title: Increased risk of cancer in chronic dialysis patients: a population-based cohort study in Taiwan.
abstract: BACKGROUND
  An increased incidence of cancer in chronic dialysis patients has not been confirmed in the Chinese population. The aim of this population-based study was to examine the risk of various types of cancers in chronic dialysis patients in Taiwan.
  
  
  METHODS
  Data of 92 348 chronic dialysis patients extracted from the National Health Institutes Research Database during 1997-2008 were analyzed. Patients newly diagnosed with end-stage renal disease, free of cancer and receiving dialysis for >3 months were eligible for inclusion in the study.
  
  
  RESULTS
  After a mean follow-up of 4.4 years, a new cancer was diagnosed in 4328 chronic dialysis patients. The standardized incidence ratio (SIR) of chronic dialysis patients was 1.4 [95% confidence interval (CI): 1.3-1.4] and annual incidence of cancer was 1.1%. A trend of an increased SIR of cancer was observed in young patients and within the first year of dialysis. Bladder cancer carried the highest SIR (SIR: 8.2, 95% CI: 6.7-9.9) and had the highest frequency (21.2%). Importantly, the frequency (15.3%) of liver cancer was the second highest and the SIR (SIR: 1.4, 95% CI: 1.2-1.5) of liver cancer in chronic dialysis patients was higher than that of their healthy counterparts. Unexpectedly, chronic dialysis patients had a significantly reduced risk of developing lung cancer.
  
  
  CONCLUSIONS
  Increased risk of cancer in chronic dialysis patients is confirmed in the Taiwanese population and it is necessary to develop different strategies for cancer screening in chronic dialysis patients among different ethnicities.
authors.affiliation: Institute of Medical Sciences, Department of Public Health, Tzu Chi University, and Department of Internal Medicine, Hualien Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
authors.forename: Hsuen-Fu
authors.initials: HF
authors.lastname: Lin
authors.forename: Yi-Hwei
authors.initials: YH
authors.lastname: Li
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Wang
authors.forename: Chu-Lin
authors.initials: CL
authors.lastname: Chou
authors.forename: De-Jhen
authors.initials: DJ
authors.lastname: Kuo
authors.forename: Te-Chao
authors.initials: TC
authors.lastname: Fang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult