title: Cancer incidence among US Medicare ESRD patients receiving hemodialysis, 1996-2009.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD) receiving dialysis have been reported to have increased risk of cancer. However, contemporary cancer burden estimates in this population are sparse and do not account for the high competing risk of death characteristic of dialysis patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  US adult patients enrolled in Medicare's ESRD program who received in-center hemodialysis.
  
  
  METHODS
  Demographic/clinical characteristics.
  
  
  RESULTS
  For overall and site-specific cancers identified using claims-based definitions, we calculated annual incidence rates (1996-2009). We estimated 5-year cumulative incidence since dialysis therapy initiation using competing-risk methods.
  
  
  RESULTS
  We observed a constant rate of incident cancers for all sites combined, from 3,923 to 3,860 cases per 100,000 person-years (annual percentage change, 0.1; 95% CI, -0.4 to 0.6). Rates for some common site-specific cancers increased (ie, kidney/renal pelvis) and decreased (ie, colon/rectum, lung/bronchus, pancreas, and other sites). Of 482,510 incident hemodialysis patients, cancer was diagnosed in 37,128 within 5 years after dialysis therapy initiation. The 5-year cumulative incidence of any cancer was 9.48% (95% CI, 9.39%-9.57%) and was higher for certain subgroups: older age, males, nonwhites, non-Hispanics, nondiabetes primary ESRD cause, recent dialysis therapy initiation, and history of transplantation evaluation. Among blacks and whites, we observed 35,767 cases compared with 25,194 expected cases if the study population had experienced rates observed in the US general population (standardized incidence ratio [SIR], 1.42; 95% CI, 1.41-1.43). Risk was most elevated for cancers of the kidney/renal pelvis (SIR, 4.03; 95% CI, 3.88-4.19) and bladder (SIR, 1.57; 95% CI, 1.51-1.64).
  
  
  CONCLUSIONS
  Claims-based cancer definitions have not been validated in the ESRD population. Information for cancer risk factors was not available in our data source.
  
  
  CONCLUSIONS
  These results suggest a high burden of cancer in the dialysis population compared to the US general population, with varying patterns of cancer incidence in subgroups.
authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: anne.butler@unc.edu.
authors: Anne M
authors: AM
authors: Butler
authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Andrew F
authors: AF
authors: Olshan
authors: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Abhijit V
authors: AV
authors: Kshirsagar
authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Jessie K
authors: JK
authors: Edwards
authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Matthew E
authors: ME
authors: Nielsen
authors: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Stephanie B
authors: SB
authors: Wheeler
authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: M Alan
authors: MA
authors: Brookhart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D011471:Prostatic Neoplasms / Q000453:epidemiology; D006435:Renal Dialysis; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: Hemodialysis; US Renal Data System (USRDS); cancer incidence; cancer risk factor; carcinoma; chronic kidney failure; claims-based cancer definition; diagnostic code; end-stage renal disease (ESRD); malignancy; tumor