New paper examines evidence for screening of renal cell carcinoma.
Juliet Usher-Smith, Rebecca K. Simmons, Sabrina H. Rossi and Grant D. Stewart
Nature Reviews Urology 28 August 2020
Renal cell carcinoma (RCC) rates are increasing worldwide, with high mortality and a high proportion of patients asymptomatic at diagnosis – so should we be screening for RCC?
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 percent 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, high proportion of asymptomatic patients, and 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, UK 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 programme. Among key considerations for an RCC screening programme 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 Using their own unpublished data and data from Kidney Cancer UK, the paper authors also highlight the public appetite for a screening programme among individuals both with and without a history of RCC.
In their conclusion, the authors summarise 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 are key, including the development of risk prediction models and 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 programme.
‘Current evidence on screening for renal cancer’ is available to read behind a paywall at Nature Reviews Urology.