The objective of this report is to provide a current overview of the ...

CBTRUS Central Brain Tumor Registry of the United States

CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2004-2007

February 2011

ACKNOWLEDGMENTS This report was prepared by the CBTRUS executive team and the research staff at the University of Illinois at Chicago, School of Public Health. The CBTRUS data presented in this report were provided through an agreement with the Centers for Disease Control and Prevention (CDC), National Program of Cancer Registries (NPCR). In addition, CBTRUS used data from the research data sets of the National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) Program. CBTRUS acknowledges and appreciates these contributions to this report and to cancer surveillance in general. Sources of geographic population-based cancer registry data included in this report: Alabama Alaska Arizona Arkansas California Colorado ConnecticutSEER Delaware District of Columbia Florida Georgia HawaiiSEER Idaho Illinois Indiana IowaSEER Kentucky Louisiana Maine Massachusetts Michigan Minnesota Mississippi Missouri

Montana Nebraska New Hampshire New Jersey New MexicoSEER New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas UtahSEER Vermont Virgina Washington West Virginia Wisconsin Wyoming

SEER

Data obtained from the SEER research data files for these population-based cancer registries. All other population-based cancer registry data provided by the NPCR.

Copyright information: All material in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Suggested citation: CBTRUS (2011). CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2004-2007. Source: Central Brain Tumor Registry of the United States, Hinsdale, IL. website: www.cbtrus.org

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BACKGROUND The Central Brain Tumor Registry of the United States (CBTRUS) was incorporated with a founding and sustaining grant from the Pediatric Brain Tumor Foundation in 1992 following a two–year study conducted by the American Brain Tumor Association to determine the feasibility of a central registry for all primary brain and central nervous system (CNS) tumor cases in the United States. Until that time, standard data reporting in the United States had been limited to only malignant cases. Non–malignant brain tumors, however, may, and often do, impose the same costs to society in terms of medical care, case fatality, and lost productivity as malignant brain tumors. A histologically non–malignant brain tumor may produce devastating effects based on its location, while a malignant tumor may not produce visible symptoms. In addition, as molecular markers have been discovered, it has become clear that certain non–malignant brain tumors may become malignant over time. Passed in 2002, the Benign Brain Tumor Cancer Registries Amendment Act (Public Law 107–260) expanded the collection of primary brain and CNS tumor data by the National Program of Cancer Registries (NPCR) to include tumors of benign and uncertain behavior beginning with the 2004 diagnosis year. All state cancer registries now include data on primary nonmalignant brain and CNS tumors in their collection practices. Starting in 2004, Uniform Data Standards guide the collection of non-malignant brain & CNS tumors; in 2005, the Uniform Data Standards for the collection of malignant brain & CNS tumors were revised. In 20102011 the Multiple Primary and Histology Coding Rules for malignant and non-malignant brain and central nervous system tumors have been undergoing revision. The CBTRUS database contains the largest aggregation of population–based data on the incidence of all primary brain and CNS tumors in the United States. Non–malignant brain and CNS tumors include those tumors with a benign behavior code of "0" or uncertain behavior code of "1" as specified in the International Classification of Diseases for Oncology, Third Edition (ICD-O-3). 1 This CBTRUS Report contains data collected from the National Program of Cancer Registries (NPCR) and states belonging to the National Cancer Institutes’ Surveillance, Epidemiology and End Results (SEER) program as its data sources. Data from forty-eight population-based cancer registries were included. This Statistical Report continues the past efforts CBTRUS has made to provide population– based incidence rates for all primary brain and CNS tumors by histology, age, gender, race and Hispanic origin. As in previous reports, these data have been organized by histological groupings that are useful for surveillance and may serve as a baseline for comparison with regional rates. They are also important for allocation and planning of specialty health–care services, for planning programs for disease prevention and control, and in the development of research proposals. These data may lead to clues that will stimulate research into the causes of this terrible disease. In the past three CBTRUS statistical reports using NPCR and SEER data, only one, two or three years of data were collected, while this report includes four years of data. As rates are often calculated as an average over 5 years to stabilize the yearly variation, rates having fewer years of data included may be less reliable. Future CBTRUS Reports will add new years of data and will eventually result in publications with 5 year increments, a standard surveillance reporting interval. CBTRUS will continue to share its expertise and to work cooperatively with the larger surveillance organizations and brain tumor clinicians and researchers to insure that primary brain tumors are collected and reported as accurately and completely as possible. 3

DISCLAIMER The Central Brain Tumor Registry of the United States (CBTRUS) is a not–for–profit corporation that gathers and disseminates epidemiologic data on primary brain and CNS tumors in order to facilitate research and establish awareness of the disease. CBTRUS makes no representations or warranties, and gives no other assurances or guarantees, expressed or implied, with respect to the accuracy or completeness of the data presented. The information provided in this publication is not intended to assist in the evaluation, diagnosis or treatment of disease in any individual person. Persons with questions regarding their own disease should contact their own physician to obtain medical assistance.

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BRAIN TUMOR STATISTICS: REPORT AND FIGURES The objective of this Statistical Report is to provide a current overview of the descriptive epidemiology of primary brain and central nervous system (CNS) tumors in the United States. CBTRUS has obtained data on all primary brain and CNS tumors from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) program. Incidence rates of primary malignant and non-malignant brain and CNS tumors for 2004-2007 were calculated by gender, age, race, and Hispanic origin. TECHNICAL NOTES Data Collection CBTRUS obtained incidence data from 48 population-based cancer registries that include cases of malignant and non–malignant (benign and uncertain) primary brain and central nervous system tumors. Data were requested for all primary malignant and non-malignant (benign or uncertain) brain and central nervous system (CNS) tumors newly diagnosed in 2004, 2005, 2006, and 2007 at any of the following sites (ICD-O-3 topography codes in parentheses): brain (C71.0–C71.9), meninges (C70.0–C70.9), spinal cord, cranial nerves, and other parts of the central nervous system (C72.0–C72.9), pituitary and pineal glands (C75.1– C75.3), and olfactory tumors of the nasal cavity [C30.0 (9522–9523)].1 Data were received without direct personal identifiers. Population data for each geographic region were obtained from the SEER program website, which receives yearly population estimates from the U.S. Census Bureau.2 The National Program of Cancer Registries (NPCR) provided data on 219,598 primary brain and CNS tumors diagnosed in 2004-2007. NPCR cancer registries had to both agree to participate in the CBTRUS Statistical Report and to pass certain data quality standards required by NPCR in order for CBTRUS to receive the data. From the Surveillance, Epidemiology, and End Results (SEER) program research dataset, data from state cancer registries not included in the NPCR data were obtained and included 9,206 primary brain and CNS tumor case records diagnosed in 2004-2007. These data were combined into a single data set for analyses. A total of 2,013 records (0.88%) were deleted from the final data analyses because of invalid site/histology combinations based on a review by the CBTRUS consulting neuropathologist or because of reclassification or duplicate records. Of these, 64 cases had bilateral acoustic neuromas in which one record was deleted and the other record was re-coded from right or left laterality to bilateral laterality and retained in the analytic data set. The final analytic data set included 226,791 records from 48 population-based cancer registries. Definition of Rates Rates measure the occurrence of disease in a population. They are calculated by counting the observed numbers of cases of an event occurring in a defined population within a specified time period and dividing by the total population at risk within the same time period. As an example, in this report the incidence of brain tumors in a state is calculated by adding the total number of newly diagnosed cases of brain tumors within that state for the years of interest and dividing by the state populations for the same years. 5

Incidence Rates measure the occurrence of newly diagnosed cases of disease. Mortality Rates quantify the number of people who have died from the disease. Prevalence Rates measure the number of people with a disease at a particular point in time or during a particular period of time. Survival Rates (percents) are the probability of surviving for a specified time period. Relative Survival Rates are defined as the observed probability of survival adjusted for the expected survival rate of the United States population for that age, gender, and calendar year. Incidence and mortality rates in this report are expressed in units of Person–Time with each person–year reflecting one individual over one year. For cancer, rates are usually expressed per 100,000 person–years. The rate of disease in an entire population is the Crude Rate. Crude rates are frequently adjusted by age. Age–Adjusted Rates to a common standard population allows for comparisons of rates across regions with different age structures. Cancer rates in this report are adjusted to the Year 2000 U.S. Standard Population. Rates for a subset of a population are specific rates. Age–Specific Rates that describe the rate of disease in a defined age group are presented in this report. Specific rates by race, Hispanic origin, and gender are also reported. The variability around the estimates of rates is reflected in the standard error, which is incorporated into the formula for computing the confidence interval associated with a certain rate. A Confidence Interval is the computed interval with a given probability, e.g., 95 percent, that the true value of a variable such as a mean, proportion, or rate is contained within the interval. For example, the age–adjusted primary brain tumor incidence rate is 19.3 cases per 100,000 person–years. We can be 95 percent certain that the actual incidence rate is within the range of 19.3 and 19.4 cases per 100,000 person–years. In order to be able to compare incidence rates among statistical reports, agencies, or registries, one must determine whether the case definition, data collection, and rate calculation are similar by asking some of the following questions: How is an incident case defined? Are all primary malignant and non–malignant tumors included in the analysis? Are only malignant tumors included in the analysis? What tumor locations (primary sites) are included in the analysis? Are lymphomas and hematopoietic neoplasms included in the incidence rates? Are the populations comparable? Are the incidence rates age–adjusted? And if so, to which standard population are they age–adjusted? Differences in case definition, data collection, methodology, analysis, and rate computation may prevent the direct comparison of published rates between sources or within sources over time. Classification by Histology The histology groupings used in this report were developed in collaboration with the CBTRUS consulting neuropathologist, Dr. Janet Bruner, of the University of Texas M.D. Anderson Cancer Center. These clinically relevant groupings are broadly based on the World Health Organization (WHO) categories for brain tumors.3,4 The list of ICD-O morphology codes included in each group is presented in Table 1. The classification scheme utilizes ICDO–3 codes1 and may include morphology codes that were not previously reported to CBTRUS.5 In Tables 1a and 1b, we present a list of malignant only and non-malignant only histologies, respectively. Gliomas are tumors that arise from glial cells, and include astrocytoma, glioblastoma, oligodendroglioma, ependymoma, mixed glioma, malignant glioma NOS, and a few more rare histologies. In this report, glioma is defined by the ICD-O-3 histology codes 9380-9384, 9391-9460, and 9480. In this report, incidence rates are provided by histology and by major histology grouping. 6

Definition of Tumor Locations (Sites) Various terms are used to describe the regions of the brain and central nervous system. The sites referred to in this report are broadly based on the categories and site codes defined in the SEER Site/Histology Validation List.6 Tumors include olfactory tumors of the nasal cavity in addition to brain tumors located in sites included in the standard definition from the Consensus Conference on Brain Tumor Definition for Registration.5 According to the standard definition from the Consensus Conference, reportable primary brain–related tumors (intracranial and central nervous system tumors) are all primary tumors, irrespective of histology and behavior, occurring in the following sites: brain; meninges; pineal gland; pituitary gland and craniopharyngeal duct; and spinal cord, cranial nerves, and other parts of the central nervous system. As per the site definition outlined by the Consensus Conference on Brain Tumor Definition for Registration5, brain lymphomas coded to any of the brain or CNS site codes listed above are included in the CBTRUS report. In this report, statistics by ICD-O-3 topography site are grouped in the following manner: the frontal lobe (ICDO site code C71.1), temporal lobe (C71.2), parietal lobe (C71.3), and occipital lobe (C71.4) are grouped together. Cerebrum (C71.0), ventricle (C71.5), cerebellum (C71.6), and brain stem (C71.7) are each grouped independently. Overlapping lesions of the brain, as well as brain sites not otherwise specified (NOS), are defined by ICDO site codes C71.8–C71.9. The cranial nerve category (C72.2–C72.5) includes the olfactory nerve, optic nerve, acoustic nerve, and other cranial nerves. The spinal cord (C72.0) and cauda equina (C72.1) are grouped together. Overlapping lesions of the brain and central nervous system, as well as nervous system sites not otherwise specified (NOS), are defined by ICDO site codes C72.8–C72.9. The meninges (C70.0–C70.9) include the cerebral meninges and spinal meninges. Pituitary tumors (C75.1–C75.2) include tumors located in the pituitary gland and craniopharyngeal duct. Pineal tumors (C75.3) include tumors located in the pineal gland. In this report, tumors located in the nasal cavity (C30.0) are olfactory tumors (defined by ICDO–3 morphology codes 9522–9523). For pediatric distributions, because of the small number of cases, olfactory tumors were grouped with other CNS tumors. Classification by Behavior Brain and central nervous system tumors classifications according to behavior ICD-O-3 standards for benign, uncertain, and malignant behaviors are coded 0, 1, and 3, respectively. In general, population-based cancer registries have been consistent in collecting and reporting malignant brain and central nervous system tumor incidence. Such has not been the case for tumors classified as non-malignant (benign and uncertain) behavior. As previously discussed, Public Law 107-260 mandated the formal collection of non-malignant brain and central nervous system tumors effective on January 1, 2004. In preparation of implementing this law, issues were recognized by CBTRUS and by the National Coordinating Council for Cancer Surveillance and were actively addressed by the joint Brain Tumor Working Group and resulted in the adoption of Uniform Data Standards (UDS) for non-malignant brain tumors in July 2003 for tumors diagnosed beginning in 2004. As a result of having UDS for brain tumor collection, CBTRUS Statistical Reports are limited to analyses of those primary brain and central nervous system tumors diagnosed during years 2004, 2005, 2006, 2007, and thereafter in the United States.

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Estimation of Incidence and Mortality Rates Incidence rates, means, and frequencies were calculated using SPSS and SEER*Stat statistical software.7-8 Statistics were not presented when fewer than 16 brain tumors were reported for the specific histology category. The suppressed cells were included in the counts and rates for the totals. Age-adjusted incidence rates and 95% confidence intervals for malignant and non– malignant tumors and for selected histology groupings by gender, race, Hispanic ethnicity, and pediatric, young adult and adult age groups were estimated. CBTRUS includes statistics on pediatric age groups 0-14 years and 0-19 years. The 0-19 year age group includes tumors diagnosed in the adolescent 15-19 year age group. The 0-14 year age group is a standard age category for childhood cancer used by other cancer surveillance organizations and has been included in this report for consistency and comparison purposes. Race categories included in this report are all races, whites, and blacks. Hispanic origin was determined using the North American Association of Central Cancer Registries (NAACCR) Hispanic Identification Algorithm, version 2, data element, which utilizes a combination of cancer registry data fields (Spanish/Hispanic Origin data element, birthplace, race, and surnames) to directly and indirectly classify cases as Hispanic or non–Hispanic. Age–adjustment using the direct method was based on five–year age groupings and standardized to the Year 2000 U.S. standard population. Age-specific incidence rates by fiveyear age groups were also calculated. The age distribution of the 2000 U.S. standard population is shown in Table 2. Combined populations for the regions included in this report are shown in Tables 3 and 4. State-level incidence and mortality rates for brain and CNS malignant tumors were retrieved from the most current Cancer Incidence in North America (CINA) publication on the NAACCR website.9 These rates were calculated for the combined five years 2003-2007 and were age-adjusted using the 2000 U.S. standard population. Differences in Brain Tumor Definition It should be noted that NPCR, SEER, and NAACCR report brain tumors differently than CBTRUS. The definition of brain tumors used by these organizations (in their published incidence and mortality statistics) includes tumors located in the brain, meninges, and other central nervous system tumors (C70.0–9, C71.0–9, and C72.0–9), but excludes lymphoma and leukemia morphologies (9590–9989) from all brain and central nervous system sites. NPCR and SEER include separate tables for malignant and non–malignant brain and CNS tumors reflecting the Consensus Conference definition in their respective publications: United States Cancer Statistics Incidence and Mortality and SEER Cancer Statistics Review. With the inclusion of non-malignant brain tumors, an increase in incidence rates may result, especially for the following histology groups and subgroups: (groups) tumors of the meninges; tumors of the cranial and spinal nerves; tumors of the sellar region; and (subgroups) unique astrocytoma variants; choroid plexus; neuronal/glial, neuronal; pineal parenchymal; nerve sheath tumors; meningioma; hemangioblastoma; other mesenchymal; germ cell tumors; pituitary; craniopharyngioma; hemangioma; neoplasm, unspecified; and all other. In contrast, the CBTRUS reports data on all tumor morphologies located within the Consensus Conference site definition including the leukemia and lymphoma morphologies (9590–9989) as well as olfactory tumors of the nasal cavity [C30.0 (9522–9523)]. NPCR, 8

SEER, and NAACCR include pilocytic astrocytomas, a tumor listed in the WHO Classification of Tumours of the Central Nervous System4 as having uncertain behavior, in their malignant brain tumor data and statistics. In support of consistency within cancer surveillance reporting, the CBTRUS categorizes pilocytic astrocytomas in the malignant tumor category to enhance comparability of rates to those reported by NPCR, SEER, and NAACCR, especially for comparison of childhood brain and CNS tumor rates. It is important to understand these differences in definition as they influence the direct comparison of published rates. It is important to note that the statistics for lymphomas and hematopoietic neoplasms contained in this report refer only to those lymphomas and hematopoietic neoplasms of the brain and central nervous system. Estimation of Number of Cases and Number of Deaths Estimated numbers of cases of malignant and non–malignant tumors were calculated using age–specific rates (CBTRUS 2004–2007 data). Population data (projections) for each state for 2011 were obtained from the U.S. Census Bureau website.2 Estimated number of deaths for malignant tumors were obtained from the American Cancer Society publication, Cancer Statistics, 2010.10 The source for its data was the U.S. Mortality Public Use Data Tapes, 1969–2007, from the National Center for Health Statistics. Estimation of Survival Rates SEER*Stat 6.6.2 statistical software was used to estimate one–through ten–year relative survival rates for primary malignant brain tumor cases diagnosed between 1995–2007 in seventeen SEER areas.7,11 This software utilizes life–table (actuarial) methods to compute survival estimates and accounts for current follow–up. The traditional cohort analysis of survival rates was utilized for the survival estimates presented in this report. Long–term cohort–based survival estimates reflect the survival experience of individuals diagnosed over the time period, often many years ago. Survival estimates were determined for brain (C71.0– C71.9), meninges (C70.0–C70.9), spinal cord, cranial nerves, and other parts of the central nervous system (C72.0–C72.9), pituitary and pineal glands (C75.1–C75.3), and olfactory tumors of the nasal cavity [C30.0 (9522–9523)]. Lymphomas and leukemias (morphology codes 9590–9989) and meningiomas (9530–9539) are included from all brain and central nervous system sites. Second or later primary tumors, cases diagnosed at autopsy, cases in which race or sex is coded as other or unknown, and cases known to be alive but for whom follow–up time could not be calculated were excluded from the SEER data analyses. Data Interpretation The CBTRUS works diligently to support the broader surveillance efforts aimed at improving the collection and reporting of primary brain tumors. However, there are inherent difficulties with interpretation of surveillance data especially in attempting comparisons. The published statistics in this CBTRUS report are not directly comparable to previous CBTRUS reports for various reasons. Observed variations and differences over years and across age, gender, and race/ethnicity groups in cancer incidence and mortality may be real, reflecting modifications in the risk factor status of the population or the consequences of improved technology affecting diagnosis and treatment programs. On the other hand, such changes may not be real but instead may be variations and fluctuations that are random or are due to dynamics associated with cancer registration and factors related to the estimation process. Therefore, any conclusions related to the data presented in this report should be made only after carefully 9

taking into account the technical notes described above as well as the following considerations. Random fluctuations in average annual rates are usual and may be substantial, especially for rates based on small incidence counts. The CBTRUS policy is to suppress data presentation for cells with counts of 15 or less in part because the reliability of such rates would be questionable. It should be noted that rates based on larger incidence counts either within cells or as a result of aggregating more diagnosis years of incidence data will improve the stability and reliability of the estimate. The 95 percent confidence intervals are included with reported rates to help put the rate in perspective and to facilitate comparisons. Factors related to completeness and data quality will vary from year to year and ultimately, will affect the magnitude of rate calculation. The population-based cancer registries contributing to the CBTRUS reports have differed over the years influencing the numbers of cases in the analytic data files, the completeness of the database, and the overall quality and utility of final data sets. For example, the total number of participating cancer registries has differed from report to report as registries achieve or fail to achieve the data quality goals. CBTRUS could not adjust the rates presented in this statistical report for differences in completeness across the databases which could result in fluctuation and variation of rate estimations. Delays in reporting are a reality and a known issue influencing registry completeness and consequently cancer rate underestimations especially for more recent data collection years. The problem would be even more likely to occur in the non-malignant brain tumors, where reporting often comes from non-hospital based sources (SEER Technical Notes: Reporting Delay; http://seer.cancer.gov/csr/1975_2007/technotes/ reportingdelay.html). The quality control editing of the data by CBTRUS continues to be refined every year, and thus, can contribute to changes in the rates between reports. Exclusion of site and histology combinations considered to be invalid by the consulting neuropathologist may have the impact of conservatively underestimating the incidence of brain and central nervous system tumors. Editing changes incorporate updates to the cancer registration coding rules which influence case ascertainment and data collection. Beginning in 2004, some brain and central nervous system site codes were reconsidered as paired sites (i.e. having a left and right side, which could result in multiple tumors being reported) rather than unpaired sites, which has likely caused some increase in the incidence of brain and central nervous system tumors. Another relevant classification tool was the 2007 Multiple Primary and Histology Coding Rules that revised the way malignant and non-malignant brain tumors were reported.12 Unclear guidelines, misinterpretation of new rules as well as learning curves associated with adoption of new or revised standards have likely resulted in over-reporting of some tumor histologies, especially the non-malignant tumors. CBTRUS has edited the data to reflect the intent of the multiple primary rules, and therefore, conservatively estimates the incidence of brain and central nervous system tumors. Revisions to clarify these rules are underway. Veteran’s Health Administration (VHA) hospitals have been the sole source of data for cancer cases diagnosed among Veterans served by those institutions. Cancer cases from VHA facilities account for at least three percent and possibly as much as eight percent of all cancer cases diagnosed among men. VHA policy that went into effect in 2007 restricting veterans health data sharing has resulted in the underreporting of cancer incidence data for diagnosis 10

years 2005 through 2007. Since late 2008, VHA facilities and states with central cancer registries have been working to establish data transfer agreements that correct the problem to assure more complete ascertainment of national cancer incidence including brain and central nervous system tumor incidence data used in CBTRUS statistical reports. Finally, population estimates used for denominators may be inaccurate or lack precision. Population data for 1990 and 2000, the years of the U.S. decennial census, are the most accurate for all age, race, Hispanic ethnicity and gender-specific categories and would, therefore, produce the most accurate incidence rates. Those for other years are not based on actual population counts but rather on interpolation or extrapolation of estimates based on demographic characteristics of the population. Incidence and mortality rates based on these population estimates would be expected to exhibit more error than those for 1990 or 2000. Population data from the 2010 decennial census will be available soon and calculations based on these data will likely result in variations in the incidence rates in future reports, especially for the older age groups. In keeping with its mission, CBTRUS continually revises its reports mindful of the broader surveillance community in which it works while balancing the input it receives from the clinical and research community, especially those comments from neuropathologists. In this way the CBTRUS attempts to facilitate communication between the communities it serves.

RESULTS Primary Brain and CNS Tumors: Distributions and Incidence by Gender, Race, Hispanic Ethnicity, Age Group, Cancer Registry and Behavior Counts of the 226,791 incident tumors reported during 2004-2007 by histology and demographic characteristics for all ages and for children ages 0-19 are presented in Tables 5– 8. Seven percent of the cases were in individuals less than 20 years of age at the time of diagnosis and 93% were in individuals 20 years of age or older at the time of the diagnosis. Approximately 43% of all brain and CNS tumors occurred in males and 57% in females. Eighty-five percent of brain and CNS tumors occurred in the persons of white race. The overall number of reported brain tumors is listed by cancer registry in Table 9. The average annual combined 2004-2007 population of 286.2 million represents approximately 96% of the U.S. population for those years. The overall percent of non–malignant tumors varied considerably by cancer registry (range: 49-73%). About sixty-seven percent of all tumors had a histologically confirmed diagnosis, with substantial regional variation (cancer registry range: 55-97%). Of the non-malignant brain tumors, 57% were histologically confirmed, while 40% were confirmed radiologically. Overall Incidence Rates The overall age-adjusted incidence rate for 2004-2007 for primary brain and CNS tumors was 19.34 per 100,000 person–years. The overall incidence rate was 4.84 per 100,000 person– years for children 0–19 years of age (4.69 per 100,000 person–years for children less than 15 years) and 25.17 per 100,000 person–years for adults (20+ years). The overall incidence rates 11

of tumors by behavior and age group (0–19 years and 20+ years) are shown in Figure 1. Incidence rates by cancer registry, age group and behavior are presented in Table 10.

Figure 1. Average Annual Age-Adjusted Incidence Ratesa of Primary Brain and CNS Tumors by Age and Behavior

Rate per 100,000 person-years

CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007

aAge-adjusted

to the 2000 United States standard population.

Overall Incidence Rates by Year No statistically significant trend in incidence rates (Figure 2) of all primary brain tumors from 2004 through 2007 was noted. However, when examined by behavior, a statistically significant downward trend of approximately 1.4% per year was apparent for malignant tumors, while there was no statistically significant trend detected in non-malignant brain tumor incidence rates. By individual year, the incidence rates in 2005 and 2006 did not differ statistically significantly from each other. However, the incidence rates in both 2004 and 2007 were statistically significantly lower than those observed in 2005 and 2006. It is likely that the lower rate in 2004 may reflect a lack of complete implementation of Public Law 107-260. Whereas, the lower rate in 2007 may reflect some degree of reporting delay, as noted in Technical Notes.

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Figure 2. Annual and Average Annual Age-Adjusted Incidence Ratesa of Primary Brain and CNS Tumors by Year


CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007

20 16 12 8 4 0

2004

2005

2006

2007

2004-2007

19.0

19.6

19.7

19.2

19.3

aAge-adjusted


Incidence Rates by Cancer Registry, Age, and Behavior The overall average annual age-adjusted incidence rate by cancer registry, age group, and behavior are displayed in Table 10. The overall incidence rates of all primary brain and CNS tumors (malignant and non–malignant) for each individual cancer registry ranged from 13.37 to 25.15 per 100,000 person–years. In addition, the incidence rates of all primary malignant brain tumors ranged from 4.64 to 9.51 per 100,000 person–years and incidence rates of all primary non–malignant brain tumors ranged from 6.51 to 17.93 per 100,000 person–years. Among adults 20 years of age and older, the cancer registry–specific incidence rates ranged from 5.35 to 12.03 per 100,000 person–years for malignant tumors and from 9.13 to 24.44 per 100,000 person–years for non-malignant tumors. For several cancer registries, the numbers of cases in those less than 20 years of age were too small to report; the highest reported incidence was 3.64 per 100,000 person-years for malignant tumors and 3.19 per 100,000 person-years for non-malignant tumors. The incidence rates by tumor behavior and cancer registry are illustrated in Figure 3. There is less variation by cancer registry in malignant tumor incidence rates as compared to incidence rates for tumors of non-malignant behavior suggesting greater consistency in reporting of the malignant tumors. The cancer registry incidence rates for the malignant tumors (cancer registry range: 4.64 to 9.51 per 100,000 person–years) are much less variable than the reported incidence rates for the non–malignant tumors (cancer registry range: 6.51 to 17.93 per 100,000 person–years). The cancer registry variation apparent in Figure 3 and Table 10, especially in reported incidence rates for the non–malignant tumors, likely reflects differences in registry reporting practices including case ascertainment. One example of this is Colorado, which has the highest estimated incidence for brain tumors overall (Table 10). Colorado also has one of the highest percentages of reported non–malignant brain tumors, as well as the lowest percentages of histologically confirmed tumors (Table 9). Even before 2004, Colorado law required active collection of all primary brain and CNS tumors. The active collection of 13

all brain tumors in Colorado results in a higher incidence rate compared to other registries, some of which did not follow these same reporting practices (see Technical Notes Sections: Classification by Behavior; Differences in Brain Tumor Definition). Improvements in standardization of brain tumor collection and reporting with time will allow observation of the true variation in the incidence of brain tumors between states. Many non–malignant brain tumors are not histologically confirmed, i.e. the percent of diagnostically confirmed nonmalignant tumors is lower than the percent of diagnostically confirmed malignant tumors. A statistically significant negative correlation exists between the proportion of tumors with non– malignant behavior and the proportion of tumors diagnostically confirmed by cancer registry for the data presented in Table 9. In general, cancer registries that have a higher proportion of non-malignant brain tumors also have fewer brain tumors that are histologically confirmed by surgery or biopsy.

Figure 3. Average Annual Age-Adjusted Incidence Ratesa of Primary Brain and CNS Tumors by State and Behavior CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007 30


Non-Malignant

Malignant

25

20

15

10

5

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KY LA ME MA MI MN MS MO MT NE NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

0

aAge-adjusted


Primary Brain and CNS Tumors: Incidence by Site, Histology, Gender, Race, Hispanic Origin, and Age Distribution of Tumors by Site and Histology The distribution of brain and CNS tumors by site is shown in Figure 4. The most common tumor site is the meninges (34%). Twenty-two percent of tumors are located within the frontal, temporal, parietal, and occipital lobes of the brain. Cerebrum, ventricle, cerebellum, and brain stem tumors account for 2%, 1%, 3%, and 2% of all tumors, respectively. The cranial nerves and the spinal cord/cauda equina account for 7% and 3% of all tumors, respectively. Together, the pituitary and pineal glands account for about 15% of tumors. Olfactory tumors of the nasal cavity account for less than 1% of tumors.

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Figure 4. Distribution of All Primary Brain and CNS Tumors by Site (N= 226,791) CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007 Meninges 33.8%

Other CNS 0.6% Cranial Nerves 7.0%

Pituitary 14.3%

Spinal Cord & Cauda Equina 3.3%

Pineal 0.4%

Other Brain 10.3%

Nasal Cavity 0.2%

Brain Stem 1.7% Cerebellum 2.8% Ventricle 1.2%

Cerebrum 2.0%

Occipital Lobe 1.3%

Parietal Lobe 4.7%

Frontal Lobe 9.3% Temporal Lobe 7.0%

The distribution by brain and CNS histology is shown in Figure 5. The most frequently reported histology is the predominately non–malignant meningioma, which accounts for 34% of all tumors, followed by glioblastoma (17%). The predominately non-malignant pituitary and nerve sheath tumors account for 13% and 9% of all tumors, respectively. Acoustic neuromas (defined by ICD-O-3 site code C72.4 and histology code 9560) account for 63% of all nerve sheath tumors. Figure 5. Distribution of All Primary Brain and CNS Tumors by Histology (N=226,791) CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007 All Other Germ Cell Tumor 6.6% 0.5%

Glioblastoma 16.7% Astrocytomas 7.0%

Other Neuroepithelial 5.1% Lymphoma 2.4%

Ependymomas 1.8% Oligodendrogliomas 2.0% Embryonal, including Medulloblastoma 1.0%

Nerve Sheath 8.6% Craniopharyngioma 0.7%

Pituitary 13.1% Meningioma 34.4%

15

Gliomas (ICD-O-3: 9380-9384, 9391-9460, 9480) account for 31% of all tumors and 80% of malignant tumors

The broad category glioma represents 31% of all tumors (Figure 5). The distribution of tumors by site for glioma is shown in Figure 6. Sixty–one percent of gliomas occur in the four lobes of the brain. Figure 6. Distribution of All Primary Brain and CNS Gliomas* by Site (N=70,528) CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007

Occipital lobe 3.3%

Cerebrum 4.8%

Ventricle Cerebellum 1.9% 2.8% Brain stem 4.2%

Other brain 19.9%

Parietal lobe 12.8%

Spinal cord and cauda equina 4.4% Temporal lobe 19.6%

*ICD-O-3 codes = 9380-9384,9391-9460,9480

Other 0.2%

Cranial nerves 1.0%

Frontal lobe 25.1%

The distribution by specific histology for glioma is illustrated in Figure 7. Glioblastoma accounts for the majority of gliomas, while astrocytoma and glioblastoma combined account for about three–quarters of gliomas. Figure 7. Distribution of All Primary Brain and CNS Gliomas* by Histology Subtypes (N=70,528) CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007

Glioma Malignant, NOS 7.0% Ependymoma 5.9%

All Other Glioma 4.3%

Astrocytomas and glioblastomas account for 76% of all gliomas*

Oligodendroglioma 6.5% Pilocytic Astrocytoma 5.2%

Glioblastoma 53.7%

Protoplasmic & Fibrillary Astrocytoma 1.6% Anaplas tic Astrocytoma 6.7% All Other Astrocytoma 8.9%

*ICD-O-3 codes = 9380-9384,9391-9460,9480

Although spinal cord, spinal meninges, and cauda equina tumors account for a relatively small percentage of all brain and CNS tumors (5%), these tumors result in significant morbidity. The most prevalent histologies found in the spinal cord, spinal meninges, and cauda equina are presented in Figure 8 for both children (0-19 years) and adults (20+ years). 16

Figure 8. Distribution of Primary Spinal Cord, Spinal Meninges and Cauda Equina Tumors by Histology CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007

Ages 0-19 (n=830) Other Neuroepithelial 18.6%

Ages 20+ (n=10,622)

All Other 8.7%

All Other 0.8%

Tumors of the Meninges 38.7%

Pilocytic Astrocytoma 13.3%

Nerve Sheath Tumors 25.8%

Other Astrocytoma/ Glioblastoma 11.9%

Nerve Sheath Tumors 15.7%


Neoplasm, Unspecified 2.6% Tumors of the Meninges 8.8%

Lymphoma 3.0%

Ependymoma 23.1%

Hemangioma 2.1% Ependymoma 21.8%

Other Astrocytoma/ Glioblastoma 2.5%

Other Neuroepithelial 2.0%

Distribution of Tumors by Site and Histology in Young Adults (Aged 20-34 Years) Nine percent of all brain and CNS tumors occurred in young adults, ages 20-34 years and the distribution of these tumors by site is shown in Figure 9. Approximately 23% of tumors diagnosed in young adults (ages 20–34 years) are located within the frontal, temporal, parietal, and occipital lobes of the brain. Cerebrum, ventricle, cerebellum, and brain stem tumors account for 2%, 3%, 5%, and 3% of all young adult tumors, respectively. Tumors of the meninges represent 14%, while the cranial nerves and the spinal cord/cauda equina account for 7% and 6%, respectively. Combined, the pituitary and pineal glands account for about 30% of young adult tumors. The distribution by histology for young adults (ages 20–34 years) is also shown in Figure 9. About half of reported histologies for tumors diagnosed in young adults are the predominately non–malignant tumors: pituitary (27%), meningioma (14%), and nerve sheath (9%). Astrocytic tumors (including glioblastoma and astrocytoma), as a group, account for 18% of all tumors. The broad category glioma accounts for 34% of tumors in young adults.

17

Figure 9. Distribution of Primary Brain and CNS Tumors by Site and Histology Among Young Adults (Ages 20-34) (N=19,279) CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007

Site Pituitary 28.5%

Pineal 1.2%

Histology Nasal Cavity 0.2% Frontal lobe 14.5%

All Other 4.5%

Pituitary 26.5%


Temporal lobe Hemangioma/ 7.3% Hemangioblastoma 3.5% Parietal lobe 4.7%

Other Astrocytoma 10.2%

Occipital lobe 1.3%

Ependymoma 4.0% Meningioma 13.7%

Cerebrum 2.2%

Meninges 13.8%

Ventricle 2.5% Other CNS 0.6% Cranial Nerves 6.7%

Other Brain 7.7%

Oligodendroglioma 5.1%

Lymphoma 1.5%

Cerebellum 5.1% Spinal Cord & Cauda Equina 5.9%

Glioblastoma 4.9%

Germ Cell Tumor 1.4%

Brain Stem 2.6%

Nerve Sheath 9.4%

Embryonal, including Medulloblastoma 1.8%

Other Neuroepithelial 9.9%

Craniopharyngioma 1.1%

Gliomas (9380-9384,9391-9460,9480) account for 34% of all tumors and 82% of malignant tumors

Incidence Rates by Site and Gender Incidence counts and average annual age-adjusted rates for brain and CNS tumors by site and gender are provided in Table 11. Incidence rates were highest for tumors located in the meninges (6.49 per 100,000 person–years), followed by tumors located in the four lobes of the brain, pituitary, other areas of the brain, cranial nerves, spinal cord/cauda equina, cerebellum, cerebrum, brain stem, ventricle, other nervous system, and pineal gland. Incidence rates were lowest for olfactory tumors of the nasal cavity (0.04 per 100,000 person– years). By gender, incidence rates were statistically significantly higher in females than in males for tumors located in the meninges and in the pituitary. Males had statistically significantly higher incidence rates of tumors located in the four lobes of the brain, cerebrum, ventricle, cerebellum, brain stem, other brain, spinal cord and cauda equina, other nervous system, and pineal compared to females. Incidence Rates by Major Histology Groupings and Specific Histologies Tables 12 through 19 display incidence rates by major histology groupings. Among major histology groupings, incidence rates were highest for tumors of the meninges (6.81 per 100,000 person–years), followed by tumors of the neuroepithelial tissue (6.55 per 100,000 person–years), tumors of the sellar region (2.70 per 100,000 person–years) and tumors of the cranial and spinal nerves (1.66 per 100,000 person–years) (Table 12). Incidence rates also varied by specific brain and CNS histology (Table 12). Incidence rates were highest for meningiomas (6.59 per 100,000 person–years), glioblastomas (3.19 per 100,000 person–years), pituitary tumors (2.56 per 100,000 person–years), and nerve sheath tumors (1.66 per 100,000 person–years). The incidence rate of the overall category glioma was 6.04 per 100,000 person–years, a major contributor to the magnitude of the 18

neuroepithelial tissue rate. Acoustic neuromas, included under tumors of cranial and spinal nerves, comprise the majority (63%; 1.04 per 100,000 person-years) of nerve sheath tumors (1.66 per 100,000 person–years) and account for 5% of all primary brain and CNS tumors. Incidence Rates by Behavior and Histology Brain and CNS tumor incidence rates by behavior (malignant and non-malignant) are presented in Table 12a. For those with malignant behavior, the incidence rate was highest for glioblastoma (3.19 per 100,000 person-years) followed by lymphoma (0.46 per 100,000 person-years) and astrocytoma, NOS (0.45 per 100,000 person-years). Meningioma (6.45 per 100,000 person-years), pituitary (2.55 per 100,000 person-years), and nerve sheath (1.64 per 100,000 person-years) tumors were the non-malignant histologies with the highest incidence rates. Incidence Rates by Gender and Histology Incidence rates by histology and gender are presented in Table 13. Incidence rates for all primary brain and CNS tumors combined are higher among females (20.67 per 100,000 person–years) than males (17.88 per 100,000 person–years). The difference between these incidence rates is statistically significant. Incidence rates for tumors of the neuroepithelial tissue are 1.4 times greater in males as compared to females, while tumors of the meninges are 2.2 times greater in females as compared to males. Incidence rates for tumors of the neuroepithelial and tumors of the meninges were statistically significantly different between males and females. The incidence rate of gliomas is higher in males (7.17 per 100,000 person– years) than in females (5.08 per 100,000 person–years). Similar patterns were found for individual histologies, with incidence rates higher in males, especially for germ cell tumors, most glial tumors, lymphomas, and embryonal/primitive/medulloblastomas, or comparable between males and females, with the notable exception of meningiomas and pituitary tumors, which are more common in women. Incidence rate ratios (male:female) for selected histologies are shown in Figure 10.

Figure 10. Patterns by Gender for Selected Histologies CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007 1.04

Pilocytic Astrocytoma Anaplastic Astrocytoma

1.39*

Glioblastoma

1.58*

Oligodendroglioma

1.28* 1.07

Ependymoma/Anaplastic Ependymoma

1.43*

Mixed Glioma

1.28*

Embryonal/Primitive/Medulloblastoma Nerve Sheath

1.00

Meningioma

0.44* 1.38*

Lymphoma Germ Cell Tumors

2.10* 0.89*

Pituitary

0.1

1

10

Log Scale

Incidence Rate Ratio (Male to Female) *Incidence Rate Ratio is statistically significantly different in males and females.

19

Incidence Rates by Race and Histology Incidence rates by histology and race are shown in Table 14. Incidence rates for all primary brain and CNS tumors combined are statistically significantly higher among whites (19.47 per 100,000 person–years) than blacks (18.02 per 100,000 person–years). Incidence rates for many histologies are statistically significantly higher for whites than blacks with the exception of meningioma, pituitary and craniopharyngioma where the rates for blacks significantly exceed those observed for whites. Incidence rate ratios (white:black) for selected histologies are shown in Figure 11. Incidence rates for mixed gliomas, nerve sheath tumors, oligodendrogliomas, protoplasmic and fibrillary astrocytomas, anaplastic astrocytomas, and glioblastomas are two or more times greater in whites than in blacks. In contrast, incidence rates for meningiomas, pituitary tumors, craniopharyngiomas, and neoplasm, unspecified are statistically significantly higher among blacks than whites.

Figure 11. Patterns by Race for Selected Histologies CBTRUS 2004-2007 1.61*

Pilocytic Astrocytoma

2.35*

Anaplastic Astrocytoma

2.12*

Glioblastoma

2.34*

Oligodendroglioma 1.69*

Ependymoma/Anaplastic Ependymoma

2.43*

Mixed Glioma 1.49*

Embryonal/Primitive/Medulloblastoma

2.53*

Nerve Sheath 0.86*

Meningioma

1.10

Lymphoma

1.51*

Germ Cell Tumors 0.55*

Pituitary

0.1

1

10

Log Scale

Incidence Rate Ratio (White to Black) *Incidence Rate Ratio is statistically significantly different in whites and blacks.

Incidence Rates by Hispanic Origin, Race, and Histology Incidence rates by histology, Hispanic origin, and race are shown in Table 15. Nine percent of tumors were in persons of Hispanic origin. The overall incidence rate for primary brain and CNS tumors among Hispanics is 18.14 per 100,000 person–years and among non–Hispanics is 19.53 per 100,000 person–years (Table 15). The difference between these two incidence rates is statistically significant. White non–Hispanics (19.75 per 100,000 person–years) have statistically significantly higher incidence rates than Hispanics (18.14 per 100,000 person– years), and black non–Hispanics (18.26 per 100,000 person–years). 20

Incidence Rates by Age and Histology The age–specific incidence rates by histology are presented in Table 16. The incidence for all brain and CNS tumors is highest among the 75–84 year olds (67.78 per 100,000 person– years) and lowest among children ages 0-19 years (4.84 per 100,000 person–years). However, the distribution patterns of histologies within age groups differ substantially as shown in Table 16. For example, the incidence rates of pilocytic astrocytoma, germ cell tumors, and medulloblastoma are higher in the younger age groups and decrease with advancing age. This is in contrast to the incidence rate of meningioma, which increases progressively with age. Age–specific incidence rates for selected histologies are graphically displayed in Figure 12. Figure 13 shows the most common and second most common brain and CNS tumor histologies by age at occurrence.

Figure 12. Age-Specific Incidence of Primary Brain and CNS Tumors by Selected Histologies CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007

70 Rate per 100,000 person-years

All Primary Tumors

60 Gliomas*

50 40

Meningioma

30

Nerve Sheath

20

Pituitary

10

Lymphoma

0

*ICD-O-3 codes = 9380-9384,9391-9460,9480

21

Figure 13. Most Common Brain and CNS Tumors by Age CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007

Age (yr)

Most Common Histology

Second Most Common Histology

0-4

Embryonal/medulloblastoma

Pilocytic astrocytoma

5-9


Malignant glioma, NOS

10-14


Neuronal/glial

15-19

Pituitary


20-34

Pituitary

Meningioma

35-44

Meningioma

Pituitary

45-54

Meningioma

Glioblastoma

55-64

Meningioma

Glioblastoma

65-74

Meningioma

Glioblastoma

75-84

Meningioma

Glioblastoma

85+

Meningioma

Neoplasm, unspecified

Childhood Primary Brain and CNS Tumors: Incidence by Site, Histology, Gender, and Age Childhood Brain Tumors Brain tumors are the second most common malignancy among children, leukemias as a group being the most common.13,14 However, brain tumors are the most common form of solid tumors in children. 13 About 7% of the reported brain and CNS tumors occurred in children ages 0-19 years. Distribution of Tumors by Site and Histology The distribution of brain and CNS tumors for children ages 0-19 years by site is shown in Figure 14. The largest percentage of childhood tumors (18%) are located within the frontal, temporal, parietal, and occipital lobes of the brain. Cerebrum, ventricle, cerebellum, and brain stem tumors account for 6%, 6%, 15%, and 11% of all childhood tumors, respectively. Other tumors of the brain account for 13% of all childhood tumors. Tumors of the meninges represent 3% of all childhood tumors. The cranial nerves and the spinal cord/cauda equina account for 6% and 5% of all childhood tumors, respectively. The pituitary and pineal glands, together, account for about 15% of all childhood tumors.

22

Figure 14. Distribution of All Childhood (Ages 0-19 years) Primary Brain and CNS Tumors by Site (N=15,295) CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007 Spinal Cord & Cauda Equina 5.1%

Other Brain 13.4%

Cranial Nerves 6.3% Other CNS 1.8% Meninges 2.9%

Brain Stem 11.1%

Pituitary 12.2%

Cerebellum 15.3%

Pineal 2.9% Frontal Lobe 6.0%

Ventricle 5.7% Cerebrum 5.8%

Temporal Lobe 7.1% Parietal Lobe 3.1%

Occipital Lobe 1.4%

Figure 15 presents the most common brain and CNS histologies in children ages 0–14 years and adolescents ages 15-19 years. For children ages 0-14 years, pilocytic astrocytomas, malignant glioma, NOS, and embryonal tumors (medulloblastomas), account for 19%, 14%, and 13%, respectively. The most common histologies in adolescents ages 15–19 years include pituitary tumors and pilocytic astrocytomas, which account for 22% and 12%, respectively, of all brain tumors in that age group (Figure 15). The broad category glioma accounts for 55% and 39% of tumors in children ages 0-14 years and adolescents aged 15–19 years, respectively. Figure 15. Distribution of Childhood Primary Brain and CNS Tumors by Histology CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007

Ages 0-14 (n=11,004) Lymphoma 0.3%

Neuronal-Glial 8.1%

Ages 15-19 (n=4,291)

All Other 8.6% Pilocytic Lymphoma Astrocytoma 0.6% 18.5% Germ Cell Tumor 5.1%

Germ Cell Tumor 3.8% Pituitary 3.3% Craniopharyngioma 3.4%

All Other Astrocytomas 9.6%

Meningioma 1.9% Nerve Sheath 4.7%

Glioblastoma 2.7%

Medulloblastoma 13.0% Glioma Malignant , NOS 14.2%

Mixed Glioma 0.6%

Oligode ndroglioma 1.4% Ependymoma 6.2%

Neuronal-Glial 8.7%

All Other 9.6%

Pilocytic Astrocytoma 11.5% All Other Astrocytomas 9.0% Glioblastoma 3.4%

Pituitary 21.6%

Oligode ndroglioma 2.7% Craniopharyngioma 2.5%

Ependymoma 4.9%

Meningioma 4.3% Nerve Sheath 6.5%


Medulloblastoma 3.9%

Mixed Glioma 1.2% Glioma Malignant , NOS 4.3%


23

Childhood Incidence Rates by Histology and Gender The incidence rates of the most common childhood tumors by gender are shown in Table 17. The overall incidence rate for childhood brain and CNS tumors (ages 0–19 years) is 4.84 per 100,000 person–years. Among major histology groupings, incidence rates were highest for tumors of the neuroepithelial tissue (3.40 per 100,000 person–years). Pilocytic astrocytoma (0.80 per 100,000 person–years), malignant glioma, not otherwise specified (0.56 per 100,000 person-years), and medulloblastoma (0.51 per 100,000 person–years) have the highest rates among individual histologies. Germ cell tumors are more than twice as common in males compared to females. Conversely, the incidence rate of pituitary tumors for females is almost three times the rate observed for males. Differences in incidence rates between males and females for embryonal, germ cell, and pituitary tumors are statistically significant. Due to small numbers for some tumors caution when interpreting and comparing incidence rates is required. Childhood Incidence Rates by Race and Gender Among those in the age group 0–19 years, brain and CNS tumors are more common in whites (5.02 per 100,000 person–years) than in blacks (3.69 per 100,000 person–years) (Table 18). This difference in incidence rates between the two races is statistically significant. Within races, incidence rates are not statistically different between males and females. Childhood Incidence Rates by Age and Histology The detailed age–specific incidence rates by histology for children are displayed in Table 19, Figure 16 and earlier in Figure 13. The incidence rate for all brain and CNS tumors is highest among 15-19 year olds (5.28 per 100,000 person–years) and lowest among 10–14 year olds (4.41 per 100,000 person–years). However, the individual histology distributions vary substantially within age groups. The incidence rates of pilocytic astrocytoma, malignant glioma NOS, ependymoma, choroid plexus, and medulloblastoma in children decrease with increasing age groups. Age–specific incidence rates for selected histologies are shown in Figure 16.

24

Figure 16. Age-Specific Incidence of Childhood Primary Brain and CNS Tumors by Selected Histologies CBTRUS Statistical Report: NPCR and SEER Data from 2004-2007 All Primary Tumors


6 5

Gliomas*

4

Embryonal, including Medulloblastoma

3

Pilocytic Astrocytoma

2 1

Ependymoma/ Anaplastic Ependymoma

0

*ICD-O-3 codes = 9380-9384,9391-9460,9480

Primary Malignant Brain Tumor Rates: Incidence, Mortality, Estimated Cases and Deaths, and Survival Incidence and Mortality Rates for Malignant Brain Tumors by State and Gender Incidence and mortality rates for primary malignant brain tumors by state were obtained from the most recent NAACCR Cancer Incidence in North America publication9 and are shown in Table 20. As shown, the 2003–2007 mortality rates by gender are available for all 50 states and the District of Columbia. Incidence rates for malignant brain tumors were available for most states from the same time period with a few exceptions. Combined incidence statistics for the United States include data from 45 state cancer registries that met or exceeded NAACCR high quality standards for 2003-2007. Estimated Numbers of Cases of All Primary Brain Tumors by State The estimated numbers of cases of all primary brain and CNS tumors for 2011 by state are shown in Table 21. The estimated numbers of cases of malignant and non–malignant tumors by state were calculated using this CBTRUS statistical report’s overall NPCR and SEER age– specific incidence rates (2004–2007) by 18 age groups, race (white, black, and other), and gender and applying them to the 2011 population projections for each state and the District of Columbia. The total number of new cases of primary brain tumors for all 50 states and the District of Columbia in 2011 is estimated to be 64,530 with 24,070 being malignant and 40,470 being non-malignant. Estimated Numbers of Deaths for Malignant Brain Tumors by State The estimated numbers of deaths for primary malignant brain tumors by state for 2010 are shown in Table 21. The estimated numbers of deaths for malignant tumors were obtained from the American Cancer Society’s Cancer Statistics, 2010 publication using the described 25

methodology.10 The total number of primary malignant brain tumor deaths for all 50 states and the District of Columbia in 2010 is estimated to be 13,140. Survival Rates for Malignant Brain Tumors by Tumor Location (Site) and Gender Survival estimates by brain and CNS tumor location (site) and gender are presented in Table 22. Patients diagnosed from 1995 through 2007 with tumors in the cerebrum, the frontal, temporal, parietal, and occipital lobes of the brain, and other brain have five–year survival rates less than 30%. Patients with tumors in the cerebellum, spinal cord/cauda equina, cranial nerves, pituitary and pineal glands, and nasal cavity have five–year survival rates greater than 70%. For most tumor locations, females have slightly better survival than males; however, males have slightly better five–year survival for tumors of the brain stem and pineal glands. Survival Rates for Malignant Brain Tumors by Histology and Age Survival estimates for malignant brain tumors by histology and age at diagnosis are presented in Tables 23 and 24. The one– through ten–year relative survival rates by histology are shown in Table 23. The estimated five– and ten–year relative survival rates for malignant brain tumors are 35.5% and 31.7%, respectively. However, there is a large variation in survival estimates depending upon tumor histologies (Table 23). For example, five–year survival rates are 94% for pilocytic astrocytomas but are less than 5% for glioblastomas. Survival generally decreases with older age at diagnosis (Table 24). Children and young adults have better survival for most histologies. Histology–Specific Summary Information The information presented in these tables can be synthesized to describe specific histologies. As an example we have chosen the two most common histologies, meningiomas and glioblastomas. Meningiomas are the most frequently reported tumors and account for more than 34% of tumors reported to CBTRUS (Table 12; Figure 5). Ninety–eight percent of meningiomas reported to CBTRUS had a non–malignant behavior code (Table 12a). Of the non-malignant meningiomas, 53% were histologically confirmed, while 45% were radiologically confirmed. Meningiomas are more common in older adults (Table 16) and are uncommon in children. The incidence of meningiomas increases with increasing age. The rates for meningiomas increase dramatically after age 65 and continue to be high even among the population aged 85 years and older (Table 16). Meningiomas are more than twice as common in females as compared to males (Table 13). The incidence in meningiomas is statistically significantly higher in blacks than whites (Table 14). As only malignant meningiomas were reported in the SEER database prior to 2004, insufficient time has passed to estimate survival for non-malignant meningiomas, and therefore, survival estimates were not generated. Information about meningioma survival estimates was obtained from a manuscript that used the National Cancer Data Base and showed the overall five–year survival rate for meningioma to be 69% (70% for benign and 55% for malignant).15 Glioblastomas (GBMs) are the second most frequently reported histology and the most common malignancy. They account for 17% of all primary brain tumors (Table 12; Figure 5). Glioblastomas are more common in older adults (Table 16) and are uncommon in children. Glioblastomas comprise approximately 3% of all tumors reported among 0–19 year olds (Tables 7 and 17). The incidence of glioblastomas increases with increasing age, with rates 26

highest in the 75 to 84 years olds (Table 16). Glioblastomas are 1.6 times more common in males (Table 13). Glioblastomas are over two times higher among whites as compared to blacks (Table 14). The relative survival estimates for glioblastoma are quite low; less than 5% of patients survived five years post diagnosis (Table 23). Glioblastoma survival estimates are somewhat higher for the small number of patients who are diagnosed under age 20 (Table 24). SUMMARY These data present an updated summary (2004–2007) of the incidence of all primary malignant and non-malignant brain and central nervous system tumors collected and reported by 48 population-based cancer registries. The overall incidence rate was 19.34 per 100,000 person-years. The incidence rates were higher in females, and whites, and increased with age. These data serve as a useful resource to clinicians, researchers, and patient families.

27

GLOSSARY ACS – American Cancer Society CBTRUS – Central Brain Tumor Registry of the United States CNS – central nervous system IARC – International Agency for Research on Cancer ICD-O-3 – International Classification of Diseases for Oncology, Third Edition NAACCR – North American Association of Central Cancer Registries NCDB – National Cancer Data Base NOS – not otherwise specified NPCR – National Program of Cancer Registries SEER – Surveillance, Epidemiology and End Results WHO – World Health Organization

REFERENCES 1 Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Perkin DM, Whelan S (eds). International Classification of Diseases for Oncology, Third edition. World Health Organization, 2000. 2

US population data. Surveillance, Epidemiology, and End Results (SEER) Program Populations (1990–2007) (http://seer.cancer.gov/popdata/), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released November 2009. 3

Kleihues P, Burger PC, and Scheithauer BW. The new WHO classification of brain tumors. Brain Pathology, 3: 255–268, 1993. 4

Louis DN, Ohgaki H, Wiestler OD, Cavanee WK. (Eds): WHO Classification of Tumours of the Central Nervous System. IARC: Lyon, 2007. 5

McCarthy BJ, Surawicz T, Bruner JM, Kruchko C, Davis F. Consensus conference on brain tumor definition for registration. Neuro–Oncology. 4:134–145, 2002 (Posted to Neuro– Oncology [serial online], Doc. 01–059, February 21, 2002. URL ). 6

ICD–O–3 SEER Site/Histology Validation List. Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute, June 21, 2004. [http://seer.cancer.gov/icd–o-3/sitetype.d06212004.pdf] 7

Surveillance Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat) version 6.6.2. 8

Statistical Packages for Social Sciences Statistics for Windows, version 18.0.0, Released July 30, 2009, (SPSS Inc., Chicago, IL). 9

Cancer Incidence in North America, 2003-2007. Volumes One, Two, and Three. North American Association of Central Cancer Registries, Inc., June 2010.

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10

Jemal A, Siegel R, Xu J, Ward E. Cancer Statistics, 2010. CA Cancer J Clin. 60:277-300, 2010. 11

Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2009 Sub (1973-2007 varying) - Linked To County Attributes - Total U.S., 1969-2007 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2010, based on the November 2009 submission. 12

Johnson CH, Peace S, Adamo P, Fritz A, Percy-Laurry A, Edwards BK. The 2007 Multiple Primary and Histology Coding Rules. National Cancer Institute, Surveillance, Epidemiology and End Results Program. Bethesda, MD, 2007.

13

Gurney JG, Smith MA, and Bunin GR. Chapter III: CNS and miscellaneous intracranial and intraspinal neoplasms. In: Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T,Young JL, Bunin GR (eds). Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975–1995, National Cancer Institute, SEER Program. NIH Pub. No. 99–4649. Bethesda, MD, 1999. [http://seer.cancer.gov/publications/childhood/] 14

Altekruse SF, Kosary CL, Krapcho M, Neyman N, Aminou R, Waldron W, Ruhl J, Howlader N, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Cronin K, Chen HS, Feuer EJ, Stinchcomb DG, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2007, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER web site, 2010. 15

McCarthy BJ, Davis FG, Freels S, Surawicz TS, Damek DM, Grutsch J, Menck HR, Laws ER Jr. Factors associated with survival in patients with meningioma. J Neurosurg 88: 831-839, 1998.

29

Table 1: CBTRUS Brain and Central Nervous System Tumor Histology Groupings, 2011 REVISION

a

b

Histology

ICDO-3 Histology Code

Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma Anaplastic astrocytoma Unique astrocytoma variants Astrocytoma, NOS

9421 9410, 9420 9401, 9411 9383, 9384, 9424 9400

Glioblastoma Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma Ependymoma variants Mixed glioma Glioma malignant, NOS Choroid plexus Neuroepithelial

9440, 9441, 9442/3 9450 9451, 9460 9391, 9392, 9393 9394 9382 9380 9390 9381, 9423, 9430, 9444

Non-malignant and malignant neuronal/glial, neuronal and mixed Pineal parenchymal Embryonal/primitive/medulloblastoma

8680,8681, 8682, 8690, 8693, 9412, 9413, 9442/1 , 9490, 9491, 9492, 9493, 9500, 9505, 9506, 9522, 9523 9360, 9361, 9362 8901, 8921, 8963, 9363, 9364, 9470, 9471, 9472,9473, 9474, 9501, 9502, 9503, 9508

c

d

Tumors of Cranial and Spinal Nerves Nerve sheath, non-malignant and malignant Other tumors of cranial and spinal nerves

9540, 9541, 9550, 9560, 9561, 9570, 9571 9562

Tumors of Meninges Meningioma Other mesenchymal, non-malignant and malignant

9530, 9531, 9532, 9533, 9534, 9537, 9538, 9539 8324, 8728, 8800, 8801, 8802, 8803, 8804, 8805, 8806, 8810, 8815, 8824, 8830 e e 8831, 8835 , 8836 , 8850, 8851, 8852, 8854, 8857, 8861, 8870 , 8890, 8897, 8900

Hemangioblastoma

8910, 8920, 8935 , 8990, 9040, 9150, 9170 , 9180, 9210, 9241, 9260, 9480, 9536 9161, 9535

e

Lymphomas and Hemopoietic Neoplasms Lymphoma

Germ Cell Tumors and Cysts Germ cell tumors, cysts and heterotopias

e

9590, 9591, 9596, 9650, 9651, 9652, 9653, 9654, 9655, 9659, 9661, 9662, 9663, 9664, 9665, 9667, 9670, 9671, 9673, 9675, 9680, 9684, 9687, 9690, 9691, 9695, 9698, 9699, 9701, 9702, 9705, 9714, 9719, 9727, 9728, 9729, 9731, 9733, 9734, 9740, 9741, 9750, 9755, 9756, 9757, 9758, 9766, 9826 , 9827, 9860, 9861, 9930, 9970 8020, 8440, 9060, 9061, 9064, 9065, 9070, 9071, 9072, 9080, 9081, 9082, e 9083, 9084, 9085, 9100, 9101

Tumors of Sellar Region Pituitary Craniopharyngioma

8022, 8040, 8140, 8146, 8190, 8202, 8240, 8246, 8260, 8270, 8271, 8272, 8280, 8281, 8290, 8300, 8310, 8320, 8323, 8333, 8334, 8341, 9582 9350, 9351, 9352

Local Extensions from Regional Tumors Chordoma/chondrosarcoma Unclassified Tumors Hemangioma Neoplasm, unspecified All other a

8711, 9220, 9231, 9240, 9370, 9371, 9372, 9373 9120, 9121, 9122, 9123, 9125, 9130, 9131, 9133, 9140 8000, 8001, 8002, 8003, 8004, 8005, 8010, 8013, 8021 e e e 8452, 8683, 8710 , 8711 , 8713 , 8720, 8811, 8840, 8860, 8896, 8980, 9173 e 9580, 9751, 9752, 9753, 9754, 9823, 9826 , 9837, 9866

Includes all the histologies listed in the standard definition of reportable brain tumors from the Consensus Conference on Brain Tumor Definitions. International Classification of Diseases for Oncology, 3rd Edition, 2000. World Health Organization, Geneva, Switzerland. c Morphology 9442/3 only. d Morphology 9442/1 only. e Histologies added in the 2011 revision of the CBTRUS histology grouping scheme as compared to the previous versions. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NOS, not otherwise specified. b

a

Table 1a: CBTRUS Brain and Central Nervous System Tumor Malignant Histologies b

Histology


Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma Anaplastic astrocytoma Unique astrocytoma variants Astrocytoma, NOS

9421/1 [Included with malignant tumors] 9410/3, 9420/3 9401/3, 9411/3 9424/3 9400/3

Glioblastoma Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma Mixed glioma Glioma malignant, NOS Choroid plexus Neuroepithelial

9440/3, 9441/3, 9442/3 9450/3 9451/3, 9460/3 9391/3, 9392/3, 9393/3 9382/3 9380/3 9390/3 9381/3, 9423/3, 9430/3


8680/3, 8693/3, 9490/3, 9500/3, 9505/3, 9522/3, 9523/3 9362/3 8901/3, 8921/3, 8963/3, 9364/3, 9470/3, 9471/3, 9472/3,9473/3, 9474/3, 9501/3, 9502/3, 9503/3, 9508/3

Tumors of Cranial and Spinal Nerves Nerve sheath, non-malignant and malignant

9540/3, 9560/3, 9561/3, 9571/3


9530/3, 9538/3, 9539/3 8728/3, 8800/3, 8801/3, 8802/3, 8803/3, 8804/3, 8805/3, 8806/3, 8810/3, 8815/3, 8830/3, 8850/3, 8851/3, 8852/3, 8854/3, 8857/3, 8890/3, 8900/3, 8910/3, 8920/3, 8990/3, 9040/3, 9150/3, 9170/3, 9180/3, 9260/3, 9480/3



9590/3, 9591/3, 9596/3, 9650/3, 9651/3, 9652/3, 9653/3, 9654/3, 9655/3, 9659/3, 9661/3, 9662/3, 9663/3, 9664/3, 9665/3, 9667/3, 9670/3, 9671/3, 9673/3, 9675/3, 9680/3, 9684/3, 9687/3, 9690/3, 9691/3, 9695/3, 9698/3, 9699/3, 9701/3, 9702/3, 9705/3, 9714/3, 9719/3, 9727/3, 9728/3, 9729/3, 9731/3, 9733/3, 9734/3, 9740/3, 9741/3, 9750/3, 9755/3, 9756/3, 9757/3, 9758/3, 9826/3, 9827/3, 9860/3, 9861/3, 9930/3 8020/3, 8440/3, 9060/3, 9061/3, 9064/3, 9065/3, 9070/3, 9071/3, 9072/3, 9080/3, 9081/3, 9082/3, 9083/3, 9084/3, 9085/3, 9100/3, 9101/3

Tumors of Sellar Region Pituitary

8022/3, 8140/3, 8190/3, 8240/3, 8246/3, 8260/3, 8270/3, 8272/3, 8280/3, 8281/3, 8290/3, 8300/3, 8310/3, 8320/3, 8323/3, 8333/3, 8341/3


8711/3, 9220/3, 9231/3, 9240/3, 9370/3, 9371/3, 9372/3 9120/3, 9130/3, 9133/3, 9140/3 8000/3, 8001/3, 8002/3, 8003/3, 8004/3, 8005/3, 8010/3, 8013/3, 8021/3 8710/3, 8711/3, 8720/3, 8811/3, 8840/3, 8896/3, 8980/3, 9580/3, 9754/3, 9823/3, 9826/3, 9837/3, 9866/3

Includes all the histologies listed in the standard definition of reportable brain tumors from the Consensus Conference on Brain Tumor Definitions. International Classification of Diseases for Oncology, 3rd Edition, 2000. World Health Organization, Geneva, Switzerland. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NOS, not otherwise specified. b

a

Table 1b: CBTRUS Brain and Central Nervous System Tumor Non-Malignant Histologies b

Histology


Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Unique astrocytoma variants Ependymoma variants Choroid plexus Neuroepithelial

9421/1 [Included with malignant tumors] 9383/1; 9384/1 9394/1 9390/0,1 9444/1


8680/0,1; 8681/1; 8682/1; 8690/1; 8693/1; 9412/1; 9413/0; 9442/1; 9490/0; 9491/0; 9492/0; 9493/0; 9505/1; 9506/1 9360/1; 9361/1 9363/0

Tumors of Cranial and Spinal Nerves Nerve sheath, non-malignant and malignant Other tumors of cranial and spinal nerves

9540/0,1; 9541/0, 9550/0; 9560/0,1; 9570/0; 9571/0 9562/0


9530/0,1; 9531/0; 9532/0; 9533/0; 9534/0; 9537/0; 9538/1; 9539/1 8324/0; 8728/0,1; 8800/0; 8810/0; 8815/0; 8824/0,1; 8830/0,1; 8831/0; 8835/1; 8836/1; 8850/0,1; 8851/0; 8852/0, 8854/0; 8857/0; 8861/0; 8870/0; 8890/0,1; 8897/1; 8900/0;

Hemangioblastoma

8920/1; 8935/0,1; 8990/0,1; 9040/0; 9150/0,1; 9170/0; 9180/0; 9210/0; 9241/0; 9536/0 9161/1; 9535/0


9740/1; 9766/1; 9970/1


8440/0; 9080/0,1; 9084/0


8040/0,1; 8140/0,1; 8146/0; 8190/0; 8202/0; 8240/1; 8260/0; 8270/0; 8271/0; 8272/0; 8280/0; 8281/0; 8290/0; 8300/0; 8310/0; 8323/0; 8333/0, 8334/0; 9582/0 9350/1; 9351/1; 9352/1


8711/0; 9220/0,1; 9373/0 9120/0; 9121/0; 9122/0; 9123/0; 9125/0; 9130/0,1; 9131/0; 9133/1 8000/0,1; 8001/0,1; 8005/0; 8010/0 8452/1; 8683/0; 8711/0; 8713/0; 8811/0; 8840/0; 8860/0; 9173/0; 9580/0; 9751/1; 9752/1; 9753/1

Includes all the histologies listed in the standard definition of reportable brain tumors from the Consensus Conference on Brain Tumor Definitions. International Classification of Diseases for Oncology, 3rd Edition, 2000. World Health Organization, Geneva, Switzerland. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NOS, not otherwise specified. b

Table 2: 2000 U.S. Standard Population Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44

2000 U.S. 18,986,520 19,919,840 20,056,779 19,819,518 18,257,225 17,722,067 19,511,370 22,179,956 22,479,229

Age Group 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

2000 U.S. 19,805,793 17,224,359 13,307,234 10,654,272 9,409,940 8,725,574 7,414,559 4,900,234 4,259,173

Age Group Total

2000 U.S. 274,633,642

a

Table 3: Average Annual Populations for 2004-2007, By Age, Gender and Race Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total a

All Races 10,041,240 9,677,296 10,209,331 10,425,503 10,395,457 9,932,701 9,664,459 10,172,715 10,802,832 10,718,854 9,538,598 8,207,941 6,137,003 4,628,062 3,694,259 3,008,206 2,094,640 1,581,178 140,930,274

Males Whites 7,818,888 7,566,090 7,945,014 8,161,198 8,233,524 7,907,204 7,704,179 8,232,945 8,869,402 8,919,542 8,031,139 7,018,698 5,324,178 4,016,873 3,239,418 2,688,369 1,887,464 1,425,015 114,989,137

Blacks 1,557,274 1,521,305 1,661,406 1,651,217 1,520,249 1,338,549 1,215,579 1,237,727 1,286,289 1,222,286 1,014,717 788,174 532,495 400,805 303,121 212,119 137,192 104,206 17,704,707

All Races 9,590,631 9,245,987 9,727,633 9,909,317 9,775,883 9,518,846 9,442,188 10,072,052 10,897,691 10,983,508 9,946,062 8,707,027 6,722,299 5,304,646 4,553,905 4,133,591 3,362,577 3,425,705 145,319,545

Females Whites 7,451,904 7,195,968 7,538,619 7,721,823 7,670,294 7,416,338 7,335,593 7,960,197 8,756,755 8,947,556 8,192,620 7,291,767 5,721,881 4,517,914 3,914,472 3,625,826 2,999,859 3,080,696 117,340,081

Population data source for 48 population-based geographic regions: Estimates from the U.S. Census Bureau .

Blacks 1,505,110 1,472,625 1,609,469 1,605,755 1,491,791 1,414,501 1,344,823 1,384,999 1,460,303 1,404,316 1,196,757 956,471 682,119 542,695 443,701 355,625 260,373 256,888 19,388,319

a

Table 4: Average Annual Populations for 2004-2007 By Age, Gender, Race and Hispanic Origin Males

a

Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total

Hispanic 2,382,985 2,004,249 1,921,106 1,760,562 1,928,576 2,145,548 1,995,551 1,772,260 1,542,248 1,231,046 922,162 682,318 464,941 339,307 252,052 185,317 115,801 83,201 21,729,230

Non-Hispanic 7,658,256 7,673,046 8,288,224 8,664,941 8,466,881 7,787,154 7,668,908 8,400,455 9,260,585 9,487,808 8,616,436 7,525,623 5,672,063 4,288,755 3,442,207 2,822,889 1,978,839 1,497,976 119,201,044 Females

Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total

Hispanic 2,285,597 1,914,874 1,835,752 1,659,396 1,633,791 1,723,774 1,693,545 1,555,831 1,410,412 1,180,180 931,575 724,142 525,342 405,380 323,897 257,285 174,291 157,751 20,392,813

Non-Hispanic 7,305,034 7,331,113 7,891,880 8,249,921 8,142,091 7,795,072 7,748,643 8,516,221 9,487,280 9,803,328 9,014,487 7,982,886 6,196,957 4,899,267 4,230,008 3,876,306 3,188,286 3,267,954 124,926,733

White NonHispanic 5,639,875 5,721,902 6,175,589 6,537,586 6,439,284 5,900,029 5,829,748 6,570,818 7,425,108 7,768,673 7,171,086 6,381,033 4,887,647 3,697,490 3,001,185 2,512,371 1,777,175 1,346,033 94,782,629

Black NonHispanic 1,434,651 1,427,307 1,571,793 1,572,105 1,445,045 1,261,215 1,147,800 1,174,835 1,230,411 1,176,806 978,606 761,918 515,363 388,371 294,374 206,243 133,709 101,625 16,822,176

White NonHispanic 5,361,831 5,435,365 5,849,772 6,194,582 6,159,342 5,818,995 5,760,559 6,515,148 7,446,910 7,851,482 7,326,886 6,616,508 5,229,400 4,137,002 3,609,168 3,382,554 2,834,695 2,931,007 98,461,202

Black NonHispanic 1,388,097 1,382,197 1,522,752 1,529,455 1,421,707 1,338,565 1,271,822 1,316,872 1,399,693 1,353,799 1,156,825 926,505 661,649 526,920 431,608 346,446 254,256 251,355 18,480,523

Population data source for 48 population-based geographic regions: Estimates from the U.S. Census Bureau .

Table 5: Number of Brain and CNS Tumors By Major Histology Groupings, Histology, Gender and Race; CBTRUS Statistical Report: NPCR and SEER, 2004-2007 Histology

By Gender Male Female

By Race White Black

Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma Anaplastic astrocytoma Unique astrocytoma variants Astrocytoma, NOS Glioblastoma Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma Ependymoma variants Mixed glioma Glioma malignant, NOS Choroid plexus Neuroepithelial Non-malignant and malignant neuronal/glial Pineal parenchymal Embryonal/primitive/medulloblastoma

42,401 1,900 734 2,651 673 2,784 21,564 1,773 769 1,531 639 1,304 2,542 253 122 1,702 176 1,284

33,939 1,763 508 2,096 424 2,410 16,326 1,411 617 1,480 496 947 2,421 258 114 1,467 228 973

68,467 3,083 1,134 4,327 921 4,573 34,973 2,848 1,244 2,607 1,023 2,017 4,244 424 212 2,651 303 1,883

4,983 363 59 254 120 386 1,945 188 68 248 53 124 456 51 16 332 77 243


9,406 9,404

10,199 10,196

17,182 17,178

916 916

21,846 20,455 345 1,046

58,611 57,453 322 836

67,188 65,026 552 1,610

8,884 8,660 66 158

2,905 2,905

2,475 2,475

4,561 4,561

550 550

747 747

345 345

878 878

107 107

14,226 13,435 791

17,179 16,371 808

23,577 22,367 1,210

5,574 5,304 270

104 104

90 90

168 168

-

5,489 783 4,628 78

6,829 1,031 5,745 53

10,426 1,555 8,758 113

1,311 143 1,159 -

97,124

129,667

192,447

22,337

Tumors of Meninges Meningioma Other mesenchymal, non-malignant and malignant Hemangioblastoma Lymphomas and Hematopoietic Neoplasms Lymphoma Germ Cell Tumors and Cysts Germ cell tumors, cysts and heterotopias Tumors of Sellar Region Pituitary Craniopharyngioma Local Extensions from Regional Tumors Chordoma/chondrosarcoma Unclassified Tumors Hemangioma Neoplasm, unspecified All other TOTAL

-Counts are not presented when fewer than 16 cases were reported for the specific histology category. The suppressed cases are included in the counts for totals. Abbreviation: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program.

Table 6: Number of Brain and CNS Tumors By Major Histology Groupings, Histology, Race and Hispanic Ethnicity; CBTRUS Statistical Report: NPCR and SEER, 2004-2007 White Black NonNonNonHistology Hispanic Hispanic Hispanic Hispanic Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma Anaplastic astrocytoma Unique astrocytoma variants Astrocytoma, NOS Glioblastoma Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma Ependymoma variants Mixed glioma Glioma malignant, NOS Choroid plexus Neuroepithelial Non-malignant and malignant neuronal/glial Pineal parenchymal Embryonal/primitive/medulloblastoma

6,728 500 88 408 129 485 2,367 335 122 389 101 248 577 99 19 351 59 451

69,612 3,163 1,154 4,339 968 4,709 35,523 2,849 1,264 2,622 1,034 2,003 4,386 412 217 2,818 345 1,806

62,134 2,628 1,051 3,936 799 4,119 32,721 2,527 1,131 2,240 929 1,782 3,709 332 195 2,324 250 1,461

4,834 348 57 248 117 377 1,901 186 66 239 52 117 435 50 321 75 231


1,537 1,537

18,068 18,063

15,797 15,793

875 875

Tumors of Meninges Meningioma Other mesenchymal, non-malignant and malignant Hemangioblastoma Lymphomas and Hematopoietic Neoplasms Lymphoma

6,650 6,353

73,807 71,555

61,050 59,166

8,709 8,491

83 214

584 1,668

473 1,411

65 153

560 560

4,820 4,820

4,033 4,033

536 536

Germ Cell Tumors and Cysts Germ cell tumors, cysts and heterotopias Tumors of Sellar Region Pituitary Craniopharyngioma

212 212 4,288 4,040 248

880 880 27,117 25,766 1,351

679 679 19,642 18,652 990

105 105 5,460 5,205 255

31 31

163 163

138 138

-

1,273 195 1,064 -

11,045 1,619 9,309 117

9,239 1,371 7,769 99

1,283 140 1,134 -

21,279

205,512

172,712

21,814

Local Extensions from Regional Tumors Chordoma/chondrosarcoma Unclassified Tumors Hemangioma Neoplasm, unspecified All other TOTAL


Table 7: Number of Childhood (Ages 0-19) Brain and CNS Tumors by Major Histology Groupings, Histology, Gender and Race; CBTRUS Statistical Report: NPCR and SEER, 2004-2007 Total

By Gender Male Female


10,732 2,529 149 256 334 699 440 203 49 776 116 111 1,746 284 40 1,268 128 1,604

5,739 1,322 85 137 163 371 258 111 25 422 78 50 862 158 701 67 916

4,993 1,207 64 119 171 328 182 92 24 354 38 61 884 126 567 61 688

8,736 2,096 122 211 256 570 341 156 626 96 94 1,412 238 1,041 81 1,325

1,307 275 16 28 59 83 64 39 100 197 27 161 39 183


802 802

405 405

397 397

642 642

94 94

Tumors of Meninges Meningioma Other mesenchymal, non-malignant and malignant Hemangioblastoma

574 391 79 104

282 196 31 55

292 195 48 49

463 304 86

66 54 -

60

38

22

42

-

638

444

194

508

59

1,762 1,286 476

584 347 237

1,178 939 239

1,359 985 374

238 174 64

16

-

-

-

-

711 172 519

379 102 265

332 70 254

588 147 425

75 64

15,295

7,880

7,415

12,352

1,854

Histology

Lymphomas and Hematopoietic Neoplasms Germ Cell Tumors and Cysts Tumors of Sellar Region Pituitary Craniopharyngioma Local Extensions from Regional Tumors Unclassified Tumors Hemangioma Neoplasm, unspecified TOTAL

By Race White Black


Table 8: Number of Childhood (Ages 0-19) Brain and CNS Tumors by Major Histology Groupings, Histology and Age at Diagnosis; CBTRUS Statistical Report: NPCR and SEER, 2004-2007 Age at Diagnosis 10-14 15-19 0-19

Histology

0-4

5-9

0-14

Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma Anaplastic astrocytoma Unique astrocytoma variants Astrocytoma, NOS Glioblastoma Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma Ependymoma variants Mixed glioma Glioma malignant, NOS Choroid plexus Neuroepithelial Non-malignant and malignant neuronal/glial Pineal parenchymal Embryonal/primitive/medulloblastoma Tumors of Cranial and Spinal Nerves Nerve sheath, non-malignant and malignant Tumors of Meninges Meningioma Other mesenchymal, non-malignant and malignant Hemangioblastoma Lymphomas and Hematopoietic Neoplasms Germ Cell Tumors and Cysts Tumors of Sellar Region Pituitary Craniopharyngioma Local Extensions from Regional Tumors Unclassified Tumors Hemangioma Neoplasm, unspecified TOTAL

3,449 698 29 43 44 211 71 29 324 23 671 192 308 43 755 192 192 93 62

2,678 674 36 62 78 150 104 31 172 17 579 33 246 32 428 150 150 64 48

2,398 662 44 74 110 170 117 52 132 27 311 30 341 24 246 179 179 140 96

2,207 495 40 77 102 168 148 91 26 148 64 44 185 29 373 29 175 281 281 277 185

10,732 2,529 149 256 334 699 440 203 49 776 116 111 1,746 284 40 1,268 128 1,604 802 802 574 391

8,525 2,034 109 179 232 531 292 112 23 628 52 67 1,561 255 895 99 1,429 521 521 297 206

104 112 25 87 160 34 120 4,123

90 242 86 156 131 20 109 3,367

226 375 248 127 177 48 122 3,514

21 71 26 218 1,033 927 106 243 70 168 4,291

79 104 60 638 1,762 1,286 476 16 711 172 519 15,295

58 33 34 420 729 359 370 468 102 351 11,004


Table 9: Characteristics of Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumors by Population-Based Cancer Registry; CBTRUS Statistical Report: NPCR and SEER, 2004-2007 No. Of Newly Percent Percent Average Annual Diagnosed Brain & Non-Malignant Histologically 2004-2007 a State CNS Tumors Tumors Confirmed Population Alabama 3,135 57.2 72.3 4,563,654 Alaska 433 66.7 64.4 671,753 Arizona 4,838 63.6 66.6 6,060,847 Arkansas 2,126 60.3 63.1 2,785,966 California 24,878 62.7 72.1 36,003,478 Colorado 4,477 71.0 55.1 4,714,257 Connecticut 2,613 56.3 76.0 3,482,957 Delaware 648 56.2 78.4 844,130 District of Columbia 317 48.9 73.2 583,714 Florida 17,727 67.0 59.3 17,808,727 Georgia 6,175 61.7 66.7 9,211,678 Hawaii 930 73.2 63.4 1,267,155 Idaho 1,081 56.6 69.8 1,442,946 Illinois 9,811 63.2 61.6 12,738,816 Indiana 4,674 59.3 62.5 6,272,339 Iowa 2,530 59.4 64.0 2,961,286 Kentucky 4,115 68.1 55.6 4,184,318 Louisiana 3,155 64.9 64.8 4,365,347 Maine 953 48.9 80.1 1,311,925 Massachusetts 4,856 55.9 76.2 6,445,774 Michigan 8,411 62.2 63.3 10,079,304 Minnesota 3,273 57.1 96.5 5,127,100 Mississippi 1,976 60.1 67.0 2,893,504 Missouri 4,805 62.5 63.7 5,809,789 Montana 714 56.7 74.5 940,727 Nebraska 1,268 56.7 74.4 1,755,443 New Hampshire 1,032 58.8 71.7 1,303,419 New Jersey 6,721 58.4 71.1 8,637,193 New Mexico 1,183 58.1 70.9 1,926,117 New York 17,843 66.6 63.9 19,358,458 North Carolina 6,766 62.0 73.4 8,767,799 North Dakota 425 53.4 59.8 636,444 Ohio 7,865 55.3 75.7 11,458,020 Oklahoma 2,513 54.3 67.7 3,554,576 Oregon 3,083 60.6 73.5 3,653,680 Pennsylvania 11,609 63.1 64.2 12,373,880 Rhode Island 940 62.6 68.0 1,061,915 South Carolina 3,257 60.3 64.5 4,293,974 South Dakota 543 57.8 70.0 783,981 Tennessee 4,804 62.9 66.0 6,026,892 Texas 18,113 66.4 59.0 23,110,942 Utah 1,876 64.8 77.0 2,548,799 Vermont 622 63.0 63.0 619,665 Virginia 4,905 59.6 74.7 7,582,134 Washington 5,996 67.5 60.1 6,311,066 West Virginia 1,578 58.2 61.9 1,805,982 Wisconsin 4,876 54.9 90.8 5,553,748 Wyoming 322 57.5 77.3 511,162 a

Population estimates were obtained from the census data provided to the SEER program. Abbreviation: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program.

a

Table 10: Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor Incidence Rates and 95% Confidence Intervals By Age, Cancer Registry, and Behavior, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2007 0-19 Years State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maine Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming a

Malignant 3.30 2.76 3.64 3.16 2.87 2.81 3.07 3.57 3.37 2.83 2.88 3.26 3.10 3.08 3.32 3.47 2.61 3.51 3.59 3.14 2.53 2.75 3.13 2.44 3.51 3.50 3.29 2.33 3.57 3.46 3.17 3.31 3.37 3.42 3.61 3.63 3.07 2.49 2.79 3.26 3.27 2.62 3.60 3.30 3.24 -

(2.82-3.85) (1.73-4.17) (3.21-4.12) (2.56-3.86) (2.71-3.04) (2.37-3.30) (2.53-3.69) (2.44-5.04) (3.10-3.65) (2.52-3.16) (2.03-3.97) (2.48-4.22) (2.81-3.40) (2.68-3.52) (2.71-4.01) (2.95-4.07) (2.18-3.10) (2.54-4.71) (3.14-4.08) (2.82-3.49) (2.14-2.98) (2.22-3.36) (2.71-3.60) (1.56-3.63) (2.73-4.43) (2.57-4.66) (2.93-3.68) (1.74-3.06) (3.31-3.84) (3.09-3.85) (1.96-4.85) (2.99-3.64) (2.83-4.00) (2.85-4.06) (3.28-3.96) (2.58-4.97) (2.58-3.62) (1.56-3.77) (2.39-3.23) (3.06-3.48) (2.70-3.93) (2.28-3.00) (3.16-4.08) (2.50-4.28) (2.80-3.74) -

20+ Years Non-Malignant 0.90 2.80 1.46 3.19 1.56 1.73 1.51 1.66 1.53 1.72 1.05 1.44 1.51 1.55 1.93 1.47 1.39 1.47 1.72 1.21 1.40 1.45 1.55 2.80 1.89 1.76 1.31 2.18 1.61 1.72 1.46 2.61 1.68 1.60 1.47 1.75 2.05 1.67 1.08 2.14 1.37 1.32 -

(0.66-1.21) (1.77-4.20) (1.18-1.77) (2.59-3.88) (1.45-1.69) (1.39-2.13) (1.15-1.96) (1.47-1.86) (1.31-1.79) (1.08-2.60) (0.62-1.65) (1.25-1.65) (1.24-1.83) (1.15-2.05) (1.54-2.39) (1.15-1.85) (0.82-2.20) (1.19-1.79) (1.48-1.98) (0.94-1.53) (1.04-1.86) (1.17-1.78) (0.88-2.52) (2.12-3.64) (1.25-2.76) (1.50-2.06) (0.88-1.88) (1.99-2.39) (1.36-1.88) (1.50-1.97) (1.10-1.88) (2.12-3.18) (1.46-1.92) (0.95-2.54) (1.14-1.86) (1.44-2.11) (1.88-2.22) (1.26-2.16) (0.86-1.33) (1.81-2.52) (0.87-2.03) (1.04-1.64) -

Malignant 8.53 7.76 8.56 8.75 8.28 9.00 9.62 9.85 9.32 8.78 8.45 5.35 10.21 8.71 9.18 9.95 9.22 7.78 10.16 9.67 9.47 8.50 8.39 9.12 9.51 9.28 9.52 9.53 7.91 8.95 8.72 9.14 8.91 9.56 9.71 9.51 9.40 8.91 8.71 8.85 8.60 9.11 11.17 8.03 9.29 9.99 12.03 8.35

(8.04-9.03) (6.33-9.41) (8.13-9.01) (8.13-9.41) (8.10-8.46) (8.48-9.54) (9.04-10.23) (8.67-11.16) (7.91-10.91) (8.54-9.02) (8.08-8.83) (4.65-6.13) (9.24-11.25) (8.41-9.02) (8.74-9.63) (9.31-10.62) (8.69-9.77) (7.30-8.29) (9.22-11.16) (9.24-10.12) (9.12-9.83) (8.04-8.99) (7.77-9.04) (8.67-9.58) (8.43-10.70) (8.46-10.15) (8.58-10.54) (9.16-9.91) (7.19-8.69) (8.71-9.20) (8.36-9.09) (7.82-10.62) (8.60-9.23) (8.98-10.17) (9.13-10.31) (9.21-9.82) (8.37-10.51) (8.40-9.44) (7.55-9.99) (8.42-9.30) (8.36-8.84) (8.34-9.92) (9.71-12.78) (7.65-8.41) (8.85-9.75) (9.19-10.83) (11.51-12.57) (6.93-9.97)

All Ages Non-Malignant

12.72 16.60 17.03 14.03 15.27 24.44 13.12 13.56 9.13 19.18 15.05 16.83 14.83 16.43 14.52 15.64 21.73 15.86 10.41 13.12 16.83 11.96 13.77 16.53 13.47 12.82 14.48 14.31 11.74 19.48 15.76 10.98 11.85 12.44 15.75 17.62 17.23 14.86 12.71 16.02 19.29 19.52 19.56 12.88 21.24 14.94 15.53 11.77

(12.13-13.34) (14.50-18.90) (16.42-17.66) (13.23-14.86) (15.03-15.52) (23.57-25.33) (12.44-13.83) (12.17-15.07) (7.74-10.70) (18.83-19.54) (14.55-15.55) (15.56-18.18) (13.66-16.09) (16.02-16.86) (13.97-15.09) (14.84-16.48) (20.92-22.57) (15.16-16.58) (9.45-11.43) (12.62-13.63) (16.37-17.30) (11.41-12.53) (12.97-14.59) (15.93-17.14) (12.14-14.91) (11.86-13.84) (13.31-15.72) (13.86-14.78) (10.85-12.68) (19.13-19.85) (15.28-16.26) (9.55-12.56) (11.49-12.22) (11.77-13.14) (15.01-16.51) (17.21-18.04) (15.84-18.73) (14.19-15.55) (11.31-14.24) (15.44-16.62) (18.94-19.65) (18.39-20.70) (17.61-21.65) (12.40-13.36) (20.57-21.92) (13.96-15.96) (14.94-16.15) (10.09-13.66)

Malignant 7.03 6.32 7.15 7.15 6.73 7.22 7.74 8.05 6.86 7.22 6.84 4.64 8.22 7.10 7.43 8.05 7.57 6.30 8.25 7.93 7.66 6.79 6.77 7.40 7.48 7.62 7.80 7.74 6.31 7.41 7.21 7.43 7.30 7.79 7.90 7.82 7.74 7.23 6.92 7.11 7.07 7.43 8.52 6.48 7.66 8.07 9.51 6.58

(6.66-7.42) (5.25-7.54) (6.82-7.49) (6.67-7.65) (6.59-6.87) (6.83-7.63) (7.29-8.21) (7.14-9.05) (5.83-8.01) (7.04-7.42) (6.56-7.12) (4.08-5.26) (7.48-9.00) (6.87-7.34) (7.10-7.77) (7.56-8.56) (7.16-7.99) (5.93-6.68) (7.52-9.03) (7.59-8.27) (7.39-7.93) (6.44-7.16) (6.30-7.26) (7.06-7.75) (6.66-8.38) (6.99-8.29) (7.06-8.58) (7.45-8.03) (5.77-6.90) (7.22-7.60) (6.93-7.50) (6.42-8.56) (7.06-7.55) (7.34-8.25) (7.46-8.37) (7.58-8.06) (6.94-8.61) (6.84-7.64) (6.05-7.89) (6.79-7.45) (6.89-7.25) (6.86-8.04) (7.44-9.72) (6.19-6.77) (7.32-8.01) (7.46-8.72) (9.11-9.92) (5.51-7.80)

Non-Malignant 9.33 12.64 12.56 10.92 11.34 17.93 9.79 10.08 6.51 14.15 11.17 12.50 10.88 12.13 10.79 11.60 16.05 11.73 7.82 9.77 12.49 8.87 10.22 12.20 10.05 9.95 10.87 10.71 8.75 14.52 11.70 8.21 8.94 9.29 11.98 13.05 12.75 11.02 9.33 11.93 14.35 14.40 14.40 9.49 15.76 11.04 11.46 8.70

(8.90-9.78) (11.11-14.31) (12.12-13.02) (10.32-11.54) (11.16-11.52) (17.30-18.57) (9.30-10.31) (9.06-11.18) (5.52-7.64) (13.90-14.42) (10.81-11.54) (11.57-13.48) (10.03-11.78) (11.83-12.44) (10.39-11.20) (11.01-12.21) (15.46-16.66) (11.22-12.25) (7.12-8.58) (9.41-10.15) (12.16-12.84) (8.47-9.29) (9.64-10.82) (11.77-12.65) (9.08-11.10) (9.23-10.71) (10.01-11.78) (10.38-11.05) (8.10-9.43) (14.26-14.79) (11.35-12.06) (7.16-9.37) (8.68-9.22) (8.80-9.80) (11.44-12.54) (12.75-13.35) (11.73-13.84) (10.53-11.52) (8.31-10.43) (11.50-12.37) (14.09-14.61) (13.58-15.25) (12.99-15.93) (9.15-9.85) (15.27-16.26) (10.33-11.80) (11.02-11.90) (7.47-10.07)

All Tumors 16.36 18.96 19.71 18.07 18.07 25.15 17.53 18.13 13.37 21.38 18.01 17.14 19.09 19.23 18.22 19.65 23.62 18.03 16.07 17.70 20.15 15.66 16.99 19.60 17.53 17.57 18.66 18.45 15.06 21.93 18.91 15.64 16.25 17.08 19.88 20.86 20.49 18.25 16.25 19.04 21.41 21.83 22.93 15.97 23.42 19.11 20.97 15.28

Rates are per 100,000 person years. - Not available. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program; CI, confidence interval; NOS, not otherwise specified.

(15.79-16.95) (17.08-20.99) (19.16-20.28) (17.30-18.86) (17.85-18.30) (24.41-25.91) (16.86-18.23) (16.75-19.59) (11.92-14.94) (21.06-21.70) (17.55-18.47) (16.04-18.29) (17.96-20.28) (18.85-19.62) (17.70-18.75) (18.88-20.44) (22.90-24.36) (17.40-18.67) (15.05-17.14) (17.20-18.21) (19.72-20.59) (15.13-16.21) (16.24-17.76) (19.05-20.17) (16.25-18.89) (16.61-18.57) (17.53-19.85) (18.01-18.90) (14.21-15.95) (21.61-22.26) (18.46-19.37) (14.16-17.23) (15.89-16.61) (16.41-17.76) (19.18-20.61) (20.48-21.25) (19.19-21.86) (17.62-18.89) (14.90-17.70) (18.50-19.59) (21.10-21.73) (20.83-22.86) (21.14-24.84) (15.52-16.43) (22.82-24.03) (18.17-20.10) (20.38-21.57) (13.63-17.07)

a

b

Table 11: Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor Incidence Rates by Site and Gender, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2007

ICDO Code C71.1-C71.4 C71.0 C71.5 C71.6 C71.7 C71.8-C71.9 C72.0-C72.1 C72.2-C72.5 C72.8-C72.9 C70.0-C70.9 C75.1-C75.2 C75.3 C30.0 (9522-9523) TOTAL a

Site Frontal, temporal, parietal, & occipital lobes of the brain Cerebrum Ventricle Cerebellum Brain stem Other brain Spinal cord and cauda equina Cranial nerves Other nervous system Meninges (cerebral & spinal) Pituitary Pineal Olfactory tumors of the nasal cavity

N

Males Adjusted Rate

95% C.I.

N

Females Adjusted Rate

95% C.I.

N

Total Adjusted Rate

95% C.I.

27,721 2,460 1,466 3,413 2,009 12,143

5.09 0.45 0.26 0.61 0.36 2.27

(5.03 -5.15) (0.43 -0.47) (0.25 -0.27) (0.59 -0.63) (0.35 -0.38) (2.23 -2.32)

22,760 2,181 1,172 2,938 1,799 11,307

3.64 0.36 0.20 0.50 0.32 1.76

(3.59 -3.69) (0.34 -0.37) (0.19 -0.22) (0.49 -0.52) (0.30 -0.33) (1.73 -1.80)

50,481 4,641 2,638 6,351 3,808 23,450

4.31 0.40 0.23 0.56 0.34 2.00

(4.27 -4.34) (0.39 -0.41) (0.22 -0.24) (0.54 -0.57) (0.33 -0.35) (1.97 -2.02)

3,831 7,492

0.68 1.33

(0.66 -0.70) (1.30 -1.36)

3,647 8,410

0.61 1.37

(0.59 -0.63) (1.34 -1.40)

7,478 15,902

0.64 1.35

(0.63 -0.66) (1.32 -1.37)

745

0.14

(0.13 -0.15)

603

0.10

(0.09 -0.11)

1,348

0.12

(0.11 -0.12)

20,234 14,727 619

3.87 2.68 0.11

(3.81 -3.92) (2.64 -2.72) (0.10 -0.12)

56,501 17,777 383

8.73 2.99 0.07

(8.65 -8.80) (2.95 -3.04) (0.06 -0.07)

76,735 32,504 1,002

6.49 2.80 0.09

(6.44 -6.53) (2.77 -2.83) (0.08 -0.09)

264 97,124

0.05 17.88

(0.04 -0.05) (17.77-17.99)

189 129,667

0.03 20.67

(0.03 -0.04) (20.56-20.79)

453 226,791

0.04 19.34

(0.04 -0.04) (19.26-19.42)

Rates are per 100,000 person years. The sites referred to in this table are loosely based on the categories and site codes defined in the SEER site/histology validation list. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program; CI, confidence interval. b

a

Table 12: Distribution and Incidence Rates of Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumors by Major Histology Groupings and Histology, AgeAdjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2007 TOTAL % of All Reported Adjusted Histology N Brain Tumors Rate 95% C.I. Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma Anaplastic astrocytoma Unique astrocytoma variants Astrocytoma, NOS Glioblastoma Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma Ependymoma variants Mixed glioma Glioma malignant, NOS Choroid plexus Neuroepithelial Non-malignant and malignant neuronal/glial Pineal parenchymal Embryonal/primitive/medulloblastoma

76,340 3,663 1,242 4,747 1,097 5,194 37,890 3,184 1,386 3,011 1,135 2,251 4,963 511 236 3,169 404 2,257

33.7 1.6 0.5 2.1 0.5 2.3 16.7 1.4 0.6 1.3 0.5 1.0 2.2 0.2 0.1 1.4 0.2 1.0

6.55 0.33 0.11 0.41 0.10 0.45 3.19 0.28 0.12 0.26 0.10 0.20 0.43 0.05 0.02 0.28 0.04 0.20

(6.51-6.60) (0.32-0.34) (0.10-0.11) (0.40-0.42) (0.09-0.10) (0.44-0.46) (3.16-3.23) (0.27-0.29) (0.11-0.13) (0.25-0.27) (0.09-0.10) (0.19-0.21) (0.42-0.45) (0.04-0.05) (0.02-0.02) (0.27-0.29) (0.03-0.04) (0.19-0.21)


19,605 19,600

8.6 8.6

1.66 1.66

(1.64-1.68) (1.64-1.68)


80,457 77,908 667 1,882

35.5 34.4 0.3 0.8

6.81 6.59 0.06 0.16

(6.76-6.85) (6.54-6.63) (0.05-0.06) (0.15-0.17)

Lymphomas and Hematopoietic Neoplasms Lymphoma

5,380 5,380

2.4 2.4

0.46 0.46

(0.45-0.47) (0.45-0.47)


1,092 1,092

0.5 0.5

0.10 0.10

(0.09-0.10) (0.09-0.10)

31,405 29,806 1,599

13.8 13.1 0.7

2.70 2.56 0.14

(2.67-2.73) (2.53-2.59) (0.13-0.15)

194 194

0.1 0.1

0.02 0.02

(0.01-0.02) (0.01-0.02)

12,318 1,814 10,373 131

5.4 0.8 4.6 0.1

1.05 0.16 0.88 0.01

(1.03-1.06) (0.15-0.16) (0.86-0.90) (0.01-0.01)

226,791

100.0

19.34

(19.26-19.42)

Tumors of Sellar Region Pituitary Craniopharyngioma Local Extensions from Regional Tumors Chordoma/chondrosarcoma Unclassified Tumors Hemangioma Neoplasm, unspecified All other TOTAL a

b

Rates are per 100,000 person years. b Refers to all brain tumors including histologies not presented in this table. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program; CI, confidence interval; NOS, not otherwise specified.

a,b

Table 12a: Distribution and Incidence Rates of Primary (Malignant and Non-Malignant) Brain and CNS Tumors by Major Histology Groupings and Histology, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004- 2007

Histology

N


71,466 3,663 1,242 4,747 311 5,194 37,890 3,184 1,386 3,011 2,251 4,963 105 201

Malignant Adjusted Rate (95% C.I.) (6.08-6.17) (0.32-0.34) (0.10-0.11) (0.40-0.42) (0.02-0.03) (0.44-0.46) (3.16-3.23) (0.27-0.29) (0.11-0.13) (0.25-0.27) (0.19-0.21) (0.42-0.45) (0.01-0.01) (0.02-0.02)

4,874 786 1,120 406 35

0.43 (0.42-0.44) 0.07 (0.06-0.07) 0.10 (0.09-0.10) 0.04 (0.03-0.04) 0.00 (0.00-0.00)

821 228 2,257

0.07 (0.07-0.08) 0.02 (0.02-0.02) 0.20 (0.19-0.21)

2,348 176 -

0.21 (0.20-0.22) 0.02 (0.01-0.02) -


211

0.02 (0.02-0.02)

19,394

1.64 (1.62-1.67)

211

0.02 (0.02-0.02)

19,389

1.64 (1.62-1.66)


1,909 1,663

0.16 (0.16-0.17) 0.14 (0.13-0.15)

78,548 76,245

6.64 (6.60-6.69) 6.45 (6.40-6.49)

246 -

0.02 (0.02-0.02) -

421 1,882

0.04 (0.03-0.04) 0.16 (0.15-0.17)

5,376 5,376

0.46 (0.45-0.47) 0.46 (0.45-0.47)

-


750

0.07 (0.06-0.07)

342

0.03 (0.03-0.03)

750

0.07 (0.06-0.07)

342

0.03 (0.03-0.03)

Tumors of Sellar Region Pituitary Craniopharyngioma Local Extensions from Regional Tumors Chordoma/chondrosarcoma

126 126 -

0.01 (0.01-0.01) 0.01 (0.01-0.01) -

31,279 29,680 1,599

2.69 (2.66-2.72) 2.55 (2.52-2.58) 0.14 (0.13-0.15)

189 189

0.02 (0.01-0.02) 0.02 (0.01-0.02)

-

4,934 4,874 48

0.42 (0.40-0.43) 0.41 (0.40-0.42) 0.00 (0.00-0.01)

7,384 1,802 5,499 83

84,961

7.28 (7.23-7.32)

141,830

Unclassified Tumors Hemangioma Neoplasm, unspecified All other TOTAL a

d

6.13 0.33 0.11 0.41 0.03 0.45 3.19 0.28 0.12 0.26

N

Non-malignant Adjusted Rate (95% C.I.)

0.20 0.43 0.01 0.02

-

0.63 0.16 0.47 0.01

(0.62-0.65) (0.15-0.16) (0.46-0.48) (0.01-0.01)

12.06 (12.00-12.13)

Rates are per 100,000 person years. b Population data source: Estimates from the U.S. Bureau of the Census, http://seer.cancer.gov/popdata/index.html d Refers to all brain tumors including histologies not presented in this table. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; SEER, Surveillance, Epidemiology and End Results Program; CI, confidence interval; NOS, not otherwise specified; CNS, central nervous system.

Table 13: Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor a Incidence Rates by Major Histology Groupings, Histology and Gender, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2007 Males Histology

Adjusted Rate

95% C.I.

Females Adjusted Rate 95% C.I.


7.72 0.34 0.13 0.48 0.12 0.51 3.99 0.31 0.14 0.27 0.11 0.23 0.47 0.05 0.02 0.30 0.03 0.23

(7.65-7.79) (0.32-0.35) (0.12-0.14) (0.46-0.50) (0.11-0.13) (0.49-0.53) (3.94-4.04) (0.30-0.33) (0.13-0.15) (0.26-0.29) (0.10-0.12) (0.22-0.25) (0.45-0.49) (0.04-0.05) (0.02-0.03) (0.29-0.32) (0.03-0.04) (0.21-0.24)

5.55 0.32 0.09 0.35 0.07 0.40 2.53 0.24 0.10 0.25 0.08 0.16 0.41 0.05 0.02 0.26 0.04 0.18

(5.49-5.61) (0.31-0.34) (0.08-0.09) (0.33-0.36) (0.07-0.08) (0.39-0.42) (2.49-2.57) (0.23-0.26) (0.10-0.11) (0.24-0.27) (0.08-0.09) (0.15-0.17) (0.39-0.42) (0.04-0.05) (0.02-0.02) (0.24-0.27) (0.04-0.05) (0.17-0.19)


1.66 1.66

(1.63-1.70) (1.63-1.70)

1.66 1.66

(1.63-1.69) (1.63-1.69)


4.16 3.91

(4.10-4.22) (3.86-3.97)

9.07 8.87

(8.99-9.14) (8.80-8.95)

0.06 0.19

(0.06-0.07) (0.17-0.20)

0.05 0.14

(0.05-0.06) (0.13-0.15)

0.54 0.54

(0.52-0.56) (0.52-0.56)

0.39 0.39

(0.37-0.40) (0.37-0.40)


0.13 0.13

(0.12-0.14) (0.12-0.14)

0.06 0.06

(0.06-0.07) (0.06-0.07)


2.58 2.44 0.14

(2.54-2.63) (2.40-2.48) (0.13-0.15)

2.89 2.75 0.14

(2.85-2.94) (2.71-2.80) (0.13-0.15)

Local Extensions from Regional Tumors Chordoma/chondrosarcoma

0.02 0.02

(0.02-0.02) (0.02-0.02)

0.02 0.02

(0.01-0.02) (0.01-0.02)

Unclassified Tumors Hemangioma Neoplasm, unspecified All other

1.06 0.14 0.91 0.02

(1.04-1.09) (0.13-0.15) (0.88-0.94) (0.01-0.02)

1.04 0.17 0.86 0.01

(1.01-1.06) (0.16-0.18) (0.84-0.88) (0.01-0.01)

17.88

(17.77-17.99)

20.67

(20.56-20.79)

TOTAL a

b

Rates are per 100,000 person years. b Refers to all brain tumors including histologies not presented in this table. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program; CI, confidence interval; NOS, not otherwise specified.

Table 14: Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor a Incidence Rates by Major Histology Groupings, Histology and Race, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2007

Histology

Whites Adjusted Rate 95% C.I.

Blacks Adjusted Rate 95% C.I.


7.03 0.35 0.12 0.45 0.10 0.48 3.45 0.31 0.13 0.28 0.11 0.22 0.45 0.05 0.02 0.29 0.03 0.21

(6.98-7.09) (0.34-0.36) (0.11-0.13) (0.43-0.46) (0.09-0.11) (0.47-0.49) (3.41-3.48) (0.29-0.32) (0.12-0.14) (0.27-0.29) (0.10-0.12) (0.21-0.23) (0.44-0.47) (0.04-0.05) (0.02-0.03) (0.28-0.30) (0.03-0.04) (0.21-0.22)

3.68 0.22 0.04 0.19 0.08 0.29 1.63 0.13 0.05 0.16 0.04 0.09 0.32 0.03 0.01 0.21 0.05 0.14

(3.57-3.78) (0.20-0.24) (0.03-0.05) (0.17-0.22) (0.06-0.09) (0.26-0.32) (1.55-1.70) (0.11-0.15) (0.04-0.06) (0.14-0.19) (0.03-0.05) (0.07-0.11) (0.29-0.35) (0.02-0.04) (0.01-0.02) (0.19-0.24) (0.04-0.06) (0.13-0.16)


1.74 1.74

(1.71-1.77) (1.71-1.77)

0.69 0.69

(0.64-0.74) (0.64-0.74)


6.64 6.42

(6.59-6.69) (6.37-6.47)

7.67 7.50

(7.51-7.83) (7.34-7.66)

0.06 0.17

(0.05-0.06) (0.16-0.18)

0.05 0.12

(0.04-0.06) (0.10-0.14)


0.46 0.46

(0.44-0.47) (0.44-0.47)

0.42 0.42

(0.38-0.46) (0.38-0.46)


0.10 0.10

(0.09-0.11) (0.09-0.11)

0.07 0.07

(0.05-0.08) (0.05-0.08)


2.45 2.32 0.13

(2.41-2.48) (2.29-2.35) (0.12-0.14)

4.39 4.19 0.19

(4.27-4.51) (4.08-4.31) (0.17-0.22)


0.02 0.02

(0.02-0.02) (0.02-0.02)

-


1.04 0.16 0.86 0.01

(1.02-1.06) (0.15-0.17) (0.84-0.88) (0.01-0.01)

1.10 0.11 0.99 -

(1.04-1.17) (0.09-0.13) (0.93-1.05) -

19.47

(19.38-19.55)

18.02

(17.77-18.26)

TOTAL a

b

-

Rates are per 100,000 person years. b Refers to all brain tumors including histologies not presented in this table. -Counts are not presented when fewer than 16 cases were reported for the specific histology category. The suppressed cases are included in the counts for totals. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program; CI, confidence interval; NOS, not otherwise specified.

a

Table 15: Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor Incidence Rates By Major Histology Groupings, Histology, Race and Hispanic b Ethnicity , Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2007

Histology

Non-Hispanics (Of Any Race) Adjusted Rate 95% C.I.

White Non-Hispanics Adjusted Rate 95% C.I.

Black Non-Hispanics Adjusted Rate 95% C.I.


5.08 0.24 0.06 0.32 0.08 0.33 2.41 0.23 0.09 0.23 0.06 0.17 0.37 0.05 0.02 0.19 0.03 0.21

(4.94-5.21) (0.22-0.26) (0.05-0.07) (0.28-0.35) (0.06-0.09) (0.30-0.37) (2.31-2.51) (0.20-0.25) (0.08-0.11) (0.21-0.26) (0.05-0.08) (0.15-0.19) (0.33-0.40) (0.04-0.06) (0.01-0.03) (0.17-0.22) (0.02-0.04) (0.19-0.23)

6.75 0.35 0.11 0.42 0.10 0.47 3.27 0.29 0.12 0.27 0.10 0.20 0.45 0.04 0.02 0.30 0.04 0.20

(6.70-6.80) (0.34-0.36) (0.11-0.12) (0.41-0.43) (0.09-0.11) (0.46-0.48) (3.24-3.30) (0.28-0.30) (0.12-0.13) (0.26-0.28) (0.10-0.11) (0.19-0.21) (0.43-0.46) (0.04-0.05) (0.02-0.02) (0.29-0.31) (0.03-0.04) (0.19-0.21)

7.33 0.38 0.13 0.47 0.10 0.51 3.55 0.32 0.14 0.29 0.12 0.23 0.47 0.05 0.02 0.31 0.03 0.22

(7.27-7.39) (0.37-0.40) (0.12-0.14) (0.45-0.48) (0.10-0.11) (0.49-0.52) (3.52-3.59) (0.31-0.34) (0.13-0.15) (0.27-0.30) (0.11-0.13) (0.22-0.24) (0.45-0.49) (0.04-0.05) (0.02-0.03) (0.30-0.33) (0.03-0.04) (0.21-0.23)

3.72 0.22 0.04 0.19 0.08 0.29 1.64 0.14 0.05 0.17 0.04 0.09 0.32 0.03 0.22 0.05 0.15

(3.62-3.83) (0.20-0.25) (0.03-0.05) (0.17-0.22) (0.07-0.10) (0.26-0.32) (1.57-1.72) (0.12-0.16) (0.04-0.07) (0.15-0.19) (0.03-0.05) (0.07-0.11) (0.29-0.35) (0.03-0.04) (0.19-0.24) (0.04-0.06) (0.13-0.17)


1.23 1.23

(1.16-1.29) (1.16-1.29)

1.72 1.72

(1.69-1.74) (1.69-1.74)

1.83 1.83

(1.80-1.86) (1.80-1.85)

0.69 0.69

(0.64-0.73) (0.64-0.73)


6.77 6.56 0.06 0.15

(6.60-6.94) (6.39-6.74) (0.05-0.07) (0.13-0.17)

6.83 6.61 0.06 0.16

(6.78-6.88) (6.56-6.66) (0.05-0.06) (0.16-0.17)

6.67 6.44 0.06 0.17

(6.61-6.72) (6.39-6.49) (0.05-0.06) (0.16-0.18)

7.77 7.60 0.05 0.12

(7.60-7.94) (7.44-7.77) (0.04-0.07) (0.10-0.14)


0.50 0.50

(0.46-0.55) (0.46-0.55)

0.45 0.45

(0.44-0.47) (0.44-0.47)

0.44 0.44

(0.43-0.46) (0.43-0.46)

0.42 0.42

(0.39-0.46) (0.39-0.46)


0.11 0.11

(0.09-0.13) (0.09-0.13)

0.10 0.10

(0.09-0.10) (0.09-0.10)

0.10 0.10

(0.09-0.10) (0.09-0.10)

0.07 0.07

(0.06-0.08) (0.06-0.08)


3.25 3.10 0.15

(3.15-3.36) (3.00-3.21) (0.13-0.17)

2.64 2.50 0.14

(2.61-2.67) (2.47-2.53) (0.13-0.15)

2.35 2.22 0.13

(2.32-2.38) (2.19-2.26) (0.12-0.14)

4.46 4.27 0.19

(4.34-4.59) (4.16-4.39) (0.17-0.22)


0.02 0.02

(0.02-0.03) (0.02-0.03)

0.02 0.02

(0.01-0.02) (0.01-0.02)

0.02 0.02

(0.01-0.02) (0.01-0.02)

-

-


1.18 0.14 1.03 -

(1.11-1.26) (0.12-0.16) (0.96-1.10) -

1.03 0.16 0.86 0.01

(1.02-1.05) (0.15-0.17) (0.85-0.88) (0.01-0.01)

1.02 0.17 0.84 0.01

(1.00-1.04) (0.16-0.18) (0.83-0.86) (0.01-0.01)

1.12 0.11 1.00 -

(1.06-1.18) (0.09-0.13) (0.94-1.06) -

18.14

(17.87-18.40)

19.53

(19.45-19.62)

19.75

(19.65-19.84)

18.26

(18.01-18.51)

TOTAL a

Hispanics (Of Any Race) Adjusted Rate 95% C.I.

c

Rates are per 100,000 person years. b Hispanic ethnicity is not mutually exclusive of race; Classified using the North American Association of Central Cancer Registries Hispanic Identification Algorithm, version 2 (NHIA v2) . c Refers to all brain tumors including histologies not presented in this table. -Counts are not presented when fewer than 16 cases were reported for the specific histology category. The suppressed cases are included in the counts for totals. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program; CI, confidence interval; NOS, not otherwise specified.

a

Table 16: Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor Age-Specific Incidence Rates by Major Histology Groupings, Histology and Age at Diagnosis; CBTRUS Statistical Report: NPCR and SEER, 2004-2007

Histology

Rate

0-14 95% C.I.

Age at Diagnosis 0-19 Rate 95% C.I.

Rate

20-34 95% C.I.

Rate

35-44 95% C.I.

Rate

45-54 95% C.I.

Age at Diagnosis 55-64 Rate 95% C.I.

Rate

65-74 95% C.I.

Rate

75-84 95% C.I.

Rate

85+ 95% C.I.

Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma Anaplastic astrocytoma Unique astrocytoma variants Astrocytoma, NOS Glioblastoma Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma Ependymoma variants Mixed glioma Glioma malignant, NOS Choroid plexus Neuroepithelial Non-malignant and malignant neuronal/glial Pineal parenchymal Embryonal/primitive/medulloblastoma Tumors of Cranial and Spinal Nerves Nerve sheath, non-malignant and malignant Tumors of Meninges Meningioma Other mesenchymal, non-malignant and malignant Hemangioblastoma Lymphomas and Hemopoietic Neoplasms Lymphoma Germ Cell Tumors and Cysts Germ cell tumors, cysts and heterotopias Tumors of Sellar Region Pituitary Craniopharyngioma Local Extensions from Regional Tumors

3.63 0.87 0.05 0.08 0.10 0.23 0.13 0.05 0.01 0.27 0.02 0.03 0.67 0.11 0.38 0.04 0.61 0.22 0.22 0.13 0.09

(3.56-3.71) (0.83-0.91) (0.04-0.06) (0.07-0.09) (0.09-0.11) (0.21-0.25) (0.11-0.14) (0.04-0.06) (0.01-0.02) (0.25-0.29) (0.02-0.03) (0.02-0.04) (0.63-0.70) (0.09-0.12) (0.36-0.41) (0.03-0.05) (0.57-0.64) (0.20-0.24) (0.20-0.24) (0.11-0.14) (0.08-0.10)

3.40 0.80 0.05 0.08 0.11 0.22 0.14 0.06 0.02 0.25 0.04 0.04 0.56 0.09 0.01 0.40 0.04 0.51 0.25 0.25 0.18 0.12

(3.34-3.47) (0.77-0.84) (0.04-0.06) (0.07-0.09) (0.10-0.12) (0.21-0.24) (0.13-0.15) (0.06-0.07) (0.01-0.02) (0.23-0.26) (0.03-0.04) (0.03-0.04) (0.53-0.58) (0.08-0.10) (0.01-0.02) (0.38-0.42) (0.03-0.05) (0.48-0.53) (0.24-0.27) (0.24-0.27) (0.17-0.20) (0.11-0.14)

3.19 0.25 0.09 0.29 0.08 0.37 0.41 0.32 0.09 0.20 0.13 0.25 0.21 0.03 0.01 0.28 0.04 0.15 0.79 0.79 1.35 1.16

(3.12-3.26) (0.23-0.27) (0.07-0.10) (0.27-0.32) (0.06-0.09) (0.34-0.39) (0.38-0.44) (0.30-0.35) (0.08-0.11) (0.18-0.22) (0.11-0.14) (0.23-0.27) (0.19-0.23) (0.02-0.04) (0.01-0.01) (0.26-0.30) (0.03-0.05) (0.13-0.16) (0.75-0.82) (0.75-0.82) (1.31-1.40) (1.11-1.20)

4.50 0.12 0.11 0.43 0.08 0.47 1.22 0.51 0.19 0.28 0.13 0.35 0.23 0.03 0.01 0.23 0.03 0.08 1.73 1.73 4.22 3.94

(4.40-4.60) (0.11-0.14) (0.10-0.13) (0.40-0.46) (0.07-0.10) (0.44-0.50) (1.17-1.28) (0.47-0.54) (0.17-0.21) (0.25-0.30) (0.12-0.15) (0.32-0.38) (0.21-0.25) (0.03-0.04) (0.01-0.02) (0.21-0.26) (0.02-0.04) (0.06-0.09) (1.66-1.79) (1.66-1.79) (4.12-4.32) (3.85-4.04)

6.99 0.09 0.13 0.51 0.11 0.46 3.71 0.43 0.19 0.33 0.14 0.26 0.27 0.03 0.02 0.22 0.04 0.06 2.92 2.92 8.04 7.72

(6.86-7.12) (0.08-0.10) (0.11-0.15) (0.48-0.55) (0.10-0.13) (0.43-0.50) (3.62-3.80) (0.40-0.46) (0.17-0.21) (0.30-0.36) (0.13-0.16) (0.23-0.28) (0.25-0.30) (0.02-0.03) (0.02-0.03) (0.20-0.24) (0.03-0.05) (0.05-0.07) (2.84-3.01) (2.84-3.00) (7.90-8.18) (7.58-7.85)

11.96 0.08 0.17 0.75 0.13 0.61 8.22 0.33 0.22 0.36 0.13 0.26 0.39 0.02 0.03 0.21 0.03 0.04 3.88 3.88 13.37 13.00

(11.77-12.16) (0.06-0.10) (0.14-0.19) (0.70-0.80) (0.11-0.15) (0.57-0.66) (8.05-8.38) (0.30-0.36) (0.20-0.25) (0.32-0.39) (0.11-0.15) (0.23-0.29) (0.35-0.42) (0.02-0.04) (0.02-0.04) (0.18-0.24) (0.02-0.04) (0.03-0.05) (3.77-3.99) (3.77-3.99) (13.16-13.58) (12.79-13.20)

17.67 0.08 0.24 1.02 0.10 0.91 13.27 0.26 0.20 0.32 0.11 0.21 0.64 0.04 0.19 0.03 0.03 3.91 3.90 22.63 22.25

(17.36-17.97) (0.06-0.10) (0.20-0.28) (0.95-1.10) (0.08-0.13) (0.85-0.99) (13.01-13.54) (0.23-0.30) (0.17-0.24) (0.28-0.36) (0.09-0.14) (0.18-0.25) (0.58-0.70) (0.03-0.06) (0.16-0.22) (0.02-0.05) (0.02-0.04) (3.76-4.05) (3.76-4.05) (22.29-22.98) (21.91-22.60)

19.45 0.06 0.22 1.06 0.07 1.15 14.49 0.17 0.16 0.20 0.07 0.16 1.31 0.06 0.19 2.98 2.98 32.33 32.00

(19.06-19.84) (0.04-0.09) (0.18-0.27) (0.97-1.16) (0.05-0.10) (1.05-1.24) (14.15-14.82) (0.14-0.21) (0.13-0.20) (0.16-0.25) (0.05-0.10) (0.12-0.20) (1.21-1.41) (0.04-0.09) (0.15-0.23) (2.83-3.14) (2.83-3.14) (31.83-32.83) (31.51-32.50)

11.40 0.39 0.66 8.30 0.08 1.48 0.09 1.48 1.48 38.66 38.50

(10.94-11.88) (0.31-0.49) (0.56-0.79) (7.91-8.71) (0.05-0.13) (1.31-1.66) (0.05-0.14) (1.32-1.66) (1.32-1.66) (37.81-39.53) (37.65-39.37)

0.02 0.01 0.02 0.02 0.18 0.18 0.31 0.15 0.16 -

(0.02-0.03) (0.01-0.02) (0.01-0.02) (0.01-0.02) (0.16-0.20) (0.16-0.20) (0.29-0.34) (0.14-0.17) (0.14-0.18) -

0.03 0.03 0.02 0.02 0.20 0.20 0.55 0.40 0.15 0.01

(0.02-0.03) (0.03-0.04) (0.01-0.02) (0.01-0.02) (0.19-0.22) (0.19-0.22) (0.53-0.58) (0.38-0.43) (0.14-0.17) (0.00-0.01)

0.04 0.16 0.12 0.12 0.11 0.11 2.29 2.20 0.09 0.02

(0.03-0.05) (0.14-0.17) (0.11-0.14) (0.11-0.14) (0.10-0.12) (0.10-0.12) (2.23-2.35) (2.14-2.26) (0.08-0.10) (0.01-0.02)

0.07 0.21 0.28 0.28 0.04 0.04 3.03 2.89 0.14 0.01

(0.06-0.08) (0.19-0.23) (0.25-0.30) (0.25-0.30) (0.03-0.05) (0.03-0.05) (2.95-3.11) (2.81-2.97) (0.12-0.16) (0.01-0.02)

0.08 0.24 0.52 0.52 0.04 0.04 3.64 3.48 0.16 0.02

(0.07-0.09) (0.22-0.27) (0.48-0.55) (0.48-0.55) (0.03-0.05) (0.03-0.05) (3.55-3.73) (3.39-3.57) (0.14-0.18) (0.01-0.03)

0.10 0.28 0.93 0.93 0.02 0.02 4.46 4.29 0.18 0.02

(0.08-0.12) (0.25-0.31) (0.87-0.98) (0.87-0.98) (0.01-0.03) (0.01-0.03) (4.34-4.59) (4.17-4.41) (0.15-0.20) (0.02-0.04)

0.11 0.27 1.83 1.83 0.03 0.03 6.09 5.91 0.18 0.05

(0.09-0.14) (0.24-0.31) (1.73-1.93) (1.73-1.93) (0.02-0.05) (0.02-0.05) (5.92-6.28) (5.74-6.09) (0.15-0.22) (0.03-0.07)

0.09 0.23 2.19 2.08 5.60 5.47 0.13 0.04

(0.06-0.12) (0.19-0.28) (2.06-2.32) (2.06-2.32) (5.39-5.81) (5.27-5.68) (0.10-0.16) (0.03-0.07)

0.10 1.02 1.02 3.42 3.37 -

(0.06-0.15) (0.88-1.17) (0.88-1.17) (3.17-3.69) (3.12-3.63) -

Chordoma/chondrosarcoma Unclassified Tumors

0.20

(0.18-0.22)

0.01 0.22

(0.00-0.01) (0.21-0.24)

0.02 0.44

(0.01-0.02) (0.41-0.47)

0.01 0.65

(0.01-0.02) (0.61-0.69)

0.02 0.88

(0.01-0.03) (0.83-0.92)

0.02 1.32

(0.02-0.04) (1.25-1.39)

0.05 2.45

(0.03-0.07) (2.34-2.57)

0.04 5.17

(0.03-0.07) (4.98-5.37)

10.37

(9.93-10.83)

Hemangioma Neoplasm, unspecified All other TOTALb

0.04 0.15 4.69

(0.04-0.05) (0.13-0.17) (4.61-4.78)

0.05 0.16 0.01 4.84

(0.05-0.06) (0.15-0.18) (0.00-0.01) (4.76-4.92)

0.13 0.31 8.30

(0.11-0.14) (0.29-0.33) (8.18-8.42)

0.19 0.45 0.01 14.45

(0.17-0.21) (0.42-0.48) (0.01-0.02) (14.27-14.63)

0.21 0.65 0.01 23.04

(0.19-0.24) (0.62-0.69) (0.01-0.02) (22.81-23.27)

0.25 1.05 0.02 35.97

(0.22-0.28) (0.99-1.11) (0.01-0.03) (35.63-36.31)

0.29 2.14 54.65

(0.25-0.33) (2.03-2.25) (54.11-55.19)

0.27 4.87 0.04 67.78

(0.22-0.31) (4.68-5.06) (0.02-0.06) (67.06-68.51)

0.18 10.15 66.40

(0.13-0.25) (9.71-10.60) (65.28-67.54)

a

Rates are per 100,000 person years and age-adjusted to the 2000 U.S. standard population. Refers to all brain tumors including histologies not presented in this table. -Counts are not presented when fewer than 16 cases were reported for the specific histology category. The suppressed cases are included in the counts for totals. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program; CI, confidence interval; NOS, not otherwise specified. b

Table 17: Selected Childhood (Ages 0-19) Primary (Malignant and Non-Malignant) Brain and Central Nervous a System Tumor Incidence Rates by Major Histology Groupings, Histology and Gender, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2007 Male Histology Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma Anaplastic astrocytoma Unique astrocytoma variants Astrocytoma, NOS Glioblastoma Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma Ependymoma variants Mixed glioma Glioma malignant, NOS Choroid plexus Neuroepithelial Non-malignant and malignant neuronal/glial Pineal parenchymal Embryonal/primitive/medulloblastoma Tumors of Cranial and Spinal Nerves Nerve sheath, non-malignant and malignant Tumors of Meninges Meningioma Other mesenchymal, non-malignant and malignant Hemangioblastoma Lymphomas and Hemopoietic Neoplasms Germ Cell Tumors and Cysts Tumors of Sellar Region Pituitary Craniopharyngioma Local Extensions from Regional Tumors Unclassified Tumors Hemangioma Neoplasm, unspecified b TOTAL a

Female Adjusted Rate 95% C.I.

TOTAL Adjusted Rate 95% C.I.

Adjusted Rate

95% C.I.

3.56 0.82 0.05 0.09 0.10 0.23 0.16 0.07 0.02 0.26 0.05 0.03 0.54 0.10 -

(3.46-3.65) (0.78-0.87) (0.04-0.07) (0.07-0.10) (0.09-0.12) (0.21-0.25) (0.14-0.18) (0.06-0.08) (0.01-0.02) (0.24-0.29) (0.04-0.06) (0.02-0.04) (0.50-0.58) (0.08-0.11) -

3.24 0.79 0.04 0.08 0.11 0.21 0.12 0.06 0.02 0.23 0.03 0.04 0.58 0.08 -

(3.15-3.33) (0.74-0.83) (0.03-0.05) (0.06-0.09) (0.10-0.13) (0.19-0.24) (0.10-0.14) (0.05-0.07) (0.01-0.02) (0.21-0.25) (0.02-0.03) (0.03-0.05) (0.54-0.62) (0.07-0.10) -

3.40 0.80 0.05 0.08 0.11 0.22 0.14 0.06 0.02 0.25 0.04 0.04 0.56 0.09 0.01

(3.34-3.47) (0.77-0.84) (0.04-0.06) (0.07-0.09) (0.10-0.12) (0.21-0.24) (0.13-0.15) (0.06-0.07) (0.01-0.02) (0.23-0.26) (0.03-0.04) (0.03-0.04) (0.53-0.58) (0.08-0.10) (0.01-0.02)

0.43 0.04 0.57 0.25

(0.40-0.47) (0.03-0.05) (0.53-0.61) (0.23-0.28)

0.37 0.04 0.44 0.26

(0.34-0.40) (0.03-0.05) (0.41-0.48) (0.23-0.28)

0.40 0.04 0.51 0.25

(0.38-0.42) (0.03-0.05) (0.48-0.53) (0.24-0.27)

0.25 0.17 0.12

(0.23-0.28) (0.15-0.19) (0.10-0.14)

0.26 0.19 0.13

(0.23-0.28) (0.17-0.21) (0.11-0.15)

0.25 0.18 0.12

(0.24-0.27) (0.17-0.20) (0.11-0.14)

0.02 0.03

(0.01-0.03) (0.03-0.04)

0.03 0.03

(0.02-0.04) (0.02-0.04)

0.03 0.03

(0.02-0.03) (0.03-0.04)

0.02 0.27 0.36 0.21 0.15

(0.02-0.03) (0.25-0.30) (0.33-0.39) (0.19-0.24) (0.13-0.17)

0.01 0.13 0.76 0.60 0.16

(0.01-0.02) (0.11-0.14) (0.72-0.80) (0.56-0.64) (0.14-0.18)

0.02 0.20 0.55 0.40 0.15

(0.01-0.02) (0.19-0.22) (0.53-0.58) (0.38-0.43) (0.14-0.17)

0.23 0.06 0.16 4.87

(0.21-0.26) (0.05-0.08) (0.15-0.19) (4.77-4.98)

0.21 0.05 0.16 4.80

(0.19-0.24) (0.04-0.06) (0.15-0.19) (4.69-4.91)

0.01 0.22 0.05 0.16 4.84

(0.00-0.01) (0.21-0.24) (0.05-0.06) (0.15-0.18) (4.76-4.92)

Rates are per 100,000 person years. Refers to all brain tumors including histologies not presented in this table. -Counts are not presented when fewer than 16 cases were reported for the specific histology category. Suppressed cases are included in the total count. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program; CI, confidence interval; NOS, not otherwise specified. b

Table 18: Childhood (Ages 0-19) Primary (Malignant and Non-Malignant) Brain and Central a Nervous System Tumor Incidence Rates by Major Histology Groupings and Race, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2007

Histology Grouping Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma Anaplastic astrocytoma Unique astrocytoma variants Astrocytoma, NOS Glioblastoma Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma Ependymoma variants Mixed glioma Glioma malignant, NOS Choroid plexus Neuroepithelial Non-malignant and malignant neuronal/glial Pineal parenchymal Embryonal/primitive/medulloblastoma Tumors of Cranial and Spinal Nerves Nerve sheath, non-malignant and malignant Tumors of Meninges Meningioma Other mesenchymal, non-malignant and malignant Hemangioblastoma Lymphomas and Hemopoietic Neoplasms Germ Cell Tumors and Cysts Tumors of Sellar Region Pituitary Craniopharyngioma Local Extensions from Regional Tumors Unclassified Tumors Hemangioma Neoplasm, unspecified b TOTAL Male Female a

Whites Adjusted Rate 95% C.I. 3.55 (3.48-3.63) 0.86 (0.82-0.89) 0.05 (0.04-0.06) 0.09 (0.08-0.10) 0.10 (0.09-0.12) 0.23 (0.21-0.25) 0.14 (0.12-0.15) 0.06 (0.05-0.07) 0.25 (0.23-0.27) 0.04 (0.03-0.05) 0.04 (0.03-0.05) 0.58 (0.55-0.61) 0.10 (0.08-0.11) 0.42 (0.40-0.45) 0.03 (0.03-0.04) 0.54 (0.51-0.57) 0.26 (0.24-0.28) 0.26 (0.24-0.28) 0.19 (0.17-0.20) 0.12 (0.11-0.14) 0.03 0.02 0.21 0.55 0.40 0.15 0.24 0.06 0.17 5.02 5.10 4.93

(0.03-0.04) (0.01-0.02) (0.19-0.22) (0.52-0.58) (0.37-0.42) (0.14-0.17) (0.22-0.26) (0.05-0.07) (0.16-0.19) (4.93-5.10) (4.98-5.23) (4.80-5.05)

Blacks Adjusted Rate 95% C.I. 2.61 (2.47-2.75) 0.55 (0.49-0.62) 0.03 (0.02-0.05) 0.06 (0.04-0.08) 0.12 (0.09-0.15) 0.16 (0.13-0.20) 0.13 (0.10-0.16) 0.08 (0.06-0.11) 0.20 (0.16-0.24) 0.40 (0.35-0.46) 0.05 (0.04-0.08) 0.32 (0.27-0.37) 0.08 (0.06-0.11) 0.37 (0.31-0.42) 0.19 (0.15-0.23) 0.19 (0.15-0.23) 0.13 (0.10-0.17) 0.11 (0.08-0.14) 0.12 0.47 0.34 0.13 0.15 0.13 3.69 3.52 3.86

(0.09-0.15) (0.41-0.53) (0.29-0.39) (0.10-0.17) (0.12-0.19) (0.10-0.16) (3.52-3.86) (3.30-3.76) (3.61-4.11)

Rates are per 100,000 person years. Refers to all brain tumors including histologies not presented in this table. -Counts are not presented when fewer than 16 cases were reported for the specific histology category. Suppressed cases are included in the total count. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program; CI, confidence interval; NOS, not otherwise specified. b

a

Table 19: Selected Childhood Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor, Age-Specific and Age-Adjusted Incidence Rates by Major Histology Groupings, Histology and Age at Diagnosis; CBTRUS Statistical Report: NPCR and SEER, 2004-2006 Age At Diagnosis 0-4 Rate Tumors of Neuroepithelial Tissue Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma Anaplastic astrocytoma Unique astrocytoma variants Astrocytoma, NOS Glioblastoma Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma Ependymoma variants Mixed glioma Glioma malignant, NOS Choroid plexus Neuroepithelial Non-malignant and malignant neuronal/glial Pineal parenchymal Embryonal/primitive/medulloblastoma Tumors of Cranial and Spinal Nerves Nerve sheath, non-malignant and malignant Tumors of Meninges Meningioma Other mesenchymal, non-malignant and malignant Hemangioblastoma Lymphomas and Hemopoietic Neoplasms Germ Cell Tumors and Cysts Tumors of Sellar Region Pituitary Craniopharyngioma Local Extensions from Regional Tumors Unclassified Tumors Hemangioma Neoplasm, unspecified TOTALb a

4.39 0.89 0.04 0.06 0.06 0.27 0.09 0.04 0.41 0.03 0.86 0.24 0.39 0.06 0.96 0.24 0.24 0.12 0.08 0.13 0.14 0.03 0.11 0.20 0.04 0.15 5.25

95% C.I.

(4.25-4.54) (0.83-0.96) (0.03-0.05) (0.04-0.07) (0.04-0.08) (0.23-0.31) (0.07-0.11) (0.03-0.05) (0.37-0.46) (0.02-0.04) (0.79-0.92) (0.21-0.28) (0.35-0.44) (0.04-0.07) (0.89-1.03) (0.21-0.28) (0.21-0.28) (0.10-0.14) (0.06-0.10) (0.11-0.16) (0.12-0.17) (0.02-0.05) (0.09-0.14) (0.17-0.24) (0.03-0.06) (0.13-0.18) (5.09-5.41)

5-9 Rate

3.54 0.89 0.05 0.08 0.10 0.20 0.14 0.04 0.23 0.02 0.77 0.04 0.33 0.04 0.57 0.20 0.20 0.09 0.06 0.12 0.32 0.11 0.21 0.17 0.03 0.14 4.45

95% C.I.

(3.41-3.68) (0.82-0.96) (0.03-0.07) (0.06-0.11) (0.08-0.13) (0.17-0.23) (0.11-0.17) (0.03-0.06) (0.20-0.26) (0.01-0.04) (0.70-0.83) (0.03-0.06) (0.29-0.37) (0.03-0.06) (0.51-0.62) (0.17-0.23) (0.17-0.23) (0.07-0.11) (0.05-0.08) (0.10-0.15) (0.28-0.36) (0.09-0.14) (0.18-0.24) (0.15-0.21) (0.02-0.04) (0.12-0.17) (4.30-4.60)

Age at Diagnosis 10-14

Rate

3.01 0.83 0.06 0.09 0.14 0.21 0.15 0.07 0.17 0.03 0.39 0.04 0.43 0.03 0.31 0.22 0.22 0.18 0.12 0.28 0.47 0.31 0.16 0.22 0.06 0.15 4.41

95% C.I.

(2.89-3.13) (0.77-0.90) (0.04-0.07) (0.07-0.12) (0.11-0.17) (0.18-0.25) (0.12-0.18) (0.05-0.09) (0.14-0.20) (0.02-0.05) (0.35-0.44) (0.03-0.05) (0.38-0.48) (0.02-0.05) (0.27-0.35) (0.19-0.26) (0.19-0.26) (0.15-0.21) (0.10-0.15) (0.25-0.32) (0.42-0.52) (0.27-0.35) (0.13-0.19) (0.19-0.26) (0.04-0.08) (0.13-0.18) (4.26-4.56)

15-19 Rate

2.71 0.61 0.05 0.10 0.13 0.21 0.18 0.11 0.03 0.18 0.08 0.05 0.23 0.04 0.46 0.04 0.22 0.35 0.35 0.34 0.23 0.03 0.09 0.03 0.27 1.27 1.14 0.13 0.30 0.09 0.21 5.28

95% C.I.

(2.60-2.83) (0.56-0.67) (0.04-0.07) (0.08-0.12) (0.10-0.15) (0.18-0.24) (0.15-0.21) (0.09-0.14) (0.02-0.05) (0.15-0.21) (0.06-0.10) (0.04-0.07) (0.20-0.26) (0.02-0.05) (0.41-0.51) (0.02-0.05) (0.18-0.25) (0.31-0.39) (0.31-0.39) (0.30-0.38) (0.20-0.26) (0.02-0.04) (0.07-0.11) (0.02-0.05) (0.23-0.31) (1.19-1.35) (1.07-1.22) (0.11-0.16) (0.26-0.34) (0.07-0.11) (0.18-0.24) (5.12-5.44)

0-19 Adjusted Rate

3.40 0.80 0.05 0.08 0.11 0.22 0.14 0.06 0.02 0.25 0.04 0.04 0.56 0.09 0.01 0.40 0.04 0.51 0.25 0.25 0.18 0.12 0.03 0.03 0.02 0.20 0.55 0.40 0.15 0.01 0.22 0.05 0.16 4.84

b

95% C.I.

(3.34-3.47) (0.77-0.84) (0.04-0.06) (0.07-0.09) (0.10-0.12) (0.21-0.24) (0.13-0.15) (0.06-0.07) (0.01-0.02) (0.23-0.26) (0.03-0.04) (0.03-0.04) (0.53-0.58) (0.08-0.10) (0.01-0.02) (0.38-0.42) (0.03-0.05) (0.48-0.53) (0.24-0.27) (0.24-0.27) (0.17-0.20) (0.11-0.14) (0.02-0.03) (0.03-0.04) (0.01-0.02) (0.19-0.22) (0.53-0.58) (0.38-0.43) (0.14-0.17) (0.00-0.01) (0.21-0.24) (0.05-0.06) (0.15-0.18) (4.76-4.92)

0-14b Adjusted Rate

3.63 0.87 0.05 0.08 0.10 0.23 0.13 0.05 0.01 0.27 0.02 0.03 0.67 0.11 0.38 0.04 0.61 0.22 0.22 0.13 0.09 0.02 0.01 0.02 0.18 0.31 0.15 0.16 0.20 0.04 0.15 4.69

95% C.I.

(3.56-3.71) (0.83-0.91) (0.04-0.06) (0.07-0.09) (0.09-0.11) (0.21-0.25) (0.11-0.14) (0.04-0.06) (0.01-0.02) (0.25-0.29) (0.02-0.03) (0.02-0.04) (0.63-0.70) (0.09-0.12) (0.36-0.41) (0.03-0.05) (0.57-0.64) (0.20-0.24) (0.20-0.24) (0.11-0.14) (0.08-0.10) (0.02-0.03) (0.01-0.02) (0.01-0.02) (0.16-0.20) (0.29-0.34) (0.14-0.17) (0.14-0.18) (0.18-0.22) (0.04-0.05) (0.13-0.17) (4.61-4.78)

Rates are per 100,000 person years. Age adjusted to the 2000 U.S. standard population. c Refers to all brain tumors including histologies not presented in this table. -Counts are not presented when fewer than 16 cases were reported for the specific histology category. The suppressed cases are included in the counts for totals. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, CDC’s National Program of Cancer Registries; SEER, NCI’s Surveillance, Epidemiology and End Results program; CI, confidence interval; NOS, not otherwise specified. b

a

Table 20: Primary Malignant Brain and CNS Tumor Incidence and Mortality Rates by b State, Age-Adjusted to the 2000 U.S. Standard Population , CINA 2003-2007 INCIDENCE MORTALITY MALES FEMALES MALES FEMALES STATE N RATE N RATE N RATE N RATE 748 7.6 634 5.6 575 5.3 477 3.5 Alabama 83 5.9 84 6.0 64 4.8 39 3.3 Alaska 1,071 7.4 895 5.7 679 4.8 555 3.4 Arizona 524 7.8 444 5.7 402 5.9 346 4.2 Arkansas 5,942 7.4 4,698 5.2 4,026 5.2 3,153 3.5 California 804 7.5 675 5.9 554 5.4 421 3.6 Colorado 687 8.1 615 6.2 413 4.8 369 3.5 Connecticut 177 8.7 129 5.6 107 5.3 80 3.3 Delaware 47 3.7 38 2.3 District of Columbia 3,693 7.8 2,980 5.6 2,350 4.8 1,908 3.3 Florida 1,395 7.0 1,277 5.6 836 4.4 706 3.2 Georgia 145 4.5 120 3.4 99 3.1 80 2.2 Hawaii 279 8.0 256 7.1 203 5.9 180 5.0 Idaho 2,209 7.6 1,904 5.6 1,303 4.6 1,161 3.3 Illinois 1,175 8.0 1,044 6.1 791 5.5 686 3.9 Indiana 654 8.8 526 6.3 483 6.5 390 4.4 Iowa 411 6.4 325 4.1 Kansas 853 8.4 670 5.9 532 5.4 426 3.6 Kentucky 666 7.3 511 4.8 583 6.0 437 3.6 Louisiana 328 9.6 237 6.1 205 5.9 168 4.0 Maine 608 4.9 487 3.2 Maryland 1,345 8.7 1,125 6.2 809 5.2 635 3.3 Massachusetts 1,987 8.3 1,686 6.2 1,384 5.8 1,071 3.8 Michigan 929 7.5 683 5.2 645 5.3 497 3.6 Minnesota 386 6.0 317 3.9 Mississippi 1,111 7.9 977 6.1 777 5.5 625 3.7 Missouri 221 8.9 139 5.3 150 6.0 110 4.1 Montana 342 8.1 284 6.0 244 5.8 208 4.1 Nebraska 289 5.0 212 3.5 Nevada 292 9.1 199 5.7 193 6.1 131 3.6 New Hampshire 1,782 8.6 1,460 6.0 948 4.6 758 3.0 New Jersey 326 7.0 223 4.4 207 4.5 154 3.0 New Mexico 3,685 8.1 3,068 5.7 2,132 4.7 1,627 2.9 New York 1,617 7.9 1,347 5.7 1,015 5.1 843 3.4 North Carolina 122 7.9 102 5.7 91 5.9 74 4.0 North Dakota 2,194 7.9 1,900 5.9 1,481 5.4 1,230 3.6 Ohio 729 8.4 619 6.3 492 5.8 386 3.8 Oklahoma 802 8.8 635 6.5 591 6.5 437 4.2 Oregon 2,647 8.5 2,258 6.1 1,602 5.0 1,355 3.4 Pennsylvania 242 9.4 186 5.9 148 5.7 124 3.8 Rhode Island 787 7.8 678 5.7 541 5.5 453 3.7 South Carolina 151 7.8 121 5.6 133 6.8 82 3.6 South Dakota 873 6.2 782 4.5 Tennessee 3,450 7.6 2,894 5.7 2,413 5.2 1,952 3.6 Texas 421 7.9 347 6.1 264 5.5 189 3.6 Utah 130 8.1 115 6.6 89 5.4 67 3.7 Vermont 1,280 7.4 1,026 5.1 835 5.0 618 3.0 Virginia 1,280 8.6 1,000 6.1 946 6.5 727 4.3 Washington 417 8.8 366 6.8 266 5.5 221 3.8 West Virginia 1,329 9.8 1,105 7.4 745 5.6 601 3.8 Wisconsin 96 7.5 74 5.6 66 5.2 58 4.2 Wyoming 51,675 7.9 42,771 5.8 36,026 5.2 28,976 3.5 United Statesc a

Rates are per 100,000 population. Source: Cancer Incidence in North America, 2003-2007. Volumes One, Two, and Three. North American Association of Central Cancer Registries, Inc., June 2010. c Combined incidence statistics for the United States include data from 45 state cancer registries that met or exceeded NAACCR high quality standards for 2003-2007. - Not available. b

a,b

Table 21: Primary Brain and Other Nervous System Tumors, Estimated Number of Cases Overall and by Behavior by State, 2011; Primary Malignant Brain and Other Nervous b,c System Tumors, Estimated Number of Deaths by State, 2010 2011 Estimated New Cases 2010 Estimated Deaths STATE All Malignant Non-Malignant Malignant Alabama 990 360 640 210 Alaska 130 50 80 Arizona 1,460 570 890 280 Arkansas 620 230 390 150 California 7,260 2,700 4,560 1,490 Colorado 1,040 400 640 210 Connecticut 770 290 480 150 Delaware 200 70 120 District of Columbia 110 30 80 Florida 4,560 1,700 2,870 800 Georgia 1,920 690 1,230 340 Hawaii 260 80 180 Idaho 320 130 190 80 Illinois 2,610 970 1,640 470 Indiana 1,330 510 820 340 Iowa 660 250 400 170 Kansas 590 220 360 140 Kentucky 910 350 560 180 Louisiana 890 320 580 210 Maine 320 120 190 80 Maryland 1,200 420 780 210 Massachusetts 1,430 540 890 280 Michigan 2,160 810 1,350 500 Minnesota 1,120 430 690 240 Mississippi 600 210 390 130 Missouri 1,260 480 790 280 Montana 220 90 140 60 Nebraska 380 150 230 90 Nevada 630 240 390 120 New Hampshire 310 120 190 70 New Jersey 1,890 690 1,200 340 New Mexico 430 170 270 80 New York 4,110 1,490 2,620 800 North Carolina 1,950 710 1,240 350 North Dakota 140 50 90 Ohio 2,480 930 1,550 540 Oklahoma 750 290 470 170 Oregon 850 330 520 210 Pennsylvania 2,830 1,060 1,770 550 Rhode Island 240 90 150 50 South Carolina 970 350 620 200 South Dakota 170 70 110 Tennessee 1,340 500 840 340 Texas 4,700 1,790 2,910 840 Utah 490 200 290 100 Vermont 150 60 90 Virginia 1,650 600 1,050 300 Washington 1,410 530 870 370 West Virginia 420 160 260 100 Wisconsin 1,220 470 750 270 Wyoming 120 50 70 United States 13,140 64,530 24,070 40,470 a

Source: Estimation based on CBTRUS NPCR and SEER 2004-2007 data. bRounded to the nearest 10. Source: Cancer Facts & Figures 2010. American Cancer Society, 2010. - Estimated number is less than 50. c

a

b

Table 22: Five-year Relative Survival Rates for Malignant Brain and Central Nervous System Tumors by Site and Gender, SEER 17 Registries, 1995-2007 ICD-O-3 CODE

b

SITE

Male N

C71.1-C71.4

Frontal, temporal, parietal, and occipital lobes of the brain

C71.0

Cerebrum

C71.5

Ventricle

C71.6

Female 5-YR

N

Total

5-YR

N

5-Yr

13,884

27.00%

10,584

29.96%

24,468

28.28%

1,301

24.77%

1,058

27.91%

2,359

26.22%

484

59.78%

371

64.80%

855

62.09%

Cerebellum

1,500

70.66%

1,158

73.03%

2,658

71.73%

C71.7

Brain stem

1,087

47.60%

987

45.33%

2,074

46.50%

C71.8-C71.9

Other brain

6,062

21.39%

4,798

25.01%

10,860

23.00%

C72.0-C72.1

Spinal cord and cauda equina

862

77.63%

703

83.21%

1,565

80.20%

C72.2-C72.5

Cranial nerves

230

90.38%

231

92.40%

461

91.40%

C72.8-C72.9

Other nervous system

276

35.32%

189

49.86%

465

41.31%

C70.0-C70.9

Meninges (cerebral and spinal)

376

57.20%

553

72.41%

929

66.08%

C75.1-C75.2

Pituitary and craniopharyngeal duct

91

65.25%

93

81.31%

184

73.56%

C75.3

Pineal

348

75.38%

107

66.05%

455

73.20%

C30.0 (9522-9523)

Olfactory tumors of the nasal cavity

196

69.24%

163

80.97%

359

75.06%

All Codes

All Sites

26,697

33.84%

20,995

37.52%

47,692

35.47%

a

The cohort analysis of survival rates was utilized for calculating the survival estimates presented in this table. Long-term cohort-based survival estimates reflect the survival experience of individuals diagnosed over the time period, and they may not necessarily reflect the long-term survival outlook of newly diagnosed cases. b The sites referred to in this table are loosely based on the categories and site codes defined in the SEER Site/Histology Validation List. Abbreviation: SEER, Survival, Epidemiology and End Results.

a,b

Table 23: One-, Two-, Three-, Four-, Five-, and 10-Year Relative Survival Rates For Selected Malignant Brain and Central Nervous System Tumors, SEER 17 Registries, 1995-2007 Histology

# Cases

1-Yr

2-Yr

3-Yr

4-Yr

5-Yr

10-Yr

Pilocytic astrocytoma Protoplasmic & fibrillary astrocytoma

2,294

97.79%

96.80%

95.90%

95.04%

94.40%

92.10%

626

74.30%

60.97%

55.29%

51.09%

48.10%

36.35%

Anaplastic astrocytoma

2,846

60.32%

42.74%

34.70%

30.50%

27.36%

21.87%

Astrocytoma, NOS

3,280

70.01%

60.14%

54.59%

50.95%

48.16%

39.10%

19,797

34.60%

12.63%

7.31%

5.40%

4.75%

2.80%

Oligodendroglioma Anaplastic oligodendroglioma Ependymoma/anaplastic ependymoma

2,453

94.17%

89.92%

86.25%

82.77%

79.48%

63.58%

970

79.91%

66.07%

59.55%

53.90%

49.40%

34.95%

1,748

94.00%

89.23%

85.81%

83.41%

82.41%

76.22%

Mixed glioma

1,296

87.52%

74.86%

67.56%

61.74%

57.32%

46.37%

Glioma malignant, NOS

2,790

60.40%

49.07%

46.30%

44.25%

43.27%

39.54%

118

54.10%

42.58%

41.98%

36.34%

33.02%

28.74%

526

88.48%

79.55%

76.46%

71.69%

70.66%

58.93%

1,865

82.42%

71.72%

66.77%

63.76%

61.71%

55.05%

3,421

47.48%

38.69%

34.23%

31.01%

28.52%

21.61%

47,692

57.21%

43.34%

38.99%

36.74%

35.47%

31.73%

Glioblastoma

Neuroepithelial Malignant neuronal/glial, Neuronal and mixed Embryonal/primitive/ medulloblastoma Lymphoma c

Total: All Brain and CNS a

The cohort analysis of survival rates was utilized for calculating the survival estimates presented in this table. Long-term cohort-based survival estimates reflect the survival experience of individuals diagnosed over the time period, and they may not necessarily reflect the long-term survival outlook of newly diagnosed cases. b Rates are an estimate of the percentage of patients alive at one, two, three, four, five, and ten year, respectively. c Includes histologies not listed in this table. Abbreviations: SEER, Survival, Epidemiology and End Results; NOS, not otherwise specified.

a,b

Table 24: One-, Two-, Three-, Four-, Five-, and Ten-Year Relative Survival Rates For Selected Malignant Brain and Central Nervous System Tumors by Age Groups, SEER 17 Registries, 1995-2007 Histology Age Group # Cases 1-Yr 2-Yr 3-Yr 4-Yr 5-Yr 10-Yr 1,366 98.7% 98.6% 98.2% 97.7% 97.3% 96.1% Pilocytic astrocytoma 0-14 1,644 98.4% 98.4% 97.8% 97.3% 96.8% 95.6% 0-19 491 96.8% 95.2% 94.0% 92.3% 91.0% 87.9% 20-44 88 94.3% 88.0% 88.0% 84.0% 82.4% 72.4% 45-54 40 95.4% 84.0% 81.0% 81.0% 81.0% c 55-64 22 c c c c c c 65-74 c c c c c c c 75+ Protoplasmic & fibrillary 89 93.1% 84.3% 84.3% 84.3% 84.3% 82.1% astrocytoma 0-14 110 94.4% 85.1% 85.1% 85.1% 85.1% 79.6% 0-19 243 91.6% 81.4% 72.3% 64.7% 58.5% 40.7% 20-44 81 71.6% 52.8% 49.4% 41.6% 39.5% c 45-54 96 55.1% 29.5% 21.7% c c c 55-64 58 c c c c c c 65-74 38 c c c c c c 75+ 150 59.7% 43.5% 34.0% 33.1% 32.0% 27.7% Anaplastic astrocytoma 0-14 200 63.7% 44.5% 35.2% 34.4% 33.6% 30.1% 0-19 933 87.3% 72.7% 62.7% 55.4% 48.5% 36.5% 20-44 532 70.1% 48.2% 37.3% 30.6% 28.6% 18.6% 45-54 485 46.9% 21.6% 13.7% 10.9% 8.2% 5.7% 55-64 411 30.7% 11.0% 5.6% 3.8% 3.3% c 65-74 285 12.9% 5.2% c c c c 75+ 422 91.2% 87.4% 84.4% 83.0% 81.9% 79.5% Astrocytoma, NOS 0-14 530 92.0% 87.8% 84.5% 83.1% 81.9% 79.2% 0-19 1,133 92.0% 83.4% 76.8% 70.7% 64.4% 44.9% 20-44 504 71.8% 57.9% 49.2% 42.2% 40.2% 29.8% 45-54 412 52.7% 33.5% 24.1% 21.2% 20.3% 11.6% 55-64 345 31.3% 20.3% 15.3% 13.1% 11.6% 5.4% 65-74 356 18.1% 8.1% 6.4% 5.6% c c 75+ 155 46.6% 26.0% 21.9% 20.9% 20.9% 13.3% Glioblastoma 0-14 239 54.5% 29.5% 20.8% 18.6% 18.6% 12.7% 0-19 2,052 66.1% 34.3% 23.2% 18.5% 16.1% 9.7% 20-44 3,561 51.8% 18.7% 9.8% 6.8% 5.6% 3.1% 45-54 4,931 39.8% 12.4% 6.2% 3.7% 3.3% 0.8% 55-64 4,831 22.3% 5.5% 2.7% 1.9% 1.4% 0.8% 65-74 4,183 9.7% 2.4% 1.2% 0.8% 0.7% c 75+ 114 97.3% 96.4% 95.3% 95.3% 95.3% 90.6% Oligodendroglioma 0-14 191 97.4% 95.1% 93.2% 93.2% 92.5% 88.6% 0-19 1,304 98.0% 95.7% 92.4% 88.4% 84.7% 67.2% 20-44 526 94.3% 88.9% 84.8% 80.9% 76.8% 55.8% 45-54 255 87.2% 78.0% 72.0% 68.6% 65.0% 46.9% 55-64 109 78.4% 68.6% 59.2% 55.7% 51.5% 35.1% 65-74 68 57.9% 42.6% 38.3% 32.4% 30.4% c 75+ c c c c c c c Anaplastic oligodendroglioma 0-14 27 88.5% c c c c c 0-19 395 93.2% 81.8% 77.4% 71.8% 65.9% 46.8% 20-44 238 83.3% 70.0% 63.2% 57.2% 52.9% 40.1% 45-54 170 72.3% 55.4% 45.0% 35.6% 32.5% 16.7% 55-64 100 50.3% 35.1% 26.9% 21.3% c c 65-74 40 c c c c c c 75+ Ependymoma/anaplastic 433 93.4% 85.6% 78.5% 72.8% 69.9% 60.5% ependymoma 0-14 520 94.2% 86.9% 80.4% 75.6% 72.8% 63.3% 0-19 564 95.9% 94.4% 92.9% 91.2% 90.9% 87.1% 20-44 304 94.3% 90.4% 88.5% 85.9% 84.9% 81.8% 45-54 209 92.5% 88.3% 86.6% 84.8% 84.4% 83.6% 55-64 100 88.6% 76.2% 72.0% 72.0% 72.0% 58.6% 65-74 51 83.2% 74.1% 63.4% 63.4% 63.4% 32.4% 75+

a,b

Table 24: One-, Two-, Three-, Four-, Five-, and Ten-Year Relative Survival Rates For Selected Malignant Brain and Central Nervous System Tumors by Age Groups, SEER 17 Registries, 1995-2007 Histology Age Group # Cases 1-Yr 2-Yr 3-Yr 4-Yr 5-Yr 10-Yr

Mixed glioma

Glioma malignant, NOS

Malignant neuronal/glial, neuronal and mixed

Embryonal/primitive/medulloblasto ma

Lymphoma

Total: All Brain and CNSd

a

0-14 0-19 20-44 45-54 55-64 65-74 75+ 0-14 0-19 20-44 45-54 55-64 65-74 75+

55 93 704 244 134 83 38 887 979 534 284 249 265 479

92.4% 91.1% 96.1% 87.8% 72.3% 65.4% c 74.0% 75.3% 88.3% 67.9% 46.4% 30.5% 14.6%

80.7% 83.3% 88.1% 72.0% 45.8% 36.5% c 59.0% 60.8% 78.1% 53.8% 29.9% 19.3% 9.8%

80.7% 83.3% 80.2% 61.6% 36.7% 30.3% c 55.9% 57.5% 73.8% 48.1% 27.3% 16.9% 8.1%

75.6% 80.1% 73.5% 55.9% 32.2% c c 54.6% 55.7% 69.0% 43.6% 24.4% 14.1% 7.5%

75.6% 80.1% 66.7% 55.1% 26.0% c c 54.4% 55.5% 64.9% 40.9% 22.0% 14.1% 6.2%

71.7% 77.7% 52.8% 37.5% 17.3% c c 52.9% 54.2% 45.6% 31.2% 21.3% 12.6% c

0-14 0-19 20-44 45-54 55-64 65-74 75+

92 112 134 114 87 43 36

86.3% 86.9% 93.3% 91.4% 89.9% 72.4% 77.3%

76.0% 75.5% 87.7% 88.7% 72.1% 62.6% 65.8%

73.1% 71.9% 84.0% 85.6% 70.9% 60.5% 55.5%

69.6% 67.4% 79.6% 79.6% 61.1% 60.5% 55.5%

69.6% 67.4% 77.2% 75.8% 61.1% 60.5% 55.5%

69.6% 67.4% 66.0% 58.9% 54.7% c c

0-14 0-19 20-44 45-54 55-64 65-74 75+ 0-14 0-19 20-44 45-54 55-64 65-74 75+ 0-14 0-19 20-44 45-54 55-64 65-74 75+

1,232 1,358 407 53 26 c c 37 59 887 574 615 689 597 5,596 6,839 10,472 7,486 8,125 7,555 7,215

80.7% 81.6% 87.0% 80.9% 69.2% c c 86.3% 82.7% 37.2% 57.9% 61.2% 48.2% 33.8% 85.6% 86.6% 82.6% 65.2% 49.6% 31.2% 16.5%

69.8% 70.4% 79.7% 64.5% c c c 82.8% 78.6% 31.4% 48.9% 50.6% 37.7% 23.1% 77.9% 78.8% 70.8% 43.7% 27.4% 16.3% 8.8%

66.0% 66.2% 72.7% 59.1% c c c 82.8% 78.6% 28.9% 45.2% 45.0% 30.1% 18.3% 74.9% 75.5% 64.6% 36.6% 21.4% 12.6% 6.9%

63.8% 63.6% 68.0% 59.1% c c c 77.3% 75.6% 27.3% 41.9% 40.9% 24.2% 15.8% 73.0% 73.6% 60.2% 32.9% 18.5% 10.9% 6.1%

61.8% 61.7% 66.0% 55.7% c c c 77.3% 75.6% 25.8% 39.3% 37.3% 21.1% 12.1% 71.9% 72.5% 56.6% 31.2% 17.4% 9.8% 5.4%

56.9% 57.0% 55.1% 34.5% c c c 77.3% 65.1% 19.8% 29.0% 27.1% 9.3% 9.7% 67.8% 68.6% 45.0% 23.4% 12.6% 6.9% 4.0%

The cohort analysis of survival rates was utilized for calculating the survival estimates presented in this table. Long-term cohort-based survival estimates reflect the survival experience of individuals diagnosed over the time period, and they may not necessarily reflect the long-term survival outlook of newly diagnosed cases. b Rates are an estimate of the percentage of patients alive at one, two, three, four, five, and ten year, respectively. c Too few cases to report/estimate. d Includes histologies not listed in this table. Abbreviations: SEER, Survival, Epidemiology and End Results; NOS, not otherwise specified.

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