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

CBTRUS

Central Brain Tumor Registry of the United States

CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors

Diagnosed in the United States in 2004-2005

Data Sources: Centers for Disease Control and Prevention,

National Program of Cancer Registries and the National Cancer Institute

Surveillance, Epidemiology and End Results Program

Web Publication Only: 2009

TABLE OF CONTENTS

CBTRUS Mission ……………………………………………………………….……………..…3

CBTRUS Funding …………………………………………………………………….………..…4

Acknowledgments ……………………………………………………………………….…......…5

Important Information Regarding the CBTRUS Statistical Report: 2004-2005 ……………….…6

Background ……………………………………………………………..…………………………7

Brain Tumor Statistics: Report and Figures ………………………………………………………8

Methods……………………………………………………………………………………………8

Results………………….…………………………………………………………..…………….10

References……………….………………………………………………………..…………..….23

Tables..……………………………………………………………………………….………...…24

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CBTRUS MISSION

The Central Brain Tumor Registry of the United States (CBTRUS) is a not-for-profit corporation committed to providing a resource for gathering and disseminating current epidemiologic data on all primary brain and central nervous system tumors, malignant and non-malignant, for the purposes of accurately describing their incidence and survival patterns, evaluating diagnosis and treatment, facilitating etiologic studies, establishing awareness of the disease, and ultimately, for the prevention of all brain tumors.

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CBTRUS Funding

Funding for the Central Brain Tumor Registry of the United States in 2008-2009 has been provided by the American Brain Tumor Association (www.abta.org), the National Brain Tumor Foundation (www.braintumor.org), the Pediatric Brain Tumor Foundation (www.pbtfus.org) and from the Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, under contract # HHSN26100800766P.

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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 public use 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 Montana Alaska Nevada Arizona New Hampshire, Arkansas New Jersey California New MexicoSEER Colorado New York ConnecticutSEER North Carolina Delaware North Dakota District of Columbia Ohio Florida Oklahoma Georgia Oregon HawaiiSEER Pennsylvania Idaho Rhode Island Illinois South Carolina Indiana South Dakota IowaSEER Tennessee Louisiana Texas Maine UtahSEER Massachusetts Virgina Michigan Washington Minnesota West Virginia Mississippi Wyoming SEER Data obtained from the SEER limited use data files for these population-based cancer registries. All other population-based cancer registry data provided by the NPCR.

Copyright information: All material in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Suggested citation: CBTRUS (2009). CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2004-2005. Source: Central Brain Tumor Registry of the United States, Hinsdale, IL. website: www.cbtrus.org

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http://www.cbtrus.org/

Important Information Regarding the CBTRUS Statistical Report: 2004-2005 The numbers of case records and population data consist of two years of data [i.e. all primary brain and central nervous system (CNS) tumors newly diagnosed in this two-year period], while the incidence rates presented in this report are an average per year over the same two-year period. At the cancer registry-level, data for those states affected by Hurricanes Katrina and Rita (TX, LA, MS, AL) are restricted to all of 2004 and the first half of 2005 (1/1-05-6/30/05). All other cancer registry data include the entire two years (2004-2005). The National Program of Cancer Registries (NPCR) provided data on 95,456 primary brain and CNS tumors diagnosed in 2004-2005. NPCR cancer registries had to both agree to participate in the CBTRUS Statistical Report and to pass certain data quality standards required by NPCR in order for CBTRUS to receive the data. From the Surveillance, Epidemiology, and End Results (SEER) Program limited-use dataset, data from cancer registries not included in the NPCR data were obtained and included 4,392 primary brain and CNS tumor case records diagnosed in 2004-2005. These data were combined into a single data set for analyses. 836 records were deleted from the final data analyses because of invalid site/histology combinations based on a review by the CBTRUS consulting neuropathologist. In addition, 22 records were duplicate records and were deleted from the final data analyses. A total of 98,990 records from 44 population-based cancer registries were included in the final dataset. The Board of Directors, Advisors and the CBTRUS staff are grateful for the financial and intellectual support the CBTRUS has received from its many friends and colleagues especially the American Brain Tumor Association, the National Brain Tumor Foundation and the Pediatric Brain Tumor Foundation. As per agreement with the Centers for Disease Control and Prevention’s NPCR rules and regulations, the data contained in the CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2004-2005 are restricted to analyses for this report and cannot be used for special data requests. 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 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 malignant cases only. 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, Public Law 107–206 required the expansion of primary brain and CNS tumor data collection to include tumors of benign and uncertain behavior beginning with the 2004 diagnosis year.

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. This database has been developed by compiling data from cancer registries that include information on both malignant and non–malignant primary brain and CNS tumors. 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 Statistical Report includes 2004-2005 data from forty-four cancer registries belonging to the Centers for Disease Control and Prevention National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology and End Results Program (SEER) of the National Cancer Institute. Data from cancer registries belonging to NPCR, in compliance with its standards and agreeing to participate in CBTRUS, were made available in 2008 under the NPCR call for data mechanism. SEER data from 2004-2005 were obtained from their limited-use dataset and were appended to the NPCR data for data analysis. This Statistical Report continues the past efforts CBTRUS has made to provide accurate, 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 listed in histologic groupings with improved clinical relevance. They are useful for surveillance and may serve as a baseline for comparison with regional rates. They are also important for allocation and planning of specialty health–care services, for planning programs for disease prevention and control, and in the development of research proposals. CBTRUS believes that these data may lead to clues that will stimulate research into the causes of this terrible disease.

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BRAIN TUMOR STATISTICS: REPORT AND FIGURES The objective of this Statistical Report is to provide a current overview of the descriptive epidemiology of all primary brain and CNS tumors in the United States. CBTRUS has obtained data on all primary brain and CNS tumors from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) program. Incidence rates of primary malignant and non–malignant brain and central nervous system tumors for 2004-2005 were calculated by gender, age, race, and Hispanic origin. METHODS Data Collection CBTRUS obtained incidence data for 2004-2005 from 39 cancer registries participating in the NPCR and 5 state cancer registries participating in the SEER program.2 Data were requested for all newly diagnosed primary malignant or non-malignant (benign or uncertain) brain or central nervous system (CNS) tumors at any of the following sites (ICD-O-3 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 state/region were obtained from the SEER program website, which receives yearly population estimates from the U.S. Census Bureau.3 Definition of Rates Rates measure the occurrence of disease in a population. They are calculated by counting the observed numbers of cases of an event occurring in a defined population within a specified time period and dividing by the total population at risk within the same time period. Incidence Rates measure the occurrence of newly diagnosed cases of disease. The rate of disease in an entire population is the Crude Incidence Rate. Crude incidence rates are frequently adjusted by age. Age–Adjusted Incidence Rates to a common standard population allows for comparisons of rates across regions with different age structures. Cancer incidence rates in this report are adjusted to the Year 2000 U.S. Standard Population. Incidence rates for a subset of a population are specific rates. Age–Specific Incidence Rates that describe the rate of disease in a defined age group are presented in this report. Specific incidence rates by race, Hispanic origin, and gender are also reported. The variability around the estimates of incidence 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. Incidence rates in this report are expressed in units of Person–Time with each person–year reflecting one individual over one year. For cancer, incidence rates are usually expressed per 100,000 person–years. Please note that measuring data in small intervals, such as the two-year interval in this report, can produce skewed statistics because small variations in the frequencies can create the appearance of dramatic shifts in rates. 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?

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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. 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.4,5 The list of ICDO–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.6 In this report, incidence rates are provided by histology and by major histology grouping. Definition of Tumor Locations (Sites) Various terms are used to describe the regions of the brain and central nervous system. The sites referred to in this report are broadly based on the categories and site codes defined in the SEER Site/Histology Validation List.7 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.6 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: meninges; brain; spinal cord, cranial nerves, other parts of the central nervous system, pituitary gland, craniopharyngeal duct, and pineal gland. For pediatric and young adult distributions, olfactory tumors were included with other CNS tumors.

Estimation of Incidence Rates Incidence rates, means, and frequencies were calculated using SAS, SPSS, and SEER*Stat statistical software.8-10 Statistics were not presented when fewer than 16 brain tumors were reported for the specific histology category. The suppressed cells were included in the counts and rates for the totals. Age-adjusted incidence rates and 95% confidence intervals for non–malignant and malignant tumors and age-adjusted incidence rates and 95% confidence intervals for selected histology groupings by gender, race, Hispanic origin (using the North American Association of Central Cancer Registries (NAACCR) Hispanic Identification Algorithm) and pediatric, young adult and adult age groups were estimated. CBTRUS includes statistics on pediatric age groups 0-14 years and 0-19 years. The 0-19 year age group includes tumors diagnosed in the adolescent 15-19 year age group, while the 0-14 year age group is more consistent with other tumor incidence publications. 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. Populations for the regions included in this report are shown in Tables 3 and 4. The number of incident tumors by gender, race, Hispanic origin, and histology are presented in Tables 5–8 for all ages and for children. Differences in Brain Tumor Definition NAACCR, NPCR, and SEER categorize brain tumors differently than CBTRUS. The definition of brain tumors used by NAACCR, NPCR, and SEER (in their published incidence and mortality statistics) includes tumors located in the brain, meninges, and other central nervous system tumors (C70.0–9,

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C71.0–9, and C72.0–9), but exclude 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 (USCS) Incidence and Mortality and Cancer Statistics Review. With the inclusion of non-malignant brain tumors, an increase in incidence rates for the following histology groups and subgroups may result: (groups) tumors of the cranial and spinal nerves; tumors of the sellar region and (subgroups) unique astrocytoma variants; neuronal/glial, neuronal; meningioma; hemangioma. 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 including olfactory tumors of the nasal cavity [C30.0 (9522–9523)]. NAACCR, NPCR, and SEER include pilocytic astrocytomas, a tumor listed in the WHO Classification of Tumours of the Central Nervous System5 as having uncertain behavior, in their malignant brain tumor data and statistics. The CBTRUS has categorized pilocytic astrocytomas in the malignant tumor category to enhance comparability of incidence rates, especially for comparison of childhood brain and CNS tumor incidence rates. It is important to understand these differences in definition as they prevent the direct comparison of published rates. Please keep in mind that statistics for lymphomas and hematopoietic neoplasms contained in this report refer only to lymphomas and hematopoietic neoplasms of the brain and central nervous system. The Benign Brain Tumor Cancer Registries Amendment Act (Public Law 107–260), requiring all NPCR registries to include the collection of tumors of benign and uncertain behavior, went into effect January 1, 2004. Standardization of brain tumor reporting occurred with adoption of Uniform Data Standards (UDS) for non–malignant brain tumors in July 2003. However, cancer registries that have required the collection of all primary brain and CNS tumors regardless of the method of diagnosis prior to 2004 may appear to have higher incidence rates than cancer registries that primarily collected histologically confirmed tumors or that did not collect benign brain tumors prior to 2004. As cancer registries become more familiar with brain tumor collection standards, we will be able to distinguish differences in reporting practices from true variation in the incidence of brain tumors between cancer registries. RESULTS Primary Brain and CNS Tumors: Incidence by Cancer Registry, Year, Behavior, and Age Distribution The number of reported brain tumors is listed by cancer registry in Table 9. Almost 99,000 tumors were reported to CBTRUS from a combined 2004-2005 population of 536.9 million that represents approximately 91% of the U.S. population for 2004-2005. The overall percent of non–malignant tumors varied considerably by cancer registry (range: 47–70%). Sixty-nine percent of all tumors had a histologically confirmed diagnosis, with substantial regional variation (cancer registry range: 58–97%). Note: SEER includes pilocytic astrocytoma, a tumor of uncertain, not malignant, behavior in their malignant brain tumor data and statistics. CBTRUS has categorized pilocytic astrocytoma in the malignant tumor category to enhance comparability of incidence rates. Overall Incidence The overall incidence rate for 2004-2005 for primary brain and CNS tumors was 18.16 per 100,000 person–years age-adjusted with the year 2000 US standard population. 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. The overall incidence rate was 4.58 per 100,000 person–years for

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children 0–19 years of age (4.47 per 100,000 person–years for children less than 15 years) and 23.62 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.

Figure 1. Average Annual Age-Adjusted Incidence Ratesa of

Primary Brain and CNS Tumors by Age and BehaviorCBTRUS Statistical Report: NPCR and SEER Data from 2004-2005

0

4

8

12

16

20

24

Non-malignant 1.2 1.5 14.8 11.0Malignant 3.3 3.1 8.8 7.2

Children (0-14 yr)

Children (0-19 yr)

Adults (20+ yr) All AgesR

ate

per

100,

000

pers

on-y

ears

aAge-adjusted to the 2000 United States population.

Incidence Rates by Cancer Registry, Age, and Behavior The overall average annual incidence rate by cancer registry, age, 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 12.38 to 23.91 per 100,000 person–years. In addition, the incidence rates of all primary non–malignant brain tumors ranged from 6.31 to 16.68 per 100,000 person–years and incidence rates of all primary malignant brain tumors ranged from 4.52 to 8.84 per 100,000 person–years. Among adults 20 years of age and older, the cancer registry–specific incidence rates ranged from 8.85 to 22.75 per 100,000 person–years for non-malignant tumors and from 5.12 to 11.10 per 100,000 person–years for 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 2.40 per 100,000 person-years for non-malignant tumors and 4.98 per 100,000 person-years for malignant tumors. There is less variation by cancer registry in malignant tumor incidence rates as compared to incidence rates for tumors of non-malignant behavior suggesting greater consistency in reporting of the malignant tumors. The variation in tumor incidence rates by cancer registry for children is less than that for adults for both malignant tumors and tumors of non–malignant behavior. Because very few non–malignant tumors occur in children, the lower variability in incidence suggests reporting differences in non–malignant tumors may be driving the variability in incidence rates between cancer registries in the adults.

The incidence rates by tumor behavior and cancer registry are illustrated in Figure 2. The cancer registry incidence rates for the malignant tumors (cancer registry range: 4.52 to 8.84 per 100,000 person–years) are much less variable than the reported incidence rates for the non–malignant tumors (cancer registry range: 6.31 to 16.68 per 100,000 person–years). The cancer registry variation shown in these figures and tables, especially in reported incidence rates for the non–malignant tumors, likely reflects differences in registry reporting practices including case ascertainment. An example of this is Colorado, which has the highest estimated incidence for brain tumors overall. Colorado also has one of the highest percentage of reported non–malignant brain tumors, as well as the lowest percentage of histologically confirmed

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tumors. Even before 2004, Colorado law required active collection of all primary brain and CNS tumors. As many non–malignant brain tumors are not histologically confirmed, this results in a lower percent of diagnostically confirmed 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 2.Average Annual Age-Adjusted Incidence Ratesa of

Primary Brain and CNS Tumors by State* and BehaviorCBTRUS Statistical Report: NPCR and SEER Data from 2004-2005

0

2

4

6

8

10

12

14

16

18

20

22

24

AK AL

AR AZ

CA

CO CT

DC DE FL GA HI

IA ID IL IN LA

MA

ME

MI

MN

MS

MT

NC

ND

NH NJ

NM NV NY

OH

OK

OR PA RI

SC SD TN

TX UT

VA

WA

WV

WY

Malignant Non-Malignant

Rat

e pe

r 10

0,00

0 pe

rson

-yea

rs

aAge-adjusted to the 2000 United States population. * Katrina affected state (AL, LA, MS, and TX) rates are based on a full year for 2004 and January-June of 2005.

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 tumors by site is shown in Figure 3. The majority of tumors (32%) are located in the meninges. Twenty-four 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 4% of all tumors, respectively. Together, the pituitary and pineal glands account for about 14% of tumors. Olfactory tumors of the nasal cavity account for less than 1% of tumors.

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Figure 3.Distribution of All Primary Brain and CNS Tumors by Site (N= 98,990)

CBTRUS Statistical Report: NPCR and SEER Data from 2004-2005

Brain Stem1.8%Cerebellum

3.1%

Ventricle1.2% Cerebrum

2.1%Occipital Lobe

1.4%Parietal Lobe

5.1%

Temporal Lobe7.4%

Frontal Lobe9.8%

Pituitary13.4%

Pineal0.4%

Nasal Cavity0.2%

Meninges32.1%

Spinal Cord & Cauda Equina3.6%

Other Brain10.9%

Cranial Nerves6.8%

Other CNS0.6%

The distribution by histology is shown in Figure 4. The most frequently reported histology is a predominately non–malignant tumor, meningioma, which accounts for over 33% of all tumors, followed by glioblastoma (18%). The predominately non-malignant pituitary and nerve sheath tumors account for 12% and 9% of all tumors, respectively. Acoustic neuromas account for 60% of all nerve sheath tumors.

Figure 4. Distribution of All Primary Brain

and CNS Tumors by Histology (N=98,990)CBTRUS Statistical Report: NPCR and SEER Data from 2004-2005

Astrocytomas7.4%

Ependymomas1.9%

Oligodendrogliomas2.1%

Meningioma33.4%

Pituitary12.2%

Craniopharyngioma0.8%

Nerve Sheath8.7%

Lymphoma2.5%

All Other12.4%

Glioblastoma17.6%

Embryonal, including Medulloblastoma

1.0%

Gliomas (ICD-O-3: 9380-9384, 9391-9460, 9480) account for 33% of all tumors and 80% of malignant tumors

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Gliomas are tumors that arise from glial cells, and include astrocytoma, glioblastoma, oligodendroglioma, ependymoma, mixed glioma, malignant glioma NOS, and other neuroepithelial tumors. In this report, glioma is defined by the ICD-O-3 histology codes 9380-9384, 9391-9460, and 9480. The broad category glioma represents 33% of all tumors (Figure 4). The distribution of tumors by site for glioma is shown in Figure 5. Sixty–one percent of gliomas occur in the frontal, temporal, parietal, and occipital lobes of the brain.

Figure 5. Distribution of All Primary Brain and CNS Gliomas* by Site (N=32,279)


Cerebellum2.9% Brain Stem

4.2%

Other Brain19.9%

Cranial Nerves1.0%

Other0.1%


Frontal Lobe24.7%

Ventricle1.9%

Temporal Lobe19.7%

Parietal Lobe13.0%

Cerebrum4.7%

Occipital Lobe3.5%

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

The distribution by specific histology for glioma is illustrated in Figure 6. Glioblastoma accounts for the majority of glioma, while astrocytoma and glioblastoma combined account for over three–quarters of gliomas.

Figure 6. Distribution of All Primary Brain and CNS Gliomas* by

Histology Subtypes (N=32,279)CBTRUS Statistical Report: NPCR and SEER Data from 2004-2005

Glioblastoma54.0%

Pilocytic Astrocytoma5.2%

Oligodendroglioma6.6%

Ependymoma5.8%

Protoplasmic & Fibrillary Astrocytoma

1.6%

All Other Glioma11.0%

All Other Astrocytoma9.0%

Anaplastic Astrocytoma

6.8%

Astrocytomas and glioblastomas account for 77% of all gliomas*

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

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Distribution of Tumors by Site and Histology in Young Adults (Aged 20-34 Years) Eight percent of tumors occurred in persons between the ages of 20–34 years. The distribution of all brain tumors by site for young adults is shown in Figure 7. The majority of tumors (28%) 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%, 6%, and 3% of all young adult tumors, respectively. Tumors of the meninges represent 13% of all young adult tumors, while the cranial nerves and the spinal cord/cauda equina each account for 7% and 6% of all young adult tumors, respectively. The pituitary and pineal glands account for about 27% of young adult tumors. The distribution by histology for young adults (ages 20–34 years) is shown in Figure 7. The most frequently reported histologies are the predominately non–malignant tumors pituitary (24%) and meningioma (13%). Astrocytic tumors (including glioblastoma and astrocytoma), as a group, account for 19% of all young adult tumors. The predominately non–malignant nerve sheath tumors account for 10% of all young adult tumors. The broad category glioma accounts for 35% of tumors in young adults.

Figure 7. Distribution of Primary Brain and CNS Tumors by Site and Histology

Among Young Adults (Ages 20-34) (N=8,313)CBTRUS Statistical Report: NPCR and SEER Data from 2004-2005

Other CNS0.9%

Cranial Nerves7.0%

Meninges13.0%

Parietal lobe4.7%

Occipital lobe1.3%

Cerebrum2.4%

Ventricle2.7%

Cerebellum5.6%

Pituitary26.4%

Other Brain7.8%

Spinal Cord & Cauda Equina

6.3%

Brain Stem2.8%

Temporal lobe7.3%

Frontal lobe14.5%

Pineal1.0%

Gliomas (9380-9384,9391-9460,9480) account for 35% of all tumors and 82% of malignant tumors

Pilocytic Astrocytoma

3.4%

Nerve Sheath10.1%

Lymphoma1.6%

Germ Cell Tumors1.1%

All Other21.4%


Glioblastoma5.3%

Meningioma13.2%

Ependymomas2.6%

Oligodendrogliomas4.1%

Embryonal, including

Medulloblastoma1.9%

Pituitary24.1%

All other Astrocytomas

10.5%

Site Histology

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Incidence Rates by Site and Gender Incidence rates by site are provided in Table 11. Males accounted for 44% of the cases and females for 56% of the cases. Incidence rates were highest for tumors located in the meninges (5.79 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 (0.03 per 100,000 person–years). By gender, incidence rates were statistically significantly higher in females than in males for tumors located in the meninges. Males had higher or similar incidence rates compared to females for all other sites. Incidence Rates by Major Histology Groupings and Specific Histologies Incidence rates by major histology groupings are provided (Tables 12 – 19). Among major histology groupings, incidence rates were highest for tumors of the neuroepithelial tissue (6.41 per 100,000 person–years), followed by tumors of the meninges (6.26 per 100,000 person–years), tumors of the sellar region (2.36 per 100,000 person–years) and tumors of the cranial and spinal nerves (1.57 per 100,000 person–years) (Table 12). Incidence rates also varied by specific histology (Table 12). Incidence rates were highest for meningiomas (6.03 per 100,000 person–years), glioblastomas (3.18 per 100,000 person–years), pituitary tumors (2.22 per 100,000 person–years), and nerve sheath tumors (1.57 per 100,000 person–years). The incidence rate of gliomas was 5.94 per 100,000 person–years, a major contributor to the magnitude of the neuroepithelial tissue rate. While acoustic neuromas comprise the majority (60%; 0.93 per 100,000 person-years) of nerve sheath tumors (1.57 per 100,000 person– years), these tumors are included under tumors of cranial and spinal nerves according to the CBTRUS grouping scheme. Acoustic neuromas account for 5% of all primary brain and CNS tumors. 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 (19.16 per 100,000 person–years) than males (17.08 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. The incidence rate of gliomas is higher in males (7.09 per 100,000 person– years) than in females (4.96 per 100,000 person–years). Similar patterns were found for individual histologies, with incidence rates higher in males, especially for germ cell tumors, glioblastomas, oligodendrogliomas, lymphomas, and embryonal/ primitive/medulloblastomas, or comparable between males and females, with the notable exception of meningiomas, which are twice as common in women. Incidence rate ratios (male:female) for selected histologies are shown in Figure 8.

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Figure 8. Patterns by Gender for Selected HistologiesCBTRUS Statistical Report: NPCR and SEER Data from 2004-2005

Incidence Rate Ratio (Male to Female)



Glioblastoma

Oligodendroglioma

Ependymoma/Anaplastic Ependymoma

Mixed Glioma

Embryonal/Primitive/Medulloblastoma

Nerve Sheath

Meningioma

Lymphoma

Germ Cell Tumors

Pituitary

0.1 1 10

Log Scale

Incidence Rates by Race and Histology Incidence rates by histology and race are shown in Table 14. Whites accounted for 85% and blacks for 10% of cases. Incidence rates for all primary brain and CNS tumors combined are higher among whites (18.38 per 100,000 person– years) than blacks (16.34 per 100,000 person–years). The difference between these incidence rates is statistically significant. Incidence rates for most histologies are higher in whites or comparable between whites and blacks. 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 significantly higher among blacks (6.63, 3.48, and 1.05 per 100,000 person–years, respectively) than whites (5.90, 2.02, and 0.84 per 100,000 person–years, respectively). Incidence rate ratios (white:black) for selected histologies are shown in Figure 9.

17

Figure 9.

Patterns by Race for Selected Histologies CBTRUS Statistical Report: NPCR and SEER Data from 2004-2005

0.1 1 10

Incidence Rate Ratio (White to Black)



Glioblastoma

Oligodendroglioma

Ependymoma/Anaplastic Ependymoma

Mixed Glioma

Embryonal/Primitive/Medulloblastoma

Nerve Sheath

Meningioma

Lymphoma

Pituitary

Craniopharyngioma

Log Scale

Incidence Rates by Hispanic Origin, Race, and Histology Incidence rates by histology, Hispanic origin, and race are shown in Table 15. Ten percent of the cases were in individuals of Hispanic origin and 90% were in individuals not of Hispanic origin. Ten percent of tumors were in persons of Hispanic origin using the North American Association of Central Cancer Registries Hispanic Identification Algorithm, version 2 (NHIA v2), data element to indicate Hispanic ethnicity. The NHIA utilizes a combination of cancer registry data fields (such as birthplace, race, and surnames) to directly and indirectly classify cases as Hispanic or non–Hispanic for analytical purposes. The overall incidence rate for primary brain and CNS tumors among Hispanics is 17.38 per 100,000 person–years and among non–Hispanics is 18.31 per 100,000 person–years (Table 15). The difference between these two incidence rates is statistically significant. White non–Hispanics (18.62 per 100,000 person–years) have statistically significantly higher incidence rates than white–Hispanics (17.27 per 100,000 person–years), and black non–Hispanics (16.55 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 tumors is highest among the 75–84 year olds (63.75 per 100,000 person–years) and lowest among children less than 20 years (4.58 per 100,000 person–years). However, different histologies have different age distributions as shown in Table 16. Note: The 0–14 year age category found in Tables 16 and 19, and in Figures 1, 10, and 13 is a standard age category for childhood cancer used by some cancer surveillance

18

organizations and has been included in this report for consistency. The incidence of pilocytic astrocytoma, germ cell tumors, and medulloblastoma are higher in the younger age groups and decrease with age. This is in contrast to the incidence rate of meningioma, which increase progressively with age. Most other tumors, such as glioblastoma and pituitary tumors, increase with age until the incidence begins to decline again at the oldest age groups. Age–specific incidence rates for selected histologies are shown in Figure 10.

Figure 10. Age-Specific Incidence of Primary Brain and

CNS Tumors by Selected Histologies CBTRUS Statistical Report: NPCR and SEER Data from 2004-2005

0

10

20

30

40

50

60

70

0-14 0-19 20-34

35-44

45-54

55-64

65-74

75-84

85+

Rat

e pe

r 10

0,00

0 pe

rson

-yea

rs

All PrimaryTumorsGliomas*

Meningioma

Nerve Sheath

Pituitary

Lymphoma

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

The most common brain and CNS tumor by age at occurrence are shown in Figure 11. The histologic–specific differences in brain and central nervous system tumor distribution by age, gender, race, and Hispanic origin suggest that these tumors have different causes.

Figure 11. Most Common Brain and CNS Tumors by Age


Age (yr) Most Common Histology0-4 Embryonal/primitive/medulloblastoma5-9 Pilocytic astrocytoma

10-14 Pilocytic astrocytoma15-19 Pituitary20-34 Pituitary35-44 Meningioma45-54 Meningioma55-64 Meningioma65-74 Meningioma75-84 Meningioma85+ Meningioma

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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.11 Brain tumors are the most common form of solid tumors in children. 11 About 7% of the reported tumors occurred in persons under the age of 20 years.

Distribution of Tumors by Site and Histology The distribution of tumors by site is shown in Figure 12. The majority of childhood tumors (18%) are located within the frontal, temporal, parietal, and occipital lobes of the brain. Cerebrum, ventricle, cerebellum, and brain stem tumors account for 6%, 6%, 16%, and 12% 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 12. Distribution of All Childhood (Ages 0-19 years)

Primary Brain and CNS Tumors by Site (N=6,830)CBTRUS Statistical Report: NPCR and SEER Data from 2004-2005


Cranial Nerves6.2%

Other CNS1.4%

Meninges3.0%

Temporal Lobe7.1%

Frontal Lobe5.7%

Pineal3.2%

Parietal Lobe3.0%

Occipital Lobe1.5%

Cerebrum5.5%

Pituitary11.6%

Other Brain13.7%

Brain Stem11.6%

Cerebellum15.8%

Ventricle5.5%

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The most common histologies in the younger age group (ages 0–14 years) include pilocytic astrocytomas, malignant glioma, NOS, and embryonal tumors (medulloblastomas), which account for 19%, 14%, and 13%, respectively, of all brain tumors in children in this age group (Figure 13). The broad category glioma accounts for 53% of tumors in children less than 15 years of age. The most common histologies in adolescents ages 15–19 years include pituitary tumors and pilocytic astrocytomas, which account for 20% and 12%, respectively, of all brain tumors in that age group (Figure 13). The broad category glioma accounts for 40% of tumors in adolescents aged 15–19 years.

Figure 13. Distribution of Childhood Primary Brain and CNS Tumors by Histology


Pilocytic astrocytoma

19.3%

All Other Astrocytoma

9.4%

Glioblastoma2.5%

Glioma malignant, NOS

13.5%

Embryonal/primitive/medulloblastoma

13.2%

Nerve sheath4.4%

Germ Cell3.7%

Pituitary2.9%


All Other21.5%

Ependymoma/anaplastic

ependymoma5.9%


Ages 0-14 (n=4,959) Ages 15-19 (n=1,871)


Pilocytic astrocytoma

11.8%

Pituitary19.7%


All Other29.4%

Nerve sheath6.4%

All Other Astrocytoma

8.8%

Glioblastoma4.2%

Germ Cell5.1% Embryonal/

primitive/medulloblastoma

4.2%

Glioma malignant, NOS4.4%

Ependymoma/anaplastic

ependymoma3.6%

Childhood Incidence Rates by Histology and Gender The incidence of the most common childhood tumors is shown in Table 17. The overall incidence rate for childhood brain tumors (ages 0–19 years) is 4.58 per 100,000 person–years. Among major histology groupings, incidence rates were highest for tumors of the neuroepithelial tissue (3.25 per 100,000 person–years). Pilocytic astrocytoma (0.79 per 100,000 person–years), malignant glioma, not otherwise specified (0.51 per 100,000 person-years), and medulloblastoma (0.49 per 100,000 person–years) are the most common individual histologies. Among the younger population, brain tumors are non-significantly more common in boys, with tumors of the neuroepithelial and embryonal tumors being more common, and germ cell tumors twice as common in boys compared to girls (Table 17). Alternatively, the incidence of

21

pituitary tumors is more than twice as large in females compared to males. The differences in incidence rates between boys and girls for neuroepithelial, embryonal tumors, germ cell, and pituitary tumors are statistically significant. The small numbers for some tumors require caution when interpreting and comparing incidence rates. Childhood Incidence Rates by Race and Gender Among the younger population (ages 0–19 years) brain tumors are more common in whites (4.74 per 100,000 person–years) than in blacks (3.50 per 100,000 person–years) (Table 18). This difference in incidence rates between the two races is statistically significant. Among both whites and blacks, incidence rates are similar in boys and girls. Childhood Incidence Rates by Age and Histology The age–specific incidence rates by histology for children are displayed in Table 19. The incidence for all brain tumors is highest among 0–4 year olds (5.01 per 100,000 person–years) and lowest among 10–14 year olds (4.13 per 100,000 person–years). However, the different histologies have different age distributions. The incidences of pilocytic astrocytoma and medulloblastoma in children decrease with age. The incidence of germ cell tumors among children increases with age, peaking in the 10–19 year age groups. Age–specific incidence rates for selected histologies are shown in Figure 14. The most common childhood brain and CNS tumor by age at occurrence are shown in Figure 11. The histology–specific differences in brain and central nervous system tumor distribution by age, gender, and race suggest that these childhood tumors have different causes.

Figure 14. Age-Specific Incidence of Childhood Primary Brain and

CNS Tumors by Selected HistologiesCBTRUS Statistical Report: NPCR and SEER Data from 2004-2005

0

1

2

3

4

5

6

0-4 5-910-14

15-19

Rat

e pe

r 10

0,00

0 pe

rson

-yea

rs

All Primary Tumors

Gliomas*

Embryonal, includingMedulloblastoma


Ependymoma/AnaplasticEpendymoma

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

22

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

2 Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence – SEER 9 Regs Limited–Use, Nov 2007 Sub (1973–2005), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2008, based on the November 2007 submission.

3US population data. Surveillance, Epidemiology, and EndResults (SEER) Program Populations (1990–2006) (http://seer.cancer.gov/popdata/), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2008.

4Kleihues P, Burger PC, and Scheithauer BW. The new WHO classification of brain tumors. Brain Pathology, 3: 255–268, 1993. 5Louis DN, Ohgaki H, Wiestler OD, Cavanee WK. (Eds): WHO Classification of Tumours of the Central Nervous System. IARC: Lyon, 2007.

6McCarthy 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>)

7ICD–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]

8SAS 9.1.3. Copyright (c) 2002–2003 by SAS Institute Inc., Cary, NC, USA.

9Surveillance Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat) version 6.4.4, April 24, 2008. 10 Statistical Packages for Social Sciences Statistics for Windows, version 17.0,0, Released August 23, 2008, (Spss Inc., Chicago, IL). 11Gurney JG, Smith MA, and Bunin GR. Chapter III: CNS and miscellaneous intracranial and intraspinal neoplasms. In: Ries LAG, Smith MA, Gurney JG, LinetM, 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/]

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Table 1: CBTRUS Brain and Central Nervous System Tumor Histology Groupings, 2009 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, 9442/3d 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, 9442/1e, 9490, 9491, neuronal and mixed 9492, 9493, 9500, 9505, 9506, 9522, 9523 Pineal parenchymal 9360, 9361, 9362 Embryonal/primitive/medulloblastoma 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, malignant 8815, 8824, 8830, 8831, 8850, 8851, 8857, 8861, 8890, 8897, 8900, 8910, 8920, 8990, 9040, 9150, 9170c, 9180, 9210, 9241, 9260, 9480 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, 9766, 9827, 9861, 9930, 9970 Germ Cell Tumors and Cysts Germ cell tumors, cysts and heterotopias 8020, 9060, 9061, 9064, 9065, 9070, 9071, 9072, 9080, 9081, 9082, 9083, 9084, 9085, 9100 Tumors of Sellar Region Pituitary 8022, 8040, 8140, 8146, 8190, 8202c, 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 8711c, 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 8683, 8720, 8811, 8840, 8860, 8896, 8980, 9173, 9580, 9751, 9752, 9753, 9754, 9823, 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. cHistologies added in the 2009 revision of the CBTRUS histology grouping scheme as compared to the previous versions. dMorphology 9442/3 only. eMorphology 9442/1 only. Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NOS, not otherwise specified.

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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 274,633,6425-9 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: Combined Populationsa for 2004 and 2005, By Age, Gender and Race

Males Females Age Group All Races Whites Blacks All Races Whites Blacks

0-4 18,865,841 14,646,694 3,049,760 18,023,381 13,960,864 2,949,8155-9 18,274,287 14,203,200 2,934,075 17,449,096 13,493,858 2,838,564

10-14 19,607,008 15,147,122 3,272,213 18,672,926 14,367,419 3,170,61515-19 19,487,313 15,191,950 3,104,956 18,511,375 14,356,864 3,024,29220-24 19,650,594 15,480,484 2,900,454 18,468,150 14,373,302 2,874,01625-29 18,389,632 14,567,416 2,483,058 17,636,446 13,632,119 2,650,48130-34 18,701,862 14,846,630 2,381,390 18,322,091 14,164,344 2,642,85435-39 19,259,436 15,528,019 2,393,319 19,076,627 15,008,682 2,677,49740-44 20,745,053 16,977,211 2,509,778 20,965,441 16,780,429 2,850,33345-49 19,986,382 16,543,349 2,327,418 20,512,332 16,610,629 2,669,86450-54 17,534,230 14,690,484 1,900,827 18,315,088 15,005,017 2,240,28255-59 14,913,995 12,724,450 1,437,710 15,839,902 13,239,096 1,743,20560-64 11,078,606 9,558,972 993,484 12,177,164 10,306,421 1,274,11965-69 8,498,652 7,335,458 765,020 9,764,307 8,267,689 1,030,56770-74 6,921,075 6,059,711 573,719 8,567,992 7,347,491 843,25675-79 5,661,887 5,047,757 408,389 7,840,159 6,861,297 687,79180-84 3,895,361 3,502,721 259,967 6,286,978 5,603,049 493,21985+ 2,808,553 2,523,297 191,744 6,164,157 5,526,610 479,503

Total 264,279,767 214,574,925 33,887,281 272,593,612 218,905,180 37,140,273a Population data source for 44 population-based geographic regions: Estimates from the U.S. Census Bureau http://seer.cancer.gov/popdata/index.html

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Table 4: Combined Populationsa for 2004 and 2005 By Age, Gender, Race and Hispanic Origin

Males

Age Group Hispanic White

Hispanic Black

Hispanic Non-

Hispanic

White Non-

Hispanic

Black Non-

Hispanic 0-4 4,441,431 4,198,535 161,012 14,424,410 10,448,159 2,888,748 5-9 3,876,598 3,568,922 180,910 14,397,689 10,634,278 2,753,165

10-14 3,793,696 3,495,140 175,917 15,813,312 11,651,982 3,096,296 15-19 3,397,588 3,136,003 149,932 16,089,725 12,055,947 2,955,024 20-24 3,942,147 3,672,673 150,201 15,708,447 11,807,811 2,750,253 25-29 4,228,184 3,959,958 149,382 14,161,448 10,607,458 2,333,676 30-34 3,897,314 3,661,771 132,251 14,804,548 11,184,859 2,249,139 35-39 3,432,380 3,218,622 122,216 15,827,056 12,309,397 2,271,103 40-44 2,975,463 2,786,520 107,124 17,769,590 14,190,691 2,402,654 45-49 2,328,727 2,176,197 86,645 17,657,655 14,367,152 2,240,773 50-54 1,733,693 1,616,881 68,088 15,800,537 13,073,603 1,832,739 55-59 1,275,665 1,193,170 48,562 13,638,330 11,531,280 1,389,148 60-64 867,959 815,665 31,724 10,210,647 8,743,307 961,760 65-69 649,926 612,169 23,732 7,848,726 6,723,289 741,288 70-74 484,192 458,168 16,390 6,436,883 5,601,543 557,329 75-79 352,235 334,777 11,016 5,309,652 4,712,980 397,373 80-84 215,782 205,565 6,417 3,679,579 3,297,156 253,550 85+ 148,242 140,641 4,610 2,660,311 2,382,656 187,134

Total 42,041,222 39,251,377 1,626,129 222,238,545 175,323,548 32,261,152 Females

Age Group Hispanic White

Hispanic Black

Hispanic Non-

Hispanic

White Non-

Hispanic

Black Non-

Hispanic 0-4 4,256,710 4,024,730 153,165 13,766,671 9,936,134 2,796,650 5-9 3,700,881 3,404,850 173,892 13,748,215 10,089,008 2,664,672

10-14 3,625,433 3,334,912 170,776 15,047,493 11,032,507 2,999,839 15-19 3,193,900 2,941,619 144,339 15,317,475 11,415,245 2,879,953 20-24 3,271,732 3,027,789 139,858 15,196,418 11,345,513 2,734,158 25-29 3,410,879 3,163,759 149,233 14,225,567 10,468,360 2,501,248 30-34 3,345,202 3,111,435 144,142 14,976,889 11,052,909 2,498,712 35-39 3,023,512 2,808,594 131,574 16,053,115 12,200,088 2,545,923 40-44 2,747,670 2,552,617 116,626 18,217,771 14,227,812 2,733,707 45-49 2,252,783 2,092,324 96,357 18,259,549 14,518,305 2,573,507 50-54 1,767,045 1,643,031 75,178 16,548,043 13,361,986 2,165,104 55-59 1,365,647 1,274,746 55,907 14,474,255 11,964,350 1,687,298 60-64 988,586 927,928 37,900 11,188,578 9,378,493 1,236,219 65-69 782,542 735,550 30,427 8,981,765 7,532,139 1,000,140 70-74 625,618 590,284 22,916 7,942,374 6,757,207 820,340 75-79 493,437 466,744 17,469 7,346,722 6,394,553 670,322 80-84 326,537 309,445 11,550 5,960,441 5,293,604 481,669 85+ 286,679 272,030 10,072 5,877,478 5,254,580 469,431

Total 39,464,793 36,682,387 1,681,381 233,128,819 182,222,793 35,458,892 a Population data source for 44 population-based geographic regions: Estimates from the U.S. Census Bureau http://seer.cancer.gov/popdata/index.html

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Table 5: Number of Brain and CNS Tumors By Major Histology Groupings, Histology, Gender and Race

CBTRUS Statistical Report: NPCR and SEER, 2004-2005 Total By Gender By Race Histology Male Female White Black Tumors of Neuroepithelial Tissue 34,806 19,405 15,401 31,224 2,299Pilocytic astrocytoma 1,685 879 806 1,411 175Protoplasmic & fibrillary astrocytoma 520 281 239 464 32Anaplastic astrocytoma 2,189 1,213 976 1,989 119Unique astrocytoma variants 466 295 171 397 45Astrocytoma, NOS 2,426 1,285 1,141 2,146 195Glioblastoma 17,442 9,997 7,445 16,132 886Oligodendroglioma 1,454 825 629 1,315 74Anaplastic oligodendroglioma 674 358 316 612 27Ependymoma/anaplastic ependymoma 1,405 717 688 1,198 119Ependymoma variants 483 278 205 442 17Mixed glioma 931 544 387 835 54Glioma malignant, NOS 2,265 1,163 1,102 1,920 229Choroid plexus 221 116 105 179 27Neuroepithelial 107 56 51 95 -Non-malignant and malignant neuronal/glial 1,340 736 604 1,122 138Pineal parenchymal 175 74 101 129 41Embryonal/primitive/medulloblastoma 1,023 588 435 838 114Tumors of Cranial and Spinal Nerves 8,631 4,179 4,452 7,522 396Nerve sheath, non-malignant and malignant 8,630 4,179 4,451 7,521 396Tumors of Meninges 34,291 9,382 24,909 28,620 3,751Meningioma 33,042 8,718 24,324 27,575 3,630Other mesenchymal, non-malignant and malignant 385 193 192 322 32Hemangioblastoma 864 471 393 723 89Lymphomas and Hematopoietic Neoplasms 2,485 1,360 1,125 2,095 259Lymphoma 2,485 1,360 1,125 2,095 259Germ Cell Tumors and Cysts 412 288 124 336 40Germ cell tumors, cysts and heterotopias 412 288 124 336 40Tumors of Sellar Region 12,789 5,918 6,871 9,640 2,216Pituitary 12,038 5,516 6,522 9,085 2,081Craniopharyngioma 751 402 349 555 135Local Extensions from Regional Tumors 105 58 47 87 -Chordoma/chondrosarcoma 105 58 47 87 -Unclassified Tumors 5,471 2,449 3,022 4,581 650Hemangioma 705 287 418 591 67Neoplasm, unspecified 4,721 2,136 2,585 3,952 580All other 45 26 19 38 -

TOTAL 98,990 43,039 55,951 84,105 9,618-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

27

Table 6: Number of Brain and CNS Tumors By Major Histology Groupings, Histology, Race and Hispanic

Ethnicity, CBTRUS Statistical Report: NPCR and SEER, 2004-2005 Hispanics Non-Hispanics

Histology Of Any Race White

Of Any Race White Black

Tumors of Neuroepithelial Tissue 3,187 3,011 31,619 28,213 2,230 Pilocytic astrocytoma 234 212 1,451 1,199 169 Protoplasmic & fibrillary astrocytoma 39 39 481 425 32 Anaplastic astrocytoma 199 190 1,990 1,799 114 Unique astrocytoma variants 64 61 402 336 44 Astrocytoma, NOS 239 227 2,187 1,919 190 Glioblastoma 1,147 1,098 16,295 15,034 867 Oligodendroglioma 152 148 1,302 1,167 74 Anaplastic oligodendroglioma 66 62 608 550 25 Ependymoma/anaplastic ependymoma 186 173 1,219 1,025 115 Ependymoma variants 49 46 434 396 17 Mixed glioma 104 98 827 737 50 Glioma malignant, NOS 254 233 2,011 1,687 217 Choroid plexus 41 40 180 139 27 Neuroepithelial - - 100 88 - Non-malignant and malignant neuronal/glial 162 149 1,178 973 132 Pineal parenchymal 21 20 154 109 40 Embryonal/primitive/medulloblastoma 223 208 800 630 110

Tumors of Cranial and Spinal Nerves 741 680 7,890 6,842 381 Nerve sheath, non-malignant and malignant 741 680 7,889 6,841 381

Tumors of Meninges 3,043 2,803 31,248 25,817 3,663 Meningioma 2,892 2,666 30,150 24,909 3,548 Other mesenchymal, non-malignant and malignant 51 47 334 275 30 Hemangioblastoma 100 90 764 633 85

Lymphomas and Hematopoietic Neoplasms 265 250 2,220 1,845 253 Lymphoma 265 250 2,220 1,845 253

Germ Cell Tumors and Cysts 80 76 332 260 39 Germ cell tumors, cysts and heterotopias 80 76 332 260 39 Tumors of Sellar Region 1,815 1,673 10,974 7,967 2,177 Pituitary 1,695 1,567 10,343 7,518 2,047 Craniopharyngioma 120 106 631 449 130

Local Extensions from Regional Tumors 21 20 84 67 - Chordoma/chondrosarcoma 21 20 84 67 -

Unclassified Tumors 557 523 4,914 4,058 636 Hemangioma 87 81 618 510 65 Neoplasm, unspecified 467 439 4,254 3,513 568 All other - - 42 35 -

TOTAL 9,709 9,036 89,281 75,069 9,386 -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

28

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, 2004-2005

Total By Gender By Race Histology Males Females Whites Blacks Tumors of Neuroepithelial Tissue 4,842 2,588 2,254 3,893 614Pilocytic astrocytoma 1,179 616 563 970 131Anaplastic astrocytoma 101 46 55 83 -Astrocytoma, NOS 325 173 152 260 39Glioblastoma 203 121 82 158 28Ependymoma/anaplastic ependymoma 362 190 172 285 51Glioma malignant, NOS 751 374 377 597 98Non-malignant and malignant neuronal/glial 552 305 247 452 70Embryonal/primitive/medulloblastoma 732 422 310 598 83Tumors of Cranial and Spinal Nerves 336 159 177 278 28Tumors of Meninges 293 138 155 234 37Lymphomas and Hematopoietic Neoplasms 33 - - - -Germ Cell Tumors and Cysts 280 193 87 234 19Tumors of Sellar Region 738 265 473 576 100Pituitary 515 150 365 405 65Craniopharyngioma 223 115 108 171 35Local Extensions from Regional Tumors - - - - -Unclassified Tumors 297 154 143 235 44

TOTAL 6,830 3,521 3,309 5,484 850-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

29

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, 2004-2005

Age at Diagnosis Histology 0-4 5-9 10-14 15-19 0-19 0-14 Tumors of Neuroepithelial Tissue 1,532 1,232 1,089 989 4,842 3,853Pilocytic astrocytoma 332 320 306 221 1,179 958Anaplastic astrocytoma 16 25 30 30 101 71Astrocytoma, NOS 90 68 89 78 325 247Glioblastoma 40 43 42 78 203 125Ependymoma/anaplastic ependymoma 155 80 59 68 362 294Glioma malignant, NOS 283 250 135 83 751 668Non-malignant and malignant neuronal/glial 135 102 151 164 552 388Embryonal/primitive/medulloblastoma 339 199 116 78 732 654Tumors of Cranial and Spinal Nerves 78 64 74 120 336 216Tumors of Meninges 61 35 63 134 293 159Lymphomas and Hematopoietic Neoplasms - - - - 33 -Germ Cell Tumors and Cysts 43 45 97 95 280 185Tumors of Sellar Region 55 97 173 413 738 325Pituitary - 29 106 369 515 146Craniopharyngioma 44 68 67 44 223 179Local Extensions from Regional Tumors - - - - - -Unclassified Tumors 70 52 74 101 297 196

TOTAL 1,848 1,529 1,582 1,871 6,830 4,959-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

30

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, 2004-2005

State

No. Of Newly Diagnosed Brain &

CNS Tumors

Percent Non-Malignant

Tumors

Percent Histologically

Confirmed

Combined 2004-2005

Populationa Alabama* 1,187 58.0 72.4 6,778,378 Alaska 137 53.3 68.6 1,331,072 Arizona 2,238 62.6 68.0 11,696,450 Arkansas 903 56.6 67.3 5,515,050 California 11,961 61.4 74.6 71,712,303 Colorado 2,081 69.3 57.6 9,282,988 Connecticut 1,256 54.1 79.8 6,968,380 Delaware 279 49.1 85.3 1,668,229 District of Columbia 145 51.7 71.0 1,161,670 Florida 8,551 65.8 60.2 35,078,650 Georgia 2,919 60.1 67.7 18,029,090 Hawaii 404 70.0 72.8 2,521,753 Idaho 528 55.1 70.3 2,817,645 Illinois 4,377 60.1 64.4 25,399,603 Indiana 2,113 58.3 65.4 12,475,984 Iowa 1,237 58.4 66.5 5,901,596 Louisiana* 1,125 63.3 67.5 6,735,831 Maine 478 46.7 80.5 2,621,114 Massachusetts 2,390 56.7 78.0 12,862,813 Michigan 4,041 60.9 63.7 20,210,660 Minnesota 1,591 57.4 96.6 10,199,450 Mississippi* 668 57.0 70.1 4,337,121 Montana 345 52.2 76.5 1,862,505 Nevada 727 57.6 75.8 4,738,908 New Hampshire 514 57.4 73.0 2,597,397 New Jersey 3,218 57.5 71.3 17,298,680 New Mexico 514 54.9 71.0 3,808,513 New York 8,452 65.0 65.4 38,521,024 North Carolina 2,999 58.0 76.9 17,217,467 North Dakota 232 49.6 62.9 1,272,752 Ohio 3,399 50.4 75.9 22,912,584 Oklahoma 1,114 51.6 68.8 7,052,478 Oregon 1,402 58.6 77.2 7,212,986 Pennsylvania 5,397 61.8 67.5 24,715,894 Rhode Island 464 59.7 67.2 2,139,580 South Carolina 1,461 58.9 66.2 8,456,426 South Dakota 270 56.3 72.2 1,554,175 Tennessee 2,110 58.7 70.0 11,901,372 Texas* 6,127 64.0 60.4 33,876,837 Utah 957 65.0 75.8 4,935,854 Virginia 2,126 54.3 78.0 15,021,621 Washington 2,791 64.5 64.0 12,460,707 West Virginia 708 56.6 63.0 3,610,244 Wyoming 154 55.2 81.2 1,009,799 * Katrina and Rita affected state (Alabama, Louisiana, Mississippi, and Texas) counts and populations are based on a full year for 2004 and January-June of 2005. a2004 and 2005 population data 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

31

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, 2004-2005

0-19 Years 20+ Years All Ages State Malignant Non-Malignant Malignant Non-Malignant Malignant Non-Malignant All Tumors Alabama* 3.38 (2.59-4.33) 1.13 (0.70 -1.72 ) 8.56 (7.77-9.41) 13.20 (12.21-14.24) 7.08 (6.47-7.73) 9.73 (9.02-10.49) 16.81 (15.86-17.80) Alaska - - 7.54 (5.51-10.04) 9.21 (6.93-11.98) 5.95 (4.45-7.77) 7.06 (5.39-9.06) 13.01 (10.72-15.63) Arizona 3.71 (3.09-4.41) 1.47 (1.09 -1.94 ) 8.44 (7.83-9.08) 16.12 (15.27-17.01) 7.08 (6.61-7.58) 11.92 (11.30-12.56) 19.00 (18.22-19.80) Arkansas 2.52 (1.78-3.45) 2.40 (1.69 -3.31 ) 8.41 (7.55-9.34) 11.35 (10.34-12.43) 6.72 (6.07-7.43) 8.78 (8.03-9.58) 15.50 (14.50-16.56) California 2.85 (2.62-3.09) 1.41 (1.26 -1.58 ) 8.38 (8.12-8.64) 14.58 (14.24-14.93) 6.79 (6.59-6.99) 10.80 (10.56-11.06) 17.59 (17.28-17.91) Colorado 3.20 (2.54-3.97) 1.61 (1.15 -2.18 ) 8.85 (8.12-9.63) 22.75 (21.55-23.99) 7.23 (6.67-7.82) 16.68 (15.82-17.58) 23.91 (22.88-24.98) Connecticut 3.24 (2.47-4.17) 1.62 (1.10 -2.30 ) 9.74 (8.91-10.63) 11.97 (11.06-12.94) 7.88 (7.24-8.55) 9.00 (8.33-9.71) 16.88 (15.95-17.85) Delaware 3.60 (2.06-5.84) - 9.98 (8.31-11.90) 10.26 (8.57-12.18) 8.15 (6.86-9.62) 7.69 (6.45-9.10) 15.84 (14.03-17.83) District of Columbia - - 8.38 (6.51-10.62) 8.85 (6.94-11.12) 6.07 (4.73-7.69) 6.31 (4.95-7.93) 12.38 (10.43-14.59) Florida 3.39 (3.02-3.80) 1.37 (1.13 -1.64 ) 8.92 (8.58-9.27) 18.60 (18.10-19.10) 7.34 (7.07-7.61) 13.66 (13.30-14.02) 20.99 (20.54-21.45) Georgia 2.45 (2.04-2.91) 1.39 (1.09 -1.75 ) 8.80 (8.26-9.36) 14.30 (13.61-15.01) 6.97 (6.57-7.39) 10.59 (10.10-11.11) 17.57 (16.93-18.23) Hawaii 3.02 (1.82-4.71) - 5.12 (4.17-6.22) 13.99 (12.35-15.77) 4.52 (3.74-5.41) 10.60 (9.39-11.92) 15.12 (13.67-16.68) Idaho 3.69 (2.52-5.21) - 10.52 (9.12-12.08) 14.77 (13.10-16.60) 8.56 (7.50-9.73) 10.70 (9.50-12.01) 19.27 (17.65-20.99) Illinois 3.07 (2.68-3.50) 1.17 (0.93 -1.45 ) 8.48 (8.06-8.91) 14.12 (13.57-14.68) 6.93 (6.60-7.26) 10.40 (10.01-10.81) 17.33 (16.82-17.85) Indiana 2.66 (2.14-3.25) 1.28 (0.94 -1.72 ) 8.71 (8.11-9.35) 13.10 (12.37-13.88) 6.98 (6.52-7.45) 9.71 (9.18-10.27) 16.69 (15.98-17.42) Iowa 3.28 (2.45-4.30) 1.62 (1.06 -2.37 ) 10.12 (9.21-11.10) 15.12 (14.01-16.30) 8.16 (7.46-8.90) 11.25 (10.44-12.11) 19.41 (18.33-20.53) Louisiana* 2.81 (2.12-3.66) 1.32 (0.86 -1.93 ) 7.58 (6.82-8.42) 14.54 (13.46-15.67) 6.21 (5.63-6.85) 10.74 (9.97-11.57) 16.96 (15.98-17.98) Maine 2.79 (1.65-4.42) - 11.10 (9.72-12.63) 9.96 (8.65-11.42) 8.72 (7.67-9.88) 7.61 (6.63-8.70) 16.33 (14.88-17.89) Massachusetts 3.63 (3.00-4.34) 1.70 (1.29 -2.20 ) 9.36 (8.76-9.99) 13.16 (12.45-13.90) 7.72 (7.25-8.20) 9.87 (9.35-10.42) 17.59 (16.89-18.31) Michigan 2.87 (2.44-3.35) 1.60 (1.29 -1.97 ) 9.59 (9.10-10.11) 15.94 (15.30-16.60) 7.66 (7.29-8.05) 11.83 (11.36-12.31) 19.49 (18.89-20.10) Minnesota 2.71 (2.14-3.39) 1.21 (0.85 -1.69 ) 8.23 (7.58-8.92) 11.81 (11.04-12.62) 6.65 (6.16-7.17) 8.77 (8.21-9.36) 15.42 (14.67-16.20) Mississippi* 2.03 (1.33-2.97) 1.43 (0.85 -2.25 ) 8.48 (7.48-9.58) 11.86 (10.66-13.15) 6.63 (5.88-7.45) 8.87 (7.99-9.81) 15.50 (14.34-16.72) Montana 3.47 (2.02-5.57) - 10.06 (8.49-11.85) 12.21 (10.43-14.20) 8.17 (6.96-9.54) 9.09 (7.79-10.54) 17.26 (15.46-19.21) Nevada 2.81 (1.98-3.88) - 7.98 (7.05-9.01) 12.16 (10.99-13.42) 6.50 (5.79-7.28) 8.99 (8.14-9.90) 15.49 (14.37-16.67) New Hampshire 3.33 (2.11-5.01) - 10.14 (8.76-11.68) 14.46 (12.82-16.27) 8.19 (7.13-9.36) 10.75 (9.54-12.06) 18.93 (17.32-20.66) New Jersey 3.13 (2.64-3.68) 1.83 (1.46 -2.26 ) 9.38 (8.86-9.93) 13.53 (12.90-14.18) 7.59 (7.19-8.01) 10.17 (9.71-10.65) 17.76 (17.15-18.39) New Mexico 2.19 (1.40-3.25) - 7.62 (6.61-8.73) 9.90 (8.74-11.16) 6.06 (5.30-6.89) 7.40 (6.55-8.32) 13.45 (12.31-14.67) New York 3.46 (3.11-3.84) 2.09 (1.82 -2.39 ) 9.06 (8.72-9.42) 18.23 (17.74-18.73) 7.45 (7.19-7.73) 13.60 (13.24-13.97) 21.05 (20.61-21.51) North Carolina 3.38 (2.87-3.95) 1.33 (1.02 -1.71 ) 8.74 (8.23-9.28) 13.36 (12.72-14.01) 7.21 (6.81-7.62) 9.91 (9.44-10.39) 17.11 (16.50-17.74) North Dakota - - 11.10 (9.07-13.46) 10.99 (9.00-13.29) 8.84 (7.29-10.61) 8.37 (6.89-10.07) 17.20 (15.04-19.60) Ohio 3.17 (2.74-3.64) 1.42 (1.14 -1.75 ) 8.57 (8.14-9.02) 9.35 (8.90-9.82) 7.02 (6.69-7.36) 7.08 (6.75-7.42) 14.10 (13.63-14.58) Oklahoma 3.12 (2.39-4.01) 1.43 (0.95 -2.07 ) 9.07 (8.27-9.93) 10.56 (9.69-11.49) 7.36 (6.75-8.02) 7.94 (7.30-8.62) 15.30 (14.41-16.23) Oregon 2.99 (2.26-3.88) 1.80 (1.24 -2.51 ) 9.65 (8.83-10.52) 14.26 (13.28-15.31) 7.74 (7.12-8.40) 10.69 (9.96-11.45) 18.43 (17.46-19.43) Pennsylvania 3.38 (2.94-3.87) 1.55 (1.27 -1.88 ) 9.28 (8.86-9.72) 16.12 (15.56-16.69) 7.59 (7.26-7.93) 11.94 (11.53-12.36) 19.53 (19.00-20.06) Rhode Island 4.98 (3.28-7.25) - 9.57 (8.13-11.19) 16.42 (14.51-18.50) 8.25 (7.10-9.54) 11.90 (10.53-13.41) 20.15 (18.35-22.09) South Carolina 3.06 (2.39-3.87) 1.37 (0.95 -1.93 ) 8.45 (7.74-9.20) 13.41 (12.51-14.37) 6.90 (6.36-7.48) 9.96 (9.30-10.65) 16.86 (16.00-17.75) South Dakota - - 8.84 (7.21-10.74) 12.47 (10.53-14.68) 7.21 (5.96-8.65) 9.15 (7.74-10.75) 16.37 (14.46-18.46) Tennessee 2.68 (2.14-3.31) 1.61 (1.20 -2.11 ) 8.86 (8.25-9.51) 13.34 (12.59-14.13) 7.09 (6.62-7.58) 9.97 (9.42-10.55) 17.06 (16.34-17.81) Texas* 3.25 (2.92-3.62) 1.84 (1.59 -2.13 ) 8.55 (8.16-8.95) 17.33 (16.77-17.90) 7.03 (6.74-7.33) 12.89 (12.48-13.30) 19.92 (19.42-20.43) Utah 3.24 (2.45-4.22) 1.82 (1.23 -2.60 ) 9.69 (8.56-10.92) 20.59 (18.93-22.35) 7.84 (7.00-8.75) 15.21 (14.01-16.47) 23.04 (21.57-24.58) Virginia 2.53 (2.06-3.07) 0.78 (0.54 -1.11 ) 8.07 (7.54-8.63) 10.37 (9.77-11.00) 6.48 (6.08-6.90) 7.62 (7.18-8.08) 14.10 (13.50-14.72) Washington 3.49 (2.89-4.19) 2.20 (1.73 -2.76 ) 9.74 (9.10-10.42) 19.11 (18.22-20.05) 7.95 (7.46-8.47) 14.26 (13.61-14.94) 22.21 (21.39-23.06) West Virginia 3.55 (2.41-5.04) - 9.20 (8.13-10.37) 12.94 (11.67-14.31) 7.58 (6.74-8.49) 9.69 (8.75-10.70) 17.26 (16.00-18.61) Wyoming - - 8.60 (6.60-11.01) 10.96 (8.69-13.65) 6.65 (5.16-8.45) 8.13 (6.47-10.08) 14.78 (12.51-17.34) aRates are per 100,000 person years *Katrina and Rita affected state (Alabama, Louisiana, Mississippi, and Texas) rates are based on a full year for 2004 and January-June of 2005. 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.

32

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, 2004-2005

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, and occipital lobes of the brain 12,839 5.09 (5.00-5.18) 10,640 3.65 (3.58-3.72) 23,479 4.31 (4.25-4.36)

C71.0 Cerebrum 1,113 0.44 (0.41-0.46) 971 0.34 (0.32-0.36) 2,084 0.39 (0.37-0.40) C71.5 Ventricle 656 0.25 (0.23-0.27) 521 0.19 (0.18-0.21) 1,177 0.22 (0.21-0.23) C71.6 Cerebellum 1,612 0.62 (0.59-0.65) 1,449 0.53 (0.50-0.55) 3,061 0.57 (0.55-0.59) C71.7 Brain stem 929 0.36 (0.33-0.38) 832 0.31 (0.29-0.33) 1,761 0.33 (0.32-0.35) C71.8-C71.9 Other brain 5,586 2.26 (2.20-2.32) 5,232 1.76 (1.71-1.80) 10,818 1.98 (1.95-2.02) C72.0-C72.1 Spinal cord and cauda equina 1,810 0.69 (0.66-0.72) 1,745 0.62 (0.59-0.65) 3,555 0.65 (0.63-0.68) C72.2-C72.5 Cranial nerves 3,205 1.22 (1.18-1.27) 3,532 1.24 (1.20-1.28) 6,737 1.23 (1.20-1.26) C72.8-C72.9 Other nervous system 343 0.13 (0.12-0.15) 292 0.1 (0.09-0.12) 635 0.12 (0.11-0.13)

C70.0-C70.9 Meninges (cerebral and spinal) 8,404 3.47 (3.39-3.55) 23,351 7.77 (7.67-7.88) 31,755 5.79 (5.73-5.86)

C75.1-C75.2 Pituitary 6,157 2.41 (2.35-2.47) 7,145 2.57 (2.51-2.63) 13,302 2.45 (2.41-2.50) C75.3 Pineal 276 0.1 (0.09-0.12) 164 0.06 (0.05-0.07) 440 0.08 (0.08-0.09) C30.0 (9522-9523)

Olfactory tumors of the nasal cavity 109 0.04 (0.04-0.05) 77 0.03 (0.02-0.03) 186 0.03 (0.03-0.04)

TOTAL 43,039 17.08 (16.91-17.24) 55,951 19.16 (19.00-19.32) 98,990 18.16 (18.05-18.27)

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.

33

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, 2004-2005

Histology

TOTAL

N

% of All Reported

Brain Tumors

Adjusted Rate (95% C.I.)

Tumors of Neuroepithelial Tissue 34,806 35.2 6.41 (6.35-6.48) Pilocytic astrocytoma 1,685 1.7 0.32 (0.31-0.34) Protoplasmic & fibrillary astrocytoma 520 0.5 0.10 (0.09-0.11) Anaplastic astrocytoma 2,189 2.2 0.40 (0.39-0.42) Unique astrocytoma variants 466 0.5 0.09 (0.08-0.10) Astrocytoma, NOS 2,426 2.5 0.45 (0.43-0.47) Glioblastoma 17,442 17.6 3.18 (3.13-3.22) Oligodendroglioma 1,454 1.5 0.27 (0.26-0.29) Anaplastic oligodendroglioma 674 0.7 0.12 (0.12-0.13) Ependymoma/anaplastic ependymoma 1,405 1.4 0.26 (0.25-0.27) Ependymoma variants 483 0.5 0.09 (0.08-0.10) Mixed glioma 931 0.9 0.17 (0.16-0.18) Glioma malignant, NOS 2,265 2.3 0.42 (0.41-0.44) Choroid plexus 221 0.2 0.04 (0.04-0.05) Neuroepithelial 107 0.1 0.02 (0.02-0.02) Non-malignant and malignant neuronal/glial 1,340 1.4 0.25 (0.24-0.27) Pineal parenchymal 175 0.2 0.03 (0.03-0.04) Embryonal/primitive/medulloblastoma 1,023 1.0 0.20 (0.18-0.21) Tumors of Cranial and Spinal Nerves 8,631 8.7 1.57 (1.54-1.61) Nerve sheath, non-malignant and malignant 8,630 8.7 1.57 (1.54-1.61) Tumors of Meninges 34,291 34.6 6.26 (6.19-6.33) Meningioma 33,042 33.4 6.03 (5.96-6.09) Other mesenchymal, non-malignant and malignant 385 0.4 0.07 (0.06-0.08) Hemangioblastoma 864 0.9 0.16 (0.15-0.17) Lymphomas and Hematopoietic Neoplasms 2,485 2.5 0.46 (0.44-0.48) Lymphoma 2,485 2.5 0.46 (0.44-0.48) Germ Cell Tumors and Cysts 412 0.4 0.08 (0.07-0.09) Germ cell tumors, cysts and heterotopias 412 0.4 0.08 (0.07-0.09) Tumors of Sellar Region 12,789 12.9 2.36 (2.32-2.40) Pituitary 12,038 12.2 2.22 (2.18-2.26) Craniopharyngioma 751 0.8 0.14 (0.13-0.15) Local Extensions from Regional Tumors 105 0.1 0.02 (0.02-0.02) Chordoma/chondrosarcoma 105 0.1 0.02 (0.02-0.02) Unclassified Tumors 5,471 5.5 1.00 (0.98-1.03) Hemangioma 705 0.7 0.13 (0.12-0.14) Neoplasm, unspecified 4,721 4.8 0.86 (0.84-0.89) All other 45 0.0 0.01 (0.01-0.01)

TOTALb 98,990 100.0 18.16 (18.05-18.27) 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.

34

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, 2004-2005 Males Females

Histology Adjusted

Rate 95% C.I. Adjusted

Rate 95% C.I.

Tumors of Neuroepithelial Tissue 7.61 (7.51-7.72) 5.39 (5.31-5.48) Pilocytic astrocytoma 0.33 (0.31-0.35) 0.31 (0.29-0.34) Protoplasmic & fibrillary astrocytoma 0.11 (0.10-0.12) 0.09 (0.08-0.10) Anaplastic astrocytoma 0.47 (0.45-0.50) 0.34 (0.32-0.37) Unique astrocytoma variants 0.11 (0.10-0.13) 0.06 (0.05-0.07) Astrocytoma, NOS 0.50 (0.47-0.53) 0.41 (0.38-0.43) Glioblastoma 4.01 (3.93-4.09) 2.48 (2.43-2.54) Oligodendroglioma 0.31 (0.29-0.33) 0.23 (0.22-0.25) Anaplastic oligodendroglioma 0.14 (0.12-0.15) 0.11 (0.10-0.13) Ependymoma/anaplastic ependymoma 0.27 (0.25-0.29) 0.25 (0.23-0.27) Ependymoma variants 0.10 (0.09-0.12) 0.07 (0.06-0.09) Mixed glioma 0.21 (0.19-0.22) 0.14 (0.13-0.16) Glioma malignant, NOS 0.46 (0.44-0.49) 0.39 (0.37-0.42) Choroid plexus 0.04 (0.04-0.05) 0.04 (0.03-0.05) Neuroepithelial 0.02 (0.02-0.03) 0.02 (0.01-0.02) Non-malignant and malignant neuronal/glial 0.28 (0.26-0.30) 0.23 (0.21-0.24) Pineal parenchymal 0.03 (0.02-0.04) 0.04 (0.03-0.05) Embryonal/primitive/medulloblastoma 0.22 (0.20-0.24) 0.17 (0.15-0.19)

Tumors of Cranial and Spinal Nerves 1.59 (1.55-1.64) 1.56 (1.51-1.61) Nerve sheath, non-malignant and malignant 1.59 (1.55-1.64) 1.56 (1.51-1.61)

Tumors of Meninges 3.86 (3.78-3.94) 8.31 (8.20-8.41) Meningioma 3.61 (3.53-3.68) 8.10 (8.00-8.20) Other mesenchymal, non-malignant and malignant 0.07 (0.06-0.09) 0.07 (0.06-0.08) Hemangioblastoma 0.18 (0.16-0.20) 0.14 (0.13-0.16)

Lymphomas and Hematopoietic Neoplasms 0.54 (0.52-0.57) 0.38 (0.36-0.40) Lymphoma 0.54 (0.52-0.57) 0.38 (0.36-0.40)

Germ Cell Tumors and Cysts 0.11 (0.09-0.12) 0.05 (0.04-0.06) Germ cell tumors, cysts and heterotopias 0.11 (0.09-0.12) 0.05 (0.04-0.06)

Tumors of Sellar Region 2.31 (2.25-2.37) 2.47 (2.41-2.53) Pituitary 2.16 (2.10-2.22) 2.34 (2.28-2.40) Craniopharyngioma 0.15 (0.14-0.17) 0.13 (0.12-0.14)

Local Extensions from Regional Tumors 0.02 (0.02-0.03) 0.02 (0.01-0.02) Chordoma/chondrosarcoma 0.02 (0.02-0.03) 0.02 (0.01-0.02)

Unclassified Tumors 1.03 (0.99-1.07) 0.99 (0.95-1.03) Hemangioma 0.11 (0.10-0.12) 0.15 (0.14-0.16) Neoplasm, unspecified 0.91 (0.87-0.95) 0.83 (0.80-0.87) All other 0.01 (0.01-0.02) 0.01 (0.00-0.01)

TOTALb 17.08 (16.91-17.24) 19.16 (19.00-19.32) 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.

35

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, 2004-2005

Whites Blacks

Histology Adjusted


Rate 95% C.I.

Tumors of Neuroepithelial Tissue 6.91 (6.83-6.99) 3.58 (3.43-3.73) Pilocytic astrocytoma 0.34 (0.33-0.36) 0.22 (0.19-0.25) Protoplasmic & fibrillary astrocytoma 0.11 (0.10-0.12) 0.05 (0.03-0.07) Anaplastic astrocytoma 0.44 (0.42-0.46) 0.19 (0.16-0.23) Unique astrocytoma variants 0.09 (0.08-0.10) 0.06 (0.04-0.08) Astrocytoma, NOS 0.48 (0.46-0.51) 0.30 (0.26-0.35) Glioblastoma 3.45 (3.39-3.50) 1.57 (1.47-1.68) Oligodendroglioma 0.30 (0.29-0.32) 0.11 (0.08-0.13) Anaplastic oligodendroglioma 0.14 (0.13-0.15) 0.04 (0.03-0.06) Ependymoma/anaplastic ependymoma 0.27 (0.26-0.29) 0.17 (0.14-0.20) Ependymoma variants 0.10 (0.09-0.11) 0.02 (0.01-0.04) Mixed glioma 0.19 (0.18-0.21) 0.08 (0.06-0.11) Glioma malignant, NOS 0.44 (0.42-0.46) 0.34 (0.29-0.39) Choroid plexus 0.04 (0.04-0.05) 0.03 (0.02-0.05) Neuroepithelial 0.02 (0.02-0.03) - - Non-malignant and malignant neuronal/glial 0.26 (0.25-0.28) 0.19 (0.16-0.22) Pineal parenchymal 0.03 (0.03-0.04) 0.06 (0.04-0.08) Embryonal/primitive/medulloblastoma 0.20 (0.19-0.22) 0.14 (0.12-0.17)

Tumors of Cranial and Spinal Nerves 1.65 (1.61-1.69) 0.63 (0.57-0.70) Nerve sheath, non-malignant and malignant 1.65 (1.61-1.69) 0.63 (0.57-0.70)

Tumors of Meninges 6.13 (6.06-6.20) 6.82 (6.59-7.04) Meningioma 5.90 (5.83-5.97) 6.63 (6.41-6.86) Other mesenchymal, non-malignant and malignant 0.07 (0.07-0.08) 0.05 (0.03-0.07) Hemangioblastoma 0.16 (0.15-0.17) 0.13 (0.11-0.17)

Lymphomas and Hematopoietic Neoplasms 0.45 (0.43-0.47) 0.41 (0.36-0.47) Lymphoma 0.45 (0.43-0.47) 0.41 (0.36-0.47)

Germ Cell Tumors and Cysts 0.08 (0.07-0.09) 0.05 (0.04-0.07) Germ cell tumors, cysts and heterotopias 0.08 (0.07-0.09) 0.05 (0.04-0.07)

Tumors of Sellar Region 2.15 (2.11-2.20) 3.69 (3.53-3.85) Pituitary 2.02 (1.98-2.07) 3.48 (3.33-3.64) Craniopharyngioma 0.13 (0.12-0.14) 0.20 (0.17-0.24)

Local Extensions from Regional Tumors 0.02 (0.02-0.02) - - Chordoma/chondrosarcoma 0.02 (0.02-0.02) - -

Unclassified Tumors 0.99 (0.96-1.01) 1.16 (1.07-1.25) Hemangioma 0.13 (0.12-0.15) 0.11 (0.08-0.14) Neoplasm, unspecified 0.84 (0.82-0.87) 1.05 (0.96-1.14) All other 0.01 (0.01-0.01) - -

TOTALb 18.38 (18.25-18.50) 16.34 (16.01-16.68) 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.

36

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, 2004-2005

Hispanics White Non-Hispanics White Black (Of Any Race) Hispanics (Of Any Race) Non-Hispanics Non-Hispanics

Histology Adjusted





Rate 95% C.I. Tumors of Neuroepithelial Tissue 5.08 (4.89-5.28) 5.16 (4.95-5.36) 6.60 (6.53-6.67) 7.20 (7.11-7.28) 3.61 (3.46-3.77) Pilocytic astrocytoma 0.23 (0.20-0.26) 0.22 (0.19-0.26) 0.34 (0.33-0.36) 0.38 (0.36-0.40) 0.22 (0.19-0.26) Protoplasmic & fibrillary astrocytoma 0.06 (0.04-0.08) 0.06 (0.04-0.09) 0.10 (0.09-0.11) 0.11 (0.10-0.13) 0.05 (0.03-0.07) Anaplastic astrocytoma 0.33 (0.28-0.38) 0.33 (0.28-0.39) 0.42 (0.40-0.43) 0.46 (0.44-0.48) 0.19 (0.16-0.23) Unique astrocytoma variants 0.09 (0.06-0.11) 0.09 (0.07-0.11) 0.09 (0.08-0.10) 0.09 (0.08-0.10) 0.06 (0.04-0.08) Astrocytoma, NOS 0.35 (0.30-0.40) 0.35 (0.31-0.41) 0.47 (0.45-0.49) 0.51 (0.48-0.53) 0.31 (0.27-0.36) Glioblastoma 2.48 (2.33-2.64) 2.54 (2.38-2.70) 3.25 (3.20-3.30) 3.55 (3.49-3.61) 1.59 (1.48-1.70) Oligodendroglioma 0.21 (0.18-0.25) 0.22 (0.19-0.26) 0.28 (0.27-0.30) 0.32 (0.30-0.34) 0.11 (0.09-0.14) Anaplastic oligodendroglioma 0.11 (0.08-0.14) 0.11 (0.08-0.14) 0.13 (0.12-0.14) 0.14 (0.13-0.16) 0.04 (0.03-0.06) Ependymoma/anaplastic ependymoma 0.22 (0.19-0.26) 0.22 (0.19-0.26) 0.27 (0.25-0.28) 0.28 (0.26-0.30) 0.17 (0.14-0.21) Ependymoma variants 0.07 (0.05-0.09) 0.07 (0.05-0.09) 0.09 (0.09-0.10) 0.11 (0.10-0.12) 0.03 (0.02-0.04) Mixed glioma 0.14 (0.11-0.17) 0.14 (0.11-0.17) 0.18 (0.17-0.19) 0.20 (0.19-0.22) 0.08 (0.06-0.10) Glioma malignant, NOS 0.33 (0.29-0.38) 0.33 (0.28-0.38) 0.44 (0.42-0.46) 0.46 (0.44-0.48) 0.34 (0.29-0.39) Choroid plexus 0.04 (0.03-0.06) 0.04 (0.03-0.06) 0.04 (0.04-0.05) 0.04 (0.04-0.05) 0.04 (0.02-0.05) Neuroepithelial - - - - 0.02 (0.02-0.03) 0.02 (0.02-0.03) - - Non-malignant and malignant neuronal/glial 0.18 (0.16-0.22) 0.18 (0.15-0.21) 0.26 (0.25-0.28) 0.28 (0.27-0.30) 0.19 (0.16-0.22) Pineal parenchymal 0.03 (0.02-0.04) 0.03 (0.02-0.04) 0.03 (0.03-0.04) 0.03 (0.03-0.04) 0.06 (0.04-0.08) Embryonal/primitive/medulloblastoma 0.21 (0.18-0.24) 0.21 (0.18-0.25) 0.19 (0.18-0.20) 0.20 (0.19-0.22) 0.14 (0.12-0.17) Tumors of Cranial and Spinal Nerves 1.22 (1.13-1.32) 1.19 (1.09-1.29) 1.62 (1.58-1.66) 1.72 (1.68-1.76) 0.63 (0.57-0.70) Nerve sheath, non-malignant and malignant 1.22 (1.13-1.32) 1.19 (1.09-1.29) 1.62 (1.58-1.66) 1.72 (1.68-1.76) 0.63 (0.57-0.70) Tumors of Meninges 6.48 (6.24-6.73) 6.37 (6.12-6.62) 6.26 (6.19-6.33) 6.13 (6.05-6.21) 6.88 (6.66-7.12) Meningioma 6.25 (6.01-6.49) 6.14 (5.90-6.39) 6.03 (5.96-6.09) 5.89 (5.82-5.96) 6.70 (6.48-6.93) Other mesenchymal, non-malignant and malignant 0.08 (0.06-0.10) 0.08 (0.05-0.10) 0.07 (0.06-0.08) 0.07 (0.07-0.08) 0.05 (0.03-0.07) Hemangioblastoma 0.16 (0.13-0.20) 0.15 (0.12-0.19) 0.16 (0.15-0.17) 0.17 (0.15-0.18) 0.13 (0.11-0.17) Lymphomas and Hematopoietic Neoplasms 0.50 (0.44-0.57) 0.50 (0.44-0.57) 0.45 (0.43-0.47) 0.44 (0.42-0.46) 0.42 (0.37-0.47) Lymphoma 0.50 (0.44-0.57) 0.50 (0.44-0.57) 0.45 (0.43-0.47) 0.44 (0.42-0.46) 0.42 (0.37-0.47) Germ Cell Tumors and Cysts 0.08 (0.06-0.10) 0.08 (0.06-0.10) 0.08 (0.07-0.09) 0.08 (0.07-0.09) 0.05 (0.04-0.07) Germ cell tumors, cysts and heterotopias 0.08 (0.06-0.10) 0.08 (0.06-0.10) 0.08 (0.07-0.09) 0.08 (0.07-0.09) 0.05 (0.04-0.07) Tumors of Sellar Region 2.88 (2.73-3.02) 2.84 (2.69-2.99) 2.30 (2.26-2.34) 2.06 (2.02-2.11) 3.76 (3.60-3.93) Pituitary 2.73 (2.59-2.87) 2.70 (2.56-2.85) 2.16 (2.12-2.20) 1.94 (1.89-1.98) 3.56 (3.40-3.72) Craniopharyngioma 0.15 (0.12-0.18) 0.14 (0.11-0.17) 0.14 (0.13-0.15) 0.13 (0.11-0.14) 0.20 (0.17-0.24) Local Extensions from Regional Tumors 0.03 (0.02-0.05) 0.03 (0.02-0.05) 0.02 (0.01-0.02) 0.02 (0.01-0.02) - - Chordoma/chondrosarcoma 0.03 (0.02-0.05) 0.03 (0.02-0.05) 0.02 (0.01-0.02) 0.02 (0.01-0.02) - - Unclassified Tumors 1.10 (1.00-1.20) 1.11 (1.00-1.22) 1.00 (0.97-1.02) 0.97 (0.94-1.01) 1.17 (1.08-1.27) Hemangioma 0.13 (0.10-0.16) 0.13 (0.10-0.17) 0.13 (0.12-0.14) 0.14 (0.12-0.15) 0.11 (0.08-0.14) Neoplasm, unspecified 0.97 (0.87-1.07) 0.97 (0.88-1.08) 0.86 (0.83-0.88) 0.83 (0.80-0.86) 1.06 (0.97-1.15) All other - - - - 0.01 (0.01-0.01) 0.01 (0.01-0.01) - -

TOTALc 17.38 (17.00-17.76) 17.27 (16.89-17.66) 18.31 (18.19-18.43) 18.62 (18.49-18.76) 16.55 (16.21-16.89) 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.

37

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, 2004-2005 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 3.47 (3.36-3.58) 3.25 (3.16-3.35) 3.03 (2.93-3.13) 4.30 (4.16-4.44) 6.91 (6.73-7.10) 11.74 (11.46-12.04) 17.49 (17.04-17.94) 19.60 (19.04-20.17) 11.67 (10.97-12.40) Pilocytic astrocytoma 0.87 (0.81-0.92) 0.79 (0.75-0.84) 0.25 (0.22-0.28) 0.12 (0.09-0.14) 0.08 (0.06-0.10) 0.06 (0.04-0.09) 0.07 (0.05-0.11) - - - - Protoplasmic & fibrillary astrocytoma 0.05 (0.04-0.07) 0.05 (0.04-0.06) 0.08 (0.06-0.10) 0.11 (0.09-0.14) 0.11 (0.08-0.13) 0.14 (0.11-0.17) 0.21 (0.16-0.26) 0.17 (0.12-0.23) - - Anaplastic astrocytoma 0.06 (0.05-0.08) 0.07 (0.06-0.08) 0.28 (0.25-0.31) 0.43 (0.39-0.48) 0.51 (0.46-0.57) 0.77 (0.70-0.85) 1.03 (0.93-1.15) 1.06 (0.93-1.20) 0.37 (0.25-0.52) Unique astrocytoma variants 0.08 (0.07-0.10) 0.09 (0.08-0.11) 0.07 (0.06-0.09) 0.07 (0.06-0.10) 0.09 (0.07-0.11) 0.13 (0.10-0.16) 0.12 (0.09-0.16) - - - - Astrocytoma, NOS 0.22 (0.20-0.25) 0.22 (0.20-0.24) 0.36 (0.33-0.40) 0.44 (0.40-0.49) 0.48 (0.43-0.53) 0.61 (0.54-0.68) 0.95 (0.84-1.06) 1.21 (1.07-1.36) 0.68 (0.52-0.87) Glioblastoma 0.11 (0.09-0.13) 0.14 (0.12-0.16) 0.40 (0.37-0.44) 1.16 (1.09-1.24) 3.74 (3.61-3.88) 8.09 (7.85-8.33) 13.16 (12.77-13.55) 14.61 (14.13-15.11) 8.57 (7.98-9.20) Oligodendroglioma 0.05 (0.04-0.07) 0.07 (0.05-0.08) 0.31 (0.28-0.35) 0.52 (0.47-0.57) 0.43 (0.38-0.47) 0.30 (0.26-0.35) 0.22 (0.17-0.27) 0.15 (0.11-0.21) - - Anaplastic oligodendroglioma - - 0.02 (0.01-0.02) 0.09 (0.07-0.11) 0.18 (0.15-0.21) 0.21 (0.18-0.24) 0.25 (0.21-0.29) 0.21 (0.17-0.27) 0.20 (0.15-0.27) - - Ependymoma/anaplastic ependymoma 0.26 (0.23-0.30) 0.24 (0.22-0.27) 0.19 (0.17-0.22) 0.26 (0.23-0.30) 0.32 (0.28-0.36) 0.37 (0.32-0.42) 0.33 (0.28-0.40) 0.25 (0.19-0.32) - - Ependymoma variants 0.02 (0.01-0.03) 0.03 (0.02-0.04) 0.11 (0.09-0.13) 0.13 (0.11-0.16) 0.15 (0.12-0.18) 0.10 (0.08-0.13) 0.08 (0.06-0.12) - - - - Mixed glioma 0.03 (0.02-0.04) 0.04 (0.03-0.05) 0.23 (0.20-0.26) 0.29 (0.26-0.33) 0.21 (0.18-0.25) 0.24 (0.20-0.29) 0.18 (0.14-0.23) 0.13 (0.09-0.19) - - Glioma malignant, NOS 0.60 (0.56-0.65) 0.51 (0.47-0.55) 0.21 (0.18-0.24) 0.23 (0.19-0.26) 0.28 (0.24-0.32) 0.38 (0.33-0.44) 0.67 (0.58-0.76) 1.32 (1.18-1.48) 1.57 (1.32-1.85) Choroid plexus 0.10 (0.08-0.12) 0.08 (0.07-0.10) 0.03 (0.02-0.04) 0.03 (0.02-0.04) 0.02 (0.01-0.04) - - - - - - - - Neuroepithelial - - 0.01 (0.01-0.02) - - - - 0.02 (0.01-0.03) 0.03 (0.02-0.05) - - 0.08 (0.05-0.13) - - Non-malignant and malignant neuronal/glial 0.35 (0.31-0.39) 0.37 (0.34-0.40) 0.24 (0.21-0.27) 0.21 (0.18-0.25) 0.19 (0.16-0.23) 0.19 (0.15-0.23) 0.16 (0.12-0.21) 0.19 (0.14-0.26) - - Pineal parenchymal 0.04 (0.03-0.06) 0.04 (0.03-0.05) 0.03 (0.02-0.04) 0.03 (0.02-0.04) 0.03 (0.02-0.05) 0.03 (0.02-0.05) - - - - - - Embryonal/primitive/medulloblastoma 0.59 (0.54-0.63) 0.49 (0.46-0.53) 0.14 (0.12-0.16) 0.08 (0.06-0.10) 0.05 (0.03-0.07) 0.04 (0.02-0.06) - - - - - -

Tumors of Cranial and Spinal Nerves 0.19 (0.17-0.22) 0.23 (0.20-0.25) 0.77 (0.72-0.82) 1.70 (1.61-1.79) 2.80 (2.68-2.92) 3.65 (3.49-3.82) 3.65 (3.45-3.86) 2.69 (2.49-2.91) 1.18 (0.97-1.43) Nerve sheath, non-malignant and malignant 0.19 (0.17-0.22) 0.23 (0.20-0.25) 0.77 (0.72-0.82) 1.70 (1.61-1.79) 2.80 (2.68-2.92) 3.65 (3.49-3.82) 3.65 (3.45-3.86) 2.69 (2.49-2.91) 1.18 (0.97-1.43)

Tumors of Meninges 0.14 (0.12-0.17) 0.20 (0.17-0.22) 1.20 (1.14-1.27) 3.88 (3.74-4.02) 7.55 (7.35-7.74) 12.43 (12.13-12.73) 20.86 (20.37-21.36) 28.99 (28.31-29.68) 35.42 (34.20-36.67) Meningioma 0.10 (0.08-0.12) 0.13 (0.11-0.15) 1.01 (0.95-1.07) 3.60 (3.47-3.73) 7.20 (7.01-7.40) 12.04 (11.75-12.34) 20.44 (19.95-20.92) 28.66 (27.98-29.35) 35.27 (34.06-36.52) Other mesenchymal, non-malignant and malignant 0.04 (0.03-0.05) 0.04 (0.03-0.05) 0.05 (0.04-0.07) 0.08 (0.07-0.11) 0.09 (0.07-0.12) 0.11 (0.08-0.14) 0.14 (0.10-0.18) 0.11 (0.07-0.16) - - Hemangioblastoma - - 0.03 (0.02-0.04) 0.14 (0.12-0.17) 0.20 (0.17-0.23) 0.25 (0.22-0.29) 0.27 (0.23-0.32) 0.29 (0.24-0.35) 0.23 (0.17-0.30) - -

Lymphomas and Hematopoietic Neoplasms 0.02 (0.01-0.03) 0.02 (0.02-0.03) 0.12 (0.10-0.14) 0.30 (0.27-0.34) 0.50 (0.45-0.56) 0.97 (0.89-1.05) 1.70 (1.56-1.84) 2.13 (1.95-2.33) 1.10 (0.90-1.34) Lymphoma 0.02 (0.01-0.03) 0.02 (0.02-0.03) 0.12 (0.10-0.14) 0.30 (0.27-0.34) 0.50 (0.45-0.56) 0.97 (0.89-1.05) 1.70 (1.56-1.84) 2.13 (1.95-2.33) 1.10 (0.90-1.34) Germ Cell Tumors and Cysts 0.17 (0.14-0.19) 0.19 (0.17-0.21) 0.08 (0.07-0.10) 0.02 (0.01-0.03) - - - - - - - - - - Germ cell tumors, cysts and heterotopias 0.17 (0.14-0.19) 0.19 (0.17-0.21) 0.08 (0.07-0.10) 0.02 (0.01-0.03) - - - - - - - - - -

Tumors of Sellar Region 0.29 (0.26-0.33) 0.49 (0.46-0.53) 1.91 (1.83-1.99) 2.61 (2.50-2.73) 3.22 (3.10-3.35) 3.85 (3.69-4.02) 5.47 (5.22-5.72) 5.03 (4.75-5.33) 3.07 (2.71-3.45) Pituitary 0.13 (0.11-0.15) 0.34 (0.31-0.37) 1.82 (1.74-1.90) 2.47 (2.36-2.58) 3.05 (2.93-3.18) 3.69 (3.53-3.85) 5.30 (5.06-5.55) 4.93 (4.65-5.22) 2.99 (2.64-3.37) Craniopharyngioma 0.16 (0.14-0.19) 0.15 (0.13-0.17) 0.10 (0.08-0.12) 0.14 (0.12-0.17) 0.17 (0.14-0.20) 0.17 (0.14-0.21) 0.17 (0.13-0.22) 0.10 (0.07-0.15) - -

Local Extensions from Regional Tumors - - - - 0.02 (0.01-0.03) - - 0.03 (0.02-0.04) - - 0.05 (0.03-0.08) - - - - Unclassified Tumors 0.18 (0.15-0.20) 0.20 (0.18-0.22) 0.42 (0.38-0.46) 0.63 (0.58-0.69) 0.78 (0.72-0.85) 1.30 (1.20-1.40) 2.28 (2.12-2.45) 5.25 (4.96-5.55) 9.94 (9.30-10.62)

TOTALb 4.47 (4.34-4.59) 4.58 (4.47-4.69) 7.55 (7.39-7.71) 13.46 (13.21-13.71) 21.81 (21.48-22.14) 33.97 (33.48-34.47) 51.50 (50.73-52.27) 63.75 (62.74-64.78) 62.40 (60.78-64.06)

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

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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, 2004-2005

Male Female TOTAL

Histology Adjusted



Rate 95% C.I.

Tumors of Neuroepithelial Tissue 3.40 (3.27-3.53) 3.10 (2.98-3.23) 3.25 (3.16-3.35) Pilocytic astrocytoma 0.81 (0.75-0.88) 0.78 (0.71-0.84) 0.79 (0.75-0.84) Anaplastic astrocytoma 0.06 (0.04-0.08) 0.08 (0.06-0.10) 0.07 (0.06-0.08) Astrocytoma, NOS 0.23 (0.19-0.26) 0.21 (0.18-0.25) 0.22 (0.20-0.24) Glioblastoma 0.16 (0.13-0.19) 0.11 (0.09-0.14) 0.14 (0.12-0.16) Ependymoma/anaplastic ependymoma 0.25 (0.21-0.29) 0.24 (0.20-0.27) 0.24 (0.22-0.27) Glioma malignant, NOS 0.49 (0.45-0.55) 0.52 (0.47-0.58) 0.51 (0.47-0.55) Non-malignant and malignant neuronal/glial 0.40 (0.35-0.45) 0.34 (0.30-0.38) 0.37 (0.34-0.40) Embryonal/primitive/medulloblastoma 0.55 (0.50-0.61) 0.43 (0.38-0.48) 0.49 (0.46-0.53)

Tumors of Cranial and Spinal Nerves 0.21 (0.18-0.24) 0.24 (0.21-0.28) 0.23 (0.20-0.25)

Tumors of Meninges 0.18 (0.15-0.21) 0.21 (0.18-0.25) 0.20 (0.17-0.22) Lymphomas and Hematopoietic Neoplasms - - - - 0.02 (0.02-0.03)

Germ Cell Tumors and Cysts 0.25 (0.22-0.29) 0.12 (0.10-0.15) 0.19 (0.17-0.21)

Tumors of Sellar Region 0.35 (0.31-0.39) 0.65 (0.59-0.71) 0.49 (0.46-0.53) Pituitary 0.20 (0.17-0.23) 0.50 (0.45-0.55) 0.34 (0.31-0.37) Craniopharyngioma 0.15 (0.13-0.18) 0.15 (0.12-0.18) 0.15 (0.13-0.17) Local Extensions from Regional Tumors - - - - - -

Unclassified Tumors 0.20 (0.17-0.24) 0.20 (0.17-0.23) 0.20 (0.18-0.22)

TOTALb 4.61 (4.46-4.77) 4.55 (4.39-4.70) 4.58 (4.47-4.69)

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.

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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, 2004-2005

Whites Blacks

Histology Grouping Adjusted


Rate 95% C.I.

Tumors of Neuroepithelial Tissue 3.37 (3.27 -3.48) 2.53 (2.33 -2.74) Pilocytic astrocytoma 0.84 (0.79 -0.90) 0.54 (0.45 -0.64) Anaplastic astrocytoma 0.07 (0.06 -0.09) - - Astrocytoma, NOS 0.23 (0.20 -0.25) 0.16 (0.11 -0.22) Glioblastoma 0.14 (0.12 -0.16) 0.12 (0.08 -0.17) Ependymoma/anaplastic ependymoma 0.25 (0.22 -0.28) 0.21 (0.16 -0.28) Glioma malignant, NOS 0.52 (0.48 -0.56) 0.41 (0.33 -0.50) Non-malignant and malignant neuronal/glial 0.39 (0.36 -0.43) 0.29 (0.23 -0.37) Embryonal/primitive/medulloblastoma 0.52 (0.48 -0.56) 0.34 (0.27 -0.42)

Tumors of Cranial and Spinal Nerves 0.24 (0.21 -0.27) 0.12 (0.08 -0.17)

Tumors of Meninges 0.20 (0.18 -0.23) 0.15 (0.11 -0.21) Lymphomas and Hematopoietic Neoplasms - - - -

Germ Cell Tumors and Cysts 0.20 (0.18 -0.23) 0.08 (0.05 -0.12)

Tumors of Sellar Region 0.50 (0.46 -0.54) 0.41 (0.33 -0.50) Pituitary 0.35 (0.31 -0.38) 0.27 (0.21 -0.34) Craniopharyngioma 0.15 (0.13 -0.17) 0.15 (0.10 -0.20)

Local Extensions from Regional Tumors - - - -

Unclassified Tumors 0.20 (0.18 -0.23) 0.18 (0.13 -0.24)

TOTALb 4.74 (4.62-4.87) 3.50 (3.27-3.74)

Male 4.80 (4.63-4.98) 3.40 (3.09-3.74) Female 4.69 (4.51-4.87) 3.60 (3.26-3.95)

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.

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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, 2004-2005

Age at Diagnosis Age at Diagnosis 0-4 5-9 10-14 15-19 0-19b 0-14b

Histology

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

Rate 95% C.I.

Rate 95% C.I.

Adjusted Rate 95% C.I.

Adjusted Rate 95% C.I.

Tumors of Neuroepithelial Tissue 4.16 (3.95-4.37) 3.45 (3.26-3.65) 2.85 (2.68-3.02) 2.60 (2.44-2.77) 3.25 (3.16-3.35) 3.47 (3.36-3.58) Pilocytic astrocytoma 0.90 (0.81-1.00) 0.90 (0.80-1.00) 0.80 (0.71-0.89) 0.58 (0.51-0.66) 0.79 (0.75-0.84) 0.87 (0.81-0.92) Anaplastic astrocytoma 0.04 (0.03-0.07) 0.07 (0.05-0.10) 0.08 (0.05-0.11) 0.08 (0.05-0.11) 0.07 (0.06-0.08) 0.06 (0.05-0.08) Astrocytoma, NOS 0.24 (0.20-0.30) 0.19 (0.15-0.24) 0.23 (0.19-0.29) 0.21 (0.16-0.26) 0.22 (0.20-0.24) 0.22 (0.20-0.25) Glioblastoma 0.11 (0.08-0.15) 0.12 (0.09-0.16) 0.11 (0.08-0.15) 0.21 (0.16-0.26) 0.14 (0.12-0.16) 0.11 (0.09-0.13) Ependymoma/anaplastic ependymoma 0.42 (0.36-0.49) 0.22 (0.18-0.28) 0.15 (0.12-0.20) 0.18 (0.14-0.23) 0.24 (0.22-0.27) 0.26 (0.23-0.30) Glioma malignant, NOS 0.77 (0.68-0.86) 0.70 (0.62-0.79) 0.35 (0.30-0.42) 0.22 (0.17-0.27) 0.51 (0.47-0.55) 0.60 (0.56-0.65) Non-malignant and malignant neuronal/glial 0.37 (0.31-0.43) 0.29 (0.23-0.35) 0.39 (0.33-0.46) 0.43 (0.37-0.50) 0.37 (0.34-0.40) 0.35 (0.31-0.39) Embryonal/primitive/medulloblastoma 0.92 (0.82-1.02) 0.56 (0.48-0.64) 0.30 (0.25-0.36) 0.21 (0.16-0.26) 0.49 (0.46-0.53) 0.59 (0.54-0.63) Tumors of Cranial and Spinal Nerves 0.21 (0.17-0.26) 0.18 (0.14-0.23) 0.19 (0.15-0.24) 0.32 (0.26-0.38) 0.23 (0.20-0.25) 0.19 (0.17-0.22) Tumors of Meninges 0.16 (0.13-0.21) 0.10 (0.07-0.14) 0.17 (0.13-0.21) 0.35 (0.30-0.42) 0.20 (0.17-0.22) 0.14 (0.12-0.17) Lymphomas and Hematopoietic Neoplasms - - - - - - - - 0.02 (0.02-0.03) - - Germ Cell Tumors and Cysts 0.12 (0.08-0.16) 0.13 (0.09-0.17) 0.25 (0.21-0.31) 0.25 (0.20-0.31) 0.19 (0.17-0.21) 0.17 (0.14-0.19) Tumors of Sellar Region 0.15 (0.11-0.19) 0.27 (0.22-0.33) 0.45 (0.39-0.53) 1.09 (0.99-1.20) 0.49 (0.46-0.53) 0.29 (0.26-0.33) Pituitary - - 0.08 (0.05-0.12) 0.28 (0.23-0.34) 0.97 (0.88-1.08) 0.34 (0.31-0.37) 0.13 (0.11-0.15) Craniopharyngioma 0.12 (0.09-0.16) 0.19 (0.15-0.24) 0.18 (0.14-0.22) 0.12 (0.08-0.16) 0.15 (0.13-0.17) 0.16 (0.14-0.19) Local Extensions from Regional Tumors - - - - - - - - - - - - Unclassified Tumors 0.19 (0.15-0.24) 0.15 (0.11-0.19) 0.19 (0.15-0.24) 0.27 (0.22-0.32) 0.20 (0.18-0.22) 0.18 (0.15-0.20)

TOTALc 5.01 (4.78-5.24) 4.28 (4.07-4.50) 4.13 (3.93-4.34) 4.92 (4.70-5.15) 4.58 (4.47-4.69) 4.47 (4.34-4.59)

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.

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

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