番茄社区

WASHINGTON -- While rates of gallbladder cancer have been decreasing in the U.S., this rare but often-deadly cancer is on the rise in Black patients, driven by more late-stage tumors, a nationwide analysis showed.

From 2001 to 2020, overall gallbladder cancer incidence rates were decreasing in all race groups except Black patients, who had an average increase of 1.03% per year (P=0.03), while the incidence of late-stage tumors increased at an average annual rate of 2.7%, reported Yazan Abboud, MD, of Rutgers New Jersey Medical School in Newark, at the Digestive Disease Week annual meeting.

Gallbladder cancer is most often diagnosed at later stages, with 41.3% of cancers in this study found in late stages, including 43.7% of cancers in Black patients, 40.8% in white patients, and 41.1% in Hispanic patients.

While incidence rates of late-stage tumors were increasing among Black patients (average annual percentage change [AAPC] 2.72, P<0.001), they were decreasing in Hispanic patients (AAPC -0.64, P=0.04) and stable in white patients (AAPC 0.07, P=0.84).

Black patients "are presenting more often, and they're presenting at a later stage," Abboud told 番茄社区. "We need to identify risk factors leading to this and raise awareness among gastroenterologists, general practitioners, and the public."

About of gallbladder cancer are diagnosed in the U.S. each year. Five-year vary from 69% for localized forms to 28% for regional forms and 3% for distant forms.

Possible explanations for the disparities between Black patients and white and Hispanic patients may include a lack of access to ultrasound, cholecystectomies, and surveillance, Abboud said.

Syed Ahsan Raza, MD, PhD, of the University of Pittsburgh, told 番茄社区 that the study reflects the findings of his own research. He led a that identified higher gallbladder cancer rates among Black patients and linked the increase to a cohort of Black patients in the South, Northeast, and Midwest regions who were born around 1971.

Raza noted that obesity could also be a factor. "Some recent reports have shown that the percentage of adolescent non-Hispanic Blacks with obesity have been increasing in the past several decades in contrast with younger non-Hispanic whites, where the prevalence of obesity has remained unchanged," he said.

"Although presence of gallstones among older adults remains the major determinant of gallbladder cancer, the prevalence of gallstone disease at a younger age is also increasing in the U.S.," he added.

In the big picture, "it is likely that the differences that we observed in gallbladder cancer trends are due to a wide variety of environmental influences, ranging from diet and physical activity, to access to care, clinical decision making, racial discrimination, and socioeconomic stress factors," he noted.

He said other groups deserve more attention too, namely Native Americans and Asian-American patients, especially first-generation immigrants.

Linda L. Wong, MD, of the University of Hawaii in Honolulu, who co-authored that showed that Black and Hispanic patients were less likely to receive curative surgery for gallbladder cancer, told 番茄社区 that the current findings highlight the importance of awareness about the disease among primary care doctors and internists.

It is vital to "identify these patients earlier, get them referred to places that can deal with it," she said, especially because surgeries and therapies can require specialized care that's not available in smaller hospitals.

Patients whose cancer is caught at early stages, such as those whose tumors are discovered during gallstone surgery, "actually do well," she added.

When cancer has spread to other organs, "locally advanced therapy is really not that helpful," she said. "We can try radical surgery in certain scenarios. If all the lymph nodes are involved, chemotherapy can prolong your life a short time. But it's generally not curative."

For this analysis, Abboud and colleagues examined data on 76,873 patients diagnosed with gallbladder cancer from 2001 to 2020 included in the U.S. Cancer Statistics database, which covers about 98% of the population.

Looking at early-stage tumors, rates remained stable for white patients (AAPC -2.61, P=0.39) and Black patients (AAPC -1.73, P=0.36), while they declined for Hispanic patients (AAPC -4.24, P=0.006).

As for regional-stage tumors, incidence rates were decreasing only in white patients (AAPC -1.61, P<0.001), and were stable in other groups.

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