- Medical School, Australian National University, Canberra, Australia
- Department of Neurosurgery, Canberra Hospital, Canberra, Australia
- Epidemiology Unit, Canberra Hospital, Canberra, Australia
- Department of Pathology, Canberra Hospital, Canberra, Australia
- Department of Cancer Services, Royal North Shore Hospital, Sydney, Australia
- Department of Radiation Oncology, Prince of Wales Hospital, Sydney, Australia
- Department of Neurosurgery, Children's Hospital at Westmead, Sydney, Australia
Vini G. Khurana
Department of Cancer Services, Royal North Shore Hospital, Sydney, Australia
DOI:10.4103/2152-7806.90696Copyright: © 2011 Dobes M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Dobes M, Khurana VG, Shadbolt B, Jain S, Smith SF, Smee R, Dexter M, Cook R. Increasing incidence of glioblastoma multiforme and meningioma, and decreasing incidence of Schwannoma (2000–2008): Findings of a multicenter Australian study. Surg Neurol Int 13-Dec-2011;2:176
How to cite this URL: Dobes M, Khurana VG, Shadbolt B, Jain S, Smith SF, Smee R, Dexter M, Cook R. Increasing incidence of glioblastoma multiforme and meningioma, and decreasing incidence of Schwannoma (2000–2008): Findings of a multicenter Australian study. Surg Neurol Int 13-Dec-2011;2:176. Available from: http://sni.wpengine.com/surgicalint_articles/increasing-incidence-of-glioblastoma-multiforme-and-meningioma-and-decreasing-incidence-of-schwannoma-2000-2008-findings-of-a-multicenter-australian-study/
Background:The incidence of primary brain tumors by subtype is currently unknown in Australia. We report an analysis of incidence by tumor subtype in a retrospective multicenter study in the state of New South Wales (NSW) and the Australian Capital Territory (ACT), with a combined population of >7 million with >97% retention rate for medical care.
Methods:Data from histologically confirmed primary brain tumors diagnosed from January 2000 through December 2008 were weighted for patient outflow and data completeness, and age standardized and analyzed using joinpoint analysis.
Results:A significant increasing incidence in glioblastoma multiforme (GBM) was observed in the study period (annual percentage change [APC], 2.5; 95% confidence interval [CI], 0.4–4.6, n = 2275), particularly after 2006. In GBM patients in the ≥65-year group, a significantly increasing incidence for men and women combined (APC, 3.0; 95% CI, 0.5–5.6) and men only (APC, 2.9; 95% CI, 0.1–5.8) was seen. Rising trends in incidence were also seen for meningioma in the total male population (APC, 5.3; 95% CI, 2.6–8.1, n = 515) and males aged 20–64 years (APC, 6.3; 95% CI, 3.8–8.8). Significantly decreasing incidence trends were observed for Schwannoma for the total study population (APC, –3.5; 95% CI, –7.2 to –0.2, n = 492), significant in women (APC, –5.3; 95% CI, –9.9 to –0.5) but not men.
Conclusion:This collection is the most contemporary data on primary brain tumor incidence in Australia. Our registries may observe an increase in malignant tumors in the next few years that they are not detecting now due to late ascertainment. We recommend a direct, uniform, and centralized approach to monitoring primary brain tumor incidence by subtype, including the introduction of nonmalignant data collection.
Keywords: Australia, cancer, incidence, late ascertainment, primary brain tumor
Trends in the overall incidence of primary brain tumors have been widely reported as either increasing,[
In the United States, Inskip et al.[
An absence of any overall trend in the incidence of brain cancers in both males and females in the population of England during 1998–2007 was recently reported.[
Given the limited data regarding primary brain tumor incidence from Australasian sources, our goal was to develop an understanding of the Australian incidence with age-, sex-, and pathology-specific analyses and trends. The three pathological subtypes analyzed in this paper, namely glioblastoma multiforme, meningioma, and Schwannoma, are consistent with previous publications,[
A full account of our methods has been published recently.[
A retrospective multicenter analysis was performed from January 2009 through July 2010 of all 13 pathology databases servicing the 24 neurosurgical centers, including all major teaching hospitals, in the Australian Capital Territory (ACT) and New South Wales (NSW) recording brain tumors diagnosed during 2000–2008. The population of NSW and ACT increased from 6.8 to 7.3 million between 2000 and 2008. Databases were queried with control for repeated presentations to and tumor recurrence in individual institutions. Data were initially collected for years 1994–2008, with complete data from all centers available from mid-1999.[
Inclusion and exclusion criteria
Approximately 12,000 records were analyzed for the period of diagnosis (2000–2008), with exclusion of records based on diagnosis, topography, and completeness, yielding a total of 7251 records for final analysis. All tumors were microscopically confirmed at a single pathology department but no independent review was performed as this was beyond the scope of the current study. Systemic lymphoma, and metastatic, extracerebral, and germ cell tumors were excluded from the analysis (not presented but discussed in our previous paper[
Coding and grading
International Classification of Diseases, 10th Edition (ICD-10), and Systematized Nomenclature of Medicine (SNOMED) classification systems were used to code all records according to 2004 guidelines of the Centers for Disease Control and Prevention.[
Standardization and statistical analysis
The ACT and NSW populations were used to benefit from the relatively low outward migration rate. Cross-border flows were estimated at 3.2% using 2008 Australian Hospital Statistics data for public and private hospitals[
Incidence by pathology
The most frequently encountered histology was a malignant tumor, glioblastoma multiforme (GBM; 30%, n = 2275) followed by a predominantly nonmalignant tumor, meningioma (24%, n = 1865). Pituitary tumors and Schwannoma accounted for 13% (n = 960) and 6% (n = 492) of all tumors, respectively. The primary malignant tumor incidence was found to have increased by approximately 35% between 2000 and 2008 (APC, 3.9; 95% CI, 2.4–5.4) with most of this increase occurring after 2006 [Figures
US standardized brain tumor incidence rates by major histological groupings by calendar year in the Australian Capital Territory and New South Wales populations for the (a) total population, (b) male population, and (c) female population. Confidence intervals are displayed. Asterisk denotes significance
A weighted total of 2275 GBM (n = 2197, 96.5%), gliosarcoma (n = 62, 2.7%), and giant cell glioblastoma (n = 17, 0.7%) were collected during 2000–2008, with a 1.6:1 male:female predominance. A significant increase in the incidence of all GBM from 3.22 to 3.96 cases per 100,000 person-years was observed in the study period of years 2000–2008 (APC, 2.5; 95% CI, 0.4–4.6;
US standardized brain tumor incidence rates for glioblastoma multiforme by calendar year in the Australian Capital Territory and New South Wales populations for the total population, total population aged 65 years and above, and male population aged 65 years and above. Confidence intervals are displayed. All three trends show a significant (*) increase using joinpoint analysis
A weighted total of 1865 meningiomas were collected during 2000–2008, with a 2.6:1 female:male predominance. Of these tumors, 92% were WHO Grade I, 7% WHO II, and 1% WHO III. From 2000 to 2008, a significantly increasing incidence trend in meningioma in men, both for total male population (APC, 5.3; 95% CI, 2.6-8.1, n = 515) and in males aged 20–64 years (APC, 6.3; 95% CI, 3.8–8.8), was observed [
US standardized brain tumor incidence rates for meningioma for the total male population and male population aged 20–64 years by calendar year from the Australian Capital Territory and New South Wales populations. Confidence intervals are displayed. Both trends show a significant (FNx01) increase using joinpoint analysis
Nerve sheath tumors
A weighted total of 492 nerve sheath tumors were used in the analysis, with a 1.1:1 female:male ratio. The current collection did not include extra-cerebral nerve sheath tumors, so the majority (76%) were labeled acoustic neuroma/vestibular Schwannoma, 12% were labelled as cerebellar, and 12% as cerebral not otherwise specified (NOS). A significantly decreasing trend was observed in all Schwannoma cases for the period of 2000–2008 (APC, –3.5; 95% CI, –7.2 to –0.2), that was significantly present in women (APC, –5.3; 95% CI, –9.9 to –0.5) but not in men (APC, –1.0; 95% CI, –7.9 to –6.3;
The key finding of this two-part study[
The recent published incidence rates (2004–2006) from the Central Brain Tumor Registry of the United States (CBTRUS) for GBM (3.17 ± 0.04 per 100,000 person-years)[
Significant trends were observed for meningioma in the period 2000–2008, particularly in men. These trends held significance when nonhistologically confirmed tumors from the region's largest SRS center were excluded (data not presented). The 2010 CBTRUS report for data for the period 2004–2006 quotes the incidence of male meningioma as 3.76 (95% CI, 3.70–3.83) cases per 100,000 person-years.[
Nerve sheath tumors
Female nerve sheath tumors in the 2010 CBTRUS publication quote an incidence rate of 1.60 (95% CI, 1.57–1.64) cases per 100,000 person-years.[
A recent study from Denmark presenting 2283 cases of vestibular Schwannoma over a 42-year study period reported an increasing incidence from 0.31 to 2.28 tumors per 100,000 person-years between 1976 and 2004, and stabilizing at 1.94 tumors per 100,000 person-years in 2008.[
Strengths and limitations of this study
We are primarily concerned with histologically confirmed primary intracerebral tumors and our collection excludes tumors diagnosed solely based on clinical, imaging, and post-mortem examination. Our study has a relatively high rate of histological specificity, with a low rate of nonspecific codes used,[
The limitations of our study have been described in our preceding publication.[
The current study represents the most contemporary collection of primary brain tumors in Australia and underpins the importance of continued monitoring. We observed significant increases in incidence rates for GBM, particularly after 2006, and meningioma with overall incidence rates comparable to recent US and European data. Incidence trends for Schwannoma, in contrast to the European experience, were observed to be significantly decreasing, but were akin to overall Schwannoma incidence rates from the United States. We are unaware of any recent peer-reviewed publications reporting a significant increase in primary brain tumor incidence, including GBM, during surveillance years as recent as those reported in the present study, which distinctively analyzes primary brain tumor incidence data as recent as December 2008. We support a direct, uniform, and centralized approach to monitoring primary brain tumor incidence by histopathological subtype, including the introduction of nonmalignant data collection.
The authors are grateful to the following participating centers and researchers: the Canberra Hospital (Dr. Martin Dobes, Dr. Vini Khurana, Dr. Sanjiv Jain, Dr. Bruce Shadbolt, Ms. Narelle Brodie), Children's Hospital at Westmead (Dr. Mark Dexter, Dr. Nicole Graf), Royal North Shore Hospital and North Shore Private Hospital, Dalcross Private Hospital, the Mater Hospital (Dr. Ray Cook, Dr. Robert Eckstein, Dr. Janice Brewer, Dr. Sarah F. Smith), the Prince of Wales Cancer Center (Dr. Robert Smee, Ms. Kathryn Broadley), St. Vincent's Public and Private Hospitals (Dr. Adrienne Morey, Ms. Lisa Katon), the Royal Prince Alfred Hospital, Liverpool Hospital, Concord Repatriation General Hospital (Dr. Paul McKenzie, Dr. Michael Buckland, Ms. Chris Hill), Douglass Hanly Moir Pathology, St. George Private Hospital (Dr. Warick Delprado, Ms. Alison Morgan), John Hunter Hospital (Dr. Stephen Braye, Ms. Tina Hope), Prince of Wales Public and Private Hospitals, St. George Public Hospital, Royal Hospital for Women, Sydney Children's Hospital (Dr. Catherine Camaris, Mr. Keith Westbury), Sydney Adventist Hospital (Dr. Bevan Hokin), Southern IML Pathology, Wollongong Hospital (Dr. Alistair Lochhead, Ms. Li Ma), Nepean Hospital (Dr. Stuart Adams, Ms. Bhuvana Ayer), and Westmead Public and Private Hospitals (Dr. Michael Bilous, Ms. Kinjal Patel). The authors wish to thank all of the neurosurgeons and pathologists whose efforts provided the basis for this multicenter study.
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