Ganga water link to gall bladder cancer? (Times of India 29 January 2011)

MUMBAI: The incidence of gall bladder disease is high among people living near the Ganga and its tributaries, says the largest-ever study of the local population over six years. A team of doctors from Mumbai conducted the study and found high concentrations of heavy metals in the water and soil of 60 villages along the Indo-Gangetic plains that could be contributing to the disease. The study was published last week in the online edition of HPB, the official journal of the International Hepato-Pancreato-Biliary Association. It has identified eight villages in Bihar's Vaishali district, located near the river Gandak, with an unusually high rate of gall bladder disease. "It's a ticking environmental time bomb," said Dr P Jagannath, one of the principal investigators of the study. He estimates between 20,000 and 30,000 people develop gall bladder disease each year because of the environmental factors in Uttar Pradesh and Bihar alone. The medical team felt that there is a need to carry out large-scale screening of people from villages. The study started with an observation that more than half of the patients with gall bladder cancer who came to Tata Memorial Hospital in Parel hailed from Bihar or Uttar Pradesh. Dr Jagannath, who was earlier with Tata Memorial Hospital and is now with Lilavati Hospital, along with International Institute of Population Studies, started on-site research for the reasons. "Cancer can have lifestyle and environmental reasons, he said. For instance, the staple diet in Bihar is sattu, which is roasted chickpea. Sattu is rich in proteins. If this is not balanced with the intake of carbohydrates, it can cause gall stones causing chronic irritation and eventually gall bladder cancer. Gall stones, however, don't always lead to cancer," said Dr Jagannath. Polluting small-scale units along the rivers have been a concern for long; industrial effluents are known to contain heavy metals that have carcinogenic effects. As part of the study, 8,421 people with symptoms were sent for ultrasonography tests. These villagers lived near rivers. About 40% of the 4,851 households surveyed in Varanasi lived within a 5-km range near the Ganga, 30% of the 3,885 households in Patna were near the Ganga and 25% near Punpun. Around 66% of 4,598 household in Vaishali were near the Gandak river. Apart from sonography scans to establish physical evidence of disease, the study also looked at samples of water and soil collected from Patna and Vaishali in Bihar. Water samples were collected from taps or from tube or borewells commonly used by the villagers. Soil was collected from three randomly selected fields. All samples were analysed for the presence of nickel, cadmium, chromium and DDT. "After the study is over, we will try for funding to ensure clean water supply to villages," Dr Jagannath said. Gall bladder cancer has high mortality of up to 80% mainly because the diagnosis is very late. "The study looked at 20 villages each in three districts even though there are 150 villages in each district. There was a prevalence of GBD of 6.2% among men and women over 30 years of age (4.45% in men and 7.37% in women). If this is the prevalence in 60 villages, it can be extrapolated how many are affected in the region," he said.