Abstract
BackgroundSince the second half of the 1990s, kidney cancer mortality has tended to stabilize and decline in many European countries, due to the decrease in the prevalence of smokers. Nevertheless, incidence of kidney cancer is rising across the sexes in some of these countries, a trend which may possibly reflect the fact that improvements in diagnostic techniques are being outweighed by the increased prevalence of some of this tumor's risk factors. This study sought to: examine the geographic pattern of kidney cancer mortality in Spain; suggest possible hypotheses that would help explain these patterns; and enhance existing knowledge about the large proportion of kidney tumors whose cause remains unknown.MethodsSmoothed municipal relative risks (RRs) for kidney cancer mortality were calculated in men and women, using the conditional autoregressive model proposed by Besag, York and Molliè. Maps were plotted depicting smoothed relative risk estimates, and the distribution of the posterior probability of RR>1 by sex.ResultsMunicipal maps displayed a marked geographic pattern, with excess mortality in both sexes, mainly in towns along the Bay of Biscay, including areas of Asturias, the Basque Country and, to a lesser extent, Cantabria. Among women, the geographic pattern was strikingly singular, not in evidence for any other tumors, and marked by excess risk in towns situated in the Salamanca area and Extremaduran Autonomous Region. This difference would lead one to postulate the existence of different exposures of environmental origin in the various regions.ConclusionThe reasons for this pattern of distribution are not clear, and it would thus be of interest if the effect of industrial emissions on this disease could be studied. The excess mortality observed among women in towns situated in areas with a high degree of natural radiation could reflect the influence of exposures which derive from the geologic composition of the terrain and then become manifest through the agency of drinking water.
Highlights
Since the second half of the 1990s, kidney cancer mortality has tended to stabilize and decline in many European countries, due to the decrease in the prevalence of smokers
The lowest Standardized mortality ratios (SMR) were registered in Galicia, Aragon, the Valencian Region, Murcian Region and Mediterranean provinces of Andalusia
Special mention must be made of the existence of a strikingly singular pattern, not in evidence for any other tumors and marked by excess risk in towns situated in the Salamanca area and Extremaduran Autonomous Region
Summary
Since the second half of the 1990s, kidney cancer mortality has tended to stabilize and decline in many European countries, due to the decrease in the prevalence of smokers. Incidence of kidney cancer is rising across the sexes in some of these countries, a trend which may possibly reflect the fact that improvements in diagnostic techniques are being outweighed by the increased prevalence of some of this tumor's risk factors. There was a trend towards stabilization in subsequent years, though this was principally in western European countries, with the rates continuing to be very high in the eastern European countries [1] The incidence of these tumors follows a trend which, though very similar to that of mortality in a good number of countries, is not in others, where it continues to rise across the sexes (e.g., Norway, Ireland, UK England, UK Scotland) [1,2]. It has been argued that the growing incorporation in recent decades of new diagnostic techniques, such as echography, computed tomography, and magnetic resonance imaging, may have had an influence on the observed rise in incidence [5], though the most recent reviews conclude that the described increase is associated with the rise in prevalence of this tumor's risk factors [6]
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