LNSLNS

We thank Prof. Triebig for his comments on the S3 guideline on renal cell carcinoma and our review article (1). He draws attention to an important occupational medical aspect in the epidemiology of renal cell carcinoma. On the basis of data from toxicity analyses, animal experiments, and epidemiological studies, the International Agency for Research on Cancer (IARC) classifies trichloroethylene as carcinogenic to humans (group 1 carcinogen) (2). Occupational exposure to trichloroethylene as a risk factor for developing renal cell cancer is of particular importance in this setting.

Cohort studies so far have not consistently shown an association between exposure to trichloroethylene and the risk of renal cell cancer. Two recent meta-analyses of available case-control and cohort studies have confirmed a moderate increase in the risk of renal cell carcinoma in association with a particularly high occupational exposure to trichloroethylene, with a meta-RR (relative risk) of 1.58 (95% confidence interval [1.28; 1.96]) (3, 4). Basically, any renal cell carcinoma may also be an occupational cancer. The proportion of occupationally caused cancers among cases of renal cell carcinoma occurring in Germany is altogether estimated as small. In addition to trichloroethylene, cadmium (cadmium compounds) and haloalkanes, aryl halides, or alkaryloxides (documentation on occupational diseases of the German employer’s liability insurance association, leaflet BK 1310) are possible carcinogens for renal cell carcinoma. Occupational exposure to carcinogens needs to be considered by doctors when taking a patient’s medical history, so as to be able to meet their obligation to notify an occupational disease to the relevant authorities.

The importance of renal cell carcinoma as an occupational disease has thus far not been considered in the S3 guideline. Prof. Triebig’s valuable comments are therefore welcome suggestions for further additions to the guideline and will be included in the forthcoming update.

DOI: 10.3238/arztebl.2017.0160b

On behalf of the authors:

Prof. Dr. med. Christian Doehn

Urologikum Lübeck, doehn@urologikum-luebeck.de

Prof. Dr. med. Steffen Weikert

Leiter der Leitlinien-Arbeitsgruppe Epidemiologie, Risikofaktoren, Prävention und Früherkennung

Conflict of interest statement

Prof. Doehn owns stock in Bayer Healthcare, AstraZeneca, and BMS. He has served as a paid consultant for Bayer Healthcare, BMS, GSK, Janssen-Cilag, Novartis, Pfizer, and Roche. He has received reimbursement of meeting participation fees from BMS, GSK, Novartis, and Pfizer, and reimbursement of travel and accommodation expenses from BMS, GSK, Novartis, Pfizer, and Roche. He has received payment for preparing scientific meetings from Bayer Healthcare, BMS, GSK, Novartis, Pfizer, and Roche.

Prof Weikert declares that no conflict of interest exists.

1.
Doehn C, Grünwald V, Steiner T, Follmann M, Rexer H, Krege S: The diagnosis, treatment and follow-up of renal cell carcinoma. Dtsch Arztebl Int 2016; 113: 590–6 VOLLTEXT
2.
IARC: Trichloroethylene, tetrachloroethylene, and some chlorinated agents. IARC
monographs on the evaluation of carcinogenic risks to humans. International Agency for Research on Cancer. World Health Organization, Lyon. Vol 106, 2014: 35–217.
3.
Scott CS, Jinot J: Trichloroethylene and cancer: systematic and quantitative review of epidemiologic evidence for identifying hazards. Int J Environ Res Public Health 2011: 4238–72 CrossRef MEDLINE PubMed Central
4.
Karami S, Lan Q, Rothman N, et al.: Occupational trichloroethylene exposure and kidney cancer risk: a meta-analysis. Occup Environ Med 2012: 858–67 CrossRef MEDLINE
1.Doehn C, Grünwald V, Steiner T, Follmann M, Rexer H, Krege S: The diagnosis, treatment and follow-up of renal cell carcinoma. Dtsch Arztebl Int 2016; 113: 590–6 VOLLTEXT
2.IARC: Trichloroethylene, tetrachloroethylene, and some chlorinated agents. IARC
monographs on the evaluation of carcinogenic risks to humans. International Agency for Research on Cancer. World Health Organization, Lyon. Vol 106, 2014: 35–217.
3.Scott CS, Jinot J: Trichloroethylene and cancer: systematic and quantitative review of epidemiologic evidence for identifying hazards. Int J Environ Res Public Health 2011: 4238–72 CrossRef MEDLINE PubMed Central
4.Karami S, Lan Q, Rothman N, et al.: Occupational trichloroethylene exposure and kidney cancer risk: a meta-analysis. Occup Environ Med 2012: 858–67 CrossRef MEDLINE

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