Gallbladder cancer in Gangetic belt

https://www.downtoearth.org.in/health/gallbladder-cancer-indias-invisible-epidemic-in-gangetic-belt

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Context:

Gallbladder Cancer (GBC) is emerging as a silent yet devastating public health crisis across India’s Gangetic plains. Despite contributing nearly 10% of the global GBC burden, it remains largely absent from national health priorities.

What is Gallbladder Cancer?

Gallbladder Cancer (GBC) is a type of cancer that begins in the gallbladder, a small pear-shaped organ located beneath the liver.
Its job is to store bile, a digestive fluid produced by the liver that helps break down fats.

How it happens?

Cells inside the gallbladder begin multiplying out of control, creating a tumour. Because symptoms appear late or are mistaken for common digestive problems, gallbladder cancer is usually detected at advanced stages, making it one of the deadliest abdominal cancers.

Types of Gallbladder cancer:

Most gallbladder cancers are:

Adenocarcinomas — cancers that develop from gland-like cells lining the gallbladder.

Other rare types include:

• Squamous cell carcinoma
• Neuroendocrine tumours

Current Status of Gallbladder cancer (GBC):

• Nearly 70% of GBC patients are women, disproportionately from low-income households.
• Delayed diagnosis worsens survival outcomes e.g., over 80% of female patients at Tata Memorial Hospital report at Stage III–IV, when surgery is no longer feasible.
• Cancer registries cover only 10% of India’s population.
• It is mostly concentrated in Gangetic belt of Uttar Pradesh, Bihar, West Bengal and Bhramaputra belt of Assam.

Why is Gallbladder Cancer concentrated in the Gangetic belt?

• The Central Ground Water Board and CPCB have repeatedly detected arsenic, cadmium and lead in drinking water across Uttar Pradesh, Bihar, West Bengal and Assam.
• Gallstones Prevalence and Chronic Infection: Regions with poor sanitation and unsafe water have high gallstone occurrence. Gallstones cause long-term irritation in the gallbladder, raising cancer risk 4–5 times.
• Pollution laws exist but enforcement is weak. Industrial discharge continues with little accountability.

What are the broader consequences of Gallbladder cancer in Gangetic belt?

• Health impact: Gallbladder cancer leads to late detection, high mortality and a growing burden on tertiary hospitals, reflecting weak primary healthcare screening and delayed diagnosis, especially among rural women.

• Gender impact: The disease disproportionately affects women because of their greater exposure to contaminated water, low priority accorded to their health within households and delayed access to treatment, deepening gender vulnerability and social marginalisation. Incidence of GBC in women in northern India is around 9–10.1 per 100,000 per year, compared to about 1 per 100,000 in southern India, highlighting a strong regional and gender skew.

• Economic impact: Treatment costs often exceeding ₹8–12 lakh force households into debt, asset liquidation and treatment abandonment, while loss of income from the patient and caregivers further weakens family livelihoods.

• Poverty and inequality: Gallbladder cancer clusters overlap with India’s least developed districts, amplifying existing multidimensional poverty, restricting access to sanitation and safe water and reinforcing cycles of deprivation among already marginalised communities. The highest-risk GBC states are Bihar, Uttar Pradesh, West Bengal, Assam, which also rank among the poorest in India, with NITI Aayog’s Multidimensional Poverty Index showing poverty rates of 9% in Bihar and 37.8% in Uttar Pradesh, far above national averages.

• Environmental impact: The disease exposes the consequences of prolonged pollution, as industrial contaminants, unsafe food chains and arsenic-laden groundwater contribute to a toxic living environment that silently harms human health. Recent Bihar Economic Survey data confirm that arsenic, fluoride, uranium, iron and nitrate contamination affect over 30,000 rural wards, with arsenic detected in 20 districts and explicitly linked to increased cancer risk.

Government initiatives:

• Cancer control policies and programs: Through the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), the government provides infrastructure, screening and treatment support for cancer, including gallbladder cancer, at the district level.

• Tertiary Cancer Care: The Government funds Regional Cancer Centres such as Tata Memorial Centre, Chittaranjan National Cancer Institute and Dr. B. Borooah Cancer Institute in Assam where advanced gallbladder cancer cases from the Gangetic belt

• Cancer care financing under PM-JAY: Under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana, eligible families receive financial support for cancer surgeries, chemotherapy and palliative care, protecting rural gallbladder cancer patients from catastrophic treatment costs.

• River Rejuvenation Measures: Initiatives like the National Clean Ganga Mission seek to improve water quality and reduce pollutant loads, indirectly contributing to mitigation of pollution-linked cancer risks in the Gangetic region.

Conclusion:

Gallbladder cancer in the Gangetic belt is not merely a medical challenge but a symptom of deeper structural failures polluted environments, gendered neglect, weak surveillance and persistent poverty. Its concentration among disadvantaged women, late diagnosis and high mortality reveal how environmental injustice translates into health inequality. Addressing this crisis requires moving beyond treatment to prevention, pollution control, gender-sensitive healthcare and mandatory reporting, because only when this invisible epidemic becomes visible in policy can meaningful change begin.

Source: Down to Earth