Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun 1;23(6):979-989.
doi: 10.1093/neuonc/noaa282.

Might changes in diagnostic practice explain increasing incidence of brain and central nervous system tumors? A population-based study in Wales (United Kingdom) and the United States

Michael Tin Chung Poon  1   2 , Paul M Brennan  2   3 , Kai Jin  1   2 , Cathie L M Sudlow  1   2 , Jonine D Figueroa  1   2
Affiliations

Might changes in diagnostic practice explain increasing incidence of brain and central nervous system tumors? A population-based study in Wales (United Kingdom) and the United States

Michael Tin Chung Poon et al. Neuro Oncol. .

Abstract

Background: Increasing incidence of central nervous system (CNS) tumors has been noted in some populations. However, the influence of changing surgical and imaging practices has not been consistently accounted for.

Methods: We evaluated average annual percentage change (AAPC) in age- and gender-stratified incidence of CNS tumors by tumor subtypes and histological confirmation in Wales, United Kingdom (1997-2015) and the United States (2004-2015) using joinpoint regression.

Findings: In Wales, the incidence of histologically confirmed CNS tumors increased more than all CNS tumors (AAPC 3.62% vs 1.63%), indicating an increasing proportion undergoing surgery. Grade II and III glioma incidence declined significantly (AAPC -3.09% and -1.85%, respectively) but remained stable for those with histological confirmation. Grade IV glioma incidence increased overall (AAPC 3.99%), more markedly for those with histological confirmation (AAPC 5.36%), suggesting reduced glioma subtype misclassification due to increased surgery. In the United States, the incidence of CNS tumors increased overall but was stable for histologically confirmed tumors (AAPC 1.86% vs 0.09%) indicating an increase in patients diagnosed without surgery. An increase in grade IV gliomas (AAPC 0.28%) and a decline in grade II gliomas (AAPC -3.41%) were accompanied by similar changes in those with histological confirmation, indicating the overall trends in glioma subtypes were unlikely to be caused by changing diagnostic and clinical management.

Conclusions: Changes in clinical practice have influenced the incidence of CNS tumors in the United Kingdom and the United States. These should be considered when evaluating trends and in epidemiological studies of putative risk factors for CNS tumors.

Keywords: cancer registry; epidemiology; incidence; population-based; trends.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Trends in age- and gender-standardized incidence rate of brain and other CNS tumors in Wales and SEER by tumor types 1997-2015. Data from the Secure Anonymised Information Linkage (SAIL) Databank in Wales and from the Surveillance, Epidemiology, and End Results (SEER) in the United States contributed to this analysis. Incidence rates were standardized to the European Standard Population 2013. Vertical dotted line denotes the year at which SEER began to include benign tumors.
Fig. 2
Fig. 2
Trends in age- and gender-standardized incidence rate of gliomas in Wales and SEER by glioma grades 1997-2015.Data from the Secure Anonymised Information Linkage (SAIL) Databank in Wales and from the Surveillance, Epidemiology, and End Results (SEER) in the United States contributed to this analysis. Incidence rates were standardized to the European Standard Population 2013. Vertical dotted line denotes the year at which SEER began to include benign tumors.
Fig. 3
Fig. 3
Number of MRI brain scans performed per 100 000 people in England 2012-2018. Data from the Diagnostic Imaging Dataset (DID) published by the National Health Service (NHS) England. Solid points denote MRI brain scans performed; unfilled points denote scans requested by the general practitioner (GP).
See this image and copyright information in PMC

References

    1. GBD 2016 Brain and Other CNS Cancer Collaborators. Global, regional, and national burden of brain and other CNS cancer, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(4):376–393. - PMC - PubMed
    1. Barnholtz-Sloan JS. Brain and central nervous system tumor statistics: access to accurate data for all countries is critical! Neuro Oncol. 2019;21(3):291–292. - PMC - PubMed
    1. Dobes M, Khurana VG, Shadbolt B, et al. . Increasing incidence of glioblastoma multiforme and meningioma, and decreasing incidence of Schwannoma (2000–2008): findings of a multicenter Australian study. Surg Neurol Int. 2011;2:176. - PMC - PubMed
    1. Korja M, Raj R, Seppa K, et al. . Glioblastoma survival is improving despite increasing incidence rates: a nationwide study between 2000 and 2013 in Finland. Neuro Oncol. 2019;21(3):370–379. - PMC - PubMed
    1. Philips A, Henshaw DL, Lamburn G, O’Carroll MJ. Brain tumours: rise in glioblastoma multiforme incidence in England 1995-2015 suggests an adverse environmental or lifestyle factor. J Environ Public Health. 2018;2018:7910754. - PMC - PubMed

Publication types