Trends in Brain Cancer Incidence and Survival in the United States: Surveillance, Epidemiology, and End Results Program, 1973 to 2001.

Sundeep Deorah, M.A.; Charles F. Lynch, M.D., Ph.D.; Zita A. Sibenaller, Ph.D.; Timothy C. Ryken, M.D.

Disclosures

Neurosurg Focus. 2006;20(4):E3 

In This Article

Abstract and Introduction

Object: An increasing incidence of brain cancer has been reported for the last three decades. In this study of brain cancer incidence and patient survival in the US, the authors attempt to update information on trends by examining data provided by the Surveillance, Epidemiology, and End Results (SEER) Program.
Methods: Population-based data from the SEER Program were used to calculate the incidence of and survival rates for people with brain cancer. The approximate Poisson method was used to calculate relative risks for brain cancer and to determine a 95% confidence interval. Annual age-standardized incidence rates were calculated, and time-trend analysis was conducted using joinpoint regression analysis.
The relative risks of brain cancer were 1.48 for men compared with women, 3.18 for elderly persons compared with young adults, 1.86 for Caucasian patients compared with African-American patients, and 1.35 for those in metropolitan counties compared with those in nonmetropolitan counties. The incidence of brain cancer increased until 1987, when the annual percentage of change reversed direction, decreasing from 1.68 to –0.44%. The elderly experienced an increase until 1985, but their rates were stable thereafter. Rising trends were noticed for glioblastoma multiforme (GBM), oligodendroglioma, anaplastic astrocytoma, medulloblastoma, and mixed glioma, and falling trends were observed for astrocytoma not otherwise specified and malignant glioma. The survival rate for patients with GBM has not shown improvement in the last two decades.
Conclusions: Increased risk of brain cancer is associated with being male, Caucasian, elderly, and residing in a metropolitan county. The incidence rate of brain cancer in the US is gradually declining, but the rising trend of GBM combined with its poor survival rate is disconcerting and needs further exploration.

Primary brain cancers have attracted increased attention in recent decades because, although the survival rate continues to remain poor, there are several reports suggesting an increasing trend in incidence rates.[8,10,11,13,15] The bulk of this increase is reportedly due to rising incidence rates among the elderly and children.[6,8,11,13] Although the exact reasons behind this trend are debatable, one reason could be that our ability to diagnose intracranial neoplasms improved dramatically after the introduction of CT in the 1970s and MR imaging in the early 1980s.[4] The use of stereotactic brain biopsy procedures and a more aggressive approach toward the diagnosis of elderly persons with neurological symptoms have likewise made their own contributions to the observed trend.[13] It is not known whether these technological advances are entirely responsible for the increasing trend or if environmental and lifestyle risk factors or the increase in life expectancy are driving the incidence rates. Recently, several epidemiological studies attempting to link the use of cellular phones with the occurrence of brain tumors have renewed concern about brain cancer incidence.[7,14]

An evaluation of the trend of increased brain cancer cases has important implications, both from clinical and public health standpoints, because it may lead to the improvement of diagnostic methods or the identification of a potential new risk factor. Accurate estimates of incidence rates help clinicians select an appropriate sample size for their clinical studies. Public health officials base their resource allocations and functions on such accurate estimates of disease burden in the community. Furthermore, histology-specific trends could suggest possible explanations for the rate of disease incidence, including etiological risk factors.

In this descriptive study, we examine the incidence of brain cancer in the US using the SEER database during a period encompassing the introduction of CT and MR imaging and the widespread use of cellular phones. We also provide population-based survival rates for patients with brain cancer. Both tumor incidence and patient survival are described by the patient's race, sex, place of residence, and duration of survival.

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