Ed immune system, nutritional deficiencies, and altered DNA repair [5]. There are also predisposing factors that contribute to the higher incidence of certain cancers in dialysis patients. Acquired renal cystic kidney disease increases the risk of renal cell carcinoma [11]. Long-term use of analgesics is a risk factor for transitional cell carcinoma of the bladder, ureter, and renal pelvis and for renal cell carcinoma [11?3]. In addition,the use of prolonged oral cyclophosphamide is a risk factor for bladder cancer [14]. Notably, there is an increased risk of several infection-associated cancers, such as the liver, cervix uteri, and tongue [5, 15?7]. The higher prevalence of infection with hepatitis B and C and human papillomavirus in HD patients probably accounts for the increased risks of these cancers [18?0]. In contrast, it remains controversial whether the risk of cancer of the lung, stomach, colon, breast, and corpus uteri is increased in patients with ESRD [5, 15?7]. In Japan, the most common cancer in ESRD patients is renal PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/15501003 cell carcinoma, and the second is multiple myeloma, followed by liver and colon cancer in males and uterine cancer in females [21]. In contrast, while the most common cancer in ESRD patients in the USA is renal Vandetanib cell carcinoma as is in Japan, the second is prostate cancer in males and breast cancer in females [22]. In addition, whether cancer risk differs between transplant periods (under immunosuppression) and periods of dialysis after transplant failure (when immunosuppression is ceased or reduced) was investigated in a retrospective cohort of 8173 kidney transplant recipients [23]. In the multivariate analysis, incidences of non-Hodgkin lymphoma, lip cancer, and melanoma, which were included in infection- or immune-related cancers, were lower during dialysis after transplant failure whereas the incidence of thyroid cancer, which was shown to be included in ESRD-related cancer, was lower during periods of transplant function. More recently, a larger retrospective study including 202,195 kidney transplant candidates and recipients also examined whether cancer risk changes betweenKitai et al. Renal Replacement Therapy (2016) 2:Page 3 oftransplant periods and periods of dialysis [22]. Due to the large sample size, this study provided more precise estimates of many individual cancers. In this study, individuals with transplants had higher adjusted risks of Kaposi sarcoma; non-Hodgkin lymphoma; Hodgkin lymphoma; melanoma; and cervical, anal, vaginal/vulvar, penile, otopharyngeal, liver, stomach, lung, lip, and non-epithelial skin cancers (which were included in infection- or immune-related cancers) than those with nonfunctioning kidneys on waiting lists and those with graft failure. In contrast, individuals with nonfunctioning kidneys had higher adjusted risks of kidney and thyroid cancers, which were considered to be related to ESRD. These studies indicated that the risk of infection- or immune-related cancers was higher in transplant recipients with functioning kidneys whereas the risk of ESRD-related cancers was higher in those under dialysis following kidney failure.Cancer screening in the ESRD population Standard malignancy-screening recommendations are based on the assumption that those screened would have a normal life span. It must be taken into consideration that benefit may be reduced or absent in individuals with low life expectancy. There is a general agreement that routine cancer screening is unlikel.