Geographical pattern of carcinoma gallbladder in Bihar and its association with river Ganges and arsenic levels: Retrospective individual consecutive patient data from Regional Cancer Centre

Richa Madhawi; Avinash Pandey; Shraddha Raj; Manish Mandal; Seema Devi; Prabhat Kumar Sinha; Rajesh Kumar Singh

doi:10.4103/sajc.sajc_37_18

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ORIGINAL ARTICLE: Gastro-intestinal & Hepatobiliary Cancer

07 (

); 167-170

doi:

10.4103/sajc.sajc_37_18

Geographical pattern of carcinoma gallbladder in Bihar and its association with river Ganges and arsenic levels: Retrospective individual consecutive patient data from Regional Cancer Centre

Richa Madhawi¹, Avinash Pandey^2,, Shraddha Raj¹, Manish Mandal³, Seema Devi¹, Prabhat Kumar Sinha⁴, Rajesh Kumar Singh¹

1 Department of Radiation Oncology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar

2 Department of Medical Oncology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar

3 Department of Gastrointestinal Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar

4 Department of Biomedical Research, Indira Gandhi Institute of Medical Sciences, Patna, Bihar

*Corresponding author: Dr. Avinash Pandey. dr.avinashp9@gmail.com

Published: 2020-12-22

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Abstract

Background: Indo-Gangetic basin is known to have higher incidence of gallbladder cancer. Proximity to River Ganga and high heavy metal in soil exposure have been postulated as risk factors. Aim: This study aims to evaluate the geographical pattern of gallbladder cancer from consecutive patient database enrolled in hospital-based cancer registry (HBCR). Objectives: To evaluate demographic profile and districtwise/zonewise dispersion of gallbladder cancer cases registered in HBCR from year 2014 to 2016. To evaluate association of carcinoma gallbladder (CaGB) due to proximity of Ganges, districts of high soil arsenic levels and referral bias. Materials and Methods: Demographic profile and district-based location of individual consecutive gallbladder cancer patient registered in Regional Cancer Centre from the year 2014 till 2016 were analyzed. Population data from 2011 census and arsenic soil content data from central groundwater body were obtained. Frequency distribution, cross tabulation, and odds ratio were used to analyze risk of CaGB across population subsets in Bihar. Results: A total of 1291 consecutive patients of CaGB were registered from 2014 to 2016. Median age at diagnosis was 55 years (range 18–95 years). Male to female ratio was 0.6. Patna (16%) followed by Vaishali (5.8%), Sitamarhi (5%), Madhubani (4.7%), Gaya (4%), and Samastipur (4%) had highest cases. Districts along main central River Ganga (n = 12) and those exposed to high arsenic soil content (n = 15) had higher odds ratio for CaGB, 1.72 (95% confidence interval [CI]: 1.54–1.91, P = 0.001), and 1.45 (95% CI: 1.30–1.62, P = 0.001), respectively. Districts within 100 km radius of our institute had higher gallbladder cancer cases, odds ratio 1.81 (95% CI: 1.62–2.03, P = 0.001), suggesting significant referral bias predominantly contributed by cases registered under Patna and Vaishali districts. Conclusion: CaGB is major public health problem in Bihar. Exposure to high soil arsenic levels and proximity to River Ganga are strongly associated with gallbladder cancer. Systematic population-based longitudinal studies are needed to explore above hypothesis.

Keywords

References

SEER Database. Available from: https://www.seer.cancer.gov/faststats/selections.php?#Output. [Last assessed on 2017 Oct 17].
GLOBOCON data. Available from: http://www.globocan.iarc.fr/Pages/fact_sheets_population.aspx. [Last assessed on 2017 Oct 17].
National Centre for Disease Informatics and Research. Release of Reports PBCR and HBCR 2012-2014. Available from: http://www.ncrpindia.org/ALL_NCRP_REPORTS/PBCR_REPORT_2012_2014/ALL_CONTENT/PDF_Printed_Version/Chapter 2_Printed.pdf. [Last assessed on 2017 Oct 17].
National Centre for Disease Informatics and Research. Release of Reports PBCR and HBCR 2012-2014. Available from: http://www.ncrpindia.org/ALL_NCRP_REPORTS/PBCR_REPORT_2012_2014/ALL_CONTENT/PDF_Printed_Version/Chapter 7_Printed.pdf. [Last assessed on 2017 Oct 17].
Shukla VK, Khandelwal C, Roy SK, Vaidya MP. Primary carcinoma of the gall bladder: A review of a 16-year period at the university hospital. J Surg Oncol 1985;28:32-5.
Khan I, Panda N, Banerjee M, Das R. Epidemiological factors in gall bladder cancer in eastern India-a single centre study. Indian J Surg Oncol 2013;4:67-72.
The Detail Analysis of Population Census 2011 Published by Govt. Of India for Bihar State. Available from: http://www.census2011.co.in/census/state/districtlist/bihar.html. [Last assessed on 2017 Oct 17].
Indian State Census 2011. Available from: http://www.census2011.co.in/states.php. [Last assessed on 2017 Oct 17].
Government of India. National Cancer Control Programme. Available from: https://www.web.archive.org/web/20111018014423.; http://www.india.gov.in/sectors/health_family/index.php?id=11. [Last assessed on 2017 Oct 17].
Indian Council of Medical Research, Hospital Based Cancer Registry. Available from: http://www.icmr.nic.in/ncrp/hbcr.pdf. [Last assessed on 2017 Oct 17].
Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: Geographical distribution and risk factors. Int J Cancer 2006;118:1591-602.
Zatonski WA, Lowenfels AB, Boyle P, Maisonneuve P, Bueno de Mesquita HB, Ghadirian P, et al. Epidemiologic aspects of gallbladder cancer: A case-control study of the SEARCH program of the international agency for research on cancer. J Natl Cancer Inst 1997;89:1132-8.
Nandakumar A, Gupta PC, Gangadharan P, Visweswara RN, Parkin DM. Geographic pathology revisited: Development of an atlas of cancer in India. Int J Cancer 2005;116:740-54.
Dhir V, Mohandas KM. Epidemiology of digestive tract cancers in India IV. Gall bladder and pancreas. Indian J Gastroenterol 1999;18:24-8.
Prasad RR, Singh JK, Mandal M, Kumar M, Prasad SS. Profile of gall bladder cancer cases in Bihar. Indian J Med Paediatr Oncol 2005;26:31.
Dixit R, Srivastava P, Basu S, Srivastava P, Mishra PK, Shukla VK, et al. Association of mustard oil as cooking media with carcinoma of the gallbladder. J Gastrointest Cancer 2013;44:177-81.
Unisa S, Jagannath P, Dhir V, Khandelwal C, Sarangi L, Roy TK, et al. Population-based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural gangetic basin of north india. HPB (Oxford) 2011;13:117-25.
Misra S, Chaturvedi A, Misra NC, Sharma ID. Carcinoma of the gallbladder. Lancet Oncol 2003;4:167-76.
Sirohi B, Rastogi S, Singh A, Sheth V, Dawood S, Talole S, et al. Use of gemcitabine-platinum in indian patients with advanced gall bladder cancer. Future Oncol 2015;11:1191-200.
Ramaswamy A, Ostwal V, Pinninti R, Kannan S, Bhargava P, Nashikkar C, et al. Gemcitabine-cisplatin versus gemcitabine-oxaliplatin doublet chemotherapy in advanced gallbladder cancers: A match pair analysis. J Hepatobiliary Pancreat Sci 2017;24:262-7.
Uttam RS. Elemental Investigation of River Ganga Water by LIBS. Available from: http://www.indiaenvironmentportal.org.in/files/file/river%20ganga.pdf. [Last accessed on 2018 Mar 13].
Dixit R, Shukla VK. Why Is Gallbladder Cancer Common in the Gangetic Belt? In: Perspectives in Cancer Prevention-Translational Cancer Research. New Delhi: Springer; 2014. p. 145-51.
Nath A, Vendan PS, Kumar S, Kumar A, Singh JK. Toxicity due to arsenic in Gangetic zone of Patna, India and its linkage with cancer. J Environ Anal Toxicol 2013;3:2161-525.
Kumar A, Ali M, Rahman SM, Iqubal AM, Anand G, Niraj PK, et al. Ground water arsenic poisoning in “Tilak Rai Ka Hatta” Village of Buxar District, Bihar, India Causing Severe Health Hazards and Hormonal Imbalance. J Environ Anal Toxicol 2015;5:1.
Kumar, Arun, Ashok Ghosh, and Nandita Singh. “Arsenic in Drinking Water: An Emerging Human Right Challenge in India.” The Human Right to Water. Springer, Cham, 2016. 55-81.
Shukla VK, Prakash A, Tripathi BD, Reddy DC, Singh S. Biliary heavy metal concentrations in carcinoma of the gall bladder: Case-control study. BMJ 1998;317:1288-9.
Chhabra D, Oda K, Jagannath P, Utsunomiya H, Takekoshi S, Nimura Y, et al. Chronic heavy metal exposure and gallbladder cancer risk in India, a comparative study with japan. Asian Pac J Cancer Prev 2012;13:187-90.

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[1] SEER Database. Available from: https://www.seer.cancer.gov/faststats/selections.php?#Output. [Last assessed on 2017 Oct 17].

[2] GLOBOCON data. Available from: http://www.globocan.iarc.fr/Pages/fact_sheets_population.aspx. [Last assessed on 2017 Oct 17].

[3] National Centre for Disease Informatics and Research. Release of Reports PBCR and HBCR 2012-2014. Available from: http://www.ncrpindia.org/ALL_NCRP_REPORTS/PBCR_REPORT_2012_2014/ALL_CONTENT/PDF_Printed_Version/Chapter 2_Printed.pdf. [Last assessed on 2017 Oct 17].

[4] National Centre for Disease Informatics and Research. Release of Reports PBCR and HBCR 2012-2014. Available from: http://www.ncrpindia.org/ALL_NCRP_REPORTS/PBCR_REPORT_2012_2014/ALL_CONTENT/PDF_Printed_Version/Chapter 7_Printed.pdf. [Last assessed on 2017 Oct 17].

[5] Shukla VK, Khandelwal C, Roy SK, Vaidya MP. Primary carcinoma of the gall bladder: A review of a 16-year period at the university hospital. J Surg Oncol 1985;28:32-5.

[6] Khan I, Panda N, Banerjee M, Das R. Epidemiological factors in gall bladder cancer in eastern India-a single centre study. Indian J Surg Oncol 2013;4:67-72.

[7] The Detail Analysis of Population Census 2011 Published by Govt. Of India for Bihar State. Available from: http://www.census2011.co.in/census/state/districtlist/bihar.html. [Last assessed on 2017 Oct 17].

[8] Indian State Census 2011. Available from: http://www.census2011.co.in/states.php. [Last assessed on 2017 Oct 17].

[9] Government of India. National Cancer Control Programme. Available from: https://www.web.archive.org/web/20111018014423.; http://www.india.gov.in/sectors/health_family/index.php?id=11. [Last assessed on 2017 Oct 17].

[10] Indian Council of Medical Research, Hospital Based Cancer Registry. Available from: http://www.icmr.nic.in/ncrp/hbcr.pdf. [Last assessed on 2017 Oct 17].

[11] Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: Geographical distribution and risk factors. Int J Cancer 2006;118:1591-602.

[12] Zatonski WA, Lowenfels AB, Boyle P, Maisonneuve P, Bueno de Mesquita HB, Ghadirian P, et al. Epidemiologic aspects of gallbladder cancer: A case-control study of the SEARCH program of the international agency for research on cancer. J Natl Cancer Inst 1997;89:1132-8.

[13] Nandakumar A, Gupta PC, Gangadharan P, Visweswara RN, Parkin DM. Geographic pathology revisited: Development of an atlas of cancer in India. Int J Cancer 2005;116:740-54.

[14] Dhir V, Mohandas KM. Epidemiology of digestive tract cancers in India IV. Gall bladder and pancreas. Indian J Gastroenterol 1999;18:24-8.

[15] Prasad RR, Singh JK, Mandal M, Kumar M, Prasad SS. Profile of gall bladder cancer cases in Bihar. Indian J Med Paediatr Oncol 2005;26:31.

[16] Dixit R, Srivastava P, Basu S, Srivastava P, Mishra PK, Shukla VK, et al. Association of mustard oil as cooking media with carcinoma of the gallbladder. J Gastrointest Cancer 2013;44:177-81.

[17] Unisa S, Jagannath P, Dhir V, Khandelwal C, Sarangi L, Roy TK, et al. Population-based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural gangetic basin of north india. HPB (Oxford) 2011;13:117-25.

[18] Misra S, Chaturvedi A, Misra NC, Sharma ID. Carcinoma of the gallbladder. Lancet Oncol 2003;4:167-76.

[19] Sirohi B, Rastogi S, Singh A, Sheth V, Dawood S, Talole S, et al. Use of gemcitabine-platinum in indian patients with advanced gall bladder cancer. Future Oncol 2015;11:1191-200.

[20] Ramaswamy A, Ostwal V, Pinninti R, Kannan S, Bhargava P, Nashikkar C, et al. Gemcitabine-cisplatin versus gemcitabine-oxaliplatin doublet chemotherapy in advanced gallbladder cancers: A match pair analysis. J Hepatobiliary Pancreat Sci 2017;24:262-7.

[21] Uttam RS. Elemental Investigation of River Ganga Water by LIBS. Available from: http://www.indiaenvironmentportal.org.in/files/file/river%20ganga.pdf. [Last accessed on 2018 Mar 13].

[22] Dixit R, Shukla VK. Why Is Gallbladder Cancer Common in the Gangetic Belt? In: Perspectives in Cancer Prevention-Translational Cancer Research. New Delhi: Springer; 2014. p. 145-51.

[23] Nath A, Vendan PS, Kumar S, Kumar A, Singh JK. Toxicity due to arsenic in Gangetic zone of Patna, India and its linkage with cancer. J Environ Anal Toxicol 2013;3:2161-525.

[24] Kumar A, Ali M, Rahman SM, Iqubal AM, Anand G, Niraj PK, et al. Ground water arsenic poisoning in “Tilak Rai Ka Hatta” Village of Buxar District, Bihar, India Causing Severe Health Hazards and Hormonal Imbalance. J Environ Anal Toxicol 2015;5:1.

[25] Kumar, Arun, Ashok Ghosh, and Nandita Singh. “Arsenic in Drinking Water: An Emerging Human Right Challenge in India.” The Human Right to Water. Springer, Cham, 2016. 55-81.

[26] Shukla VK, Prakash A, Tripathi BD, Reddy DC, Singh S. Biliary heavy metal concentrations in carcinoma of the gall bladder: Case-control study. BMJ 1998;317:1288-9.

[27] Chhabra D, Oda K, Jagannath P, Utsunomiya H, Takekoshi S, Nimura Y, et al. Chronic heavy metal exposure and gallbladder cancer risk in India, a comparative study with japan. Asian Pac J Cancer Prev 2012;13:187-90.

Geographical pattern of carcinoma gallbladder in Bihar and its association with river Ganges and arsenic levels: Retrospective individual consecutive patient data from Regional Cancer Centre

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