Current Evidence on Screening for Renal Cancer - Beyond the Abstract
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 established risk factors for RCC (which include older age, smoking, hypertension, and obesity) is likely associated with the rising incidence of RCC. With 60% 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% of all patients developing the disease will eventually die from it. The increasing incidence, the high proportion of asymptomatic patients, and the high mortality rate mean that RCC meets some of the criteria for suitability for screening.
In this Nature Reviews Urology paper, the authors from the University of Cambridge, United Kingdom, review the evidence for RCC screening and demonstrate the necessity for further research as first steps towards the development of a clinical trial for a screening program. Among key considerations for an RCC screening program identified are 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 Using their own unpublished data and data from Kidney Cancer UK, the paper authors also highlight the public appetite for a screening program among individuals both with and without a history of RCC.
In their conclusion, the authors summarize their findings into seven recommendations for future research priorities to aid the development of future clinical trials. Establishing the optimal screening modality and target population is key, including the development of risk prediction models and the development of non-invasive early detection markers from the blood and urine. This information will inform the design and implementation of clinical trials of RCC screening. Finally, the authors advocate for an evaluation of the public acceptability and impact on participants of any potential RCC screening program.
Written by: Juliet Usher-Smith, MA, MB, BChir, MPhil, PhD, MRCGP, Department of Public Health and Primary Care, University of Cambridge, Cambridge, England; Rebecca K. Simmons, MD, Department of Public Health, University of Aarhus, Aarhus, Denmark; Sabrina H. Rossi, MD, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, England; and Grant D. Stewart, BSc, FRCSEd (Urol), MBChB, PhD, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, England
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