Malignant neoplasm of the bile duct — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 53 of 2024

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the bile duct or death from malignant neoplasm of the bile duct with the circumstances of a person's relevant service:

1. (1)
   having an infestation of the hepatobiliary tract with the liver flukes Clonorchis sinensis, Opisthorchis viverrini or Opisthorchis felineus before clinical onset;
2. (2)
   having primary sclerosing cholangitis before clinical onset;
3. (3)
   having inflammatory bowel disease before clinical onset;
4. (4)
   having cholelithiasis, choledocholithiasis or hepatolithiasis before clinical onset;

   Note: Cholelithiasis relates to the formation of stones in the gallbladder, choledocholithiasis relates to stones in the bile ducts, and hepatolithiasis relates to stones in the bile ducts inside the liver.

5. (5)
   having had an injection of Thorotrast (thorium dioxide) before clinical onset;
6. (6)
   having cirrhosis of the liver before clinical onset;
7. (7)
   having chronic infection with the hepatitis B virus at the time of clinical onset;

   Note: chronic infection with hepatitis B virus is defined in the Schedule 1 - Dictionary.

8. (8)
   having chronic infection with the hepatitis C virus at the time of clinical onset;

   Note: chronic infection with hepatitis C virus is defined in the Schedule 1 - Dictionary.

9. (9)
   having diabetes mellitus for at least 5 years before clinical onset;
10. (10)
    being obese for at least 5 years within the 20 years before clinical onset;

    Note: being obese is defined in the Schedule 1 - Dictionary.

11. (11)
    inhaling respirable asbestos fibres in an enclosed space: (a) for a cumulative period of at least 1,000 hours before the clinical onset of malignant neoplasm of the intrahepatic bile duct; and (b) at the time material containing respirable asbestos fibres was being applied, removed, dislodged, cut or drilled; and (c) where the first inhalation of respirable asbestos fibres commenced at least five years before the clinical onset of malignant neoplasm of the intrahepatic bile duct;

    Note: hazardous asbestos fibres (chrysotile (white asbestos), amosite (brown asbestos), crocidolite (blue asbestos)) are an asbestos fibre less than 3 micrometers in diameter and at least 5 micrometers long (with a width to length ratio of greater than 1:3).

12. (12)
    inhaling respirable asbestos fibres in an open environment: (a) for a cumulative period of at least 3,000 hours before the clinical onset of malignant neoplasm of the intrahepatic bile duct; and (b) at the time material containing respirable asbestos fibres was being applied, removed, dislodged, cut or drilled; and (c) where the first inhalation of respirable asbestos fibres commenced at least five years before the clinical onset of malignant neoplasm of the intrahepatic bile duct;

    Note: hazardous asbestos fibres (chrysotile (white asbestos), amosite (brown asbestos), crocidolite (blue asbestos)) are an asbestos fibre less than 3 micrometres in diameter and at least 5 micrometres long (with a width to length ratio of greater than 1:3).

13. (13)
    undergoing solid organ transplantation excluding corneal transplant, at least 5 years before clinical onset;
14. (14)
    smoking at least 30 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before clinical onset, and: (a) smoking commenced at least 5 years before the clinical onset of malignant neoplasm of the bile duct; or (b) where smoking has ceased, the clinical onset of malignant neoplasm of the bile duct has occurred within 20 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

15. (15)
    having non-alcoholic fatty liver disease for at least 5 years within the 20 years before clinical onset;
16. (16)
    consuming at least 400 kilograms of alcohol at least 5 years before clinical onset;
17. (17)
    inhaling, ingesting or having cutaneous contact with 1,2- dichoropropane for at least 1,000 ppm-years at least 2 years before clinical onset;

    Note: ppm-years is defined in the Schedule 1 - Dictionary.

18. (18)
    having an infection with Helicobacter pylori, Helicobacter bilis or Helicobacter hepaticus at least 10 years before clinical onset;
19. (19)
    having IgG4 sclerosing cholangitis before the clinical onset of malignant neoplasm of the bile duct;
20. (20)
    having evidence of infection with Epstein-Barr virus before the clinical onset of lymphoepithelioma-like bile duct cancer;
21. (21)
    inability to obtain appropriate clinical management for malignant neoplasm of the bile duct before clinical worsening;

Aggravation-only factors: the factors in subsection 9(21) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.