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Their incidence has varied for unknown reasons and we hypothesize that Thorotrast, a previously used carcinogenic radiographic contrast medium, has contributed to the incidence trends. We obtained incidence and survival data from the NORDCAN database, which includes cancer registry data from Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE), which are globally the oldest national cancer databases, starting from 1943 in DK, 1953 in FI and NO and 1960 in SE, and extending to 2016. The incidence trend for GBC showed a broad maximum around 1980 in men (close to 3\/100\u2009000) and women (4\/100\u2009000), except for NO, where this phenomenon was not seen. In 1955, FI and NO incidence rates were equal but FI rates peaked and later declined similar to DK and SE rates. By 2010, the incidence was similar in all Nordic countries, for both men and women, at close to 2.0\/100\u2009000. Birth cohort analysis showed strong effects for countries other than NO. Relative 1\u2010year survival increased for men from 20% to about 50% and similarly for women although at a 5 percentage points lower level. Survival in NO was better than in other countries in the 1980s. Thorotrast, causing a high risk of GBC, was extensively used in the Nordic countries between 1930 and end of 1940s, with the exception of NO, where these was no documented use. These data suggest that Thorotrast influenced GBC epidemiology and probably worsened survival in certain periods.<\/jats:p>","DOI":"10.1002\/ijc.33980","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T15:03:06Z","timestamp":1645801386000},"page":"200-208","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Long\u2010term incidence and survival trends in cancer of the gallbladder and extrahepatic bile ducts in Denmark, Finland, Norway and Sweden with etiological implications related to Thorotrast"],"prefix":"10.1002","volume":"151","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2769-3316","authenticated-orcid":false,"given":"Kari","family":"Hemminki","sequence":"first","affiliation":[{"name":"Biomedical Center, Faculty of Medicine Charles University in Pilsen  Pilsen Czech Republic"},{"name":"Division of Cancer Epidemiology German Cancer Research Center (DKFZ)  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asta","family":"F\u00f6rsti","sequence":"additional","affiliation":[{"name":"Hopp Children's Cancer Center (KiTZ)  Heidelberg Germany"},{"name":"Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) German Cancer Consortium (DKTK)  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otto","family":"Hemminki","sequence":"additional","affiliation":[{"name":"Cancer Gene Therapy Group, Translational Immunology Research Program University of Helsinki  Helsinki Finland"},{"name":"Department of Urology Helsinki University Hospital and University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaclav","family":"Liska","sequence":"additional","affiliation":[{"name":"Department of Surgery University Hospital, School of Medicine in Pilsen  Pilsen Czech Republic"},{"name":"Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen Charles University in Prague  Pilsen Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7103-8530","authenticated-orcid":false,"given":"Akseli","family":"Hemminki","sequence":"additional","affiliation":[{"name":"Cancer Gene Therapy Group, Translational Immunology Research Program University of Helsinki  Helsinki Finland"},{"name":"Comprehensive Cancer Center Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00153-7"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hym149"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19941115)74:10<2863::AID-CNCR2820741020>3.0.CO;2-5"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djk201"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28161"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004649900864"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-015-3267-2"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-007-0309-6"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-013-3084-3"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.52.4.592"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)71123-4"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djz103"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.31835"},{"issue":"2","key":"e_1_2_11_15_1","first-page":"1","article-title":"Ionizing radiation, part 2: some internally deposited radionuclides. 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