Is Gallbladder Cancer Preventable?

November 10, 2017

There is always a question – Is cancer linked to the environment and could environmental pollution be one of the reasons for increase in incidence of cancer?
 
There has been some substantial work done in the field of gall bladder cancer. Interestingly the gall bladder diseases are far more common in Northern India than in the South. Almost 8 times more common in the North India as compared to South India.
 
How is it that in the same country there is such clear geographical differences?
 
Back in 2000 all gall bladder cancer cases coming to Tata Memorial Hospital were collected and were traced to the village of their origin. On plotting the data, it was found that the cases were all clustered on few districts in Northern India. It was worth investigating further. A large population based survey in 60 villages in rural Patna and Vaishali in Bihar and Varanasi in UP was conducted. Surprisingly it was found that is an increase in gall bladder disease and gall bladder cancer occurs in a very few pockets which are like epicentres of gall bladder diseases. This was published in 2010.
 
The soil and water samples were also tested and alarmingly an increase in heavy metals in the drinking water was found. Obviously, there is significant environment pollution happening in these areas. We know that the liver is an organ which clears away all the toxins in the body and excretes it as bile, so the biliary concentrations of these heavy metals were studied and were also very high. Not being satisfied with this indirect evidence, tissue samples of gall bladder in Northern India were checked and it was found that there are heavy metals within the cells. This is a substantial evidence of heavy metals which are actually well-known carcinogens like cadmium, chromium and lead which are banned across the world. (Published 2012).
 
How did these toxins get into the soil and how did these heavy metal contaminations happen? The reason is not too far to look in. Most of the industrial effluent passes into the holy river of Ganges for purification. This is responsible for the significant amount of not only river water but also ground water contamination.
 
Unfortunately, bile concentrates these metals and some of the population have a peculiar genetic pathway of transporting these heavy metals into the bile which possibly explains why some people are more prone than others. Gall stone diseases in this area is extremely high due to dietary factors in this region. We know that we cannot change the genes nor can we change the dietary pattern in a short period of time but certainly it is the environment which can be made safer.
 
Approaching industrial leaders like Mr. Uchiyamada, Chairman of Toyota Motors Corporation , who is committed to clear energy and who are willing to start a water purification plant in these areas of high incidence where they supply highly purified drinking water free of heavy metals to the villages, for free of cost.
 
On September 2015, Toyota installed a water purification plant in the village of Basni in Varanasi and in Vaishali district of Bihar in 2016. Close to 30,000 litres of water is dispensed. This is being maintained by the village panchayats who have taken the responsibility of the plant. This is the first such example of active intervention to prevent disease in an area which has environmental pollution.
 
In different parts of the world similar occurrences are documented. SL Raheja Hospital, Mahim ( A Fortis Associate) is committed to research and will be one of the nodal centres for such studies.
 
It is such studies that will increase our understanding and help us prevent a disease which otherwise is fatal. Such efforts are to be scaled up substantially with the help of the government and industry through their CSR activities. Only then we can substantially reduce deaths from gall bladder cancer.

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