15.3 Risk factors

Table 15.2 Risk factors for kidney cancer, by direction of association and strength of evidence


Increases risk

Decreases risk

Convincing or probable

Tobacco smoking1


Body fatness2,3,4




High blood pressure6



Arsenic and inorganic arsenic compounds7


Cadmium and cadmium compounds7


Ionizing radiation8


Family history of kidney cancer9,10,11


Smokeless tobacco12,13


Antihypertensive drugs6,14, 15

Occupational exposure to trichloroethylene16


1 Secretan et al., 2009; 2 World Cancer Research Fund / American Institute of Cancer Research, 2007; 3 Ildaphonse et al., 2009;

4 Mathew et al., 2009; 5 Ljunberg et al., 2011; 6 Corrao et al., 2007; 7 Straif et al., 2009; 8 El Ghissassi et al., 2009; 9 one or more first degree relative(s) with cancer of the kidney; 10 Hung et al., 2007; 11 Clague et al., 2009; 12 chewing tobacco or snuff; 13 Lee and Hamling, 2009; 14 diuretic and non-diuretic; 15 Grossman et al., 2001; 16 Kelsh et al., 2010; 17 Lee et al., 2007

The two most common types of kidney cancer are renal cell carcinoma and urothelial cell carcinoma of the renal pelvis; the majority (over 90%) are renal cell carcinomas. Tobacco smoking is causally associated with renal cell cancer in both men and women (Table 15.2): there is a dose-response relationship with number of cigarettes smoked and, in some studies, risk reduces after cessation of smoking (International Agency for Research on Cancer, 2004b). An association between use of smokeless tobacco and kidney cancers in general has also been suggested.

As regards other lifestyle-related risk factors, pooled analysis of prospective studies suggests that drinking alcohol may be associated with a moderately decreased risk of renal cell cancers. In contrast, studies consistently show that body fatness is associated with elevated risk. Overall, risk increases by almost one-third per 5kg/m2 increase in body mass index and perhaps to a slightly greater extent in women than men.

Advanced kidney disease, which makes dialysis necessary, raises the risk of renal cell cancer, but the underlying mechanism is unclear. Hypertension has also been associated with a 60% increased risk of renal cell cancer. Risk may also be raised in those who have used antihypertensive drugs, but whether the associations hold in men and women and after adjustment for other risk factors is somewhat uncertain.

Exposure to cadmium and cadmium compounds, which generally takes place occupationally, and to arsenic or inorganic arsenic compounds, which may be occupational or ingested in food or drinking water, is likely to cause kidney cancer. Occupational exposure to tricholoroethylene, a hydrocarbon commonly used as an industrial solvent, has been associated with a modestly raised risk, but concerns remain about whether the association could be due to uncontrolled confounding.

After accounting for other risk factors, risk of kidney cancer in general, and renal cell cancer in particular, is increased by between 40% and 100% in those with at least one affected first degree relative.

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