URINARY-TRACT CANCER AND HEREDITARY NONPOLYPOSIS COLORECTAL-CANCER - RISKS AND SCREENING OPTIONS

Purpose: We investigate the risk of the different types of urinary tra ct cancer in hereditary nonpolyposis colorectal cancer families and re view screening options. Materials and Methods: We retrospectively calc ulated the relative and cumulative risks of developing urinary tract c ancer by comparing tumor occurrence in patients and their first degree relatives in the Dutch hereditary nonpolyposis colorectal cancer regi stry with those in the general Dutch population. A person-year analysi s was used, including data on 1,321 individuals from 50 hereditary non polyposis colorectal cancer families. Results: The relative risk of de veloping transitional cell cancer of the renal pelvis or ureter was 14 .04 (95% confidence interval 6.69 to 29.45, p <0.05) and the cumulativ e risk was 2.6%. The risks of renal (excluding renal pelvis) and bladd er cancers were not significantly increased. Urinary tract cancer was diagnosed at a relatively young age and many women were affected. Some familial clustering was observed. Conclusions: Our findings indicate that hereditary nonpolyposis colorectal cancer is associated with an i ncreased risk of transitional cell cancer of the upper urinary tract. The cumulative risk is relatively low, although a subset of hereditary nonpolyposis colorectal cancer families may be exposed to a much high er risk. As yet nothing is known of the clinical impact of screening f or urinary tract cancer in cases of hereditary nonpolyposis colorectal cancer. In a research setting screening by excretory urography of her editary nonpolyposis colorectal cancer families with a strong history of upper urinary tract cancer should be considered.