Current evidence on screening for renal cancer
Juliet Usher-Smith, Rebecca K. Simmons, Sabrina H. Rossi and Grant D. Stewart
Renal cell carcinoma (RCC) rates are increasing worldwide, with high mortality and a high proportion of patients asymptomatic at diagnosis – so should we be screening for RCC?
Patients with kidney cancer, their caregivers, and clinicians alike define the study of early detection and treatment of RCC as one of their top research priorities. The societal increase in risk factors for RCC (which include older age, smoking, hypertension and obesity) is likely related to the rising incidence of RCC. With 60 percent of RCC patients asymptomatic at diagnosis, many cases are detected late and over a quarter of patients have evidence of metastases at diagnoses. This makes RCC the most lethal urological malignancy; 50 percent of all patients developing the disease will eventually die from it. The increasing incidence, high proportion of asymptomatic patients, and high mortality rate mean that RCC meets some of the criteria for suitability for screening.
In a recently published Nature Reviews Urology paper, Kidney Cancer UK trustee Professor Grant Stewart of the University of Cambridge, and his co-authors, review the evidence for RCC screening, making a case that further research is necessary to begin the development of a clinical trial for a screening programme. The authors identify some key considerations for an RCC screening programme: the need for a better understanding of whether screening will lead to better patient outcomes and not just length- or lead-time biases; what screening methods would be most suitable for accurate diagnosis; how to effectively target screening for public benefit and cost-effectiveness; and how to balance the need for early diagnosis with the potential harm of overdiagnosis. Using their own unpublished data, from work funded by Kidney Cancer UK, and data from the charity’s annual survey, the paper authors also highlight the public appetite for a screening programme among individuals both with and without a history of RCC.
Professor Stewart said: “Although Kidney Cancer UK data show that there is appetite for an RCC screening programme, there is research still to be done in order to design an effective programme for clinical trial. As examples, we need to test the best screening methods, determine the prevalence of silent kidney cancers in the community and better understand the natural history of small kidney cancers in order to avoid overtreatment of these lesions which will be identified in the screening process”.
‘Current evidence on screening for renal cancer’ is available to read behind a paywall at Nature Reviews Urology.
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