Objective : To look for an increase in the incidental detection of renal cell carcinoma (RCC) over the last two decades and to see if different patterns of healthcare use for men and women have implications for tumour detection and survival.

Material and Methods : We present an historical series of 368 consecutive patients treated with nephrectomy for RCC during the period 1978-2000. The patients were classified according to detection mode (incidental or symptomatic disease), TNM stage and cancer-related death.

Results : The frequency of incidentally detected RCC (IRCC) increased from 21.1% to 34.7% between the first and second decades of the study. The IRCC group had significantly more low-stage (I-II) tumours ( p = 0.002), a smaller tumour size ( p < 0.0001) at operation and significantly better cancer-specific survival ( p = 0.0048) than the symptomatic renal cell carcinoma (SRCC) group. The frequency of women was significantly higher in the IRCC group than in the SRCC group ( p = 0.02). Females had significantly more low-stage (I-II) tumours ( p = 0.02) and better cancer-specific survival ( p = 0.05) than males.

Conclusions : The number of incidentally discovered renal tumours is increasing. IRCC have lower TNM-stage and are smaller than SRCC. IRCC have better long term cancer specific survival than SRCC. The better survival rate found in females may be due to more extensive use of the healthcare system by females than males.