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 [1-7]. 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 [4,8]. Other solid tumors were not more common in dialysis patients.
●A more recent study of cancer incidence in US Medicare hemodialysis patients between 1996 and 2009 found a SIR of 1.42. The highest risk was for cancer of the kidney/renal pelvis (SIR 4.03) and bladder (SIR 1.57). This review of Medicare claims data found higher risks of cancer in those over 65 years of age at dialysis initiation (11.28 percent), males (10.93 percent), and nonwhites (9.79 percent) . History of kidney transplantation also increased the cancer risk to 11.67 percent.
●There is also an increased risk of cancer in Taiwanese dialysis patients, particularly cancers of the bladder and liver . In this cohort, unlike in the other studies [4,7], the highest cancer risk occurred in younger patients and during the first year of dialysis .
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