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Incidence of primary brain tumors

Official reprint from UpToDate® ©2015 UpToDate®

Incidence of primary brain tumors
Dominique Michaud, Sc.D
David Schiff, MD
Tracy Batchelor, MD, MPH

Section Editors
Jay S Loeffler, MD
Patrick Y Wen, MD

Deputy Editor
April F Eichler, MD, MPH

Disclosures: Dominique Michaud, Sc.D Nothing to disclose. David Schiff, MD Grant/Research/Clinical Trial Support:
AngioChem, Stemline Therapeutics, Cortice Biosciences [Glioblastoma]. Consultant/Advisory Boards: Cavion, Genentech,
Heron Therapeutics, Midatech Pharma, Vascular Biogenics, Celldex Therapeutics, Sigma Tau Pharmaceuticals

All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Oct 2015. | This topic last updated: Nov 11, 2015.
INTRODUCTION — Primary brain tumors are a diverse group of neoplasms arising from different cells
of the central nervous system (CNS). Although uncommon, there is evidence that the incidence of these
tumors has been rising for as much as fifty years. (See "Classification of gliomas", section on
'Histopathologic and molecular classification'.)
The incidence of primary malignant and benign brain tumors will be reviewed here. Risk factors for the
development of brain tumors as well as the incidence of brain metastases are discussed separately.
(See "Risk factors for brain tumors" and "Overview of the clinical manifestations, diagnosis, and
management of patients with brain metastases".)
SOURCES OF DATA — The Central Brain Tumor Registry of the United States (CBTRUS) includes both
benign and malignant lesions in its data collection. The CBTRUS was established in 1992 and compiles
information from twelve state cancer registries [1]. Earlier data from the SEER program and other US
cancer registries were limited to malignant brain tumors; however, as of 2004, data on nonmalignant
brain tumors have been systematically collected by US cancer registries after the passage of Public Law
107-260, the Benign Brain Tumor Cancer Registries Amendment Act [2].
Inclusion of benign lesions is important to properly evaluate differences in etiology and to assess the
potential impact of intervention studies. Benign lesions often produce the same neurologic symptoms as
malignant tumors and distinguishing between benign and malignant based upon clinical grounds can be
difficult. In addition, both benign and malignant lesions are frequently treated similarly with either surgical
intervention or radiation therapy, and many malignant brain tumors probably originate from benign
precursors. (See "Classification of gliomas", section on 'Histopathologic and molecular classification'.)
INCIDENCE AND MORTALITY — The US incidence rate for primary brain and nervous system tumors
in adults (aged 20 years or older) is estimated to be 28.6 per 100,000 persons (data from 51 cancer
registries, 2008 to 2012) [3]. Approximately one-third of tumors are malignant and the remainder are
benign or borderline malignant [2,3].
The incidence rate for children (aged 0 to 19 years) is much lower (5.6 per 100,000 children) [3],
although a higher percentage of primary brain tumors are malignant in children compared with adults (65
versus 33 percent) [2].
Mortality — Although brain tumors account for only 2 percent of all cancers, these neoplasms result in a
disproportionate share of cancer morbidity and mortality. The annual age-adjusted mortality rate for
primary malignant brain and CNS tumors in the United States (2008 to 2012) was 5.8 per 100,000
population [4]. Including all ages and all races, the approximate five-year survival rate for malignant brain

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the five year survival rate among children under age 14 is 62 percent. Pituitary tumors account for 15 to 20 percent. Gender — There is a slight male predominance in the incidence of malignant brain tumors. and completeness of surgical resection [8].Incidence of primary brain tumors http://www. Less significant predictors of favorable prognosis include long duration of symptoms. This difference is primarily explained by the higher incidence of meningiomas in women (10.10]. survival rates vary according to age and histologic type. medulloblastoma and other embryonal tumors are uncommon after the age of 20 [12]. The five-year survival rates for the most common histologic subtypes. However. primary central nervous system lymphoma for 2 to 3 percent.000 person-years) [3]. Most intracranial tumors occur in people older than 45 years of age. tumors of the pituitary. high performance status. Adults — In adults. glioblastoma. data from CBTRUS indicate that the incidence of the most common primary malignant brain tumor in adults.. five-year survival rates for medulloblastoma increased by 20 percent from the 1970s to the 1980s. increases with increasing age and is highest in 75 to 84 year olds [3]. Age — The incidence of brain tumors varies with age and histology (figure 1). and high-grade glioma (anaplastic gliomas and glioblastoma). malignant brain tumors are less common among Asian/Pacific Islanders and American Indian/Alaskan Natives [3. medulloblastoma. anaplastic astrocytoma and glioblastoma.. As an example.7 per 100. although autopsy series suggest that incidence rises continuously with increasing age [11]. Exceptions include meningioma. for all primary malignant brain tumors combined. where rates for blacks significantly exceed those observed in whites [3]. young age.5]. small preoperative tumor size.5]. For all histologic types. absence of mental changes at time of diagnosis. cerebellar location of tumor. there were modest gains in survival between 1975 and 1995 for those younger than 65. However. In general. Glioblastoma rarely occurs before the age of 15 but dramatically increases after the age of 45.000 per year and the male-to-female ratio is approximately equal [3].6 versus 5. The most common include low-grade astrocytoma. Data compiled from several tumor registries suggest a peak incidence of all primary brain tumors around age 50. gliomas (principally astrocytoma) account for approximately 30 percent and meningioma 35 to 40 percent of symptomatic primary brain tumors (table 1). when both malignant and benign tumor types are examined. males account for less than one-half of all cases (42 versus 58 percent) [3]. Race — Whites have a higher incidence of primary brain tumors compared with blacks across most histologies [3. tumors is 34 percent [3. Brain tumor incidence rates are approximately 5. Overall survival in patients with malignant brain tumors has not improved significantly over the last fifty years. The incidence of meningioma is likely higher when neuroimaging studies are included because of the large number of asymptomatic tumors [11]. The different histologic subtypes of neuroepithelial brain tumors seen in children and their relative frequency are shown in the following table (table 2). Children — In children and adolescents up to the age of 19 years. although data suggest a leveling off of survival rates [7]. respectively [3]. pediatric and young adult populations have a better survival than do older adults. compared with 5 percent in adults 65 years of age and older [5].8 per but not older individuals [6].uptodate. In contrast. Similarly. while the incidence of malignant brain tumors in Hispanics is intermediate between that in whites or African Americans [3. 2 of 4 11/19/15 7:02 PM . In general. and craniopharyngioma. brain tumors are the most common solid malignancy and the second leading cause of cancer death after leukemia.9]. As an example. and craniopharyngioma for 1 percent. and lower pathologic grade are favorable prognostic factors for primary brain tumors. Although little progress has been made in survival from glioblastoma in the last thirty years. are 28 percent and 5 percent.

17].17]. There is limited epidemiological evidence from a longitudinally studied population in Rochester. Minnesota suggesting that a rise in brain tumor mortality may have been evident since the 1940s [16]. and the United Kingdom. MRI. (See "Clinical presentation. (See 'Mortality' above.13. improved diagnostic capability cannot fully account for the magnitude of the observed increase in brain tumor incidence [9.) ● The incidence of brain tumors varies with age and histology. pathologic features. However. The increases observed in the United States were present in all age strata and racial groups.) ● The overall incidence of brain tumors has been rising. neurosurgical technology) may account for some of the observed disparities.uptodate. this increase seems to be confined mainly to the elderly population. This observation suggests that environmental factors may influence the development of brain cancer. data on the benign tumors are being collected systematically by all cancer registries. and diagnosis of primary central nervous system lymphoma". Primary central nervous system lymphoma — There was an overall increase in the incidence of primary central nervous system lymphoma from the 1960s to the 1990s. it appears that most migrants acquire the brain cancer incidence rates of their host country. are rapidly fatal. There is agreement that at least part of this increase is the result of more complete case ascertainment with improved diagnostic technology [11.14]. which has been attributed at least in part to an increased frequency of these tumors in immunocompromised populations. glioblastomas. As of 2004. gender or geographic differences. while there are a number of less common tumor types that are seen almost exclusively in children (table 2).Incidence of primary brain tumors http://www. leave open the possibility that an environmental exposure may account for part of the increasing incidence of brain tumors. The incidence in whites rose 80 percent from 1950 to 1994 and 18 percent from 1973 to 1994 [5. (See "Risk factors for brain tumors". while developing nations have lower rates.) SUMMARY Benign tumors can produce substantial morbidity and can occasionally be fatal. Despite sparse data from developing countries. However. (See 'Temporal trends' above.) International trends and migrant studies — Increasing incidence rates of brain tumors have been observed in many other countries of the world over the last thirty years. with migrants developing increases in brain cancer incidence and mortality. in conjunction with the evidence suggesting the increase may have been occurring for many decades. For most migrant studies. In general.. Temporal trends — Multiple studies have documented rising incidence rates for brain tumors in several industrialized countries. These data. but there is a possibility that environmental factors may be contributing to a true increase in incidence as well. The precise etiology of this increase in brain tumor incidence remains unclear. Gliomas and meningiomas are most common tumors in adults. similar to findings in other parts of the world [15]. section on 'Epidemiology'. differences in the availability of diagnostic methodology (CT.) The most common malignant brain tumors. Canada. (See 'Sources of data' above. the brain cancer incidence appears to be associated with the level of economic development..) 3 of 4 11/19/15 7:02 PM . with no clear ethnic. The highest incidence rates are noted in industrialized nations such as the United States. the host country had elevated incidence rates compared to the country of origin. ● Mortality data on individuals with brain tumors indicate that younger patients have a significantly better prognosis compared to older individuals. (See 'Age' above. This is most likely due to more frequent diagnosis with improved imaging modalities. these studies were complicated by disparities in case ascertainment in the countries under study.

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