Cancer screening in patients with end-stage renal disease
- Jean L Holley, MD, FACP
Jean L Holley, MD, FACP
- Clinical Professor of Medicine
- University of Illinois, Urbana-Champaign
Although controversial, the overall incidence of cancer is reported to be higher in patients with end-stage renal disease (ESRD) than in the general population [1-6]. An international study of cancer registries reported that, between the years 1980 to 1994, cancer occurred in 25,044 of 831,804 dialysis patients (compared with an expected number of 21,185), resulting in an overall standardized cancer incidence of 1.18 . The following findings were noted:
●In all three participating geographic areas (United States, Europe, and Australia/New Zealand), the highest cancer incidence was in patients <35 years of age, with a decreasing incidence with increasing age.
●The type of malignancies observed resembled those seen in transplant patients, but were different from those in control individuals (see "Development of malignancy following solid organ transplantation") Dialysis patients, for example, were more likely to develop cancer of the bladder (standardized incidence ratio [SIR] 1.5), kidney (SIR 3.6), liver, thyroid, tongue, and cervix, as well as multiple myeloma and non-Hodgkin lymphoma [4,7]. Other solid tumors were not more common in dialysis patients.
Risk factors — The following predisposing factors probably contribute to the higher incidence of some tumors in dialysis patients:
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