Kidney cancer risk factors

Prevention

Preventable cases of kidney cancer, UK

Excess bodyweight

Kidney cancer cases linked to excess bodyweight, UK

Smoking

Kidney cancer cases linked to exposure to tobacco smoke, UK

Radiation

Kidney cancer cases linked to ionising radiation exposure, UK

42% (47% in males and 34% in females) of kidney cancer cases each year in the UK are linked to major lifestyle and other risk factors.[1]

Kidney cancer risk is associated with a number of risk factors.[2,3]

Kidney Cancer Risk Factors

Increases risk ('sufficient' or 'convincing' evidence') May increase risk ('limited' or 'probable' evidence) Decreases risk ('sufficient' or 'convincing' evidence) May decrease risk ('limited' or 'probable' evidence)
  • Tobacco smoking[a,b]
  • X-radiation, gamma-radiation[a]
  • Trichloroethylene[a]
  • Plants containing aristolochic acid[b]
  • Analgesics containing phenacetin
  • Body fatness
  • Arsenic and inorganic arsenic compounds[a,c]
  • Cadmium and cadmium compounds[a]
  • Printing processes[a]
  • Aristolochic acid (not in plants)[b]
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International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications. Find out more about IARC and WCRF/AICR classifications.

a Kidney; b Renal pelvis and ureter; c WCRF/AICR classifies arsenic in drinking water as a possible cause of kidney cancer based on limited-suggestive evidence

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Tobacco smoking is classified by the International Agency for Research on Cancer (IARC) as a cause of kidney, renal pelvis and ureter cancers.[1] An estimated 29% of kidney cancers in men, and 15% in women, in the UK are caused by smoking.[2]

Kidney cancer risk is 52-54% higher in current smokers compared with never-smokers, meta-analyses have shown.[3,4]

Kidney cancer risk increases with the amount smoked; it is 58-103% higher in those who smoke more than 20 cigarettes per day, compared with never-smokers, a meta-analysis showed.[4]

Kidney cancer risk among ex-smokers who quit more than 10 years ago is comparable to that of never-smokers, a meta-analysis showed.[4]

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Body fatness is classified by the World Cancer Research Fund/American Institute (WCRF) and the International Agency for Research on Cancer (IACR) as a cause of kidney cancer.[1] An estimated 24% of kidney cancers in the UK are linked to overweight and obesity.[2]

Kidney cancer risk among men is 22% higher in those who are overweight (body mass index [BMI] 25-30) and 63% higher in those who are obese (BMI 30+), a meta-analysis showed.[3] Kidney cancer risk among women is 38% higher in those who are overweight and 95% higher in those who are obese, a meta-analysis showed.[3]

Overweight and obesity may increase kidney cancer risk by raising insulin, oestrogens and growth factors levels, and changing cholesterol metabolism or the immune system.[4]

Wilms tumour risk is higher in children with a higher birth-weight, a meta-analysis showed.[5]

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Kidney cancer risk is 22% lower in people with the highest physical activity levels, versus with those with the lowest, a meta-analysis showed.[1]

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Kidney cancer risk is 62% higher in people with a history of hypertension, a meta-analysis showed; this may relate to hypertension treatment but evidence is unclear.[1]

Kidney cancer risk is 54-100% higher in diuretics users versus non-users, a meta-analysis showed; this may relate to the underlying hypertension but evidence is unclear.[2]

Hypertension may cause damage to the kidney directly, or increase susceptibility to carcinogens.[3]

References

  1. Corrao G, Scotti L, Bagnardi V, Sega R. Hypertension, antihypertensive therapy and renal-cell cancer: a meta-analysis. Curr Drug Saf 2007;2:125-33.
  2. Grossman E, Messerli FH, Goldbourt U. Antihypertensive therapy and the risk of malignancies. Eur Heart J 2001;22:1343-52.
  3. Brennan P, van der Hel O, Moore LE, et al. Tobacco smoking, body mass index, hypertension, and kidney cancer risk in central and eastern Europe. Br J Cancer 2008;99:1912-5.
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Kidney cancer risk among men is 41% higher in those with kidney stones, a meta-analysis showed.[1] Kidney cancer risk among women is not associated with kidney stones, a meta-analysis showed.[1]

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Kidney cancer risk is 3.6 times higher in people with end stage renal disease receiving dialysis, and risk increases with the number of years on dialysis, a cohort study showed.[1]

Kidney cancer risk among people with chronic kidney disease increases with poorer kidney function, a cohort study showed;[2] however detection bias (increased diagnostic activity in this population) may partly explain this.

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Kidney cancer risk is 40% higher in diabetics compared with non-diabetics, meta-analyses have shown.[1,2]

Kidney cancer risk among diabetics may be higher in insulin users than non-users, a meta-analysis showed.[3] Kidney cancer risk among diabetics is not associated with metformin or pioglitazone use,[4] meta-analyses have shown.

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Kidney cancer risk among males is 16% higher in those with Parkinson’s disease versus those without, a cohort study showed.[1] Kidney cancer risk among females is not associated with Parkinson’s disease, a cohort study showed.[1]

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Kidney cancer risk is 38% higher in non-aspirin NSAID ever-users, compared with never/rare users, a meta-analysis showed.[1] Kidney cancer risk is not associated with aspirin use, a meta-analysis showed.[1]

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Phenacetin (an analgesic) is classified by the International Agency for Research on Cancer (IARC) as a cause of renal pelvis and ureter cancers.[1] Phenacetin has been banned in the UK since 1980.

Aristolochic acid (most commonly found in traditional Chinese medicines) is classified by IARC as a cause of renal pelvis and ureter cancers.[1] Upper urothelial tract cancer risk is around 6 times higher in people exposed to aristolochic acid, a meta-analysis showed.[2]

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Gamma radiation and X radiation are classified by the International Agency for Research on Cancer (IARC) as causes of kidney cancer.[1]

Kidney cancer death risk is not associated with exposure to atomic bomb radiation, a cohort study showed.[2]

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Kidney cancer risk is 5-7 times higher in organ transplant recipients compared with the general population, a cohort study and meta-analysis have shown.[1,2] Kidney cancer risk is particularly high in kidney transplant recipients compared with other solid organ transplant recipients, a cohort study showed; higher cancer risk in this population may reflect that reasons for needing kidney transplant may also be kidney cancer risk factors e.g. kidney disease.[3]

Childhood kidney cancer risk may be higher in organ transplant recipients, cohort studies have shown.[4,5]

References

  1. Engels EA, Pfeiffer RM, Fraumeni JF Jr, et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA 2011;306(17):1891-901.
  2. Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 2007;370(9581):59-67.
  3. Hall EC, Pfeiffer RM, Segev DL, Engels EA. Cumulative incidence of cancer after solid organ transplantation. Cancer 2013;119(12):2300-8.
  4. Smith JM, Martz K, McDonald RA, et al. Solid tumors following kidney transplantation in children. Pediatr Transplant. 2013;17(8):726-30.
  5. Simard JF, Baecklund E, Kinch A, et al. Pediatric organ transplantation and risk of premalignant and malignant tumors in Sweden. Am J Transplant. 2011;11(1):146-51.
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Kidney cancer risk is higher in people with certain autoimmune conditions including Crohn’s disease, hyperthyroidism, and rheumatoid arthritis, a cohort study showed.[1] Kidney cancer risk is higher in people with sarcoidosis versus those without, a meta-analysis showed.[2]

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Kidney cancer risk is 4-8% higher per child given birth to, a meta-analysis showed.[1]

Kidney cancer risk is 33% higher in women who have had a hysterectomy, a meta-analysis showed.[2] This may be linked with use of hormone replacement therapy by these women, physical changes after/injuries during surgery, or conditions which led to the hysterectomy being necessary.[1]

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Exposure to trichloroethylene is classified by the International Agency for Research on Cancer (IARC) as a cause of kidney cancer; and exposure to arsenic, cadmium or printing processes are classified as probable causes of kidney cancer, based on limited evidence.[1]

Kidney cancer risk is 32% higher in people with occupational trichloroethylene exposure, a meta-analysis showed.[2]

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Renal cell carcinoma risk is 2.2-2.6 times higher in people with a first-degree relative with kidney cancer, a meta-analysis showed.[1] Renal cell carcinoma risk does not differ significantly between people whose sibling is affected and people whose parent is affected, a cohort study showed.[2]

Renal cell carcinoma risk is higher in people whose parent has/had lung or prostate cancer, and those whose sibling has/had bladder or thyroid cancer, melanoma, or non-Hodgkin lymphoma, a cohort study showed.[1]

References

  1. Clague J, Lin J, Cassidy A, et al. Family history and risk of renal cell carcinoma: results from a case-control study and systematic meta-analysis. Cancer Epidemiol Biomarkers Prev 2009;18:801-7.
  2. Liu H, Sundquist J, Hemminki K. Familial renal cell carcinoma from the Swedish Family-Cancer Database. Eur Urol 2011;60:987-93.
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Kidney cancer risk is higher in people with some rare genetic syndromes. 61% of renal cell carcinoma cases have Von Hippel Lindau mutations, a cohort study showed.[1] Other kidney cancer syndromes include Hereditary Papillary Renal Carcinoma, Birt-Hogg-Dubé syndrome, Hereditary Leiomyomatosis Renal Cell Carcinoma, Succinate Dehydrogenase Renal Cell Carcinoma, Tuberous Sclerosis, Cowden's Disease,[2] and Li-Fraumeni syndrome (childhood adrenocortical carcinoma).[3] Reliable estimates of kidney cancer risk associated with these syndromes are lacking, due to the syndromes’ rarity.

References

  1. van Houwelingen KP, van Dijk BA, Hulsbergen-van de Kaa CA, et al. Prevalence of von Hippel-Lindau gene mutations in sporadic renal cell carcinoma: results from The Netherlands cohort study. BMC Cancer 2005;5:57.
  2. Linehan WM, Ricketts CJ. The metabolic basis of kidney cancer. Semin Cancer Biol 2013;23(1):46-55.
  3. Schneider K, Garber J. Li-Fraumeni Syndrome. In: Pagon RA, Bird TD, Dolan CR, et al, editor. GeneReviews™ [internet]. Seattle (WA): University of Washington, 1999 [Updated 2010].
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Kidney cancer risk is higher in survivors of thyroid[1] and testicular cancers,[2] and cervical squamous cell carcinoma,[3] meta- and pooled analyses have shown.

This may reflect the effect of treatment for the primary cancer, or shared risk factors between primary and secondary cancers.

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Alcoholic drinks are classified by the World Cancer Research Fund/American Institute (WCRF) and the International Agency for Research on Cancer (IACR) as unlikely to increase kidney cancer risk, but no judgement is made on whether alcoholic drinks protect against kidney cancer, due to limited evidence.[1]

Kidney cancer risk is 10-21% lower in light-to-moderate alcohol drinkers (around 1-3 drinks per day) compared with non-drinkers, with limited additional benefit from more than around 1 drink per day, meta-analyses have shown.[2,3]

References

  1. World Cancer Research Fund/ American Institute for Cancer Research. Food, nutrition, physical activity and the prevention of cancer: A global perspective. Washington DC: AICR, 2007.
  2. Song DY, Song S, Song Y, et al. Alcohol intake and renal cell cancer risk: a meta-analysis. Br J Cancer 2012; May 22:106(11):1881-90.
  3. Bellocco R, Pasquali E, Rota M, et al. Alcohol drinking and risk of renal cell carcinoma: results of a meta-analysis. Ann Oncol. 2012 Sep;23(9):2235-44.
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The World Cancer Research Fund/American Institute (WCRF) and the International Agency for Research on Cancer (IACR) make no judgment on the association between kidney cancer risk and intake of cereals (grains) and their products; vegetables; fruits; meat; poultry; fish; eggs; milk and dairy products; total fat; soft drinks; tea; carbohydrate; protein; vitamin A; retinol; vitamin C; vitamin E; beta-carotene; flavonol; Seventh-day Adventist diets; physical activity; body fatness at age 18-20; weight at age 18-20; birth weight; adult attained height; age at menarche; or energy intake, due to limited evidence.[1] Coffee is classified by WCRF/AICR as unlikely to have a substantial effect on kidney cancer risk.[1]

Kidney cancer risk is not associated with the following factors, meta- and pooled analyses or systematic reviews have shown:

  • Hepatitis C infection[2] (though some evidence of higher risk[3]).
  • Fish consumption.[4]
  • Red or processed meat consumption[5] (though some evidence of higher risk with processed meat,[4] and with red or processed meat in women only[6]).
  • Vitamin D (blood levels).[6]

References

  1. World Cancer Research Fund/ American Institute for Cancer Research. Food, nutrition, physical activity and the prevention of cancer: A global perspective. Washington DC: AICR, 2007.
  2. Hofmann JN, Torner A, Chow WH, et al. Risk of kidney cancer and chronic kidney disease in relation to hepatitis C virus infection: a nationwide register-based cohort study in Sweden. Eur J Cancer Prev 2011;20:326-30.
  3. Gordon SC, Moonka D, Brown KA, et al. Risk for renal cell carcinoma in chronic hepatitis C infection. Cancer Epidemiol Biomarkers Prev 2010;19:1066-73.
  4. Bai HW, Qian YY, Shi BY, et al. The association between fish consumption and risk of renal cancer: a meta-analysis of observational studies. PLoS One 2013;8(11):e81939.
  5. Alexander DD, Cushing CA. Quantitative assessment of red meat or processed meat consumption and kidney cancer. Cancer Detect Prev 2009;32(5-6):340-51.
  6. Shanmugalingam T, Crawley D, Bosco C, et al. Obesity and cancer: the role of vitamin D. BMC Cancer 2014;14:712.
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