The epidemiology of renal cell carcinoma

Our plain-English summary of The epidemiology of renal cell carcinoma, by L. Lipworth, R.E. Tarone, J.K. McLaughlin (The Journal of Urology, 2006).

The study

• Authors: L. Lipworth, R.E. Tarone, J.K. McLaughlin
• Journal: The Journal of Urology
• Published: 2006;176(6 Pt 1):2353-8
• Type of article: Review
• Cited by: 289 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: We identified and examined risk factors for renal cell cancer, some of which may explain in part the trends of steadily increasing incidence rates, particularly in black Americans.

Materials And Methods: Epidemiological studies were identified through a MEDLINE(R) search of the literature through February 2006. A qualitative summary of the results of individual studies is presented.

Results: Cigarette smoking and obesity are the most consistently established causal risk factors, accounting for about 20% and 30% of renal cell cancers, respectively. Hypertension appears to independently influence renal cell cancer risk. Neither acetaminophen nor other analgesics have been convincingly linked with renal cell cancer. With respect to diet a general protective effect of fruit and vegetable consumption is the only consistently reported finding. For occupational factors the weight of the evidence provides no consistent support for the hypotheses that renal cell cancer may be caused by asbestos, gasoline or trichloroethylene exposure. Self-reported family history is associated with 2 to 3-fold increases in risk and the major inherited forms of renal cell cancer together account for about 2% of this malignancy.

Conclusions: A further reduction in cigarette smoking, and a decrease in the rates of obesity and hypertension would likely moderate the increasing incidence of renal cell cancer. Epidemiological studies, including evaluation of gene-environment interactions, are needed to specifically identify reasons for the increasing incidence, particularly for assessing the roles of obesity and hypertension. Special attention should be focused on black Americans since their incidence rate recently increased to significantly surpass that in white Americans.

In plain English

This was a review article, not a new study. The authors searched the MEDLINE database for epidemiological studies of renal cell cancer, the main type of kidney cancer, published through February 2006, and summarized the results qualitatively. They described cigarette smoking as the most consistently established causal risk factor. They said obesity had been linked to excess risk in virtually every study that examined it. On asbestos, they noted that 2 earlier cohort studies had linked asbestos to kidney cancer: one of insulators and one of asbestos product workers. A large international case-control study with 200 exposed cases found a relative risk of 1.4 with self-reported asbestos exposure, but data on how long people were exposed did not support an association. A meta-analysis of occupationally exposed cohorts showed little association. The authors concluded that the weight of the evidence gave no consistent support to asbestos, gasoline or trichloroethylene as causes of renal cell cancer. They stated that they did not cite every study they identified and emphasized findings consistent across the literature.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review with a qualitative summary of published epidemiological studies, updating the authors' earlier review
• Who was studied: Published epidemiological studies of renal cell (kidney) cancer found through a MEDLINE search of the literature through February 2006, mainly case-control studies plus some cohort studies; articles from 1999 through 2006 were added to an earlier review covering studies through 1999
• Exposure: Many suspected risk factors: cigarette smoking, obesity, hypertension and blood-pressure drugs, analgesics, diet, alcohol, hormonal factors, dialysis and transplantation, radiation, and occupational exposures including asbestos (fiber type not specified), gasoline and trichloroethylene
• Main results:
  • The authors described cigarette smoking as the most consistently established causal risk factor for renal cell cancer. A meta-analysis they cited reported a relative risk of 1.54 in male smokers and 1.22 in female smokers.
  • Obesity had been linked to excess renal cell cancer risk in virtually every case-control and cohort study that examined it.
  • In the authors' reading, the evidence pointed to hypertension itself, rather than diuretics or other blood-pressure drugs, as influencing renal cell cancer.
  • Asbestos had been linked to kidney cancer in 2 earlier cohort studies, one of insulators and one of asbestos product workers.
  • A large international case-control study with 200 exposed cases showed a relative risk of 1.4 for renal cell cancer with self-reported asbestos exposure.
  • In that international study, data on duration of asbestos exposure did not support an association.
  • A meta-analysis of occupationally exposed cohorts indicated little association between kidney cancer risk and asbestos exposure.
  • The collective evidence did not support a relationship between gasoline and renal cell cancer.
  • The weight of the evidence did not provide consistent, credible support for trichloroethylene (TCE) as a cause of renal cell cancer in humans.
  • Having a first degree relative with kidney cancer was associated with a 2 to 3-fold increased risk in most studies.
  • Neither acetaminophen, aspirin nor other nonsteroidal anti-inflammatory drugs had been convincingly linked with renal cell cancer.
• The authors' conclusion: The authors concluded that further reductions in cigarette smoking and in rates of obesity, and probably hypertension, would likely curb to some degree the rising incidence of renal cell cancer. They called for further studies, with particular attention to black Americans.
• Limitations the authors state:
  • The authors did not attempt to cite every study they identified and emphasized findings that were consistent across the literature.
  • Genetics of renal cell cancer was not addressed in the review.

Topics

Medical terms in this study, explained in our Lexicon: Epidemiology, Carcinoma, Incidence.

Related studies

• Renal cell carcinoma — P.A. Godley, M.A. Escobar (1998)
• Occupational risk factors for renal cell carcinoma: agent-specific results from a case-control study in Germany. MURC Study Group. Multicenter urothelial and renal cancer study — B. Pesch, J. Haerting, et al. (2000)
• Occupational risk factors for renal cell cancer: a case--control study in northern Italy — S. Mattioli, D. Truffelli, et al. (2002)
• Genomic profiling of the genes on chromosome 3p in sporadic clear cell renal cell carcinoma — Y. Togo, Y. Yoshikawa, et al. (2016)
• A comparative immunohistochemical study of malignant mesothelioma and renal cell carcinoma: the diagnostic utility of Leu-M1, Ber EP4, Tamm-Horsfall protein and thrombomodulin — R.L. Attanoos, H. Goddard, et al. (1995)
• Value of PAX8, PAX2, napsin A, carbonic anhydrase IX, and claudin-4 immunostaining in distinguishing pleural epithelioid mesothelioma from metastatic renal cell carcinoma — N.G. Ordóñez (2013)

Browse more research in The Journal of Urology, or return to medical research.