Less overdiagnosis of kidney cancer? An age-period-cohort analysis of incidence trends in 16 populations worldwide

Abstract

The increasing rates of kidney cancer incidence, reported in many populations globally, have been attributed both to increasing exposures to environmental risk factors, as well as increasing levels of incidental diagnosis due to widespread use of imaging. To better understand these trends, we examine long-term cancer registry data worldwide, focusing on the roles of birth cohort and calendar period, proxies for changes in risk factor prevalence and detection practice respectively.

We used an augmented version of the Cancer Incidence in Five Continents series to analyse kidney cancer incidence rates 1978-2007 in 16 geographically representative populations worldwide by sex for ages 30-74, using age-period-cohort (APC) analysis.

The full APC model provided the best fit to the data in most studied populations. While kidney cancer incidence appears to have been increasing in successive generations born from the early 20^th century to mid-1970s in most countries, period-specific rates were increasing since late 1970-s, followed by a stabilization from the mid-1990s in certain European countries (Czech Republic, Lithuania, Finland, Spain) as well as Japan, and from the mid-2000s, in Colombia, Costa Rica and Australia.

Our results indicate that the effects of both birth cohort and calendar period contribute to the international kidney cancer incidence trends. While cohort-specific increases may partly reflect the rising trends in obesity prevalence and the need for more effective primary prevention policies, the attenuations in period-specific increases (observed in 8 of the 16 populations) highlight a possible change in imaging practices that could lead to mitigation of overdiagnosis and overtreatment. This article is protected by copyright. All rights reserved.

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