Epidemiology and screening for renal cancer

Abstract

PurposeThe widespread use of abdominal imaging has affected the epidemiology of renal cell carcinoma (RCC). Despite this, over 25% of individuals with RCC have evidence of metastases at presentation. Screening for RCC has the potential to downstage the disease.MethodsWe performed a literature review on the epidemiology of RCC and evidence base regarding screening. Furthermore, contemporary RCC epidemiology data was obtained for the United Kingdom and trends in age-standardised rates of incidence and mortality were analysed by annual percentage change statistics and joinpoint regression.ResultsThe incidence of RCC in the UK increased by 3.1% annually from 1993 through 2014. Urinary dipstick is an inadequate screening tool due to low sensitivity and specificity. It is unlikely that CT would be recommended for population screening due to cost, radiation dose and increased potential for other incidental findings. Screening ultrasound has a sensitivity and specificity of 82–83% and 98–99%, respectively; however, accuracy is dependent on tumour size. No clinically validated urinary nor serum biomarkers have been identified. Major barriers to population screening include the relatively low prevalence of the disease, the potential for false positives and over-diagnosis of slow-growing RCCs. Individual patient risk-stratification based on a combination of risk factors may improve screening efficiency and minimise harms by identifying a group at high risk of RCC.ConclusionThe incidence of RCC is increasing. The optimal screening modality and target population remain to be elucidated. An analysis of the benefits and harms of screening for patients and society is warranted.Electronic supplementary materialThe online version of this article (10.1007/s00345-018-2286-7) contains supplementary material, which is available to authorized users.

Genomics and clinical correlates of renal cell carcinoma

“…Genetic risk factors are known to play a role in sporadic RCC development [7, 8]. Patients who have at least one first degree relative with RCC are at an increased risk of developing the disease (OR 1.4, 95% CI 0.71–2.76) [9].…”

Imaging for the diagnosis and response assessment of renal tumours

“…In Western European countries such as the UK, the majority of renal cancers are early of stage (stage I–II: 56%), as a result of the rising incidence of incidentally detected tumours with the increased use of cross-sectional imaging [2, 3]. Characterisation of incidental renal lesions remains a diagnostic challenge, particularly for small renal masses (SRM, < 4 cm in size) and in differentiating malignancy from oncocytoma and fat-poor angiomyolipoma.…”

Renal cell carcinoma: standards and controversies

“…The pace of basic, translational and clinical RCC research development is rapid. We have selected, as outlined below, those topics where we felt that we must improve our knowledge and understanding to provide improved prevention, diagnostic and treatment strategies to our patients.With the widespread use of modern cross-sectional abdominal imaging, the incidence of asymptomatic renal tumours has been increasing, especially in patients over the age of 70 [1,2]. Many of these incidentalomas do not have and will not develop adverse pathological or clinical features meaning any intervention may not change the natural history of the disease.…”

“…With the widespread use of modern cross-sectional abdominal imaging, the incidence of asymptomatic renal tumours has been increasing, especially in patients over the age of 70 [1,2]. Many of these incidentalomas do not have and will not develop adverse pathological or clinical features meaning any intervention may not change the natural history of the disease.…”

“…Unfortunately, while imaging is an essential part of the workup, precise criteria to determine the biology of a renal tumour are lacking [2]. However, this "opportunistic", unspecific screening by non-urological specialities has decreased the number of patients presenting with advanced RCC [1], which results from a shift to an earlier stage where RCC is curable or does not cause harm if left alone. "Smart" ultrasound-based screening of a target population defined by established risk factors (age, sex, body mass index, smoking history) and promising plasma markers such as kidney injury molecule-1 [3] may be even more beneficial.…”