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The incorporation of diagnostic and therapeutic improvements, as well as the different smoking patterns, may have had an influence on the observed variability in renal cancer mortality across Europe. This study examined time trends in kidney cancer mortality in fourteen European countries during the last two decades of the 20th century.
Kidney cancer deaths and population estimates for each country during the period 1981-2000 were drawn from the World Health Organization Mortality Database. Age- and period-adjusted mortality rates, as well as annual percentage changes in age-adjusted mortality rates, were calculated for each country and geographical region. Log-linear Poisson models were also fitted to study the effect of age, death period, and birth cohort on kidney cancer mortality rates within each country.
For men, the overall standardized kidney cancer mortality rates in the eastern, western, and northern European countries were 20, 25, and 53% higher than those for the southern European countries, respectively. However, age-adjusted mortality rates showed a significant annual decrease of -0.7% in the north of Europe, a moderate rise of 0.7% in the west, and substantial increases of 1.4% in the south and 2.0% in the east. This trend was similar among women, but with lower mortality rates. Age-period-cohort models showed three different birth-cohort patterns for both men and women: a decrease in mortality trend for those generations born after 1920 in the Nordic countries, a similar but lagged decline for cohorts born after 1930 in western and southern European countries, and a continuous increase throughout all birth cohorts in eastern Europe. Similar but more heterogeneous regional patterns were observed for period effects.
Kidney cancer mortality trends in Europe showed a clear north-south pattern, with high rates on a downward trend in the north, intermediate rates on a more marked rising trend in the east than in the west, and low rates on an upward trend in the south. The downward pattern observed for cohorts born after 1920-1930 in northern, western, and southern regions suggests more favourable trends in coming years, in contrast to the eastern countries where birth-cohort pattern remains upward.
The incidence of kidney cancer has been rising over the last two decades, especially in cases where the disease is localized. Although rates of renal surgery parallel this trend, mortality rates have continued to rise. To investigate the basis of this "treatment disconnect" (i.e., increased rates of treatment accompanied by increased mortality rates), we analyzed patient data from nine registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. We assembled a cohort of 34,503 kidney cancer patients and derived incidence, treatment, and mortality trends for kidney cancer, overall and as a function of tumor size. From 1983 to 2002, the overall age-adjusted incidence rate for kidney cancer rose from 7.1 to 10.8 cases per 100,000 US population; tumors < or = 4 cm in size accounted for most of the increase. Adjusted rates of renal surgery increased concurrently, most notably for tumors < or = 4 cm (0.9-3.6 surgeries per 100,000 US population). However, among kidney cancer patients, all-cause mortality per 100,000 US population increased from 1.5 deaths in 1983 to 6.5 deaths in 2002, with the greatest absolute increase noted for patients with lesions > 7 cm. Our results demonstrate that the rising incidence of kidney cancer is largely attributable to an increase in small renal masses that are presumably curable. The fact that increased detection and treatment of small tumors is not reducing mortality argues for a reassessment of the current treatment paradigm.
Context Clinical surveys have revealed that incidental
detection of renal cell carcinoma is rising because of increased use of
imaging procedures.Objective To examine incidence, mortality, and survival trends of
renal cell and renal pelvis cancers by age, sex, race, and tumor stage
at diagnosis.Design Calculation of age-adjusted incidence and mortality rates,
along with 5-year relative survival rates, using data from the National
Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)
program.Setting and Participants Patients diagnosed as having kidney
cancer from 1975 through 1995 in the 9 geographic areas covered by
tumor registries in the SEER program, which represent about 10% of the
US population.Main Outcome Measures Incidence, mortality, and 5-year relative
survival rates by time periods.Results The age-adjusted incidence rates for renal cell carcinoma
between 1975 and 1995 for white men, white women, black men, and black
women were 9.6, 4.4, 11.1, and 4.9 per 100,000 person-years,
respectively. The corresponding rates for renal pelvis cancer were 1.5,
0.7, 0.8, and 0.5 per 100,000 person-years. Renal cell cancer
incidence rates increased steadily between 1975 and 1995, by 2.3%
annually among white men, 3.1% among white women, 3.9% among black
men, and 4.3% among black women. Increases were greatest for localized
tumors but were also seen for more advanced and unstaged tumors. In
contrast, the incidence rates for renal pelvis cancer declined among
white men and remained stable among white women and blacks. Although
5-year relative survival rates for patients with renal cell cancer
improved among whites but not among blacks, kidney cancer mortality
rates increased in all race and sex groups.Conclusions Increasing detection of presymptomatic tumors by
imaging procedures, such as ultrasonography, computed tomography, and
magnetic resonance imaging, does not fully explain the upward incidence
trends of renal cell carcinoma. Other factors may be contributing to
the rapidly increasing incidence of renal cell cancer in the United
States, particularly among blacks.
Despite declines in incidence rates for the most common cancers, the incidence of several cancers has increased in the past decade, including cancers of the pancreas, liver, thyroid, and kidney and melanoma of the skin, as well as esophageal adenocarcinoma and certain subsites of oropharyngeal cancer associated with human papillomavirus (HPV) infection. Population-based incidence data compiled by the North American Association of Central Cancer Registries were used to examine trends in incidence rates from 1999 through 2008 for the 7 cancers listed by sex, age group, race/ethnicity, and stage at diagnosis. Joinpoint regression was used to calculate average annual percent changes in incidence rates (1999-2008). Rates for HPV-related oropharyngeal cancer, esophageal adenocarcinoma, cancer of the pancreas, and melanoma of the skin increased only in whites, except for esophageal adenocarcinoma, which also increased in Hispanic men. Liver cancer rates increased in white, black, and Hispanic men and in black women only. In contrast, incidence rates for thyroid and kidney cancers increased in all racial/ethnic groups, except American Indian/Alaska Native men. Increases in incidence rates by age were steepest for liver and HPV-related oropharyngeal cancers among those aged 54 to 64 years and for melanoma of the skin in those aged 65 years and older. Notably, for HPV-related oropharyngeal cancer in men and thyroid cancer in women, incidence rates were higher in those aged 55 to 64 years than in those aged 65 years and older. Rates increased for both local and advanced stage diseases for most cancer sites. The reasons for these increasing trends are not entirely known. Part of the increase (for esophageal adenocarcinoma and cancers of the pancreas, liver, and kidney) may be linked to the increasing prevalence of obesity as well as increases in early detection practices for some cancers. These rising trends will exacerbate the growing cancer burden associated with population expansion and aging. Additional research is needed to determine the underlying reasons for these increasing trends. CA Cancer J Clin 2012. © 2012 American Cancer Society.
The rising incidence of renal cell carcinoma (RCC) has been largely attributed to the increasing use of imaging procedures.
Our aim was to examine stage-specific incidence, mortality, and survival trends of RCC in North America.
We computed age-adjusted incidence, survival, and mortality rates using the Surveillance Epidemiology and End Results database. Between 1988 and 2006, 43,807 patients with histologically confirmed RCC were included.
We calculated incidence, mortality, and 5-yr survival rates by year. Reported findings were stratified according to disease stage.
Age-adjusted incidence rate of RCC rose from 7.6 per 100,000 person-years in 1988 to 11.7 in 2006 (estimated annual percentage change [EAPC]: +2.39%; p<0.001). Stage-specific age-adjusted incidence rates increased for localized stage: 3.8 in 1988 to 8.2 in 2006 (EAPC: +4.29%; p<0.001) and decreased during the same period for distant stage: 2.1 to 1.6 (EAPC: -0.57%; p=0.01). Stage-specific survival rates improved over time for localized stage but remained stable for regional and distant stages. Mortality rates varied significantly over the study period among localized stage, 1.3 in 1988 to 2.4 in 2006 (EAPC: +3.16%; p<0.001), and distant stage, 1.8 in 1988 to 1.6 in 2006 (EAPC: -0.53%; p=0.045). Better detailed staging information represents a main limitation of the study.
The incidence rates of localized RCC increased rapidly, whereas those of distant RCC declined. Mortality rates significantly increased for localized stage and decreased for distant stage. Innovation in diagnosis and management of RCC remains necessary.
A retrospective survey of renal cell carcinoma between 1975 and 1993 at eight collaborating institutions was conducted with special reference to the incidental detection and mortality of renal cancer. The analysis demonstrated a recent dramatic increase in the frequency of incidental renal cancer, which now comprises two-thirds of all renal cancers, and a simultaneous recession in non-incidental or suspected renal cancer. Incidental renal cancer has remained unchanged during the last decade as far as patient demographics, occasion and method of detection, and the degree of tumor extension are concerned. On the other hand, the annual number of deaths from renal cancer has significantly decreased, and kidney-sparing surgery has been more frequently performed. These results indicate that incidental renal cancers are now in the majority, and earlier detection may contribute to improving the mortality and morbidity from the disease as a whole.
Recent epidemiological studies have demonstrated an increasing incidence of testicular cancer in white men which appears to be correlated with the period of birth. Because this birth cohort phenomenon can explain etiological factors in testicular cancer, we determine whether this trend is present throughout the United States based on an analysis of testicular cancer incidence by birth cohort.
Testicular cancer incidence was obtained from the National Cancer Institute Surveillance, Epidemiology and End Results database from 1973 to 1995. Numbers of cases were extracted and grouped by 5-year birth cohorts for all testicular germ cell neoplasms. Poisson regression analysis with variables of age, time of diagnosis and birth cohort were used to determine relative risk. Poisson models were compared using computer log linear model software.
Between 1973 and 1995 the incidence of testicular cancer in the United States increased 51% (3.61 to 5.44/100,000). Analysis of Poisson models revealed that birth cohort was strongly associated with relative risk of testicular cancer (p = 0.001). In addition, peak age at diagnosis decreased for each successive birth cohort.
The overall incidence of testicular cancer in white men and the relative risk of testicular cancer have been increasing in the United States. This trend is strongly associated with birth cohort in concordance with previously reported European data. Moreover, testicular cancer is being diagnosed at a younger age as evidenced by a shift to the left in the age of peak incidence. These unique epidemiological patterns offer a basis for analysis of potential etiological factors.
Obesity and hypertension have been implicated as risk factors for the development of renal-cell cancer.
We examined the health records of 363,992 Swedish men who underwent at least one physical examination from 1971 to 1992 and were followed until death or the end of 1995. Men with cancer (renal-cell cancer in 759 and renal-pelvis cancer in 136) were identified by cross-linkage of data with the nationwide Swedish Cancer Registry. Poisson regression analysis was used to estimate relative risks, with adjustments for age, smoking status, body-mass index, and diastolic blood pressure.
As compared with men in the lowest three eighths of the cohort for body-mass index, men in the middle three eighths had a 30 to 60 percent greater risk of renal-cell cancer, and men in the highest two eighths had nearly double the risk (P for trend, <0.001). There was also a direct association between higher blood pressures and a higher risk of renal-cell cancer (P for trend, <0.001 for diastolic pressure; P for trend, 0.007 for systolic pressure). After the first five years of follow-up had been excluded to reduce possible effects of preclinical disease, the risk of renal-cell cancer was still consistently higher in men with a higher body-mass index or higher blood pressure. At the sixth-year follow-up, the risk rose further with increasing blood pressures and decreased with decreasing blood pressures, after adjustment for base-line measurements. Men who were current or former smokers had a greater risk of both renal-cell cancer and renal-pelvis cancer than men who were not smokers. There was no relation between body-mass index or blood pressure and the risk of renal-pelvis cancer.
Higher body-mass index and elevated blood pressure independently increase the long-term risk of renal-cell cancer in men. A reduction in blood pressure lowers the risk.
Rising incidence of renal cell carcinoma in the United States
- Chow Wh
- Devesa
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- Warren
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Chow WH, Devesa SS, Warren JL, et al. Rising incidence of renal cell carcinoma in the United States. JAMA. 1999;281:1628-1631.