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Keywords:

  • Europe;
  • incidence;
  • kidney cancer;
  • mortality;
  • time trends;
  • tobacco

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGEMENTS
  8. CONFLICT OF INTEREST
  9. REFERENCES

OBJECTIVE

To update trends in kidney cancer mortality in 32 European countries and the European Union (EU) as a whole, as mortality from kidney cancer has increased throughout Europe until the late 1980s or early 1990s, and has tended to stabilise or decline thereafter.

METHODS

Data from the World Health Organization mortality database over the period 1980–2004 were used to compute age-specific and age-standardized (world standard) rates per 100 000 persons at all ages, and truncated to 35–64 years.

RESULTS

In men in the EU, mortality rates from kidney cancer peaked at 4.8 per 100 000 in 1990–1994, and declined to 4.1 (−13%) in 2000–2004. In women in the EU, the corresponding values were 2.1 in 1990–1994 and 1.8 (−17%) in 2000–2004. The main decreases were in Scandinavian countries, and other western European countries. In most eastern European countries kidney mortality rates tended to stabilise, even if values remained high, especially in the Czech Republic and Baltic countries. For kidney cancer incidence, there were decreases in rates for both sexes in Sweden throughout the 25-year calendar period considered. In the last 10 years considered, incidence rates decreased or tended to stabilise also in other northern European countries in both sexes, except in the UK.

CONCLUSION

The present work confirms and further quantifies the recent favourable trends in kidney cancer mortality and (to a lesser degree) in incidence across most European countries. Thus, improvements in diagnosis and treatments cannot largely explain the declines in mortality. Apart from a favourable role of reduced tobacco smoking in men, the interpretation of these trends remains undefined.


Abbreviations
ICD

International Classification of Diseases

EU

European Union.

INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGEMENTS
  8. CONFLICT OF INTEREST
  9. REFERENCES

Mortality from kidney cancer increased throughout Europe until the late 1980s or early 1990s, and tended to stabilise or decline thereafter, mainly in western Europe, although rates remained exceedingly high in several countries of central and eastern Europe, e.g. the Czech Republic, Hungary, Poland, and Baltic countries [1]. This was related to favourable changes in exposure to tobacco smoking in men, although tobacco cannot account for the similar trends registered in women [2–4].

It is therefore possible that recent trends in kidney cancer mortality in Europe are influenced by changes in diagnosis and treatment of the disease. To address this issue, and further monitor trends in kidney cancer in Europe, we updated to 2004 trends in mortality in various European countries, and contrasted trends in incidence with those in mortality for the 11 countries providing information on both incidence and mortality.

METHODS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGEMENTS
  8. CONFLICT OF INTEREST
  9. REFERENCES

Official death certification numbers for kidney cancer from 32 European countries for the period 1980–2004 were derived from the WHO database, as available on electronic support [5]. Data for Latvia were available in the WHO database from 1996 onwards, for Estonia from 1994, for Lithuania from 1993, for Slovakia from 1992, for the Republic of Moldova from 2000, and for the Czech Republic from 1990. For Belgium the data are available up to 1997, for Denmark up to 2001, for Italy, Slovakia and Sweden up to 2002, and for France, Hungary, and Portugal up to 2003. The European Union (EU) was defined as the 27 member states as of January 2007 (i.e. Austria, Belgium, Bulgaria, the Czech Republic, Cyprus, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the UK). Data for Cyprus were not available. During the calendar period considered (1980–2004) three different revisions of the International Classification of Diseases (ICD) were used [6–8]. Classification of cancer deaths was re-coded, for all calendar periods and countries, according to the 10th Revision of the ICD [8].

Estimates of the resident population, based on official censuses, were obtained from the same WHO database [5]. From the matrices of certified deaths and resident populations, age-specific rates for each 5-year age group and calendar year were computed. Age-standardized rates per 100 000 men and women (at all ages), and truncated to 35–64 years, were computed using the direct method, and based on the world standard population [9].

Incidence data for 11 selected European countries were extracted from the successive volumes of Cancer Incidence in Five Continents [10]. Additional more recent information was found in various national cancer registry reports available in the Internet [11–18].

RESULTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGEMENTS
  8. CONFLICT OF INTEREST
  9. REFERENCES

Table 1 gives overall age-standardized mortality rates in 32 separate European countries (plus England and Wales, Scotland and Northern Ireland) and the EU overall in 1980–1984, 1990–1994 and 2000–2004, and the corresponding percentage change in rate. In the EU as a whole, mortality from kidney cancer peaked in the early 1990s at 4.8 per 100 000 men and 2.1 per 100 000 women, then declined to 4.1 per 100 000 men and 1.8 per 100 000 women. This pattern of trends reflects the decrease in kidney cancer mortality observed since the early 1990s in several western and central European countries, e.g. France (−13% in men and −10% in women, over the last 10 years), Germany (−31% in both sexes), Italy (−12% and −14%) Austria (−33% and −32%, respectively) and the Netherlands (−20% and −19%, respectively), and since the 1980s in most Scandinavian countries, which had high rates in the past. Kidney cancer mortality rates in the Czech Republic remained high (10.3 per 100 000 men, 4.4 per 100 000 per women), even though rates declined by 6% in men and 13% in women over the last decade. Similarly, in most eastern European countries, kidney cancer mortality rates were high, with some levelling in men and some reductions in the rates in women during 1990–2004. In southern Europe, rates in men in the early 2000s ranged from 2.8 per 100 000 in Greece to 3.8 per 100 000 in Italy, and rates in women ranged from 0.8 per 100 000 in Portugal to 1.6 per 100 000 in Malta. However, during 1990–2004, mortality rates in men declined (−12%) only in Italy, while in women the rates declined in Portugal (−14%) and Spain (−4%), besides Italy (−14%).

Table 1.  Overall age-adjusted (world population) mortality rates from kidney cancer per 100 000 men and women in separate European countries in 1980–1984, 1990–1994 and 2000–2004 (unless noted in parentheses; see Methods), and the corresponding change in rates (Δ%)
CountryMenWomen
1980–19841990–19942000–2004Δ% 1992/1982Δ% 2002/19921980–19841990–19942000–2004Δ% 1992/1982Δ% 2002 /1992
Austria5.58 5.70 3.81  2.15−33.163.092.811.90 −9.06−32.38
Belgium4.28 4.32 –  0.93  –2.392.19 −8.37  –
Bulgaria1.77 2.26 – 27.68  –0.921.11 20.65  –
Croatia 3.65 4.84  – 32.601.641.87  – 14.02
Czechoslovakia7.23 9.35 – 29.32  –3.084.13 34.09  –
Czech Republic10.9610.32  – −5.845.044.37  –−13.29
Denmark (2000–2001)5.47 4.93 4.98 −9.87  1.013.543.092.86−12.71 −7.44
Estonia 7.62 8.12  –  6.563.052.36  –−22.62
Finland5.32 5.48 4.71  3.01−14.052.762.832.40  2.54−15.19
France (2000–2003)4.01 4.47 3.89  11.47−12.981.771.761.58 −0.56−10.23
Germany5.93 6.25 4.30  5.40−31.202.582.751.91  6.59−30.55
Greece2.25 2.51 2.78  11.56 10.760.901.041.09 15.56  4.81
Hungary (2000–2003)4.83 6.47 6.18 33.95 −4.482.272.672.60 17.62 −2.62
Iceland5.13 6.56 6.73 27.88  2.594.623.823.94−17.32  3.14
Ireland2.76 3.55 4.56 28.62 28.451.581.601.69  1.27  5.62
Italy (2000–2002)3.54 4.28 3.75 20.90−12.381.441.621.40 12.50−13.58
Latvia 7.39 7.30  –  –2.74  –  –
Lithuania 7.39 7.46  –  0.953.393.10  – −8.55
Luxembourg4.74 3.90 3.50−17.72−10.261.422.201.69 54.93−23.18
Malta2.87 3.36 3.60 17.07  7.141.471.181.63−19.73 38.14
Netherlands4.98 5.25 4.20  5.42−20.002.582.602.11  0.78−18.85
Norway4.82 4.51 4.01 −6.43 −11.092.352.272.07 −3.40 −8.81
Poland – 6.11  – −1.223.392.51  –−25.96
Portugal (2000–2003)2.04 2.19 2.25  7.35  2.740.910.950.82  4.40−13.68
Republic of Moldova – 2.74  –  –1.27  –  –
Romania – 2.52  –  –1.28  –  –
Slovakia (2000–2002) 6.12 6.60  –  7.843.023.02  –  0.00
Slovenia 3.89 4.91  – 26.222.081.78  –−14.42
Spain2.09 2.91 2.95 39.23  1.370.941.121.07 19.15 −4.46
Sweden (2000–2002)5.93 5.10 4.30−14.00−15.693.432.812.45−18.08−12.81
Switzerland4.43 4.57 –  3.16  –2.552.21−13.33  –
United Kingdom3.46 3.98 3.93 15.03 −1.261.621.941.88 19.75 −3.09
UK, England & Wales3.41 3.93 3.87 15.25 −1.531.571.891.85 20.83 −2.12
UK, N. Ireland2.99 4.06 4.39 35.79  8.131.462.151.74 47.26−19.07
UK, Scotland4.21 4.39 4.40  4.28  0.232.142.372.26 10.75 −4.64
European Union (27)4.07 4.75 4.13 16.71−13.051.912.121.76 10.99−16.98

Table 2 gives corresponding values for truncated mortality rates for those aged 35–64 years. In the two decades considered, in the EU the mortality rates increased and subsequently declined in both men (6.1, 6.7 and 5.6 per 100 000 men, in 1982, 1992 and 2002, respectively) and women (2.7, 2.8 and 2.1 per 100 000, respectively). The highest mortality rates in 2000–2004 were again reported in the Czech Republic (14.1 per 100 000 men and 5.2 per 100 000 women), Iceland (11.5 and 4.7, respectively), Lithuania (11.9 and 4.1, respectively) and Slovakia (10.3 and 3.9, respectively).

Table 2.  Age-adjusted (world population) mortality rates from kidney cancer per 100 000 men and women aged 35–64 years in separate European countries in 1980–1984, 1990–1994 and 2000–2004 (unless noted in parentheses; see Methods), and the corresponding change in rates (Δ%)
CountryMenWomen
1980–19841990–19942000–2004Δ% 1992/1982Δ% 2002/19921980–19841990–19942000–2004Δ% 1992/1982Δ% 2002/1992
Austria 8.21 7.39 4.44 −9.99−39.924.513.271.81−27.49−44.65
Belgium 5.98 5.35 –−10.54  –3.321.96−40.96  –
Bulgaria 3.35 3.89 – 16.12  –1.431.76 23.08  –
Croatia – 5.88 6.65  – 13.102.242.45  –  9.38
Czechoslovakia13.1415.37 – 16.97  –5.376.66 24.02  –
Czech Republic –16.9414.07  –−16.947.755.21  –−32.77
Denmark (2000–2001) 7.59 6.77 6.30−10.80 −6.945.424.183.18−22.88−23.92
Estonia –15.1713.28  –−12.463.132.92  – −6.71
Finland 8.20 8.19 6.14 −0.12−25.034.003.252.54−18.75−21.85
France (2000–2003) 5.53 5.86 4.84  5.97−17.412.412.182.02 −9.54 −7.34
Germany 9.24 8.69 5.38 −5.95−38.093.783.652.05 −3.44−43.84
Greece 3.32 3.47 3.33  4.52 −4.031.291.271.15 −1.55 −9.45
Hungary (2000–2003) 7.23 9.91 9.48 37.07 −4.343.033.623.04 19.47−16.02
Iceland 6.85 7.74 11.53 12.99 48.976.525.594.73−14.26−15.38
Ireland 4.65 5.11 6.04  9.89 18.202.562.572.22  0.39−13.62
Italy (2000–2002) 5.64 5.72 4.74  1.42−17.131.992.051.54  3.02−24.88
Latvia – –10.75  –  –3.20  –  –
Lithuania –12.36 11.85  – −4.134.614.10  – −11.06
Luxembourg 5.87 5.09 3.38−13.29−33.602.753.771.40  37.09−62.86
Malta 5.09 3.81 4.44−25.15 16.542.371.423.20−40.08125.35
Netherlands 6.98 7.03 5.30  0.72−24.613.773.322.33−11.94−29.82
Norway 6.73 5.55 5.12−17.53 −7.753.182.712.25−14.78−16.97
Poland – – 9.18  –  –3.34  –  –
Portugal (2000–2003) 2.46 2.85 2.85 15.85  0.000.991.170.98  –  –
Republic of Moldova – – 5.09  –  –2.29  –  –
Romania – – 4.39  –  –1.69  –  –
Slovakia (2000–2002) –10.3710.25  – −1.164.593.91  –−14.81
Slovenia – 4.73 6.19  – 30.873.071.95  –−36.48
Spain 2.93 3.79 3.98 29.35  5.011.211.321.24  9.09 −6.06
Sweden (2000–2002) 8.75 6.63 5.03−24.23−24.134.683.542.66−24.36−24.86
Switzerland 6.30 5.17 –−17.94  –3.512.71−22.79  –
United Kingdom 5.47 6.01 5.47  9.87 −8.992.532.852.42 12.65−15.09
UK, England & Wales 5.40 5.98 5.40 10.74 −9.702.472.792.39 12.96−14.34
UK, N. Ireland 5.03 6.21 5.32 23.46−14.332.103.112.06 48.10−33.76
UK, Scotland 6.38 6.28 6.29 −1.57  0.163.203.432.85  7.19−16.91
European Union (27) 6.06 6.69 5.55 10.40−17.042.682.792.10  4.10−24.73

Table 3 shows age-standardized (all ages and truncated to 35–64 years) incidence rates from kidney cancer in selected northern and eastern European countries. There were substantial declines for both sexes in Sweden throughout the 25-year calendar period considered. In the last 10 years considered, incidence rates decreased or tended to stabilise in northern countries in both sexes, except for England and Scotland. In eastern Europe, there were increases in the last decades in both sexes, except for women in the early 2000s. In the last 10 years considered, incidence rates were highest in the Czech Republic, peaking at 18.8 in 1990–1994 and 21.7 per 100 000 men in 2000–2004, and 10.1 in 1990–1994 and 10.3 per 100 000 women in 2000–2004, and in Slovakia where the corresponding incidence rates were 11.9 and 13.5 per 100 000 men, and 6.2 and 6.7 per 100 000 women.

Table 3.  Overall and truncated 35–64 years age-adjusted (world population) incidence rates of kidney cancer per 100 000 men and women in separate selected European countries in 1980–1984, 1990–1994 and 2000–2004 (unless noted in parentheses), and the corresponding change in rates (Δ%)
CountryMenWomen
1980–19841990–19942000–2004Δ% 1992/1982Δ% 2002/19921980–19841990–19942000–2004Δ% 1992/1982Δ% 2002/1992
Overall
 Czech Rep.   (2000–2003)11.8318.8321.66 59.17 15.03 5.2810.0710.29 90.72  2.18
 Denmark   (2000–2003) 7.42 7.45 7.46  0.40  0.13 4.73 4.49 3.95 −5.07−12.03
 Finland 8.5810.95 9.77 27.62−10.78 4.90 6.33 5.80 29.18 −8.37
 Ireland   (2000–2002) – 7.55 9.73  – 28.87 – 3.94 4.54  – 15.23
 Netherlands   (2000–2003) –10.27 9.43  – −8.18 – 5.48 5.03  – −8.21
 Norway 8.03 8.41 9.47  4.73 12.60 4.12 4.68 4.56 13.59 −2.56
 Slovakia   (2000–2003) 7.23 11.8713.46 64.18 13.40 3.63 6.20 6.66 70.80  7.42
 Slovenia 6.60 8.08 9.95 22.42 23.14 2.29 4.51 4.42 96.94 −2.00
 Sweden10.07 8.32 6.81−17.38−18.15 5.80 5.20 4.19−10.34−19.42
 UK, England 5.69 7.31 8.36 28.47 14.36 2.70 3.55 4.27 31.48 20.28
 UK, Scotland 6.45 7.81 9.02 21.09 15.49 3.35 4.30 4.85 28.36 12.79
Truncated 35–64 years
 Czech Rep.   (2000–2003)22.6533.3037.08 47.02  11.3510.2318.0716.26 76.64−10.02
 Denmark   (2000–2003) 11.58 11.9312.52  3.02  4.95 7.63 6.19 5.43−18.87−12.28
 Finland14.6618.0214.89 22.92−17.37 8.37 9.54 8.08 13.98−15.30
 Ireland   (2000–2002) – 11.6215.28  – 31.50 – 6.04 6.96  – 15.23
 Netherlands –15.9213.82  –−13.19 – 8.55 7.27  –−14.97
 Norway13.7013.1016.22 −4.38 23.82 6.17 6.84 6.64 10.86 −2.92
 Slovakia   (2000–2003)14.5023.0825.32 59.17  9.71 7.05 11.30 11.48 60.28  1.59
 Slovenia12.4712.6016.06  1.04 27.46 3.72 7.66 6.89105.91−10.05
 Sweden16.2612.5710.58−22.69−15.83 9.03 7.83 6.00−13.29−23.37
 UK, England 9.46 11.7612.83 24.31  9.10 4.33 5.64 6.34 30.25 12.41
 UK, Scotland10.7612.4714.44 15.89 15.80 5.21 7.37 7.02 41.46 −4.75

Figures 1 and 2 contrast trends in overall age-adjusted mortality and incidence rates from kidney cancer in men and women in selected European countries providing data. In both sexes, trends in mortality and incidence rates were similar, with recent decreases in Sweden, Finland and the Netherlands, except for the Czech Republic, England, Scotland and Slovenia, where incidence rates increased faster than mortality rates. In the last 5 years considered, incidence rates were more than twice the mortality rates, except for Denmark and Sweden. The results were similar for incidence rates in those aged 35–64 years in men and women, as reported in Figs 3 and 4.

image

Figure 1. Trends in overall age-adjusted (on the world standard population) mortality and incidence rates from kidney cancer per 100 000 men in 11 northern and eastern European countries between 1980 and 2004. Incidence, dashed line; mortality, solid line.

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image

Figure 2. Trends in overall age-adjusted (on the world standard population) mortality and incidence rates from kidney cancer per 100 000 women in 11 northern and eastern European countries between 1980 and 2004. Key as Fig. 1.

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image

Figure 3. Trends in truncated (at 35–64 years) age-adjusted (on the world standard population) mortality and incidence rates from kidney cancer per 100 000 men in 11 northern and eastern European countries between 1980 and 2004. Key as Fig. 1.

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image

Figure 4. Trends in truncated at 35–64 years age-adjusted (on the world standard population) mortality and incidence rates from kidney cancer per 100 000 women in 11 northern and eastern European countries between 1980 and 2004. Key as Fig. 1.

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DISCUSSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGEMENTS
  8. CONFLICT OF INTEREST
  9. REFERENCES

The present analysis confirms, and further quantifies, the declines in kidney cancer mortality reported from several European countries since the 1990s [1]. In general, the decreases were larger in men, in middle age, and in western European countries. This is consistent with a relevant role of tobacco in kidney cancer risk and mortality, as men, particularly from western Europe, are the population showing more favourable changes in smoking habits over the last few decades.

It is more difficult to understand and explain the favourable trends in kidney cancer mortality in women from most European countries, including France and Spain, or several countries of central and eastern Europe, where the prevalence of tobacco, and consequently, tobacco-related cancer mortality, has been expanding over the last few years [2,19].

Being overweight is a second well recognized risk factor for kidney cancer, after tobacco smoking [20,21]. However, trends in overweight and obesity cannot explain the favourable trends observed in kidney cancer mortality, as, if anything, the prevalence of overweight and obesity has tended to increase over the last few years in several, though not all, European countries [22–24].

Dietary factors might also have some role, but their influence on renal carcinogenesis remains unclear. However, several studies found inverse relationships between a diet rich in vegetables and fruit and kidney cancer [25–30]. Reduced exposure to occupational carcinogens might also have had a favourable role, although the impact of occupational exposures on kidney cancer risk remains unquantified. Hypertension has also been related to the risk of kidney cancer, but it is unclear whether pharmacological control of hypertension might have had some measurable effect on kidney cancer rates [31–33]. Likewise, better control of UTIs might also favourably influence the risk of kidney cancer [21].

In several of the countries providing data, trends in incidence were consistent, or only moderately less favourable, than those in mortality. This indicates that: (i) changes in diagnosis and certification are unlikely to have played a major role in recent trends of kidney cancer mortality in Europe; and (ii), improved and earlier diagnosis, through ultrasonography and other newer imaging techniques, as well as advances in surgical and medical treatment [34], are unlikely to have had a major impact in the favourable trends in kidney cancer mortality, although a moderate influence cannot be excluded.

Thus, the present work confirms and further quantifies the recent favourable trends in kidney cancer mortality and (to a lesser degree) in incidence across most European countries. However, apart from a role of reduced tobacco smoking in men, the interpretation of these trends remains open to discussion.

ACKNOWLEDGEMENTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGEMENTS
  8. CONFLICT OF INTEREST
  9. REFERENCES

This work was conducted with the contribution of the Italian and Swiss Leagues Against Cancer, the Swiss Foundation for Research Against Cancer, and the Italian Association for Cancer Research. The work of this paper was undertaken while C.L.V. was a senior fellow at the International Agency for Research on Cancer, and C.G. a fellow of the Italian Association for Cancer Research.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGEMENTS
  8. CONFLICT OF INTEREST
  9. REFERENCES
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