Epidemiologic characteristics and risk factors for renal cell cancer

Our plain-English summary of Epidemiologic characteristics and risk factors for renal cell cancer, by L. Lipworth, R.E. Tarone, L. Lund, et al (Clinical Epidemiology, 2009).

The study

• Authors: L. Lipworth, R.E. Tarone, L. Lund, J.K. McLaughlin
• Journal: Clinical Epidemiology
• Published: 2009;1:33-43
• Cited by: 47 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Incidence rates of renal cell cancer, which accounts for 85% of kidney cancers, have been rising in the United States and in most European countries for several decades. Family history is associated with a two- to four-fold increase in risk, but the major forms of inherited predisposition together account for less than 4% of renal cell cancers. Cigarette smoking, obesity, and hypertension are the most consistently established risk factors. Analgesics have not been convincingly linked with renal cell cancer risk. A reduced risk of renal cell cancer among statin users has been hypothesized but has not been adequately studied. A possible protective effect of fruit and vegetable consumption is the only moderately consistently reported dietary finding, and, with the exception of a positive association with parity, evidence for a role of hormonal or reproductive factors in the etiology of renal cell cancer in humans is limited. A recent hypothesis that moderate levels of alcohol consumption may be protective for renal cell cancer is not strongly supported by epidemiologic results, which are inconsistent with respect to the categories of alcohol consumption and the amount of alcohol intake reportedly associated with decreased risk. For occupational factors, the weight of the evidence does not provide consistent support for the hypotheses that renal cell cancer may be caused by asbestos, gasoline, or trichloroethylene exposure. The established determinants of renal cell cancer, cigarette smoking, obesity, and hypertension, account for less than half of these cancers. Novel epidemiologic approaches, including evaluation of gene-environment interactions and epigenetic mechanisms of inherited and acquired increased risk, are needed to explain the increasing incidence of renal cell cancer.

In plain English

This article was a narrative review, not a new study. The authors searched MEDLINE for papers on kidney or renal cancer and risk factors or epidemiology published through 2008. They gave a qualitative summary, emphasizing findings that were consistent across the literature rather than citing every paper. They reviewed family history, obesity, cigarette smoking, high blood pressure, medicines, diet, alcohol, hormonal factors, occupation, and dialysis and kidney transplantation. On asbestos, the authors noted that two cohort studies, one of insulators and one of asbestos products workers, had reported elevated renal cancer mortality. Self-reported asbestos exposure had also been linked in several case-control studies. However, an extensive meta-analysis of cohort studies of asbestos-exposed workers showed little relation to increased risk. The review did not name specific asbestos fiber types. The authors wrote that renal cell cancer has not been convincingly linked to any occupational exposure. They concluded that smoking, obesity and hypertension are at best moderate in their effect and account for less than half of these cancers.

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 (qualitative) review of published epidemiologic studies
• Who was studied: Published epidemiologic papers on renal cell cancer identified through a MEDLINE search, published through 2008, plus references from earlier review papers. The number of papers reviewed is not stated.
• Exposure: Many suspected risk factors for renal cell cancer. The occupational exposures discussed were asbestos (no fiber type specified), gasoline and trichloroethylene.
• Main results:
  • The authors reported that, compared with bladder cancer, renal cell cancer has not been convincingly linked to any occupational exposure.
  • Earlier studies cited by the authors reported elevated renal cancer mortality in a cohort of insulators and a cohort of asbestos products workers. Several case-control studies, including the large international study, linked self-reported asbestos exposure to renal cell cancer.
  • An extensive meta-analysis of occupational cohort studies of asbestos-exposed workers, cited by the authors, showed little relation to increased risk for renal cancer.
  • A meta-analysis cited by the authors reported statistically significant relative risks for renal cell cancer of 1.5 for male smokers and 1.2 for female smokers.
  • A meta-analysis cited by the authors reported summary risk ratios per 5 kg/m2 increase in body mass index of 1.24 (95% CI 1.15 to 1.34) among men and 1.34 (95% CI 1.25 to 1.43) among women.
  • The authors stated that the collective evidence does not support a relation between gasoline and renal cell cancer risk.
  • The authors stated that the evidence does not provide consistent, credible support for trichloroethylene as a cause of renal cell cancer, and that the question remains open.
• The authors' conclusion: The authors concluded that the identified causes of renal cell cancer (cigarette smoking, obesity and hypertension) are at best moderate in their effect on risk and account for less than half of these cancers. They called for new approaches, including gene-environment and epigenetic studies.
• Limitations the authors state:
  • The authors did not cite every paper they identified, choosing instead to emphasize findings consistent across the literature.
  • The authors noted it is unclear how much of the international variation in incidence reflects completeness of reporting by country.

Topics

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

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• Occupational risk factors for renal cell cancer: a case--control study in northern Italy — S. Mattioli, D. Truffelli, et al. (2002)
• The epidemiology of renal cell carcinoma — L. Lipworth, R.E. Tarone, et al. (2006)
• Occupational exposure to dusts and risk of renal cell carcinoma — S. Karami, P. Boffetta, et al. (2011)
• Epidemiologic characteristics of compensated occupational lung cancers among Korean workers — Y.S. Ahn, K.S. Jeong (2014)
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