Chapter 11: Cancer of the Gallbladder

The Burden of Digestive Diseases in the United States

James E. Everhart, M.D., M.P.H.

About 3,000 cases of gallbladder cancer were estimated to have occurred in 2004 (Table 1). Gallbladder cancer was the only digestive system malignancy that occurred predominantly among women (nearly twice the age-adjusted rate of men) and was one of the few nongenital cancers that had a female predominance. It was predominantly a diagnosis of the elderly, with a median age of diagnosis of age 73 years (PDF, 28KB) , the highest of any digestive system cancer. Age-adjusted rates were too low to draw inferences about ethnic differences in risk. Incidence of gallbladder cancer declined by 42.2 percent from 1979 to 1997, and was then stable through 2004 (Figure 1). Five-year survival increased modestly to about 9 percent. Outpatient and inpatient data were too sparse to draw inferences, except that the rate of hospitalization with gallbladder cancer declined substantially until the mid-1990s and has been stable since (Figure 2).

Because of low survival, gallbladder cancer mortality was similar to incidence. As underlying cause, there were nearly 2,000 deaths in 2004 and just under 11,000 YPLL prior to age 75 years (Table 3), which reflects the older age at which gallbladder cancer occurred. Rates were 6.8 times as high in the oldest age group (65 years and older) as among those ages 45–64 years. Age-adjusted mortality rates were higher for blacks than whites, and for females than males. The death rate for gallbladder cancer declined by 47 percent between 1979 and 2004 (Figure 3). Because gallstones are the major recognized risk factor for gallbladder cancer, it is of interest that there was a similar decline (56.1 percent) in gallstone disease-related mortality over that period.

Table 1. Gallbladder Cancer: Number of Cases and Incidence Rates by Age, Race/Ethnicity, and Sex, 2004

Source: Surveillance, Epidemiology, and End Results (SEER) Program

Demographic Characteristics Number of Cases Incidence per 100,000 Unadjusted Incidence per 100,000 Age-Adjusted
AGE (Years)
Under 15
AGE (Years)
15–44
79 0.1
AGE (Years)
45–64
850 1.2
AGE (Years)
65+
2,257 6.6
RACE/ETHNICITY
Non-Hispanic White
2,129 1.1 0.9
RACE/ETHNICITY
Non-Hispanic Black
356 1.0 1.5
RACE/ETHNICITY
Hispanic
348 0.9 1.9
RACE/ETHNICITY
Asian/Pacific Islander
142 1.2 1.4
RACE/ETHNICITY
American Indian/Alaska Native
Sex
Female
2,180 1.5 1.4
Sex
Male
867 0.6 0.8
Total 3,034 1.1

Figure 1. Gallbladder Cancer: Age-Adjusted Incidence Rates and 5-Year Survival Rates, 1979–2004

Incidence per 100,000 declined from 1.84 in 1979 to 1.07 in 1997, and was then stable through 2004. Five-year survival increased modestly from 7.84 percent in 1979 to 9.64 percent in 1999, the last year for which it could be calculated.
Source: Surveillance, Epidemiology, and End Results (SEER) Program

Table 2. Gallbladder Cancer: Number and Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With First-Listed and All-Listed Diagnoses by Age, Race, and Sex in the United States, 2004

Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (3-year average, 2003–2005), and Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP NIS)

Demographic Characteristics Ambulatory Care Visits First-Listed Diagnosis Number in Thousands Ambulatory Care Visits First-Listed Diagnosis Rate per 100,000 Ambulatory Care Visits All-Listed Diagnosis Number in Thousands Ambulatory Care Visits All-Listed Diagnosis Rate per 100,000 Hospital Discharges First-Listed Diagnosis Number in Thousands Hospital Discharges First-Listed Diagnosis Rate per 100,000 Hospital Discharges All-Listed Diagnosis Number in Thousands Hospital Discharges All-Listed Diagnosis Rate per 100,000
AGE (Years)
Under 15
AGE (Years)
15–44
0 0
AGE (Years)
45–64
1 1 1 2
AGE (Years)
65+
2 6 4 11
Race
White
2 1 5 2
Race
Black
0 1 1 2
Sex
Female
2 1 4 2
Sex
Male
1 1 2 1
Total 3 1 6 2

Figure 2. Gallbladder Cancer: Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With All–Listed Diagnoses in the United States, 1979–2004 (Ambulatory Care Visit Data Unavailable)

The number of ambulatory care visits during the period was too small to provide estimates. Hospitalizations per 100,000 declined substantially from 5.05 in 1979 to 1.35 in 1992 and have been stable since with a rate of 1.86 in 2004.
Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (averages 1992–1993, 1994–1996, 1997–1999, 2000–2002, 2003–2005), and National Hospital Discharge Survey (NHDS)

Table 3. Gallbladder Cancer: Number and Age-Adjusted Rates of Deaths and Years of Potential Life Lost (to Age 75) by Age, Race, and Sex in the United States, 2004

Source: Vital Statistics of the United States

Demographic Characteristics Underlying Cause Number of Deaths Underlying Cause Rate per 100,000 Underlying Cause Years of Potential Life Lost in Thousands Underlying or Other Cause Number of Deaths Underlying or Other Cause Rate per 100,000
AGE (Years)
Under 15
AGE (Years)
15–44
41 0.0 1.5 44 0.0
AGE (Years)
45–64
422 0.6 7.1 443 0.6
AGE (Years)
65+
1,476 4.1 2.3 1,585 4.4
Race
White
1,600 0.6 8.5 1,715 0.7
Race
Black
227 0.9 1.6 239 0.9
Sex
Female
1,343 0.8 7.4 1,422 0.8
Sex
Male
596 0.5 3.5 650 0.5
Total 1,939 0.7 10.9 2,072 0.7

Figure 3. Gallbladder Cancer: Age-Adjusted Rates of Death in the United States, 1979–2004

The death rate declined between 1979 and 2004. Underlying-cause mortality per 100,000 decreased from 1.22 in 1979 to 0.64 in 2004. All-cause mortality per 100,000 decreased from 1.34 in 1979 to 0.69 in 2004.
Source: Vital Statistics of the United States
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