Epidemiology of biliary tract cancers: an update

Background: Biliary tract cancer (BTC) is a rare cancer in Europeand North America, characterized by wide geographic variation,with high incidence in some areas of Latin America and Asia. Materials and methods: BTC mortality and incidence have beenupdated according to recent data, using joinpoint regressionanalysis. Results: Since the 1980s, decreasing trends in BTC mortalityrates (age-standardized, world standard population) were observedin the European Union as a whole, in Australia, Canada, HongKong, Israel, New Zealand, and the United States, and high-riskcountries such as Japan and Venezuela. Joinpoint regressionanalysis indicates that decreasing trends were more favorableover recent calendar periods. High-mortality rates are, however,still evident in central and eastern Europe (4–5/100 000women), Japan (4/100 000 women), and Chile (16.6/100 000 women).Incidence rates identified other high-risk areas in India (8.5/100000 women), Korea (5.6/100 000 women), and Shanghai, China (5.2/100000 women). Conclusions: The decreasing BTC mortality trends essentiallyreflect more widespread and earlier adoption of cholecystectomyin several countries, since gallstones are the major risk factorfor BTC. There are, however, high-risk areas, mainly from SouthAmerica and India, where access to gall-bladder surgery remainsinadequate. Key words: biliary tract cancer, epidemiology, gall-bladder cancer, incidence, mortality, risk factorsReceived for publication April 24, 2008. Revision received June 24, 2008. Accepted for publication June 26, 2008.