Gallbladder cancer in South America: epidemiology and prevention.

The incidence and the mortality of gallbladder cancer (GBC) show significant variation worldwide, with high age-standardized rates in western South America (SA). Due to the lack of effective measures for prevention, the late diagnosis and the small benefit of systemic treatment, GBC has an ominous prognosis and became an important public health problem in this part of the continent, where the most important risk factors are gallstone disease, female gender, age, ethnic groups, and low socioeconomic status. Many genetic abnormalities have been described in series from SA, some of them similar and others unique in comparison to gene alterations in GBC from other regions of the world. Prophylactic cholecystectomy (PC) is one of the strategies to decrease the mortality but its cost-effectiveness is questionable. A way to improve the performance of PC is to identify molecular risk factors that in combination with currently known ones detect patients with very high risk for developing GBC. Also, more research studies are required to better understand the epidemiology and molecular biology in order to improve the prevention and treatment of this lethal disease.