Stage–specific incidence trends of renal cancers in the East of England, 1999–2016

Annie Herbert,Matthew E Barclay,Minjoung M Koo,Brian Rous,David C Greenberg,Gary Abel,Georgios Lyratzopoulos

doi:10.1016/j.canep.2020.101883

Abstract

ObjectivesTo determine stage-specific time-trends in renal cancer incidence. MethodsWe used population-based East Anglia data 1999−2016 (population ∼2 million) on 5,456 primary renal cancer diagnoses, estimating stage-specific annual incidence using Poisson regression, allowing for changing time-trends, and adjusting for sex, age, and socioeconomic deprivation. ResultsRenal cancer incidence increased from 9.8–16.4 cases per 100,000 during 1999−2016. Incidence of Stage I, II, and III cases increased over time, most steeply for Stage I, with annual Incidence Rate Ratio [IRR] for Stage I of 1.09 (95 % CI 1.07–1.12) during 1999−2010; and 1.03 (1.00–1.05) during 2011−2016. In contrast, the annual incidence of Stage IV renal cancer decreased during most years, IRR of 0.99 (0.98–1.00) during 2003−2016. ConclusionThe findings are consistent with both earlier detection of symptomatic renal cancer and increasing identification of asymptomatic lesions. However, the decreasing incidence of late-stage disease suggests genuine shifts towards earlier diagnosis.

Highlights

In different countries, in spite of decreasing mortality, the incidence of renal cancer has been increasing since the mid-1990s [1,2,3]
There were 5,456 cases of renal cancer diagnosed during 1999− 2016 in our study population which ranged from 2,195,688 in the first study year (1999) to an estimated 2,472,283 in latter study years
We used cancer registry data with highly complete information on stage at diagnosis, further complemented by use of multiple imputation to account for missing stage

Summary

Introduction

In spite of decreasing mortality, the incidence of renal cancer has been increasing since the mid-1990s [1,2,3]. In the UK, renal cancer incidence has approximately doubled since 1995, with further increases projected over the two decades [1]. Understand ing the drivers of increasing incidence is important for informing rele vant cancer prevention and control policies. Rising trends in the incidence of renal cancer have been attributed to greater use of abdominal imaging over time, leading to increasing incidental detection of small asymptomatic tumours May reflect increasing frequency of symptomatic disease, due to greater exposure of the population to risk factors such as obesity in previous decades [9,10]. Stage-specific incidence trends can elucidate the drivers of rising overall incidence [7,8,11,12]. We hypothesised that the increasing inci dence of renal diagnoses overall could be partly attributed to increasing incidence of early-stage cases, though remaining equipoised as to the exact partitioning of incidence trends in early or late stage disease

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