Kidney transplantation is the only cure for progressive kidney failure that requires renal replacement by dialysis. This intervention is now very successful, but is limited by increased mortality associated with infection, cardiovascular disease, and cancer. One important cancer related cause of death in this population is colorectal cancer. In a linked research paper (doi:10.1136/bmj.e4657), Collins and colleagues study the prevalence of this cancer in kidney transplant recipients aged over 50 years and the diagnostic accuracy of colonoscopy screening in this population.1

Although deaths from colorectal cancer are starting to fall in the general population, probably because of greater public awareness and more systematic screening,2 kidney transplant recipients have a twofold increased risk of de novo colorectal cancer.3 4 5 These patients are often younger at diagnosis than those in the general population. Their five year survival rate was also significantly lower than for other patients with colorectal cancer in an observational study that used the National Cancer Institute Survival, Epidemiology and End Result (SEER) database.6 This worse prognosis is probably related to increased tumour aggressiveness, reduced …