- Breast and cervical cancer are the leading cause of
death in women.
- The prevalence of cancer in women with chronic
kidney disease (CKD) is two fold higher compared to women in general
- But most women with advanced CKD do not receive
screening for breast and cervical cancer.
Women with advanced kidney disease do not receive the
recommended breast or cervical cancer screening.
Such women face a higher risk of developing cancer compared to women in general
population. The prevalence of cancer is two fold higher in women with advanced kidney disease, finds a new study.
The increased risk appears to be specific for cancers of
- Urinary tract
- Viral-related (human-papillomavirus)
- Digestive tract
Chronic Kidney Disease
Chronic kidney disease
a long-term disease of the
kidneys in which the ability of the kidneys to function normally is gradually
lost. Most of the time, CKD is caused by chronic conditions like diabetes and
high blood pressure that affects the functioning of kidneys over time.
‘Cancer screening has the potential to improve cancer outcomes. Therefore a better understanding of patient and health professional preferences toward cancer screening among women with chronic kidney disease is necessary.’
Progression of this condition leads to kidney failure, which requires dialysis or kidney transplant for sustenance of life.
About 26 million adults across the U.S have CKD and millions are at the risk of developing the condition.
In women, breast cancer is the most common
consequence of CKD followed by cancers of the lung and urinary tract.
Kidney transplant increases the risk of
cancer by three to four-fold
Dialysis increases the risk of cervical, kidney, bladder, stomach, thyroid and
lung cancers. After dialysis, cancer risk increases by 10% to 80%.
Breast and cervical cancer screening is especially
important in women with chronic kidney disease (CKD) because cancer is a
significant cause of illness and death in such patients.
The research team led by Germaine Wong, PhD, (The University of Sydney,
in Australia), Jade Hayward, and Danielle Nash, PhD (Institute for Clinical
Evaluative Sciences, ICES Western facility, in Ontario, Canada) examined the patterns of breast and cervical cancer
screening in women with CKD, based on the stage and age of the kidney disease and assessed the predictors of screening.
In the retrospective study, researchers gathered data from
2002 to 2013 from the Ontario, Canada administrative healthcare databases.
The study included:
- 141,326 women for breast cancer
women for cervical cancer screening
Screening rates for breast and cervical cancer were low
- Older women
- Women with advanced stage kidney
disease that required
- Women with higher burden of co-morbidities
associated with CKD
- Women belonging to the lower
The two-year cumulative incidences of breast cancer
- 61% among women without CKD,
- 54% for those with CKD stage 3,
- 37% for CKD stages 4 and 5,
- 26% for women with kidney failure
who were on dialysis
Similar patterns were observed for the three-year
cumulative incidences of cervical cancer screening.
Breast and Cervical Cancer
In the United States, breast cancer is the most common type
of cancer that affects women after skin cancer. According to the American
Cancer Society, breast cancer
estimates for 2016 are
- Around 246, 660 new cases of
invasive breast cancer
- Around 61,000 new cases of
non-invasive breast cancer
- Around 40,450 women are expected
to die due to breast cancer
In India, according to the Indian Council of Medical
Research, there will be around 1.5 lakh new cases of breast cancer in 2016.
is once one of the most
common causes of cancer death for American women. According to the American
Cancer Society, the estimates for cervical cancer in the United States for 2016
- About 12,990 new cases of invasive cervical cancer
will be diagnosed.
- About 4,120 women will die from cervical cancer.
cases of cervical cancer occur in women younger than 50 years. It rarely develops
in women younger than 20 years. About 20% of cervical cancers are found in
women older than 65 years.
used of Pap test has reduced the incidence of cervical cancer by 50% in the
last 40 years. Pap test can detect early cancerous changes in the cervix and
identify the disease when it is most curable.
research team concluded that the main cause of lower screening rates among
older women with advanced chronic kidney disease on dialysis may be because they may be lacking in capacity to deal with the
complexity of dialysis management. This
may have prompted them to potentially neglect less imminent
issues such as preventive health care and early cancer detection
"Given that cancer screening has the potential to
improve cancer outcomes, targeted strategies to inform shared decision making
in screening is critical." said Dr. Wong
In an accompanying editorial, Deidra Crews, MD, ScM and
Waseem Khaliq, MBBS, MPH, (Johns Hopkins University School of Medicine) noted
that "enhanced coordination of care between nephrologists, general
practitioners and women's health care providers may serve to promote cancer
screening among women with CKD. Ultimately, however, nephrologists may forge
long-term trusting relationships with kidney patients that will afford them the
greatest opportunity to engage in shared-decision making together and select
the cancer screening plan that is most appropriate for the patient's individual
health status and personal priorities."
The findings appear in the Clinical Journal of the
American Society of Nephrology
- Germaine Wong, et al. Patterns and Predictors of Screening for Breast and Cervical Cancer in Women with CKD. Clinical Journal of the American Society of Nephrology; (2016) doi:10.2215/CJN.05990616
- About Chronic Kidney Disease - (https://www.kidney.org/kidneydisease/aboutckd)
- Chronic kidney disease and cancer: a troubling connection - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823382/)
- Inhibiting the GRP78 Protein in Estrogen Receptor-Positive Breast Cancer Reduces Resistance to Treatment - (//www.medindia.net/news/healthinfocus/inhibiting-the-grp78-protein-in-estrogen-receptor-positive-breast-cancerreduces-resistance-to-treatment-163980-1.htm)
- What are the key statistics about cervical cancer? - (http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-key-statistics)