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Effect of smoking, hypertension and lifestyle factors on kidney cancer — perspectives for prevention and screening programmes

Nature Reviews Urology volume 20, pages 669–681 (2023)Cite this article

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Abstract

Renal cell carcinoma (RCC) incidence has doubled over the past few decades. However, death rates have remained stable as the number of incidental renal mass diagnoses peaked. RCC has been recognized as a European health care issue, but to date, no screening programmes have been introduced. Well-known modifiable risk factors for RCC are smoking, obesity and hypertension. A direct association between cigarette consumption and increased RCC incidence and RCC-related death has been reported, but the underlying mechanistic pathways for this association are still unclear. Obesity is associated with an increased risk of RCC, but interestingly, improved survival outcomes have been reported in obese patients, a phenomenon known as the obesity paradox. Data on the association between other modifiable risk factors such as diet, dyslipidaemia and physical activity with RCC incidence are conflicting, and potential mechanisms underlying these associations remain to be elucidated.

Key points

  • Optimal secondary prevention methods for renal cell carcinoma (RCC) are to be determined, but opportunistic screening for other causes might have a role in this context. Attempts to standardize screening for RCC have been reported, but RCC incidence in the overall population is too low to hamper any positive results. Additional studies are needed to establish patient risk factors.

  • Well-established modifiable risk factor for RCC are smoking, obesity and hypertension.

  • Mechanistic insights into the role of smoking as a risk factor for RCC are still immature. However, inhibition of the catabolism of oligosaccharide chains mediated by smoking seems to have a role in cancer growth.

  • Obesity was shown to increase the risk of RCC by almost two-folds. Conversely, patients with advanced or metastatic RCC seem to benefit from obesity in terms of survival owing to fat immunoinfiltrates, which ameliorate patients’ outcomes by facilitating destruction of cancer cells.

  • Hypertension is a risk factor for RCC incidence and poor prognosis; however, the overlap with obesity needs to be elucidated.

  • The effects of diabetes, dyslipidaemia or metabolic syndrome on RCC risk seem to overlap, and results from existing studies are conflicting. Similarly, the role of physical activity, diet and alcohol as risk factors for RCC is not well described in the literature.

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Fig. 1: Risk factors for RCC.

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  1. These authors contributed equally: Riccardo Campi, Giacomo Rebez.

Authors and Affiliations

  1. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy

    Riccardo Campi

  2. Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands

    Riccardo Campi, Giacomo Rebez, Tobias Klatte, Eduard Roussel, Idir Ouizad, Alexander Ingels, Nicola Pavan, Onder Kara, Selcuk Erdem, Riccardo Bertolo, Umberto Capitanio & Maria Carmen Mir

  3. Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy

    Giacomo Rebez & Nicola Pavan

  4. Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK

    Tobias Klatte

  5. Department of Urology, KU Leuven, Leuven, Belgium

    Eduard Roussel

  6. Department of Urology, Bichat-Claude Bernard Hospital, Paris, France

    Idir Ouizad

  7. Department of Urology, Henri Mondor Hospital, Créteil, France

    Alexander Ingels

  8. Faculty of Medicine, Kocaeli University, İzmit, Turkey

    Onder Kara

  9. Department of Urology, Istanbul University, Istanbul, Turkey

    Selcuk Erdem

  10. Urology Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy

    Riccardo Bertolo

  11. Department of Urology, San Raffaele Scientific Institute, Milan, Italy

    Umberto Capitanio

  12. Division of Experimental Oncology/Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy

    Umberto Capitanio

  13. Department of Urology, Hospital Universitario La Ribera, Valencia, Spain

    Maria Carmen Mir

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Contributions

R.C., G.R., E.R., I.O., A.I., N.P., O.K., S.E., R.B., U.C. and M.C.M. made a substantial contribution to discussion of content. R.C., T.K., E.R., I.O., A.I., N.P., O.K., S.E., R.B., U.C. and M.C.M. researched data for the article. All authors wrote the article. M.C.M., R.C. and G.R. reviewed/edited the manuscript before submission.

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Correspondence to Maria Carmen Mir.

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Nature Reviews Urology thanks Alina Vrieling; Teemu Murtola, who co-reviewed with Antti Pöyhönen; and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Campi, R., Rebez, G., Klatte, T. et al. Effect of smoking, hypertension and lifestyle factors on kidney cancer — perspectives for prevention and screening programmes. Nat Rev Urol 20, 669–681 (2023). https://doi.org/10.1038/s41585-023-00781-8

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