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Cancer Screening in Renal Transplant Recipients: What Is the Evidence?

Germaine Wong^*,, Jeremy R. Chapman, and Jonathan C. Craig

^* National Health and Medical Research Council Centre for Clinical Research Excellence in Renal Medicine, Children's Hospital at Westmead and Centre for Transplant and Renal Research, Westmead Hospital, Westmead, and School of Public Health, University of Sydney, Sydney, New South Wales, Australia

Correspondence: Dr. Germaine Wong, Centre for Kidney Research, Children's Hospital at Westmead, Locked bag 4001, Westmead, NSW 2145, Australia. Phone: +61-0-2-98455-1488; Fax: +61-0-2-9845-1493; E-mail germainw{at}chw.edu.au

Increased cancer risk is well established in the renal transplant population. Little, however, is known about the benefits and harms of cancer screening, treatment effectiveness, and the overall cancer prognosis in renal transplant recipients. In this study, we critically appraised guidelines for cancer screening in the renal transplant and general populations using standard criteria for an evidence-based screening program. Guidelines were included when they were applied to adult participants, had objectives specific to cancer screening, and were written in English. Recommendations for breast and colorectal cancer screening in the general population were supported by evidence of cancer-specific mortality benefits from randomized, controlled trials of cancer screening. Convincing evidence from observational studies had demonstrated population cervical cancer screening was effective, also, test performance of mammography, faecal occult blood testing, and Pap smear were accurate. Population breast, colorectal, and cervical cancer screening also appeared to be good value for money in the general population. On the contrary, recommendations for cancer screening in renal transplant recipients were entirely extrapolated from data in the general population. Studies in the general population have led to the development of cancer screening guidelines in transplant recipients. Because of increased cancer risk, differences in diagnostic test performance, competing risks for deaths from causes such as cardiovascular disease and reduced overall life expectancies, validity of their recommendations are uncertain. Future studies are needed to address these issues to provide the necessary evidence for informed decision-making.