Evaluating the need for kidney cancer screening

By Dr Rebecca Case-Upton BSc (Hons), PhD
Medical Publications

A positive prognosis for kidney cancer is greatly increased if the disease is diagnosed at an earlier stage:

• People with stage 1 disease have an 80% chance of surviving five years. This decreases to 5% for those with stage 4 disease ¹.
• 46% of people are diagnosed with stage 3 or 4 kidney cancer and more than a quarter of people will already have metastasis when diagnosed (stage 4, 27%) 2.

We are actively aiming to improve early diagnosis rates, in order to make a huge impact on the number of people that survive kidney cancer.
Kidney Cancer UK conducted a survey to ascertain what symptoms were present prior to diagnosis. Questions included: how they were diagnosed, symptom patterns presented to GP’s, disease stage, time since diagnosis and disease progression.
131 people responded to the survey. One of the most important findings was that 50% of people were diagnosed (with varying stage disease) during an unrelated medical scan. These accidental discoveries highlight an area where a screening programme could make a huge difference.
A further important finding, which supports the need for a screening programme to improve early diagnosis, is that many people do not feel unwell prior to diagnosis:

• 36% of people were diagnosed following investigations initiated by their GP. Although this figure seems lower than expected, many people do not feel unwell prior to being diagnosed with kidney cancer so would be unlikely to visit their GP.
• A significant proportion (44%) of people did not feel unwell prior to being diagnosed with kidney cancer.
• 22% of people felt unwell but only because they had other medical conditions unrelated to kidney cancer.
• Only 34% of people described feeling unwell with symptoms that were related to kidney cancer.

Kidney cancer is described as having a triad of symptoms that indicate its presence: blood in urine, pain in the flank/back or side and a mass in the flank/back or side. According to our survey, having blood in urine and pain in the back/side or flank are two of the most commonly presented symptoms. However of the 131 people questioned, only 26 and 27% visited the GP with these symptoms. Thirteen different symptoms were described and on average a person described only two symptoms to their GP. The symptoms described were often unspecific, such as fatigue, a cough, night sweats or high temperature.
When comparing the symptoms experienced across each stage group, the presentation of haematuria increased as the disease stage increased. As did the presentation of a persistent cough. However high blood pressure occurred in earlier stage disease. Apart from these symptoms there were no major patterns in symptom presentation and earlier or advanced disease.
A ‘blood in pee’ campaign is currently running to raise awareness of kidney cancer, which KCUK fully supports. However, only 50% of people experienced haematuria and almost 20% of people said that it wasn’t visible; a urine test picked it up. As the stage of the disease increased, the haematuria became more visible and prevalent. Relying on the detection of haematuria as a tool for diagnosing kidney cancer in its early stages is questionable.
Ultimately, we believe that there are many improvements to be made in detecting kidney cancer at an earlier and more treatable stage. Far too many people do not display any symptoms prior to diagnosis and those displayed can be varied and vague. Our survey provides strong evidence that large groups of people could have their cancer detected earlier via an ultrasound screening programme.
References.
 

1. http://www.cancerresearchuk.org/about-cancer/type/kidney-cancer/treatment/statistics-and-outlook-for-kidney-cancer

2. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/kidney-cancer/incidence#heading-Three