The Indian Council of Medical Research (ICMR) has issued a draft 'consensus document' for the management of gallbladder cancer (GBC), a rare though notoriously lethal malignancy, with marked ethnic and geographical variations. It is a very common disease in countries such as India, Chile, Japan, central Europe – Poland, Israel and south Pakistan.

According to senior ICMR officials, this document represents a consensus on the current principles of management for gallbladder cancer. It has been put together by a team of national experts in the field.

Officials said that there is no level 1 evidence for most of the issues on the subject and the expert committee has therefore taken into account published literature and institutional experience of members of the task force who are leaders in the field. These guidelines are meant to aid clinicians undertaking surgery for gallbladder diseases and GBC and are nowhere binding.

In India, GBC is most prevalent in northern and northeastern states of Uttar Pradesh, Bihar, Orissa, West Bengal and Assam. It is two times higher in women than men and is the leading digestive cancer in women in northern India cities. The highest frequency of the disease is found among females (two to six times more common) over the age of 65. Aside from gallstones, female gender, ethnicity, genetic susceptibility and lifestyle factors a number of associated risk factors appear to favor the development of GBC either as neoplastic initiators, such as unknown endo- and exobiotic mutagens, or as neoplastic promoters, including chronic inflammation and infection.

Six cancer registries of the ICMR (1990-96) show a 10 times lower incidence of GBC per 1,00,000 in South India compared with the North, the age-adjusted incidence rate (AAR) for females being 0.8 in Chennai in the south and 8.9 in Delhi in the north. GBC ranks amongst the first 10 cancers in the ICMR registries (2006-2008) of Delhi, Dibrugarh, Kolkata, Bhopal and Mumbai. The incidence of GBC increases after the age of 45 years and is maximum at the age of 65 years. A recent study of Unisa S et al 20116, performed ultrasonography (USG) in 5100 with and 1448 people without symptoms, respectively in Eastern UP and Bihar. USG revealed a prevalence of Gallbladder disease (GBD) of 6.2 per cent.