Neoplasia in dialysis patients: pathophysiology, epidemiology, and screening

Chronic renal failure can be considered an immunosuppressed state. One immunologic function that may be compromised is tumor surveillance. Studies have suggested an incidence of cancer that is greater in dialysis patients that in the age- and sex-matched non dialysis population. A drawback to many previous studies is "ascertainment bias," wherein closely monitored populations have a higher rate of cancer detection. However, allowing for systematic bias, a true increase in neoplasia appears to exist in dialysis patients. While many agencies have established protocols for cancer screening in the general population, little has been written about recommendations for cancer screening in dialysis patients. Moreover, the high mortality from cardiovascular disease may render cancer screening protocols redundant and cost-ineffective. This article offers recommendations that emphasize that risk profile of individual patients rather than a population-based approach to cancer screening.