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Abstract

We appreciate the kind and thoughtful editorial remarks. As previously stated, the incidence of renal cell carcinoma (RCC) has been rising steadily in the United States for several decades, and many have attributed this in part to the increased detection of small, incidental renal masses found on cross-sectional imaging. 1 Chow W.H. Devesa S.S. Warren J.L. et al. Rising incidence of renal cell carcinoma in the United States. JAMA. 1999; 281: 1628-1631 Crossref PubMed Scopus (1333) Google Scholar , 2 Homma Y. Kawabe K. Kitamura T. et al. Increased incidental detection and reduced mortality in renal cancer – recent retrospective analysis at eight institutions. Int J Urol. 1995; 2: 77-80 Crossref PubMed Scopus (142) Google Scholar , 3 Hollingsworth J.M. Miller D.C. Daignault S. et al. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006; 98: 1331-1334 Crossref PubMed Scopus (907) Google Scholar , 4 Simard EP, Ward EM, Siegel R, et al. Cancers with increasing incidence trends in the United States: 1999 through 2008 [e-pub ahead of print]. CA Cancer J Clin. doi:10.3322/caac.20141. Accessed May 15, 2012. Google Scholar However, several observations have challenged the assertion that these incidence trends are solely due to the incidental detection of localized renal tumors by routine imaging. For example, Chow et al demonstrated not only an increased incidence of advanced stage tumors but also a steady parallel rise in the RCC mortality rate (a trend that was upheld even after adjusting for stage). 1 Chow W.H. Devesa S.S. Warren J.L. et al. Rising incidence of renal cell carcinoma in the United States. JAMA. 1999; 281: 1628-1631 Crossref PubMed Scopus (1333) Google Scholar , 5 Sun M. Thuret R. Abdollah F. et al. Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. Eur Urol. 2011; 59: 135-141 Abstract Full Text Full Text PDF PubMed Scopus (232) Google Scholar Therefore, the question of whether these adverse temporal trends in RCC incidence rates are mostly driven by factors related to the year of diagnosis (period-related factors such as increased abdominal imaging) or to factors related to the year of birth (cohort-related factors such as rates of obesity, hypertension, new genetic mutations, etc), or a combination thereof, has become increasingly germane. Indeed, a more thorough understanding of the factors that mediate RCC risk would help guide investigators and public health officials to design and implement thoughtful screening and detection programs in high-risk populations. Editorial CommentUrologyVol. 82Issue 1PreviewRenal cell carcinoma (RCC) has a steadily increasing incidence in the United States.1 The change in incidence and natural history of RCC is often attributed to the widespread use of abdominal imaging and the incidental detection of small renal masses. However, the etiology of sporadic RCC remains poorly understood. Full-Text PDF