Contemporary Epidemiology of Renal Cell Cancer

Abstract

We analyzed renal cell cancer incidence patterns in the United States and reviewed recent epidemiologic evidence with regard to environmental and host genetic determinants of renal cell cancer risk. Renal cell cancer incidence rates continued to rise among all racial/ethnic groups in the United States, across all age groups, and for all tumor sizes, with the most rapid increases for localized stage disease and small tumors. Recent cohort studies confirmed the association of smoking, excess body weight, and hypertension with an elevated risk of renal cell cancer, and suggested that these factors can be modified to reduce the risk. There is increasing evidence for an inverse association between renal cell cancer risk and physical activity and moderate intake of alcohol. Occupational exposure to TCE has been positively associated with renal cell cancer risk in several recent studies, but its link with somatic mutations of the VHL gene has not been confirmed. Studies of genetic polymorphisms in relation to renal cell cancer risk have produced mixed results, but genome-wide association studies with larger sample size and a more comprehensive approach are underway. Few epidemiologic studies have evaluated risk factors by subtypes of renal cell cancer defined by somatic mutations and other tumor markers. Keywords renal cell cancer; incidence trends; cohort studies; smoking; obesity; hypertension; diet; occupation; genetic polymorphism; somatic mutation Malignant tumors of the kidney account for about 4% of cancer incidence and 2% of cancer mortality in the United States, with over 54,000 new cases and 13,000 deaths having been estimated for 2008. 1 More than 85% of kidney cancers arise in the renal parenchyma, with the remainder arising in the renal pelvis. 2 Renal pelvis cancer is mostly of the transitional cell type and is not the focus of this review. Nearly all cancers originating in the renal parenchyma are adenocarcinomas (renal cell carcinoma), in which clear cell is the predominant subtype. 3 The remainder is made up of the papillary type and other rare histologic types, such as collecting duct and chromophobe carcinomas. 3,4 Distinct morphologic and genetic characteristics have also been described for renal cell carcinoma in familial cancer syndromes. [5][6][7] Descriptive and analytic epidemiologic studies in general have not distinguished the subtypes of renal cell carcinoma, except for studies involving the von Hippel-Lindau (VHL) gene mutation that is seen primarily in the clear cell type. 8 Since the clear cell type comprises 85% to 90% of renal cell carcinoma, 3 the epidemiology of renal cell carcinoma is strongly influenced by that of the clear cell type.* Correspondence: Wong-Ho Chow, National Cancer Institute, 6120 Executive Blvd, EPS 8100, Bethesda, Maryland 20892-7240, USA. choww@mail.nih.gov. NIH Public Access Author ManuscriptCancer J. Author manuscript; available in PMC 2011 April 15. DESCRIPTIVE EPIDEMIOLOGY Incidence patterns and temporal trendsIncidence rates of renal cell carcinoma h...

Family history of cancer and renal cell cancer risk in Caucasians and African Americans

“…Several genetic syndromes predisposing to familial RCC have been identified. The most common of the hereditary syndromes are germline mutations in the von Hippel -Lindau (VHL) tumoursuppressor gene on chromosome 3p, which is associated exclusively with the clear cell histological subtype (Czene and Hemminki, 2002;Hung et al, 2007;Chow and Devesa, 2008). In addition to RCC, individuals with this germline mutation are at an increased risk for developing tumours of the central nervous system, retina, endolymphatic sac of the inner ear, broad ligament, Family history of cancer and RCC risk by race S Karami et al adrenal glands, and pancreas (Kaelin, 2008).…”

“…Since 1950, in the United States, there has been a 126% increase in RCC incidence (Paglino et al, 2007), with higher rates reported among African Americans (AAs) than among Caucasians (Chow and Devesa, 2008). The increasing rates of RCC over time may reflect, in part, the increasing use of imaging modalities (Paglino et al, 2007;Chow and Devesa, 2008;Patard, 2009). However, as the increase involves all tumour sizes, not just those at the local stage (Patard, 2009), imaging modalities alone do not entirely explain the increase.…”

“…Adenocarcinoma of the renal parenchyma (renal cell carcinoma (RCC)) is the most common form, accounting for more than 85% of kidney cancers (Chow and Devesa, 2008). Since 1950, in the United States, there has been a 126% increase in RCC incidence (Paglino et al, 2007), with higher rates reported among African Americans (AAs) than among Caucasians (Chow and Devesa, 2008).…”

“…Smoking, obesity, and hypertension are primary risk factors that may explain half of all RCC diagnoses in the United States (Benichou et al, 1998;Chow and Devesa, 2008). RCC risk has been examined in relation to familial history of cancer in a number of epidemiological studies (McLaughlin et al, 1984;Kreiger et al, 1993;Goldgar et al, 1994;Mellemgaard et al, 1994;Schlehofer et al, 1996;Gago-Dominguez et al, 2001;Hemminki, 2002, 2003;Gudbjartsson et al, 2002;Negri et al, 2006;Hung et al, 2007;Randi et al, 2007;Clague et al, 2009).…”

Cytoreductive Surgery in the Management of Renal Tumours: Rationale, Current Evidence and Future Perspectives

“…At first presentation, 45% of patients will have localised disease, 25-30% will have locally advanced disease with lymph node or local organ involvement and around 25% patients have metastatic disease [2,3]. In the past, nephrectomy was offered mainly as a means of palliation to relieve the pain from local infiltration or haematuria when the conservative measures failed.…”