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Gallbladder cancer is affecting thousands, especially women, in India’s Gangetic belt.
It is driven by environmental pollution and socio-economic factors.
Despite its prevalence, it remains neglected by policymakers.
Gallbladder cancer (GBC) is silently claiming thousands of lives across India’s Gangetic plains, yet it remains absent from the country’s public health agenda. Despite being among the top five cancers in northern states, GBC has never been treated as a national priority by policymakers, insurers or even most cancer registries.
India accounts for nearly 10 per cent of the global burden, with the highest concentration along the Gangetic belt, particularly in Uttar Pradesh, Bihar, West Bengal and Assam.
Women are disproportionately affected, often presenting at advanced stages where curative treatment is no longer an option. What makes this tragedy all the more avoidable is that much of it is environmentally driven — rooted in contamination of water, food and soil — and could have been prevented through timely regulation and surveillance.
The clustering of GBC cases along the Ganga is no coincidence. Decades of research point to a confluence of industrial pollution, arsenic and heavy metal contamination, poor sanitation and chronic infections as key drivers. The Central Ground Water Board and the Central Pollution Control Board have repeatedly documented arsenic, cadmium and lead in drinking water across districts in Uttar Pradesh, Bihar and West Bengal.
Industrial effluents discharged directly into rivers, pesticide residues and adulterated mustard oil compound the risk. Families consume contaminated fish and groundwater daily, turning the Ganga — the cultural lifeline of North India — into a carrier of carcinogenic exposure. Unlike communicable diseases, the effects of such contamination are insidious, building silently over years until they manifest as cancer in middle age.
Nearly 70 per cent of GBC patients are women, most from low-income households. Biology may play a role, but socio-economic factors are decisive. Women in affected regions often cook with reused oil, consume leftover food stored without refrigeration and are exposed to contaminated water for domestic chores.
The delay in diagnosis is deadly. In tertiary hospitals such as Tata Memorial, over 80 per cent of female GBC patients arrive with Stage III or IV disease, when surgery is no longer viable. Treatment costs, often exceeding Rs 8-12 lakh, push families into debt or force them to abandon care. Without insurance or state support, most quietly discontinue treatment.
This is why gallbladder cancer is not just a medical crisis, but a social and economic one. Its geography overlaps almost perfectly with India’s most disadvantaged districts — those with high multidimensional poverty, poor sanitation and gender inequality.
The crisis reflects systemic failures in environmental governance. Cancer registries cover barely 10% of India’s population, leaving much of the Gangetic plain unmonitored. Pollution laws are weakly enforced and industrial discharge continues unchecked.
Without mandatory cancer reporting, clusters remain invisible, and preventive action is delayed. The National Cancer Registry Programme (NCRP) relies largely on hospital-based data, missing the rural poor who never reach tertiary centres. This invisibility perpetuates neglect, allowing contamination to continue unchecked.
To confront this crisis, India must act decisively. First, it should make cancer notifiable. Mandatory reporting would generate real-time data, reveal hidden clusters and guide interventions. We cannot fight what we cannot see, and we cannot see what we do not measure.
Additionally, integrating health with river governance is vital. This includes linking cancer surveillance with the National Clean Ganga Mission to connect environmental and health data.
Pollution laws must also be enforced properly, through closer monitoring of industrial discharge and groundwater contamination and holding industries accountable.
Community-level prevention is also key. Awareness campaigns for women, routine water testing and affordable screening through district hospitals are needed to tackle the crisis.
The country should try to develop a gender-sensitive health policy. For this, it is important to recognise the disproportionate burden on women and tailor interventions accordingly.
Assam is not alone in facing this challenge. Bangladesh operates a National Residue Control Program for seafood. Vietnam monitors metal contamination in coastal communities. The Philippines has a National Residue Monitoring Plan for aquaculture products.
India’s own Marine Products Export Development Authority runs a National Residue Control Plan, but it is geared toward exports, not the fish consumed daily by Indian families. What India lacks is a national framework to safeguard freshwater fish and food sources for domestic markets.
Gallbladder cancer is not just a medical crisis — it is an environmental epidemic born of neglect. It exposes how pollution, gender inequality and weak governance converge to create invisible health disasters. Declaring cancer notifiable will not solve everything, but it will make the crisis visible, measurable and actionable.
What gets counted, gets confronted. Until then, the Gangetic belt will remain the epicentre of an epidemic that thrives in silence, not because science lacks answers, but because policy has yet to ask the right questions.
Urvashi Prasad is a senior fellow at Pahlé India Foundation and former director of NITI Aayog. Shreya Anjali is a public health analyst with Pahlé India Foundation. Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth.