Higher Incidence of Brain and CNS Tumors Among People Living in Appalachia
A recent study published by Ostrom et al in the Journal of Neuro-Oncology showed that compared to the rest of the United States, the Appalachian region has a 5% higher incidence of malignant primary brain tumors and other central nervous system (CNS) tumors, a higher mortality rate due to these tumors, and poorer survival rates.
The study compared malignant vs nonmalignant brain and CNS tumors and explored several variables including race, ethnicity, age, subregions within Appalachia, and types of health-care coverage. Appalachia was selected because it already is known that residents of the region have a higher incidence of other types of cancer as well as a prevalence of behaviors or conditions such as smoking, obesity, diabetes, and other cancer-associated behavioral and environmental risk factors.
“Examining differences in incidence and survival by place of residence can provide information that is essential to understanding how risk and survival varies in the population,” said first author Quinn Ostrom, PhD, Postdoctoral Associate at Baylor College of Medicine. “Some of this variation may relate to access to health care, which can affect timing of diagnosis or whether individuals are diagnosed at all. These disparities may also point to unusual environmental or behavioral variables that merit public health investigation.”
Study Findings
Additional key findings from this study include:
- The incidence of malignant primary brain tumors in Appalachia was higher in both males and females and in all age groups compared to U.S. incidence rates. Incidence among males was higher than females, which is similar to sex differences in incidence in the larger U.S. population.
- The incidence of glioblastoma is notably higher in central and northern Appalachia compared to the rest of the United States.
- The incidence of nonmalignant brain and CNS tumors in Appalachia was 3% lower than the rest of the United States, and Appalachian incidence also was lower for two of the most common types of nonmalignant brain tumors: meningioma and pituitary tumors.
- Incidence rates within Appalachia varied, with the highest incidence of malignant primary brain tumors in the Northern and Central regions.
- 5-year relative survival for malignant primary brain tumors was lower (31.4% vs 36.0%), and mortality due to malignant primary brain tumors was higher in Appalachia (4.86/100,000 vs 4.34/100,000, P < .0001).
- When stratified by race, the incidence of malignant primary brain tumors was decreased among some populations, notably white non-Hispanics. The higher density of white non-Hispanics in Appalachia may contribute to the increased overall incidence.
“Large studies like this can point researchers to unexpected variables that merit further investigation,” said senior author Jill Barnholtz-Sloan, PhD, of the Case Western Reserve University School of Medicine. “We may want to layer in genetic research, depending on the availability of biospecimens, with a focused look at how cancer-associated behavioral risk factors correlate … or we may want to explore potential regional environmental factors. These multifaceted lines of inquiry are critical for us to better understand this disease.”
Disclosure: The study authors’ full disclosures can be found at link.springer.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
