The prevalence of gallbladder cancer, the commonest biliary malignancy, shows geographical and racial variations. It is reported to be rare in India. However, the incidence of gallbladder cancer in north and central India is very high--it is the commonest gastrointestinal cancer in women. Even Indian migrants to different countries have a higher risk of having gallbladder cancer as compared to the respective native populations. The incidence of gallbladder cancer parallels the prevalence of gall stone disease; large and long-standing gall stones being associated with a higher risk of gallbladder cancer. Gall stone disease is common in north India and occurs at a younger age than in the western populations. Moreover, patients with gall stone disease present for treatment a long time after the onset of symptoms. Both these factors result in prolonged exposure of the gallbladder to stones. Besides gall stone disease, various other factors may also play a role in the causation of gallbladder cancer which is an (north) Indian disease.