1988-v03n03-p145.pdf

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 2004-2008

February 2012 (March 23, 2012 Revision)

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 2004-2008

February 2012 (March 23, 2012 Revision)

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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 Georgia Michigan New York Tennessee Alaska HawaiiSEER Minnesota North Carolina Texas Arizona Idaho Mississippi North Dakota UtahSEER Arkansas Illinois Missouri Ohio Vermont California Indiana Montana Oklahoma Virginia Colorado IowaSEER Nebraska Oregon Washington ConnecticutSEER Kentucky Nevada Pennsylvania West Virginia Delaware Louisiana New Hampshire Rhode Island Wisconsin District of Columbia Maine New Jersey South Carolina Wyoming Florida Massachusetts New MexicoSEER South Dakota 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. We acknowledge support of the CBTRUS in 2011-2012 from the American Brain Tumor Association, the National Brain Tumor Society, the Pediatric Brain Tumor Foundation, the Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Department of Health and Human Services under contract #HHSN261201000576P, and from the Centers for Disease Control and Prevention under Cooperative Agreement 1U58DP003831. The contents in this report are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. 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 (2012). CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2004-2008 (March 23, 2012 Revision). Source: Central Brain Tumor Registry of the United States, Hinsdale, IL. website: www.cbtrus.org

http://www.cbtrus.org/�

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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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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 non-malignant brain and CNS tumors in their collection practices. Starting in 2004, Uniform Data Standards guide the collection of non-malignant brain and CNS tumors; in 2005, the Uniform Data Standards for the collection of malignant brain and CNS tumors were revised. In 2010-2012 the Multiple Primary and Histology Coding Rules for malignant and non-malignant brain and CNS 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 provided by forty-nine population-based cancer registries from the NPCR and selected states belonging to the National Cancer Institutes’ Surveillance, Epidemiology, and End Results (SEER) program as its data sources. This Statistical Report continues the past efforts that 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. The information is also important for allocation and planning of specialty health–care services, in the planning of disease prevention and control programs, and in the development of research proposals. These data may lead to clues that will stimulate research into the causes of this terrible disease. This CBTRUS statistical report is the first to include five years of data from NPCR and SEER. As rates are commonly calculated as an average over 5 years to stabilize the yearly variation, rates having fewer years of data included in the previous four CBTRUS reports were less reliable than those reported here. 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 and CNS tumors are collected and reported as accurately and completely as possible.

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BRAIN TUMOR STATISTICS: REPORT AND FIGURES The objective of this CBTRUS Statistical Report is to provide a current overview of the descriptive epidemiology of primary brain and CNS tumors in the United States. CBTRUS has obtained data on all primary brain and CNS tumors from the NPCR and SEER programs for diagnosis years 2004-2008. Incidence counts and rates of primary malignant and non-malignant brain and CNS tumors were calculated by histology, gender, age, race, and Hispanic origin. TECHNICAL NOTES Data Collection CBTRUS does not collect data directly from patient's medical records. Data for its analyses come from the Centers for Disease Control and Prevention, NPCR and the National Cancer Institute, SEER program. Central cancer registries in states provide data to these sources and provide a valuable role in the collection process. CBTRUS obtained incidence data from 49 population-based cancer registries that include cases of malignant and non–malignant (benign and uncertain) primary brain and CNS tumors. Data were requested for all newly diagnosed primary malignant and non-malignant tumors in 2004-2008 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 updated population estimates on a yearly basis from the United States Bureau of the Census.2

NPCR provided data on 285,294 primary brain and CNS tumors diagnosed in 2004-2008. 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 SEER research data files, data from state cancer registries not included in the NPCR data were obtained and included 11,800 primary brain and CNS tumor case records diagnosed in 2004-2008. These data were combined into a single data set for analyses. A total of 1,108 records (0.37%) 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, 102 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 295,986 records from 49 population-based cancer registries. Definitions Measures in Surveillance Epidemiology The rate is the basic measure of disease occurrence as it expresses probability or risk of disease in a defined population over a specified period of time. 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

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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 unadjusted 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 termed 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 and CNS tumor incidence rate is 19.89 cases per 100,000 person–years. We can be 95 percent certain that the actual incidence rate is within the range of 19.82 and 19.96 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 ICD-O–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.

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Anatomic Location of Tumor 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 ICD-O–3 morphology codes 9522–9523). Classification by Behavior Brain and CNS tumor 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 CNS 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 CNS 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 and CNS tumors in July 2003 for tumors diagnosed beginning in 2004. Measurement Methods Counts, means, rates, ratios, proportions, and other relevant statistics were calculated using SPSS and/or SEER*Stat statistical software.7-8 Statistics are suppressed when counts are fewer than 16 within a specific category. However, the data in the suppressed cells are 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

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ethnicity, and pediatric, young adult and adult age groups were estimated. Trends across annual incidence rates were not estimated because a time frame of five years as presented in this report is not sufficient to detect a real change in the rate pattern with any degree of confidence. 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 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 five-year 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 2004-2008 and were age-adjusted using the 2000 U.S. standard population. Brain Tumor Definition Differences 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, 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

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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. The age-specific rate method was utilized to project 2012 estimates of all primary brain tumors using the CBTRUS 2004-2008 age-sex-race-specific brain tumor incidence rates for a group by the age-sex-race-specific projections for that group. Projected population estimates for 2012 were derived for the 50 states and District of Columbia using the US Census Bureau 1990-2008 population data (seer.cancer.gov/popdata/index.html).2 Estimated numbers of deaths for malignant tumors were obtained from the American Cancer Society publication, Cancer Statistics, 2012.10 The source for its data was the U.S. Mortality Public Use Data Tapes, 1969–2008, from the National Center for Health Statistics. Estimation of Survival Rates SEER*Stat 7.0.5 statistical software was used to estimate one–through ten–year relative survival rates for primary malignant brain tumor cases diagnosed between 1995–2008 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 taking into account the technical notes described above as well as the following considerations.

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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 less than 16 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 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.

http://seer.cancer.gov/csr/1975_2007/technotes/�

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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 295,986 incident tumors reported during 2004-2008 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 2004-2008 population of 290.3 million represents approximately 97% of the U.S. population for those years. The overall percent of non–malignant tumors varied considerably by cancer registry (range: 51-74%). 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, 56% were histologically confirmed, while 41% were confirmed radiologically. Overall Incidence Rates The overall age-adjusted incidence rate for 2004-2008 for primary brain and CNS tumors was 19.89 per 100,000 person–years. The overall incidence rate was 5.05 per 100,000 person–years for children 0–19 years of age (4.92 per 100,000 person–years for children less than 15 years) and 25.86 per 100,000 person–years for adults (20+ years). The overall incidence rates 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.

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

CBTRUS Statistical Report: NPCR and SEER Data from 2004-2008

Children (0-14 yr)

Children (0-19 yr)

Adults (20+ yr) All Ages

Non-malignant 1.4 1.8 16.9 12.6Malignant 3.5 3.3 8.9 7.3

0

5

10

15

20

25

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aAge-adjusted to the 2000 United States standard population.

Overall Incidence Rates by Year Figure 2 displays annual age-adjusted incidence rates of all primary brain and CNS tumors by behavior from 2004 through 2008. The incidence rates of all primary brain and CNS tumors among diagnostic years 2005-2008 did not differ statistically significantly from each other. However, the incidence rate in 2004 was statistically significantly lower than those observed in 2005-2008. It is likely that the lower rate in 2004 may reflect a lack of complete implementation of Public Law 107-260.

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


2004 2005 2006 2007 2008Total 19.2 19.9 20.1 20.1 20.1Malignant 7.4 7.4 7.3 7.3 7.2Nonmalignant 11.8 12.5 12.8 12.8 12.9

aRates per 100,000 person-years Age-adjusted to the 2000 United States standard population

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 14.37 to 25.63 per 100,000 person–years. In addition, the incidence rates of all primary malignant brain tumors ranged from 4.74 to 8.57 per 100,000 person–years and incidence rates of all primary non–malignant brain tumors ranged from 7.23 to 18.36 per 100,000 person–years. Among adults 20 years of age and older, the cancer registry–specific incidence rates ranged from 5.53 to 10.73 per 100,000 person–years for malignant tumors and from 9.90 to 25.08 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 3.82 per 100,000 person-years for malignant tumors and 3.44 per 100,000 person-years for non-malignant tumors. The incidence rates by tumor behavior and four geographic regions including Northeast, Midwest, South, and West are illustrated in Figure 3. It is apparent that there is less variation by region 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 state cancer registry and regional variations apparent in Table 10 and Figure 3, 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 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

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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 non-malignant 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 Behavior and Geographic Region


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aAge-adjusted to the 2000 United States standard population.

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= 295,986)


Frontal Lobe9.1%

Temporal Lobe6.8%Parietal Lobe

4.5%Occipital Lobe1.3%

Cerebrum2.0%

Ventricle1.2%

Cerebellum2.9%

Brain Stem1.6%

Other Brain10.2%

Spinal Cord & Cauda Equina3.2%

Cranial Nerves6.9%

Other CNS0.6%

Meninges34.3%

Pituitary14.7%

Pineal0.5%

Nasal Cavity0.2%

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 35% of all tumors, followed by glioblastoma (16%). The predominately non-malignant pituitary and nerve sheath tumors account for 14% 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=295,986)


Glioblastoma16.3%

Astrocytomas6.8%

Ependymomas1.8%

Oligodendrogliomas1.9%

Embryonal, including Medulloblastoma

1.1%

Meningioma34.7%

Pituitary13.5%

Craniopharyngioma0.9%

Nerve Sheath8.5%

Lymphoma2.3%

Other Neuroepithelial5.0%

Germ Cell Tumor0.5%

All Other6.7%

Gliomas (ICD-O-3: 9380-9384, 9391-9460, 9480) account for 30% of all tumors and 80% of malignant tumors

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The broad category glioma represents 30% 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=89,617)


Frontal Lobe25.3%

Temporal Lobe19.6%

Parietal Lobe12.7%

Occipital Lobe3.3%

Cerebrum4.8%

Ventricle1.9%

Cerebellum2.8%

Brain Stem4.2%

Other Brain19.8%


Cranial Nerves1.1%

Other CNS0.0%All Other

0.2%

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

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=89,617)


Glioblastoma53.9%

All Other Astrocytoma

8.8%

Anaplastic Astrocytoma

6.7%

Protoplasmic and Fibrillary

Astrocytoma1.8%

Pilocytic Astrocytoma5.2%

Oligodendroglioma6.4%

Ependymoma5.8%

Glioma Malignant, NOS7.1%

All Other Glioma4.3% Astrocytomas and

glioblastomas account for 76% of all gliomas*

*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

17

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).

Figure 8. Distribution of Primary Spinal Cord, Spinal Meninges and Cauda Equina Tumors by Histology


Ages 0-19 (n=1,040) Ages 20+ (n=13,572)

Lymphoma3.0%

Nerve Sheath Tumors25.1%

Pilocytic Astrocytoma

0.8%

Other Astrocytoma/ Glioblastoma

2.5%Other

Neuroepithelial2.1%

Ependymoma21.5%

Hemangioma2.3%

Neoplasm, Unspecified

2.6%

Tumors of the Meninges

39.2%

All Other0.9%


13.0%

Other Astrocytoma/ Glioblastoma

11.9%

Ependymoma23.0%

Tumors of the Meninges

9.1%

Nerve Sheath Tumors15.4%

Other Neuroepithelial

19.0%

All Other8.6%

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 17% of all tumors. The broad category glioma accounts for 32% of tumors in young adults.

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Figure 9. Distribution of Primary Brain and CNS Tumors by Site and Histology Among Young Adults (Ages 20-34) (N=25,250)


Frontal Lobe12.1%

Temporal Lobe6.3%

Parietal Lobe3.2%

Occipital Lobe0.9%

Cerebrum2.2%

Ventricle2.5%

Cerebellum5.0%

Brain Stem2.6%

Other Brain7.9%Spinal Cord &

Cauda Equina5.7%

Cranial Nerves6.5%

Other CNS0.7%

Meninges13.8%

Pituitary29.2%

Pineal1.2%

Nasal Cavity0.2%

Site

Gliomas (9380-9384,9391-9460,9480) account for 32% of all tumors and 81% of malignant tumors

Glioblastoma4.7%


3.0%

Other Astrocytomas

9.7%

Ependymomas3.8%

Oligodendroglioma4.8%

Embryonal, including

Medulloblastoma1.9%

Other Neuroepithelial

9.8%Craniopharyngioma

1.5%

Nerve Sheath9.1%

Germ Cell Tumor1.3%

Lymphoma1.5%

Meningioma13.7%

Hemangioma/Hemangioblastoma

3.5%

Pituitary27.1%

All Other4.6%

Histology

19

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 (6.76 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, pineal, and olfactory tumors of the nasal cavity 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 (7.08 per 100,000 person–years), followed by tumors of the neuroepithelial tissue (6.60 per 100,000 person–years), tumors of the sellar region (2.89 per 100,000 person–years) and tumors of the cranial and spinal nerves (1.68 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 (6.84 per 100,000 person–years), glioblastomas (3.20 per 100,000 person–years), pituitary tumors (2.71 per 100,000 person–years), and nerve sheath tumors (1.67 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 neuroepithelial tissue rate. Acoustic neuromas, included under tumors of cranial and spinal nerves, comprise the majority (63%; 1.06 per 100,000 person-years) of nerve sheath tumors (1.67 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 (3.20 per 100,000 person-years) followed by lymphoma (0.46 per 100,000 person-years) and astrocytoma, NOS (0.44 per 100,000 person-years). Meningioma (6.70 per 100,000 person-years), pituitary (2.70 per 100,000 person-years), and nerve sheath (1.66 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 (21.34 per 100,000 person–years) than males (18.32 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

20

rate of gliomas is higher in males (7.17 per 100,000 person– years) than in females (5.07 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 2004-2008

Incidence Rate Ratio (Male to Female)



Glioblastoma

Oligodendroglioma

Ependymoma/Anaplastic Ependymoma

Mixed Glioma

Embryonal/Primitive/Medulloblastoma

Nerve Sheath

Meningioma

Lymphoma

Germ Cell Tumors

Pituitary

Log Scale

1.04

1.42*

1.58*

1.26*

1.13*

1.38*

1.34*

1.00

0.44*

1.38*

2.16*

0.89*

*Incidence Rate Ratio is statistically significantly different in males and females. 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 (19.97 per 100,000 person–years) than blacks (18.89 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, anaplastic astrocytomas, and glioblastomas are two or more times greater in whites than in blacks. In contrast, incidence rates for meningiomas, pituitary tumors, and neoplasm, unspecified are statistically significantly higher among blacks than whites.

21

Figure 11. Patterns by Race for Selected Histologies CBTRUS Statistical Report: NPCR and SEER Data from 2004-2008

Incidence Rate Ratio (White to Black)



Glioblastoma

Oligodendroglioma

Ependymoma/Anaplastic Ependymoma

Mixed Glioma

Embryonal/Primitive/Medulloblastoma

Nerve Sheath

Meningioma

Lymphoma

Germ Cell Tumors

Pituitary

Log Scale

1.52*

2.35*

2.11*

2.43*

1.87*

2.37*

1.57*

2.39*

0.84*

1.09*

1.52*

0.55*

*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. Ten percent of tumors were in persons of Hispanic origin. The overall incidence rate for primary brain and CNS tumors among Hispanics is 18.82 per 100,000 person–years and among non–Hispanics is 20.08 per 100,000 person–years (Table 15). The difference between these two incidence rates is statistically significant. White non–Hispanics (20.25 per 100,000 person–years) have statistically significantly higher incidence rates than Hispanics (18.82 per 100,000 person–years), and black non–Hispanics (19.17 per 100,000 person–years). 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 85+ year olds (71.06 per 100,000 person–years) and lowest among children ages 0-19 years (5.05 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.

22

Figure 12. Age-Specific Incidence of Primary Brain and CNS Tumors by Selected Histologies


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

Figure 13. Most Common Brain and CNS Tumors by AgeCBTRUS Statistical Report: NPCR and SEER Data from 2004-2008

Age (yr) Most Common Histology Second Most Common Histology

0-4 Embryonal/medulloblastoma Pilocytic astrocytoma5-9 Pilocytic astrocytoma Malignant glioma, NOS

10-14 Pilocytic astrocytoma Neuronal/glial

15-19 Pituitary Pilocytic astrocytoma

20-34 Pituitary Meningioma

35-44 Meningioma Pituitary

45-54 Meningioma Glioblastoma




85+ Meningioma Neoplasm, unspecified

23

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 (17%) are located within the frontal, temporal, parietal, and occipital lobes of the brain. Cerebrum, ventricle, cerebellum, and brain stem tumors account for 6%, 6%, 17%, and 11% of all childhood tumors, respectively. Other tumors of the brain account for 14% 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.

Figure 14. Distribution of All Childhood (Ages 0-19 years) Primary Brain and CNS Tumors by Site (N=20,273)


Frontal Lobe6.0%

Temporal Lobe6.9%

Parietal Lobe3.0%

Occipital Lobe1.2%

Cerebrum5.6%

Ventricle5.8%

Cerebellum16.7%

Brain Stem10.7%

Other Brain13.6%


Cranial Nerves6.2%

Other CNS1.6%

Meninges2.8%

Pituitary12.2%

Pineal2.9%

Nasal Cavity0.1%

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, embryonal tumors (including medulloblastomas), and malignant glioma, NOS, account for 18%, 15%, and 14%, respectively. The most common histologies in adolescents ages 15–19 years include pituitary tumors and pilocytic astrocytomas, which account for 22% and 11%, respectively, of all brain tumors in that age group (Figure 15). The broad category glioma accounts for 53% and 38% of tumors in children ages 0-14 years and adolescents aged 15–19 years, respectively.

24

Figure 15. Distribution of Childhood Primary Brain and CNS Tumors by Histology



17.7%

All Other Astrocytomas

9.0%

Glioblastoma2.6%


Ependymomas5.7%Mixed Glioma

0.6%

Glioma Malignant , NOS

13.7%


Medulloblastoma15.1%

Nerve Sheath4.9%

Meningioma1.8%


Pituitary3.4%

Germ Cell Tumor3.6%

Lymphoma0.3%

Neuronal-Glial7.8%

All Other8.7%


Ages 0-14 (n=14,653)

Ages 15-19 (n=5,620)



11.2%

All Other Astrocytomas

8.6%

Glioblastoma3.3%


Ependymomas4.5%

Mixed Glioma1.0%

Glioma Malignant , NOS4.6%


Medulloblastoma4.3%

Nerve Sheath6.2%

Meningioma4.4%


Pituitary21.9%

Germ Cell Tumor5.2%

Lymphoma0.5%

Neuronal-Glial8.6%

All Other10.1%

25

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 5.05 per 100,000 person–years. Among major histology groupings, incidence rates were highest for tumors of the neuroepithelial tissue (3.52 per 100,000 person–years). Pilocytic astrocytoma (0.81 per 100,000 person–years), medulloblastoma (0.61 per 100,000 person–years), and malignant glioma, not otherwise specified (0.57 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, neuronal/glial, 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 (5.23 per 100,000 person–years) than in blacks (3.87 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 0-4 year olds (5.46 per 100,000 person–years) and lowest among 10–14 year olds (4.62 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.

Figure 16. Age-Specific Incidence of Childhood Primary Brain and CNS Tumors by Selected Histologies


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

26

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 2004–2008 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 47 state cancer registries that met or exceeded NAACCR high quality standards for 2004-2008. Estimated Numbers of Cases of All Primary Brain Tumors by State The estimated numbers of cases of all primary brain and CNS tumors for 2012 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 (2004–2008) by 18 age groups, race (white, black, and other), and gender and applying them to the 2012 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 2012 is estimated to be 66,290 with 24,300 being malignant and 41,980 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 2012 are shown in Table 21. The estimated numbers of deaths for malignant tumors were obtained from the American Cancer Society’s Cancer Statistics, 2012 publication using the described methodology.10 The total number of primary malignant brain tumor deaths for all 50 states and the District of Columbia in 2012 is estimated to be 13,700. 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 2008 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

27

33.7% and 27.9%, 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 35% 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, 51% were histologically confirmed, while 47% 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 16% 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 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 (2004–2008) of the incidence of all primary malignant and non-malignant brain and central nervous system tumors collected and reported by 49 population-based cancer registries. The overall incidence rate was 19.89 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.

28

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.

2US population data. Surveillance, Epidemiology, and End Results (SEER) Program Populations (1990–2008) (http://seer.cancer.gov/popdata/), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released November 2010. 3Kleihues P, Burger PC, and Scheithauer BW. The new WHO classification of brain tumors. Brain Pathology, 3: 255–268, 1993. 4Louis DN, Ohgaki H, Wiestler OD, Cavanee WK. (Eds): WHO Classification of Tumours of the Central Nervous System. IARC: Lyon, 2007.

5McCarthy 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 <neuro–oncoogy.mc.duke.edu>).

6ICD–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 7.0.5. 8 Statistical Packages for Social Sciences Statistics for Windows, version 18.0.0, Released July 30, 2009, (SPSS Inc., Chicago, IL).

9Cancer Incidence in North America, 2004-2008. Volumes One, Two, and Three. North American Association of Central Cancer Registries, Inc., May 2011. 10Siegel R, Naishadham D, Jemal A. Cancer Statistics, 2012. CA Cancer J Clin 62:10-29, 2012.

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11Surveillance, 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 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on the November 2010 submission. 12Johnson 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.

13Gurney 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 Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER web site, 2011.

15McCarthy 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.

http://seer.cancer.gov/csr/1975_2008/�

Table 1: CBTRUS Brain and Central Nervous System Tumor Histology Groupings, 2012 REVISIONa Histology ICDO-3b Histology Code Tumors of Neuroepithelial Tissue Pilocytic astrocytoma 9421 Protoplasmic & fibrillary astrocytoma 9410, 9420 Anaplastic astrocytoma 9401, 9411 Unique astrocytoma variants 9383, 9384, 9424 Astrocytoma, NOS 9400 Glioblastoma 9440, 9441, 9442/3c Oligodendroglioma 9450 Anaplastic oligodendroglioma 9451, 9460 Ependymoma/anaplastic ependymoma 9391, 9392, 9393 Ependymoma variants 9394 Mixed glioma 9382 Glioma malignant, NOS 9380 Choroid plexus 9390 Neuroepithelial 9381, 9423, 9430, 9444 Non-malignant and malignant neuronal/glial, 8680,8681, 8682, 8690, 8693, 9412, 9413, 9442/1d, 9490, 9491, neuronal and mixed 9492, 9493, 9500, 9505, 9506, 9522, 9523 Pineal parenchymal 9360, 9361, 9362 Embryonal/primitive/medulloblastoma 8901, 8921, 8963, 9363, 9364, 9470, 9471, 9472,9473, 9474, 9501, 9502, 9503, 9508 Tumors of Cranial and Spinal Nerves Nerve sheath, non-malignant and malignant 9540, 9541, 9550, 9560, 9561, 9570, 9571 Other tumors of cranial and spinal nerves 9562 Tumors of Meninges Meningioma 9530, 9531, 9532, 9533, 9534, 9537, 9538, 9539 Other mesenchymal, non-malignant and 8324, 8728, 8800, 8801, 8802, 8803, 8804, 8805, 8806, 8810, 8815, 8824, 8830 malignant 8831, 8835, 8836, 8850, 8851, 8852, 8853e, 8854, 8857, 8861, 8870 , 8890, 8897, 8900, 8910, 8912e, 8920, 8935, 8990, 9040, 9136e, 9150, 9170, 9180, 9210, 9241, 9260, 9480, 9536 Hemangioblastoma 9161, 9535 Lymphomas and Hemopoietic Neoplasms Lymphoma 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, 9760e, 9766, 9826 , 9827, 9860, 9861, 9930, 9970 Germ Cell Tumors and Cysts Germ cell tumors, cysts and heterotopias 8020, 8440, 9060, 9061, 9064, 9065, 9070, 9071, 9072, 9080, 9081, 9082, 9083, 9084, 9085, 9100, 9101 Tumors of Sellar Region Pituitary 8022, 8040, 8140, 8146, 8190, 8202, 8240, 8246, 8260, 8270, 8271, 8272, 8280, 8281, 8290, 8300, 8310, 8320, 8323, 8333, 8334, 8341, 9582 Craniopharyngioma 9350, 9351, 9352 Local Extensions from Regional Tumors Chordoma/chondrosarcoma 9220, 9231, 9240, 9370, 9371, 9372, 9373 Unclassified Tumors Hemangioma 9120, 9121, 9122, 9123, 9125, 9130, 9131, 9133, 9140 Neoplasm, unspecified 8000, 8001, 8002, 8003, 8004, 8005, 8010, 8013, 8021 All other 8452, 8683, 8710, 8711, 8713, 8720, 8811, 8840, 8860, 8896, 8980, 9173 9580, 9751, 9752, 9753, 9754, 9823, 9826, 9837, 9866 aIncludes all the histologies listed in the standard definition of reportable brain tumors from the Consensus Conference on Brain Tumor Definitions. bInternational Classification of Diseases for Oncology, 3rd Edition, 2000. World Health Organization, Geneva, Switzerland. cMorphology 9442/3 only. dMorphology 9442/1 only. eHistologies added in the 2012 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.

Table 1a: CBTRUS Brain and Central Nervous System Tumor Malignant Histologiesa Histology ICDO-3b Histology Code Tumors of Neuroepithelial Tissue Pilocytic astrocytoma 9421/1 [Included with malignant tumors] Protoplasmic & fibrillary astrocytoma 9410/3, 9420/3 Anaplastic astrocytoma 9401/3, 9411/3 Unique astrocytoma variants 9424/3 Astrocytoma, NOS 9400/3 Glioblastoma 9440/3, 9441/3, 9442/3 Oligodendroglioma 9450/3 Anaplastic oligodendroglioma 9451/3, 9460/3 Ependymoma/anaplastic ependymoma 9391/3, 9392/3, 9393/3 Mixed glioma 9382/3 Glioma malignant, NOS 9380/3 Choroid plexus 9390/3 Neuroepithelial 9381/3, 9423/3, 9430/3 Non-malignant and malignant neuronal/glial, 8680/3, 8693/3, 9490/3, 9500/3, 9505/3, 9522/3, 9523/3 neuronal and mixed Pineal parenchymal 9362/3 Embryonal/primitive/medulloblastoma 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 Tumors of Meninges Meningioma 9530/3, 9538/3, 9539/3 Other mesenchymal, non-malignant and 8728/3, 8800/3, 8801/3, 8802/3, 8803/3, 8804/3, 8805/3, 8806/3, 8810/3, malignant 8815/3, 8830/3, 8850/3, 8851/3, 8852/3, 8853/3, 8854/3, 8857/3, 8890/3,

8900/3, 8910/3, 8912/3, 8920/3, 8990/3, 9040/3, 9150/3, 9170/3, 9180/3, 9260/3, 9480/3

Lymphomas and Hemopoietic Neoplasms Lymphoma 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, 9760/3, 9826/3, 9827/3, 9860/3, 9861/3, 9930/3 Germ Cell Tumors and Cysts Germ cell tumors, cysts and heterotopias 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 Local Extensions from Regional Tumors Chordoma/chondrosarcoma 9220/3, 9231/3, 9240/3, 9370/3, 9371/3, 9372/3 Unclassified Tumors Hemangioma 9120/3, 9130/3, 9133/3, 9140/3 Neoplasm, unspecified 8000/3, 8001/3, 8002/3, 8003/3, 8004/3, 8005/3, 8010/3, 8013/3, 8021/3 All other 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 aIncludes all the histologies listed in the standard definition of reportable brain tumors from the Consensus Conference on Brain Tumor Definitions. bInternational 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.

Table 1b: CBTRUS Brain and Central Nervous System Tumor Non-Malignant Histologiesa Histology ICDO-3b Histology Code Tumors of Neuroepithelial Tissue Pilocytic astrocytoma 9421/1 [Included with malignant tumors] Unique astrocytoma variants 9383/1; 9384/1 Ependymoma variants 9394/1 Choroid plexus 9390/0,1 Neuroepithelial 9444/1 Non-malignant and malignant neuronal/glial, 8680/0,1; 8681/1; 8682/1; 8690/1; 8693/1; 9412/1; 9413/0; 9442/1; 9490/0; 9491/0; neuronal and mixed 9492/0; 9493/0; 9505/1; 9506/1 Pineal parenchymal 9360/1; 9361/1 Embryonal/primitive/medulloblastoma 9363/0 Tumors of Cranial and Spinal Nerves Nerve sheath, non-malignant and malignant 9540/0,1; 9541/0, 9550/0; 9560/0,1; 9570/0; 9571/0 Other tumors of cranial and spinal nerves 9562/0 Tumors of Meninges Meningioma 9530/0,1; 9531/0; 9532/0; 9533/0; 9534/0; 9537/0; 9538/1; 9539/1 Other mesenchymal, non-malignant and 8324/0; 8728/0,1; 8800/0; 8810/0; 8815/0; 8824/0,1; 8830/0,1; 8831/0; 8835/1; 8836/1; malignant 8850/0,1; 8851/0; 8852/0, 8854/0; 8857/0; 8861/0; 8870/0; 8890/0,1; 8897/1; 8900/0;

8920/1; 8935/0,1; 8990/0,1; 9040/0; 9136/1, 9150/0,1; 9170/0; 9180/0; 9210/0; 9241/0; 9536/0

Hemangioblastoma 9161/1; 9535/0 Lymphomas and Hemopoietic Neoplasms Lymphoma 9740/1; 9766/1; 9970/1 Germ Cell Tumors and Cysts Germ cell tumors, cysts and heterotopias 8440/0; 9080/0,1; 9084/0 Tumors of Sellar Region Pituitary 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 Craniopharyngioma 9350/1; 9351/1; 9352/1 Local Extensions from Regional Tumors Chordoma/chondrosarcoma 9220/0,1; 9373/0 Unclassified Tumors Hemangioma 9120/0; 9121/0; 9122/0; 9123/0; 9125/0; 9130/0,1; 9131/0; 9133/1 Neoplasm, unspecified 8000/0,1; 8001/0,1; 8005/0; 8010/0 All other 8452/1; 8683/0; 8711/0; 8713/0; 8811/0; 8840/0; 8860/0; 9173/0; 9580/0; 9751/1; 9752/1; 9753/1 aIncludes all the histologies listed in the standard definition of reportable brain tumors from the Consensus Conference on Brain Tumor Definitions. bInternational 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.

Table 2: 2000 U.S. Standard Population Age Group 2000 U.S. Age Group 2000 U.S. Age Group 2000 U.S.

0-4 18,986,520 45-49 19,805,793 Total 274,633,642 5-9 19,919,840 50-54 17,224,359

10-14 20,056,779 55-59 13,307,234 15-19 19,819,518 60-64 10,654,272 20-24 18,257,225 65-69 9,409,940 25-29 17,722,067 70-74 8,725,574 30-34 19,511,370 75-79 7,414,559 35-39 22,179,956 80-84 4,900,234 40-44 22,479,229 85+ 4,259,173

Table 3: Average Annual Populationsa for 2004-2008, By Age, Gender and Race Males Females Age Group All Races Whites Blacks All Races Whites Blacks

0-4 10,280,307 7,983,450 1,591,557 9,829,820 7,609,994 1,538,172 5-9 9,892,877 7,723,692 1,541,855 9,449,406 7,345,942 1,492,921

10-14 10,248,223 7,972,041 1,659,550 9,762,688 7,562,176 1,608,387 15-19 10,623,176 8,305,117 1,686,362 10,068,390 7,828,945 1,638,667 20-24 10,596,014 8,376,037 1,552,274 9,962,162 7,799,958 1,516,985 25-29 10,145,256 8,049,917 1,377,299 9,747,160 7,568,110 1,443,168 30-34 9,698,402 7,724,932 1,228,045 9,453,951 7,336,070 1,352,311 35-39 10,219,334 8,265,743 1,246,982 10,097,280 7,970,031 1,392,843 40-44 10,762,011 8,831,061 1,283,119 10,838,738 8,697,292 1,454,674 45-49 10,816,948 8,998,414 1,232,857 11,072,048 9,015,526 1,416,855 50-54 9,719,975 8,180,242 1,037,517 10,125,219 8,335,669 1,222,008 55-59 8,360,768 7,140,673 809,173 8,870,725 7,414,640 982,336 60-64 6,354,781 5,512,574 550,615 6,949,676 5,910,009 704,324 65-69 4,763,984 4,137,806 408,701 5,449,319 4,643,334 553,656 70-74 3,774,871 3,302,242 315,550 4,619,210 3,962,410 457,252 75-79 3,083,687 2,746,236 226,885 4,175,447 3,648,981 371,545 80-84 2,150,558 1,937,488 141,519 3,413,473 3,037,555 270,202 85+ 1,516,925 1,379,408 85,475 3,410,262 3,085,321 234,336

Total 143,008,098 116,567,073 17,975,334 147,294,977 118,771,963 19,650,642 a Population data source for 49 population-based geographic regions: Estimates from the U.S. Census Bureau <http://seer.cancer.gov/popdata/index.html>.

Table 4: Average Annual Populationsa for 2004-2008 By Age, Gender, Race and Hispanic Origin

Males

Age Group Hispanic Non-Hispanic White Non-

Hispanic Black Non-

Hispanic 0-4 2,503,077 7,777,230 5,699,283 1,459,712 5-9 2,116,180 7,776,697 5,774,121 1,444,776

10-14 1,963,858 8,284,365 6,163,674 1,567,954 15-19 1,875,559 8,747,617 6,574,352 1,603,025 20-24 2,011,968 8,584,046 6,504,573 1,474,147 25-29 2,150,534 7,994,722 6,040,414 1,298,667 30-34 2,016,785 7,681,618 5,832,810 1,158,725 35-39 1,811,253 8,408,081 6,567,178 1,183,121 40-44 1,575,423 9,186,588 7,355,803 1,226,421 45-49 1,270,481 9,546,467 7,810,487 1,186,252 50-54 954,546 8,765,429 7,289,622 1,000,547 55-59 704,691 7,656,077 6,482,130 782,231 60-64 485,287 5,869,494 5,057,097 532,841 65-69 349,091 4,414,893 3,809,233 396,075 70-74 259,464 3,515,407 3,057,084 306,561 75-79 191,670 2,892,017 2,564,302 220,809 80-84 120,508 2,030,050 1,822,726 137,942 85+ 83,727 1,433,198 1,299,901 82,842

Total 22,444,102 120,563,995 95,704,787 17,062,647 Females

Age Group Hispanic Non-Hispanic White Non-

Hispanic Black Non-

Hispanic 0-4 2,401,278 7,428,542 5,418,571 1,412,082 5-9 2,019,920 7,429,486 5,486,046 1,399,544

10-14 1,872,672 7,890,016 5,839,516 1,519,847 15-19 1,737,330 8,331,060 6,229,945 1,558,814 20-24 1,708,982 8,253,181 6,218,502 1,444,698 25-29 1,745,136 8,002,024 5,951,337 1,366,744 30-34 1,696,301 7,757,650 5,760,299 1,278,486 35-39 1,575,749 8,521,531 6,506,745 1,323,792 40-44 1,428,964 9,409,775 7,370,308 1,393,270 45-49 1,209,886 9,862,161 7,891,942 1,365,167 50-54 957,611 9,167,608 7,446,048 1,181,033 55-59 745,218 8,125,507 6,720,087 951,533 60-64 546,249 6,403,427 5,398,034 683,143 65-69 416,280 5,033,039 4,251,910 537,687 70-74 331,643 4,287,568 3,649,751 444,952 75-79 262,597 3,912,850 3,400,653 362,270 80-84 179,957 3,233,516 2,867,092 263,934 85+ 162,120 3,248,142 2,931,714 228,509

Total 20,997,895 126,297,082 99,338,500 18,715,504 a Population data source for 49 population-based geographic regions: Estimates from the U.S. Census Bureau <http://seer.cancer.gov/popdata/index.html>.

Table 5: Number of Brain and CNS Tumors By Major Histology Groupings, Histology, Gender and Race; CBTRUS Statistical Report: NPCR and SEER, 2004-2008 By Gender By Race Histology Male Female White Black Tumors of Neuroepithelial Tissue 54,352 43,327 87,400 6,467 Pilocytic astrocytoma 2,414 2,241 3,888 485 Protoplasmic & fibrillary astrocytoma 949 660 1,466 83 Anaplastic astrocytoma 3,384 2,621 5,470 320 Unique astrocytoma variants 900 529 1,199 155 Astrocytoma, NOS 3,475 2,970 5,649 497 Glioblastoma 27,564 20,763 44,552 2,501 Oligodendroglioma 2,189 1,788 3,559 224 Anaplastic oligodendroglioma 962 791 1,567 91 Ependymoma/anaplastic ependymoma 1,932 1,865 3,265 319 Ependymoma variants 794 621 1,277 66 Mixed glioma 1,628 1,216 2,531 160 Glioma malignant, NOS 3,274 3,106 5,444 602 Choroid plexus 373 396 649 69 Neuroepithelial 144 147 262 21 Non-malignant and malignant neuronal/glial 2,185 1,888 3,388 432 Pineal parenchymal 237 313 420 97 Embryonal/primitive/medulloblastoma 1,948 1,412 2,814 345 Tumors of Cranial and Spinal Nerves 12,013 13,094 21,949 1,234 Nerve sheath, non-malignant and malignant 12,009 13,088 21,941 1,234 Tumors of Meninges 28,747 77,430 88,463 11,880 Meningioma 26,839 75,763 85,443 11,558 Other mesenchymal, non-malignant and malignant 557 589 958 112 Hemangioblastoma 1,351 1,078 2,062 210 Lymphomas and Hematopoietic Neoplasms 3,687 3,168 5,810 694 Lymphoma 3,687 3,168 5,810 694 Germ Cell Tumors and Cysts 969 437 1,124 137 Germ cell tumors, cysts and heterotopias 969 437 1,124 137 Tumors of Sellar Region 19,362 23,173 31,856 7,582 Pituitary 18,061 21,867 29,893 7,129 Craniopharyngioma 1,301 1,306 1,963 453 Local Extensions from Regional Tumors 136 113 214 17 Chordoma/chondrosarcoma 136 113 214 17 Unclassified Tumors 7,084 8,894 13,505 1,664 Hemangioma 1,138 1,509 2,251 214 Neoplasm, unspecified 5,846 7,302 11,100 1,436 All other 100 83 154 -

TOTAL 126,350 169,636 250,321 29,675 -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, 2004-2008

Histology Hispanic Non-

Hispanic

White Non-

Hispanic

Black Non-

Hispanic Tumors of Neuroepithelial Tissue 8,792 88,887 79,124 6,259 Pilocytic astrocytoma 646 4,009 3,300 462 Protoplasmic & fibrillary astrocytoma 103 1,506 1,368 81 Anaplastic astrocytoma 517 5,488 4,974 311 Unique astrocytoma variants 170 1,259 1,039 149 Astrocytoma, NOS 610 5,835 5,077 487 Glioblastoma 3,082 45,245 41,624 2,439 Oligodendroglioma 429 3,548 3,150 222 Anaplastic oligodendroglioma 170 1,583 1,407 88 Ependymoma/anaplastic ependymoma 500 3,297 2,791 308 Ependymoma variants 124 1,291 1,161 65 Mixed glioma 308 2,536 2,239 152 Glioma malignant, NOS 751 5,629 4,746 576 Choroid plexus 139 630 520 67 Neuroepithelial 25 266 239 19 Non-malignant and malignant neuronal/glial 463 3,610 2,958 416 Pineal parenchymal 78 472 349 96 Embryonal/primitive/medulloblastoma 677 2,683 2,182 321 Tumors of Cranial and Spinal Nerves 2,033 23,074 20,117 1,186 Nerve sheath, non-malignant and malignant 2,033 23,064 20,109 1,186 Tumors of Meninges 8,932 97,245 80,216 11,671 Meningioma 8,522 94,080 77,579 11,357 Other mesenchymal, non-malignant and malignant 128 1,018 834 111 Hemangioblastoma 282 2,147 1,803 203 Lymphomas and Hematopoietic Neoplasms 706 6,149 5,145 679 Lymphoma 706 6,149 5,145 679 Germ Cell Tumors and Cysts 278 1,128 864 133 Germ cell tumors, cysts and heterotopias 278 1,128 864 133 Tumors of Sellar Region 5,939 36,596 26,401 7,431 Pituitary 5,544 34,384 24,791 6,995 Craniopharyngioma 395 2,212 1,610 436 Local Extensions from Regional Tumors 44 205 172 16 Chordoma/chondrosarcoma 44 205 172 16 Unclassified Tumors 1,664 14,314 11,970 1,626 Hemangioma 300 2,347 1,969 210 Neoplasm, unspecified 1,345 11,803 9,865 1,402 All other 19 164 136 -

TOTAL 28,388 267,598 224,009 29,001 -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 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, 2004-2008

Total By Gender By Race

Histology

Male Female White Black Tumors of Neuroepithelial Tissue 14,108 7,586 6,522 11,455 1,732 Pilocytic astrocytoma 3,231 1,690 1,541 2,658 368 Protoplasmic & fibrillary astrocytoma 189 106 83 155 22 Anaplastic astrocytoma 327 177 150 268 39 Unique astrocytoma variants 413 210 203 314 75 Astrocytoma, NOS 878 470 408 715 104 Glioblastoma 568 326 242 437 95 Oligodendroglioma 246 139 107 191 43 Anaplastic oligodendroglioma 58 31 27 47 - Ependymoma/anaplastic ependymoma 948 516 432 758 120 Ependymoma variants 145 94 51 116 - Mixed glioma 142 64 78 123 16 Glioma malignant, NOS 2,258 1,118 1,140 1,826 260 Choroid plexus 405 221 184 335 40 Neuroepithelial 47 - - 38 - Non-malignant and malignant neuronal/glial 1,630 899 731 1,340 200 Pineal parenchymal 173 86 87 107 54 Embryonal/primitive/medulloblastoma 2,450 1,424 1,026 2,027 269 Tumors of Cranial and Spinal Nerves 1,059 539 520 855 113 Nerve sheath, non-malignant and malignant 1,059 539 520 855 113 Tumors of Meninges 779 369 410 625 92 Meningioma 514 245 269 400 73 Other mesenchymal, non-malignant and malignant 139 55 84 123 - Hemangioblastoma 126 69 57 102 - Lymphomas and Hematopoietic Neoplasms 72 46 26 51 16 Lymphoma 72 46 26 51 16 Germ Cell Tumors and Cysts 816 579 237 644 78 Germ cell tumors, cysts and heterotopias 816 579 237 644 78 Tumors of Sellar Region 2,493 861 1,632 1,923 338 Pituitary 1,730 471 1,259 1,338 227 Craniopharyngioma 763 390 373 585 111 Local Extensions from Regional Tumors 23 - - 20 - Chordoma/chondrosarcoma 23 - - 20 - Unclassified Tumors 923 472 451 758 96 Hemangioma 243 134 109 206 18 Neoplasm, unspecified 653 322 331 531 76 All other 27 - - 21 -

TOTAL 20,273 10,466 9,807 16,331 2,467 -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 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, 2004-2008

Age at Diagnosis Histology 0-4 5-9 10-14 15-19 0-19 0-14 Tumors of Neuroepithelial Tissue 4,567 3,578 3,115 2,848 14,108 11,260 Pilocytic astrocytoma 893 875 831 632 3,231 2,599 Protoplasmic & fibrillary astrocytoma 44 46 53 46 189 143 Anaplastic astrocytoma 57 87 84 99 327 228 Unique astrocytoma variants 60 97 130 126 413 287 Astrocytoma, NOS 270 177 218 213 878 665 Glioblastoma 94 133 153 188 568 380 Oligodendroglioma 36 37 64 109 246 137 Anaplastic oligodendroglioma - - - 30 58 28 Ependymoma/anaplastic ependymoma 392 214 166 176 948 772 Ependymoma variants - - 43 79 145 66 Mixed glioma 29 23 32 58 142 84 Glioma malignant, NOS 852 747 402 257 2,258 2,001 Choroid plexus 268 47 43 47 405 358 Neuroepithelial - - - 16 47 31 Non-malignant and malignant neuronal/glial 386 314 445 485 1,630 1,145 Pineal parenchymal 57 42 31 43 173 130 Embryonal/primitive/medulloblastoma 1,117 700 389 244 2,450 2,206 Tumors of Cranial and Spinal Nerves 267 205 241 346 1,059 713 Nerve sheath, non-malignant and malignant 267 205 241 346 1,059 713 Tumors of Meninges 128 90 186 375 779 404 Meningioma 76 59 132 247 514 267 Other mesenchymal, non-malignant and malignant 50 27 23 39 139 100 Hemangioblastoma - - - 89 126 37 Lymphomas and Hematopoietic Neoplasms - - - 29 72 43 Lymphoma - - - 29 72 43 Germ Cell Tumors and Cysts 126 122 273 295 816 521 Germ cell tumors, cysts and heterotopias 126 122 273 295 816 521 Tumors of Sellar Region 178 354 568 1,393 2,493 1,100 Pituitary 38 102 359 1,231 1,730 499 Craniopharyngioma 140 252 209 162 763 601 Local Extensions from Regional Tumors - - - - 23 - Chordoma/chondrosarcoma - - - - 23 - Unclassified Tumors 209 168 223 323 923 600 Hemangioma 49 32 63 99 243 144 Neoplasm, unspecified 151 131 153 218 653 435 All other - - - - 27 -

TOTAL 5,491 4,536 4,626 5,620 20,273 14,653 -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 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, 2004-2008

State

No. Of Newly Diagnosed Brain &

CNS Tumors

Percent Non-Malignant

Tumors

Percent Histologically

Confirmed

Average Annual 2004-2007

Populationa Alabama 4,075 57.1 72.8 4,593,315 Alaska 614 66.9 63.4 675,761 Arizona 6,240 64.0 65.8 6,157,595 Arkansas 2,768 61.7 61.6 2,809,487 California 32,167 63.4 71.2 36,027,875 Colorado 5,795 71.3 54.9 4,758,195 Connecticut 3,344 56.9 75.9 3,485,751 Delaware 841 56.7 75.9 852,135 District of Columbia 428 50.9 72.4 584,461 Florida 22,717 67.5 59.1 17,989,880 Georgia 8,204 63.2 65.8 9,314,558 Hawaii 1,220 73.9 62.0 1,271,762 Idaho 1,406 57.3 69.5 1,461,749 Illinois 12,889 64.3 61.7 12,732,026 Indiana 6,270 60.6 60.7 6,300,739 Iowa 3,255 60.2 64.1 2,965,581 Kentucky 5,269 68.5 55.2 4,218,769 Louisiana 4,075 65.2 65.5 4,383,079 Maine 1,259 51.2 77.5 1,314,369 Massachusetts 6,305 57.0 75.8 6,482,716 Michigan 10,911 62.9 62.9 10,063,126 Minnesota 4,127 56.7 96.9 5,151,205 Mississippi 2,597 61.6 66.5 2,903,687 Missouri 6,324 63.9 63.1 5,858,563 Montana 985 60.0 72.3 946,436 Nebraska 1,652 57.9 73.0 1,761,240 Nevada 1,992 59.1 74.6 2,482,887 New Hampshire 1,322 60.0 71.0 1,309,058 New Jersey 8,681 59.4 70.2 8,631,306 New Mexico 1,529 58.5 73.1 1,941,294 New York 22,766 67.2 63.3 19,375,191 North Carolina 8,837 63.5 72.5 8,875,784 North Dakota 535 54.8 61.7 637,612 Ohio 10,162 55.5 73.9 11,496,247 Oklahoma 3,120 54.4 67.7 3,575,553 Oregon 3,967 60.7 72.9 3,676,973 Pennsylvania 15,236 64.4 63.3 12,473,314 Rhode Island 1,170 62.1 68.5 1,061,022 South Carolina 4,213 61.1 64.8 4,344,883 South Dakota 713 58.9 68.4 788,891 Tennessee 6,219 63.1 64.6 6,083,056 Texas 23,674 67.4 58.6 23,345,621 Utah 2,415 64.7 76.6 2,582,683 Vermont 806 65.0 64.5 619,691 Virginia 6,599 61.3 72.3 7,638,994 Washington 7,880 68.4 59.5 6,369,773 West Virginia 2,030 59.7 62.0 1,808,106 Wisconsin 5,931 58.0 93.3 5,570,738 Wyoming 452 60.4 76.5 515,693 aPopulation 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.

Table 10: Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor Incidence Ratesa 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, 2004-2008

0-19 Years 20+ Years All Ages State Malignant Non-Malignant Malignant Non-Malignant Malignant Non-Malignant All Tumors Alabama 3.31 (2.88-3.80) 1.02 (0.79-1.30) 8.85 (8.41-9.31) 13.06 (12.52-13.61) 7.26 (6.93-7.62) 9.60 (9.21-10.00) 16.87 (16.35-17.40) Alaska 2.96 (1.99-4.22) 3.15 (2.17-4.43) 8.77 (7.41-10.31) 18.58 (16.62-20.71) 7.10 (6.08-8.24) 14.16 (12.72-15.70) 21.26 (19.48-23.15) Arizona 3.44 (3.07-3.85) 1.62 (1.36-1.91) 8.72 (8.34-9.12) 17.36 (16.82-17.92) 7.21 (6.91-7.51) 12.85 (12.45-13.26) 20.06 (19.56-20.56) Arkansas 3.18 (2.64-3.80) 3.44 (2.89-4.08) 8.69 (8.14-9.27) 14.80 (14.07-15.56) 7.11 (6.68-7.55) 11.55 (11.00-12.11) 18.65 (17.96-19.37) California 2.98 (2.83-3.13) 1.64 (1.53-1.75) 8.35 (8.19-8.51) 15.94 (15.71-16.16) 6.81 (6.68-6.93) 11.83 (11.67-12.00) 18.64 (18.44-18.85) Colorado 2.94 (2.54-3.38) 1.66 (1.36-2.00) 9.02 (8.56-9.50) 25.08 (24.29-25.87) 7.28 (6.93-7.64) 18.36 (17.79-18.94) 25.63 (24.97-26.31) Connecticut 3.20 (2.71-3.76) 1.54 (1.21-1.94) 9.67 (9.15-10.22) 13.56 (12.94-14.20) 7.82 (7.41-8.23) 10.11 (9.66-10.58) 17.92 (17.32-18.55) Delaware 3.64 (2.61-4.93) 1.57 (0.93-2.48) 9.96 (8.90-11.12) 13.97 (12.71-15.31) 8.15 (7.33-9.04) 10.41 (9.49-11.40) 18.56 (17.32-19.87) District of Columbia - - - - 9.17 (7.92-10.56) 9.90 (8.61-11.34) 7.14 (6.20-8.19) 7.23 (6.29-8.27) 14.37 (13.03-15.82) Florida 3.45 (3.21-3.70) 1.81 (1.64-2.00) 8.80 (8.58-9.01) 19.69 (19.37-20.01) 7.26 (7.09-7.43) 14.56 (14.32-14.80) 21.82 (21.53-22.11) Georgia 3.02 (2.74-3.32) 1.68 (1.47-1.91) 8.46 (8.14-8.80) 16.15 (15.70-16.61) 6.90 (6.65-7.16) 12.00 (11.67-12.34) 18.90 (18.49-19.32) Hawaii 2.78 (2.03-3.72) 1.74 (1.16-2.51) 5.53 (4.89-6.24) 17.92 (16.74-19.16) 4.74 (4.23-5.30) 13.28 (12.42-14.18) 18.02 (17.01-19.07) Idaho 3.23 (2.53-4.06) 1.40 (0.95-1.98) 10.38 (9.51-11.31) 15.36 (14.29-16.50) 8.33 (7.67-9.03) 11.36 (10.58-12.18) 19.69 (18.66-20.75) Illinois 3.04 (2.79-3.30) 1.60 (1.42-1.80) 8.87 (8.60-9.15) 17.50 (17.12-17.89) 7.20 (6.99-7.41) 12.94 (12.66-13.22) 20.14 (19.79-20.49) Indiana 3.47 (3.09-3.88) 1.73 (1.47-2.03) 9.35 (8.95-9.75) 15.81 (15.30-16.34) 7.66 (7.36-7.97) 11.77 (11.40-12.16) 19.43 (18.95-19.92) Iowa 3.33 (2.79-3.95) 1.50 (1.15-1.93) 10.04 (9.47-10.65) 16.30 (15.56-17.06) 8.12 (7.68-8.58) 12.06 (11.52-12.61) 20.17 (19.48-20.89) Kentucky 3.56 (3.09-4.09) 2.25 (1.87-2.68) 9.18 (8.71-9.67) 22.16 (21.42-22.91) 7.57 (7.21-7.94) 16.45 (15.91-17.00) 24.01 (23.37-24.68) Louisiana 2.91 (2.51-3.37) 1.59 (1.30-1.94) 7.82 (7.39-8.27) 16.28 (15.65-16.92) 6.41 (6.08-6.76) 12.06 (11.61-12.54) 18.48 (17.91-19.06) Maine 3.70 (2.81-4.79) 1.29 (0.80-1.98) 10.11 (9.28-11.00) 11.70 (10.78-12.67) 8.27 (7.62-8.97) 8.72 (8.04-9.43) 16.99 (16.05-17.97) Massachusetts 3.62 (3.22-4.05) 1.57 (1.31-1.86) 9.68 (9.30-10.08) 13.75 (13.29-14.22) 7.94 (7.64-8.25) 10.26 (9.92-10.60) 18.20 (17.75-18.66) Michigan 3.41 (3.10-3.73) 1.84 (1.62-2.08) 9.53 (9.22-9.85) 17.59 (17.17-18.03) 7.78 (7.54-8.02) 13.07 (12.76-13.39) 20.85 (20.46-21.25) Minnesota 2.84 (2.46-3.26) 1.26 (1.01-1.55) 8.49 (8.07-8.92) 11.87 (11.38-12.38) 6.87 (6.55-7.20) 8.83 (8.47-9.20) 15.69 (15.22-16.19) Mississippi 2.71 (2.23-3.25) 1.47 (1.13-1.89) 8.46 (7.91-9.04) 14.83 (14.10-15.60) 6.81 (6.39-7.25) 11.00 (10.47-11.56) 17.81 (17.13-18.51) Missouri 3.23 (2.84-3.64) 1.50 (1.25-1.80) 9.09 (8.70-9.50) 17.71 (17.15-18.28) 7.41 (7.11-7.72) 13.06 (12.66-13.47) 20.47 (19.96-20.98) Montana 2.76 (1.91-3.86) 1.60 (0.99-2.45) 9.59 (8.61-10.65) 15.74 (14.45-17.12) 7.63 (6.88-8.43) 11.68 (10.74-12.69) 19.31 (18.10-20.58) Nebraska 3.70 (2.98-4.53) 2.78 (2.17-3.52) 9.34 (8.60-10.12) 13.68 (12.79-14.62) 7.72 (7.15-8.32) 10.55 (9.89-11.25) 18.27 (17.40-19.19) Nevada 2.31 (1.83-2.87) 0.80 (0.52-1.16) 8.30 (7.70-8.93) 13.36 (12.59-14.16) 6.58 (6.13-7.05) 9.75 (9.20-10.34) 16.33 (15.61-17.08) New Hampshire 3.71 (2.84-4.76) 2.24 (1.60-3.06) 9.34 (8.51-10.24) 14.89 (13.84-16.01) 7.73 (7.07-8.42) 11.26 (10.48-12.09) 18.99 (17.97-20.05) New Jersey 3.54 (3.21-3.91) 1.79 (1.55-2.05) 9.52 (9.19-9.86) 15.05 (14.63-15.48) 7.81 (7.55-8.07) 11.25 (10.94-11.56) 19.05 (18.65-19.46) New Mexico 2.31 (1.78-2.94) 1.38 (0.98-1.90) 8.05 (7.40-8.74) 12.11 (11.30-12.95) 6.40 (5.91-6.92) 9.03 (8.44-9.65) 15.43 (14.66-16.23) New York 3.59 (3.36-3.83) 2.22 (2.04-2.40) 8.95 (8.73-9.17) 20.04 (19.72-20.37) 7.41 (7.24-7.58) 14.93 (14.69-15.17) 22.34 (22.05-22.63) North Carolina 3.33 (3.02-3.67) 1.69 (1.46-1.93) 8.64 (8.32-8.97) 16.64 (16.20-17.09) 7.12 (6.87-7.37) 12.35 (12.03-12.68) 19.47 (19.06-19.88) North Dakota 3.18 (2.07-4.67) - - 8.87 (7.71-10.17) 11.46 (10.14-12.91) 7.24 (6.34-8.23) 8.53 (7.57-9.59) 15.78 (14.44-17.20) Ohio 3.42 (3.14-3.73) 1.87 (1.67-2.10) 9.09 (8.81-9.38) 12.16 (11.83-12.49) 7.47 (7.25-7.69) 9.21 (8.97-9.45) 16.67 (16.35-17.00) Oklahoma 3.26 (2.77-3.80) 1.45 (1.14-1.83) 9.43 (8.91-9.97) 12.28 (11.69-12.90) 7.66 (7.26-8.07) 9.18 (8.74-9.63) 16.83 (16.24-17.44) Oregon 3.82 (3.28-4.41) 2.54 (2.11-3.03) 9.76 (9.24-10.29) 16.21 (15.55-16.90) 8.05 (7.65-8.47) 12.29 (11.80-12.80) 20.34 (19.71-21.00) Pennsylvania 3.68 (3.39-4.00) 1.90 (1.70-2.13) 9.52 (9.25-9.80) 18.69 (18.32-19.08) 7.85 (7.63-8.06) 13.88 (13.60-14.16) 21.72 (21.37-22.08) Rhode Island 3.82 (2.84-5.02) 1.75 (1.13-2.59) 9.41 (8.49-10.39) 16.92 (15.68-18.23) 7.80 (7.08-8.57) 12.57 (11.66-13.53) 20.37 (19.21-21.59) South Carolina 3.14 (2.70-3.63) 1.57 (1.27-1.92) 8.83 (8.38-9.30) 15.33 (14.72-15.95) 7.20 (6.85-7.56) 11.38 (10.94-11.83) 18.58 (18.02-19.15) South Dakota 2.41 (1.59-3.51) - - 8.88 (7.83-10.03) 13.60 (12.30-15.01) 7.03 (6.24-7.89) 10.01 (9.07-11.04) 17.04 (15.80-18.36) Tennessee 3.22 (2.85-3.64) 1.92 (1.63-2.24) 8.85 (8.47-9.25) 16.49 (15.96-17.03) 7.24 (6.94-7.54) 12.31 (11.93-12.70) 19.55 (19.06-20.04) Texas 3.37 (3.19-3.57) 2.20 (2.04-2.36) 8.58 (8.37-8.79) 20.18 (19.86-20.51) 7.09 (6.93-7.25) 15.02 (14.79-15.26) 22.11 (21.82-22.39) Utah 3.69 (3.15-4.30) 1.66 (1.30-2.09) 9.02 (8.34-9.73) 19.81 (18.80-20.86) 7.49 (6.98-8.02) 14.60 (13.88-15.36) 22.09 (21.20-23.01) Vermont 2.25 (1.35-3.56) - - 10.70 (9.43-12.10) 21.09 (19.27-23.04) 8.28 (7.33-9.33) 15.51 (14.19-16.92) 23.79 (22.15-25.52) Virginia 2.88 (2.56-3.22) 1.17 (0.97-1.40) 8.16 (7.82-8.51) 14.16 (13.72-14.61) 6.64 (6.39-6.91) 10.43 (10.11-10.76) 17.08 (16.66-17.50) Washington 3.64 (3.25-4.07) 2.52 (2.20-2.88) 9.38 (8.99-9.79) 22.33 (21.72-22.95) 7.74 (7.43-8.05) 16.65 (16.20-17.10) 24.38 (23.84-24.93) West Virginia 3.46 (2.72-4.33) 1.45 (0.99-2.05) 9.81 (9.10-10.55) 15.71 (14.81-16.65) 7.99 (7.44-8.56) 11.62 (10.96-12.30) 19.60 (18.75-20.49) Wisconsin 3.18 (2.79-3.61) 1.43 (1.17-1.72) 10.73 (10.29-11.19) 15.85 (15.31-16.40) 8.57 (8.23-8.91) 11.71 (11.32-12.11) 20.27 (19.76-20.80) Wyoming 2.88 (1.76-4.44) - - 8.42 (7.14-9.86) 13.87 (12.22-15.68) 6.83 (5.85-7.93) 10.25 (9.05-11.56) 17.08 (15.52-18.76) aRates 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.

Table 11: Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor Incidence Ratesa by Siteb and Gender, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2008

Males Females Total

ICDO Code Site N Adjusted

Rate 95% C.I. N Adjusted

Rate 95% C.I. N Adjusted

Rate 95% C.I.

C71.1-C71.4

Frontal, temporal, parietal, & occipital lobes of the brain 35,443 5.11 (5.06 -5.17 ) 28,927 3.65 (3.61 -3.69 ) 64,370 4.32 (4.29 -4.35 )

C71.0 Cerebrum 3,111 0.45 (0.43 -0.46 ) 2,786 0.36 (0.35 -0.37 ) 5,897 0.40 (0.39 -0.41 ) C71.5 Ventricle 1,934 0.27 (0.26 -0.28 ) 1,606 0.22 (0.21 -0.23 ) 3,540 0.24 (0.24 -0.25 ) C71.6 Cerebellum 4,606 0.65 (0.63 -0.67 ) 3,890 0.53 (0.51 -0.55 ) 8,496 0.59 (0.58 -0.60 ) C71.7 Brain stem 2,571 0.36 (0.35 -0.38 ) 2,284 0.32 (0.30 -0.33 ) 4,855 0.34 (0.33 -0.35 ) C71.8-C71.9 Other brain 15,641 2.30 (2.27 -2.34 ) 14,523 1.79 (1.76 -1.82 ) 30,164 2.02 (2.00 -2.05 )

C72.0-C72.1 Spinal cord and cauda equina 4,870 0.68 (0.66 -0.70 ) 4,613 0.61 (0.59 -0.62 ) 9,483 0.64 (0.63 -0.66 )

C72.2-C72.5 Cranial nerves 9,602 1.34 (1.31 -1.37 ) 10,878 1.40 (1.37 -1.42 ) 20,480 1.37 (1.35 -1.38 ) C72.8-C72.9 Other nervous system 982 0.14 (0.13 -0.15 ) 834 0.11 (0.10 -0.12 ) 1,816 0.12 (0.12 -0.13 )

C70.0-C70.9 Meninges (cerebral & spinal) 26,687 4.02 (3.97 -4.07 ) 74,806 9.11 (9.04 -9.18 ) 101,493 6.76 (6.72 -6.80 )

C75.1-C75.2 Pituitary 19,756 2.83 (2.79 -2.87 ) 23,736 3.16 (3.12 -3.20 ) 43,492 2.95 (2.92 -2.98 ) C75.3 Pineal 824 0.11 (0.11 -0.12 ) 526 0.07 (0.07 -0.08 ) 1,350 0.09 (0.09 -0.10 ) C30.0 (9522-9523)

Olfactory tumors of the nasal cavity 323 0.05 (0.04 -0.05 ) 227 0.03 (0.03 -0.03 ) 550 0.04 (0.03 -0.04 )

TOTAL 126,350 18.32 (18.22 -18.42 ) 169,636 21.34 (21.24 -21.44 ) 295,986 19.89 (19.82 -19.96 ) aRates are per 100,000 person years. bThe 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.

Table 12: Distribution and Incidence Ratesa of Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumors by Major Histology Groupings and Histology, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2008

Histology

TOTAL

N

% of All Reported

Brain Tumors

Adjusted

Rate 95% C.I. Tumors of Neuroepithelial Tissue 97,679 33.0 6.60 (6.56-6.64) Pilocytic astrocytoma 4,655 1.6 0.33 (0.32-0.34) Protoplasmic & fibrillary astrocytoma 1,609 0.5 0.11 (0.10-0.12) Anaplastic astrocytoma 6,005 2.0 0.41 (0.40-0.42) Unique astrocytoma variants 1,429 0.5 0.10 (0.09-0.10) Astrocytoma, NOS 6,445 2.2 0.44 (0.43-0.45) Glioblastoma 48,327 16.3 3.20 (3.17-3.23) Oligodendroglioma 3,977 1.3 0.28 (0.27-0.28) Anaplastic oligodendroglioma 1,753 0.6 0.12 (0.11-0.13) Ependymoma/anaplastic ependymoma 3,797 1.3 0.26 (0.25-0.27) Ependymoma variants 1,415 0.5 0.10 (0.09-0.10) Mixed glioma 2,844 1.0 0.20 (0.19-0.20) Glioma malignant, NOS 6,380 2.2 0.44 (0.43-0.45) Choroid plexus 769 0.3 0.05 (0.05-0.06) Neuroepithelial 291 0.1 0.02 (0.02-0.02) Non-malignant and malignant neuronal/glial 4,073 1.4 0.28 (0.27-0.29) Pineal parenchymal 550 0.2 0.04 (0.04-0.04) Embryonal/primitive/medulloblastoma 3,360 1.1 0.24 (0.23-0.25) Tumors of Cranial and Spinal Nerves 25,107 8.5 1.68 (1.65-1.70) Nerve sheath, non-malignant and malignant 25,097 8.5 1.67 (1.65-1.70) Tumors of Meninges 106,177 35.9 7.08 (7.04-7.12) Meningioma 102,602 34.7 6.84 (6.79-6.88) Other mesenchymal, non-malignant and malignant 1,146 0.4 0.08 (0.07-0.08) Hemangioblastoma 2,429 0.8 0.17 (0.16-0.17) Lymphomas and Hematopoietic Neoplasms 6,855 2.3 0.46 (0.45-0.47) Lymphoma 6,855 2.3 0.46 (0.45-0.47) Germ Cell Tumors and Cysts 1,406 0.5 0.10 (0.09-0.10) Germ cell tumors, cysts and heterotopias 1,406 0.5 0.10 (0.09-0.10) Tumors of Sellar Region 42,535 14.4 2.89 (2.86-2.91) Pituitary 39,928 13.5 2.71 (2.68-2.73) Craniopharyngioma 2,607 0.9 0.18 (0.17-0.19) Local Extensions from Regional Tumors 249 0.1 0.02 (0.02-0.02) Chordoma/chondrosarcoma 249 0.1 0.02 (0.02-0.02) Unclassified Tumors 15,978 5.4 1.07 (1.06-1.09) Hemangioma 2,647 0.9 0.18 (0.17-0.19) Neoplasm, unspecified 13,148 4.4 0.88 (0.87-0.90) All other 183 0.1 0.01 (0.01-0.01) TOTALb 295,986 100.0 19.89 (19.82-19.96) aRates are per 100,000 person years. bRefers 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 12a: Distribution and Incidence Ratesa,b 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, 2004-2008

Malignant Non-malignant

Histology N Adjusted Rate

(95% C.I.) N Adjusted Rate

(95% C.I.)

Tumors of Neuroepithelial Tissue 91,287 6.16 (6.12-6.20) 6,392 0.44 (0.43-0.45) Pilocytic astrocytoma 4,655 0.33 (0.32-0.34) - - Protoplasmic & fibrillary astrocytoma 1,609 0.11 (0.10-0.12) - - Anaplastic astrocytoma 6,005 0.41 (0.40-0.42) - - Unique astrocytoma variants 401 0.03 (0.03-0.03) 1,028 0.07 (0.07-0.08) Astrocytoma, NOS 6,445 0.44 (0.43-0.45) - - Glioblastoma 48,327 3.20 (3.17-3.23) - - Oligodendroglioma 3,977 0.28 (0.27-0.28) - - Anaplastic oligodendroglioma 1,751 0.12 (0.11-0.13) - - Ependymoma/anaplastic ependymoma 3,797 0.26 (0.25-0.27) - - Ependymoma variants 18 0.00 (0.00-0.00) 1,397 0.10 (0.09-0.10) Mixed glioma 2,844 0.20 (0.19-0.20) - - Glioma malignant, NOS 6,380 0.44 (0.43-0.45) - - Choroid plexus 143 0.01 (0.01-0.01) 626 0.04 (0.04-0.05) Neuroepithelial 251 0.02 (0.02-0.02) 40 0.00 (0.00-0.00) Non-malignant and malignant neuronal/glial 1,016 0.07 (0.07-0.07) 3,057 0.21 (0.21-0.22) Pineal parenchymal 309 0.02 (0.02-0.02) 241 0.02 (0.02-0.02) Embryonal/primitive/medulloblastoma 3,359 0.24 (0.23-0.25) - - Tumors of Cranial and Spinal Nerves 252 0.02 (0.02-0.02) 24,855 1.66 (1.64-1.68) Nerve sheath, non-malignant and malignant 252 0.02 (0.02-0.02) 24,845 1.66 (1.64-1.68) Tumors of Meninges 2,379 0.16 (0.15-0.17) 103,798 6.92 (6.88-6.96) Meningioma 2,005 0.13 (0.13-0.14) 100,597 6.70 (6.66-6.74) Other mesenchymal, non-malignant and malignant 353 0.02 (0.02-0.03) 793 0.05 (0.05-0.06) Hemangioblastoma 21 0.00 (0.00-0.00) 2,408 0.16 (0.16-0.17) Lymphomas and Hematopoietic Neoplasms 6,847 0.46 (0.45-0.47) - - Lymphoma 6,847 0.46 (0.45-0.47) - - Germ Cell Tumors and Cysts 966 0.07 (0.06-0.07) 440 0.03 (0.03-0.03) Germ cell tumors, cysts and heterotopias 966 0.07 (0.06-0.07) 440 0.03 (0.03-0.03) Tumors of Sellar Region 157 0.01 (0.01-0.01) 42,378 2.88 (2.85-2.90) Pituitary 150 0.01 (0.01-0.01) 39,778 2.70 (2.67-2.72) Craniopharyngioma - - 2,600 0.18 (0.17-0.19) Local Extensions from Regional Tumors 244 0.02 (0.01-0.02) - - Chordoma/chondrosarcoma 244 0.02 (0.01-0.02) - - Unclassified Tumors 6,305 0.42 (0.41-0.43) 9,673 0.65 (0.64-0.67) Hemangioma 19 0.00 (0.00-0.00) 2,628 0.18 (0.17-0.19) Neoplasm, unspecified 6,216 0.41 (0.40-0.42) 6,932 0.47 (0.46-0.48) All other 70 0.01 (0.00-0.01) 113 0.01 (0.01-0.01)

TOTALd 108,437 7.31 (7.27-7.36) 187,549 12.58 (12.52-12.64) aRates are per 100,000 person years. dRefers 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; 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 Incidence Ratesa by Major Histology Groupings, Histology and Gender, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2008

Males Females

Histology Adjusted

Rate 95% C.I. Adjusted

Rate 95% C.I. Tumors of Neuroepithelial Tissue 7.78 (7.71-7.85) 5.59 (5.54-5.64) Pilocytic astrocytoma 0.34 (0.32-0.35) 0.32 (0.31-0.34) Protoplasmic & fibrillary astrocytoma 0.14 (0.13-0.14) 0.09 (0.08-0.09) Anaplastic astrocytoma 0.48 (0.47-0.50) 0.34 (0.33-0.35) Unique astrocytoma variants 0.13 (0.12-0.13) 0.07 (0.07-0.08) Astrocytoma, NOS 0.50 (0.48-0.51) 0.39 (0.38-0.41) Glioblastoma 4.00 (3.95-4.05) 2.53 (2.50-2.57) Oligodendroglioma 0.31 (0.29-0.32) 0.25 (0.23-0.26) Anaplastic oligodendroglioma 0.14 (0.13-0.14) 0.11 (0.10-0.11) Ependymoma/anaplastic ependymoma 0.27 (0.26-0.28) 0.25 (0.24-0.26) Ependymoma variants 0.11 (0.10-0.12) 0.08 (0.08-0.09) Mixed glioma 0.23 (0.22-0.24) 0.17 (0.16-0.18) Glioma malignant, NOS 0.48 (0.46-0.49) 0.41 (0.40-0.43) Choroid plexus 0.05 (0.05-0.06) 0.06 (0.05-0.06) Neuroepithelial 0.02 (0.02-0.03) 0.02 (0.02-0.02) Non-malignant and malignant neuronal/glial 0.30 (0.29-0.32) 0.26 (0.25-0.27) Pineal parenchymal 0.03 (0.03-0.04) 0.04 (0.04-0.05) Embryonal/primitive/medulloblastoma 0.27 (0.26-0.28) 0.20 (0.19-0.21) Tumors of Cranial and Spinal Nerves 1.68 (1.65-1.71) 1.68 (1.65-1.71) Nerve sheath, non-malignant and malignant 1.68 (1.65-1.71) 1.68 (1.65-1.71) Tumors of Meninges 4.32 (4.27-4.37) 9.45 (9.38-9.51) Meningioma 4.05 (4.00-4.10) 9.23 (9.16-9.29) Other mesenchymal, non-malignant and malignant 0.08 (0.07-0.09) 0.08 (0.07-0.08) Hemangioblastoma 0.19 (0.18-0.20) 0.14 (0.13-0.15) Lymphomas and Hematopoietic Neoplasms 0.54 (0.52-0.56) 0.39 (0.38-0.41) Lymphoma 0.54 (0.52-0.56) 0.39 (0.38-0.41) Germ Cell Tumors and Cysts 0.13 (0.13-0.14) 0.06 (0.06-0.07) Germ cell tumors, cysts and heterotopias 0.13 (0.13-0.14) 0.06 (0.06-0.07) Tumors of Sellar Region 2.77 (2.73-2.81) 3.09 (3.05-3.13) Pituitary 2.59 (2.55-2.62) 2.91 (2.87-2.95) Craniopharyngioma 0.18 (0.17-0.19) 0.18 (0.17-0.19) Local Extensions from Regional Tumors 0.02 (0.02-0.02) 0.02 (0.01-0.02) Chordoma/chondrosarcoma 0.02 (0.02-0.02) 0.02 (0.01-0.02) Unclassified Tumors 1.09 (1.06-1.11) 1.07 (1.05-1.09) Hemangioma 0.16 (0.15-0.17) 0.20 (0.19-0.21) Neoplasm, unspecified 0.91 (0.89-0.94) 0.86 (0.84-0.88) All other 0.02 (0.01-0.02) 0.01 (0.01-0.01)

TOTALb 18.32 (18.22-18.42) 21.34 (21.24-21.44) aRates are per 100,000 person years. bRefers 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 Incidence Ratesa by Major Histology Groupings, Histology and Race, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2008

Whites Blacks

Histology Adjusted


Rate 95% C.I. Tumors of Neuroepithelial Tissue 7.08 (7.03-7.13) 3.75 (3.65-3.84) Pilocytic astrocytoma 0.35 (0.34-0.36) 0.23 (0.21-0.25) Protoplasmic & fibrillary astrocytoma 0.12 (0.12-0.13) 0.05 (0.04-0.06) Anaplastic astrocytoma 0.45 (0.43-0.46) 0.19 (0.17-0.21) Unique astrocytoma variants 0.10 (0.10-0.11) 0.08 (0.07-0.09) Astrocytoma, NOS 0.47 (0.46-0.48) 0.29 (0.26-0.32) Glioblastoma 3.45 (3.42-3.48) 1.64 (1.57-1.70) Oligodendroglioma 0.30 (0.29-0.31) 0.12 (0.11-0.14) Anaplastic oligodendroglioma 0.13 (0.12-0.14) 0.05 (0.04-0.07) Ependymoma/anaplastic ependymoma 0.27 (0.27-0.28) 0.17 (0.15-0.19) Ependymoma variants 0.11 (0.10-0.11) 0.04 (0.03-0.05) Mixed glioma 0.21 (0.21-0.22) 0.09 (0.08-0.11) Glioma malignant, NOS 0.46 (0.44-0.47) 0.33 (0.31-0.36) Choroid plexus 0.06 (0.05-0.06) 0.03 (0.03-0.04) Neuroepithelial 0.02 (0.02-0.02) 0.01 (0.01-0.02) Non-malignant and malignant neuronal/glial 0.29 (0.28-0.30) 0.22 (0.20-0.24) Pineal parenchymal 0.04 (0.03-0.04) 0.05 (0.04-0.06) Embryonal/primitive/medulloblastoma 0.25 (0.24-0.26) 0.16 (0.14-0.18) Tumors of Cranial and Spinal Nerves 1.75 (1.73-1.78) 0.73 (0.69-0.78) Nerve sheath, non-malignant and malignant 1.75 (1.73-1.78) 0.73 (0.69-0.78) Tumors of Meninges 6.90 (6.85-6.94) 8.11 (7.96-8.26) Meningioma 6.65 (6.60-6.69) 7.92 (7.77-8.07) Other mesenchymal, non-malignant and malignant 0.08 (0.07-0.08) 0.07 (0.05-0.08) Hemangioblastoma 0.17 (0.16-0.18) 0.12 (0.11-0.14) Lymphomas and Hematopoietic Neoplasms 0.46 (0.45-0.47) 0.42 (0.39-0.45) Lymphoma 0.46 (0.45-0.47) 0.42 (0.39-0.45) Germ Cell Tumors and Cysts 0.10 (0.09-0.11) 0.07 (0.06-0.08) Germ cell tumors, cysts and heterotopias 0.10 (0.09-0.11) 0.07 (0.06-0.08) Tumors of Sellar Region 2.61 (2.58-2.64) 4.69 (4.58-4.80) Pituitary 2.45 (2.42-2.47) 4.44 (4.34-4.55) Craniopharyngioma 0.17 (0.16-0.17) 0.25 (0.23-0.28) Local Extensions from Regional Tumors 0.02 (0.02-0.02) 0.01 (0.01-0.02) Chordoma/chondrosarcoma 0.02 (0.02-0.02) 0.01 (0.01-0.02) Unclassified Tumors 1.06 (1.04-1.08) 1.11 (1.06-1.17) Hemangioma 0.19 (0.18-0.19) 0.13 (0.11-0.15) Neoplasm, unspecified 0.86 (0.85-0.88) 0.98 (0.93-1.03) All other 0.01 (0.01-0.02) - -

TOTALb 19.97 (19.89-20.05) 18.89 (18.67-19.11) aRates are per 100,000 person years. bRefers 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.

Table 15: Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor Incidence Ratesa By Major Histology Groupings, Histology, Race and Hispanic Ethnicityb, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2008 Hispanics Non-Hispanics White Black (Of Any Race) (Of Any Race) Non-Hispanics Non-Hispanics

Histology Adjusted




Rate 95% C.I. Tumors of Neuroepithelial Tissue 5.13 (5.02-5.25) 6.80 (6.76-6.85) 7.38 (7.33-7.43) 3.79 (3.69-3.89) Pilocytic astrocytoma 0.24 (0.22-0.26) 0.35 (0.34-0.36) 0.38 (0.37-0.40) 0.23 (0.21-0.25) Protoplasmic & fibrillary astrocytoma 0.05 (0.04-0.07) 0.12 (0.11-0.12) 0.13 (0.13-0.14) 0.05 (0.04-0.06) Anaplastic astrocytoma 0.31 (0.28-0.34) 0.42 (0.41-0.43) 0.47 (0.45-0.48) 0.19 (0.17-0.21) Unique astrocytoma variants 0.08 (0.07-0.09) 0.10 (0.10-0.11) 0.11 (0.10-0.11) 0.08 (0.07-0.09) Astrocytoma, NOS 0.33 (0.30-0.36) 0.46 (0.45-0.47) 0.49 (0.48-0.51) 0.3 (0.27-0.32) Glioblastoma 2.43 (2.34-2.52) 3.27 (3.24-3.31) 3.56 (3.52-3.59) 1.65 (1.58-1.72) Oligodendroglioma 0.23 (0.20-0.25) 0.29 (0.28-0.29) 0.32 (0.31-0.33) 0.13 (0.11-0.15) Anaplastic oligodendroglioma 0.10 (0.09-0.12) 0.12 (0.12-0.13) 0.14 (0.13-0.14) 0.05 (0.04-0.07) Ependymoma/anaplastic ependymoma 0.23 (0.21-0.26) 0.26 (0.26-0.27) 0.28 (0.27-0.29) 0.17 (0.15-0.19) Ependymoma variants 0.06 (0.05-0.07) 0.10 (0.10-0.11) 0.12 (0.11-0.12) 0.04 (0.03-0.05) Mixed glioma 0.16 (0.14-0.18) 0.20 (0.20-0.21) 0.23 (0.22-0.24) 0.09 (0.08-0.11) Glioma malignant, NOS 0.38 (0.35-0.41) 0.45 (0.44-0.47) 0.48 (0.46-0.49) 0.34 (0.31-0.37) Choroid plexus 0.05 (0.04-0.07) 0.05 (0.05-0.06) 0.06 (0.05-0.06) 0.04 (0.03-0.04) Neuroepithelial 0.01 (0.01-0.02) 0.02 (0.02-0.02) 0.02 (0.02-0.03) 0.01 (0.01-0.02) Non-malignant and malignant neuronal/glial 0.20 (0.18-0.22) 0.30 (0.29-0.31) 0.32 (0.31-0.33) 0.22 (0.20-0.25) Pineal parenchymal 0.03 (0.03-0.04) 0.04 (0.04-0.04) 0.04 (0.03-0.04) 0.05 (0.04-0.06) Embryonal/primitive/medulloblastoma 0.24 (0.22-0.26) 0.24 (0.23-0.25) 0.26 (0.25-0.27) 0.16 (0.14-0.18) Tumors of Cranial and Spinal Nerves 1.27 (1.21-1.33) 1.73 (1.71-1.75) 1.84 (1.81-1.86) 0.73 (0.69-0.78) Nerve sheath, non-malignant and malignant 1.27 (1.21-1.33) 1.73 (1.71-1.75) 1.84 (1.81-1.86) 0.73 (0.69-0.78) Tumors of Meninges 7.08 (6.93-7.24) 7.10 (7.06-7.15) 6.92 (6.87-6.97) 8.24 (8.09-8.39) Meningioma 6.86 (6.71-7.02) 6.86 (6.81-6.90) 6.67 (6.62-6.71) 8.05 (7.90-8.20) Other mesenchymal, non-malignant and malignant 0.07 (0.06-0.08) 0.08 (0.08-0.08) 0.08 (0.08-0.09) 0.07 (0.06-0.08) Hemangioblastoma 0.15 (0.14-0.17) 0.17 (0.16-0.17) 0.17 (0.16-0.18) 0.12 (0.11-0.14) Lymphomas and Hematopoietic Neoplasms 0.49 (0.45-0.53) 0.45 (0.44-0.47) 0.44 (0.43-0.46) 0.43 (0.39-0.46) Lymphoma 0.49 (0.45-0.53) 0.45 (0.44-0.47) 0.44 (0.43-0.46) 0.43 (0.39-0.46) Germ Cell Tumors and Cysts 0.11 (0.10-0.13) 0.10 (0.09-0.10) 0.10 (0.09-0.10) 0.07 (0.06-0.08) Germ cell tumors, cysts and heterotopias 0.11 (0.10-0.13) 0.10 (0.09-0.10) 0.10 (0.09-0.10) 0.07 (0.06-0.08) Tumors of Sellar Region 3.51 (3.41-3.61) 2.82 (2.79-2.85) 2.50 (2.47-2.53) 4.78 (4.67-4.89) Pituitary 3.33 (3.23-3.42) 2.64 (2.61-2.67) 2.34 (2.31-2.37) 4.52 (4.42-4.63) Craniopharyngioma 0.18 (0.17-0.21) 0.18 (0.17-0.19) 0.16 (0.16-0.17) 0.25 (0.23-0.28) Local Extensions from Regional Tumors 0.03 (0.02-0.03) 0.02 (0.01-0.02) 0.02 (0.01-0.02) 0.01 (0.01-0.02) Chordoma/chondrosarcoma 0.03 (0.02-0.03) 0.02 (0.01-0.02) 0.02 (0.01-0.02) 0.01 (0.01-0.02) Unclassified Tumors 1.20 (1.13-1.26) 1.06 (1.04-1.08) 1.05 (1.03-1.07) 1.13 (1.07-1.19) Hemangioma 0.17 (0.15-0.19) 0.18 (0.18-0.19) 0.19 (0.18-0.20) 0.13 (0.11-0.15) Neoplasm, unspecified 1.02 (0.96-1.08) 0.87 (0.85-0.88) 0.85 (0.83-0.87) 0.99 (0.94-1.04) All other 0.01 (0.01-0.02) 0.01 (0.01-0.02) 0.01 (0.01-0.02) - -

TOTALc 18.82 (18.58-19.06) 20.08 (20.00-20.16) 20.25 (20.16-20.33) 19.17 (18.94-19.39) aRates are per 100,000 person years. bHispanic ethnicity is not mutually exclusive of race; Classified using the North American Association of Central Cancer Registries Hispanic Identification Algorithm, version 2 (NHIA v2) . cRefers 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.

Table 16: Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor Age-Specific Incidence Ratesa by Major Histology Groupings, Histology and Age at Diagnosis; CBTRUS Statistical Report: NPCR and SEER, 2004-2008

Age at Diagnosis Age at Diagnosis 0-14 0-19 20-34 35-44 45-54 55-64 65-74 75-84 85+

Histology Rate 95% C.I. Rate 95% C.I. Rate 95% C.I. Rate 95% C.I. Rate 95% C.I. Rate 95% C.I. Rate 95% C.I. Rate 95% C.I. Rate 95% C.I.

Tumors of Neuroepithelial Tissue 3.77 (3.70-3.84) 3.52 (3.46-3.57) 3.22 (3.16-3.29) 4.52 (4.43-4.62) 7.05 (6.94-7.16) 11.97 (11.79-12.14) 17.60 (17.33-17.88) 19.31 (18.97-19.66) 11.79 (11.36-12.22) Pilocytic astrocytoma 0.88 (0.84-0.91) 0.81 (0.78-0.84) 0.25 (0.23-0.27) 0.12 (0.11-0.14) 0.09 (0.08-0.10) 0.08 (0.07-0.09) 0.08 (0.06-0.10) 0.06 (0.04-0.08) - - Protoplasmic & fibrillary astrocytoma 0.05 (0.04-0.06) 0.05 (0.04-0.05) 0.09 (0.08-0.10) 0.12 (0.10-0.13) 0.13 (0.12-0.15) 0.18 (0.16-0.20) 0.23 (0.20-0.26) 0.22 (0.18-0.26) 0.08 (0.05-0.13) Anaplastic astrocytoma 0.08 (0.07-0.09) 0.08 (0.07-0.09) 0.30 (0.28-0.32) 0.43 (0.40-0.46) 0.51 (0.48-0.54) 0.75 (0.71-0.79) 1.01 (0.95-1.08) 1.04 (0.96-1.12) 0.40 (0.33-0.49) Unique astrocytoma variants 0.10 (0.09-0.11) 0.10 (0.09-0.11) 0.08 (0.07-0.09) 0.09 (0.08-0.10) 0.12 (0.11-0.14) 0.13 (0.12-0.15) 0.10 (0.08-0.12) 0.07 (0.05-0.10) - - Astrocytoma, NOS 0.22 (0.21-0.24) 0.22 (0.20-0.23) 0.37 (0.35-0.39) 0.47 (0.44-0.50) 0.45 (0.42-0.48) 0.60 (0.56-0.64) 0.88 (0.82-0.94) 1.07 (0.99-1.15) 0.63 (0.53-0.73) Glioblastoma 0.13 (0.12-0.14) 0.14 (0.13-0.15) 0.41 (0.39-0.43) 1.23 (1.18-1.27) 3.74 (3.66-3.82) 8.20 (8.05-8.34) 13.25 (13.02-13.49) 14.49 (14.20-14.79) 8.63 (8.26-9.00) Oligodendroglioma 0.05 (0.04-0.06) 0.06 (0.05-0.07) 0.32 (0.30-0.34) 0.50 (0.47-0.54) 0.43 (0.40-0.45) 0.32 (0.30-0.35) 0.24 (0.21-0.28) 0.18 (0.15-0.21) - - Anaplastic oligodendroglioma 0.01 (0.01-0.01) 0.01 (0.01-0.02) 0.09 (0.08-0.10) 0.19 (0.17-0.21) 0.19 (0.17-0.21) 0.23 (0.21-0.25) 0.20 (0.17-0.23) 0.14 (0.11-0.17) - - Ependymoma/anaplastic ependymoma 0.26 (0.24-0.28) 0.24 (0.22-0.25) 0.20 (0.19-0.22) 0.27 (0.25-0.30) 0.33 (0.31-0.36) 0.35 (0.32-0.38) 0.33 (0.29-0.37) 0.21 (0.17-0.25) 0.07 (0.04-0.12) Ependymoma variants 0.02 (0.02-0.03) 0.04 (0.03-0.04) 0.12 (0.11-0.13) 0.13 (0.12-0.15) 0.14 (0.12-0.15) 0.13 (0.11-0.15) 0.11 (0.09-0.14) 0.08 (0.06-0.10) - - Mixed glioma 0.03 (0.02-0.04) 0.04 (0.03-0.04) 0.25 (0.24-0.27) 0.34 (0.32-0.37) 0.27 (0.25-0.29) 0.26 (0.23-0.28) 0.21 (0.18-0.24) 0.15 (0.12-0.19) - - Glioma malignant, NOS 0.67 (0.64-0.70) 0.57 (0.54-0.59) 0.22 (0.20-0.23) 0.23 (0.21-0.25) 0.29 (0.26-0.31) 0.40 (0.37-0.43) 0.65 (0.60-0.70) 1.25 (1.17-1.34) 1.53 (1.38-1.69) Choroid plexus 0.12 (0.11-0.13) 0.10 (0.09-0.11) 0.04 (0.03-0.04) 0.04 (0.03-0.05) 0.03 (0.03-0.04) 0.04 (0.03-0.05) 0.02 (0.01-0.03) 0.03 (0.02-0.05) - - Neuroepithelial 0.01 (0.01-0.02) 0.01 (0.01-0.02) 0.01 (0.01-0.01) 0.01 (0.01-0.02) 0.02 (0.02-0.03) 0.03 (0.03-0.04) 0.04 (0.03-0.06) 0.07 (0.05-0.09) - - Non-malignant and malignant neuronal/glial 0.38 (0.36-0.41) 0.41 (0.39-0.43) 0.29 (0.27-0.30) 0.23 (0.21-0.26) 0.22 (0.20-0.24) 0.21 (0.19-0.23) 0.19 (0.16-0.22) 0.20 (0.16-0.24) 0.09 (0.06-0.14) Pineal parenchymal 0.04 (0.04-0.05) 0.04 (0.04-0.05) 0.04 (0.03-0.05) 0.03 (0.03-0.04) 0.04 (0.03-0.05) 0.04 (0.03-0.05) 0.04 (0.02-0.05) 0.03 (0.01-0.04) - - Embryonal/primitive/medulloblastoma 0.73 (0.70-0.77) 0.61 (0.59-0.63) 0.16 (0.15-0.18) 0.09 (0.07-0.10) 0.06 (0.05-0.07) 0.04 (0.03-0.05) 0.03 (0.02-0.04) 0.03 (0.02-0.04) - - Tumors of Cranial and Spinal Nerves 0.24 (0.22-0.26) 0.26 (0.25-0.28) 0.79 (0.76-0.82) 1.73 (1.68-1.79) 2.89 (2.82-2.97) 3.90 (3.80-4.00) 4.01 (3.88-4.14) 3.10 (2.96-3.24) 1.55 (1.40-1.71) Nerve sheath, non-malignant and malignant 0.24 (0.22-0.26) 0.26 (0.25-0.28) 0.79 (0.76-0.82) 1.73 (1.68-1.79) 2.89 (2.82-2.97) 3.90 (3.80-4.00) 4.00 (3.88-4.14) 3.10 (2.96-3.24) 1.55 (1.40-1.71) Tumors of Meninges 0.14 (0.12-0.15) 0.19 (0.18-0.21) 1.41 (1.37-1.46) 4.38 (4.29-4.47) 8.39 (8.27-8.52) 13.78 (13.60-13.97) 23.42 (23.11-23.74) 33.38 (32.93-33.83) 41.85 (41.04-42.66) Meningioma 0.09 (0.08-0.10) 0.13 (0.12-0.14) 1.20 (1.16-1.24) 4.07 (3.98-4.15) 8.04 (7.92-8.16) 13.37 (13.19-13.56) 23.00 (22.70-23.32) 33.03 (32.59-33.48) 41.67 (40.87-42.48) Other mesenchymal, non-malignant and malignant 0.03 (0.03-0.04) 0.03 (0.03-0.04) 0.06 (0.05-0.07) 0.10 (0.08-0.11) 0.10 (0.09-0.11) 0.13 (0.11-0.15) 0.14 (0.12-0.16) 0.12 (0.10-0.15) 0.07 (0.04-0.11) Hemangioblastoma 0.01 (0.01-0.02) 0.03 (0.03-0.04) 0.16 (0.14-0.17) 0.22 (0.20-0.24) 0.25 (0.23-0.28) 0.28 (0.25-0.31) 0.28 (0.25-0.32) 0.23 (0.19-0.27) 0.11 (0.07-0.16) Lymphomas and Hemopoietic Neoplasms 0.01 (0.01-0.02) 0.02 (0.01-0.02) 0.13 (0.11-0.14) 0.28 (0.26-0.31) 0.49 (0.46-0.52) 0.93 (0.88-0.98) 1.85 (1.76-1.94) 2.21 (2.09-2.33) 1.09 (0.96-1.23) Lymphoma 0.01 (0.01-0.02) 0.02 (0.01-0.02) 0.13 (0.11-0.14) 0.28 (0.26-0.31) 0.49 (0.46-0.52) 0.93 (0.88-0.98) 1.85 (1.76-1.94) 2.21 (2.09-2.33) 1.09 (0.96-1.23) Germ Cell Tumors and Cysts 0.18 (0.16-0.19) 0.20 (0.19-0.22) 0.11 (0.10-0.12) 0.05 (0.04-0.06) 0.04 (0.03-0.04) 0.02 (0.02-0.03) 0.03 (0.02-0.04) 0.03 (0.02-0.04) - - Germ cell tumors, cysts and heterotopias 0.18 (0.16-0.19) 0.20 (0.19-0.22) 0.11 (0.10-0.12) 0.05 (0.04-0.06) 0.04 (0.03-0.04) 0.02 (0.02-0.03) 0.03 (0.02-0.04) 0.03 (0.02-0.04) - - Tumors of Sellar Region 0.37 (0.35-0.40) 0.62 (0.59-0.64) 2.45 (2.39-2.51) 3.31 (3.23-3.39) 3.86 (3.78-3.95) 4.72 (4.61-4.83) 6.37 (6.21-6.54) 5.88 (5.70-6.07) 3.83 (3.59-4.08) Pituitary 0.17 (0.16-0.19) 0.43 (0.41-0.45) 2.33 (2.27-2.38) 3.14 (3.06-3.22) 3.66 (3.58-3.74) 4.49 (4.39-4.60) 6.13 (5.97-6.29) 5.73 (5.54-5.92) 3.75 (3.51-4.00) Craniopharyngioma 0.20 (0.19-0.22) 0.19 (0.18-0.21) 0.12 (0.11-0.14) 0.17 (0.15-0.19) 0.21 (0.19-0.23) 0.23 (0.21-0.26) 0.24 (0.21-0.27) 0.15 (0.13-0.19) 0.08 (0.05-0.13) Local Extensions from Regional Tumors - - 0.01 (0.00-0.01) 0.02 (0.01-0.02) 0.01 (0.01-0.02) 0.02 (0.02-0.03) 0.03 (0.02-0.04) 0.05 (0.03-0.06) 0.04 (0.03-0.06) - - Chordoma/chondrosarcoma - - 0.01 (0.00-0.01) 0.02 (0.01-0.02) 0.01 (0.01-0.02) 0.02 (0.02-0.03) 0.03 (0.02-0.04) 0.05 (0.03-0.06) 0.04 (0.03-0.06) - - Unclassified Tumors 0.20 (0.19-0.22) 0.23 (0.22-0.24) 0.46 (0.44-0.49) 0.68 (0.64-0.71) 0.91 (0.87-0.95) 1.35 (1.29-1.41) 2.48 (2.38-2.58) 5.12 (4.95-5.30) 10.92 (10.51-11.34) Hemangioma 0.05 (0.04-0.06) 0.06 (0.05-0.07) 0.15 (0.13-0.16) 0.21 (0.19-0.23) 0.26 (0.23-0.28) 0.29 (0.26-0.32) 0.34 (0.30-0.38) 0.29 (0.25-0.33) 0.21 (0.15-0.27) Neoplasm, unspecified 0.15 (0.13-0.16) 0.16 (0.15-0.18) 0.31 (0.29-0.33) 0.45 (0.43-0.48) 0.64 (0.61-0.68) 1.04 (0.99-1.09) 2.11 (2.02-2.21) 4.79 (4.63-4.96) 10.66 (10.26-11.08) All other 0.01 (0.00-0.01) 0.01 (0.00-0.01) 0.01 (0.00-0.01) 0.01 (0.01-0.02) 0.01 (0.01-0.02) 0.02 (0.02-0.03) 0.03 (0.02-0.04) 0.04 (0.03-0.06) - - TOTALb 4.92 (4.84-5.00) 5.05 (4.98-5.12) 8.59 (8.48-8.69) 14.96 (14.79-15.13) 23.66 (23.45-23.86) 36.70 (36.39-37.00) 55.80 (55.32-56.28) 69.07 (68.42-69.71) 71.06 (70.01-72.12) aRates are per 100,000 person years and age-adjusted to the 2000 U.S. standard population. bRefers 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.

Table 17: Selected Childhood (Ages 0-19) Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor Incidence Ratesa by Major Histology Groupings, Histology and Gender, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2008

Male Female TOTAL

Histology Adjusted



Rate 95% C.I. Tumors of Neuroepithelial Tissue 3.69 (3.61-3.78) 3.33 (3.25-3.41) 3.52 (3.46-3.57) Pilocytic astrocytoma 0.83 (0.79-0.87) 0.79 (0.75-0.83) 0.81 (0.78-0.84) Protoplasmic & fibrillary astrocytoma 0.05 (0.04-0.06) 0.04 (0.03-0.05) 0.05 (0.04-0.05) Anaplastic astrocytoma 0.09 (0.07-0.10) 0.08 (0.07-0.09) 0.08 (0.07-0.09) Unique astrocytoma variants 0.10 (0.09-0.12) 0.10 (0.09-0.12) 0.10 (0.09-0.11) Astrocytoma, NOS 0.23 (0.21-0.25) 0.21 (0.19-0.23) 0.22 (0.20-0.23) Glioblastoma 0.16 (0.14-0.18) 0.12 (0.11-0.14) 0.14 (0.13-0.15) Oligodendroglioma 0.07 (0.06-0.08) 0.05 (0.05-0.07) 0.06 (0.05-0.07) Anaplastic oligodendroglioma 0.02 (0.01-0.02) 0.01 (0.01-0.02) 0.01 (0.01-0.02) Ependymoma/anaplastic ependymoma 0.25 (0.23-0.27) 0.22 (0.20-0.24) 0.24 (0.22-0.25) Ependymoma variants 0.05 (0.04-0.06) 0.03 (0.02-0.03) 0.04 (0.03-0.04) Mixed glioma 0.03 (0.02-0.04) 0.04 (0.03-0.05) 0.04 (0.03-0.04) Glioma malignant, NOS 0.55 (0.52-0.58) 0.58 (0.55-0.62) 0.57 (0.54-0.59) Choroid plexus 0.11 (0.09-0.12) 0.09 (0.08-0.11) 0.10 (0.09-0.11) Neuroepithelial - - - - 0.01 (0.01-0.02) Non-malignant and malignant neuronal/glial 0.44 (0.41-0.47) 0.37 (0.35-0.40) 0.41 (0.39-0.43) Pineal parenchymal 0.04 (0.03-0.05) 0.04 (0.04-0.06) 0.04 (0.04-0.05) Embryonal/primitive/medulloblastoma 0.69 (0.66-0.73) 0.52 (0.49-0.55) 0.61 (0.59-0.63) Tumors of Cranial and Spinal Nerves 0.26 (0.24-0.28) 0.27 (0.24-0.29) 0.26 (0.25-0.28) Nerve sheath, non-malignant and malignant 0.26 (0.24-0.28) 0.27 (0.24-0.29) 0.26 (0.25-0.28) Tumors of Meninges 0.18 (0.16-0.20) 0.21 (0.19-0.23) 0.19 (0.18-0.21) Meningioma 0.12 (0.10-0.13) 0.14 (0.12-0.15) 0.13 (0.12-0.14) Other mesenchymal, non-malignant and malignant 0.03 (0.02-0.04) 0.04 (0.03-0.05) 0.03 (0.03-0.04) Hemangioblastoma 0.03 (0.03-0.04) 0.03 (0.02-0.04) 0.03 (0.03-0.04) Lymphomas and Hematopoietic Neoplasms 0.02 (0.02-0.03) 0.01 (0.01-0.02) 0.02 (0.01-0.02) Lymphoma 0.02 (0.02-0.03) 0.01 (0.01-0.02) 0.02 (0.01-0.02) Germ Cell Tumors and Cysts 0.28 (0.26-0.31) 0.12 (0.11-0.14) 0.20 (0.19-0.22) Germ cell tumors, cysts and heterotopias 0.28 (0.26-0.31) 0.12 (0.11-0.14) 0.20 (0.19-0.22) Tumors of Sellar Region 0.42 (0.39-0.45) 0.83 (0.79-0.87) 0.62 (0.59-0.64) Pituitary 0.23 (0.21-0.25) 0.64 (0.60-0.67) 0.43 (0.41-0.45) Craniopharyngioma 0.19 (0.17-0.21) 0.19 (0.17-0.21) 0.19 (0.18-0.21) Local Extensions from Regional Tumors - - - - 0.01 (0.00-0.01) Chordoma/chondrosarcoma - - - - 0.01 (0.00-0.01) Unclassified Tumors 0.23 (0.21-0.25) 0.23 (0.21-0.25) 0.23 (0.22-0.24) Hemangioma 0.07 (0.05-0.08) 0.06 (0.05-0.07) 0.06 (0.05-0.07) Neoplasm, unspecified 0.16 (0.14-0.17) 0.17 (0.15-0.19) 0.16 (0.15-0.18) All other - - - - 0.01 (0.00-0.01) TOTALb 5.09 (4.99-5.19) 5.00 (4.90-5.10) 5.05 (4.98-5.12) aRates are per 100,000 person years. bRefers 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.

Table 18: Childhood (Ages 0-19) Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor Incidence Ratesa by Major Histology Groupings and Race, Age-Adjusted to the 2000 U.S. Standard Population; CBTRUS Statistical Report: NPCR and SEER, 2004-2008

Whites Blacks

Histology Grouping Adjusted


Rate 95% C.I. Tumors of Neuroepithelial Tissue 3.67 (3.60-3.74) 2.73 (2.60-2.86) Pilocytic astrocytoma 0.86 (0.82-0.89) 0.58 (0.52-0.64) Protoplasmic & fibrillary astrocytoma 0.05 (0.04-0.06) 0.04 (0.02-0.05) Anaplastic astrocytoma 0.09 (0.08-0.10) 0.06 (0.04-0.08) Unique astrocytoma variants 0.10 (0.09-0.11) 0.12 (0.09-0.15) Astrocytoma, NOS 0.23 (0.21-0.25) 0.16 (0.13-0.20) Glioblastoma 0.14 (0.13-0.15) 0.15 (0.12-0.18) Oligodendroglioma 0.06 (0.05-0.07) 0.07 (0.05-0.09) Anaplastic oligodendroglioma 0.02 (0.01-0.02) - - Ependymoma/anaplastic ependymoma 0.24 (0.23-0.26) 0.19 (0.16-0.23) Ependymoma variants 0.04 (0.03-0.05) - - Mixed glioma 0.04 (0.03-0.05) 0.03 (0.01-0.04) Glioma malignant, NOS 0.59 (0.56-0.61) 0.41 (0.37-0.47) Choroid plexus 0.11 (0.09-0.12) 0.06 (0.04-0.08) Neuroepithelial 0.01 (0.01-0.02) - - Non-malignant and malignant neuronal/glial 0.43 (0.41-0.45) 0.31 (0.27-0.36) Pineal parenchymal 0.03 (0.03-0.04) 0.09 (0.07-0.11) Embryonal/primitive/medulloblastoma 0.65 (0.62-0.68) 0.42 (0.37-0.48) Tumors of Cranial and Spinal Nerves 0.27 (0.26-0.29) 0.18 (0.15-0.21) Nerve sheath, non-malignant and malignant 0.27 (0.26-0.29) 0.18 (0.15-0.21) Tumors of Meninges 0.20 (0.18-0.22) 0.14 (0.11-0.17) Meningioma 0.13 (0.12-0.14) 0.11 (0.09-0.14) Other mesenchymal, non-malignant and malignant 0.04 (0.03-0.05) - - Hemangioblastoma 0.03 (0.03-0.04) - - Lymphomas and Hematopoietic Neoplasms 0.02 (0.01-0.02) 0.03 (0.01-0.04) Lymphoma 0.02 (0.01-0.02) 0.03 (0.01-0.04) Germ Cell Tumors and Cysts 0.21 (0.19-0.22) 0.12 (0.10-0.15) Germ cell tumors, cysts and heterotopias 0.21 (0.19-0.22) 0.12 (0.10-0.15) Tumors of Sellar Region 0.61 (0.59-0.64) 0.52 (0.47-0.58) Pituitary 0.42 (0.40-0.45) 0.35 (0.30-0.40) Craniopharyngioma 0.19 (0.17-0.21) 0.18 (0.15-0.21) Local Extensions from Regional Tumors 0.01 (0.00-0.01) - - Chordoma/chondrosarcoma 0.01 (0.00-0.01) - - Unclassified Tumors 0.24 (0.23-0.26) 0.15 (0.12-0.18) Hemangioma 0.07 (0.06-0.08) 0.03 (0.02-0.04) Neoplasm, unspecified 0.17 (0.16-0.19) 0.12 (0.09-0.15) All other 0.01 (0.00-0.01) - - TOTALb 5.23 (5.15-5.31) 3.87 (3.72-4.02) Male 5.31 (5.20-5.42) 3.76 (3.56-3.98) Female 5.14 (5.03-5.26) 3.97 (3.76-4.20) aRates are per 100,000 person years. bRefers 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.

Table 19: Selected Childhood Primary (Malignant and Non-Malignant) Brain and Central Nervous System Tumor, Age-Specific and Age-Adjusted Incidence Ratesa by Major Histology Groupings,

Histology and Age at Diagnosis; CBTRUS Statistical Report: NPCR and SEER, 2004-2008 Age At Diagnosis Age at Diagnosis 0-4 5-9 10-14 15-19 0-19 b 0-14b

Rate 95% C.I. Rate 95% C.I. Rate 95% C.I. Rate 95% C.I. Adjusted


Rate 95% C.I. Tumors of Neuroepithelial Tissue 4.54 (4.41-4.68) 3.70 (3.58-3.82) 3.11 (3.01-3.23) 2.75 (2.65-2.86) 3.52 (3.46-3.57) 3.77 (3.70-3.84) Pilocytic astrocytoma 0.89 (0.83-0.95) 0.91 (0.85-0.97) 0.83 (0.78-0.89) 0.61 (0.56-0.66) 0.81 (0.78-0.84) 0.88 (0.84-0.91) Protoplasmic & fibrillary astrocytoma 0.04 (0.03-0.06) 0.05 (0.04-0.06) 0.05 (0.04-0.07) 0.04 (0.03-0.06) 0.05 (0.04-0.05) 0.05 (0.04-0.06) Anaplastic astrocytoma 0.06 (0.04-0.07) 0.09 (0.07-0.11) 0.08 (0.07-0.10) 0.10 (0.08-0.12) 0.08 (0.07-0.09) 0.08 (0.07-0.09) Unique astrocytoma variants 0.06 (0.05-0.08) 0.10 (0.08-0.12) 0.13 (0.11-0.15) 0.12 (0.10-0.15) 0.10 (0.09-0.11) 0.10 (0.09-0.11) Astrocytoma, NOS 0.27 (0.24-0.30) 0.18 (0.16-0.21) 0.22 (0.19-0.25) 0.21 (0.18-0.24) 0.22 (0.20-0.23) 0.22 (0.21-0.24) Glioblastoma 0.09 (0.08-0.11) 0.14 (0.12-0.16) 0.15 (0.13-0.18) 0.18 (0.16-0.21) 0.14 (0.13-0.15) 0.13 (0.12-0.14) Oligodendroglioma 0.04 (0.03-0.05) 0.04 (0.03-0.05) 0.06 (0.05-0.08) 0.11 (0.09-0.13) 0.06 (0.05-0.07) 0.05 (0.04-0.06) Anaplastic oligodendroglioma - - - - - - 0.03 (0.02-0.04) 0.01 (0.01-0.02) 0.01 (0.01-0.01) Ependymoma/anaplastic ependymoma 0.39 (0.35-0.43) 0.22 (0.19-0.25) 0.17 (0.14-0.19) 0.17 (0.15-0.20) 0.24 (0.22-0.25) 0.26 (0.24-0.28) Ependymoma variants - - - - 0.04 (0.03-0.06) 0.08 (0.06-0.10) 0.04 (0.03-0.04) 0.02 (0.02-0.03) Mixed glioma 0.03 (0.02-0.04) 0.02 (0.02-0.04) 0.03 (0.02-0.05) 0.06 (0.04-0.07) 0.04 (0.03-0.04) 0.03 (0.02-0.04) Glioma malignant, NOS 0.85 (0.79-0.91) 0.77 (0.72-0.83) 0.40 (0.36-0.44) 0.25 (0.22-0.28) 0.57 (0.54-0.59) 0.67 (0.64-0.70) Choroid plexus 0.27 (0.23-0.30) 0.05 (0.04-0.07) 0.04 (0.03-0.06) 0.05 (0.03-0.06) 0.10 (0.09-0.11) 0.12 (0.11-0.13) Neuroepithelial - - - - - - 0.02 (0.01-0.03) 0.01 (0.01-0.02) 0.01 (0.01-0.02) Non-malignant and malignant neuronal/glial 0.38 (0.35-0.42) 0.33 (0.29-0.36) 0.45 (0.40-0.49) 0.47 (0.43-0.51) 0.41 (0.39-0.43) 0.38 (0.36-0.41) Pineal parenchymal 0.06 (0.04-0.07) 0.04 (0.03-0.06) 0.03 (0.02-0.04) 0.04 (0.03-0.06) 0.04 (0.04-0.05) 0.04 (0.04-0.05) Embryonal/primitive/medulloblastoma 1.11 (1.05-1.18) 0.72 (0.67-0.78) 0.39 (0.35-0.43) 0.24 (0.21-0.27) 0.61 (0.59-0.63) 0.73 (0.70-0.77) Tumors of Cranial and Spinal Nerves 0.27 (0.23-0.30) 0.21 (0.18-0.24) 0.24 (0.21-0.27) 0.33 (0.30-0.37) 0.26 (0.25-0.28) 0.24 (0.22-0.26) Nerve sheath, non-malignant and malignant 0.27 (0.23-0.30) 0.21 (0.18-0.24) 0.24 (0.21-0.27) 0.33 (0.30-0.37) 0.26 (0.25-0.28) 0.24 (0.22-0.26) Tumors of Meninges 0.13 (0.11-0.15) 0.09 (0.08-0.11) 0.19 (0.16-0.22) 0.36 (0.33-0.40) 0.19 (0.18-0.21) 0.14 (0.12-0.15) Meningioma 0.08 (0.06-0.09) 0.06 (0.05-0.08) 0.13 (0.11-0.16) 0.24 (0.21-0.27) 0.13 (0.12-0.14) 0.09 (0.08-0.10) Other mesenchymal, non-malignant and malignant 0.05 (0.04-0.07) 0.03 (0.02-0.04) 0.02 (0.02-0.03) 0.04 (0.03-0.05) 0.03 (0.03-0.04) 0.03 (0.03-0.04) Hemangioblastoma - - - - - - 0.09 (0.07-0.11) 0.03 (0.03-0.04) 0.01 (0.01-0.02) Lymphomas and Hematopoietic Neoplasms - - - - - - 0.03 (0.02-0.04) 0.02 (0.01-0.02) 0.01 (0.01-0.02) Lymphoma - - - - - - 0.03 (0.02-0.04) 0.02 (0.01-0.02) 0.01 (0.01-0.02) Germ Cell Tumors and Cysts 0.12 (0.10-0.15) 0.13 (0.11-0.15) 0.27 (0.24-0.31) 0.29 (0.25-0.32) 0.20 (0.19-0.22) 0.18 (0.16-0.19) Germ cell tumors, cysts and heterotopias 0.12 (0.10-0.15) 0.13 (0.11-0.15) 0.27 (0.24-0.31) 0.29 (0.25-0.32) 0.20 (0.19-0.22) 0.18 (0.16-0.19) Tumors of Sellar Region 0.18 (0.15-0.21) 0.37 (0.33-0.41) 0.57 (0.52-0.62) 1.35 (1.28-1.42) 0.62 (0.59-0.64) 0.37 (0.35-0.40) Pituitary 0.04 (0.03-0.05) 0.11 (0.09-0.13) 0.36 (0.32-0.40) 1.19 (1.12-1.26) 0.43 (0.41-0.45) 0.17 (0.16-0.19) Craniopharyngioma 0.14 (0.12-0.17) 0.26 (0.23-0.30) 0.21 (0.18-0.24) 0.16 (0.13-0.18) 0.19 (0.18-0.21) 0.20 (0.19-0.22) Local Extensions from Regional Tumors - - - - - - - - 0.01 (0.00-0.01) - - Chordoma/chondrosarcoma - - - - - - - - 0.01 (0.00-0.01) - - Unclassified Tumors 0.21 (0.18-0.24) 0.17 (0.15-0.20) 0.22 (0.20-0.25) 0.31 (0.28-0.35) 0.23 (0.22-0.24) 0.20 (0.19-0.22) Hemangioma 0.05 (0.04-0.06) 0.03 (0.02-0.05) 0.06 (0.05-0.08) 0.10 (0.08-0.12) 0.06 (0.05-0.07) 0.05 (0.04-0.06) Neoplasm, unspecified 0.15 (0.13-0.18) 0.14 (0.11-0.16) 0.15 (0.13-0.18) 0.21 (0.18-0.24) 0.16 (0.15-0.18) 0.15 (0.13-0.16) All other - - - - - - - - 0.01 (0.00-0.01) - - TOTALb 5.46 (5.32-5.61) 4.69 (4.56-4.83) 4.62 (4.49-4.76) 5.43 (5.29-5.58) 5.05 (4.98-5.12) 4.92 (4.84-5.00) aRates are per 100,000 person years. bAge adjusted to the 2000 U.S. standard population. cRefers 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.

Table 20: Primary Malignant Brain and CNS Tumor Incidence and Mortality Ratesa by State, Age-Adjusted to the 2000 U.S. Standard Population , CINA 2004-2008b

INCIDENCE MORTALITY MALES FEMALES MALES FEMALES STATE N RATE N RATE N RATE N RATE Alabama 779 7.8 681 5.9 598 5.4 497 3.6 Alaska 96 6.9 96 6.7 63 4.6 47 3.8 Arizona 1,139 7.6 949 5.9 705 4.8 580 3.5 Arkansas 528 7.7 454 5.7 400 5.7 358 4.2 California 6,028 7.4 4,659 5.1 4,119 5.3 3,160 3.4 Colorado 844 7.7 707 6.0 545 5.2 431 3.6 Connecticut 704 8.3 600 6.0 413 4.8 369 3.5 Delaware 197 9.5 140 5.9 113 5.5 90 3.6 District of Columbia - - - - 57 4.5 36 2.3 Florida 3,730 7.8 3,041 5.7 2,387 4.8 1,920 3.2 Georgia 1,469 7.3 1,297 5.6 875 4.6 730 3.2 Hawaii 150 4.6 120 3.4 96 2.9 63 1.7 Idaho 295 8.3 262 7.1 189 5.4 185 5.0 Illinois 2,219 7.5 1,981 5.8 1,350 4.7 1,114 3.2 Indiana 1,231 8.3 1,073 6.2 805 5.5 707 4.0 Iowa 684 9.2 521 6.1 507 6.8 367 4.1 Kansas - - - - 414 6.4 324 4.1 Kentucky 865 8.4 684 5.9 547 5.4 426 3.5 Louisiana 656 7.2 510 4.8 580 5.8 422 3.5 Maine 336 9.7 243 6.2 219 6.1 171 4.1 Maryland - - - - 576 4.5 510 3.3 Massachusetts 1,350 8.7 1,130 6.2 816 5.2 629 3.2 Michigan 2,042 8.4 1,715 6.2 1,447 6.0 1,099 3.8 Minnesota 940 7.6 698 5.2 632 5.2 513 3.6 Mississippi 437 7.3 403 5.6 373 5.7 326 4.0 Missouri 1,122 7.8 996 6.1 784 5.5 657 3.8 Montana 228 9.1 142 5.4 151 5.8 105 3.8 Nebraska 341 8.0 310 6.5 251 5.9 223 4.4 Nevada - - - - 309 5.2 206 3.3 New Hampshire 291 8.9 202 5.7 204 6.3 136 3.7 New Jersey 1,764 8.5 1,473 6.0 961 4.7 762 3.0 New Mexico 349 7.4 237 4.5 221 4.7 161 3.0 New York 3,700 8.1 3,001 5.5 2,150 4.7 1,641 2.9 North Carolina 1,630 7.7 1,377 5.7 1,044 5.1 827 3.3 North Dakota 118 7.5 102 5.7 90 5.8 75 3.9 Ohio 2,253 8.0 1,975 6.1 1,512 5.4 1,253 3.7 Oklahoma 711 8.1 618 6.3 496 5.8 400 3.8 Oregon 842 9.1 625 6.3 587 6.3 444 4.2 Pennsylvania 2,693 8.5 2,316 6.2 1,606 5.0 1,340 3.4 Rhode Island 234 9.1 174 5.6 145 5.5 117 3.6 South Carolina 830 8.0 673 5.5 556 5.5 460 3.6 South Dakota 143 7.2 127 5.9 113 5.8 93 4.1 Tennessee 1,180 8.0 954 5.7 892 6.2 736 4.1 Texas 3,508 7.5 2,930 5.7 2,378 4.9 1,997 3.5 Utah 436 7.9 363 6.1 272 5.5 196 3.6 Vermont 136 8.4 119 6.7 87 5.3 72 3.9 Virginia 1,315 7.4 1,041 5.1 848 5.0 645 3.1 Washington 1,283 8.4 1,025 6.1 973 6.5 723 4.2 West Virginia 408 8.6 365 6.7 270 5.5 229 3.9 Wisconsin 1,263 9.2 997 6.6 798 5.8 611 3.8 Wyoming 96 7.3 73 5.6 66 5.1 52 3.8 United Statesc 54,151 7.9 44,629 5.7 36,590 5.2 29,235 3.5 aRates are per 100,000 population. bSource: Cancer Incidence in North America, 2004-2008. Volumes One, Two, and Three. North American Association of Central Cancer Registries, Inc., May 2011. c Combined incidence statistics for the United States include data from 47 state cancer registries that met or exceeded NAACCR high quality standards for 2004-2008. - Not available.

Table 21: Primary Brain and Other Nervous System Tumors, Estimated Number of Cases a,b Overall and by Behavior by State, 2012; Primary Malignant Brain and Other Nervous System Tumors, Estimated Number of Deathsb,c by State, 2012

2012 Estimated New Cases 2012 Estimated Deaths STATE All Malignant Non-Malignant Malignant Alabama 1,030 370 670 230 Alaska 130 50 80 - Arizona 1,500 570 930 300 Arkansas 640 240 410 150 California 7,320 2,680 4,640 1,540 Colorado 1,060 400 650 230 Connecticut 780 290 500 160 Delaware 210 70 130 50 District of Columbia 120 - 90 - Florida 4,650 1,700 2,960 850 Georgia 2,010 710 1,310 350 Hawaii 250 80 170 - Idaho 340 130 210 90 Illinois 2,670 970 1,700 500 Indiana 1,380 520 860 320 Iowa 680 260 420 180 Kansas 600 230 370 150 Kentucky 950 360 600 190 Louisiana 890 310 580 210 Maine 330 120 200 80 Maryland 1,220 420 800 230 Massachusetts 1,450 540 920 300 Michigan 2,210 810 1,400 530 Minnesota 1,150 430 710 240 Mississippi 610 210 400 140 Missouri 1,330 490 840 300 Montana 230 90 140 60 Nebraska 390 150 240 100 Nevada 590 220 370 140 New Hampshire 310 120 190 70 New Jersey 1,880 680 1,210 340 New Mexico 440 170 270 90 New York 4,240 1,500 2,730 740 North Carolina 2,050 740 1,320 390 North Dakota 140 50 90 - Ohio 2,570 950 1,620 570 Oklahoma 780 290 490 200 Oregon 880 330 540 220 Pennsylvania 2,920 1,070 1,850 570 Rhode Island 240 90 150 50 South Carolina 1,030 360 670 220 South Dakota 180 70 110 - Tennessee 1,410 520 890 340 Texas 4,900 1,840 3,070 900 Utah 520 210 320 110 Vermont 150 60 90 - Virginia 1,690 600 1,080 320 Washington 1,450 540 910 400 West Virginia 430 160 270 100 Wisconsin 1,260 480 780 300 Wyoming 120 50 70 - United States 66,290 24,300 41,980 13,700 aSource: Estimation based on CBTRUS NPCR and SEER 2004-2008 data. bRounded to the nearest 10. cSource: Siegel R, Naishadham D, Jemal A. Cancer Statistics, 2012. CA Cancer J Clin 62:10-29, 2012. - Estimated number is less than 50.

Table 22: Five-year Relative Survival Ratesa for Malignant Brain and Central Nervous System Tumors by Siteb and Gender, SEER 17 Registries, 1995-2008c

ICD-O-3 CODE SITEb Male Female Total N 5-YR N 5-YR N 5-Yr

C71.1-C71.4 Frontal, temporal, parietal, and occipital lobes of the brain 15,380 25.63% 11,685 28.24% 27,065 26.77%

C71.0 Cerebrum 1,426 23.37% 1,155 26.44% 2,581 24.78% C71.5 Ventricle 529 59.31% 405 64.32% 934 61.52% C71.6 Cerebellum 1,629 69.67% 1,274 72.62% 2,903 70.97% C71.7 Brain stem 1,210 47.90% 1,086 45.68% 2,296 46.85% C71.8-C71.9 Other brain 6,607 20.16% 5,265 22.80% 11,872 21.34% C72.0-C72.1 Spinal cord and cauda equina 954 77.41% 783 82.53% 1,737 79.78% C72.2-C72.5 Cranial nerves 256 90.80% 251 92.26% 507 91.54% C72.8-C72.9 Other nervous system 299 34.96% 200 49.28% 499 40.91% C70.0-C70.9 Meninges (cerebral and spinal) 410 55.92% 592 70.66% 1,002 64.47%

C75.1-C75.2 Pituitary and craniopharyngeal duct 101 65.76% 102 77.75% 203 72.14% C75.3 Pineal 398 75.09% 122 64.80% 520 72.81%

C30.0 (9522-9523) Olfactory tumors of the nasal cavity 214 70.06% 175 80.54% 389 75.34%

All Codes All Sites 29,413 32.29% 23,095 35.54% 52,508 33.72% aThe 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. bThe sites referred to in this table are loosely based on the categories and site codes defined in the SEER Site/Histology Validation List. c Estimated by CBTRUS using 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 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on the November 2010 submission. Abbreviation: SEER, Survival, Epidemiology and End Results.

Table 23: One-, Two-, Three-, Four-, Five-, and Ten-Year Relative Survival Ratesa,b For Selected Malignant Brain and Central Nervous System Tumors, SEER 17 Registries, 1995-2008c

Histology # Cases 1-Yr 2-Yr 3-Yr 4-Yr 5-Yr 10-Yr Pilocytic astrocytoma 2,538 97.64% 96.48% 95.47% 94.66% 94.05% 91.32% Protoplasmic & fibrillary astrocytoma 718 75.39% 61.53% 55.95% 50.58% 47.58% 35.36% Anaplastic astrocytoma 3,107 60.98% 43.02% 34.70% 30.26% 27.00% 19.01% Astrocytoma, NOS 3,571 70.08% 59.78% 53.88% 49.79% 46.82% 36.20% Glioblastoma 21,910 35.20% 13.17% 7.54% 5.50% 4.70% 2.32% Oligodendroglioma 2,631 94.15% 89.95% 85.96% 82.32% 79.25% 62.62% Anaplastic oligodendroglioma 1,058 80.30% 66.16% 58.58% 52.85% 48.42% 33.21% Ependymoma/anaplastic ependymoma 1,938 93.78% 89.26% 86.01% 83.43% 82.27% 77.17% Mixed glioma 1,425 87.42% 75.56% 68.54% 63.00% 58.35% 45.52% Glioma malignant, NOS 3,096 60.69% 49.11% 45.72% 43.22% 41.76% 36.40% Neuroepithelial 127 52.40% 41.46% 40.61% 34.71% 31.55% 27.69% Malignant neuronal/glial, Neuronal and mixed 575 88.91% 80.32% 77.07% 72.49% 71.56% 59.82% Embryonal/primitive/ medulloblastoma 2,050 82.35% 71.96% 67.09% 63.90% 61.69% 55.20% Lymphoma 3,712 47.65% 38.76% 34.09% 30.87% 28.21% 20.78% Total: All Brain and CNSd 52,508 57.22% 42.99% 38.09% 35.38% 33.72% 27.92% aThe 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. bRates are an estimate of the percentage of patients alive at one, two, three, four, five, and ten year, respectively. c Estimated by CBTRUS using 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 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on the November 2010 submission. dIncludes histologies not listed in this table. Abbreviations: SEER, Survival, Epidemiology and End Results; NOS, not otherwise specified.

Table 24: One-, Two-, Three-, Four-, Five-, and Ten-Year Relative Survival Ratesa,b For Selected Malignant Brain and Central Nervous System Tumors by Age Groups, SEER 17 Registries, 1995-2008c

Histology Age Group # Cases 1-Yr 2-Yr 3-Yr 4-Yr 5-Yr 10-Yr Pilocytic astrocytoma 0-14 1,520 98.5% 98.2% 97.8% 97.4% 97.1% 95.4% 0-19 1,830 98.2% 98.1% 97.4% 97.1% 96.6% 95.1% 20-44 543 96.7% 94.9% 93.4% 91.8% 90.8% 86.5% 45-54 90 94.8% 86.9% 85.8% 80.6% 77.7% 68.8% 55-64 43 95.9% 86.3% 83.6% 83.6% 83.6% 57.3% 65-74 23 d d d d d d 75+ d d d d d d d Protoplasmic & fibrillary astrocytoma 0-14 104 93.8% 85.7% 85.7% 84.1% 84.1% 82.2% 0-19 127 94.2% 85.9% 85.9% 84.7% 84.7% 80.2% 20-44 281 92.3% 82.6% 73.4% 65.6% 59.7% 42.0% 45-54 92 73.5% 55.4% 52.5% 43.6% 41.8% d 55-64 107 55.3% 27.4% 21.3% d d d 65-74 66 30.9% d d d d d 75+ 45 d d d d d d Anaplastic astrocytoma 0-14 166 60.4% 42.3% 33.8% 32.9% 32.0% 27.4% 0-19 225 65.2% 44.1% 34.6% 33.9% 33.2% 28.1% 20-44 1,013 87.9% 73.4% 63.7% 56.0% 49.2% 34.7% 45-54 588 70.8% 49.7% 39.1% 32.8% 30.9% 19.3% 55-64 528 48.1% 23.2% 14.1% 11.5% 9.2% 6.4% 65-74 434 31.2% 12.1% 6.2% 4.4% 3.9% d 75+ 319 14.7% 5.6% d d d d Astrocytoma, NOS 0-14 452 91.5% 87.5% 84.5% 83.3% 81.9% 79.9% 0-19 572 92.4% 88.1% 84.6% 83.4% 82.1% 79.5% 20-44 1,235 92.1% 83.9% 77.3% 70.8% 65.1% 45.9% 45-54 543 71.2% 57.1% 48.6% 41.9% 40.4% 29.5% 55-64 459 54.3% 34.6% 25.3% 22.7% 21.3% 12.2% 65-74 378 33.2% 22.0% 17.2% 15.1% 13.2% 6.8% 75+ 384 18.3% 8.1% 6.4% 5.6% d d Glioblastoma 0-14 173 46.9% 25.8% 21.3% 20.5% 20.5% 14.0% 0-19 259 54.6% 29.9% 21.2% 19.4% 19.4% 14.0% 20-44 2,227 66.9% 35.1% 23.9% 19.1% 16.6% 9.8% 45-54 3,959 52.8% 19.8% 10.7% 7.7% 6.1% 3.0% 55-64 5,536 40.8% 13.6% 6.9% 4.2% 3.8% 0.7% 65-74 5,344 23.4% 6.3% 3.0% 2.1% 1.4% 0.6% 75+ 4,585 9.8% 2.6% 1.3% 0.8% 0.8% d Oligodendroglioma 0-14 114 97.4% 96.5% 94.5% 94.5% 94.5% 90.8% 0-19 199 97.5% 95.4% 93.0% 93.0% 92.4% 89.4% 20-44 1,390 98.2% 95.8% 92.6% 88.6% 85.2% 67.4% 45-54 572 94.1% 88.7% 84.5% 81.1% 77.6% 56.7% 55-64 281 86.7% 78.4% 71.7% 67.8% 64.4% 47.9% 65-74 116 78.7% 69.5% 60.1% 53.0% 49.7% 32.6% 75+ 73 60.5% 45.4% 40.1% 35.6% 34.0% d Anaplastic oligodendroglioma 0-14 d d d d d d d 0-19 31 89.1% d d d d d 20-44 429 93.0% 81.7% 76.2% 70.3% 64.8% 45.8% 45-54 258 83.4% 69.1% 61.2% 55.5% 52.1% 39.1% 55-64 193 74.1% 58.2% 47.6% 39.8% 35.9% 17.3% 65-74 106 50.7% 33.8% 25.9% 21.3% d d 75+ 41 d d d d d d Ependymoma/anaplastic ependymoma 0-14 475 92.9% 85.2% 78.6% 72.7% 70.2% 61.8% 0-19 566 93.6% 86.5% 80.6% 75.4% 72.9% 64.5% 20-44 629 96.2% 94.8% 93.5% 91.8% 91.3% 88.4% 45-54 339 94.1% 90.4% 88.8% 86.1% 84.3% 82.2% 55-64 232 92.4% 88.2% 86.4% 85.0% 84.3% 84.0% 65-74 111 89.9% 78.7% 74.4% 74.4% 74.4% 63.6% 75+ 61 79.8% 72.7% 63.7% 63.7% 63.7% d

Table 24: One-, Two-, Three-, Four-, Five-, and Ten-Year Relative Survival Ratesa,b For Selected Malignant Brain and Central Nervous System Tumors by Age Groups, SEER 17 Registries, 1995-2008c

Histology Age Group # Cases 1-Yr 2-Yr 3-Yr 4-Yr 5-Yr 10-Yr Mixed glioma 0-14 61 92.9% 82.3% 82.3% 77.6% 77.6% 68.4% 0-19 103 91.7% 84.6% 84.6% 82.0% 82.0% 75.7% 20-44 774 96.0% 88.5% 81.0% 75.0% 68.2% 54.4% 45-54 277 87.6% 73.5% 64.1% 58.4% 56.3% 35.1% 55-64 148 70.3% 47.0% 38.2% 34.4% 29.1% 21.4% 65-74 84 65.1% 37.7% 32.2% d d d 75+ 39 d d d d d d Glioma malignant, NOS 0-14 974 74.4% 60.2% 57.3% 56.0% 55.8% 54.7% 0-19 1,085 75.8% 62.1% 59.0% 57.3% 57.1% 55.8% 20-44 599 87.6% 77.5% 72.9% 68.7% 64.6% 49.0% 45-54 329 70.1% 56.3% 49.9% 46.0% 43.8% 35.1% 55-64 272 47.9% 31.7% 29.0% 25.5% 22.9% 21.3% 65-74 286 31.5% 20.3% 17.8% 14.9% 14.9% 9.8% 75+ 525 14.8% 9.5% 7.6% 7.0% 5.4% d Malignant neuronal/glial, neuronal and mixed 0-14 103 87.8% 78.6% 76.0% 72.9% 72.9% 72.9% 0-19 125 88.2% 77.9% 74.8% 70.8% 70.8% 66.2% 20-44 147 93.8% 88.6% 83.7% 80.0% 77.8% 67.6% 45-54 125 91.4% 88.1% 85.4% 78.9% 75.4% 58.9% 55-64 90 90.5% 74.5% 73.5% 63.6% 63.6% 55.8% 65-74 47 73.3% 64.5% 62.6% 62.6% 62.6% d 75+ 41 77.5% 62.4% 54.1% 54.1% 54.1% d Embryonal/primitive/medulloblastoma 0-14 1,360 80.4% 69.8% 66.0% 63.6% 61.5% 55.9% 0-19 1,502 81.3% 70.5% 66.3% 63.6% 61.6% 56.4% 20-44 436 87.8% 80.6% 73.7% 69.2% 66.6% 57.4% 45-54 58 82.5% 68.4% 63.7% 61.0% 57.7% 38.3% 55-64 31 63.0% d d d d d 65-74 d d d d d d d 75+ d d d d d d d Lymphoma 0-14 38 84.1% 81.2% 77.7% 73.4% 73.4% 73.4% 0-19 60 81.5% 76.1% 74.1% 71.7% 71.7% 63.9% 20-44 949 38.5% 32.6% 30.1% 28.4% 27.0% 20.7% 45-54 623 58.3% 49.4% 45.4% 41.5% 38.0% 27.7% 55-64 670 61.0% 50.7% 44.5% 40.8% 37.6% 28.0% 65-74 747 47.9% 37.7% 30.5% 25.0% 21.7% 11.7% 75+ 663 33.2% 22.4% 18.0% 16.0% 12.8% 10.0% Total: All Brain and CNSe 0-14 6,160 85.4% 77.8% 74.8% 72.9% 71.9% 67.8% 0-19 7,546 86.6% 78.9% 75.6% 73.7% 72.6% 68.6% 20-44 11,400 83.0% 71.3% 65.2% 60.6% 57.1% 45.5% 45-54 8,273 65.8% 44.5% 37.3% 33.5% 31.6% 23.8% 55-64 9,058 50.2% 28.1% 21.7% 18.9% 17.7% 12.8% 65-74 8,291 31.9% 16.9% 12.9% 11.1% 10.0% 7.1% 75+ 7,940 16.6% 8.8% 7.0% 6.2% 5.6% 3.4% aThe 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. bRates are an estimate of the percentage of patients alive at one, two, three, four, five, and ten year, respectively. cEstimated by CBTRUS using 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 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on the November 2010 submission. dToo few cases to report/estimate. eIncludes histologies not listed in this table. Abbreviations: SEER, Survival, Epidemiology and End Results; NOS, not otherwise specified.

1,520 1,830 543

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