Kidney cancer risk factors

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.[2-4]

Kidney Cancer Risk Factors

Kidney cancer is more common in older people and men.

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 33% higher in current smokers compared with non-smokers, a meta-analysis showed.[3]

Kidney cancer risk increases with the number of cigarettes smoked per day and smoking duration, a meta-analysis showed.[4] Kidney cancer risk is 50-76% higher in heavy smokers (those who smoke more than 20 cigarettes per day or have more than 50 pack-years  of exposure), 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]

Body fatness is classified by the International Agency for Research on Cancer (IACR) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as a cause of kidney cancer.[1,2] An estimated 24% of kidney cancers in the UK are linked to overweight and obesity.[3]

Kidney cancer risk is 22% higher in men who are overweight (body mass index [BMI] 25-29.9) and 63% higher in men who are obese (BMI 30+), compared with those of a normal weight (BMI 18.5-24.9), a meta-analysis showed.[4] Kidney cancer risk is 38% higher in women who are overweight and 95% higher in women who are obese compared with those of a normal weight, a meta-analysis showed.[4]

Overweight and obesity may increase kidney cancer risk by raising insulin, oestrogens and growth factors levels, and changing cholesterol metabolism or the immune system.[5]

Wilms tumour risk is higher in children with a higher birth-weight, a meta-analysis showed.[6]

Kidney cancer risk is 23% higher per 10cm height increment, a meta-analysis showed.[1]

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]

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]

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]

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.

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.

Kidney cancer risk may be 57% higher in people with gallstones, versus those without, a pooled case-control study showed, though evidence is mixed.[1]

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]

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]

Kidney cancer risk is 32% higher in paracetamol (acetaminophen) ever-users, compared with never/rare users, a meta-analysis showed.[1]

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]

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]

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]

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]

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]

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, welding fumes 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]

An estimated 2-4% of kidney cancers are caused by inherited factors.[1]

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]

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.

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.

Alcoholic drinks are classified by the World Cancer Research Fund/American Institute (WCRF) as probably protective against kidney cancer, based on evidence for alcohol intake of up to 30 grams per day.[1]

Kidney cancer risk is 10-23% lower in light-to-moderate alcohol drinkers (up to 12.5-50g [1.5-6 units] of alcohol per day) compared with non- or occasional drinkers, with limited additional benefit above this level, meta-analyses have shown.[2,4]

The World Cancer Research Fund/American Institute (WCRF) and the International Agency for Research on Cancer (IACR) make no judgement on the association between kidney cancer risk and intake of cereals (grains) and their products; dietary fibre; vegetables; fruits; meat; poultry; fish; eggs; milk and dairy products; total fat; soft drinks; tea; coffee; carbohydrate; protein; calcium; vitamin A; retinol; vitamin C; vitamin E; beta-carotene; alpha-carotene; lycopene; beta-cryptoxanthin; lutein and zeaxanthin; flavonol; folate; vitamin B6; Seventh day Adventist diets; physical activity; birth weight; age at menarche; or energy intake, due to limited evidence.[1]

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

• Hepatitis C infection[2]
• Fish consumption.[3]
• Red or processed meat consumption[4] (though some evidence of higher risk with processed meat,[4] and with red or processed meat in women only[5]).
• Vitamin D (blood levels).[5]
• Nitrate (renal cell cancer).[6]
• Systemic lupus erythematosus.[7]
• Vitamin C intake.[8]