Chronic episodes of cholecystitis are the most significant risk factor for gallbladder carcinoma. Gallbladder carcinoma is very rare and typically is diagnosed intra-operatively. Chronic cholecystitis is a risk factor due to chronic inflammation inducing cellular changes that can predispose to cancer. The repeat inflammatory changes can eventually lead to cancer thus the reason why the gallbladder is removed electively in patients who experience episodes. Cholecystectomy is sufficient treatment for carcinoma confined to the gallbladder mucosa only. When approaching this question the diagnosis is already given. What is being tested are the risk factors surrounding gallbladder carcinoma. While smoking and alcohol use are risk factors for gallbladder cancer, the greatest risk factor is repeat inflammatory changes to the organ of interest - chronic cholescystitis. Knowing risk factors is typically not sufficient for the USMLE - you must also know which are the greatest risk factors.Illustration A depicts a gallbladder carcinoma detected by ultrasound. Incorrect Answers:Answer 1: African-American race is not a risk factor for gallbladder cancer. It is most common in central and South America, central and eastern Europe, Japan and northern India; and in certain ethnic groups such as Native American Indians and Hispanics.Answer 3: Smoking is a risk factor for many cancers but is not as significant of a risk factor as gallstones. Smoking is a more prominent risk factor for lung, bladder and renal cancers.Answer 4: Alcohol is a risk factor for many cancers but is not as significant of a risk factor as gallstones. Alcohol abuse is associated with cancer of the esophagus, gallbladder, and liver (if cirrhotic).Answer 5: Obesity, not low BMI, is a risk factor for gallbladder carcinoma. Think of these individuals eating fatty meals that induces CCK release that can predispose to contraction of the sphincter of Oddi and episodes of cholecystitis. A calcified gallbladder or gallbladder polyps greater than 10mm, as well as individuals who are carries of Salmonella typhi are at risk for gallbladder carcinoma. Screening should be performed in these patients (1).