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A Statistical Report of the Incidence of First Primary Central Nervous System Tumors in California, 2001-2005

Monica Brown, MPH, PhD, Katrina Bauer, MS, CTR and Deanna LeTendre, RHIT, CTR
Public Health Institute, California Department of Public Health, Chronic Disease Surveillance and Research Branch, Sacramento, California
Rudolph Schrot, MD
Assistant Professor, Department of Neurological Surgery, University of California, Davis
October 2008

Acknowledgement and Disclaimer

The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N01-PC-54404 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement 1U58DP00807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

The authors would like to thank Mark Allen, Research Scientist II and Winny Roshala, CTR, Quality Control Specialist II of the California Cancer Registry for their technical support and editorial guidance.

Introduction

Central nervous system (CNS) cancers encompass neoplasms of the neuroepithelial tissue and membranous coverings of the brain and spinal cord, tumors of the pituitary gland, those arising from the cranial nerves and from CNS hematopoietic cells. All are contained within the bony cranial or spinal vault. First primary CNS tumors (PCNST) are distinguished from subsequent independent tumors of same organ and secondary tumors, which are metastatic from a primary non-neural site. Compared to other forms of cancer, PCNST are rare. In California, these cancers generally represent only 1.5% of incident cancer cases and 2.6% of cancer deaths [1]. Despite these statistics, PCNST are an important source of cancer morbidity and mortality and generate intense interest from clinicians, researchers, the public health community and the general public.

PCNST among children, adolescents and teens differ from those in adults in frequency, histological appearance and clinical behavior.[2] PCNST are the second most common form of cancer among children 15 years and younger and the third most common among those 15-19 years old in California. While PCNST represent only 1.3% of incident cancers among adults, 20 years and older, they represent between 26.4% (5-9 year olds) to 9.5% (15-19 year olds) of incident cancers among persons less than 20 years old.[1] PCNST among children, adolescents and teens tend to have short latent periods, often grow rapidly and are aggressively invasive.[2] They are the second leading cause of cancer death among children less than 15 years old representing between 32% (5-9 year olds) and 12% (15-19 year olds) of cancer deaths as compared to 3% of cancer deaths for adults 20 years and older.[1]

With the enactment of Public Law 107-260 in 2004, the Benign Brain Tumor Cancer Registries Amendment Act, all state and metropolitan cancer registries are now required to collect data on benign PCNST and those of uncertain behavior [3]. The California Cancer Registry began to voluntarily collect benign brain tumor data in 2001. In this study, we examined the incidence of first primary PCNST collected by the CCR from 2001-2005. For benign PCNST, this study period represents the first 5-years of data collection in California and is the first population-based study of benign PCNST in the country. The CCR provides a robust source of epidemiologic data from a densely populous and demographically diverse geographic area. Delineating the epidemiology of PCNST in California will constitute a backdrop for future basic, translational, clinical and public health research and also serve as a baseline for monitoring incidence trends over time.

Materials and Methods

Case Identification

Cases used in these analyses were identified using the California Cancer Registry (CCR), a population-based registry composed of eight regional registries collecting cancer incidence and mortality data for the entire population of California. In 1985, California state law mandated the reporting of all newly diagnosed cancers in California, and statewide implementation began January 1, 1988. This state law was amended requiring the collection of benign and uncertain behavior brain and other nervous system tumors beginning January 1, 2001. Cases are reported to the Chronic Disease Surveillance and Research Branch of the California Department of Public Health from hospitals and any other facilities providing care or therapy to cancer patients residing in California [4]. Cases diagnosed outside of California, at autopsy or from death certificates were excluded. For this study, first primary cases of malignant, benign and uncertain behavior brain and other nervous system tumors diagnosed between January 1, 2001 and December 31, 2005 and reported to the CCR as of October 2007 were used. Only cases diagnosed or treated at the reporting facility were included in these analyses. Diagnoses of 98% of the 24,944 cases were confirmed by histology (79.0%) and radiography (19.3%). The remaining 1.7% was confirmed by a variety of methods, including but not limited to cytology and clinical determination. Less than 0.5% of cases included in these analyses were confirmed by an unknown method. In this manuscript, the term "uncertain behavior" is used and is synonymous with "borderline behavior". These terms are defined similarly but their use is specific to certain classification systems. Uncertain behavior is used in the International Classification of Diseases (ICD) [5] systems, while borderline behavior is the term used by the CDC/NPCR [6], SEER [7] program and thus the CCR. Only cases with anatomical sites, histology codes and tumor behavior defined as reportable in Cancer Reporting in California: Abstracting and Coding Procedures for Hospitals, Volume 1, Section II.1.9.1 and Appendix V were included in these analyses.[8] For children, adolescents and teens, diagnostic groups were organized using the SEER Program's site/histology modification to the International Classification of Childhood Cancer (ICCC).[9, 10] The table below, lists ICCC diagnostic groups by ICD-O-3 morphology and topography codes.

For adults, anatomical sites included were the meninges (C70.0-C70.9), brain (C71.0-C71.9), cerebrum (C71.0), brain lobes (C71.1-C71.4), ventricle, NOS (C71.5), cerebellum, NOS (C71.6), brain stem (C71.7), spinal cord (C72.0), cauda equina (C72.1), cranial nerves (C72.2), pituitary gland (C75.1), craniopharyngeal duct (C75.2) and pineal gland (C75.3).[8] For other selected analyses, overlapping lesions of brain (C71.8), brain, NOS (C71.9) and/or nervous system, NOS (C72.9) were included. Although the use of some anatomical sites and histology codes differed, the 2007-2008 report of CBTRUS, 2000-2004, was used as a guide for the organization of histology codes in Table 2 [11].

The collection of benign and borderline brain and other nervous system tumors became a statewide effort beginning in 2001, however the nationwide effort did not begin until 2004. Inconsistencies in data collection occurred primarily as a result of coding rule changes with cases diagnosed in 2004 and 2005. To utilize all eligible cases, the inconsistencies needed to be resolved. Cross tabulations of cases by histology, behavior, and anatomical site were reviewed by the authors, a regional registry quality control coordinator and a neurosurgeon to determine the accuracy of coding and the appropriate categorization for presentation. Based on their assessment, several cases were reassigned histology, behavior, and/or anatomical site codes, and several more cases were deleted from the research database entirely.

Variables

Age, sex, race/ethnicity and residential address of patient that were used in these analyses were collected by the CCR from the patient’s medical record. Race/ethnicity was derived from patient self-identification, assumptions based on personal appearance, or inferences based on the race/ethnicity of the parents, birthplace, surname, or maiden name. Race/ethnicity was classified into four mutually exclusive categories of non-Hispanic white, non-Hispanic black, Hispanic and Asian-Pacific Islander. Cases with other race/ethnicity, age, or sex were excluded from these analyses. Hispanic ethnicity identification was enhanced by the use of computerized comparisons to the 1980 U.S. census list of Hispanic surnames. Patients identified as Hispanic on the medical record, or patients identified as white, black, or of unknown race with a Hispanic surname were classified as Hispanic. Use of this method can misclassify some persons as Hispanic when they are not [12].

The RUCAs were developed by the University of Washington's Rural Health Research Center (RHRC) and the Economic Research Service. Funding for the development of the RUCAs came from the federal Health Resources and Service Administration's Office of Rural Health Policy and the Department of Agriculture's Economic Research Service [13]. The RUCAs are a census tract-based taxonomy that utilizes the standard Census Bureau Urbanized Area and Urban Cluster definitions in combination with work commuting data to characterize the nation’s census tracts regarding their urban and rural status and functional relationships [14]. For these analyses, urban and rural census tracts in California were dichotomized based on Categorization C as recommended in “Using RUCA Data” published by the RHRC [14].

Socioeconomic status (SES) was assigned based on the patient’s census block group (2000 U.S. census) derived from their address at time of initial diagnosis as reported in the medical record. This SES variable is an index that utilizes education, employment characteristics, median household income, proportion of the population living 200% below the Federal Poverty Level (FPL), median rent and median housing value of census tract of residence for case and denominator population. A principal components analysis was used to identify quintiles of SES ranging from 1 the lowest, to 5 the highest [15].

Statistical Analysis

Counts and proportions were calculated using SAS 9.0, Cary, NC. Age-specific incidence rates (ASIR) were calculated specific to each 5-year age group. When incidence rates were calculated for multiple 5-year age groups, for example among children and adolescents, <15 years old, age-adjusted incidence rates (AAIR) were standardized to the 2000 U.S. standard population.[16] Denominators were based on the 2000 U.S. census. All rates were calculated using SEER*Stat 6.3.6, Silver Spring, MD.

Interpretation of Statistics

This is the first study to examine both malignant and benign PCNST in California [17]. California is a large, heavily populated state with a unique ethnic, cultural and economically diverse population. Since this diversity is reflected in the CCR, we were able to conduct robust analyses and make comparisons that few states and countries can perform. The CCR’s epidemiologic value stems from the 1988 state mandated comprehensive reporting of cancer cases from all physicians, hospitals, clinics, treatment facilities and pathology laboratories. Therefore, a single standard is utilized for statewide data collection, quality assurance, training, and education for cancer registration. This high standard results in optimal case ascertainment and a high level of accuracy for many data items.

Our study and data source are not without limitations. This study was solely conducted using the CCR and was not supplemented with other data. These data are collected for the purpose of surveillance and can be less detailed than those derived from medical records to support the design of a specific research study. Population-based cancer registry data derive from many sources, thus, the quality of some variables could vary. Individual level social indicators are not available to the CCR. Our SES measure is an index based on census tract of residence at diagnosis. This composite measure is more efficient for data analysis, and avoids biases inherent in use of individual component indicators. As with all composite measures, there is a loss of information and/or precision when compared to the use of individual component indicators. Another potential source of error is the misclassification of cases. Despite a rigorous data review and cleaning process, cases could have been misclassified based on tumor behavior, histology, and/or anatomical site.

Cancer incidence is difficult to compare across geographical areas, time-periods, and data systems. Data used in national and international incidence studies, can differ in diagnostic and neuropathological assessment as well as in case ascertainment practices.[18-21] All U.S. statistics and population-based studies on brain or CNS tumors utilize data from one of four centralized systems: the National Program of Cancer Registries (NPCR) operated by the CDC, the North American Association of Central Cancer Registries (NAACCR), a professional organization, the Surveillance Epidemiology and End Results program (SEER) of the NCI, and the Central Brain Tumor Registry of the United States (CBTRUS), a not-for-profit organization. Both NPCR and NAACCR cover more than 95% of the U.S. population[6, 22], while SEER represents only 26%.[7] CBTRUS differs from the other agencies in that it is a voluntary and not mandated repository for CNS tumor data. In 1999, CBTRUS was estimated to cover only 15% of the U.S. population[23], with contributions from 16 state registries (excluding California).[11]

The World Health Organization (WHO) produces the ICD family of classification systems which includes the ICD-O[5] and the WHO grading scheme,[24] both tumor malignancy scales. The ICD-O tumor behavior codes are intended to apply across many neoplasms, whereas the WHO grading scheme is specific to CNS tumors. The ICD-O system is used by cancer data collection agencies, the WHO grading scheme is used by clinicians. The WHO grading scheme does not explicitly have an option for coding tumors of uncertain behavior, therefore discrepancies in coding a similar pathology report can occur.

Differences between PCNST incidence statistics in epidemiologic studies can also arise from the organization of histology code sub-groupings for data presentation. Histology code sub-grouping differences can affect incidence case counts, proportions and rates. SEER designed and implemented an incidence site recode system that standardizes sub-groups for the ICD-O [5]. These variables are based on primary site and histology codes and were added to the SEER data system as a convenience for researchers [7]. This system is used by the CCR as well as all member central cancer registries of NPCR, NAACCR and SEER. This system is not used by CBTRUS or in international studies.

PCNST in California

  • We identified 24,923 cases of first primary central nervous system tumors in the CCR from 2001 to 2005.
  • A total of 9,236 (37.1%) cases were malignant, 14,057 (56.4%) cases were benign and 1,630 (6.5%) cases were of uncertain behavior.
  • The AAIR of malignant PCNST in California was 5.8 cases per 100,000 persons and benign PCNST was 8.5 cases per 100,000 persons. For tumors of uncertain behavior the AAIR was 1.0 per 100,000.
  • Subjects comprising our patient population were mostly adults, 20-64 years old (59.5%); 54.5% female; 60.8% non-Hispanic white; 46.5% of high SES and 93.5% urban residents at the time of diagnosis.

Trends in Incidence

  • Malignant PCNST has been decreasing in all age groups since 1988.
  • Benign PCNST have been increasing. For those less than 20 years old and those, 65 years and older, this increase was statistically significant (p<0.05).
  • PCNST of uncertain behavior have had a slight increase. For those less than 20 years old and those 20-64 years old this increase has been statistically significant (p<0.05).

 

Incidence by Age Groups

  • Age-specific incidence of malignant tumors was lowest for both men and women in their early twenties. The ASIR for men was higher than the ASIR for women, with the gap increasing between ages 40 and 79. Incidence of malignant tumors peaked for both men and women in their late 70's and decreased thereafter.
  • Benign tumors were lowest in childhood and adolescence and increased with increasing age. ASIRs for benign tumors were consistently higher among females for all age groups except for ages 10-14.

PCNST Among Children, Adolescents & Teens

  • There were 2,096 cases of PCNST among children, adolescents and teens, from birth to 19 years old in California from 2001-2005.
  • Of those cases, 1,114 (53.1%) were malignant, 698 (33.3%) were benign and 284 (13.6%) were of uncertain behavior.
  • The AAIR per 100,000 was 2.1 for malignant, 1.3 for benign and 0.5 for tumors of uncertain behavior

Incidence by Age Groups

  • The highest incidence of PCNST was for malignant PCNST among children less than five years old (2.6 per 100,000). This pattern changed for 15-19 year olds where incidence of benign equaled that of malignant (1.7 versus 1.8 per 100,000). The lowest incidence, at every age group, was for tumors of uncertain behavior.
  • The ASIR for boys for malignant and uncertain behavior PCNST were higher than that for girls at all age groups. Incidence rates for girls with benign PCNST were higher than that for boys until 10-14 years old, where they appeared to be same. Benign ASIRs increased among 15-19 year old girls where they exceeded the malignant PCNST rate among boys.
  • Adolescents showed the widest sex-specific gulf for malignant PCNST. The ASIR among girls started to decline dramatically from 5 to 14 years old. Incidence rates for boys declined as well but not as dramatically. When PCNST incidence rates were compared by age group, sex and tumor behavior, we found that the only significant differences were among adolescents.
  • The ASIR for malignant PCNST for adolescent boys was 2.2 and for adolescent girls was 1.5 per 100,000. Malignant PCNST incidence among teen boys was 2.1 and 1.4 per 100,000 for teen girls. Benign PCNST among teen boys was 1.5 but was 2.2 per 100,000 for teen girls (data not shown).

Patient Demographics by Age Group

(Table 1)

  • For nearly all age groups, a higher proportion of malignant and uncertain PCNST were diagnosed among boys, while benign PCNST occurred more frequently in girls. The exception was a higher proportion of benign PCNST among 10-14 year old boys.
  • Hispanic children less than five years old had the highest proportion of PCNST regardless of tumor behavior. Non-Hispanic white adolescents and teens had the highest proportion of PCNST in the 10-14 and 15-19 age groups. In the 5-9 age group, Hispanic children had the highest proportion for tumors with malignant and uncertain behavior, and non-Hispanic white children had the highest proportion of benign PCNST.
  • Among children less than five years old, more cases were from lower SES regardless of tumor behavior. For children 5-9 years old, more cases of malignant and uncertain PCNST were among low SES and more cases of benign PCNST were from high SES. For adolescents and teens, all cases of malignant PCNST were from those in the highest SES. For those 10-14 years old, a higher proportion of benign PCNST were from high SES, a higher proportion of uncertain PCNST were from low SES. For those 15-19 years old, more cases of uncertain behavior were from high SES while more cases of benign behavior were from low SES.

Age-Specific Incidence by Race/Ethnicity

(Table 2)

  • For many age group/race/ethnicity/tumor behavior subgroups, incidence rates could not be calculated due to the small number of cases.
  • Where incidence rates could be calculated and compared, we found no statistically significant differences by race/ethnicity for any age group by tumor behavior.
  • Incidence rates were highest for non-Hispanic whites at every age group by tumor behavior except for children <5 and 15-19, where Asian-Pacific Islanders had a marginally higher malignant incidence rate.

Histology by Tumor Behavior

(Table 3)

  • Among children less than five years old, the primary malignant diagnosis was ependymomas and choroid plexus (IIIA). For children 5-9 years old, other gliomas (IIID) was ranked first only slightly ahead of astrocytomas (IIIB), which was followed closely by medulloblastomas (IIIC1).
  • Germ cell tumors (XA) ranked a close second to astrocytomas (IIIB) among adolescents 10-14 years old.
  • Among teens, benign PCNST classified as other specified intracranial and intraspinal tumors (IIIE) were ranked first. The majority of patients in that sub-category were diagnosed specifically with pituitary adenoma (66.7%). Overall, pituitary adenoma was 20.1% of all diagnoses in this age group.
  • In all age groups, the majority of tumors of uncertain behavior were classified as other specified intracranial and intraspinal tumors (IIIE). In nearly every age group, the majority of those patients were diagnosed specifically with gangliogliomas, representing between 37.0% (5-9 year olds) to 47.8% (10-14 year olds) of those cases (data not shown).
  • Among children less than five years old, there were nearly an equal number of patients diagnosed with craniophargiomas and gangliogliomas (36.1% and 38.9%, respectively) (data not shown).

Histology by Patient Demographics

(Table 4)

  • The distribution of astrocytomas, both malignant and benign, was nearly the same for boys and girls less than 15 years old, while among teens, more astrocytomas were seen in boys. Boys had the highest proportion of cases of ependymomas and choroid plexus tumors and medulloblastomas and PNET tumors.
  • Astrocytomas and PNET tumors were distributed nearly equally among non-Hispanic white and Hispanic children. All other histologies were distributed mostly in adolescents and teen non-Hispanic whites.
  • For children less than 10 years old, ependymomas and choroid plexus tumors and medulloblastomas and PNETs occurred most often in areas of low SES. Astrocytomas occurred mostly in the low SES category for children less than five years old. Among 5-9 year olds, cases of astrocytoma were distributed evenly over SES categories. Among adolescents and teens, there were more cases of astrocytoma in the high SES category. Benign astrocytomas occurred more often in areas of low SES for children ages less than 5 and 15-19 and in areas of high SES for children ages 5-14 years old.

PCNST Among Adults, 20-64 Years Old

  • There were 14,819 cases of PCNST among adults, 20-64 years old.
  • Of those cases, 5,202 (35.1%) were malignant, 8,676 (58.6%) were benign and 941 (6.3%) were of uncertain behavior.
  • The AAIR per 100,000 was 5.1 for malignant, 8.3 for benign and 0.6 for tumors of uncertain behavior.
  • Our patient population was 53.6% female; 58.6% non-Hispanic white; 46.9% of high SES and 93.3% urban residents at time of diagnosis (Table 5)

Age-Adjusted Incidence by Sex and Race/ethnicity

  • Incidence of malignant tumors was highest for non-Hispanic white men (7.6 per 100,000), followed by non-Hispanic white women and Hispanic men (5.0 and 4.9 per 100,000 respectively).
  • Incidence rates were lowest for Asian-Pacific Islander and non-Hispanic black women (2.6 and 2.5 per 100,000 respectively).
  • Incidence of benign tumors was highest for all women with rates by race/ethnicity being very close, ranging from 10.5 to 9.1 per 100,000). These differences were not statistically significant.
  • Incidence rates for tumors of uncertain behavior were similar regardless of sex and race/ethnicity.

Distribution of Cases by Sex and SES

  • The proportion of malignant tumors was highest for high in men SES (9.9%) followed by low SES (6.7%).
  • Similarly, the proportion of benign tumors was highest for women in the highest SES (16.6%) followed by women in the low SES (12.4%).
  • The proportion of tumors of uncertain behavior was similarly distributed regardless of sex or SES.

(Table 5)

Histology by Tumor Behavior

(Table 6)

  • Malignant PCNST were primarily glioblastoma (43.8%).
  • The majority of benign tumors consisted of meningiomas (44.5%), followed by pituitary tumors (28.2%) and nerve sheath tumors (23.5%). These 3 histologies represented 96% of all benign PCNST.
  • The largest proportion of tumors of uncertain behavior were meningiomas (25.2%) followed by hemangioblastomas (18.2%) in this age group.

Histology by Patient Demographics

(Table 7) (Table 8) (Table 9)

  • The AAIR for glioblastomas among men was nearly twice the rate among women, while the rate of meningiomas among women was nearly 3 times the rate among men.
  • Non-Hispanic white men had significantly the highest AAIR of glioblastoma (3.6 per 100,000).
  • Non-Hispanic white men and women had the highest AAIR for nerve sheath tumors (2.5 and 2.3 per 100,000, respectively).
  • Non-Hispanic black and white women had the highest AAIR for meningiomas (6.0 and 5.9 per 100,000, respectively).
  • Non-Hispanic black women and men, and Hispanic women had the highest incidence of pituitary tumors (3.5, 3.2 and 3.4 per 100,000, respectively).

PCNST by Anatomic Site and Patient Demographics

(Table 10) (Table 11)

  • Malignant PCNST were primarily of the "lobes of the brain" (58.8%), followed distantly by "overlapping lesions of the brain" (15.6%).
  • Malignant tumors by anatomical site were found most often among men (59.7%), non-Hispanic whites (64.3%) and Hispanics (23.1%), those in the highest SES group (47.1%) and urban dwellers (93.3%).
  • Hispanics had higher proportions of tumors of the cerebellum (36.4%) and ventricles (34.2%), and Asian-Pacific Islanders had higher proportions of tumors of the pineal gland (16.3%) relative to other anatomical sites.
  • Benign PCNST were primarily of the meninges (41.4%) and the pituitary gland (28.3%).
  • The distribution of benign cases was similar to the distribution of malignant PCNST except that benign tumors were seen mostly in women (62.4%).
  • Hispanics had a higher proportion of tumors of the pituitary gland (35.7%) relative to other anatomical sites.
  • Benign PCNST classified as Brain/Nervous System, NOS (45.8%) were more frequent among patients of low SES compared to other sites.

PCNST Among Seniors, 65 Years and Older

  • There were 8,008 cases of PCNST among seniors, 65 years and older.
  • Of those cases, 2,920 (36.5%) were malignant, 4,683 (58.5%) were benign and 405 (5.1%) were of uncertain behavior.
  • The AAIR per 100,000 was 15.6 for malignant, 24.8 for benign and 1.3 for tumors of uncertain behavior.
  • Our patient population was 58.3% female; 69.8% non-Hispanic white; 47.6% of high SES and 92.9% urban at the time of diagnosis (Table 12).

Age-Adjusted Incidence by Sex and Race/Ethnicity

  • Incidence of malignant tumors was highest for senior non-Hispanic white men (20.7 per 100,000), followed by Hispanic men (18.4 per 100,000 respectively).
  • Incidence of benign tumors was highest for senior non-Hispanic black men and women at 31.9 and 31.4 per 100,000, respectively. These rates far exceed those of both men and women in the 20-64 year old age group.
  • Although the AAIR was higher than that for 20-64 year olds, the incidence pattern was the same for tumors of uncertain behavior among seniors, being similarly distributed regardless of sex or race/ethnicity.

Distribution of cases by Sex and SES

 

  • Malignant tumors were more frequent among senior men in the high SES group (9.3%) followed by senior women in the high SES group (8.4%).
  • Benign tumors were more frequent among women in the highest SES group (17.1%) followed by women in the lowest SES group (12.2%).
  • Tumors of uncertain behavior were similarly distributed regardless of sex or SES.

Histology by Tumor Behavior

(Table 13)

  • Malignant PCNST were primarily glioblastoma (63.4%).
  • The majority of benign tumors consisted of meningiomas (71.8%).
  • The largest proportion of tumors of uncertain behavior was meningiomas (43.0%).

Histology by Patient Demographics

(Table 14) (Table 15) (Table 16)

  • The AAIR for glioblastomas was four times higher among senior men than those 20-64 years (12.2 compared to 2.9 per 100,000) and 1.5 times greater than senior women. Senior non-Hispanic white and Hispanic men had the highest incidence of glioblastomas at 13.7 and 12.4 per 100,000, respectively.
  • The AAIR for meningiomas among senior women was nearly four-fold that of women 20-64 years old (22.2 compared to 5.6 per 100,000) and twice that of senior men. Senior non-Hispanic black and Asian-Pacific Islander women had the highest AAIR at 23.2 per 100,000 followed closely by senior non-Hispanic white and Hispanic women (22.1 and 21.1 per 100,000, respectively).
  • The AAIRs for lymphomas were similar for senior men and women (1.6 and 1.4 per 100,000, respectively). Senior Asian-Pacific Islander men had the highest AAIR at 2.3 per 100,000.
  • Senior Asian-Pacific Islander men had the highest incidence of nerve sheath tumors at 4.0 per 100,000.
  • Senior non-Hispanic black men had the highest incidence of pituitary tumors at 14.8 per 100,000. This is four-times the rate found among non-Hispanic black men 20-64 years old.

PCNST by Anatomic Site and Patient Demographics

(Table 17) (Table 18)

  • Malignant PCNST occurred more frequently in the "lobes of the brain" (57.9%), followed distantly by "overlapping lesions of the brain" (19.9%).
  • Malignant tumors by anatomical site were distributed evenly among senior men and women (50.9% versus 49.1%).
  • The vast majority of benign tumors were of the meninges (66.9%).
  • Overall, benign tumors were seen mostly in women (63.9%).

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