title: Modest improvement in 20 years of kidney cancer care in the Netherlands.
abstract: OBJECTIVE
  For an evaluation of the progress achieved in the field of kidney cancer care in the Netherlands in the last decades, we described trends in incidence, treatment, mortality and relative survival.
  
  
  METHODS
  All adult patients newly diagnosed with kidney cancer between 1989 and 2009 (N=32,545) were selected from the Netherlands Cancer Registry. Age-standardised incidence and mortality rates were calculated. Follow-up was completed until January 2010. In order to assess trends estimated annual percentages of change (EAPC) were estimated.
  
  
  RESULTS
  The incidence of kidney cancer has been fairly stable between 1989 and 2001 with a European Standardised Rate of approximately 11 per 100,000 person years (PY). Since 2001 the incidence increased to 13 per 100,000 PY in 2009 (EAPC: 2.4%; 95%confidence interval (CI): 1.5 to 3.4%). The mortality rate decreased slightly over time, from 6.2 per 100,000 PY in 1989 to 5.6 in 2010. No changes in treatment were observed, except for the introduction of targeted therapies for stage IV disease, since 2005. The 5-year relative survival improved from 51% in 1989-1994 to 58% in 2005-2009 (EAPC: 0.9%; 95%CI 0.7 to 1.2%). Improvement in survival was especially seen in males, younger age groups and low stages.
  
  
  CONCLUSIONS
  The incidence of kidney cancer has increased slightly, and survival improved modestly, resulting in a decreasing mortality. A positive effect of the introduction of targeted therapies for metastatic kidney cancer was observed in 1-year relative survival. For progress in kidney cancer care, effective prevention strategies and new therapies remain warranted.
authors.affiliation: Dept of Cancer Registry and Research, Comprehensive Cancer Centre the Netherlands, Utrecht, The Netherlands. s.vandeschans@iknl.nl
authors.forename: Saskia A M
authors.initials: SA
authors.lastname: van de Schans
authors.forename: Katja K H
authors.initials: KK
authors.lastname: Aben
authors.forename: Peter F A
authors.initials: PF
authors.lastname: Mulders
authors.forename: John B A G
authors.initials: JB
authors.lastname: Haanen
authors.forename: Carla
authors.initials: C
authors.lastname: van Herpen
authors.forename: Rob H A
authors.initials: RH
authors.lastname: Verhoeven
authors.forename: Henrike E
authors.initials: HE
authors.lastname: Karim-Kos
authors.forename: Egbert
authors.initials: E
authors.lastname: Oosterwijk
authors.forename: Lambertus A L M
authors.initials: LA
authors.lastname: Kiemeney
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D055815:Young Adult