Epidemiology and screening for renal cancer

• Published in: World journal of urology Vol. 36; no. 9; pp. 1341 - 1353
• Main Authors: Rossi, Sabrina H., Klatte, Tobias, Usher-Smith, Juliet, Stewart, Grant D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2018; Springer Nature B.V
• Subjects: Age; Age Distribution; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - epidemiology; Computed tomography; Early Detection of Cancer - methods; Epidemiology; Humans; Incidence; Invited Review; Kidney cancer; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - epidemiology; Literature reviews; Medicine; Medicine & Public Health; Metastases; Nephrology; Oncology; Renal cell carcinoma; Risk factors; Sensitivity and Specificity; Sex Distribution; Statistical analysis; Tomography, X-Ray Computed - economics; Tomography, X-Ray Computed - standards; Tumors; Ultrasonography - standards; Ultrasound; United Kingdom - epidemiology; Urology; United Kingdom; United Kingdom > UK; Screening; Review; Renal cell carcinoma; Ultrasound; Early detection
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-018-2286-7

Purpose
The 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.
Methods
We 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.
Results
The 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.
Conclusion
The 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.