-based studies regarding this topic.[3,19–22] Using a large population database, we aim to describe the epidemiology and risk factors of GBC in the US.

We present the following article in accordance with the STROBE reporting checklist (available at http://dx.doi.org/10.21037/cco-20-230.