Cancer of the Gallbladder in Bolivia: Suggestions Concerning Etiology

In order to investigate the very high incidence of gallbladder cancer in Bolivia, a series of patients with gallbladder cancer and/or cholelithiasis from a hospital in La Paz was compared to a series of patients with cholelithiasis from Philadelphia. Each group demonstrated a similar female predilection. Bolivian patients with gallbladder cancer were older than patients with cholelithiasis who, in turn, were older than the general population (p < 0.001). Racial differences demonstrated previously were confirmed. Bolivian gallstones were uniformly cholesterol in type, in contrast to the US series, in which 27% of patients had black pigment stones. Bile specimens obtained from Bolivian patients with cholelithiasis had a lower concentration of bile salts, phospholipids, and cholesterol than bile specimens from US cholelithiasis patients (p < 0.01, < 0.001, and < 0.001, respectively). These biochemical differences may help to explain the differing incidence of cholelithiasis and gallbladder cancer in the US and Bolivia.