Douglas K. Rex, MD reviewing Shabanzadeh DM et al. Gastroenterology 2017 Feb 23.
Routine screening seems reasonable in patients with gallstones or prior cholecystectomy.
Cholecystectomy has been associated with an increased risk for right-sided colon cancer. This link is often attributed to increased exposure of proximal colon mucosa to secondary bile acids after cholecystectomy.
In a prospective study from Copenhagen, residents aged 30 to 70 years were invited to undergo abdominal ultrasound between 1982 and 1992 and then followed for a median of 25 years. Of 5928 participants, 7% had gallstones and 3% had cholecystectomy at baseline. Of those with gallstones, 15% had awareness of gallstones, and the remainder were not notified of the results. During follow-up, 7% developed at least one gastrointestinal (GI) cancer, 23% developed a non-GI cancer, 45% were alive without cancer, and 25% died of other causes. Only 1% were lost to follow-up.
Overall risk for GI cancers was elevated in persons with gallstone disease (defined as either gallstones or cholecystectomy; hazard ratio, 1.5) and in patients with cholecystectomy alone (HR, 1.7). In subgroups of colorectal cancers, right-sided cancer was associated with gallstone disease and gallstones, but not with cholecystectomy alone. Rates of other specific GI cancers were not elevated in patients with gallstone disease.
Shabanzadeh DM et al. Association between screen-detected gallstone disease and cancer in a cohort study. Gastroenterology 2017 Feb 23; [e-pub].