We analyzed renal cell cancer incidence patterns in the United States and reviewed recent epidemiologic evidence with regard to environmental and host genetic determinants of renal cell cancer risk. Renal cell cancer incidence rates continued to rise among all racial/ethnic groups in the United States, across all age groups, and for all tumor sizes, with the most rapid increases for localized stage disease and small tumors. Recent cohort studies confirmed the association of smoking, excess body weight, and hypertension with an elevated risk of renal cell cancer, and suggested that these factors can be modified to reduce the risk. There is increasing evidence for an inverse association between renal cell cancer risk and physical activity and moderate intake of alcohol. Occupational exposure to TCE has been positively associated with renal cell cancer risk in several recent studies, but its link with somatic mutations of the VHL gene has not been confirmed. Studies of genetic polymorphisms in relation to renal cell cancer risk have produced mixed results, but genome-wide association studies with larger sample size and a more comprehensive approach are underway. Few epidemiologic studies have evaluated risk factors by subtypes of renal cell cancer defined by somatic mutations and other tumor markers. Keywords renal cell cancer; incidence trends; cohort studies; smoking; obesity; hypertension; diet; occupation; genetic polymorphism; somatic mutation Malignant tumors of the kidney account for about 4% of cancer incidence and 2% of cancer mortality in the United States, with over 54,000 new cases and 13,000 deaths having been estimated for 2008. 1 More than 85% of kidney cancers arise in the renal parenchyma, with the remainder arising in the renal pelvis. 2 Renal pelvis cancer is mostly of the transitional cell type and is not the focus of this review. Nearly all cancers originating in the renal parenchyma are adenocarcinomas (renal cell carcinoma), in which clear cell is the predominant subtype. 3 The remainder is made up of the papillary type and other rare histologic types, such as collecting duct and chromophobe carcinomas. 3,4 Distinct morphologic and genetic characteristics have also been described for renal cell carcinoma in familial cancer syndromes. [5][6][7] Descriptive and analytic epidemiologic studies in general have not distinguished the subtypes of renal cell carcinoma, except for studies involving the von Hippel-Lindau (VHL) gene mutation that is seen primarily in the clear cell type. 8 Since the clear cell type comprises 85% to 90% of renal cell carcinoma, 3 the epidemiology of renal cell carcinoma is strongly influenced by that of the clear cell type.* Correspondence: Wong-Ho Chow, National Cancer Institute, 6120 Executive Blvd, EPS 8100, Bethesda, Maryland 20892-7240, USA. choww@mail.nih.gov.
NIH Public Access Author ManuscriptCancer J. Author manuscript; available in PMC 2011 April 15.
DESCRIPTIVE EPIDEMIOLOGY Incidence patterns and temporal trendsIncidence rates of renal cell carcinoma h...