Keynote presentation by UBC's Rachel Murphy on the epidemiology of kidney cancer. Presented at the ON-DECK Knowledge Translation event in Vancouver, November 7th, 2017

1. Epidemiology of Kidney Cancer:
Pathways to Prevention
Rachel Murphy, PhD
School of Population and Public Health, UBC

2. Topics
Epidemiology of kidney cancer
1. Risk factors
2. Incidence rates and trends
3. Mortality rates and trends

3. Epidemiology of kidney cancer
Kidney cancer includes renal parenchyma (mainly
renal cell cancer) and renal pelvis tumors
10th most common cancer in Canada
– 6,600 Canadians will be diagnosed in 2017
– 2,400 women (2.3% of cancer cases)
– 4,200 men (4.1% of cancer cases)

4. Cancer prevention
Prevention is a critical part of cancer control and
reducing the burden of cancer on Canadians
Primary prevention: aims to prevent disease before
it occurs
– Preventing exposure to hazards
– Altering unhealthy or unsafe behaviours

5. Cancer prevention
Eating well, maintaining a healthy body weight and
being physically active prevents ~30% of cancers1
1Kushi LH et al. CA Cancer J Clin. 2012;62:30-67
2Tom Blackwell, nationalpost.com/features/is-
prevention-the-ultimate-cure-for-cancer
“…further curbing the population’s risk
will likely require broad, structural
changes, policies that make fresh produce
as cheap and accessible as Big Macs”
– John Spinelli

6. Risk factors for kidney cancer
Known risk factors
– Age
– Sex
– Cigarette smoking
– Body weight
– Genetic conditions
– End-stage kidney disease and dialysis
– Family history
– Exposure to trichloroethylene
– Alcohol

7. Risk factors
Possible risk factors
– Exposure to radiation
– Arsenic in drinking water
– Exposure to cadmium
– Exposure to printing processes
– History of thyroid cancer
– Horseshoe kidney
– Hysterectomy
– Diabetes
– Height
– Physical activity
– Hypertension

8. Modifiable risk factors
What factors can you change?
– Exposure to carcinogens?
– Cigarette smoking
– Body weight
– Alcohol
– Diabetes?
– Physical activity

9. Modifiable risk factors
Smoking
• Causal risk factor: DNA damage, genetic alterations, tissue
hypoxia and smoking related-conditions like COPD
• Risk is 50% higher in male and 20% higher in female
smokers
• Dose-response pattern
• Smoking cessation reduces risk IF quit for >10 years

10. Modifiable risk factors
Body weight
• Overweight and obesity account for >40% of renal cell
cancers in US and >30% in Europe1
• 24% increased risk (men) and 34% increased risk (women)
for every 5 kg/m2 increase in BMI
• Weight cycling, weight gain and abdominal obesity are all
risk factors
How?
• Insulin resistance, adipokines, inflammation,
oxidative stress
1Calle EE, Kaaks R. Nature Rev. 2004;4:579-591

11. Modifiable risk factors
Body weight
It’s not too late to reduce your risk!
• Losing >5% of body weight improves cancer risk markers
• Losing >5% of body weight reduces the risk of some cancers
by ~66%1
1Luo J et al. JCO; 35(11):1189-1193.

12. Modifiable risk factors
Physical activity
• Only a few studies have studied physical activity and kidney
cancer
• Greater physical activity is associated with lower risk
• Possible dose-response relationship
How?
• Indirect: body weight, blood pressure
• Direct: insulin sensitivity, inflammation, oxidative stress

13. Modifiable risk factors
Physical activity
What can we do?
• Adopt a physically active lifestyle
• Include at least 150 min of moderate intensity or 75
min of vigorous intensity activity each week1
• Limit sedentary time1
1Kushi LH et al. CA Cancer J Clin. 2012;62:30-67

14. Modifiable risk factors
Diet
• Mixed findings
– Greater fruits and vegetables are associated with decreased risk
– Antioxidants have protective or null associations
– Increased fat intake may be a risk factor but some studies are
null
– Increased energy intake positively associated (modestly)
– Increased processed meat intake positively associated

15. Modifiable risk factors
Diet
What can we do?
• Eat a healthy diet with an emphasis on plant foods
• >2.5 cups/d of fruit and vegetables
• Limit consumption of red and processed meats
• Choose whole grains
1Kushi LH et al. CA Cancer J Clin. 2012;62:30-67

16. Topic #2: Incidence rates & trends
Incidence
rates vary
substantially
worldwide1
1Curado MP et al. IARC Scientific Publications No. 160, Lyon, IARC

17. Incidence rates in Canada
Canadian Cancer Society, 2017
Incidence rates also vary within a Country

18. Obesity Rates in Canada
1Curado MP et al. IARC Scientific Publications No. 160, Lyon, IARC

19. Smoking rates in Canada
Statistics Canada 2014
26.2%
33.3% 62%
14.3%
19%
20.5%
16.3%
17.4%
19.6%
20.9%
22.1%
19.7%
21.7%

20. Incidence trends
• Between 2012 and 2020, kidney cancer is expected to
increase globally by 22%
Causes?
• Population aging
• Increased prevalence of risk factors: overweight/obesity,
hypertension
• Smoking continues to be prevalent

21. Incidence trends in Canada
Canadian Cancer Society, 2017
• Between 2001-2010, the
annual % change in age-
standardized incidence
rates was 1.3%
• The % change in new
cases is expected to soar
by >90% in 2028-2032
vs. cases in 2003-2007

22. Topic #3: Mortality
• 12th most common cause of cancer-related death
• 1,900 Canadians will die from kidney cancer in 2017
– 1,200 men will die from kidney cancer
• 5-year survival is 67%
Improvements in treatment  Increased survivors
• >24,000 Canadians who were diagnosed 10+ years
ago are alive today
Canadian Cancer Society, 2017

23. Mortality rates
Canadian Cancer Society, 2017

24. Mortality trends
Canadian Cancer Society, 2017

25. Summary

26. Rachel Murphy
Centre of Excellence in Cancer Prevention
Faculty of Medicine | School of Population and Public Health
The University of British Columbia
Rm-167 2206 East Mall | Vancouver, BC Canada V6T 1Z3
Phone 604 822 6108 | Fax 604 822 4994
Rachel.murphy@ubc.ca | @cancerprevent |
www.cancerprevent.ca | youtube.com/user/cancerprevent
Contact