CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017–2021

Mackenzie Price; Christine Ballard; Julia Benedetti; Corey Neff; Gino Cioffi; Kristin A Waite; Carol Kruchko; Jill S Barnholtz-Sloan; Quinn T Ostrom

doi:10.1093/neuonc/noae145

. 2024 Oct 6;26(Suppl 6):vi1–vi85. doi: 10.1093/neuonc/noae145

CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017–2021

Mackenzie Price ¹, Christine Ballard ^2,³, Julia Benedetti ^4,⁵, Corey Neff ^6,⁷, Gino Cioffi ^8,⁹, Kristin A Waite ^10,¹¹, Carol Kruchko ¹², Jill S Barnholtz-Sloan ^13,^14,^15,^1,^✉, Quinn T Ostrom ^16,^17,^18,^19,^1,^✉

¹ Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A

² Department of Neurosurgery, Duke University School of Medicine, Durham, NC, U.S.A

³ Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A

⁴ Department of Neurosurgery, Duke University School of Medicine, Durham, NC, U.S.A

⁵ Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A

⁶ Department of Neurosurgery, Duke University School of Medicine, Durham, NC, U.S.A

⁷ Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A

⁸ Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, U.S.A

⁹ Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A

¹⁰ Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, U.S.A

¹¹ Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A

¹² Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A

¹³ Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A

¹⁴ Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, U.S.A

¹⁵ Center for Biomedical Informatics & Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, MD, U.S.A

¹⁶ Department of Neurosurgery, Duke University School of Medicine, Durham, NC, U.S.A

¹⁷ Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A

¹⁸ The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, U.S.A

¹⁹ Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A

Jill S. Barnholtz-Sloan and Quinn T. Ostrom equally supervised this report

^✉

Corresponding Author: Jill S. Barnholtz-Sloan, Ph.D., National Cancer Institute, Shady Grove Campus, 9609 Medical Center Dr. Rockville, MD 20850. Email: jill.barnholtz-sloan@nih.gov Office Phone: (240) 620-0790.

^✉

Corresponding Author: Quinn T. Ostrom, Ph.D., M.P.H., Duke University School of Medicine, DUMC Box 3050, Durham, NC 27710. Email: Quinn.Ostrom@duke.edu. Office Phone: (919) 613-4810

PMCID: PMC11456825 PMID: 39371035

Abstract

The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention and the National Cancer Institute, is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors available and supersedes all previous reports in terms of completeness and accuracy. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. Between 2017 and 2021, the average annual age-adjusted incidence rate (AAAIR) of all primary malignant and non-malignant brain and other CNS tumors was 25.34 per 100,000 population (malignant AAAIR=6.89 and non-malignant AAAIR=18.46). This overall rate was higher in females compared to males (28.77 versus 21.78 per 100,000) and non-Hispanic Black persons compared to persons who were non-Hispanic White (26.60 versus 25.72 per 100,000), non-Hispanic American Indian/Alaska Native (23.48 per 100,000), non-Hispanic Asian or Pacific Islander (19.86 per 100,000), and Hispanic persons of all races (22.37 per 100,000). Gliomas accounted for 22.9% of all tumors. The most commonly occurring malignant brain and other CNS histopathology was glioblastoma (13.9% of all tumors and 51.5% of all malignant tumors), and the most common predominantly non-malignant histopathology was meningioma (41.7% of all tumors and 56.8% of all non-malignant tumors). Glioblastomas were more common in males, and meningiomas were more common in females. In children and adolescents (ages 0-19 years), the incidence rate of all primary brain and other CNS tumors was 6.02 per 100,000 population. There were 87,053 deaths attributed to malignant brain and other CNS tumors between 2017 and 2021. This represents an average annual mortality rate of 4.41 per 100,000 population and an average of 17,411 deaths per year. The five-year relative survival rate following diagnosis of a malignant brain or other CNS tumor was 35.7%. For a non-malignant brain or other CNS tumor the five-year relative survival rate was 92.0%.

EXECUTIVE SUMMARY

The Central Brain Tumor Registry of the United States (CBTRUS) database, developed in collaboration with the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) of the United States (US) National Institutes of Health, is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States. As such, CBTRUS represents the entire US population. The CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017–2021 contains the most up-to-date population-based data on primary brain tumors available through the US surveillance system and supersedes all previous reports in terms of completeness and accuracy. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. Accordingly, this report represents a current, comprehensive source for the descriptive epidemiology of primary central nervous system tumors.

New to the CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017–2021: For the first time in an annual statistical report, we present proportions of medulloblastoma molecular subtypes by age at diagnosis.

Incidence: Newly Diagnosed Primary Brain and Other CNS Tumors, 2017-2021

Between 2017 and 2021, the average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 25.34 per 100,000 population. The AAAIR of malignant brain and other CNS tumors only was 6.89 per 100,000 population versus 18.46 per 100,000 population for non-malignant tumors.
The overall incidence rate was higher in females compared to males (28.77 vs 21.78 per 100,000, respectively). Primary malignant tumors were more frequent in males than females (8.06 vs 5.84 per 100,000, respectively).
Incidence was slightly higher among persons who were non-Hispanic Black (26.60 per 100,000) compared with persons who were non-Hispanic White (25.72 per 100,000), non-Hispanic American Indian/Alaska Native (23.48 per 100,000), non-Hispanic Asian or Pacific Islander (19.86 per 100,000), or Hispanic persons of all races (22.37 per 100,000).
Approximately 27.1% of all brain and other CNS tumors were malignant and 72.9% were non-malignant, which makes non-malignant tumors more than twice as common as malignant tumors.
Gliomas accounted for 22.9% of all tumors. The most commonly occurring malignant brain and other CNS tumor histopathology was glioblastoma (14.0% of all tumors and 51.5% of all malignant tumors).
The most common predominantly non-malignant histopathology was meningioma (41.4% of all tumors and 56.8% of all non-malignant tumors). Meningiomas were more common in females.
In children and adolescents (ages 0-19 years), the AAAIR of malignant and non-malignant brain and other CNS tumors was 6.02 per 100,000 population.
The most common medulloblastoma subtypes were Sonic Hedgehog (SHH)-activated & TP53-wildtype (included in the SHH group) and non-wingless (WNT)/non-SHH medulloblastoma (including both group 3/group C and group 4/group D).

Time Trends in Primary Brain and Other CNS Tumors Incidence, 2004-2021, excluding 2020

While incidence of brain and other CNS tumors increased overall and among non-malignant tumors only, there was a significant decrease in malignant tumors overall from 2004-2017.
Non-malignant brain tumors only had significant increases in incidence from 2004-2009 and from 2009-2021.

Mortality: Deaths Due to Primary Brain and Other CNS Tumors, 2017-2021

There were 87,053 deaths attributed to malignant brain and other CNS tumors. This represents an average annual mortality rate of 4.41 per 100,000 population and an average of 17,411 deaths per year.
Among children ages 0-14 years, brain and other CNS cancer is the most common cause of cancer death and the second most significant contributors to cancer death in adolescents and young adults ages 15-39 years.

Survival: From Diagnosis to One-, Five-, and Ten-Years Beyond, 2001-2020 (varying)

The five-year relative survival rate following diagnosis of a primary malignant brain and other CNS tumor was 35.7%. Among malignant brain and other CNS tumors, the five-year relative survival rate was highest in persons ages 0-14 years (75.3%) and ages 15-39 years (72.2%) as compared to those ages 40+ years (21.1%).
Among primary non-malignant brain and other CNS tumors, the five-year relative survival rate was 92.0%. Survival following diagnosis with a non-malignant brain and other CNS tumor was highest in persons ages 15-39 years (98.4%) and ages 0-14 years (97.7%) as compared to those ages 40+ years (90.5%).

INTRODUCTION

The objective of the CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017–2021 is to provide a comprehensive summary of the current descriptive epidemiology of all primary brain and other central nervous system (CNS) tumors in the US population. Primary brain and other CNS tumors include those tumors that originate from the tissues of the brain or other CNS sites. The Central Brain Tumor Registry of the United States (CBTRUS) obtained the latest available population-based data on all newly diagnosed primary brain and other CNS tumors reported from the Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries (NPCR), and the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) Program for diagnosis years 2017–2021. Incidence counts and rates of primary malignant and non-malignant brain and other CNS tumors are presented by histopathology, sex, age at diagnosis, race-Hispanic ethnicity, and geographic location. Mortality rates for malignant brain and comparison cancers were calculated using the National Center for Health Statistics’ (NCHS) National Vital Statistics System (NVSS) data from 2017-2021. Also presented are relative survival rates, median survival, and adjusted hazard ratios for selected malignant and non-malignant histopathologies calculated using NPCR data for the period 2001-2020 (2004-2020 for non-malignant tumors).

BACKGROUND

CBTRUS is a unique professional research organization that focuses exclusively on providing high-quality statistical data on the population-based incidence of primary brain and other CNS tumors in the United States (for more information on CBTRUS see: http://www.cbtrus.org/about/ and Kruchko, et al.¹). CBTRUS was incorporated as a nonprofit 501(c)(3) in 1992 following a study conducted by the American Brain Tumor Association to determine the feasibility of a population-based central registry focused on all reported primary brain and other CNS tumors in the United States.

This report represents the thirty-second (32 ^nd ) anniversary of CBTRUS and the twenty-seventh (27 ^th ) statistical report published by CBTRUS. For this thirteenth (13^th) report published as a Supplement to Neuro-Oncology, the official journal of the Society for Neuro-Oncology (http://www.soc-neuro-onc.org), CBTRUS continues its past efforts to provide the most up-to-date population-based incidence rates for all reported newly-diagnosed primary brain and other CNS tumors by behavior (malignant and non-malignant), histopathology, age at diagnosis, sex, race-Hispanic ethnicity, selected brain molecular markers (BMM), and geographic location. These data have been organized by clinically relevant histopathology groupings that reflect the 2016 World Health Organization (WHO) Classification of Tumours of the Central Nervous System, including selected molecularly-defined histopathologies beginning in diagnosis year 2018.^2,3 These data provide important information for allocation and planning of specialty healthcare services such as clinical trials, research activities, and disease prevention and control programs. These data may also stimulate research into the causes of this group of diseases, which often result in significant morbidity and mortality.

CBTRUS is currently the only population-based site-specific registry in the United States that works in partnership with a public cancer surveillance organization, the CDC’s NPCR, and from which data are directly received through the NPCR Cancer Surveillance System Submission Specifications mechanism⁴ under a special agreement. Collection of central (state) cancer data was mandated in 1992 by Public Law 102-515, the Cancer Registries Amendment Act.⁵ This mandate was expanded to include non-malignant tumors with the 2002 passage of Public Law 107–260, starting January 1, 2004.⁶ CBTRUS combines the NPCR data with data from the NCI’s SEER Program,⁷ which was established for national cancer surveillance in the early 1970s. All data from NPCR and SEER originate from tumor registrars who adhere to the Uniform Data Standards (UDS) for malignant and non-malignant brain and other CNS tumors as directed by the North American Association of Central Cancer Registries (NAACCR) (http://www.naaccr.org). Along with the UDS, there are quality control checks and a system for rating each central cancer registry (CCR) to ensure that these data are as accurate and complete as possible. As a surveillance partner, CBTRUS reports high-quality data on brain and other CNS tumors with histopathological specificity useful to the communities it serves.

The CBTRUS database is comprised of the largest histopathology-specific aggregation of population-based data limited to the incidence, prevalence, mortality, and survival of primary brain and other CNS tumors in the United States, and it is likely the largest histopathology-specific aggregation of primary brain and other CNS tumor cases in the world. The CBTRUS database now includes survival data from 43 CCRs and incidence data from all 52 CCRs in the United States and Puerto Rico (excluding Indiana cases from diagnosis years 2020 and 2021). Aggregate information on all cancers from all 52 CCRs (excluding Indiana cases from diagnosis years 2020 and 2021) in the United States, including primary brain and other CNS tumors, is available from the United States Cancer Statistics (USCS).⁸

Risk Factors for Primary Brain and Other CNS Tumors

Many environmental, behavioral, and genetic risk factors have been explored as a causative agent for primary brain tumor and other CNS tumors. However, few have been proven to be associated with impacting a person’s risk of developing a tumor. Exposure to ionizing radiation (the type of radiation generated by atomic bombs, therapeutic radiation treatment, and some forms of medical imaging) is shown to increase a person’s risk of developing a CNS tumor (particularly meningiomas). Also, having a first-degree family member (including parents, children, and full siblings) who have been diagnosed with a brain tumor has been shown to increase risk approximately two-fold. However, having a history of allergy or other atopic disease (including eczema, psoriasis, and asthma) reduces a person’s risk of developing a CNS tumor (particularly glioma). Several recent review articles have elaborated on the current state of risk factor research in primary brain and other CNS tumors.^9-12

Data Collection and classification

CBTRUS does not collect data directly from patients’ medical records. Registration of individual cases (tumors) is conducted by cancer registrars at the institution where diagnosis and/or treatment occur and is then transmitted to the CCR, which further transmits this information to NPCR, SEER, and/or NAACCR. Some CCRs also send their data to SEER; data from those CCRs are taken from the NPCR file to eliminate duplicate cases. As noted, data for CBTRUS analyses come from the NPCR and SEER programs. By law, all primary malignant and non-malignant CNS tumors are reportable diseases based on their site, and CCRs play an essential role in the collection process. Brain and other CNS tumors are reported using the site definition described in Public Law 107-260.⁶ These data are population-based and represent a comprehensive documentation of all reported cancers diagnosed within a geographic region for the years included in this report.

CBTRUS obtained de-identified incidence data from 52 CCRs (48 NPCR and 4 SEER) that include cases of malignant and non-malignant (benign and uncertain behaviors) primary brain and other CNS tumors. The population-based CCRs include 50 state registries, plus the District of Columbia and Puerto Rico (Figure 1). Data were requested for all reported primary malignant and non-malignant tumors that were newly diagnosed from 2017 to 2021 at any of the following International Classification of Diseases for Oncology, Third Edition (ICD-O-3) anatomic sites which also serve as the data definition guiding CBTRUS reporting: brain, meninges, spinal cord, cranial nerves, and other parts of the CNS, pituitary and pineal glands, and olfactory tumors of the nasal cavity (ICD-O-3 site code C30.0 and histopathology codes 9522-9523 only) (Table 1).

Figure 1. — Availability by Central Cancer Registry for SEER and NPCR Incidence Data (2017-2021) and Survival Data (2001-2020)

Table 1.

Central Brain Tumor Registry of the United States (CBTRUS) Brain and Other Central Nervous System Tumor Site Groupings

Site	ICD-O-3^a Site Code
Olfactory tumors of the nasal cavity^b	C30.0
Meninges (cerebral & spinal)	C70.0-C70.9
Cerebral meninges	C70.0
Spinal meninges	C70.1
Meninges, NOS	C70.9
Cerebrum	C71.0
Frontal lobe of brain	C71.1
Temporal lobe of brain	C71.2
Parietal lobe of brain	C71.3
Occipital lobe of brain	C71.4
Ventricle	C71.5
Cerebellum	C71.6
Brainstem	C71.7
Other brain^c	C71.8-C71.9
Overlapping lesion of brain	C71.8
Brain, NOS	C71.9
Spinal cord and cauda equina	C72.0-C72.1
Spinal cord	C72.0
Cauda equina	C72.1
Cranial nerves	C72.2-C72.5
Olfactory nerve	C72.2
Optic nerve	C72.3
Acoustic nerve	C72.4
Cranial nerve, NOS	C72.5
Other nervous system^c	C72.8-C72.9
Overlapping lesion of brain and central nervous system	C72.8
Nervous system, NOS	C72.9
Pituitary and craniopharyngeal duct	C75.1-C75.2
Pituitary gland	C75.1
Craniopharyngeal duct	C75.2
Pineal gland	C75.3

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^a International Classification of Diseases for Oncology, 3rd Edition, 2000. World Health Organization, Geneva, Switzerland.

^b ICD-O-3 histopathology codes 9522-9523 only.

^c These ICD-O-3 codes are combined for analysis in figures and tables presented in this report.

NPCR provided data on 465,975 primary brain and other CNS tumors diagnosed from 2017 to 2021 (Figure 2). An additional 13,950 case records for the period were obtained from SEER for primary brain and other CNS tumor case records from 2017 to 2021 for Connecticut, Hawaii, Iowa, and New Mexico only. These data were combined into a single dataset of 479,925 records for quality control. The final analytic dataset had 469,866 records, which included 467,894 records from the 50 state CCRs and the District of Columbia used in the analytic dataset, and an additional 1,972 records from Puerto Rico. A total of 10,059 records (2.1%) were deleted from the final analytic dataset for one or more of the following reasons:

Records with ICD-O-3 behavior code of /2 (indicates in situ cases, which is not a relevant classification for brain and other CNS tumors).
Records with an invalid site/histopathology combination according to the CBTRUS histopathology grouping scheme.
Possible duplicate records that included a less accurate reporting source than microscopic confirmation, also referred to as histopathologic confirmation (e.g., radiographic versus microscopic confirmation), possible duplicate record for recurrent disease, or errors in time sequence of diagnosis.
Possible duplicate records for bilateral vestibular schwannoma or meningioma that were merged to one paired-site record.

Records from Puerto Rico are included only in a supplementary analysis (See Supplemental Material), and these cases are not included in the overall statistics presented in this report. Data were not available from Indiana for diagnosis years 2020 and 2021 due to data quality issues reported by NPCR.

Age-adjusted incidence rates per 100,000 population for the entire United States for selected other cancers were obtained from the USCS, produced by the CDC and the NCI, for the purpose of comparison with brain and other CNS tumor incidence rates.¹³ This database includes both NPCR and SEER data and together, the programs represent the entire US population.

De-identified survival data for malignant brain and other CNS tumors were obtained from NPCR for 43 CCRs for the years 2001 to 2020 and for non-malignant brain and other CNS tumors for the years 2004 to 2020. This dataset provides population-based information for 91.7% of the US population for the years 2001 to 2020 and is a subset of the data used for the incidence calculations presented in this report. Survival information is derived from both active and passive follow-up.

Mortality data used in this report are from the NVSS, which includes death certification data for individuals from all 50 states and the District of Columbia, therefore it represents the entire US population. NVSS data are not collected through the cancer registration system. These data represent the primary cause of death listed on each individual death certificate, and as a result, deaths in persons with cancer may be recorded as non-cancer deaths. NVSS data are limited to deaths in which a primary malignant brain and other CNS tumor was listed as the primary cause of death on the death certificate. Comparison data on malignant brain and other CNS tumors and other comparison cancers were obtained using SEER*Stat.¹⁴

Anatomic Location of Tumor Sites

Various terms are used to describe the regions of the brain and other CNS. The specific sites used in this report are based on the topography codes found in the ICD-O-3 and are broadly based on the categories and site codes defined in the SEER Site/Histology Validation List. CBTRUS groups ICD-O-3 sites C71.8 (Overlapping lesion of the brain) and C71.9 (Brain, Not Otherwise Specified, NOS) into “Other brain” and C72.8 (Overlapping lesion of brain and CNS) and C72.9 (Nervous system, NOS) into ‘Other nervous system’ for display in figures. This report also presents counts and incidence for specific sites separately in its tables. See Table 1 for the CBTRUS primary site groupings. A new variable for the direct identification of the pons site was developed with support from CBTRUS to discriminate between sites included under the broad category of Brainstem (C71.7), which was initiated on January 1,2024 and will be available for analysis beginning in 2027 as per reporting timelines.

Classification by Histopathology and Behavior

There are over 100 distinct types of primary brain and other CNS tumors, referred to as ‘histopathologies’, each with its own spectrum of clinical presentations, treatments, and outcomes. These histopathologies can be broadly classified as non-malignant (ICD-O-3 behavior codes of /0 for benign and /1 for uncertain) or malignant (ICD-O-3 behavior code of /3) and are reviewed and updated periodically by expert neuropathologists. The World Health Organization (WHO) publishes these classification updates for all cancer sites and utilizes the ICD-O-3 for assignment of histopathology, behavior, and site codes. CBTRUS is using Histopathology Groupings according to 2016 WHO Classification of Tumours of the Central Nervous System.In anticipation of aligning its histology groupings to 2021 WHO, CBTRUS successfully petitioned the UDS Committee of NAACCR to include 2021 WHO Tumor Types not identifiable through current ICD-O-3 codes into collection practices, which commenced collection in diagnosis year 2024 and will be available for analysis beginning in 2027 (see more information under Classification by BMM).

The ICD-O-3 codes in this current CBTRUS grouping¹⁵ (Table 2) may include morphology codes that were not previously reported to CBTRUS.¹⁶ Gliomas are tumors that arise from glial or precursor cells and include glioblastoma, astrocytoma, oligodendroglioma, ependymoma, oligoastrocytoma (mixed glioma), and a few rare histopathologies. As there is no standard definition for gliomas, CBTRUS defines gliomas as ICD-O-3 histopathology codes 9380-9384 and 9391-9460 as starred in Table 2. It is also important to note that the statistics for lymphomas and hematopoietic neoplasms contained in this report refer only to those lymphomas and hematopoietic neoplasms that arise in the brain and other CNS ICD-O-3 topography codes (Table 1).

Table 2.

Central Brain Tumor Registry of the United States (CBTRUS), 2021 Brain and Other Central Nervous System Tumor Histopathology Groupings (Based on 2016 WHO Classification)

Histopathology	ICD-O-3^a Histopathology Codes^b	ICD-O-3^a Histopathology and Behavior Code^b
Histopathology	ICD-O-3^a Histopathology Codes^b	Malignant	Non-Malignant
Diffuse Astrocytic and Oligodendroglial Tumors
Diffuse astrocytoma^*	9381, 9400, 9410, 9411, 9420, 9442/1	9381/3, 9400/3, 9410/3, 9411/3, 9420/3	9442/1
Anaplastic astrocytoma^*	9401	9401/3	None
Glioblastoma^*	9440, 9441, 9442/3, 9445^c	9440/3, 9441/3, 9442/3, 9445/3	None
Oligodendroglioma^*	9450	9450/3	None
Anaplastic oligodendroglioma^*	9451, 9460	9451/3, 9460/3	None
Oligoastrocytic tumors^*	9382	9382/3	None
Other Astrocytic Tumors
Pilocytic astrocytoma^*	9421, 9425^c	9421/1^d, 9421/3,9425/3	None
Unique astrocytoma variants^*	9384, 9424, 9431^c	9424/3	9384/1, 9431/1
Ependymal tumors^*	9383, 9391 (excluding site C75.1 for behavior /1), 9392- 9394, 9396^c	9391/3, 9392/3, 9393/3, 9396/3	9383/1, 9391/1 (excluding site C75.1), 9394/1
Other Gliomas
Glioma malignant, NOS^*	9380, 9385^c	9380/3, 9385/3	None
Other neuroepithelial tumors^*	9423, 9430, 9444	9423/3, 9430/3	9444/1
Neuronal and Mixed Neuronal-Glial Tumors^*	8680, 8681, 8690, 8693, 9412, 9413, 9490, 9492 (excluding site C75.1), 9493, 9505, 9506, 9509^c, 9522 (site C30.0 only), 9523 (site C30.0 only)	8680/3, 8693/3, 9490/3, 9505/3, 9509/3, 9522/3 (site C30.0 only), 9523/3 (site C30.0 only)	8680/0,1, 8681/1, 8690/1, 8693/1, 9412/1, 9413/0, 9490/0, 9492/0 (excluding site C75.1), 9493/0, 9505/0,1, 9506/1, 9509/1
Choroid Plexus Tumors	9390	9390/3	9390/0,1
Tumors of The Pineal Region	9360, 9361, 9362, 9395^c	9362/3, 9395/3	9360/1, 9361/1
Embryonal Tumors	8963, 9364, 9470-9478^c, 9480, 9500, 9501/3, 9502/3, 9508	8963/3, 9364/3, 9470/3, 9471/3, 9472/3, 9473/3, 9474/3, 9475/3, 9476/3, 9477/3, 9478/3, 9480/3, 9500/3, 9501/3, 9502/3, 9508/3	None
Medulloblastoma	9470-9472,9474-9478	9470/3, 9471/3, 9472/3, 9474/3, 9475/3, 9476/3, 9477/3, 9478/3,	None
Atypical teratoid/rhabdoid tumor	9508	9508/3	None
Other embryonal tumors^e	8963, 9364, 9473, 9480, 9500, 9501, 9502	8963/3, 9364/3, 9473/3, 9480/3, 9500/3, 9501/3, 9502/3	None
Tumors of Cranial and Paraspinal Nerves
Nerve sheath tumors	9540, 9541, 9550, 9560, 9561, 9570, 9571	9540/3, 9560/3, 9561/3, 9571/3	9540/0,1, 9541/0, 9550/0, 9560/0,1, 9570/0, 9571/0
Other tumors of cranial and paraspinal nerves	9562, 9563	None	9562/0, 9563/0
Tumors of Meninges
Meningioma	9530-9535, 9537-9539	9530/3, 9537/3, 9538/3, 9539/3	9530/0,1, 9531/0, 9532/0, 9533/0, 9534/0, 9535/0, 9537/0, 9538/1, 9539/1
Mesenchymal tumors	8324, 8710, 8711, 8800-8806, 8810, 8811, 8815, 8821, 8824, 8825, 8830, 8831, 8835, 8836, 8840, 8850-8854, 8857, 8861, 8870, 8880, 8890, 8897, 8900-8902, 8910, 8912, 8920, 8921, 8935, 8990, 9040, 9120, 9125, 9130, 9131, 9136, 9150, 9161, 9170, 9180, 9210, 9220, 9231, 9240, 9241, 9243, 9260, 9370-9373	8710/3, 8711/3, 8800/3, 8801/3, 8802/3, 8803/3, 8804/3, 8805/3, 8806/3, 8810/3, 8811/3, 8815/3^c, 8825/3, 8830/3, 8840/3, 8850/3, 8851/3, 8852/3, 8853/3, 8854/3, 8857/3, 8890/3, 8900/3, 8901/3, 8902/3, 8910/3, 8912/3, 8920/3, 8921/3, 8935/3, 8990/3, 9040/3, 9120/3, 9130/3, 9150/3, 9170/3, 9180/3, 9220/3, 9231/3, 9240/3, 9243/3, 9260/3, 9370/3, 9371/3, 9372/3	8324/0, 8711/0, 8800/0, 8810/0, 8811/0, 8815/0,1^c, 8821/1, 8824/0,1, 8825/0,1, 8830/0,1, 8831/0, 8835/1, 8836/1, 8840/0, 8850/0,1, 8851/0, 8852/0, 8854/0, 8857/0, 8861/0, 8870/0, 8880/0, 8890/0,1, 8897/1, 8900/0, 8920/1, 8935/0,1, 8990/0,1, 9040/0, 9120/0, 9125/0, 9130/0,1, 9131/0, 9136/1, 9150/0,1, 9161/0,1, 9170/0, 9180/0, 9210/0, 9220/0, 9241/0, 9373/0
Primary melanocytic lesions	8720, 8728, 8770	8720/3, 8728/3, 8770/3	8728/0,1, 8770/0
Lymphomas and Hematopoietic Neoplasms
Lymphoma	9590, 9591, 9596, 9650-9655, 9659, 9661-9665, 9667, 9670, 9671, 9673, 9675, 9680, 9684, 9687, 9688, 9690, 9691, 9695, 9698, 9699, 9701, 9702, 9705, 9712, 9714, 9715, 9719, 9724, 9727-9729, 9735, 9737, 9738, 9750, 9751, 9755, 9756, 9811-9819, 9823, 9826, 9827, 9831, 9832, 9837, 9861, 9866, 9930, 9965, 9966, 9967, 9970, 9971, 9975	9590/3, 9591/3, 9596/3, 9650/3, 9651/3, 9652/3, 9653/3, 9654/3, 9655/3, 9659/3, 9661/3, 9662/3, 9663/3, 9664/3, 9665/3, 9667/3, 9670/3, 9671/3, 9673/3, 9675/3, 9680/3, 9684/3, 9687/3, 9688/3, 9690/3, 9691/3, 9695/3, 9698/3, 9699/3, 9701/3, 9702/3, 9705/3, 9712/3, 9714/3, 9715/3, 9719/3, 9724/3, 9727/3, 9728/3, 9729/3, 9735/3, 9737/3, 9738/3, 9750/3, 9751/3, 9755/3, 9756/3, 9811/3, 9812/3, 9813/3, 9814/3, 9815/3, 9816/3, 9817/3, 9818/3, 9819/3, 9823/3, 9826/3, 9827/3, 9831/3, 9832/3, 9837/3, 9861/3, 9866/3, 9930/3, 9965/3, 9966/3, 9967/3, 9971/3, 9975/3	9750/1, 9751/1, 9970/1
Other hematopoietic neoplasms	9731, 9733, 9734, 9740, 9741, 9749, 9752-9754, 9757-9760, 9766, 9860,	9731/3, 9733/3, 9734/3, 9740/3, 9741/3, 9749/3, 9753/3, 9754/3, 9757/3, 9758/3, 9759/3, 9760/3, 9766/3, 9860/3,	9740/1, 9752/1, 9753/1, 9766/1
Germ Cell Tumors	8440, 9060, 9061, 9064, 9065, 9070-9072, 9080-9083, 9084/3, 9085, 9100, 9101	8440/3, 9060/3, 9061/3, 9064/3, 9065/3, 9070/3, 9071/3, 9072/3, 9080/3, 9081/3, 9082/3, 9083/3, 9084/3, 9085/3, 9100/3, 9101/3	8440/0, 9080/0,1
Tumors of Sellar Region
Tumors of the pituitary	8040 (site C75.1 only), 8140 (site C75.1 only), 8146 (site C75.1 only), 8246, 8260 (site C75.1 only), 8270-8272, 8280, 8281, 8290, 8300, 8310, 8323, 9391/1 (site C75.1 only), 9432^c (site C75.1 only), 9492 (site C75.1 only), 9580, 9582	8140/3, 8246/3, 8260/3, 8270/3, 8272/3, 8280/3, 8281/3, 8290/3, 8300/3, 8310/3, 8323/3, 9580/3	8040/0,1, 8140/0,1, 8146/0, 8260/0, 8270/0, 8271/0, 8272/0, 8280/0, 8281/0, 8290/0, 8300/0, 8310/0, 8323/0, 9391/1 (site C75.1 only), 9432/1, 9492/0 (site C75.1 only), 9580/0, 9582/0
Craniopharyngioma	9350-9352	None	9350/1, 9351/1, 9352/1
Unclassified Tumors
Hemangioma	9121-9123, 9133, 9140	9133/3, 9140/3	9121/0, 9122/0, 9123/0, 9133/1
Neoplasm, unspecified	8000-8005, 8010, 8020, 8021	8000/3, 8001/3, 8002/3, 8003/3, 8004/3, 8005/3, 8010/3, 8020/3, 8021/3	8000/0,1, 8001/0,1, 8005/0, 8010/0
All other	8320, 8452, 8713, 8896, 8980, 9084/0, 9173, 9363, 9503	8320/3, 8452/3, 8896/3, 8980/3, 9503/3	8452/1, 8713/0, 9084/0, 9173/0, 9363/0

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^a International Classification of Diseases for Oncology, 3rd Edition, 2000. World Health Organization, Geneva, Switzerland.

^b See the CBTRUS website for additional information about the specific histopathology codes included in each group: http://www.cbtrus.org.

^c Added starting with diagnosis year 2018.

^d This histopathology is re-coded from behavior /1 to /3 and included in estimates for malignant brain and other central nervous system tumors by cancer surveillance organizations. Please see the following for more information: Ostrom QT, Kruchko C, Barnholtz-Sloan JS. Pilocytic astrocytomas: where do they belong in cancer reporting? Neuro Oncol. 2020;22(2):298-300. doi: 10.1093/neuonc/noz202.

^e Includes tumors formerly classified as primitive neuroectodermal tumors of the central nervous system (PNET).

^* All or some of this histopathology is included in the CBTRUS definition of gliomas, including ICD-O-3 histopathology codes 9380-9384, 9391-9460.

Abbreviations: WHO, World Health Organization; NOS, not otherwise specified.

The CBTRUS data definition and classification scheme is available within NPCR’s US Cancer Statistics Dataset (https://www.cdc.gov/cancer/uscs/public-use/index.htm), SEER*Explorer (https://seer.cancer.gov/statistics-network/explorer), and the NAACCR Cancer In North America Dataset (https://www.naaccr.org/cina-data-products-overview/).^17,18

Classification by Brain Molecular Markers (BMM)

Primary brain and other CNS tumors are a highly heterogeneous group of diseases, and characterization of unique tumor histopathologies within this group has been refined over time. The development of technologies for characterizing DNA sequence, RNA abundance as a measure of gene activity, and biochemical alterations that affect gene expression (such as DNA methylation) have led to the discovery of several factors known as ‘biomarkers.’ Biomarkers can be used to more accurately classify these tumors than histopathologic appearance alone. With the increased recognition of the value of biomarkers for specific brain tumor histopathologies in classification, the WHO Classification of Tumours of the Central Nervous System included biomarkers in its 2016 revision. However, implementing the collection of these markers in cancer registration is multi-faceted and includes an ongoing educational and training component.

As of 2011, SEER registries began collecting information on three validated biomarkers for primary brain and other CNS tumors as Site-Specific Factors (SSF): promoter methylation status of O-6-Methylguanine-DNA Methyltransferase (MGMT) (SSF 4), deletion of 1p (SSF 5), and deletion of 19q (SSF 6).¹⁹ Starting with diagnosis year 2018, the broad US cancer registry system began collecting information on multiple brain and other CNS markers, including isocitrate dehydrogenase 1/2 (IDH1/2) mutation, 1p/19q codeletion, medulloblastoma molecular subtypes, and all biomarkers found in 2016 WHO classification using the variable BMM (please see Supplementary Table 1). Additional molecularly-defined histopathologies from 2016 WHO were added using their new ICD-O-3 codes for which collection also began in 2018. These data were available to CBTRUS for the first time with the 2021 NPCR and SEER data releases. As such, these data are for the 2018-2021 diagnosis years only. CBTRUS evaluated the completeness of these markers in their first year (2018) of collection (please see Iorgulescu, et al.²⁰). The collection of new molecularly defined histologies, introduced in the 2021 WHO classification, began with diagnosis year starting January 1, 2024 for the first time and will be available for analysis by CBTRUS in reporting year 2027.

Classification by WHO Grade

Primary brain and other CNS tumors are not staged according to the American Joint Commission of Cancer (AJCC) schema like other types of cancers. Instead, they are classified according to the WHO Classification of Tumours of the Central Nervous System which assigns a CNS grade (grade I through grade IV assigned prior to 2021 WHO Classification) based on predicted clinical behavior. The WHO classification scheme was first released in 2000, and though it was updated in 2007 and 2016,² these updated schema were not fully implemented by US CCRs until diagnosis year 2019 or reporting year 2022. Updates made in 2007 and 2016 may affect diagnostic practices used in characterization of individual tumors included in this report. Significant changes were made to grading nomenclature and criteria in the 2021 fifth edition of the WHO Classification of Tumours of the Central Nervous System and may affect cases diagnosed in 2021 that are included in this report. As of the 2021 WHO classification, grade is clinically reported using Arabic numerals, but for the purpose of reporting grade for cases collected under prior WHO Classification versions, CBTRUS uses both Arabic and Roman numerals.

The WHO grading assignments are recorded by cancer registrars as Collaborative Stage Site-Specific Factor 1 - WHO Grade Classification as directed in the AJCC, 8th Edition, Chapter 72 on Brain and Spinal Cord²¹ (cases diagnosed from 2011-2017), Site-Specific Data Items (SSDI) Grade Pathological (cases diagnosed 2018 or later that has been resected and for which no neoadjuvant therapy was administered, NAACCR #3844), and SSDI Grade Clinical (cases diagnosed 2018 or later before any treatment has been received, NAACCR #3843).²² Site-specific factor variables were a required component of cancer registry data collection for brain and other CNS tumors beginning in 2004 for SEER registries and beginning in 2011 for NPCR registries, and these factors were collected through 2017 at which point they were replaced with SSDI. Completeness of these variables have improved significantly over time.^19,23

Completeness of this variable is defined as having a value equal to WHO grade 1/I, 2/II, 3/III, or 4/IV. Cases where WHO grade is marked as “not applicable” or ‘not documented’ are considered incomplete. It is not possible to conclusively determine WHO grade, which is based on the appearance of tumor cells, when a tumor is radiographically-confirmed only. Some tumor types (including tumors of the pituitary and lymphomas) are often not assigned a WHO grade. This information may also be assigned but not included in the pathology report.

Brain Tumor Definition Differences

Currently, NPCR, SEER, and NAACCR report primary brain and other CNS tumors differently from CBTRUS. The definition of primary brain and other CNS tumors used by these organizations in their published incidence and mortality statistics includes tumors located in the following ICD-O-3 sites: brain (C70.0-9), meninges (C71.0-9), and other CNS tumors (C72.0-9) but excludes lymphoma and leukemia histopathologies (ICD-O-3 histopathology codes 9590-9989) from all brain and other CNS sites.²⁴ In contrast, the CBTRUS definition includes data on all tumor morphologies located within the Consensus Conference site definition including lymphoma and other hematopoietic histopathologies, tumors of the pituitary, and olfactory tumors of the nasal cavity (Table 1). Additionally, CBTRUS reports data on primary brain and other CNS tumors irrespective of behavior, whereas many reporting organizations may only publish rates for malignant brain and other CNS tumors due to the original mandate that focused only on malignant tumors, sometimes using the term “cancer” to broadly identify these tumors in their reports. These differences in definition therefore influence the direct comparison of published rates.

CBTRUS is currently engaged in ongoing collaboration with other cancer registry reporting groups, including SEER, to harmonize brain tumor reporting definitions. Therefore, it is likely that these reporting differences will cease to exist in the future.

Pilocytic astrocytoma is clinically considered and classified as a grade 1/I, non-malignant tumor by the WHO guidelines for brain and other CNS tumors.² For the purposes of cancer registration, these tumors have historically been reported as malignant tumors both in the United States and by the International Agency for Research on Cancer (IARC) and International Association of Cancer Registries. Classification of these tumors as malignant has been followed by CBTRUS in its reporting unless otherwise stated. This practice does not correlate with their clinical classification (WHO Classification) and presents a challenge to correctly report population-based incidence and survival patterns associated with these tumors. However, cases diagnosed as pilocytic astrocytoma will be coded correctly as a non-malignant brain tumor histopathology beginning January 1, 2023 and will be available for CBTRUS to report as a non-malignant brain tumor in 2026.²⁵ Please see recent publications for additional discussion of the effect of this classification on cancer incidence and survival reporting.^26,27

While 2021 WHO classifications have not been implemented in the classification used for this report, changes in diagnostic criteria will affect reported statistics. Most notably, several histopathologies were eliminated in the 2016 and 2021 WHO classifications which are retained in this report as these codes are still used in cancer registration, with decreasing frequency. These changes will affect reported rates for specific histopathologic groups and means the reported rates cannot be compared to those from prior reports. Notable examples of this are oligoastrocytoma, primitive neuroectodermal tumors, and ICD-O-3 code 9423, included in the other neuroepithelial and neuroglial tumor grouping, leading to substantial declines in cases reported within these categories.

In the United States, cancer registries and surveillance groups only collect data on primary CNS tumors (meaning tumors that originate within the brain and spinal cord) and do not collect data on tumors that metastasize to the brain or spinal cord from other primary sites. As a result, only primary brain and other CNS tumors are included in this report.

STATISTICAL METHODS

The CBTRUS Statistical Report presents the following population-based measures: incidence rates, mortality rates, observed survival (median survival time and hazard ratios), and relative survival rates (for more information on definitions of terms and measures used see: https://cbtrus.org/cbtrus-glossary/).

Estimation of Incidence Rates and Time Trends

AAAIR, incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using the CBTRUS analytic dataset²⁸ per 100,000 population for years 2017-2021, were based on five-year age groups and were standardized to the 2000 US standard population for consistency with other US reporting agencies where this population is the standard used for age-adjustment.²⁹ Age-adjusted incidence rates used formulas described by Tiwari et al. to calculate CI.³⁰ Population data for each geographic region were obtained from the SEER program website.³¹ IRRs used formulas described by Fay et al. to calculate p-values which were considered statistically significantly different when the p-value was less than 0.05.³² Joinpoint 5.2.0^33,34 was used to estimate incidence time trends and generate annual percentage changes (APC) and 95% CI for diagnosis years 2004-2021 excluding 2020 as an outlier (see the impact of COVID-19 statement below). Modified Bayesian Information Criterion procedures included in Joinpoint were used to select the best-fitting model.

Estimation of Mortality Rates, Relative Survival Rates, Overall Survival, and Adjusted Hazard Ratios

Average annual age-adjusted mortality rates (AAAMR) for deaths resulting from all primary malignant brain and other CNS tumors were calculated using the age at death in the mortality data available in SEER*Stat Online Database provided by NCHS from death certificates per 100,000 population. These data were available for 50 states and the District of Columbia only. In addition to the total age-adjusted mortality rate for the United States, age-adjusted mortality rates are presented by sex and state.

The one-, five-, and ten-year relative survival rates for primary malignant and non-malignant brain and other CNS tumor cases diagnosed between 2001-2020 (2004-2020 for non-malignant tumors) in 43 NPCR CCRs were estimated using SEER*Stat. Median survival time for all reported primary malignant brain and other CNS tumors diagnosed between 2001-2020 in 43 NPCR CCRs was calculated by histopathology using the Kaplan-Meier method as well as by three age at diagnosis groups (0-14 years old, 15-39 years old, and 40+ years old). Second or later primary tumors, cases diagnosed at autopsy, cases in which either race or sex is coded as other or unknown, and cases known to be alive but for whom follow-up time could not be calculated, were excluded from survival data analyses.

Cox proportional hazard models were used to test associations between demographic factors and overall survival by histopathology for malignant brain and other CNS tumors diagnosed in 2001-2020. All models were adjusted for age at diagnosis group (0-14 years [reference group], 15-39 years, 40+ years), sex (male [reference group], female), and race-Hispanic ethnicity (non-Hispanic White [reference group], non-Hispanic Black, non-Hispanic American Indian/Alaskan Native, non-Hispanic Asian or Pacific Islander, and Hispanic all races). These models were used to estimate hazard ratios associated with each group and corresponding 95% CI and p-values. Adjusted estimates included all covariates (age at diagnosis, sex, and race-ethnicity) a priori, regardless of individual significance level. The proportional hazards assumption was tested separately by histopathology, and residuals were examined for all variables.

Variable Definitions

Age is reported using age groups by years including all ages, 0-19, 20+ years and NIH age groups (0-14, 15-39, 40+ years). Hispanic ethnicity was defined using the NAACCR Hispanic Identification Algorithm, version 2, data element, which utilizes a combination of cancer registry data fields (Spanish/Hispanic Origin data element, birthplace, race, and surnames) to directly and indirectly classify cases as Hispanic or non-Hispanic. Race and Hispanic ethnicity were combined and reported as non-Hispanic White, non-Hispanic Black, non-Hispanic American Indian/Alaska Native, non-Hispanic Asian or Pacific Islander, and Hispanic (all races). Other race, unspecified, and unknown race or ethnicity are included in statistics that are not race-Hispanic ethnicity-specific.

Statistical Software

Counts, means, medians, rates, ratios, proportions, and other relevant statistics were calculated using R 4.3.1 statistical software and/or SEER*Stat 8.4.2. Figures and tables were created in R using the following packages: flextable, knitr, officer, plotly, SEER2R, sf, survminer, tigris, and tidyverse.^35-43 Rates are suppressed when counts are fewer than 16 within a cell, but they are included in totals, except when data are suppressed from only one cell to prevent identification of the number in the suppressed cell. NOTE: Reported percentages may not add up to 100% due to rounding.

Impact of the COVID-19 Pandemic on 2020 Cancer Data

Health care disruptions caused by the COVID-19 pandemic have significantly affected cancer incidence data through delays in diagnosis, as well as new case abstraction.

The 2020 data are included in all calculated incidence, mortality, and survival rates. The 2020 data were excluded from time trends analysis as an outlier.

Cancer Incidence Rates Relative to 2019 and 2021 Rates

As discussed in the technical notes, incidence in more recent years of cancer registry data may be lower than the ‘true’ amount due to delays in data collection (Figure 3A). This leads to increases in annual incidence for these years in future data releases. The SEER program annually produces a special dataset that attempts to ‘adjust’ for these delays. In the 2023 CBTRUS Statistical Report, it was shown that compared to other more common cancer sites, delay-adjusted incidence ofmalignant brain and other CNS tumors for 2020 was more similar to 2019 than for other cancer sites, and incidence ofmalignant brain tumors in 2020 was comparable to prior years (Supplementary Figure 1). CBTRUS has since published a study evaluating monthly incidence rates of primary brain and other CNS tumors in 2020 compared to 2019 and found that there were significant decreases in newly diagnosed tumors primarily among non-malignant tumors.

Figure 3. — A) Annual Age-Adjusted Incidence Rates^a of All Primary Brain and Other Central Nervous System Tumors by Year and Behavior, and B) Average Annual Age-Adjusted Incidence Rates of All Primary Brain and Other Central Nervous System Tumors by Age Group at Diagnosis and Behavior

Exclusion of 2020 Incidence Data from Trends

All trends analyses are estimated using data collected through diagnosis year 2021 but exclude 2020 as an outlier. Please see the statement from the NCI’s SEER program on the impact of the COVID-19 pandemic, including a recorded webinar, at https://seer.cancer.gov/data/covid-impact.html.

RESULTS

Supplemental Data

CBTRUS has made supplemental additional figures and tables available. These materials are noted in the text as Supplementary Tables and Figures .

Incidence and Mortality in Comparison to Other Common Neoplasms in the United States, 2017-2021

AAAIRs for primary brain and other CNS tumors and a selection of common cancers (USCS) in the United States are presented by age group at diagnosis in Figure 4A for children (ages 0-14 years), Figure 4C for adolescents and young adults (AYA) (ages 15-39 years), and Figure 4E older adults (ages 40+ years).

Figure 4. — Average Annual Age-Adjusted Incidence Rates^a with 95% Confidence Intervals of All Primary Brain and Other Central Nervous System Tumors in Comparison to the Top Eight Highest Incidence Cancers Among A) Children Ages 0-14 Years, C) Adolescents and Young Adults Ages 15-39 Years, and E) Older Adults Ages 40+ Years; and Average Annual Age-Adjusted Mortality with 95% Confidence Intervals of All Primary Brain and Other Central Nervous System Tumors in Comparison to the Top Five Causes of Cancer Death and Top Three Non-Cancer Causes of Death for B) Children Ages 0-14 Years, D) Adolescents and Young Adults Ages 15-39 Years, and F) Older Adults Ages 40+ Years

Brain and other CNS tumors (both malignant and non-malignant) were the most common tumor type in children, with an AAAIR of 5.61 per 100,000 population.
Leukemia was the second most common tumor in children, with an AAAIR of 5.00 per 100,000 population.
Brain and other CNS tumors (both malignant and non-malignant) among AYA had an AAAIR of 12.07 per 100,000 population. These tumors were the second most common tumor type in this age group.
Breast cancer among females only was the most common tumor type among AYA and older adults, with AAAIRs of 26.19 and 348.02 per 100,000 female population, respectively.
Among older adults, brain and other CNS tumors were the seventh most common cancer with an AAAIR of 46.14 per 100,000 female population.
The second most common tumor type among older adults was prostate cancer, which had an incidence rate of 262.81 per 100,000 male population.

AAAMR for primary malignant brain and other CNS tumors, a selection of common cancers, and the top three non-cancer causes of death in the United States are presented by age group at diagnosis in Figure 4B for children (ages 0-14 years), Figure 4D for adolescents and young adults (AYA) (ages 15-39 years), and Figure 4F for older adults (ages 40+ years).

The most common causes of death in children were perinatal conditions (17.76 per 100,000).
Childhood brain and other CNS cancer (malignant), while rare, contributes substantially to cancer related mortality in children 0-14 years and is the most common cause of cancer death.
Malignant brain and other CNS tumors among children had an AAAMR of 0.66 per 100,000 and were the eighth most common cause of death in this age group.
In AYA, accidents and adverse effects were the leading causes of death (50.83 per 100,000).
Among AYA, malignant brain and other CNS tumors had an AAAMR of 0.94 per 100,000 population and were the 13^th most common cause of death in this age group and the second most common cause of cancer death.
Breast cancer (female only) was the most common cause of cancer death in AYA (2.18 per 100,000).
Heart disease was the largest contributor to mortality in older adults, with an AAAMR of 381.82 per 100,000 population.
Among older adults, malignant brain and other CNS tumors had an AAAMR of 9.15 per 100,000 and were the 27th most common cause of death.
Lung and bronchus cancer was the most common cause of cancer death in older adults (78.37 per 100,000).

Incidence and Completeness for Molecularly-Defined Brain and Other CNS Tumor Histopathologies

Please see the 2022 CBTRUS statistical report (https://doi.org/10.1093/neuonc/noac202)⁴⁴ for an overview of biomarkers collected in US cancer registry data.

Completeness of Brain Molecular Markers Variable Data Collection, 2018-2021

The BMM variable and molecularly-defined ICD-O-3 codes are specific to certain histopathologies (please see the 2023 CBTRUS Statistical Report⁴⁵Supplementary Tables 2-4). Frequency of reported molecular markers for relevant histopathologies are shown in Table 3. Completeness of molecular marker reporting using BMM variable is shown in Figure 5.

Table 3.

Distribution of Brain Molecular Markers for Select Histopathologically-Confirmed Molecularly Defined^a Glioma and Embryonal Tumor Histopathologies

Histopathology	2018-2021 Frequency (%)
Diffuse Astrocytoma
9400/3: Diffuse astrocytoma, IDH-mutant^b	2,528 (47%)
9400/3: Diffuse astrocytoma, IDH-wildtype^a	1,788 (33.2%)
9400/3: Diffuse astrocytoma, IDH Status Unknown	1,065 (19.8%)
Anaplastic Astrocytoma
9401/3: Anaplastic astrocytoma, IDH-mutant^a	2,151 (46.5%)
9401/3: Anaplastic astrocytoma, IDH-wildtype^a	1,976 (42.7%)
9401/3: Anaplastic astrocytoma, IDH Status Unknown	497 (10.7%)
Glioblastoma
9440/3: Glioblastoma, IDH-wildtype^a	39,733 (80.4%)
9440/3: Glioblastoma, IDH Status Unknown	7,310 (14.6%)
9441/3: Giant cell glioblastoma	284 (0.6%)
9442/3: Gliosarcoma	972 (2.0%)
9445/3: Glioblastoma, IDH-mutant^b	1,194 (2.4%)
Oligodendroglioma
9450/3: Oligodendroglioma, IDH-mutant and 1 p/19q co-deleted^a	2,508 (92.1%)
9450/3: Oligodendroglioma, NOS	214 (7.9%)
Anaplastic Oligodendroglioma
9451/3: Anaplastic oligodendroglioma, IDH-mutant and 1 p/19q co-deleted^a	1,226 (94.5%)
9451/3: Oligodendroglioma, anaplastic	72 (5.5%)
Medulloblastoma
9470/3: Medulloblastoma, NOS	753 (45.2%)
9471/3: Desmoplastic nodular medulloblastoma	--
9471/3: Medulloblastoma, SHH-activated and TP53-wildtype^a	347 (20.8%)
9472/3: Medullomyoblastoma	--
9474/3: Large cell medulloblastoma	112 (6.7%)
9475/3: Medulloblastoma, WNT-activated, NOS^b	74 (4.4%)
9476/3: Medulloblastoma, SHH-activated and TP53-mutant^b	46 (2.8%)
9477/3: Medulloblastoma, non-WNT/non-SHH^b	295 (17.7%)

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^a Collected in NAACCR Item #3816, Brain Molecular Markers.

^b. New ICD-O-3 codes implemented in 2018.

-- Cases and rates are not presented when fewer than 16 cases were reported for the specific category.

Data Source : CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2018-2021

Abbreviations : CBTRUS, Central Brain Tumor Registry of the United States; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program; IDH, Isocitrate dehydrogenase; NOS, not otherwise specified; SHH, sonic hedgehog; WNT, wingless and Int-1.

Figure 5. — Completeness of the Brain Molecular Marker Variable^a and Selected Histopathologies by ICD-O-3 Code by Year of Diagnosis

Among glioblastoma patients, 1,194 cases were coded as 9445/3, Glioblastoma IDH-mutant (2.4%), 39,733 cases were coded as 9440/3, Glioblastoma IDH-wildtype (80.4%), and 7,310 cases as 9440/3, Glioblastoma IDH Status Unknown (14.6%).
Frequency of IDH1/2 mutation reporting was high in diffuse astrocytoma (9400/3, 84.9%) and anaplastic astrocytoma (9401/3, 91.7%). Biomarker reporting was complete in 92.5% of oligodendroglioma coded as 9450/3 and 96.9% of anaplastic oligodendroglioma coded as 9451/3.
Medulloblastoma coded as 9471/3, 98.0% had complete biomarker reporting.
From 2020 to 2021, completeness of biomarker reporting improved for all assigned ICD-O-3 codes except Oligodendroglioma 9450/3 which decreased, and anaplastic astrocytoma 9401/3 which stayed the same (Figure 5).

Frequency and Incidence of Molecularly-Defined Brain and Other CNS Tumor Histopathologies, 2018-2021

Total cases of molecularly-defined histopathologies diagnosed in 2018-2021, age-adjusted incidence rates, median age of diagnosis, and distribution by sex and race-Hispanic ethnicity are shown in Table 4.

Table 4.

Four-Year Total, Average Annual Age-Adjusted Incidence Rates^a with 95% Confidence Intervals, Median Age at Diagnosis, Sex, and Race-Hispanic Ethnicity of Histopathologically-Confirmed Molecularly Defined Brain and Other Central Nervous System Tumors by WHO Grade^b for Diagnosis Years 2018-2021

Histopathology	ICD-O-3 Histopathology Codes	WHO Grade	Total Cases (2018–2021)^c	Rate (95% CI)	Age (median, interquartile range)	Female (%)	Non-Hispanic White (%)	Non-Hispanic Black(%)	Hispanic (%)	Non-Hispanic American Indian/Alaska Native (%)	Non-Hispanic Asian or Pacific Islander (%)
Adult-type diffuse glioma
IDH-mutant Astrocytoma (BMM 1, 3)	9400/3, 9401/3, 9445/3	All grades	5,867	0.46 (0.44-0.47)	37 (29-49)	42.5%	76.7%	6.7%	12.5%	0.7%	3.5%
		2/II^d	1,675	0.13 (0.13-0.14)	35 (28-45)	42.2%	75.5%	6.7%	12.3%	1.0%	4.4%
		3/III	1,814	0.14 (0.14-0.15)	37 (30-48)	43.1%	78.5%	5.9%	11.9%	0.5%	3.2%
		4/IV	1,346	0.10 (0.10-0.11)	38 (31-51)	41.7%	76.6%	6.4%	12.6%	0.7%	3.8%
IDH-wildtype Astrocytoma and Glioblastoma^d,e (BMM 2, 4, 5)	9400/3, 9401/3, 9440/3	All grades	43,489	2.70 (2.68-2.73)	65 (56-73)	41.6%	81.5%	6.3%	8.8%	0.5%	2.9%
		2/II	742	0.05 (0.05-0.06)	50 (33-64)	45.3%	76.2%	9.1%	9.8%	0.8%	4.1%
		3/III	1,242	0.08 (0.08-0.09)	60 (44-70)	46.5%	79.2%	7.4%	8.8%	--	4.1%
		4/IV	31,378	1.94 (1.92-1.96)	65 (57-72)	40.7%	81.7%	6.2%	8.7%	0.5%	2.9%
IDH-mutant & 1p/19q-codeleted Oligodendroglioma (BMM 6, 7)	9450/3, 9451/3	All grades	3,734	0.29 (0.28-0.30)	45 (35-56)	43.5%	75.6%	4.8%	14.1%	0.9%	4.6%
		2/II	1,885	0.15 (0.14-0.16)	42 (34-53)	44.4%	74.4%	5.0%	14.9%	--	4.9%
		3/III	1,220	0.09 (0.09-0.10)	48 (37-58)	41.3%	76.6%	4.9%	12.9%	--	4.9%
Medulloblastoma ^f
SHH-activated & TP53-wildtype (BMM 8)	9471/3	All grades	347	0.03 (0.03-0.03)	19 (5-31)	38.6%	55.4%	14.1%	24.9%	--	4.7%
SHH-activated & TP53-mutant	9476/3	All grades	46	<0.01	11 (8-31.5)	39.1%	45.7%	--	43.5%	--	--
WNT-activated	9475/3	All grades	74	0.01 (0.01-0.01)	11 (8-14)	54.1%	58.1%	21.6%	--	--	--
Non-WNT/non-SHH	9477/3	All grades	295	0.03 (0.02-0.03)	8 (5-12)	32.5%	63.4%	--	25.1%	--	6.3%
Other tumor types
Diffuse midline glioma, H3 K27M-mutant	9385/3	All grades	777	0.06 (0.06-0.07)	16 (7-32)	52.0%	55.9%	12.4%	23.8%	--	7.3%
ETMR C19MC-altered (BMM 9)	9478/3	All grades	65	0.01 (0.00-0.01)	2 (1-3)	55.4%	67.2%	--	--	--	--
RELA-fusion ependymoma	9396/3	All grades	47	<0.01	12 (4-23.5)	46.8%	58.7%	--	--	--	--

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^a Rates are per 100,000 and are age-adjusted to the 2000 US standard population.

^b WHO grade is reported according to 2016 WHO classification in which Roman numerals are used to denote tumor grade.

^c Excludes cases with missing molecular classification data or that are not histopathologically-confirmed.

^d Adult-type diffuse glioma cases reported as WHO grade I or “low-grade, NOS” were grouped with WHO grade II.

^e In WHO-CNS5, grading is denoted using Arabic numerals rather than roman numerals. In this 2021 revision, all IDH-wildtype adult-type diffuse astrocytic gliomas are classified as glioblastoma, IDH-wildtype, WHO CNS grade 4, without separate grades 2 or 3.

^f Both histopathologically-defined and new molecularly-defined ICD-O-3 codes for medulloblastomas were reported in the registry data; however, only a single ICD-O-3 diagnosis can be reported per case. As a result, the national incidence rates could not be estimated for the SHH-activated and TP53 mutant subtype and RELA-fusion ependymoma.

- Counts and rates are not presented when fewer than 16 cases were reported for the specific category. The suppressed cases are included in the counts and rates for totals.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2018-2021

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program; US, United States; CI, confidence interval; NOS, Not otherwise specified; BMM, Brain Molecular Marker; SHH, sonic hedgehog; WNT, wingless and Int-1.

The IDH1/2-mutant astrocytoma subtype had an incidence rate of 0.46 per 100,000 population, while IDH1/2-wildtype astrocytoma subtype had an incidence rate of 2.70 per 100,000 population. Median age of diagnosis for these subtypes was 37 and 65 years, respectively.
When stratified by WHO grade, 65.1% of WHO grade 2/II astrocytoma were IDH1/2-mutant, while 54.0% and 3.6% of WHO grade 3/III and 4/IV astrocytoma were IDH1/2-mutant (Figure 6).
The most common medulloblastoma subtypes were Sonic Hedgehog (SHH)-activated & TP53-wildtype (included in the SHH group) and non-wingless (WNT)/non-SHH medulloblastoma (including both group 3/group C and group 4/group D), which both had incidence rates of 0.03 per 100,000 population, and a median age of diagnosis of 19 years and 8 years, respectively.
Incidence of the WNT-activated medulloblastoma subtype (also known as the WNT group) was 0.01 per 100,000 population, with a median age of diagnosis of 11 years. The SHH-activated, and TP53-mutant medulloblastoma subtype (included in the SHH group) were too rare to calculate incidence.
In children ages 0-14 years and AYA, the most common medulloblastoma subtype was SHH-activated and TP53-wildtype (18.4% and 29.1%, respectively; Figure 7).
In adults 40+, the most common medulloblastoma subtype was non-WNT/non-SHH (24.2%).
Molecular subtype data were missing for many medulloblastoma cases, but the completeness of these data is expected to increase in future years as seen with 9471/3, desmoplastic nodular medulloblastoma (Figure 9).
Embryonal tumors with multilayered rosettes, C19MC-altered had incidence rates of 0.01 per 100,000 population and a median age of diagnosis of 2 years. Completeness of this molecular subtype decreased from 2019 to 2020 but increased in 2021 to 90.5%.

Figure 6. — Frequency of *IDH* Mutations^a by WHO Grade for Selected Astrocytoma Histopathologies^b

Figure 7. — Frequency of Molecularly Defined Medulloblastoma Subtypes^a

Figure 9. — Distribution^a of Primary Brain and Other Central Nervous System Tumors by Behavior (Five-Year Total=467,894; Annual Average Cases=93,579)

Time Trends in Primary Brain and Other CNS Tumors, 2004-2021, excluding 2020

Due to instability in cancer incidence due to health care disruption caused by the COVID-19 pandemic, CBTRUS does not include incidence data from 2020 in time trends analysis for the 2024 Statistical Report. In lieu of updated histopathology-specific time trends, we present overall trends in malignant and non-malignant brain tumor incidence and select histopathologies.

Incidence rates of cancer overall and many specific cancer histopathologies have decreased over time. Overall, changes in incidence rates of all primary brain and other CNS tumors between 2004 and 2021 have been small. As stated previously, there are many things that can affect incidence rates over time that are not related to ‘true’ changes in incidence of these tumors such as demographic changes, changes in histopathology classification, and changes in cancer registration practices. The latter is especially applicable to the collection of non-malignant brain and other CNS tumors.

For an overview of the overall incidence time trends by histopathology, sex, race, and Hispanic ethnicity from 2004-2019 see the 2023 CBTRUS Statistical Report (https://doi.org/10.1093/neuonc/noad149).⁴⁵

Please see Figure 8A for incidence trends overall and by behavior.

While incidence of brain and other CNS tumors increased overall and among non-malignant tumors only, there was a significant decrease in malignant tumors overall from 2004-2017 (APC: -0.4% [95%CI: -0.5%, -0.3%]) and from 2017-2021 (APC: -2.0% [95%CI: -2.6%, -1.3%]).
Overall and non-malignant brain tumors only had significant increases in incidence from 2004-2009 and from 2009-2021.

Please see Figure 8B for incidence trends of meningiomas and select gliomas.

Adult diffuse gliomas had a significant decrease from 2004-2021 (APC: -0.7% [95%CI: -0.9%, -0.6%]).
Meningiomas significantly increased from 2004-2021 (APC: 2.2% [95%CI: 1.8, 2.7]).
There was no significant change over time in the incidence of glioblastomas.

Please see Figure 8C for incidence trends of embryonal tumors including medulloblastoma and ATRT.

Overall, embryonal tumors had a significant decrease in incidence from 2004-2021 (APC: -1.4% [95%CI: -1.9%, -0.8%]).
ATRT had a significant increase in incidence from 2004-2021 (APC: 1.6 [95%CI: 0.1, 3.1]).

Distributions and Incidence by Site, Behavior, and Histopathology

Counts and rates from the 467,894 brain and other CNS tumors (27.1% malignant, 126,807 cases; 72.9% non-malignant; 341,087 cases included in Figure 9) reported during 2017-2021 overall and by sex for all ages are shown by site in Table 5 and by histopathology in Table 6. Counts and rates are shown by histopathology and behavior for selected histopathologies where there is a statistically sufficient number of individuals to calculate rates (>16 individuals).

Table 5.

Five-Year Total, Annual Average Total^a, and Average Annual Age-Adjusted Incidence Rates^b with 95% Confidence Intervals of All Brain and Other Central Nervous System Tumors by Site^c and Sex

Site (ICD-O-3 Topography Code)	Total				Male				Female
Site (ICD-O-3 Topography Code)	Total (2017-2021)	Annual Average	% of all tumors	Rate (95% CI)	Total (2017-2021)	Annual Average	% of all tumors	Rate (95% CI)	Total (2017-2021)	Annual Average	% of all tumors	Rate (95% CI)
Olfactory tumors of the nasal cavity (C30.0)^d	709	142	0.2%	0.04 (0.04-0.04)	403	81	0.2%	0.05 (0.04-0.05)	306	61	0.1%	0.03 (0.03-0.04)
Frontal, temporal, parietal, and occipital lobes of the brain (C71.1-C71.4)	77,652	15,530	16.6%	4.14 (4.11-4.17)	43,752	8,750	22.9%	4.89 (4.85-4.94)	33,900	6,780	12.3%	3.47 (3.43-3.51)
Frontal lobe (C71.1)	34,594	6,919	7.4%	1.88 (1.85-1.90)	18,608	3,722	9.7%	2.11 (2.08-2.14)	15,986	3,197	5.8%	1.66 (1.63-1.69)
Temporal lobe (C71.2)	25,041	5,008	5.4%	1.32 (1.31-1.34)	14,956	2,991	7.8%	1.66 (1.63-1.69)	10,085	2,017	3.6%	1.03 (1.01-1.05)
Parietal lobe (C71.3)	14,365	2,873	3.1%	0.75 (0.74-0.76)	8,119	1,624	4.2%	0.89 (0.87-0.91)	6,246	1,249	2.3%	0.62 (0.61-0.64)
Occipital lobe (C71.4)	3,652	730	0.8%	0.19 (0.18-0.20)	2,069	414	1.1%	0.23 (0.22-0.24)	1,583	317	0.6%	0.16 (0.15-0.17)
Cerebrum (C71.0)	7,385	1,477	1.6%	0.41 (0.40-0.42)	3,945	789	2.1%	0.46 (0.44-0.47)	3,440	688	1.2%	0.38 (0.36-0.39)
Ventricle (C71.5)	4,212	842	0.9%	0.26 (0.25-0.26)	2,348	470	1.2%	0.29 (0.27-0.30)	1,864	373	0.7%	0.23 (0.22-0.24)
Cerebellum (C71.6)	8,943	1,789	1.9%	0.55 (0.54-0.56)	4,858	972	2.5%	0.60 (0.59-0.62)	4,085	817	1.5%	0.50 (0.49-0.52)
Brainstem (C71.7)	5,975	1,195	1.3%	0.38 (0.37-0.39)	3,196	639	1.7%	0.40 (0.39-0.41)	2,779	556	1.0%	0.36 (0.34-0.37)
Other brain (C71.8-C71.9)	33,690	6,738	7.2%	1.80 (1.78-1.82)	18,172	3,634	9.5%	2.07 (2.04-2.10)	15,518	3,104	5.6%	1.57 (1.54-1.59)
Overlapping lesion of brain (C71.8)	12,802	2,560	2.7%	0.67 (0.66-0.68)	7,262	1,452	3.8%	0.80 (0.78-0.82)	5,540	1,108	2.0%	0.55 (0.54-0.57)
Brain, NOS (C71.9)	20,888	4,178	4.5%	1.13 (1.12-1.15)	10,910	2,182	5.7%	1.26 (1.24-1.29)	9,978	1,996	3.6%	1.02 (1.00-1.04)
Spinal cord and cauda equina (C72.0-C72.1)	12,469	2,494	2.7%	0.72 (0.71-0.73)	6,597	1,319	3.4%	0.77 (0.75-0.79)	5,872	1,174	2.1%	0.67 (0.65-0.69)
Spinal cord (C72.0)	12,062	2,412	2.6%	0.70 (0.68-0.71)	6,368	1,274	3.3%	0.75 (0.73-0.77)	5,694	1,139	2.1%	0.65 (0.63-0.67)
Cauda equina (C72.1)	407	81	0.1%	0.02 (0.02-0.02)	229	46	0.1%	0.03 (0.02-0.03)	178	36	0.1%	0.02 (0.02-0.02)
Cranial nerves (C72.2-C72.5)	31,248	6,250	6.7%	1.69 (1.67-1.71)	14,661	2,932	7.7%	1.64 (1.61-1.66)	16,587	3,317	6.0%	1.76 (1.73-1.78)
Olfactory nerve (C72.2)	44	9	0.0%	<0.01	20	4	0.0%	<0.01	24	5	0.0%	<0.01
Optic nerve (C72.3)	1,776	355	0.4%	0.12 (0.12-0.13)	801	160	0.4%	0.11 (0.10-0.12)	975	195	0.4%	0.13 (0.13-0.14)
Acoustic nerve (C72.4)	22,996	4,599	4.9%	1.22 (1.20-1.23)	10,842	2,168	5.7%	1.19 (1.17-1.21)	12,154	2,431	4.4%	1.25 (1.23-1.27)
Cranial nerve, NOS (C72.5)	6,432	1,286	1.4%	0.35 (0.34-0.36)	2,998	600	1.6%	0.34 (0.32-0.35)	3,434	687	1.2%	0.37 (0.36-0.38)
Other nervous system (C72.8-C72.9)	2,381	476	0.5%	0.13 (0.12-0.14)	1,178	236	0.6%	0.13 (0.13-0.14)	1,203	241	0.4%	0.13 (0.12-0.13)
Overlapping lesion of brain & CNS (C72.8)	391	78	0.1%	0.02 (0.02-0.02)	200	40	0.1%	0.02 (0.02-0.03)	191	38	0.1%	0.02 (0.02-0.02)
Nervous system, NOS (C72.9)	1,990	398	0.4%	0.11 (0.10-0.11)	978	196	0.5%	0.11 (0.10-0.12)	1,012	202	0.4%	0.11 (0.10-0.11)
Meninges (cerebral and spinal) (C70.0-C70.9)	196,423	39,285	42.0%	10.22 (10.17-10.26)	53,798	10,760	28.1%	6.10 (6.05-6.15)	142,625	28,525	51.6%	13.96 (13.88-14.03)
Cerebral meninges (C70.0)	162,763	32,553	34.8%	8.47 (8.43-8.51)	45,012	9,002	23.5%	5.10 (5.06-5.15)	117,751	23,550	42.6%	11.53 (11.47-11.60)
Spinal meninges (C70.1)	7,865	1,573	1.7%	0.40 (0.39-0.41)	1,739	348	0.9%	0.19 (0.18-0.20)	6,126	1,225	2.2%	0.59 (0.57-0.61)
Meninges, NOS (C70.9)	25,795	5,159	5.5%	1.34 (1.33-1.36)	7,047	1,409	3.7%	0.80 (0.78-0.82)	18,748	3,750	6.8%	1.83 (1.80-1.86)
Pituitary (C75.1- C75.2)	85,262	17,052	18.2%	4.91 (4.88-4.94)	37,411	7,482	19.6%	4.27 (4.23-4.32)	47,851	9,570	17.3%	5.66 (5.60-5.71)
Pituitary gland (C75.1)	83,167	16,633	17.8%	4.79 (4.75-4.82)	36,296	7,259	19.0%	4.14 (4.09-4.18)	46,871	9,374	16.9%	5.54 (5.49-5.59)
Craniopharyngeal duct (C75.2)	2,095	419	0.4%	0.12 (0.12-0.13)	1,115	223	0.6%	0.13 (0.13-0.14)	980	196	0.4%	0.12 (0.11-0.12)
Pineal (C75.3)	1,545	309	0.3%	0.10 (0.09-0.10)	919	184	0.5%	0.12 (0.11-0.12)	626	125	0.2%	0.08 (0.07-0.08)
Total	467,894	93,579	100.0%	25.34 (25.27-25.42)	191,238	38,248	100.0%	21.78 (21.68-21.88)	276,656	55,331	100.0%	28.77 (28.66-28.88)

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^a Annual average cases are calculated by dividing the five-year total by five.

^b Rates are per 100,000 and are age-adjusted to the 2000 US standard population.

^c The sites referred to in this table are loosely based on the categories and site codes defined in the SEER site/histopathology validation list.

^d ICD-O-3 histopathology codes 9522-9523 only.

- Counts and rates are not presented when fewer than 16 cases were reported for the specific category. The suppressed cases are included in the counts and rates for totals.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2017-2021

Table 6.

Five-Year Total, Annual Average Total^a, and Average Annual Age-Adjusted Incidence Rates^b with 95% Confidence Intervals for All Brain and Other Central Nervous System Tumors by Major Histopathology Grouping, Histopathology, Behavior, and Sex

Histopathology	All				Male					Female
Histopathology	Total (2017-2021)	Annual Average	% of all tumors	Rate (95% CI)	Total (2017-2021)	Annual Average	% Malignant^c	% Non-Malignant	Rate (95% CI)	Total (2017-2021)	Annual Average	% Malignant	% Non-Malignant	Rate (95% CI)
Diffuse Astrocytic and Oligodendroglial Tumors	84,398	16,880	18.0%	4.40 (4.37-4.43)	48,689	9,738	100.0%	0.0%	5.35 (5.30-5.40)	35,709	7,142	100.0%	0.0%	3.56 (3.52-3.60)
Diffuse astrocytoma	7,535	1,507	1.6%	0.45 (0.44-0.46)	4,228	846	99.9%	0.1%	0.51 (0.50-0.53)	3,307	661	99.9%	0.1%	0.39 (0.38-0.41)
Anaplastic astrocytoma	6,057	1,211	1.3%	0.35 (0.34-0.36)	3,343	669	100.0%	0.0%	0.39 (0.38-0.41)	2,714	543	100.0%	0.0%	0.30 (0.29-0.32)
Glioblastoma	65,365	13,073	13.9%	3.27 (3.25-3.30)	38,055	7,611	100.0%	0.0%	4.07 (4.03-4.11)	27,310	5,462	100.0%	0.0%	2.58 (2.54-2.61)
Oligodendroglioma	3,562	712	0.8%	0.22 (0.21-0.23)	1,995	399	100.0%	0.0%	0.25 (0.24-0.26)	1,567	313	100.0%	0.0%	0.19 (0.19-0.20)
Anaplastic oligodendroglioma	1,740	348	0.4%	0.10 (0.10-0.11)	998	200	99.8%	0.2%	0.12 (0.11-0.13)	742	148	100.0%	0.0%	0.09 (0.08-0.09)
Oligoastrocytic tumors	139	28	0.0%	0.01 (0.01-0.01)	70	14	100.0%	0.0%	0.01 (0.01-0.01)	69	14	100.0%	0.0%	0.01 (0.01-0.01)
Other Astrocytic Tumors	6,403	1,281	1.4%	0.43 (0.42-0.44)	3,425	685	86.9%	13.1%	0.46 (0.44-0.47)	2,978	596	86.0%	14.0%	0.41 (0.40-0.43)
Pilocytic astrocytoma	5,472	1,094	1.2%	0.37 (0.36-0.38)	2,921	584	92.8%	7.2%	0.39 (0.38-0.40)	2,551	510	90.9%	9.1%	0.35 (0.34-0.37)
Unique astrocytoma variants	931	186	0.2%	0.06 (0.06-0.07)	504	101	52.6%	47.4%	0.07 (0.06-0.07)	427	85	56.9%	43.1%	0.06 (0.05-0.06)
Malignant	508	102	0.1%	0.03 (0.03-0.04)	265	53	100.0%	0.0%	0.03 (0.03-0.04)	243	49	100.0%	0.0%	0.03 (0.03-0.04)
Non-Malignant	423	85	0.1%	0.03 (0.03-0.03)	239	48	0.0%	100.0%	0.03 (0.03-0.04)	184	37	0.0%	100.0%	0.03 (0.02-0.03)
Ependymal Tumors	6,834	1,367	1.5%	0.41 (0.40-0.42)	3,905	781	50.9%	49.1%	0.47 (0.45-0.48)	2,929	586	59.4%	40.6%	0.35 (0.34-0.36)
Malignant	3,725	745	0.8%	0.23 (0.22-0.23)	1,986	397	100.0%	0.0%	0.24 (0.23-0.25)	1,739	348	100.0%	0.0%	0.21 (0.20-0.22)
Non-Malignant	3,109	622	0.7%	0.18 (0.17-0.19)	1,919	384	0.0%	100.0%	0.23 (0.22-0.24)	1,190	238	0.0%	100.0%	0.14 (0.13-0.15)
Other Gliomas	9,156	1,831	2.0%	0.56 (0.55-0.57)	4,678	936	99.5%	0.5%	0.58 (0.57-0.60)	4,478	896	99.4%	0.6.%	0.54 (0.53-0.56)
Glioma malignant, NOS	9,102	1,820	1.9%	0.56 (0.54-0.57)	4,654	931	100.0%	0.0%	0.58 (0.56-0.60)	4,448	890	100.0%	0.0%	0.54 (0.52-0.56)
Other neuroepithelial tumors	54	11	0.01%	<0.01	24	5	4.2%	95.8%	<0.01	30	6	10.0%	90.0%	<0.01
Neuronal and Mixed Neuronal-Glial Tumors	5,303	1,061	1.1%	0.34 (0.33-0.34)	2,857	571	17.4%	82.6%	0.36 (0.35-0.37)	2,446	489	16.8%	83.2%	0.31 (0.30-0.32)
Malignant	907	181	0.2%	0.05 (0.05-0.06)	497	99	100.0%	0.0%	0.06 (0.05-0.06)	410	82	100.0%	0.0%	0.05 (0.04-0.05)
Non-Malignant	4,396	879	0.9%	0.28 (0.28-0.29)	2,360	472	0.0%	100.0%	0.30 (0.29-0.31)	2,036	407	0.0%	100.0%	0.26 (0.25-0.28)
Choroid Plexus Tumors	805	161	0.2%	0.05 (0.05-0.06)	395	79	17.2%	82.8%	0.05 (0.05-0.06)	410	82	11.5%	88.5%	0.05 (0.05-0.06)
Malignant	115	23	0.0%	0.01 (0.01-0.01)	68	14	100.0%	0.0%	0.01 (0.01-0.01)	47	9	100.0%	0.0%	0.01 (0.00-0.01)
Non-Malignant	690	138	0.1%	0.04 (0.04-0.05)	327	65	0.0%	100.0%	0.04 (0.04-0.05)	363	73	0.0%	100.0%	0.05 (0.04-0.05)
Tumors of The Pineal Region	712	142	0.2%	0.04 (0.04-0.05)	318	64	70.1%	29.9%	0.04 (0.04-0.04)	394	79	55.8%	44.2%	0.05 (0.04-0.05)
Malignant	443	89	0.1%	0.03 (0.02-0.03)	223	45	100.0%	0.0%	0.03 (0.02-0.03)	220	44	100.0%	0.0%	0.03 (0.02-0.03)
Non-Malignant	269	54	0.1%	0.02 (0.01-0.02)	95	19	0.0%.	100.0%	0.01 (0.01-0.01)	174	35	0.0%	100.0%	0.02 (0.02-0.02)
Embryonal Tumors	3,005	601	0.6%	0.21 (0.20-0.22)	1,781	356	100.0%	0.0%	0.24 (0.23-0.25)	1,224	245	100.0%	0.0%	0.17 (0.16-0.18)
Tumors of Cranial and Spinal Nerves	37,467	7,493	8.0%	2.02 (2.00-2.04)	17,984	3,597	0.6%	99.4%	2.00 (1.97-2.03)	19,483	3,897	0.6%	99.4%	2.05 (2.02-2.08)
Nerve sheath tumors	37,436	7,487	8.0%	2.02 (2.00-2.04)	--	--	--	--	--	--	--	--	--	--
Malignant	209	42	0.0%	0.01 (0.01-0.01)	--	--	--	--	--	--	--	--	--	--
Non-Malignant	37,227	7,445	7.9%	2.01 (1.99-2.03)	--	--	--	--	--	--	--	--	--	--
Other tumors of cranial and spinal nerves	31	6	0.0%	<0.01	--	--	--	--	--	--	--	--	--	--
Tumors of Meninges	201,193	40,239	43.0%	10.49 (10.44-10.54)	56,183	11,237	2.2%	97.8%	6.37 (6.32-6.43)	145,010	29,002	0.9%	99.0%.1%	14.23 (14.15-14.30)
Meningiomas	195,297	39,059	41.7%	10.15 (10.11-10.20)	53,150	10,630	1.4%	98.6%	6.02 (5.97-6.07)	142,147	28,429	0.6%	99.4%	13.90 (13.83-13.98)
Malignant	1,608	322	0.3%	0.08 (0.08-0.09)	735	147	100.0%	0.0%	0.08 (0.08-0.09)	873	175	100.0%	0.0%	0.09 (0.08-0.09)
Non-Malignant	193,689	38,738	41.4%	10.07 (10.02-10.11)	52,415	10,483	0.0%	100.0%	5.94 (5.89-5.99)	141,274	28,255	0.0%	100.0%	13.82 (13.74-13.89)
Mesenchymal tumors	5,747	1,149	1.2%	0.33 (0.32-0.34)	2,937	587	14.3%	85.7%	0.34 (0.33-0.35)	2,810	562	13.6%	86.4%	0.32 (0.31-0.33)
Malignant	801	160	0.2%	0.05 (0.04-0.05)	419	84	100.0%	0.0%	0.05 (0.04-0.05)	382	76	100.0%	0.0%	0.04 (0.04-0.05)
Non-Malignant	4,946	989	1.1%	0.28 (0.28-0.29)	2,518	504	0.0%	100.0%	0.29 (0.28-0.30)	2,428	486	0.0%	100.0%	0.28 (0.27-0.29)
Primary melanocytic lesions	149	30	0.03%	0.01 (0.01-0.01)	96	19	67.7%	32.3%	0.01 (0.01-0.01)	53	11	56.6%	43.4%	0.01 (0.00-0.01)
Malignant	95	19	0.02%	0.01 (0.00-0.01)	65	13	100.0%	0.0%	0.01 (0.01-0.01)	30	6	100.0%	0.0%	<0.01
Non-Malignant	54	11	0.01%	<0.01	31	6	0.0%	100.0%	<0.01	23	5	0.0%	100.0%	<0.01
Lymphomas and Hemopoietic Neoplasms	8,616	1,723	1.8%	0.44 (0.43-0.45)	4,396	879	99.5%	0.5%	0.48 (0.47-0.50)	4,220	844	99.4%	0.6%	0.40 (0.39-0.41)
Lymphoma	8,565	1,713	1.8%	0.44 (0.43-0.45)	4,369	874	99.6%	0.4%	0.48 (0.46-0.49)	4,196	839	99.4%	0.6%	0.40 (0.39-0.41)
Other hematopoietic neoplasms	51	10	0.01%	<0.01	27	5	92.6%	7.4%	<0.01	24	5	87.5%	12.5%	<0.01
*Germ Cell Tumors*	1,214	243	0.3%	0.08 (0.08-0.09)	895	179	90.6%	9.4%	0.12 (0.11-0.12)	319	64	79.6%	20.4%	0.04 (0.04-0.05)
Malignant	1,065	213	0.2%	0.07 (0.07-0.08)	811	162	100.0%	0.0%	0.10 (0.10-0.11)	254	51	100.0%	0.0%	0.04 (0.03-0.04)
Non-Malignant	149	30	0.0%	0.01 (0.01-0.01)	84	17	0.0%	100.0%	0.01 (0.01-0.01)	65	13	0.0%	100.0%	0.01 (0.01-0.01)
Tumors of Sellar Region	84,283	16,857	18.0%	4.85 (4.82-4.89)	37,043	7,409	0.2%	99.8%	4.23 (4.18-4.27)	47,240	9,448	0.1%	99.9%	5.59 (5.53-5.64)
Tumors of the pituitary	81,187	16,237	17.4%	4.67 (4.64-4.70)	35,439	7,088	0.2%	99.8%	4.03 (3.99-4.08)	45,748	9,150	0.1%	99.9%	5.41 (5.36-5.46)
Malignant	111	22	0.02%	0.01 (0.01-0.01)	70	14	100.0%	0.0%	0.01 (0.01-0.01)	41	8	100.0%	0.0%	<0.01
Non-Malignant	81,076	16,215	17.3%	4.66 (4.63-4.70)	35,369	7,074	0.0%	100.0%	4.03 (3.98-4.07)	45,707	9,141	0.0%	100.0%	5.41 (5.35-5.46)
Craniopharyngioma	3,096	619	0.7%	0.18 (0.18-0.19)	1,604	321	0.2%	99.8%	0.19 (0.18-0.20)	1,492	298	0.1%	99.9%	0.18 (0.17-0.18)
Unclassified Tumors	18,505	3,701	3.9%	1.02 (1.00-1.03)	8,689	1,738	40.1%	59.9%	1.04 (1.02-1.06)	9,816	1,963	37.0%	63.0%	1.01 (0.99-1.03)
Hemangioma	4,475	895	0.9%	0.26 (0.25-0.27)	2,089	418	0.0%	100.0%	0.25 (0.24-0.26)	2,386	477	0.0%	100.0%	0.27 (0.26-0.28)
Neoplasm, unspecified	13,562	2,712	2.9%	0.73 (0.72-0.74)	6,347	1,269	54.4%	45.6%	0.76 (0.74-0.78)	7,215	1,443	49.8%	50.2%	0.71 (0.70-0.73)
Malignant	7,050	1,410	1.5%	0.37 (0.36-0.38)	3,454	691	100.0%	0.0%	0.41 (0.40-0.43)	3,596	719	100.0%	0.0%	0.33 (0.32-0.35)
Non-Malignant	6,512	1,302	1.4%	0.36 (0.35-0.37)	2,893	579	0.0%	100.0%	0.35 (0.33-0.36)	3,619	724	0.0%	100.0%	0.38 (0.37-0.39)
All other	468	94	0.1%	0.03 (0.03-0.03)	253	51	11.9%	88.1%	0.03 (0.03-0.04)	215	43	16.3%	83.7%	0.03 (0.02-0.03)
Malignant	65	13	0.0%	<0.01	30	6	100.0%	0.0%	<0.01	35	7	100.0%	0.0%	<0.01
Non-Malignant	403	81	0.1%	0.02 (0.02-0.03)	223	45	0.0%	100.0%	0.03 (0.02-0.03)	180	36	0.0%	100.0%	0.02 (0.02-0.03)
Total ^d	467,894	93,579	100.0%	25.34 (25.27-25.42)	191,238	38,248	37.1%	62.9%	21.78 (21.68-21.88)	276,656	55,331	20.2%	79.8%	28.77 (28.66-28.88)
*Malignant*	*126,807*	*25,361*	*27.1%*	*6.89 (6.85-6.92)*	*70,934*	*14,187*	*100.0%*	*0.0%*	*8.06 (8.00-8.12)*	*55,873*	*11,175*	*100.0%*	*0.0%*	*5.84 (5.79-5.89)*
*Non-Malignant*	*341,087*	*68,217*	*72.9%*	*18.46 (18.39-18.52)*	*120,304*	*24,061*	*0.0%*	*100.0%*	*13.72 (13.64-13.80)*	*220,783*	*44,157*	*0.0%*	*100.0%*	*22.93 (22.83-23.03)*

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^a Annual average cases are calculated by dividing the five-year total by five.

^b Rates are per 100,000 and are age-adjusted to the 2000 US standard population.

^c Assigned behavior code of /3 (see Table 2).

^d Refers to all brain tumors including histopathologies not presented in this table.

- Counts and rates are not presented when fewer than 16 cases were reported for the specific category. The suppressed cases are included in the counts and rates for totals.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2017-2021

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program; CI, confidence interval; NOS, not otherwise specified.

Distribution and Incidence Rates of Tumors by Site

The distribution of brain and other CNS tumors by site is shown in Figure 10A, and incidence by site is shown in Table 5.

Overall, the most common tumor site was the meninges, representing 42.0% of all tumors.
Frontal (7.4%), temporal (5.4%), parietal (3.1%), and occipital lobes (0.8%) accounted for 16.6% of all tumors.
The cranial nerves (6.7%) and the spinal cord/cauda equina (2.7%) accounted for 9.4% of all tumors.
The pituitary and craniopharyngeal duct accounted for 18.2% of all tumors.
Incidence rates were highest for tumors located in the meninges (10.22 per 100,000) and lowest for tumors in the olfactory nerve (<0.01 per 100,000).

Distribution and Incidence Rates by Major Histopathology Grouping, Specific Histopathology, and Behavior

The distribution by brain and other CNS histopathologies is shown in Figure 10B and Table 6.

The most frequently reported histopathologies overall were meningioma (41.7%), followed by tumors of the pituitary (17.4%) and glioblastoma (14.0%).
Tumors of the pituitary (17.4%) and nerve sheath tumors (8.0%) combined accounted for slightly more than one-fourth of all tumors (25.4%), the vast majority of which were non-malignant.

AAAIRs overall by major histopathology grouping, specific histopathology, and behavior by sex are shown in Table 6 and Supplementary Figure 2. Among CBTRUS major histopathology groupings, incidence rates were highest for tumors of the meninges (10.49 per 100,000 population), followed by tumors of the sellar region (4.85 per 100,000 population), diffuse astrocytic and oligodendroglial tumors (4.40 per 100,000 population), and tumors of the cranial and spinal nerves (2.02 per 100,000 population).

Incidence rates were highest for meningioma (10.15 per 100,000), tumors of the pituitary (4.67 per 100,000, 99% non-malignant), glioblastoma (3.27 per 100,000), and nerve sheath tumors (2.02 per 100,000).
Most nerve sheath tumors were vestibular schwannoma (76.8% of nerve sheath tumors, 1.52 per 100,000, Table 7).
Of all vestibular schwannoma tumors, 50.3% occurred in persons ages 40-64 years.
After glioblastoma, the most frequently occurring malignant histopathologies were glioma malignant, NOS (0.56 per 100,000), diffuse astrocytoma (0.45 per 100,000), and lymphomas (0.44 per 100,000) (Figure 9 and Table 6).

Table 7.

Five-Year Total, Annual Average Total^a, and Average Annual Age-Adjusted Incidence Rates^b with 95% Confidence Intervals for Selected Non-Malignant Histopathologies by Sex, Age Group at Diagnosis, Race and Hispanic Ethnicity, and Histopathology

Group	Vestibular Schwannoma^c			Pituitary Adenoma^d			WHO Grade^e I Meningioma			WHO Grade^e II Meningioma
Group	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)
*Sex*
Male	13,446	2,689	1.48 (1.45-1.51)	31,606	6,321	3.59 (3.55-3.63)	28,897	5,779	3.25 (3.21-3.28)	4,238	848	0.47 (0.46-0.49)
Female	15,127	3,025	1.57 (1.54-1.60)	40,540	8,108	4.77 (4.72-4.82)	79,364	15,873	7.87 (7.81-7.93)	5,867	1,173	0.61 (0.60-0.63)
*Age Groups*
0-14 years	182	36	0.06 (0.05-0.07)	1,070	214	0.35 (0.33-0.37)	139	28	0.05 (0.04-0.05)	86	17	0.03 (0.02-0.03)
15-39 years	3,633	727	0.68 (0.66-0.70)	20,814	4,163	3.80 (3.74-3.85)	6,419	1,284	1.24 (1.20-1.27)	1,087	217	0.21 (0.19-0.22)
40-64 years	14,384	2,877	2.56 (2.52-2.60)	29,488	5,898	5.63 (5.56-5.70)	42,956	8,591	7.58 (7.51-7.66)	4,660	932	0.84 (0.82-0.87)
65+ years	10,374	2,075	3.87 (3.79-3.94)	20,774	4,155	7.91 (7.80-8.02)	58,747	11,749	22.95 (22.77-23.14)	4,272	854	1.63 (1.59-1.69)
*Race and Hispanic Ethnicity*
Non-Hispanic White	21,999	4,400	1.74 (1.71-1.76)	39,486	7,897	3.51 (3.47-3.54)	76,550	15,310	5.63 (5.59-5.68)	6,676	1,335	0.52 (0.51-0.54)
Non-Hispanic Black	1,592	318	0.73 (0.70-0.77)	14,314	2,863	6.78 (6.67-6.90)	13,644	2,729	6.61 (6.49-6.72)	1,577	315	0.73 (0.70-0.77)
Hispanic (all races)	2,411	482	0.95 (0.91-0.99)	11,868	2,374	4.44 (4.36-4.53)	10,582	2,116	4.78 (4.68-4.87)	1,015	203	0.42 (0.39-0.45)
Non-Hispanic American Indian/Alaska Native	149	30	1.11 (0.94-1.31)	590	118	4.42 (4.06-4.81)	726	145	5.63 (5.22-6.07)	59	12	0.48 (0.36-0.62)
Non-Hispanic Asian or Pacific Islander	1,731	346	1.54 (1.47-1.61)	3,781	756	3.44 (3.33-3.55)	4,808	962	4.50 (4.37-4.63)	609	122	0.56 (0.52-0.61)
Total	28,573	5,715	1.52 (1.50-1.54)	72,146	14,429	4.13 (4.10-4.16)	108,261	21,652	5.65 (5.62-5.69)	10,105	2,021	0.54 (0.53-0.55)

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^a Annual average cases are calculated by dividing the five-year total by five.

^b Rates are per 100,000 and are age-adjusted to the 2000 US standard population.

^c ICD-O-3 histopathology code 9560/0 and ICD-O-3 topography code C72.4 and C72.5.

^d ICD-O-3 histopathology code 8272/0 and ICD-O-3 topography code C75.1.

^e Benign or borderline meningioma with WHO grade determined by a combination of the following variables: CS site specific factor variable 1 (2018+), WHO grade pathological, and WHO grade clinical.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2017-2021

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program; CI, confidence interval; NOS, not otherwise specified.; WHO. World Health Organization

Distribution of Tumors by Site, Histopathology, and Behavior

The distribution of malignant and non-malignant brain and other CNS tumors by site are shown in Figure 11A and Figure 12A, respectively.

For malignant tumors, frontal (25.1%), temporal (17.8%), parietal (10.4%), and occipital (2.5%) accounted for 55.8% of tumors (Figure 11A).
For non-malignant tumors, 56.9% of all tumors occurred in the meninges, while 24.9% occurred in the pituitary and cricopharyngeal duct (Figure 12A).

The distribution of malignant and non-malignant brain and other CNS tumors by histopathology are shown in Figure 11B and Figure 12B, respectively, as well as in Table 6.

The majority of newly diagnosed malignant CNS tumors were glioblastoma (51.5%, Figure 11B).
The majority of newly diagnosed non-malignant CNS tumors were meningioma (56.8%, Figure 12B).
The most common non-malignant nerve sheath tumor (based on multiple sites in the brain and CNS) was vestibular schwannoma (defined by histopathology code 9560, also formerly called acoustic neuromas) (76.8%, Figure 12B).

Distribution of Gliomas by Site and Histopathology

The broad category glioma (ICD-O-3 histopathology codes 9380–9384, 9391–9460; see Table 2 for more information) represented approximately 23% of all primary brain and other CNS tumors and 81% of malignant tumors. The distribution of gliomas by site and histopathology are shown in Figure 13A and Figure 13B, respectively.

Figure 13. — Distribution^a of Primary Brain and Other Central Nervous System Gliomas (ICD-O-3 histopathology codes 9380-9384 and 9391-9460) (Five-Year Total=107,219; Annual Average Cases=21,444) by A) Site and B) Histopathology Subtypes

The proportion of brain and CNS tumors classified as glioma varied substantially by age. Gliomas represented 58.0%, 26.9%, and 21.9% in persons ages 0-14 years, 15-39 years, and 40+ years, respectively (Table 8).
Most gliomas occurred in the supratentorium (frontal, temporal, parietal, and occipital lobes combined). Only a very small proportion of gliomas occurred in areas of the CNS other than the brain.
Glioblastoma accounted for most gliomas (61.0%).

Table 8.

Five-Year Total, Annual Average Total^a, and Average Annual Age-Adjusted Incidence Rates^b with 95% Confidence Intervals of Brain and Other Central Nervous System Tumors by Histopathology and NCI Age Group

Histopathology	Children^c (0-14 years)			AYA^d (15-39 years)			Older Adults (40+ years)
Histopathology	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)
*Diffuse Astrocytic and Oligodendroglial Tumors*	1,121	224	0.37 (0.35-0.39)	9,649	1,930	1.78 (1.75-1.82)	73,628	14,726	8.58 (8.51-8.64)
Diffuse astrocytoma	513	103	0.17 (0.16-0.19)	2,804	561	0.51 (0.49-0.53)	4,218	844	0.54 (0.52-0.55)
Anaplastic astrocytoma	158	32	0.05 (0.04-0.06)	1,899	380	0.35 (0.33-0.36)	4,000	800	0.50 (0.48-0.51)
Glioblastoma	391	78	0.13 (0.12-0.14)	3,028	606	0.57 (0.55-0.59)	61,946	12,389	7.07 (7.02-7.13)
Oligodendroglioma	45	9	0.02 (0.01-0.02)	1,397	279	0.26 (0.25-0.27)	2,120	424	0.29 (0.28-0.31)
Anaplastic oligodendroglioma	--	--	----	--	--	--	1,257	251	0.16 (0.15-0.17)
Oligoastrocytic tumors	--	--	--	--	--	--	87	17	0.01 (0.01-0.01)
*Other Astrocytic Tumors*	3,772	754	1.25 (1.21-1.29)	1,895	379	0.34 (0.33-0.36)	736	147	0.10 (0.09-0.11)
Pilocytic astrocytoma	3,402	680	1.13 (1.09-1.17)	1,494	299	0.27 (0.26-0.28)	576	115	0.08 (0.07-0.08)
Unique astrocytoma variants	370	74	0.12 (0.11-0.14)	401	80	0.07 (0.07-0.08)	160	32	0.02 (0.02-0.03)
Malignant	126	25	0.04 (0.03-0.05)	268	54	0.05 (0.04-0.05)	114	23	0.02 (0.01-0.02)
Non-Malignant	244	49	0.08 (0.07-0.09)	133	27	0.02 (0.02-0.03)	46	9	0.01 (0.00-0.01)
*Ependymal Tumors*	885	177	0.29 (0.28-0.31)	1,855	371	0.34 (0.33-0.36)	4,094	819	0.52 (0.50-0.53)
Malignant	767	153	0.26 (0.24-0.27)	926	185	0.17 (0.16-0.18)	2,032	406	0.26 (0.25-0.27)
Non-Malignant	118	24	0.04 (0.03-0.05)	929	186	0.17 (0.16-0.18)	2,062	412	0.26 (0.25-0.27)
*Other Gliomas*	2,679	536	0.89 (0.86-0.93)	2,030	406	0.37 (0.35-0.39)	4,447	889	0.55 (0.53-0.57)
Glioma malignant, NOS	--	--	--	--	--	--	4,410	882	0.54 (0.53-0.56)
Other neuroepithelial tumors	--	--	--	--	--	--	37	7	0.01 (0.00-0.01)
*Neuronal and Mixed Neuronal-Glial Tumors*	*1,370*	*274*	*0.45 (0.43-0.48)*	*2,201*	*440*	*0.40 (0.38-0.41)*	*1,732*	*346*	*0.23 (0.22-0.24)*
Malignant	74	15	0.02 (0.02-0.03)	179	36	0.03 (0.03-0.04)	654	131	0.08 (0.07-0.09)
Non-Malignant	1,296	259	0.43 (0.40-0.45)	2,022	404	0.36 (0.35-0.38)	1,078	216	0.15 (0.14-0.16)
*Choroid Plexus Tumors*	330	66	0.11 (0.10-0.12)	215	43	0.04 (0.03-0.04)	260	52	0.03 (0.03-0.04)
Malignant	84	17	0.03 (0.02-0.04)	--	--	--	--	--	--
Non-Malignant	246	49	0.08 (0.07-0.09)	--	--	--	--	--	--
*Tumors of The Pineal Region*	132	26	0.04 (0.04-0.05)	252	50	0.05 (0.04-0.05)	328	66	0.04 (0.04-0.05)
Malignant	115	23	0.04 (0.03-0.05)	160	32	0.03 (0.02-0.03)	168	34	0.02 (0.02-0.02)
Non-Malignant	17	3	0.01 (0.00-0.01)	92	18	0.02 (0.01-0.02)	160	32	0.02 (0.02-0.02)
*Embryonal Tumors*	2,061	412	0.69 (0.66-0.72)	698	140	0.12 (0.12-0.13)	246	49	0.04 (0.03-0.04)
Medulloblastoma	1,395	279	0.47 (0.44-0.49)	598	120	0.11 (0.10-0.12)	162	32	0.03 (0.02-0.03)
Atypical teratoid/rhabdoid tumor	370	74	0.13 (0.11-0.14)	31	6	0.01 (0.00-0.01)	17	3	<0.01
All other embryonal	210	42	0.07 (0.06-0.08)	35	7	0.01 (0.00-0.01)	34	7	<0.01
*Tumors of Cranial and Spinal Nerves*	457	91	0.15 (0.14-0.16)	5,441	1,088	1.02 (0.99-1.04)	31,569	6,314	3.78 (3.74-3.83)
Nerve sheath tumors	--	--	--	--	--	--	31,545	6,309	3.78 (3.74-3.82)
Malignant	--	--	--	--	--	--	146	29	0.02 (0.02-0.02)
Non-Malignant	--	--	--	--	--	--	31,399	6,280	3.76 (3.72-3.81)
Other tumors of cranial and spinal nerves	--	--	--	--	--	--	24	5	<0.01
*Tumors of Meninges*	686	137	0.23 (0.21-0.24)	12,047	2,409	2.30 (2.26-2.34)	188,460	37,692	22.37 (22.27-22.47)
Meningiomas	--	--	--	--	--	--	184,501	36,900	21.88 (21.78-21.98)
Malignant	--	--	--	--	--	--	1,500	300	0.18 (0.17-0.19)
Non-Malignant	--	--	--	--	--	--	183,001	36,600	21.70 (21.60-21.81)
Mesenchymal tumors	365	73	0.12 (0.11-0.13)	1,537	307	0.28 (0.27-0.29)	3,845	769	0.48 (0.46-0.49)
Malignant	71	14	0.02 (0.02-0.03)	174	35	0.03 (0.03-0.04)	556	111	0.07 (0.06-0.08)
Non-Malignant	294	59	0.10 (0.09-0.11)	1,363	273	0.25 (0.24-0.26)	3,289	658	0.41 (0.39-0.42)
Primary melanocytic lesions	--	--	--	--	--	--	114	23	0.01 (0.01-0.02)
Malignant	--	--	--	--	--	--	73	15	0.01 (0.01-0.01)
Non-Malignant	--	--	--	--	--	--	41	8	<0.01
*Lymphomas and Hemopoietic Neoplasms*	83	17	0.03 (0.02-0.03)	504	101	0.09 (0.09-0.10)	8,029	1,606	0.93 (0.91-0.95)
Lymphoma	--	--	--	--	--	--	7,984	1,597	0.92 (0.90-0.94)
Other hematopoietic neoplasms	--	--	--	--	--	--	45	9	0.01 (0.00-0.01)
*Germ Cell Tumors*	521	104	0.17 (0.16-0.19)	623	125	0.11 (0.10-0.12)	70	14	0.01 (0.01-0.01)
Malignant	454	91	0.15 (0.14-0.16)	584	117	0.10 (0.10-0.11)	27	5	<0.01
Non-Malignant	67	13	0.02 (0.02-0.03)	39	8	0.01 (0.00-0.01)	43	9	0.01 (0.00-0.01)
*Tumors of Sellar Region*	1,867	373	0.61 (0.58-0.64)	25,213	5,043	4.60 (4.54-4.65)	57,203	11,441	7.18 (7.12-7.25)
Tumors of the pituitary	1,228	246	0.40 (0.38-0.42)	24,526	4,905	4.47 (4.41-4.53)	55,433	11,087	6.97 (6.91-7.03)
Malignant	--	--	--	--	--	--	89	18	0.01 (0.01-0.01)
Non-Malignant	--	--	--	--	--	--	55,344	11,069	6.96 (6.90-7.02)
Craniopharyngioma	639	128	0.21 (0.20-0.23)	687	137	0.13 (0.12-0.14)	1,770	354	0.22 (0.21-0.23)
*Unclassified Tumors*	941	188	0.31 (0.29-0.33)	2,776	555	0.51 (0.49-0.53)	14,788	2,958	1.79 (1.76-1.82)
Hemangioma	271	54	0.09 (0.08-0.10)	1,182	236	0.22 (0.20-0.23)	3,022	604	0.38 (0.36-0.39)
Neoplasm, unspecified	527	105	0.17 (0.16-0.19)	1,480	296	0.27 (0.26-0.29)	11,555	2,311	1.38 (1.36-1.41)
Malignant	177	35	0.06 (0.05-0.07)	398	80	0.07 (0.07-0.08)	6,475	1,295	0.77 (0.75-0.78)
Non-Malignant	350	70	0.12 (0.10-0.13)	1,082	216	0.20 (0.19-0.21)	5,080	1,016	0.62 (0.60-0.63)
All other	143	29	0.05 (0.04-0.06)	114	23	0.02 (0.02-0.02)	211	42	0.03 (0.02-0.03)
Malignant	33	7	0.01 (0.01-0.02)	--	--	--	--	--	--
Non-Malignant	110	22	0.04 (0.03-0.04)	--	--	--	--	--	--
Total ^e	16,905	3,381	5.61 (5.52-5.69)	65,399	13,080	12.07 (11.98-12.16)	385,590	77,118	46.14 (45.99-46.29)
*Malignant*	*10,895*	*2,179*	*3.62 (3.56-3.69)*	*17,205*	*3,441*	*3.16 (3.11-3.21)*	*98,707*	*19,741*	*11.59 (11.51-11.66)*
*Non-Malignant*	*6,010*	*1,202*	*1.98 (1.93-2.03)*	*48,194*	*9,639*	*8.91 (8.83-8.99)*	*286,883*	*57,377*	*34.55 (34.42-34.68)*

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^a Annual average cases are calculated by dividing the five-year total by five.

^b Rates are per 100,000 and are age-adjusted to the 2000 US standard population.

^c Children as defined by the National Cancer Institute, see: http://www.cancer.gov/researchandfunding/snapshots/pediatric.

^d Adolescents and Young Adults (AYA), as defined by the National Cancer Institute, see: http://www.cancer.gov/cancertopics/aya.

^e Refers to all brain tumors including histopathologies not presented in this table.

-- Counts and rates are not presented when fewer than 16 cases were reported for the specific category. The suppressed cases are included in the counts and rates for totals.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2017-2021

Abbreviations: AYA, Adolescents and Young Adults; CBTRUS, Central Brain Tumor Registry of the United States; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program; CI, confidence interval; NOS, not otherwise specified.

Distribution of Spinal Cord Tumors by Age

Although spinal cord tumors account for a relatively small percentage of brain and other CNS tumors, they result in significant morbidity. The most common histopathologies found in the spinal cord, spinal meninges, and cauda equina are shown for both children and adolescents (ages 0-19 years, Figure 14A) and adults (ages 20+ years, Figure 14B).

Figure 14. — Distribution^a of Primary Spinal Cord, Spinal Meninges, and Cauda Equina Tumors by Histopathology in A) Children and Adolescents (Ages 0-19 Years, Five-Year Total=1,368; Annual Average Cases=274) and B) Adults (Ages 20+ Years, Five-Year Total=18,966; Annual Average Cases=3,793)

The predominant histopathology group for those ages 0-19 years was ependymal tumors (18.3%) followed by nerve sheath tumors (17.0%).
Meningiomas (40.2%) accounted for the largest proportion of spinal cord tumors among those ages 20 years and older, followed by nerve sheath tumors (31.6%).

Distributions and Incidence by Age at Diagnosis

Incidence Rates by Age at Diagnosis

The overall incidence rates of tumors by behavior and age group at diagnosis (0-14 years, 0-19 years, and 20+ years) are shown in Figure 3B and by select histopathology by five-year age group at diagnosis in Figure 15. Total counts and AAAIR by five-year age group at diagnosis (0-19 years) and ten-year age group (20-85+ years) are shown in Supplementary Table 2 and Supplementary Table 3, respectively.

Figure 15. — Average Annual Age-Adjusted Incidence Rates^a of Brain and Other Central Nervous System Tumors by Selected Histopathologies and Age Group at Diagnosis for A) Children Ages 0-14 Years, B) Adolescents and Young Adults Ages 15-39 Years, and B) Older Adults Ages 40+ Years

The overall AAAIR for 2017-2021 for all primary brain and other CNS tumors was 25.34 per 100,000 population (Table 6).
The overall incidence rate was 5.61 per 100,000 population for children ages 0-14 years, 12.07 per 100,000 population for AYA 15-39 years, and 46.14 per 100,000 population for adults ages 40+ years (Table 8).
The incidence rate for all brain and other CNS tumors was highest among ages 85+ years (98.22 per 100,000) and lowest among children ages 5-9 years (5.29 per 100,000).
Incidence rates of other astrocytic tumors and embryonal tumors were higher in the younger age groups and decreased with advancing age.
Glioblastoma and diffuse and anaplastic astrocytoma incidence were highest among persons ages 70-74 years.
Incidence rates of anaplastic astrocytoma, meningiomas, lymphomas and hemopoietic neoplasms, tumors of the sellar region, hemangioma, and non-malignant tumors overall were lower in the younger age groups and increased with advancing age.

Median Age at Diagnosis

The median age at diagnosis for all primary brain and other CNS tumors was 62 years (Figure 16).

The histopathology-specific median ages ranged from 8 years for embryonal tumors to 71 years for neoplasm, unspecified.
Pilocytic astrocytoma and embryonal tumors occurred mostly in children, while unique astrocytoma variants, glioma malignant, NOS, neuronal and mixed neuronal-glial tumors, tumors of the pineal region, and all other were most common among AYA.
The most diagnosed histopathologies in older ages were glioblastoma, meningiomas, and lymphoma (median age of 66, 68, and 69 years, respectively).

Distribution and Incidence Rates of Tumors by Site, Histopathology, and Age at Diagnosis

Distribution and Incidence Rates of Tumors by Site, Histopathology, and Age at Diagnosis in Children and Adolescents (Ages 0-19 Years)

Brain and other CNS tumors are the most common form of solid tumors in children and account for most of the cancer mortality in this age group. About 5.3% of the reported brain and other CNS tumors during 2017-2021 occurred in children and adolescents ages 0-19 years (Table 9).

Table 9.

Five-Year Total, Annual Average Total^a, and Average Annual Age-Adjusted Incidence Rates^b with 95% Confidence Intervals for Brain and Other Central Nervous System Tumors Among Children and Adolescents (Ages 0-19 Years) by Histopathology and Sex

Histopathology	Total (Ages 0-19 Years)			Male			Female
Histopathology	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)
*Diffuse Astrocytic and Oligodendroglial Tumors*	1,751	350	0.42 (0.40-0.44)	946	189	0.45 (0.42-0.48)	805	161	0.40 (0.37-0.43)
Diffuse astrocytoma	759	152	0.18 (0.17-0.20)	396	79	0.19 (0.17-0.21)	363	73	0.18 (0.16-0.20)
Anaplastic astrocytoma	248	50	0.06 (0.05-0.07)	143	29	0.07 (0.06-0.08)	105	21	0.05 (0.04-0.06)
Glioblastoma	606	121	0.15 (0.14-0.16)	342	68	0.16 (0.14-0.18)	264	53	0.13 (0.12-0.15)
Oligodendroglioma	112	22	0.03 (0.02-0.03)	52	10	0.02 (0.02-0.03)	60	12	0.03 (0.02-0.04)
Anaplastic oligodendroglioma	--	--	--	--	--	--	--	--	--
Oligoastrocytic tumors	--	--	--	--	--	--	--	--	--
*Other Astrocytic Tumors*	4,529	906	1.11 (1.08-1.15)	2,427	485	1.17 (1.12-1.22)	2,102	420	1.06 (1.01-1.10)
Pilocytic astrocytoma	4,029	806	0.99 (0.96-1.02)	2,165	433	1.04 (1.00-1.09)	1,864	373	0.94 (0.90-0.98)
Unique astrocytoma variants	500	100	0.12 (0.11-0.13)	262	52	0.13 (0.11-0.14)	238	48	0.12 (0.10-0.13)
Malignant	211	42	0.05 (0.04-0.06)	99	20	0.05 (0.04-0.06)	112	22	0.05 (0.05-0.07)
Non-Malignant	289	58	0.07 (0.06-0.08)	163	33	0.08 (0.07-0.09)	126	25	0.06 (0.05-0.08)
*Ependymal Tumors*	1,132	226	0.28 (0.26-0.29)	653	131	0.31 (0.29-0.34)	479	96	0.24 (0.22-0.26)
Malignant	902	180	0.22 (0.21-0.24)	513	103	0.25 (0.23-0.27)	389	78	0.20 (0.18-0.22)
Non-Malignant	230	46	0.05 (0.05-0.06)	140	28	0.07 (0.05-0.08)	90	18	0.04 (0.04-0.05)
*Other Gliomas*	3,241	648	0.80 (0.77-0.83)	1,560	312	0.75 (0.71-0.79)	1,681	336	0.85 (0.81-0.89)
Glioma malignant, NOS	--	--	--	--	--	--	--	--	--
Other neuroepithelial tumors	--	--	--	--	--	--	--	--	--
Neuronal and Mixed Neuronal-Glial Tumors	2,026	405	0.49 (0.47-0.51)	1,150	230	0.54 (0.51-0.58)	876	175	0.43 (0.41-0.46)
Malignant	107	21	0.03 (0.02-0.03)	45	9	0.02 (0.02-0.03)	62	12	0.03 (0.02-0.04)
Non-Malignant	1,919	384	0.46 (0.44-0.49)	1,105	221	0.52 (0.49-0.55)	814	163	0.40 (0.38-0.43)
*Choroid Plexus Tumors*	375	75	0.09 (0.08-0.10)	211	42	0.10 (0.09-0.12)	164	33	0.08 (0.07-0.10)
Malignant	85	17	0.02 (0.02-0.03)	51	10	0.03 (0.02-0.03)	34	7	0.02 (0.01-0.02)
Non-Malignant	290	58	0.07 (0.06-0.08)	160	32	0.08 (0.07-0.09)	130	26	0.07 (0.06-0.08)
*Tumors of The Pineal Region*	189	38	0.05 (0.04-0.05)	92	18	0.04 (0.04-0.05)	97	19	0.05 (0.04-0.06)
Malignant	158	32	0.04 (0.03-0.05)	--	--	--	--	--	--
Non-Malignant	31	6	0.01 (0.01-0.01)	--	--	--	--	--	--
*Embryonal Tumors*	2,248	450	0.56 (0.54-0.58)	1,331	266	0.65 (0.61-0.68)	917	183	0.47 (0.44-0.50)
Medulloblastoma	1,554	311	0.39 (0.37-0.40)	980	196	0.47 (0.45-0.51)	574	115	0.29 (0.27-0.32)
Atypical teratoid/rhabdoid tumor	376	75	0.10 (0.09-0.11)	191	38	0.10 (0.08-0.11)	185	37	0.10 (0.08-0.11)
All other embryonal	221	44	0.06 (0.05-0.06)	101	20	0.05 (0.04-0.06)	120	24	0.06 (0.05-0.07)
*Tumors of Cranial and Spinal Nerves*	872	174	0.21 (0.20-0.22)	431	86	0.20 (0.18-0.22)	441	88	0.22 (0.20-0.24)
Nerve sheath tumors	--	--	--	--	--	--	--	--	--
Other tumors of cranial and spinal nerves	--	--	--	--	--	--	--	--	--
*Tumors of Meninges*	1,279	256	0.31 (0.29-0.32)	634	127	0.30 (0.27-0.32)	645	129	0.32 (0.29-0.34)
Meningiomas	680	136	0.16 (0.15-0.17)	317	63	0.15 (0.13-0.16)	363	73	0.18 (0.16-0.20)
Malignant	18	4	<0.01	--	--	--	--	--	--
Non-Malignant	662	132	0.16 (0.15-0.17)	--	--	--	--	--	--
Mesenchymal tumors	--	--	--	--	--	--	--	--	--
Primary melanocytic lesions	--	--	--	--	--	--	--	--	--
*Lymphomas and Hemopoietic Neoplasms*	114	23	0.03 (0.02-0.03)	67	13	0.03 (0.02-0.04)	47	9	0.02 (0.02-0.03)
Lymphoma	--	--	--	--	--	--	--	--	--
Other hematopoietic neoplasms	--	--	--	--	--	--	--	--	--
*Germ Cell Tumors*	814	163	0.20 (0.18-0.21)	568	114	0.27 (0.24-0.29)	246	49	0.12 (0.11-0.14)
Malignant	741	148	0.18 (0.17-0.19)	521	104	0.24 (0.22-0.26)	220	44	0.11 (0.10-0.13)
Non-Malignant	73	15	0.02 (0.01-0.02)	47	9	0.02 (0.02-0.03)	26	5	0.01 (0.01-0.02)
*Tumors of Sellar Region*	4,798	960	1.14 (1.10-1.17)	1,438	288	0.67 (0.64-0.71)	3,360	672	1.62 (1.57-1.68)
Tumors of the pituitary	4,006	801	0.94 (0.91-0.97)	1,001	200	0.46 (0.43-0.49)	3,005	601	1.44 (1.39-1.49)
Craniopharyngioma	792	158	0.19 (0.18-0.21)	437	87	0.21 (0.19-0.23)	355	71	0.18 (0.16-0.20)
*Unclassified Tumors*	1,408	282	0.34 (0.32-0.36)	733	147	0.35 (0.32-0.37)	675	135	0.34 (0.31-0.36)
Hemangioma	463	93	0.11 (0.10-0.12)	242	48	0.11 (0.10-0.13)	221	44	0.11 (0.09-0.12)
Neoplasm, unspecified	774	155	0.19 (0.18-0.20)	392	78	0.19 (0.17-0.21)	382	76	0.19 (0.17-0.21)
Malignant	238	48	0.06 (0.05-0.07)	128	26	0.06 (0.05-0.07)	110	22	0.06 (0.05-0.07)
Non-Malignant	536	107	0.13 (0.12-0.14)	264	53	0.13 (0.11-0.14)	272	54	0.14 (0.12-0.15)
All other	171	34	0.04 (0.04-0.05)	99	20	0.05 (0.04-0.06)	72	14	0.04 (0.03-0.05)
Malignant	38	8	0.01 (0.01-0.01)	20	4	0.01 (0.01-0.01)	18	4	0.01 (0.01-0.01)
Non-Malignant	133	27	0.03 (0.03-0.04)	79	16	0.04 (0.03-0.05)	54	11	0.03 (0.02-0.04)
Total ^c	24,776	4,955	6.02 (5.95-6.10)	12,241	2,448	5.83 (5.73-5.94)	12,535	2,507	6.22 (6.11-6.33)
*Malignant*	*13,596*	*2,719*	*3.34 (3.28-3.40)*	*7,397*	*1,479*	*3.55 (3.47-3.63)*	*6,199*	*1,240*	*3.12 (3.05-3.20)*
*Non-Malignant*	*11,180*	*2,236*	*2.68 (2.63-2.73)*	*4,844*	*969*	*2.28 (2.22-2.35)*	*6,336*	*1,267*	*3.10 (3.02-3.17)*

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^a Annual average cases are calculated by dividing the five-year total by five.

^b Rates are per 100,000 and are age-adjusted to the 2000 US standard population.

^c Refers to all brain tumors including histopathologies not presented in this table.

- Counts and rates are not presented when fewer than 16 cases were reported for the specific category. The suppressed cases are included in the counts and rates for totals.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2017-2021

The distribution of brain and other CNS tumors in children and adolescents by site is shown in Figure 17A.

The largest percentages of tumors in childhood and adolescents were in the pituitary and craniopharyngeal duct (19.6%), followed by the cerebellum (13.3%).
Frontal, temporal, parietal, and occipital lobes of the brain accounted for 5.9%, 6.5%, 2.6%, and 1.0% of all brain and other CNS tumors in childhood and adolescents, respectively.
Cerebrum, ventricle, and brainstem accounted for 5.2%, 5.2%, and 10.1% of all brain and other CNS tumors in childhood and adolescence, respectively.

Incidence rates for children and adolescents are shown in Table 9. Figure 17B shows the most common brain and other CNS histopathologies in children and adolescents ages 0-19 years.

Overall AAAIRs were highest for other astrocytic tumors (1.11 per 100,000) and tumors of the sellar region (1.14 per 100,000). Among these tumors, the most common histopathologies were pilocytic astrocytoma (0.99 per 100,000) and tumors of the pituitary (0.94 per 100,000).
For children and adolescents, gliomas, and embryonal tumors accounted for 43.0%, and 9.1%, respectively.
The most common glioma histopathology was pilocytic astrocytoma (16.3%).
Medulloblastomas accounted for 69.1% of all embryonal tumors in this age group.
Tumors of the pituitary were the most common nonglial and predominantly non-malignant histopathology and accounted for 16.2% of all tumors in this age group.
Gliomas accounted for 43.0% of tumors in children and adolescents.

Distribution of Tumors by Site and Histopathology in Children (Ages 0-14 Years)

Approximately 3.6% of all reported tumors occurred in children (Table 8). The distribution of brain and other CNS tumors for children by site is shown in Figure 18A.

Tumors of cerebellum (16.4%) comprised the largest proportion of tumors followed by tumors located in other brain (13.3%) and brainstem (12.6%).

Incidence rates for children ages 0-14 are shown in Table 9. Figure 18B shows the most common brain and other CNS histopathologies in children.

For children, gliomas, and embryonal tumors accounted for 50.0%, of brain and other CNS tumors respectively.
The most common glioma histopathology was pilocytic astrocytoma (20.1%). Medulloblastomas, ATRT, and all other embryonal tumors accounted for 67.7%, 18.0%, and 10.2%, respectively of embryonal tumors in children.

Distribution of Tumors by Site and Histopathology in Adolescents (Ages 15-19 Years)

From 2017-2021 approximately 1.7% of the reported brain and other CNS tumors occurred in adolescents for a total of 7,871 tumors diagnosed (Supplementary Table 2). The distribution of these tumors by site is shown in Figure 19A.

Figure 19. — Distribution^a in Adolescents (Ages 15-19 Years) of Primary Brain and Central Nervous System Tumors (Five-Year Total=7,871; Annual Average Cases=1,574) by A) Site and B) Histopathology

37.7% of these tumors were diagnosed in the pituitary and craniopharyngeal duct.
The frontal lobe, temporal lobe, occipital lobe, and parietal lobe accounted for 17.4% of tumors in this age group.

Incidence rates for adolescents are shown in Supplementary Table 2. The distribution of brain and other CNS tumors in adolescents by histopathology is shown in Figure 19B.

Incidence of malignant tumors was 2.50 per 100,000 population, and incidence of non-malignant tumors was 4.76 per 100,000 population.
The most common histopathology in adolescents was tumors of the pituitary (35.3%).
Gliomas accounted for 27.9% of brain tumors in adolescents.
The most common glioma histopathology was pilocytic astrocytoma (8.0%).

Distribution and Incidence Rates of AYA Primary Brain and Other CNS Tumors (Ages 15-39 Years)

There were 65,399 primary brain and other CNS tumors diagnosed in AYA between 2017 and 2021, representing 14.0% of all brain and other CNS tumors (Table 8). The distribution of these tumors by site and histopathology is shown in Figure 20A and Figure 20B, respectively.

Figure 20. — Distribution^a in Adolescents and Young Adults^b (Ages 15-39 Years) of Primary Brain and Other Central Nervous System Tumors (Five-Year Total=65,399; Annual Average Cases=13,080) by A) Site and B) Histopathology

The overall incidence rate in the AYA age group was 12.07 per 100,000 population.
Incidence of malignant tumors was 3.16 per 100,000 population, and incidence of non-malignant tumors was 8.91 per 100,000 population.
The majority of AYA brain and other CNS tumors occurred in the pituitary and craniopharyngeal duct (39.0%), followed by the meninges (16.5%).
Approximately 16.5% of tumors diagnosed in AYA were located within the frontal, temporal, and parietal lobes of the brain combined.
The most common histopathology in AYA was tumors of the pituitary (37.5%), followed by meningiomas (16.0%) and nerve sheath tumors (8.3%).
Gliomas accounted for approximately 27.0% of all brain and other CNS tumors in AYA.

Distribution and Incidence Rates by CCR and Diagnostic Confirmation

The overall number of reported tumors is listed by CCR in Table 10. While most malignant tumors are diagnosed by histopathologic confirmation (where the patient receives surgery and diagnosis is confirmed on tissue by a pathologist), brain and other CNS tumors may also be diagnosed by radiographic confirmation only (where the tumor was visualized on MRI, CT, X-ray, or other imaging technology, but surgery was not performed). Please note, while five years of data are available for most included CCR, data were not available from Indiana for diagnosis years 2020 and 2021 due to data quality issues.

Table 10.

Five-Year Total, Annual Average Total^a, Average Annual Age-Adjusted Incidence Rates^b with 95% Confidence Intervals, and Characteristics of All Brain and Other Central Nervous System Tumors by Central Cancer Registry, Behavior, and Diagnostic Confirmation

Central Cancer Registry	All						Malignant						Non-Malignant
Central Cancer Registry	Total (2017-2021)	Annual Average	Rate (95% CI)	Histo- pathologically Confirmed (%)^c	Radio- graphically Confirmed (%)^d	Average Annual 5-Year Population^e	Total (2017-2021)	Annual Average	Rate (95% CI)	% Malignant	Histo- pathologically Confirmed (%)	Radio- graphically Confirmed (%)	Total (2017-2021)	Annual Average	Rate (95% CI)	% Non-Malignant	Histo- pathologically Confirmed (%)	Radio- graphically Confirmed (%)
Alabama	5,934	1,187	20.56 (20.02-21.11)	52.9%	38.5%	5,002,474	2,036	780	7.07 (6.75-7.39)	34.3%	73.8%	5.7%	3,898	62	13.49 (13.06-13.94)	65.7%	42.0%	55.6%
Alaska	933	187	25.46 (23.78-27.22)	46.8%	50.2%	736,359	253	136	6.74 (5.90-7.67)	27.1%	79.8%	15.0%	680	15	18.72 (17.28-20.24)	72.9%	34.6%	63.2%
Arkansas	4,013	803	23.40 (22.65-24.16)	49.4%	44.2%	3,006,820	1,233	556	7.11 (6.71-7.54)	30.7%	78.4%	9.9%	2,780	42	16.28 (15.66-16.92)	69.3%	36.5%	59.4%
Arizona	8,666	1,733	21.23 (20.77-21.69)	59.2%	36.6%	7,073,375	2,714	1,190	6.66 (6.41-6.93)	31.3%	84.9%	6.9%	5,952	109	14.56 (14.18-14.95)	68.7%	47.5%	50.2%
California	49,150	9,830	23.00 (22.79-23.21)	54.1%	40.8%	39,429,793	13,763	7,077	6.46 (6.35-6.57)	28.0%	84.7%	7.9%	35,387	499	16.54 (16.36-16.71)	72.0%	42.3%	53.6%
Colorado	9,172	1,834	30.00 (29.37-30.63)	45.5%	51.5%	5,721,926	2,095	1,415	6.79 (6.50-7.10)	22.8%	83.7%	10.6%	7,077	94	23.20 (22.65-23.76)	77.2%	34.2%	63.6%
Connecticut	5,131	1,026	24.08 (23.40-24.78)	61.4%	35.6%	3,609,329	1,635	699	7.71 (7.33-8.11)	31.9%	88.6%	7.4%	3,496	51	16.37 (15.81-16.95)	68.1%	48.6%	48.9%
District of Columbia	876	175	25.96 (24.22-27.79)	45.9%	50.7%	678,736	195	136	5.75 (4.95-6.65)	22.3%	83.6%	10.8%	681	7	20.21 (18.68-21.84)	77.7%	35.1%	62.1%
Delaware	1,293	259	21.92 (20.68-23.23)	56.1%	41.9%	982,212	411	176	6.91 (6.22-7.65)	31.8%	89.0%	7.5%	882	15	15.02 (13.99-16.10)	68.2%	40.8%	57.9%
Florida	36,544	7,309	26.90 (26.61-27.20)	48.7%	47.5%	21,355,666	9,444	5,420	7.12 (6.97-7.27)	25.8%	84.5%	9.7%	27,100	322	19.78 (19.54-20.03)	74.2%	36.2%	60.7%
Georgia	15,907	3,181	28.18 (27.73-28.63)	46.5%	47.2%	10,624,034	3,640	2,453	6.40 (6.19-6.62)	22.9%	83.0%	10.0%	12,267	186	21.77 (21.38-22.17)	77.1%	35.7%	58.3%
Hawaii	1,528	306	17.55 (16.65-18.50)	55.6%	39.1%	1,454,785	389	228	4.66 (4.19-5.17)	25.5%	82.8%	11.1%	1,139	12	12.89 (12.12-13.70)	74.5%	46.3%	48.7%
Iowa	4,835	967	26.54 (25.77-27.33)	52.9%	44.1%	3,181,182	1,366	694	7.45 (7.05-7.87)	28.2%	84.0%	11.0%	3,469	48	19.09 (18.43-19.76)	71.8%	40.6%	57.1%
Idaho	2,641	528	26.59 (25.56-27.66)	53.2%	44.7%	1,812,834	746	379	7.48 (6.93-8.05)	28.2%	82.3%	13.8%	1,895	26	19.11 (18.24-20.02)	71.8%	41.7%	56.9%
Illinois	19,428	3,886	26.96 (26.57-27.35)	48.7%	48.2%	12,826,944	4,813	2,923	6.73 (6.54-6.93)	24.8%	88.2%	6.6%	14,615	186	20.23 (19.89-20.57)	75.2%	35.7%	61.9%
Indiana^f	4,734	947	21.37 (20.75-22.01)	53.4%	42.3%	6,754,970	1,585	630	7.15 (6.79-7.52)	33.5%	83.5%	10.0%	3,149	59	14.22 (13.71-14.74)	66.5%	38.2%	58.6%
Kansas	3,839	768	23.49 (22.73-24.27)	51.7%	45.1%	2,933,724	1,099	548	6.75 (6.34-7.17)	28.6%	89.1%	7.0%	2,740	43	16.75 (16.10-17.41)	71.4%	36.7%	60.4%
Kentucky	7,719	1,544	30.30 (29.61-31.01)	43.6%	47.6%	4,495,065	1,974	1,149	7.71 (7.36-8.07)	25.6%	81.9%	9.9%	5,745	89	22.59 (21.99-23.20)	74.4%	30.4%	60.6%
Louisiana	6,811	1,362	26.41 (25.77-27.07)	51.5%	43.7%	4,658,273	1,599	1,042	6.23 (5.92-6.55)	23.5%	86.4%	9.1%	5,212	69	20.19 (19.62-20.76)	76.5%	40.7%	54.3%
Massachusetts	8,349	1,670	20.75 (20.29-21.22)	64.2%	31.0%	6,990,649	2,823	1,105	7.06 (6.79-7.33)	33.8%	88.1%	6.0%	5,526	99	13.69 (13.32-14.07)	66.2%	52.0%	43.7%
Maryland	8,545	1,709	24.57 (24.04-25.11)	51.7%	43.1%	6,152,332	2,294	1,250	6.64 (6.36-6.92)	26.9%	84.7%	5.6%	6,251	86	17.94 (17.48-18.40)	73.2%	39.5%	56.9%
Maine	1,684	337	19.45 (18.46-20.48)	65.4%	29.6%	1,358,685	686	200	7.86 (7.24-8.52)	40.7%	81.9%	9.2%	998	18	11.59 (10.83-12.40)	59.3%	54.1%	43.7%
Michigan	12,273	2,455	20.84 (20.46-21.23)	56.3%	38.7%	10,061,055	3,916	1,671	6.68 (6.46-6.90)	31.9%	86.2%	5.5%	8,357	109	14.16 (13.85-14.48)	68.1%	42.2%	54.3%
Minnesota	7,638	1,528	23.99 (23.44-24.55)	60.3%	36.8%	5,672,668	2,433	1,041	7.68 (7.37-8.00)	31.9%	87.8%	8.2%	5,205	88	16.31 (15.85-16.77)	68.2%	47.4%	50.2%
Missouri	9,079	1,816	25.62 (25.08-26.17)	46.9%	48.4%	6,141,616	2,546	1,307	7.23 (6.94-7.53)	28.0%	83.3%	7.8%	6,533	87	18.39 (17.93-18.86)	72.0%	32.7%	64.2%
Mississippi	3,761	752	22.57 (21.84-23.33)	53.3%	42.8%	2,966,860	1,014	549	6.15 (5.77-6.56)	27.0%	86.0%	9.8%	2,747	44	16.42 (15.79-17.07)	73.0%	41.2%	55.0%
Montana	1,641	328	25.61 (24.32-26.96)	49.9%	46.2%	1,078,663	512	226	8.00 (7.28-8.77)	31.2%	83.2%	12.5%	1,129	15	17.61 (16.54-18.73)	68.8%	34.8%	61.5%
North Carolina	15,452	3,090	26.25 (25.82-26.68)	50.2%	45.6%	10,366,295	4,044	2,282	6.92 (6.70-7.14)	26.2%	85.6%	8.4%	11,408	148	19.33 (18.97-19.70)	73.8%	37.6%	58.8%
North Dakota	889	178	21.41 (19.97-22.92)	45.2%	51.2%	774,338	277	122	6.62 (5.84-7.48)	31.2%	81.2%	12.3%	612	10	14.78 (13.59-16.05)	68.8%	28.9%	68.8%
Nebraska	2,331	466	21.88 (20.97-22.81)	57.1%	39.4%	1,952,114	821	302	7.67 (7.14-8.23)	35.2%	84.9%	8.8%	1,510	34	14.21 (13.48-14.97)	64.8%	41.9%	56.1%
New Hampshire	2,072	414	24.66 (23.55-25.81)	53.0%	43.4%	1,372,344	665	281	8.02 (7.38-8.69)	32.1%	88.6%	6.0%	1,407	23	16.65 (15.74-17.59)	67.9%	36.2%	61.0%
New Jersey	15,255	3,051	28.87 (28.40-29.35)	47.4%	47.1%	9,238,193	3,849	2,281	7.29 (7.05-7.53)	25.2%	85.3%	8.4%	11,406	156	21.59 (21.18-22.00)	74.8%	34.7%	60.1%
New Mexico	2,137	427	17.79 (17.01-18.59)	66.3%	27.7%	2,109,821	719	284	5.87 (5.44-6.34)	33.6%	87.5%	5.8%	1,418	22	11.92 (11.28-12.58)	66.3%	55.6%	38.7%
Nevada	4,485	897	26.29 (25.50-27.09)	45.0%	50.5%	3,059,673	1,036	690	6.05 (5.68-6.44)	23.1%	82.0%	8.9%	3,449	43	20.23 (19.55-20.94)	76.9%	34.0%	63.0%
New York	33,895	6,779	29.47 (29.14-29.79)	47.8%	48.6%	20,119,982	7,811	5,217	6.85 (6.70-7.01)	23.0%	85.8%	9.6%	26,084	351	22.61 (22.33-22.90)	77.0%	36.4%	60.3%
Ohio	14,227	2,845	21.08 (20.72-21.45)	61.2%	33.8%	11,769,995	4,903	1,865	7.23 (7.02-7.44)	34.5%	87.5%	5.9%	9,324	200	13.86 (13.56-14.15)	65.5%	47.3%	48.5%
Oklahoma	4,781	956	22.06 (21.42-22.71)	56.0%	40.1%	3,949,391	1,466	663	6.78 (6.43-7.15)	30.7%	81.9%	9.6%	3,315	56	15.28 (14.75-15.82)	69.3%	44.6%	53.6%
Oregon	5,149	1,030	21.04 (20.45-21.65)	61.8%	32.7%	4,209,566	1,732	683	7.05 (6.71-7.40)	33.6%	83.8%	6.8%	3,417	56	14.00 (13.51-14.49)	66.4%	50.7%	45.9%
Pennsylvania	20,515	4,103	26.24 (25.87-26.62)	47.5%	48.1%	12,984,443	5,750	2,953	7.43 (7.23-7.64)	28.0%	81.7%	8.8%	14,765	202	18.81 (18.49-19.13)	72.0%	34.2%	63.4%
Rhode Island	1,222	244	18.87 (17.78-20.02)	63.6%	31.1%	1,092,927	466	151	7.26 (6.58-7.98)	38.1%	84.8%	4.7%	756	13	11.62 (10.77-12.52)	61.9%	50.5%	47.4%
South Carolina	6,604	1,321	21.87 (21.32-22.42)	54.2%	41.6%	5,077,928	2,007	919	6.61 (6.32-6.92)	30.4%	86.0%	7.8%	4,597	64	15.25 (14.79-15.72)	69.6%	40.3%	56.3%
South Dakota	1,114	223	22.33 (20.98-23.74)	40.0%	56.6%	882,280	299	163	6.17 (5.46-6.94)	26.8%	79.3%	14.4%	815	9	16.16 (15.02-17.36)	73.2%	25.6%	72.2%
Tennessee	9,430	1,886	24.10 (23.60-24.60)	48.9%	47.3%	6,860,162	2,734	1,339	7.02 (6.75-7.30)	29.0%	83.9%	8.8%	6,696	95	17.07 (16.65-17.50)	71.0%	34.6%	63.0%
Texas	41,022	8,204	28.45 (28.17-28.73)	45.8%	49.0%	28,868,666	9,701	6,264	6.63 (6.49-6.76)	23.6%	81.5%	11.9%	31,321	537	21.82 (21.57-22.07)	76.3%	34.8%	60.5%
Utah	6,837	1,367	46.94 (45.81-48.08)	37.8%	60.6%	3,232,467	1,168	1,134	7.65 (7.21-8.12)	17.1%	84.5%	11.5%	5,669	69	39.28 (38.25-40.34)	82.9%	28.2%	70.7%
Virginia	10,096	2,019	20.94 (20.53-21.37)	56.6%	39.9%	8,587,881	3,040	1,411	6.33 (6.10-6.57)	30.1%	85.7%	6.3%	7,056	111	14.61 (14.26-14.96)	69.9%	44.1%	54.3%
Vermont	935	187	23.46 (21.87-25.13)	55.9%	41.5%	642,301	313	124	7.95 (7.03-8.97)	33.5%	88.5%	5.8%	622	8	15.50 (14.23-16.87)	66.5%	39.5%	59.5%
Washington	14,135	2,827	33.65 (33.08-34.22)	42.0%	53.6%	7,619,624	3,198	2,187	7.62 (7.35-7.89)	22.6%	82.3%	10.1%	10,937	138	26.03 (25.53-26.54)	77.4%	30.2%	66.3%
Wisconsin	9,630	1,926	28.14 (27.56-28.73)	46.6%	50.4%	5,870,171	2,576	1,411	7.51 (7.21-7.82)	26.8%	82.6%	12.1%	7,054	91	20.63 (20.13-21.14)	73.2%	33.4%	64.4%
West Virginia	2,869	574	26.08 (25.08-27.11)	46.1%	48.5%	1,802,152	808	412	7.32 (6.79-7.88)	28.2%	84.5%	8.2%	2,061	31	18.76 (17.91-19.64)	71.8%	31.0%	64.2%
Wyoming	688	138	21.38 (19.75-23.11)	59.0%	38.2%	576,696	210	96	6.48 (5.60-7.46)	30.5%	86.7%	8.1%	478	7	14.90 (13.54-16.36)	69.5%	46.9%	51.5%

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^a Annual average cases are calculated by dividing the five-year total by five.

^b Rates are per 100,000 and are age-adjusted to the 2000 US standard population.

^c Histopathologic confirmation includes tumors classified as having diagnosis confirmed by: positive histopathology, positive cytology, positive histopathology plus – positive immunophenotyping and/or positive genetic studies, or positive microscopic confirmation, method not specified.

^d Radiographic confirmation includes tumors classified as having diagnosis confirmed by Radiography and/or other imaging techniques without microscopic confirmation.

^e Population estimates were obtained from the United States Bureau of the Census available on the SEER program website.

^f Excluded diagnosis years 2020 and 2021 due to data quality issues reported by NPCR.

- Counts and rates are not presented when fewer than 16 cases were reported for the specific category, or where the inclusion of the count and rate would allow for back-calculation of suppressed values. The suppressed cases are included in the counts and rates for totals.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2017-2021

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program.

Approximately 72.9% of tumors were non-malignant, but there was variation by CCR (range: 59.3%-77.7%).
Overall, 50.6% of tumors were histopathologically-confirmed. A larger proportion of malignant tumors were histopathologically-confirmed (84.4%) compared to non-malignant tumors (38.1%).
A slight majority of non-malignant brain and other CNS tumors were radiographically-confirmed (58.4%), but this proportion varied substantially by CCR.

The overall AAAIRs by behavior and CCR are shown in Table 10 and Figure 21 and by age in Supplementary Table 4.

There was less variation by region for malignant tumor incidence rates (Figure 21A) compared to incidence rates for non-malignant tumors (Figure 21B). CCR and regional variations likely reflect differences in reporting and case ascertainment practices, however this the subject of ongoing investigation. Please see Supplementary Figure 3 for combined incidence of malignant and non-malignant tumors by CCR.
The overall AAAIRs of all tumors (malignant and non-malignant) for each individual CCR ranged from 17.55 (Hawaii) to 46.94 (Utah) per 100,000 population.
AAAIRs of all primary malignant tumors by CCR ranged from 4.66 to 8.02 per 100,000 population for Hawaii and New Hampshire, respectively.
AAAIRs of all primary non-malignant tumors by CCR ranged from 11.59 to 39.28 per 100,000 for Maine and Utah, respectively.
In persons less than 20 years of age, CCR-specific incidence rates ranged from 3.49 to 7.86 per 100,000 population for Hawaii and Kentucky, respectively.
Among adults 20 years of age and older, CCR-specific incidence rates ranged from 23.21 to 63.15 per 100,000 population for Hawaii and Utah, respectively.

Distribution by Histopathology, CNS WHO Grade, Diagnostic Confirmation, and Treatment Completeness

The distribution of reported tumors with histopathologically-confirmed diagnosis from 2017 to 2021 is listed by histopathology and reported WHO grade in Table 11.

Table 11.

Distribution of Histopathologically-Confirmed Brain and Other Central Nervous System Tumors by WHO Grade Completeness, Treatment Information Completeness, and Histopathology, 2017-2021

Histopathology	Histo- pathologically Confirmed (%)^a	WHO Grade Completeness (%)^b			Assigned WHO Grade^c				Radiation Information Completeness (%)^d	Surgical Extent of Resection Information Completeness (%)^e
Histopathology	Histo- pathologically Confirmed (%)^a	Complete	Incomplete	Not Applicable	WHO Grade 1/I	WHO Grade 2/II	WHO Grade 3/III	WHO Grade 4/IV	Radiation Information Completeness (%)^d	Surgical Extent of Resection Information Completeness (%)^e
*Diffuse Astrocytic and Oligodendroglial Tumors*	94.5%	92.1%	0.0%	0.0%	0.7%	10.0%	11.1%	78.2%	13.9%	99.7%
Diffuse astrocytoma	93.4%	84.2%	0.0%	0.1%	3.2%	67.9%	14.6%	14.3%	10.4%	99.5%
Anaplastic astrocytoma	99.5%	93.7%	0.0%	0.1%	0.3%	3.6%	87.5%	8.5%	18.8%	99.6%
Glioblastoma	93.9%	92.7%	0.0%	0.0%	0.4%	0.2%	0.7%	98.6%	13.9%	99.7%
Oligodendroglioma	96.9%	93.2%	0.0%	0.0%	1.3%	87.5%	10.0%	1.2%	10.3%	99.6%
Anaplastic oligodendroglioma	99.3%	93.4%	0.0%	0.1%	0.3%	6.1%	89.2%	4.4%	18.9%	99.7%
Oligoastrocytic tumors	94.2%	87.0%	0.0%	0.0%	2.6%	25.2%	58.3%	13.9%	34.5%	99.2%
*Other Astrocytic Tumors*	84.4%	87.8%	0.1%	0.3%	87.6%	8.0%	3.7%	0.7%	1.5%	99.7%
Pilocytic astrocytoma	86.1%	87.6%	0.1%	0.3%	96.5%	2.4%	0.6%	0.5%	1.3%	99.8%
Unique astrocytoma variants	74.4%	89.0%	0.0%	0.0%	28.3%	45.6%	24.4%	1.8%	3.1%	99.4%
Malignant	97.4%	92.1%	0.0%	0.0%	3.7%	61.3%	32.9%	2.2%	5.7%	99.6%
Non-Malignant	46.8%	81.3%	0.0%	0.0%	98.8%	0.6%	0.0%	0.6%	0.0%	99.0%
*Ependymal Tumors*	83.1%	89.4%	0.0%	0.2%	36.0%	49.2%	14.1%	0.8%	5.4%	99.8%
Malignant	92.4%	90.0%	0.0%	0.2%	3.8%	72.0%	23.1%	1.1%	8.7%	99.8%
Non-Malignant	72.0%	88.6%	0.0%	0.0%	86.3%	13.4%	0.0%	0.2%	1.4%	99.7%
*Other Gliomas*	47.5%	53.6%	0.2%	0.5%	8.5%	17.6%	13.6%	60.3%	6.8%	99.4%
Glioma malignant, NOS	47.3%	53.3%	0.2%	0.6%	8.5%	16.5%	13.8%	61.2%	6.9%	99.4%
Other neuroepithelial tumors	79.6%	83.7%	0.0%	0.0%	7.9%	89.5%	0.0%	2.6%	3.7%	100.0%
*Neuronal and Mixed Neuronal-Glial Tumors*	91.2%	63.9%	8.0%	12.8%	84.9%	12.2%	2.1%	0.8%	3.1%	99.5%
Malignant	98.0%	24.6%	27.7%	44.1%	32.3%	4.5%	48.1%	15.0%	13.1%	98.9%
Non-Malignant	89.7%	79.7%	0.1%	0.2%	87.1%	12.6%	0.1%	0.2%	1.1%	99.6%
*Choroid Plexus Tumors*	86.1%	82.0%	0.1%	0.1%	64.9%	22.9%	11.7%	0.5%	1.1%	99.1%
Malignant	96.5%	74.1%	0.9%	0.9%	11.6%	5.8%	79.1%	3.5%	1.7%	99.1%
Non-Malignant	84.3%	83.5%	0.0%	0.0%	74.2%	25.8%	0.0%	0.0%	1.0%	99.1%
*Tumors of The Pineal Region*	79.2%	37.4%	12.7%	50.0%	0.0%	100.0%	0.0%	0.0%	8.4%	99.6%
Malignant	98.0%	37.9%	12.1%	49.9%	--	--	--	--	12.6%	99.5%
Non-Malignant	48.3%	35.4%	14.6%	50.0%	--	--	--	--	1.5%	100.0%
*Embryonal Tumors*	98.7%	84.9%	0.1%	0.6%	0.7%	0.6%	0.7%	97.9%	15.1%	99.9%
*Tumors of Cranial and Spinal Nerves*	47.1%	62.3%	0.0%	0.0%	99.7%	0.1%	0.1%	0.1%	3.1%	99.4%
Nerve sheath tumors	47.1%	62.3%	0.0%	0.0%	99.7%	0.1%	0.1%	0.1%	3.1%	99.4%
Malignant	79.4%	25.3%	0.0%	0.0%	69.0%	7.1%	19.0%	4.8%	6.7%	98.2%
Non-Malignant	46.9%	62.7%	0.0%	0.0%	99.8%	0.1%	0.0%	0.0%	3.1%	99.4%
Other tumors of cranial and spinal nerves	38.7%	41.7%	0.0%	0.0%	100.0%	0.0%	0.0%	0.0%	0.0%	100.0%
*Tumors of Meninges*	34.9%	85.8%	0.1%	0.1%	81.2%	16.8%	1.9%	0.1%	1.3%	99.6%
Meningiomas	33.7%	87.2%	0.0%	0.0%	81.3%	17.2%	1.4%	0.1%	1.2%	99.6%
Malignant	80.2%	88.0%	0.0%	0.0%	21.4%	15.7%	62.2%	0.7%	7.4%	98.7%
Non-Malignant	33.3%	87.2%	0.0%	0.0%	82.6%	17.3%	0.1%	0.1%	1.2%	99.7%
Mesenchymal tumors	76.0%	67.0%	0.8%	1.0%	79.4%	8.9%	11.2%	0.5%	3.2%	99.4%
Malignant	96.6%	45.9%	4.2%	4.4%	9.6%	14.3%	73.8%	2.3%	12.5%	99.0%
Non-Malignant	72.7%	71.7%	0.1%	0.2%	89.7%	8.2%	1.9%	0.2%	1.7%	99.5%
Primary melanocytic lesions	89.3%	16.7%	3.6%	3.6%	60.9%	13.0%	13.0%	13.0%	6.7%	99.2%
Malignant	94.7%	11.6%	5.3%	5.3%	36.4%	9.1%	27.3%	27.3%	7.4%	98.9%
Non-Malignant	79.6%	27.9%	0.0%	0.0%	83.3%	16.7%	0.0%	0.0%	5.6%	100.0%
*Lymphomas and Hemopoietic Neoplasms*	95.3%	2.1%	0.4%	1.5%	57.9%	2.3%	12.3%	27.5%	3.7%	99.2%
Lymphoma	95.3%	2.1%	0.4%	1.4%	58.0%	1.8%	12.4%	27.8%	3.6%	99.3%
Other hematopoietic neoplasms	98.0%	3.8%	5.7%	20.8%	50.0%	50.0%	0.0%	0.0%	23.5%	94.0%
*Germ Cell Tumors*	87.6%	8.1%	29.9%	33.2%	37.2%	9.0%	12.8%	41.0%	14.1%	99.5%
Malignant	89.5%	6.7%	31.4%	34.6%	5.8%	13.5%	19.2%	61.5%	16.1%	99.7%
Non-Malignant	73.8%	23.9%	13.4%	17.9%	100.0%	0.0%	0.0%	0.0%	0.0%	98.2%
*Tumors of Sellar Region*	41.3%	21.1%	29.0%	49.8%	100.0%	0.0%	0.0%	0.0%	0.6%	99.5%
Tumors of the pituitary	39.7%	19.9%	30.1%	50.0%	100.0%	0.0%	0.0%	0.0%	0.4%	99.5%
Malignant	70.3%	13.5%	36.5%	50.0%	--	--	--	--	2.7%	97.4%
Non-Malignant	39.7%	19.9%	30.1%	50.0%	100.0%	0.0%	0.0%	0.0%	0.4%	99.5%
Craniopharyngioma	83.9%	36.3%	14.9%	46.9%	100.0%	0.0%	0.0%	0.0%	4.8%	99.7%
*Unclassified Tumors*	16.1%	22.6%	5.8%	7.1%	93.7%	2.0%	1.5%	2.8%	0.6%	93.9%
Hemangioma	25.4%	33.8%	0.1%	0.15%	100.0%	0.0%	0.0%	0.0%	0.4%	98.2%
Neoplasm, unspecified	11.7%	15.4%	10.0%	12.1%	86.7%	4.2%	3.8%	5.4%	0.6%	89.9%
Malignant	9.1%	5.6%	5.0%	5.5%	31.4%	14.3%	25.7%	28.6%	0.6%	88.6%
Non-Malignant	14.6%	21.2%	12.9%	16.1%	96.1%	2.4%	0.0%	1.5%	0.6%	90.8%
All other	52.8%	24.1%	2.0%	2.4%	81.7%	6.7%	1.7%	10.0%	1.7%	99.6%
Malignant	96.9%	33.3%	3.0%	4.5%	47.6%	19.0%	4.8%	28.6%	12.3%	100.0%
Non-Malignant	45.7%	20.9%	1.6%	1.6%	100.0%	0.0%	0.0%	0.0%	0.0%	99.5%
Total ^f	51.1%	65.1%	7.8%	13.4%	43.3%	13.1%	6.5%	37.2%	3.9%	99.5%
*Malignant*	*86.1%*	*79.7%*	*1.1%*	*1.8%*	*6.0%*	*12.1%*	*12.0%*	*69.9%*	*11.2%*	*99.6%*
*Non-Malignant*	*38.1%*	*55.2%*	*12.3%*	*21.1%*	*85.6%*	*14.1%*	*0.2%*	*0.1%*	*1.2%*	*99.5%*

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^a Histopathologic confirmation includes tumors classified as diagnosis confirmed by: positive histopathology, positive cytology, positive histopathology plus – positive immunophenotyping and/or positive genetic studies, or positive microscopic confirmation, method not specified.

^b Completeness is defined as having an assigned code that corresponds with a WHO grade as defined by the American Joint Commission on Cancer’s Collaborative Staging schema.

^c Grade as recorded in the American Joint Commission on Cancer’s Collaborative Staging schema, SSDI Clinical Grade (2018+ only) or SSDI Pathological Grade (2018+ only). WHO grade may be reported according to 2007 or 2016 WHO classification depending on year of diagnosis, in which roman numerals are used to denote tumor grade.

^d Radiation is defined using a recoded variable based on NAACCR Item #1360 (http://datadictionary.naaccr.org/default.aspx?c=10#136). Completeness is defined as having a value other than “none” or “unknown.”

^e Surgery is defined using a recoded variable based on NAACCR Item #1290(http://datadictionary.naaccr.org/default.aspx?c=10#1290). Please see the SEER site-specific surgery codes for more information on coding for this variable (https://seer.cancer.gov/archive/tools/SEER2003.surg.prim.site.codes.pdf). Completeness is defined as having a value other than “unknown.”

^f Refers to all brain tumors including histopathologies not presented in this table.

- Percentages are not presented when category is not applicable.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2017-2021

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; CNS, central nervous system; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program; WHO, World Health Organization

Overall, 65.1% of tumors had complete WHO grade information, but there was substantial variation by histopathology.
The histopathologic types with the highest WHO grade completeness were anaplastic astrocytoma (93.7%), anaplastic oligodendroglioma (93.4%), anaplastic oligodendroglioma (93.4%), and oligodendroglioma (93.2%).

Distribution of Tumors in Puerto Rico

The distribution of brain and other CNS tumors diagnosed among residents of Puerto Rico by histopathology is shown in Supplementary Figure 4.

Approximately 43.6% of brain tumors were malignant and 56.4% were non-malignant. The most common histopathologies were non-malignant meningiomas (28.2%), followed by glioblastoma (20.1%).

Distributions and Incidence by Sex, 2017-2021

Incidence Rates and Distribution by Site, Behavior, Histopathology and Sex

Incidence counts and AAAIRs for brain and other CNS tumors by site and sex are shown in Table 5.

Incidence rates were higher in females than in males for tumors located in the cranial nerves, meninges, and pituitary, while males had higher incidence rates for tumors located in most other sites.

Incidence by histopathology, behavior and sex is available in Table 6.

Overall, 40.9% of all brain tumors diagnosed occurred in males (191,238 tumors) and 59.1% in females (276,656 tumors).
Among males, 37.1% of tumors (70,934 tumors) were malignant while 62.9% were non-malignant (120,304 tumors).
Among females, 20.2% of tumors (55,873 tumors) were malignant while 79.8% were non-malignant (220,783 tumors).
Incidence rates for all primary brain and other CNS tumors combined were higher among females (28.77 per 100,000) than males (21.78 per 100,000).
The incidence rate of tumors of meninges was higher in females (14.23 per 100,000) than in males (6.37 per 100,000).
Incidence of glioblastoma was higher in males (4.07 per 100,000) than in females (2.58 per 100,000).

IRR (male:female) for selected histopathologies and histopathology groupings are shown in (Figure 22).

Incidence was significantly higher in males for most histopathologies, such as germ cell tumors (IRR=2.61 p<0.0001), most glial tumors, lymphomas (IRR=1.20, p<0.0001), and embryonal tumors (IRR=1.39, p<0.0001).
In addition to non-malignant meningiomas (IRR=0.43, p<0.0001), tumors of the pituitary (IRR=0.75, p<0.0001) were also more common in females than in males.

Incidence Rates by Sex and Histopathology in Children and Adolescents (Ages 0-19 Years)

The incidence rates for brain and other CNS tumors in children and adolescents by histopathology overall and by sex are shown in Table 9.

Females in this age group had higher incidence for other gliomas, tumors of cranial and spinal nerves, tumors of meninges, and tumors of sellar region.
Incidence of malignant tumors was higher in males (3.55 per 100,000) than females (3.12 per 100,000).

Incidence Rates by Racial-Hispanic Ethnic Group and Histopathology

Incidence rates by racial-Hispanic ethnic group and histopathology are shown in Table 12.

Table 12.

Histopathology	Non-Hispanic White			Non-Hispanic Black			Non-Hispanic American Indian/Alaska Native			Non-Hispanic Asian or Pacific Islander			Hispanic (all races)
Histopathology	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)
*Diffuse Astrocytic and Oligodendroglial Tumors*	67,310	13,462	5.09 (5.05-5.13)	5,323	1,065	2.47 (2.40-2.54)	454	91	3.33 (3.02-3.67)	2,562	512	2.35 (2.26-2.45)	7,856	1,571	3.31 (3.23-3.39)
Diffuse astrocytoma	5,648	1,130	0.55 (0.53-0.56)	562	112	0.26 (0.24-0.29)	54	11	0.40 (0.30-0.52)	274	55	0.25 (0.22-0.28)	858	172	0.31 (0.29-0.33)
Anaplastic astrocytoma	4,738	948	0.43 (0.41-0.44)	386	77	0.18 (0.16-0.20)	36	7	0.28 (0.19-0.39)	212	42	0.19 (0.17-0.22)	603	121	0.22 (0.20-0.24)
Glioblastoma	52,852	10,570	3.71 (3.68-3.75)	4,096	819	1.88 (1.83-1.95)	314	63	2.29 (2.04-2.57)	1,835	367	1.69 (1.61-1.77)	5,696	1,139	2.53 (2.46-2.60)
Oligodendroglioma	2,670	534	0.27 (0.26-0.29)	183	37	0.09 (0.08-0.10)	36	7	0.26 (0.18-0.37)	146	29	0.13 (0.11-0.15)	451	90	0.16 (0.14-0.18)
Anaplastic oligodendroglioma	1,300	260	0.12 (0.12-0.13)	--	--	--	--	--	--	--	--	--	231	46	0.08 (0.07-0.10)
Oligoastrocytic tumors	102	20	0.01 (0.01-0.01)	--	--	--	--	--	--	--	--	--	17	3	0.01 (0.00-0.01)
*Other Astrocytic Tumors*	4,113	823	0.52 (0.50-0.53)	741	148	0.34 (0.32-0.37)	57	11	0.41 (0.31-0.54)	251	50	0.26 (0.23-0.30)	1,021	204	0.30 (0.28-0.31)
Pilocytic astrocytoma	3,553	711	0.45 (0.43-0.46)	635	127	0.29 (0.27-0.32)	--	--	--	--	--	--	834	167	0.24 (0.22-0.26)
Unique astrocytoma variants	560	112	0.07 (0.06-0.07)	106	21	0.05 (0.04-0.06)	--	--	--	--	--	--	187	37	0.06 (0.05-0.06)
Malignant	323	65	0.04 (0.03-0.04)	41	8	0.02 (0.01-0.03)	--	--	--	--	--	--	102	20	0.03 (0.02-0.04)
Non-Malignant	237	47	0.03 (0.03-0.03)	65	13	0.03 (0.02-0.04)	--	--	--	--	--	--	85	17	0.02 (0.02-0.03)
*Ependymal Tumors*	4,807	961	0.46 (0.45-0.47)	594	119	0.28 (0.25-0.30)	54	11	0.40 (0.30-0.53)	259	52	0.24 (0.21-0.27)	967	193	0.33 (0.31-0.35)
Malignant	2,499	500	0.25 (0.24-0.26)	368	74	0.17 (0.15-0.19)	27	5	0.20 (0.13-0.30)	179	36	0.17 (0.15-0.20)	567	113	0.19 (0.17-0.20)
Non-Malignant	2,308	462	0.21 (0.20-0.22)	226	45	0.11 (0.09-0.12)	27	5	0.20 (0.13-0.29)	80	16	0.07 (0.06-0.09)	400	80	0.14 (0.13-0.16)
*Other Gliomas*	6,172	1,234	0.61 (0.60-0.63)	982	196	0.46 (0.43-0.49)	63	13	0.50 (0.39-0.65)	407	81	0.40 (0.37-0.45)	1,303	261	0.45 (0.43-0.48)
Glioma malignant, NOS	6,133	1,227	0.61 (0.59-0.62)	--	--	--	--	--	--	--	--	--	--	--	--
Other neuroepithelial tumors	39	8	<0.01	--	--	--	--	--	--	--	--	--	--	--	--
*Neuronal and Mixed Neuronal-Glial Tumors*	*3,564*	*713*	*0.39 (0.38-0.40)*	*528*	*106*	*0.24 (0.22-0.26)*	36	7	*0.27 (0.18-0.37)*	*265*	53	*0.26 (0.23-0.29)*	*760*	*152*	*0.24 (0.22-0.25)*
Malignant	655	131	0.06 (0.05-0.06)	68	14	0.03 (0.03-0.04)	--	--	--	--	--	--	112	22	0.04 (0.03-0.05)
Non-Malignant	2,909	582	0.33 (0.32-0.35)	460	92	0.21 (0.19-0.23)	--	--	--	--	--	--	648	130	0.20 (0.18-0.21)
*Choroid Plexus Tumors*	534	107	0.06 (0.05-0.07)	76	15	0.03 (0.03-0.04)	--	--	--	--	--	--	136	27	0.04 (0.04-0.05)
Malignant	67	13	0.01 (0.01-0.01)	--	--	--	--	--	--	--	--	--	27	5	0.01 (0.01-0.01)
Non-Malignant	467	93	0.05 (0.05-0.06)	--	--	--	--	--	--	--	--	--	109	22	0.04 (0.03-0.04)
*Tumors of The Pineal Region*	441	88	0.05 (0.04-0.05)	116	23	0.05 (0.04-0.06)	--	--	--	--	--	--	105	21	0.04 (0.03-0.04)
Malignant	269	54	0.03 (0.02-0.03)	75	15	0.03 (0.03-0.04)	--	--	--	--	--	--	69	14	0.02 (0.02-0.03)
Non-Malignant	172	34	0.02 (0.01-0.02)	41	8	0.02 (0.01-0.03)	--	--	--	--	--	--	36	7	0.01 (0.01-0.02)
*Embryonal Tumors*	1,715	343	0.22 (0.21-0.23)	331	66	0.15 (0.14-0.17)	35	7	0.27 (0.19-0.37)	170	34	0.18 (0.16-0.21)	671	134	0.19 (0.18-0.21)
*Tumors of Cranial and Spinal Nerves*	28,164	5,633	2.27 (2.24-2.30)	2,314	463	1.07 (1.03-1.12)	212	42	1.58 (1.37-1.82)	2,431	486	2.18 (2.09-2.27)	3,424	685	1.33 (1.29-1.38)
Nerve sheath tumors	28,140	5,628	2.27 (2.24-2.30)	--	--	--	--	--	--	--	--	--	--	--	--
Malignant	125	25	0.01 (0.01-0.01)	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	28,015	5,603	2.26 (2.23-2.28)	--	--	--	--	--	--	--	--	--	--	--	--
Other tumors of cranial and spinal nerves	24	5	<0.01	--	--	--	--	--	--	--	--	--	--	--	--
*Tumors of Meninges*	141,617	28,323	10.36 (10.31-10.42)	25,299	5,060	12.33 (12.17-12.49)	1,285	257	10.14 (9.57-10.73)	9,052	1,810	8.58 (8.40-8.76)	20,446	4,089	9.42 (9.29-9.56)
Meningiomas	137,680	27,536	10.01 (9.96-10.07)	24,647	4,929	12.03 (11.87-12.18)	1,238	248	9.79 (9.23-10.37)	8,805	1,761	8.35 (8.18-8.53)	19,593	3,919	9.11 (8.98-9.25)
Malignant	1,023	205	0.07 (0.07-0.08)	235	47	0.11 (0.10-0.13)	--	--	--	105	21	0.10 (0.08-0.12)	217	43	0.10 (0.09-0.12)
Non-Malignant	136,657	27,331	9.94 (9.88-9.99)	24,412	4,882	11.91 (11.76-12.07)	--	--	--	8,700	1,740	8.25 (8.08-8.43)	19,376	3,875	9.01 (8.88-9.15)
Mesenchymal tumors	3,819	764	0.34 (0.33-0.35)	--	--	--	--	--	--	--	--	--	--	--	--
Malignant	526	105	0.05 (0.04-0.05)	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	3,293	659	0.30 (0.28-0.31)	556	111	0.26 (0.24-0.28)	--	--	--	--	--	--	718	144	0.25 (0.24-0.27)
Primary melanocytic lesions	118	24	0.01 (0.01-0.01)	--	--	--	--	--	--	--	--	--	--	--	--
Malignant	74	15	0.01 (0.00-0.01)	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	44	9	<0.01	--	--	--	--	--	--	--	--	--	--	--	--
*Lymphomas and Hemopoietic Neoplasms*	6,139	1,228	0.43 (0.42-0.44)	685	137	0.33 (0.30-0.35)	43	9	0.29 (0.21-0.40)	586	117	0.54 (0.50-0.59)	1,060	212	0.48 (0.45-0.51)
Lymphoma	6,110	1,222	0.43 (0.41-0.44)	--	--	--	--	--	--	--	--	--	--	--	--
Other hematopoietic neoplasms	29	6	<0.01	--	--	--	--	--	--	--	--	--	--	--	--
*Germ Cell Tumors*	619	124	0.08 (0.07-0.08)	--	--	--	--	--	--	138	28	0.14 (0.12-0.17)	287	57	0.08 (0.07-0.09)
Malignant	532	106	0.07 (0.06-0.07)	--	--	--	--	--	--	--	--	--	254	51	0.07 (0.06-0.08)
Non-Malignant	87	17	0.01 (0.01-0.01)	--	--	--	--	--	--	--	--	--	33	7	0.01 (0.01-0.02)
*Tumors of Sellar Region*	46,263	9,253	4.15 (4.11-4.19)	16,516	3,303	7.82 (7.70-7.95)	695	139	5.23 (4.83-5.64)	4,384	877	3.99 (3.87-4.11)	13,902	2,780	5.16 (5.07-5.25)
Tumors of the pituitary	44,521	8,904	3.98 (3.94-4.02)	15,946	3,189	7.56 (7.44-7.68)	676	135	5.07 (4.68-5.48)	4,214	843	3.83 (3.71-3.94)	13,390	2,678	4.98 (4.90-5.07)
Malignant	65	13	0.01 (0.00-0.01)	21	4	0.01 (0.01-0.02)	--	--	--	--	--	--	--	--	--
Non-Malignant	44,456	8,891	3.98 (3.94-4.02)	15,925	3,185	7.55 (7.43-7.67)	--	--	--	--	--	--	--	--	--
Craniopharyngioma	1,742	348	0.17 (0.16-0.18)	570	114	0.26 (0.24-0.28)	19	4	0.16 (0.09-0.24)	170	34	0.16 (0.14-0.19)	512	102	0.17 (0.16-0.19)
*Unclassified Tumors*	13,011	2,602	1.03 (1.02-1.05)	1,955	391	0.96 (0.92-1.01)	110	22	0.89 (0.73-1.08)	686	137	0.67 (0.62-0.72)	2,329	466	1.01 (0.96-1.05)
Hemangioma	2,939	588	0.27 (0.26-0.28)	487	97	0.23 (0.21-0.25)	23	5	0.17 (0.11-0.26)	209	42	0.19 (0.16-0.22)	703	141	0.26 (0.24-0.28)
Neoplasm, unspecified	9,785	1,957	0.74 (0.72-0.75)	1,419	284	0.71 (0.67-0.75)	--	--	--	--	--	--	1,535	307	0.72 (0.68-0.76)
Malignant	5,386	1,077	0.38 (0.37-0.39)	618	124	0.32 (0.29-0.34)	--	--	--	--	--	--	664	133	0.35 (0.32-0.38)
Non-Malignant	4,399	880	0.36 (0.34-0.37)	801	160	0.39 (0.37-0.42)	--	--	--	--	--	--	871	174	0.37 (0.34-0.39)
All other	287	57	0.03 (0.03-0.03)	49	10	0.02 (0.02-0.03)	--	--	--	--	--	--	91	18	0.03 (0.03-0.04)
Malignant	35	7	<0.01	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	252	50	0.03 (0.02-0.03)	--	--	--	--	--	--	--	--	--	--	--	--
Totald	324,469	64,894	25.72 (25.62-25.81)	55,589	11,118	26.60 (26.37-26.83)	3,065	613	23.48 (22.63-24.35)	21,256	4,251	19.86 (19.59-20.13)	54,267	10,853	22.37 (22.17-22.57)
*Malignant*	*96,098*	*19,220*	*7.73 (7.68-7.78)*	*9,588*	*1,918*	*4.49 (4.39-4.58)*	*741*	*148*	*5.53 (5.13-5.96)*	*4,717*	*943*	*4.47 (4.34-4.60)*	*13,856*	*2,771*	*5.54 (5.44-5.64)*
*Non-Malignant*	*228,371*	*45,674*	*17.99 (17.91-18.07)*	*46,001*	*9,200*	*22.11 (21.90-22.32)*	*2,324*	*465*	*17.94 (17.20-18.71)*	*16,539*	*3,308*	*15.39 (15.15-15.63)*	*40,411*	*8,082*	*16.83 (16.66-17.01)*

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^a Annual average cases are calculated by dividing the five-year total by five.

^b Rates are per 100,000 and are age-adjusted to the 2000 US standard population.

^c Hispanic ethnicity is not mutually exclusive of race; Classified using the North American Association of Central Cancer Registries Hispanic Identification Algorithm, version 2 (NHIA v2).

^d Refers to all brain tumors including histopathologies not presented in this table.

- Counts and rates are not presented when fewer than 16 cases were reported for the specific category. The suppressed cases are included in the counts and rates for totals.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2017-2021

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program; CI, confidence interval; NOS, not otherwise specified

Incidence rates for all primary brain and other CNS tumors combined were lower for persons who are non-Hispanic Asian or Pacific Islander (19.86 per 100,000) compared to persons who are non-Hispanic White (25.72 per 100,000), non-Hispanic Black (26.60 per 100,000), non-Hispanic American Indian/Alaska Native (23.48 per 100,000), and Hispanic persons of all races (22.37 per 100,000).
Incidence rates for malignant primary brain and other CNS tumors were highest in persons who are non-Hispanic White (7.73 per 100,000) compared to persons who are non-Hispanic Black (4.49 per 100,000), non-Hispanic American Indian/Alaska Native (5.53 per 100,000), non-Hispanic Asian or Pacific Islander (4.47 per 100,000), and Hispanic persons of all races (5.54 per 100,000).
Incidence rates for non-malignant primary brain and other CNS tumors were highest in persons who are non-Hispanic Black (22.11 per 100,000) compared to persons who are non-Hispanic White (17.99 per 100,000), non-Hispanic American Indian/Alaska Native (17.94 per 100,000), non-Hispanic Asian or Pacific Islander (15.39 per 100,000), and Hispanic persons of all races (16.83 per 100,000).

IRR (non-Hispanic White:non-Hispanic Black) for selected histopathologies are shown in Figure 23A.

Incidence rates for diffuse astrocytoma, anaplastic astrocytoma, glioblastoma, and nerve sheath tumors (all p<0.0001) were approximately 2 times greater in persons who are non-Hispanic White than in persons who are non-Hispanic Black.
Incidence of oligodendroglioma was 3.05 times greater in persons who are non-Hispanic White than in persons who are non-Hispanic Black (p<0.0001).
Incidence rates for meningioma (malignant and non-malignant) and tumors of the pituitary were greater among persons who were non-Hispanic Black than persons who were non-Hispanic White.

IRR (non-Hispanic White: non-Hispanic Asian or Pacific Islander) for selected histopathologies are shown in Figure 23B.

Incidence rates for glioblastoma (p<0.0001) were 2.19 times greater in persons who are non-Hispanic White than in persons who are non-Hispanic Asian or Pacific Islander.
Germ cell tumors (p<0.0001) were 0.53 times greater among persons who are non-Hispanic Asian or Pacific Islander than persons who are non-Hispanic White.
While non-malignant meningioma had higher incidence in persons who are non-Hispanic White (IRR: 1.20), malignant meningioma had higher incidence in persons who are non-Hispanic Asian or Pacific Islander (IRR:0.75).

IRR (non-Hispanic White:Hispanic all races) for selected histopathologies are shown in Figure 23C.

Diffuse astrocytoma, anaplastic astrocytoma, oligodendroglioma, pilocytic astrocytoma, and nerve sheath tumors are almost 2-times greater in persons who are non-Hispanic White compared to Hispanic persons of all races.
Hispanic persons of all races had higher incidence in malignant meningioma (IRR=0.76) and tumors of the pituitary (IRR=0.80) than persons who were non-Hispanic White.

While there are several histopathologies where significant differences in incidence were observed by race and/or ethnicity, in most cases the actual difference in incidence rates is small and may not be biologically significant.

Incidence Rates by Racial-Ethnic Group and Histopathology in Children and Adolescents (Ages 0-19 Years)

Incidence rates for brain and other CNS tumors by histopathology and racial-Hispanic ethnic group for children and adolescents are shown in Table 13.

Table 13.

Five-Year Total, Annual Average Total^a, and Average Annual Age-Adjusted Incidence Rates^b with 95% Confidence Intervals for All Brain and Other Central Nervous System Tumors Among Children and Adolescents (Ages 0-19 Years) by Histopathology and Race and Hispanic Ethnicity^c

Histopathology	Non-Hispanic White			Non-Hispanic Black			Non-Hispanic American Indian/Alaska Native			Non-Hispanic Asian or Pacific Islander			Hispanic (all races)
Histopathology	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)
*Diffuse Astrocytic and Oligodendroglial Tumors*	1,105	221	0.51 (0.48-0.54)	196	39	0.31 (0.27-0.36)	--	--	--	--	--	--	299	60	0.29 (0.26-0.32)
Diffuse astrocytoma	496	99	0.23 (0.21-0.25)	78	16	0.13 (0.10-0.16)	--	--	--	--	--	--	115	23	0.11 (0.09-0.13)
Anaplastic astrocytoma	161	32	0.07 (0.06-0.09)	25	5	0.04 (0.03-0.06)	--	--	--	--	--	--	41	8	0.04 (0.03-0.05)
Glioblastoma	352	70	0.16 (0.14-0.18)	79	16	0.13 (0.10-0.16)	--	--	--	--	--	--	122	24	0.12 (0.10-0.14)
Oligodendroglioma	79	16	0.04 (0.03-0.04)	--	--	--	--	--	--	--	--	--	16	3	0.02 (0.01-0.03)
Anaplastic oligodendroglioma	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Oligoastrocytic tumors	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
*Other Astrocytic Tumors*	2,816	563	1.33 (1.28-1.38)	546	109	0.88 (0.81-0.96)	46	9	1.18 (0.86-1.57)	178	36	0.69 (0.59-0.80)	768	154	0.74 (0.69-0.80)
Pilocytic astrocytoma	2,543	509	1.21 (1.16-1.25)	481	96	0.77 (0.71-0.85)	--	--	--	--	--	--	653	131	0.63 (0.58-0.68)
Unique astrocytoma variants	273	55	0.13 (0.11-0.14)	65	13	0.11 (0.08-0.13)	--	--	--	--	--	--	115	23	0.11 (0.09-0.13)
Malignant	121	24	0.05 (0.05-0.07)	21	4	0.03 (0.02-0.05)	--	--	--	--	--	--	51	10	0.05 (0.04-0.06)
Non-Malignant	152	30	0.07 (0.06-0.09)	44	9	0.07 (0.05-0.10)	--	--	--	--	--	--	64	13	0.06 (0.05-0.08)
*Ependymal Tumors*	666	133	0.31 (0.29-0.34)	130	26	0.21 (0.18-0.25)	--	--	--	--	--	--	241	48	0.23 (0.20-0.26)
Malignant	512	102	0.24 (0.22-0.27)	--	--	--	--	--	--	--	--	--	192	38	0.19 (0.16-0.21)
Non-Malignant	154	31	0.07 (0.06-0.08)	--	--	--	--	--	--	--	--	--	49	10	0.05 (0.03-0.06)
*Other Gliomas*	1,881	376	0.89 (0.85-0.93)	411	82	0.66 (0.60-0.73)	32	6	0.82 (0.56-1.16)	159	32	0.62 (0.53-0.72)	636	127	0.61 (0.57-0.66)
Glioma malignant, NOS	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Other neuroepithelial tumors	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
*Neuronal and Mixed Neuronal-Glial Tumors*	*1,255*	*251*	*0.58 (0.55-0.61)*	*241*	48	*0.38 (0.34-0.44)*	--	--	--	--	--	--	*361*	72	*0.35 (0.31-0.38)*
Malignant	68	14	0.03 (0.02-0.04)	--	--	--	--	--	--	--	--	--	20	4	0.02 (0.01-0.03)
Non-Malignant	1,187	237	0.55 (0.52-0.58)	--	--	--	--	--	--	--	--	--	341	68	0.33 (0.29-0.36)
*Choroid Plexus Tumors*	227	45	0.11 (0.10-0.13)	44	9	0.07 (0.05-0.10)	--	--	--	--	--	--	75	15	0.07 (0.06-0.09)
Malignant	49	10	0.02 (0.02-0.03)	--	--	--	--	--	--	--	--	--	18	4	0.02 (0.01-0.03)
Non-Malignant	178	36	0.09 (0.07-0.10)	--	--	--	--	--	--	--	--	--	57	11	0.06 (0.04-0.07)
*Tumors of The Pineal Region*	102	20	0.05 (0.04-0.06)	47	9	0.08 (0.06-0.10)	--	--	--	--	--	--	31	6	0.03 (0.02-0.04)
Malignant	82	16	0.04 (0.03-0.05)	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	20	4	0.01 (0.01-0.01)	--	--	--	--	--	--	--	--	--	--	--	--
*Embryonal Tumors*	1,274	255	0.62 (0.58-0.65)	258	52	0.42 (0.37-0.47)	27	5	0.72 (0.47-1.04)	143	29	0.55 (0.46-0.65)	482	96	0.47 (0.43-0.51)
Medulloblastoma	887	177	0.42 (0.40-0.45)	168	34	0.27 (0.23-0.32)	20	4	0.52 (0.32-0.80)	97	19	0.37 (0.30-0.46)	337	67	0.33 (0.29-0.36)
Atypical teratoid/rhabdoid tumor	200	40	0.10 (0.09-0.11)	--	--	--	--	--	--	--	--	--	79	16	0.08 (0.06-0.10)
All other embryonal	131	26	0.06 (0.05-0.08)	28	6	0.05 (0.03-0.07)	--	--	--	--	--	--	47	9	0.05 (0.03-0.06)
*Tumors of Cranial and Spinal Nerves*	522	104	0.24 (0.22-0.26)	86	17	0.14 (0.11-0.17)	--	--	--	40	8	0.15 (0.11-0.21)	173	35	0.17 (0.14-0.19)
Nerve sheath tumors	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Other tumors of cranial and spinal nerves	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
*Tumors of Meninges*	667	133	0.30 (0.28-0.33)	183	37	0.29 (0.25-0.33)	--	--	--	--	--	--	312	62	0.30 (0.27-0.34)
Meningiomas	353	71	0.16 (0.14-0.18)	120	24	0.19 (0.16-0.23)	--	--	--	--	--	--	147	29	0.14 (0.12-0.17)
Mesenchymal tumors	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Primary melanocytic lesions	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
*Lymphomas and Hemopoietic Neoplasms*	66	13	0.03 (0.02-0.04)	--	--	--	--	--	--	--	--	--	23	5	0.02 (0.01-0.03)
Lymphoma	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Other hematopoietic neoplasms	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
*Germ Cell Tumors*	385	77	0.18 (0.16-0.20)	--	--	--	--	--	--	98	20	0.39 (0.31-0.47)	210	42	0.20 (0.18-0.23)
Malignant	346	69	0.16 (0.14-0.18)	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	39	8	0.02 (0.01-0.03)	--	--	--	--	--	--	--	--	--	--	--	--
*Tumors of Sellar Region*	2,394	479	1.06 (1.02-1.11)	622	124	0.98 (0.90-1.06)	48	10	1.18 (0.87-1.57)	218	44	0.85 (0.74-0.97)	1,299	260	1.25 (1.18-1.32)
Tumors of the pituitary	1,994	399	0.87 (0.83-0.91)	508	102	0.79 (0.73-0.87)	--	--	--	--	--	--	1,102	220	1.06 (1.00-1.12)
Craniopharyngioma	400	80	0.19 (0.17-0.21)	114	23	0.18 (0.15-0.22)	--	--	--	--	--	--	197	39	0.19 (0.16-0.22)
*Unclassified Tumors*	811	162	0.37 (0.35-0.40)	170	34	0.27 (0.23-0.32)	--	--	--	--	--	--	306	61	0.30 (0.26-0.33)
Hemangioma	272	54	0.12 (0.11-0.14)	41	8	0.07 (0.05-0.09)	--	--	--	--	--	--	111	22	0.11 (0.09-0.13)
Neoplasm, unspecified	439	88	0.20 (0.18-0.22)	107	21	0.17 (0.14-0.21)	--	--	--	21	4	0.08 (0.05-0.12)	157	31	0.15 (0.13-0.18)
Malignant	135	27	0.06 (0.05-0.07)	42	8	0.07 (0.05-0.09)	--	--	--	--	--	--	40	8	0.04 (0.03-0.05)
Non-Malignant	304	61	0.14 (0.12-0.16)	65	13	0.10 (0.08-0.13)	--	--	--	--	--	--	117	23	0.11 (0.09-0.14)
All other	100	20	0.05 (0.04-0.06)	22	4	0.04 (0.02-0.05)	--	--	--	--	--	--	38	8	0.04 (0.03-0.05)
Malignant	21	4	0.01 (0.01-0.02)	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	79	16	0.04 (0.03-0.05)	--	--	--	--	--	--	--	--	--	--	--	--
Total ^d	14,171	2,834	6.58 (6.47-6.69)	3,042	608	4.87 (4.69-5.04)	237	47	6.03 (5.29-6.85)	1,182	236	4.59 (4.33-4.86)	5,216	1,043	5.03 (4.90-5.17)
*Malignant*	*8,004*	*1,601*	*3.78 (3.69-3.86)*	*1,676*	*335*	*2.70 (2.57-2.83)*	*128*	26	*3.30 (2.75-3.92)*	*700*	*140*	*2.72 (2.52-2.93)*	*2,612*	*522*	*2.53 (2.43-2.62)*
*Non-Malignant*	*6,167*	*1,233*	*2.80 (2.73-2.87)*	*1,366*	*273*	*2.17 (2.05-2.28)*	*109*	22	*2.73 (2.24-3.30)*	*482*	96	*1.87 (1.71-2.05)*	*2,604*	*521*	*2.50 (2.41-2.60)*

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^a Annual average cases are calculated by dividing the five-year total by five.

^b Rates are per 100,000 and are age-adjusted to the 2000 US standard population.

^c Hispanic ethnicity is not mutually exclusive of race; Classified using the North American Association of Central Cancer Registries Hispanic Identification Algorithm, version 2 (NHIA v2).

^d Refers to all brain tumors including histopathologies not presented in this table.

- Counts and rates are not presented when fewer than 16 cases were reported for the specific category. The suppressed cases are included in the counts and rates for totals.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR and NCI’s SEER, 2017-2021

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program; CI, confidence interval; NOS, not otherwise specified

Incidence rates were highest among children and adolescents who are non-Hispanic White (6.58 per 100,000) compared to children and adolescents who are non-Hispanic Black (4.87 per 100,000), non-Hispanic American Indian/Alaska Native (6.03 per 100,000), non-Hispanic Asian or Pacific Islander (4.59 per 100,000), or Hispanic children and adolescents of all races (5.03 per 100,000).
Incidence rates for malignant brain tumors were highest among children and adolescents who are non-Hispanic White (3.78 per 100,000) compared to children and adolescents who are non-Hispanic Black (2.70 per 100,000), non-Hispanic American Indian/Alaska Native (3.30 per 100,000), non-Hispanic Asian or Pacific Islander (2.72 per 100,000), or Hispanic children and adolescents of all races (2.53 per 100,000).

Prevalence and lifetime risk for brain and other CNS tumors

Please see the 2023 CBTRUS Statistical Report⁴⁵ for an overview of estimated prevalence and lifetime risk of primary brain and other CNS tumors in the United States.

Mortality Rates for Malignant Brain and Other CNS Tumors by State and Sex, 2017-2021

Mortality due to malignant brain tumors in comparison to COVID-19 deaths for older adults (ages 40+) from 2020 only are presented in the 2023 CBTRUS Statistical Report.⁴⁵

AAAMR for primary malignant brain and other CNS tumors in the United States by state and sex are shown in Table 14 and Figure 24.

Table 14.

Five-Year Total, Annual Average Total^a, and Average Annual Age-Adjusted Mortality^b Rates^c with 95% Confidence Intervals for Malignant Brain and Other Central Nervous System Cancers Overall and by State and Sex

State	Total			Female			Male
State	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)	Total (2017-2021)	Annual Average	Rate (95% CI)
Alaska	166	33	4.53 (3.83-5.32)	58	12	3.33 (2.50-4.34)	108	22	5.77 (4.65-7.08)
Alabama	1,501	300	4.81 (4.56-5.07)	689	138	4.06 (3.76-4.39)	812	162	5.67 (5.27-6.09)
Arkansas	886	177	4.79 (4.47-5.13)	403	81	4.04 (3.64-4.47)	483	97	5.62 (5.12-6.16)
Arizona	1,878	376	4.29 (4.09-4.49)	797	159	3.46 (3.21-3.72)	1,081	216	5.22 (4.91-5.55)
California	9,804	1,961	4.43 (4.34-4.52)	4,162	832	3.53 (3.42-3.64)	5,642	1,128	5.47 (5.32-5.61)
Colorado	1,382	276	4.32 (4.09-4.56)	600	120	3.62 (3.33-3.93)	782	156	5.12 (4.75-5.50)
Connecticut	1,042	208	4.55 (4.26-4.84)	470	94	3.83 (3.48-4.22)	572	114	5.48 (5.03-5.97)
Washington DC	109	22	3.16 (2.58-3.82)	49	10	2.68 (1.97-3.57)	60	12	3.77 (2.85-4.88)
Delaware	254	51	3.89 (3.41-4.43)	110	22	3.03 (2.46-3.70)	144	29	4.95 (4.14-5.88)
Florida	6,401	1,280	4.30 (4.19-4.41)	2,785	557	3.48 (3.35-3.62)	3,616	723	5.21 (5.04-5.39)
Georgia	2,489	498	4.27 (4.10-4.44)	1,127	225	3.54 (3.33-3.76)	1,362	272	5.14 (4.86-5.43)
Hawaii	251	50	2.77 (2.42-3.15)	103	21	2.14 (1.73-2.63)	148	30	3.47 (2.91-4.09)
Iowa	925	185	4.73 (4.42-5.05)	398	80	4.02 (3.62-4.46)	527	105	5.55 (5.07-6.06)
Idaho	504	101	4.79 (4.37-5.24)	206	41	3.78 (3.27-4.36)	298	60	5.87 (5.20-6.60)
Illinois	3,174	635	4.17 (4.03-4.33)	1,360	272	3.30 (3.13-3.49)	1,814	363	5.20 (4.96-5.46)
Indiana	1,782	356	4.52 (4.31-4.74)	786	157	3.74 (3.48-4.02)	996	199	5.43 (5.09-5.79)
Kansas	868	174	5.05 (4.71-5.41)	385	77	4.34 (3.90-4.81)	483	97	5.87 (5.34-6.43)
Kentucky	1,295	259	4.72 (4.46-5.00)	552	110	3.80 (3.48-4.15)	743	149	5.79 (5.36-6.24)
Louisiana	1,157	231	4.25 (4.01-4.51)	525	105	3.58 (3.27-3.91)	632	126	5.03 (4.63-5.46)
Massachusetts	1,994	399	4.60 (4.39-4.81)	853	171	3.63 (3.38-3.89)	1,141	228	5.74 (5.40-6.09)
Maryland	1,430	286	3.95 (3.75-4.17)	623	125	3.18 (2.93-3.45)	807	161	4.88 (4.54-5.25)
Maine	509	102	5.24 (4.77-5.75)	211	42	4.05 (3.49-4.69)	298	60	6.59 (5.83-7.44)
Michigan	2,972	594	4.71 (4.53-4.89)	1,270	254	3.77 (3.56-3.99)	1,702	340	5.81 (5.52-6.10)
Minnesota	1,553	311	4.64 (4.41-4.89)	633	127	3.68 (3.38-3.99)	920	184	5.73 (5.35-6.12)
Missouri	1,765	353	4.67 (4.45-4.90)	759	152	3.73 (3.46-4.01)	1,006	201	5.76 (5.40-6.14)
Mississippi	891	178	5.07 (4.73-5.42)	414	83	4.33 (3.91-4.79)	477	95	5.97 (5.43-6.55)
Montana	345	69	4.83 (4.31-5.40)	151	30	4.10 (3.44-4.87)	194	39	5.62 (4.82-6.52)
North Carolina	2,606	521	4.19 (4.02-4.35)	1,162	232	3.45 (3.25-3.66)	1,444	289	5.09 (4.82-5.37)
North Dakota	192	38	4.43 (3.80-5.13)	87	17	3.87 (3.07-4.82)	105	21	4.97 (4.03-6.05)
Nebraska	584	117	5.15 (4.73-5.60)	262	52	4.42 (3.88-5.01)	322	64	5.95 (5.30-6.66)
New Hampshire	452	90	4.89 (4.43-5.40)	189	38	3.83 (3.28-4.46)	263	53	6.08 (5.33-6.91)
New Jersey	2,295	459	4.05 (3.88-4.22)	1,026	205	3.33 (3.13-3.55)	1,269	254	4.90 (4.63-5.19)
New Mexico	534	107	4.07 (3.72-4.45)	232	46	3.34 (2.91-3.82)	302	60	4.91 (4.36-5.52)
Nevada	757	151	4.24 (3.94-4.57)	332	66	3.55 (3.17-3.96)	425	85	5.03 (4.55-5.55)
New York	4,617	923	3.77 (3.66-3.89)	2,015	403	3.03 (2.90-3.17)	2,602	520	4.64 (4.46-4.83)
Ohio	3,346	669	4.57 (4.42-4.74)	1,475	295	3.76 (3.56-3.96)	1,871	374	5.52 (5.27-5.79)
Oklahoma	1,157	231	5.07 (4.78-5.38)	517	103	4.23 (3.86-4.63)	640	128	6.02 (5.55-6.52)
Oregon	1,281	256	4.82 (4.55-5.10)	544	109	3.89 (3.56-4.25)	737	147	5.84 (5.42-6.29)
Pennsylvania	3,815	763	4.50 (4.36-4.66)	1,635	327	3.57 (3.39-3.76)	2,180	436	5.58 (5.34-5.83)
Rhode Island	330	66	4.57 (4.08-5.11)	147	29	3.69 (3.10-4.38)	183	37	5.71 (4.89-6.64)
South Carolina	1,495	299	4.66 (4.42-4.92)	680	136	3.95 (3.65-4.28)	815	163	5.52 (5.13-5.93)
South Dakota	280	56	5.31 (4.68-6.00)	109	22	3.78 (3.07-4.61)	171	34	7.07 (6.02-8.26)
Tennessee	1,971	394	4.79 (4.57-5.01)	870	174	3.96 (3.69-4.24)	1,101	220	5.76 (5.42-6.13)
Texas	6,145	1,229	4.18 (4.07-4.29)	2,680	536	3.43 (3.30-3.57)	3,465	693	5.06 (4.89-5.24)
Utah	691	138	4.74 (4.39-5.12)	295	59	3.98 (3.53-4.47)	396	79	5.59 (5.04-6.19)
Virginia	2,164	433	4.30 (4.12-4.49)	946	189	3.49 (3.26-3.72)	1,218	244	5.29 (4.99-5.60)
Vermont	245	49	5.61 (4.88-6.41)	108	22	4.78 (3.86-5.87)	137	27	6.57 (5.45-7.87)
Washington	2,241	448	5.09 (4.87-5.31)	948	190	4.11 (3.85-4.39)	1,293	259	6.17 (5.82-6.52)
Wisconsin	1,778	356	4.83 (4.60-5.07)	766	153	3.96 (3.67-4.26)	1,012	202	5.80 (5.43-6.18)
West Virginia	574	115	4.63 (4.24-5.05)	243	49	3.66 (3.19-4.19)	331	66	5.71 (5.08-6.39)
Wyoming	176	35	5.11 (4.35-5.96)	72	14	4.09 (3.16-5.22)	104	21	6.25 (5.06-7.64)
Total	87,053	17,411	4.41 (4.38-4.44)	37,819	7,564	3.59 (3.55-3.63)	49,234	9,847	5.37 (5.32-5.42)

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^a Annual average cases are calculated by dividing the five-year total by five.

^b Estimated by CBTRUS using Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Mortality - All COD, Aggregated with State, Total US (1990-2021) <Katrina/Rita Population Adjustment>, National Cancer Institute, DCCPS, Surveillance Research Program, released January 2024. Underlying mortality data provided by NCHS (www.cdc.gov/nchs).

^c Rates are per 100,000 and are age-adjusted to the 2000 US standard population.

Data Source: CBTRUS Statistical Report: NCHS and NVSS, 2017-2021

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NCHS, National Center for Health Statistics; NVSS, United States Vital Statistics System; CI, confidence interval.

Figure 24. — Average Annual Age-Adjusted Mortality Rates^a for Malignant Primary Brain and Other Central Nervous System Tumors by Central Cancer Registry

The aggregate total number of observed deaths was 87,053, for an AAAMR rate of 4.41 per 100,000 population.
There was considerable variation by individual state, which ranged from a low of 2.77 deaths (Hawaii) per 100,000 population to a high of 5.61 deaths (Vermont) per 100,000 population. Rates may vary by state for multiple reasons, including demographic variation and procedures for deciding primary cause of death on a death certificate.
Males had a higher mortality rate for malignant brain and other CNS tumors than females in the US population, with 5.37 per 100,000 population as compared to 3.59 per 100,000 population.

Overall Survival and Relative Survival, 2001-2020

Estimates of median survival in months by histopathology and age group for all individuals diagnosed with primary malignant brain and other CNS tumors irrespective of whether individuals received any treatment for their tumor are shown in Table 15.

Table 15.

Nineteen-Year Total Deaths and Median Survival in Months with 95% Confidence Intervals for Primary Selected Malignant Brain and Other Central Nervous System Tumor Histopathologies

Histopathology	Newly Diagnosed Tumors (2001-2020)	Deaths (2001-2020)	Median Survival (95% CI)
Diffuse astrocytoma	27,106	15,144	64 (61-66)
Anaplastic astrocytoma	20,100	14,230	21 (21-22)
Glioblastoma	168,030	151,023	9 (8-9)
Oligodendroglioma	13,263	4,268	207 (199-215)
Anaplastic oligodendroglioma	6,002	2,923	107 (101-113)
Oligoastrocytic tumors	7,211	4,016	110 (105-115)
Pilocytic astrocytoma	17,469	1,429	(-**)
Unique astrocytoma variants	1,559	410	(-**)
Ependymal tumors	12,784	2,981	(-**)
Glioma malignant, NOS	23,466	11,460	90 (82-99)
Choroid plexus tumors	441	165	219 (146-**)
Other neuroepithelial tumors	198	65	215 (198-**)
Neuronal and mixed neuronal-glial tumors	2,768	936	201 (183-**)
Tumors of the pineal region	1,288	486	173 (146-229)
Embryonal tumors	11,840	4,652	(-**)
Medulloblastoma	7,907	2,322	(-**)
Atypical teratoid/rhabdoid tumor	1,262	809	15 (13-17)
All other embryonal	2,671	1,521	45 (37-55)
Nerve sheath tumors	742	284	(194-)
Meningiomas	5,467	2,838	103 (96-110)
Mesenchymal tumors	2,181	906	142 (129-156)
Primary melanocytic lesions	203	149	13 (11-21)
Lymphoma	22,866	15,544	18 (17-19)
Other hemopoietic neoplasms	223	112	138 (87-212)
Germ cell tumor	3,519	538	(-**)
Tumors of the pituitary	491	178	209 (187-**)
All other	121	37	(-**)

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** Cannot be calculated due to median survival not being observed.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR 2001-2020.

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; CI, confidence interval; NOS, not otherwise specified; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program.

Median survival was lowest for glioblastoma (9 months) and highest for choroid plexus tumors (219 months, or approximately 18 years).
Median survival was not able to be estimated for pilocytic astrocytoma, unique astrocytoma variants, ependymal tumors, embryonal tumors, germ cell tumors, nerve sheath tumors, and all other as >50% of individuals remained alive during the 16-year follow up period.
Within embryonal tumors, median survival for ATRT was lowest (15 months), followed by all other embryonal (45 months or nearly 4 years), while medulloblastoma median survival was not able to be estimated.
Many other published survival estimates (including many of those previously published by CBTRUS^46-48 incorporate treatment patterns which may explain differences between these population-level estimates and other published estimates.

Demographic factors such as age at diagnosis, sex, and race-Hispanic ethnicity are known to have a significant effect on survival time after diagnosis in primary brain and other CNS tumors. Hazard ratios for the effect of age groups, sex, and race-Hispanic ethnicity are shown in Table 16 for all individuals irrespective of whether they received any treatment for their tumor.

Table 16.

Hazards Ratios and 95% Confidence Intervals for Primary Malignant Brain and Other Central Nervous System Tumor Histopathologies by Age Group at Diagnosis, Sex, and Race and Hispanic Ethnicity

Histopathology	Newly Diagnosed Tumors (2001-2020)	Deaths (2001-2020)	Age at Diagnosis Groups^a				Sex^b		Race and Hispanic Ethnicity^c
			(15-39) Years^d		40+ Years		Female		Non-Hispanic Black		Hispanic (all races)		Non-Hispanic American Indian/Alaska Native		Non-Hispanic Asian or Pacific Islander
			HR (95% CI)	P-value	HR (95% CI)	P-value	HR (95% CI)	P-value	HR (95% CI)	P-value	HR (95% CI)	P-value	HR (95% CI)	P-value	HR (95% CI)	P-value
Diffuse astrocytoma	27,106	15,144	1.89 (1.73-2.07)	<0.0001	6.82 (6.26-7.42)	<0.0001	0.94 (0.91-0.97)	0.0003	1.05 (0.99-1.12)	0.1283	0.79 (0.74-0.83)	<0.0001	0.80 (0.65-0.99)	0.0353	0.88 (0.79-0.97)	0.0124
Anaplastic astrocytoma	20,100	14,230	0.37 (0.34-0.41)	<0.0001	1.26 (1.16-1.37)	<0.0001	0.96 (0.93-0.99)	0.0116	1.09 (1.02-1.16)	0.0113	0.82 (0.78-0.87)	<0.0001	0.96 (0.76-1.20)	0.7017	0.81 (0.73-0.90)	<0.0001
Glioblastoma	168,030	151,023	0.74 (0.69-0.78)	<0.0001	1.81 (1.71-1.92)	<0.0001	1.02 (1.01-1.03)	0.0021	0.93 (0.91-0.95)	<0.0001	0.78 (0.76-0.79)	<0.0001	1.00 (0.92-1.08)	0.9620	0.70 (0.68-0.73)	<0.0001
Oligodendroglioma	13,263	4,268	3.80 (2.66-5.43)	<0.0001	8.18 (5.74-11.65)	<0.0001	0.88 (0.83-0.94)	<0.0001	1.35 (1.19-1.53)	<0.0001	0.77 (0.69-0.86)	<0.0001	1.06 (0.72-1.56)	0.7676	0.80 (0.66-0.96)	0.0165
Anaplastic oligodendroglioma	6,002	2,923	0.72 (0.50-1.05)	0.0905	1.57 (1.09-2.27)	0.0156	0.89 (0.83-0.96)	0.0029	1.25 (1.08-1.46)	0.0033	0.79 (0.69-0.89)	0.0002	0.91 (0.55-1.51)	0.7125	0.77 (0.63-0.93)	0.0070
Oligoastrocytic tumors	7,211	4,016	1.86 (1.41-2.46)	<0.0001	3.85 (2.92-5.09)	<0.0001	0.92 (0.86-0.98)	0.0084	1.35 (1.19-1.53)	<0.0001	0.85 (0.76-0.95)	0.0038	1.23 (0.85-1.78)	0.2825	0.93 (0.77-1.11)	0.4006
Pilocytic astrocytoma	17,469	1,429	1.81 (1.58-2.07)	<0.0001	8.91 (7.87-10.10)	<0.0001	0.85 (0.77-0.95)	0.0029	1.35 (1.15-1.58)	0.0002	1.03 (0.88-1.21)	0.6991	1.32 (0.77-2.29)	0.3159	0.86 (0.60-1.23)	0.4183
Unique astrocytoma variants	1,559	410	1.18 (0.88-1.57)	0.2616	4.55 (3.43-6.05)	<0.0001	0.73 (0.60-0.89)	0.0021	1.01 (0.75-1.36)	0.9490	0.88 (0.66-1.19)	0.4115	1.97 (0.93-4.17)	0.0774	1.63 (1.01-2.64)	0.0452
Ependymal tumors	12,784	2,981	0.45 (0.40-0.50)	<0.0001	1.01 (0.93-1.10)	0.8414	0.76 (0.71-0.82)	<0.0001	1.28 (1.14-1.44)	<0.0001	1.04 (0.94-1.15)	0.4769	0.93 (0.58-1.48)	0.7582	0.83 (0.66-1.04)	0.1006
Glioma malignant, NOS	23,466	11,460	0.81 (0.76-0.87)	<0.0001	3.54 (3.38-3.70)	<0.0001	1.01 (0.97-1.05)	0.5995	1.09 (1.03-1.16)	0.0028	1.03 (0.97-1.09)	0.2836	0.87 (0.68-1.12)	0.2770	0.92 (0.83-1.02)	0.1302
Choroid plexus tumors	441	165	0.77 (0.46-1.29)	0.3213	1.75 (1.17-2.61)	0.0059	1.02 (0.75-1.39)	0.8886	1.48 (0.94-2.35)	0.0933	0.72 (0.48-1.08)	0.1123	2.71 (0.83-8.85)	0.0996	1.12 (0.58-2.16)	0.7272
Other neuroepithelial tumors	198	65	1.94 (0.74-5.09)	0.1762	11.43 (4.76-27.43)	<0.0001	0.76 (0.45-1.28)	0.2958	0.68 (0.29-1.62)	0.3883	0.56 (0.26-1.21)	0.1383	(-**)	**	1.28 (0.46-3.58)	0.6397
Neuronal and mixed neuronal-glial tumors	2,768	936	1.55 (1.16-2.07)	0.0028	2.60 (2.01-3.37)	<0.0001	0.90 (0.79-1.02)	0.1022	1.42 (1.14-1.77)	0.0017	1.15 (0.94-1.40)	0.1804	2.29 (1.22-4.29)	0.0102	0.92 (0.67-1.27)	0.6199
Tumors of the pineal region	1,288	486	0.71 (0.57-0.89)	0.0034	1.26 (1.01-1.57)	0.0400	0.81 (0.67-0.97)	0.0204	1.14 (0.91-1.43)	0.2476	1.04 (0.80-1.34)	0.7803	1.32 (0.54-3.21)	0.5417	0.62 (0.34-1.13)	0.1148
Embryonal tumors	11,840	4,652	0.83 (0.77-0.89)	<0.0001	2.01 (1.84-2.19)	<0.0001	1.00 (0.95-1.06)	0.9342	1.21 (1.10-1.32)	<0.0001	0.97 (0.91-1.05)	0.4768	0.64 (0.42-0.96)	0.0326	0.99 (0.85-1.15)	0.8791
Medulloblastoma	7,907	2,322	0.85 (0.77-0.93)	0.0008	1.76 (1.53-2.02)	<0.0001	0.91 (0.84-0.99)	0.0290	1.11 (0.97-1.27)	0.1178	0.99 (0.90-1.10)	0.9221	0.59 (0.33-1.04)	0.0685	0.80 (0.64-1.01)	0.0603
Atypical teratoid/rhabdoid tumor	1,262	809	0.94 (0.67-1.32)	0.7138	1.03 (0.63-1.69)	0.9061	0.94 (0.82-1.08)	0.3835	1.25 (1.02-1.53)	0.0342	1.12 (0.95-1.33)	0.1800	0.74 (0.27-1.97)	0.5410	1.27 (0.94-1.73)	0.1220
All other embryonal	2,671	1,521	1.38 (1.22-1.56)	<0.0001	2.60 (2.29-2.95)	<0.0001	0.91 (0.82-1.01)	0.0678	1.24 (1.06-1.44)	0.0072	0.92 (0.80-1.05)	0.2275	0.95 (0.45-2.00)	0.8883	1.10 (0.85-1.43)	0.4802
Nerve sheath tumors	742	284	1.49 (0.83-2.70)	0.1830	1.46 (0.83-2.57)	0.1944	0.74 (0.59-0.94)	0.0137	1.68 (1.20-2.36)	0.0028	1.01 (0.70-1.46)	0.9400	**	**	0.31 (0.13-0.74)	0.0088
Meningiomas	5,467	2,838	0.84 (0.49-1.44)	0.5156	2.76 (1.66-4.58)	<0.0001	0.70 (0.65-0.76)	<0.0001	0.97 (0.87-1.07)	0.5455	0.75 (0.66-0.87)	<0.0001	0.82 (0.46-1.44)	0.4845	0.89 (0.73-1.08)	0.2252
Mesenchymal tumors	2,181	906	0.67 (0.50-0.89)	0.0056	1.54 (1.20-1.98)	0.0007	0.95 (0.83-1.08)	0.4113	1.08 (0.87-1.35)	0.4713	0.87 (0.71-1.06)	0.1666	1.32 (0.65-2.64)	0.4407	0.78 (0.56-1.10)	0.1581
Primary melanocytic lesions	203	149	0.37 (0.20-0.67)	0.0013	0.54 (0.33-0.89)	0.0151	0.83 (0.59-1.18)	0.3006	1.99 (1.02-3.88)	0.0444	1.52 (0.90-2.55)	0.1160	--	--	1.15 (0.47-2.87)	0.7561
Lymphoma	22,866	15,544	4.23 (2.96-6.05)	<0.0001	8.22 (5.78-11.69)	<0.0001	0.94 (0.91-0.97)	0.0002	1.14 (1.08-1.20)	<0.0001	0.89 (0.84-0.94)	<0.0001	1.11 (0.91-1.36)	0.2945	0.79 (0.74-0.85)	<0.0001
Other hemopoietic neoplasms	223	112	**	**	**	**	1.05 (0.71-1.53)	0.8161	0.87 (0.54-1.39)	0.5556	0.62 (0.33-1.17)	0.1401	1.94 (0.47-8.00)	0.3607	1.70 (0.73-3.94)	0.2161
Germ cell tumor	3,519	538	0.98 (0.82-1.18)	0.8329	3.06 (2.18-4.29)	<0.0001	1.30 (1.07-1.58)	0.0093	0.86 (0.63-1.17)	0.3327	1.11 (0.89-1.37)	0.3551	1.54 (0.64-3.72)	0.3400	1.04 (0.78-1.39)	0.7886
Tumors of the pituitary	491	178	**	**	**	**	0.92 (0.68-1.24)	0.5842	1.24 (0.86-1.79)	0.2412	0.69 (0.41-1.17)	0.1682	**	**	0.42 (0.13-1.34)	0.1443
Neoplasm, unspecified	10,243	8,359	0.76 (0.62-0.93)	0.0068	3.75 (3.19-4.41)	<0.0001	1.05 (1.01-1.10)	0.0276	0.71 (0.65-0.76)	<0.0001	0.69 (0.63-0.75)	<0.0001	0.74 (0.54-1.00)	0.0497	0.76 (0.66-0.89)	0.0004
All other	121	37	0.93 (0.42-2.04)	0.8562	1.93 (0.85-4.37)	0.1144	0.72 (0.37-1.40)	0.3310	1.06 (0.45-2.51)	0.8948	0.80 (0.34-1.89)	0.6069	--	--	**	**

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^a Reference group is children (<15) as defined by the National Cancer Institute, see: http://www.cancer.gov/researchandfunding/snapshots/pediatric.

^b Reference group is males.

^c Reference group is White Non-Hispanic.

^d Adolescents and Young Adults (AYA), as defined by the National Cancer Institute, see: http://www.cancer.gov/cancertopics/aya.

** Cannot be calculated.

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR 2001-2020

Abbreviations: CBTRUS, Central Brain Tumor of the United States; NPCR, National Program of Cancer Registries; CI, confidence interval; NOS, not otherwise specified; HR, hazard ratio.

AYA (ages 15-39 years at diagnosis) had better overall survival as compared to children (ages 0-14 years at diagnosis) in more than half of the histopathologies evaluated. Children and AYA age groups had similar survival in anaplastic oligodendroglioma, choroid plexus tumors, meningiomas, germ cell tumors, and all other tumors.
Older adults (ages 40+ years) had poorer survival than children in nearly every histopathology except for primary melanocytic lesions.
Females generally had better survival outcomes in glioblastoma, germ cell tumors, and neoplasm unspecified.
Persons who are non-Hispanic Black had poorer survival outcomes as compared to persons who are non-Hispanic White except for glioblastoma and neoplasm unspecified.
Persons who are non-Hispanic American Indian/Alaska Native had poorer survival as compared to individuals who are non-Hispanic White in many histopathologies, though the small size of this population meant that many of these associations were non-significant.
Being a non-Hispanic Asian or Pacific Islander person was associated with improved survival in many histopathologies as compared to persons who were non-Hispanic White, though many of these associations were non-significant.
Being a Hispanic person of any race was associated with improved survival in many histopathologies as compared to persons who were non-Hispanic White, though many of these associations were non-significant.

When interpreting these results, it is important to remember that these models do not incorporate important factors that affect survival such as treatment patterns, health insurance, or type of facility at which an individual received treatment, all of which may be associated with these demographic factors as well as overall survival.

Relative Survival Rates for Brain and Other CNS Tumors by Site and Behavior, 2001-2020 (varying)

Relative survival estimates by site and behavior are shown in Table 17.

Table 17.

One-, Five-, and Ten-Year Relative Survival Rates^a,b (RS) with 95% Confidence Intervals for Brain and Other Central Nervous System Tumors by Site and Behavior

Site (ICD-O Topography Code)	All (2004-2020)				Malignant (2001-2020)^c				Non-Malignant (2004-2020)^d
Site (ICD-O Topography Code)	N	1-Year Relative Survival (95% CI)	5-Year Relative Survival (95% CI)	10-Year Relative Survival (95% CI)	N^e	1-Year Relative Survival (95% CI)	5-Year Relative Survival (95% CI)	10-Year Relative Survival (95% CI)	N^f	1-Year Relative Survival (95% CI)	5-Year Relative Survival (95% CI)	10-Year Relative Survival (95% CI)
Olfactory tumors of the nasal cavity ^g	2,100	91.7 (90.3-92.8)	81.3 (79.0-83.3)	72.6 (69.5-75.5)	2,098	92.7 (91.4-93.8)	82.6 (80.5-84.5)	73.5 (70.5-76.2)	--	--	--	--
Frontal, temporal, parietal, and occipital lobes of the brain	227,964	60.2 (60.0-60.4)	31.8 (31.6-32.0)	26.5 (26.3-26.8)	204,952	58.3 (58.0-58.5)	27.4 (27.2-27.6)	21.7 (21.5-21.9)	23,026	91.3 (90.9-91.7)	87.3 (86.7-87.8)	83.9 (83.2-84.6)
Frontal lobe	98,810	62.3 (62.0-62.6)	36.9 (36.6-37.2)	30.6 (30.2-30.9)	89,434	61.5 (61.1-61.8)	34.2 (33.9-34.6)	27.2 (26.9-27.6)	9,376	89.9 (89.2-90.6)	84.7 (83.8-85.6)	80.5 (79.2-81.8)
Temporal lobe	72,909	61.2 (60.8-61.5)	29.1 (28.7-29.4)	24.5 (24.2-24.9)	64,547	58.5 (58.1-58.9)	23.1 (22.7-23.4)	18.0 (17.6-18.3)	8,006	94.0 (93.4-94.6)	91.3 (90.5-92.1)	89.4 (88.4-90.4)
Parietal lobe	44,273	54.4 (53.9-54.9)	25.3 (24.9-25.8)	20.9 (20.5-21.4)	40,836	51.8 (51.3-52.3)	20.8 (20.4-21.2)	16.3 (15.9-16.8)	3,920	89.0 (87.8-90.0)	84.7 (83.2-86.1)	80.7 (78.8-82.6)
Occipital lobe	11,972	58.5 (57.6-59.5)	29.8 (28.9-30.8)	25.9 (24.9-26.9)	10,135	54.3 (53.3-55.3)	21.7 (20.9-22.6)	17.8 (16.9-18.7)	1,724	91.1 (89.5-92.5)	87.9 (85.8-89.7)	83.7 (80.8-86.2)
Cerebrum	21,174	58.3 (57.7-59.0)	38.6 (37.8-39.3)	34.8 (34.0-35.6)	18,002	53.0 (52.2-53.7)	29.8 (29.1-30.5)	26.1 (25.4-26.9)	3,792	89.6 (88.5-90.6)	85.9 (84.5-87.3)	82.0 (80.0-83.9)
Ventricle, NOS	12,649	86.9 (86.2-87.5)	79.5 (78.7-80.3)	75.8 (74.9-76.8)	5,797	77.5 (76.4-78.6)	64.9 (63.6-66.2)	60.5 (59.0-61.9)	7,262	94.6 (94.0-95.1)	91.5 (90.7-92.3)	88.9 (87.7-90.0)
Cerebellum, NOS	27,308	88.3 (87.9-88.7)	79.1 (78.6-79.7)	75.5 (74.8-76.1)	18,080	85.8 (85.2-86.3)	72.9 (72.2-73.6)	68.3 (67.5-69.1)	10,780	95.0 (94.5-95.4)	92.4 (91.7-93.1)	90.2 (89.1-91.2)
Brainstem	18,968	77.8 (77.2-78.4)	62.9 (62.1-63.6)	58.3 (57.4-59.1)	15,693	72.9 (72.2-73.6)	53.9 (53.0-54.7)	49.0 (48.2-49.9)	4,709	92.8 (92.0-93.6)	89.3 (88.1-90.4)	85.9 (84.3-87.4)
Other Brain	92,323	53.1 (52.8-53.4)	34.6 (34.2-34.9)	30.7 (30.4-31.1)	77,639	46.9 (46.5-47.3)	25.5 (25.1-25.8)	21.6 (21.2-21.9)	17,308	85.9 (85.3-86.4)	80.6 (79.9-81.3)	76.8 (75.8-77.7)
Overlapping lesion of brain	39,518	45.8 (45.3-46.3)	21.2 (20.8-21.7)	17.2 (16.7-17.6)	37,779	44.4 (43.9-45.0)	18.5 (18.1-18.9)	14.3 (13.9-14.8)	2,575	83.5 (81.9-85.0)	78.2 (76.2-80.0)	73.7 (71.3-76.0)
Brain, NOS	52,805	58.6 (58.1-59.0)	44.5 (44.1-45.0)	40.9 (40.4-41.4)	39,860	49.3 (48.8-49.8)	32.1 (31.6-32.6)	28.4 (27.9-28.9)	14,733	86.3 (85.7-86.9)	81.1 (80.3-81.8)	77.3 (76.3-78.3)
Spinal cord and cauda equina	36,890	96.2 (96.0-96.4)	93.3 (92.9-93.7)	91.6 (91.0-92.2)	11,455	89.9 (89.3-90.5)	81.9 (81.1-82.7)	78.1 (77.0-79.1)	26,093	99.1 (98.9-99.3)	98.8 (98.3-99.1)	98.3 (97.6-98.8)
Spinal cord	35,551	96.2 (95.9-96.4)	93.2 (92.8-93.6)	91.4 (90.8-92.0)	11,179	89.9 (89.3-90.5)	81.8 (81.0-82.6)	78.0 (76.9-79.0)	24,996	99.2 (99.0-99.3)	98.8 (98.4-99.1)	98.2 (97.5-98.8)
Cauda equina	1,339	97.0 (95.7-97.9)	95.1 (92.9-96.6)	95.0 (92.6-96.6)	276	91.1 (86.7-94.1)	86.5 (80.7-90.7)	83.0 (75.7-88.2)	1,097	98.4 (97.1-99.2)	97.9 (95.2-99.1)	97.9 (95.2-99.1)
Cranial nerves	88,274	99.3 (99.2-99.4)	99.3 (99.2-99.4)	99.3 (99.2-99.4)	4,880	97.3 (96.8-97.8)	94.4 (93.6-95.1)	93.3 (92.4-94.1)	83,824	99.5 (99.4-99.5)	99.5 (99.4-99.5)	99.5 (99.4-99.5)
Olfactory nerve	123	93.3 (86.4-96.8)	89.2 (79.2-94.5)	87.1 (73.2-94.1)	42	88.9 (73.9-95.6)	77.2 (58.8-88.1)	70.3 (48.4-84.3)	82	95.8 (86.8-98.7)	93.7 (80.0-98.1)	93.7 (80.0-98.1)
Optic nerve	5,156	98.4 (98.0-98.8)	96.4 (95.7-96.9)	95.7 (94.8-96.4)	4,370	98.1 (97.7-98.5)	95.8 (95.1-96.4)	94.9 (94.1-95.6)	1,180	99.7 (98.2-100.0)	98.3 (95.2-99.4)	97.5 (92.7-99.2)
Acoustic nerve	67,851	99.5 (99.4-99.6)	99.5 (99.4-99.6)	99.5 (99.4-99.6)	165	94.4 (88.9-97.2)	93.0 (86.7-96.4)	93.0 (86.7-96.4)	67,731	99.5 (99.4-99.6)	99.5 (99.4-99.6)	99.5 (99.4-99.6)
Cranial nerve, NOS	15,144	98.9 (98.6-99.1)	98.8 (98.4-99.0)	98.8 (98.4-99.0)	303	88.7 (84.2-91.9)	75.8 (69.8-80.9)	71.1 (63.4-77.4)	14,831	99.1 (98.9-99.3)	99.1 (98.9-99.3)	99.1 (98.9-99.3)
Other nervous system	7,091	79.4 (78.3-80.3)	71.3 (70.1-72.5)	67.1 (65.6-68.6)	3,600	64.0 (62.3-65.5)	50.4 (48.5-52.2)	44.6 (42.5-46.8)	3,369	97.4 (96.6-98.0)	94.7 (93.5-95.7)	92.1 (90.3-93.6)
Overlapping lesion of brain & CNS	954	74.9 (71.9-77.7)	65.5 (61.9-68.9)	61.1 (56.6-65.2)	543	62.8 (58.4-66.9)	46.1 (41.3-50.8)	38.7 (33.2-44.1)	406	94.0 (90.7-96.1)	90.3 (85.7-93.5)	88.9 (81.7-93.4)
Nervous system, NOS	6,137	80.0 (79.0-81.1)	72.2 (70.9-73.5)	68.0 (66.3-69.5)	3,057	64.2 (62.4-65.9)	51.1 (49.1-53.1)	45.6 (43.3-47.9)	2,963	97.8 (97.1-98.4)	95.2 (93.9-96.2)	92.5 (90.6-94.1)
Meninges (cerebral and spinal)	480,840	93.3 (93.2-93.3)	88.1 (87.9-88.2)	83.3 (83.1-83.5)	6,898	83.8 (82.9-84.8)	67.4 (66.0-68.7)	60.3 (58.7-62.0)	474,236	93.4 (93.3-93.5)	88.5 (88.3-88.6)	83.7 (83.5-84.0)
Cerebral meninges	393,762	93.2 (93.1-93.3)	88.0 (87.8-88.1)	83.0 (82.7-83.3)	4,982	84.8 (83.7-85.9)	67.2 (65.6-68.8)	60.1 (58.1-62.1)	388,985	93.3 (93.2-93.4)	88.3 (88.1-88.5)	83.4 (83.1-83.7)
Spinal meninges	21,049	97.5 (97.2-97.8)	96.3 (95.6-96.8)	94.6 (93.5-95.6)	484	86.8 (83.2-89.6)	76.5 (71.6-80.6)	71.5 (65.4-76.8)	20,584	97.8 (97.5-98.0)	96.8 (96.1-97.3)	95.3 (94.1-96.2)
Meninges, NOS	66,029	92.1 (91.9-92.4)	86.2 (85.8-86.7)	81.4 (80.7-82.0)	1,432	79.4 (77.1-81.6)	64.7 (61.6-67.6)	57.0 (53.2-60.6)	64,667	92.4 (92.2-92.7)	86.8 (86.3-87.2)	82.0 (81.4-82.7)
Pituitary and craniopharyngeal duct	225,559	98.0 (97.9-98.1)	96.5 (96.4-96.7)	94.6 (94.3-94.8)	1,533	87.7 (85.8-89.3)	76.0 (73.4-78.5)	68.5 (65.3-71.5)	224,165	98.1 (98.0-98.1)	96.7 (96.5-96.8)	94.8 (94.5-95.0)
Pituitary gland	219,274	98.1 (98.1-98.2)	96.9 (96.7-97.0)	95.1 (94.8-95.3)	1,504	87.9 (86.0-89.5)	76.5 (73.8-78.9)	68.9 (65.6-71.9)	217,909	98.2 (98.1-98.3)	97.0 (96.9-97.2)	95.3 (95.0-95.5)
Craniopharyngeal duct	6,285	92.7 (92.0-93.3)	84.9 (83.8-86.0)	77.9 (76.4-79.3)	29	75.9 (55.0-88.1)	--	--	6,256	92.8 (92.0-93.4)	85.1 (84.0-86.1)	78.1 (76.6-79.5)
Pineal gland	5,061	91.8 (90.9-92.5)	82.1 (80.9-83.2)	77.3 (75.8-78.8)	3,425	90.2 (89.1-91.1)	76.7 (75.1-78.2)	71.5 (69.7-73.2)	1,931	94.3 (93.0-95.3)	90.7 (88.9-92.2)	86.5 (84.0-88.7)

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^a The cohort analysis of survival rates was utilized for calculating the survival estimates presented in this table. Long term cohort-based survival estimates reflect the survival experience of individuals diagnosed over the time period, and they may not necessarily reflect the long-term survival outlook of newly diagnosed cases.

^b Rates are an estimate of the percentage of patients alive at one, two, five, and ten years, respectively.

^c Assigned behavior code of /3 (see Table 2).

^d Assigned behavior code of /0 or /1 (see Table 2).

^e Total number of cases that occurred within the included NPCR registries between 2001-2020.

^f Total number of cases that occurred within the included NPCR registries between 2004-2020.

^g ICD-O-3 histopathology codes 9522-9523 only.

--Rates were not presented for categories with 50 or fewer cases and were suppressed for rates where fewer than 16 cases were surviving within a category.

^** Confidence interval could not be calculated.

Data Source : CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR 2001-2020

Abbreviations : CBTRUS, Central Brain Tumor of the United States; NPCR, National Program of Cancer Registries; CI, confidence interval; NOS, not otherwise specified.

The highest overall five-year survival was for tumors occurring in the acoustic nerves (99.5%).
The lowest overall five-year survival was for tumors occurring in the overlapping lesion of the brain (21.2%).
The five-year survival for malignant tumors by site ranged from 18.5% (tumors in the overlapping lesion of the brain) to 95.8% (tumors in the optic nerves).
The five-year survival for non-malignant tumors ranged from 78.2% (tumors in the overlapping lesion of the brain) to 99.5% (tumors in the cranial nerves and acoustic nerve).

Relative Survival Rates for Brain and Other CNS Tumors by Histopathology, Behavior, and Age Group, 2001-2020 (varying)

Relative survival estimates for brain and other CNS tumors by histopathology, behavior, and age at diagnosis are shown in Table 18.

Table 18.

One-, Five-, and Ten-Year Relative Survival Rates^a,b (RS) with 95% Confidence Intervals for Brain and Other Central Nervous System Tumors by Histopathology and Behavior, Overall, and by NCI Age Group at Diagnosis

Histopathology	Age Groups (years)	All (2004-2020)				Malignant (2001-2020)^c				Non-Malignant (2004-2020)^d
Histopathology	Age Groups (years)	N^e	1-Year Relative Survival (95% CI)	5-Year Relative Survival (95% CI)	10-Year Relative Survival (95% CI)	N^f	1 Year Relative Survival (95% CI)	5 Year Relative Survival (95% CI)	10 Year Relative Survival (95% CI)	N^e	1-Year Relative Survival (95% CI)	5-Year Relative Survival (95% CI)	10-Year Relative Survival (95% CI)
Diffuse astrocytoma	0-14 years^g	2,320	92.3 (91.1-93.3)	82.1 (80.4-83.7)	79.5 (77.6-81.2)	2,871	91.9 (90.9-92.9)	81.5 (79.9-82.9)	79.1 (77.4-80.6)	--	--	--	--
	15-39 years^h	7,751	95.8 (95.3-96.2)	79.0 (77.9-79.9)	62.5 (61.1-63.9)	9,138	95.3 (94.9-95.7)	77.8 (76.8-78.7)	60.8 (59.6-62.1)	--	--	--	--
	40+ years	13,452	63.8 (62.9-64.6)	34.2 (33.3-35.1)	25.7 (24.8-26.6)	16,144	62.1 (61.3-62.9)	33.0 (32.2-33.8)	24.4 (23.6-25.3)	--	--	--	--
	All ages	23,523	77.2 (76.6-77.8)	54.0 (53.3-54.6)	43.6 (42.8-44.4)	28,153	76.0 (75.5-76.5)	52.8 (52.1-53.4)	42.3 (41.6-43.0)	60	87.7 (75.5-94.1)	78.7 (64.6-87.7)	66.3 (49.3-78.8)
Anaplastic astrocytoma	0-14 years	726	67.0 (63.4-70.3)	25.5 (22.2-28.9)	20.4 (17.2-23.8)	829	66.5 (63.1-69.6)	25.5 (22.4-28.6)	20.8 (17.9- 24.0)	--	----	--	--
	15-39 years	5,012	92.7 (91.9-93.4)	64.3 (62.8-65.8)	48.1 (46.2-49.9)	5,752	91.7 (91.0-92.4)	62.8 (61.4-64.2)	46.9 (45.3-48.6)	--	--	--	--
	40+ years	12,011	58.3 (57.4-59.2)	20.5 (19.7-21.3)	14.6 (13.8-15.4)	14,071	56.6 (55.7-57.4)	20.0 (19.2-20.7)	14.4 (13.7-15.1)	--	--	--	--
	All ages	17,749	68.4 (67.7-69.1)	33.0 (32.2-33.8)	24.2 (23.4-25.0)	20,652	66.8 (66.1-67.4)	32.1 (31.4-32.8)	23.7 (23.0-24.4)	--	--	--	--
Glioblastoma	0-14 years	1,294	58.5 (55.8-61.2)	20.7 (18.4-23.1)	17.1 (14.8-19.4)	1,486	58.0 (55.4-60.5)	21.5 (19.4-23.8)	18.1 (16.0-20.3)	--	--	--	--
	15-39 years	7,755	77.2 (76.3-78.2)	28.4 (27.3-29.5)	20.0 (18.9-21.1)	8,969	76.4 (75.5-77.3)	27.9 (26.9-29.0)	19.8 (18.9-20.8)	--	--	--	--
	40+ years	142,121	41.2 (40.9-41.4)	5.7 (5.6- 5.9)	3.5 (3.4- 3.6)	162,319	39.7 (39.5-40.0)	5.5 (5.3- 5.6)	3.4 (3.3- 3.5)	--	--	--	--
	All ages	151,170	43.2 (42.9-43.4)	7.1 (6.9- 7.2)	4.5 (4.4- 4.6)	172,774	41.8 (41.6-42.1)	6.8 (6.7-7.0)	4.4 (4.3- 4.6)	--	--	--	--
Oligodendroglioma	0-14 years	317	97.5 (95.0-98.7)	94.2 (90.9-96.3)	91.4 (87.4-94.2)	410	97.3 (95.2-98.5)	94.3 (91.5-96.2)	91.6 (88.1-94.0)	--	--	--	--
	15-39 years	4,618	98.6 (98.2-98.9)	92.6 (91.7-93.4)	79.6 (78.0-81.1)	5,617	98.6 (98.3-98.9)	92.4 (91.5-93.1)	78.8 (77.4-80.1)	--	--	--	--
	40+ years	6,437	93.2 (92.5-93.8)	79.0 (77.8-80.1)	65.8 (64.2-67.4)	7,808	92.4 (91.7-93.0)	77.7 (76.6-78.8)	64.1 (62.7-65.5)	--	--	--	--
	All ages	11,372	95.5 (95.1-95.9)	85.0 (84.2-85.7)	72.3 (71.2-73.4)	13,835	95.1 (94.7-95.4)	84.3 (83.6-84.9)	71.1 (70.1-72)	--	--	--	--
Anaplastic oligodendroglioma	0-14 years	--	--	--	--	61	86.7 (75.1-93.2)	62.3 (48.5-73.4)	53.9 (39.7-66.1)	--	--	--	--
	15-39 years	--	--	--	--	1,812	95.8 (94.7-96.6)	79.0 (76.8-80.9)	64.9 (62.1-67.5)	--	--	--	--
	40+ years	3,568	86.4 (85.1-87.5)	60.6 (58.8-62.4)	46.7 (44.5-48.9)	4,352	84.5 (83.3-85.6)	57.0 (55.3-58.6)	43.7 (41.8-45.6)	--	--	--	--
	All ages	5,090	89.2 (88.3-90.1)	66.7 (65.2-68.2)	52.5 (50.6-54.3)	6,225	87.8 (87.0-88.6)	63.5 (62.2-64.9)	50.1 (48.6-51.7)	--	--	--	--
Oligoastrocytic tumors	0-14 years	161	92.0 (86.6-95.3)	78.8 (71.6-84.4)	76.7 (69.2-82.6)	208	90.9 (86.1-94.1)	76.4 (70.0-81.6)	74.9 (68.3-80.3)	--	--	--	--
	15-39 years	2,680	97.6 (96.9-98.1)	81.0 (79.4-82.5)	61.2 (59.1-63.2)	3,285	97.4 (96.8-97.9)	79.8 (78.3-81.1)	59.9 (58.0-61.7)	--	--	--	--
	40+ years	3,283	82.9 (81.6-84.2)	54.6 (52.8-56.3)	42.9 (41-44.8)	3,981	81.8 (80.6-83.0)	53.0 (51.4-54.6)	41.1 (39.4-42.8)	--	--	--	--
	All ages	6,124	89.6 (88.8-90.4)	66.9 (65.6-68.1)	51.9 (50.5-53.2)	7,474	89.0 (88.2-89.7)	65.5 (64.4-66.6)	50.4 (49.1-51.6)	--	--	--	--
Pilocytic astrocytoma	0-14 years	9,703	99.0 (98.8-99.2)	97.4 (97-97.7)	96.1 (95.6-96.5)	10,801	98.8 (98.6-99)	97.1 (96.8-97.5)	95.7 (95.3-96.2)	378	100.0 (-)	--	--
	15-39 years	4,712	98.4 (97.9-98.7)	94.7 (94-95.4)	92.9 (91.9-93.7)	5,401	98.3 (97.9-98.6)	94.6 (93.9-95.3)	92.8 (91.9-93.6)	--	--	--	--
	40+ years	1,597	91.5 (89.9-92.9)	79.4 (76.9-81.6)	76.0 (72.8-78.9)	1,825	91.3 (89.8-92.6)	78.8 (76.5-80.9)	76.2 (73.4-78.8)	--	--	--	--
	All ages	16,012	98.1 (97.8-98.3)	94.8 (94.4-95.2)	93.1 (92.6-93.6)	18,027	97.9 (97.7-98.1)	94.6 (94.2-94.9)	92.9 (92.4-93.4)	446	99.6 (97.6-99.9)	--	--
Unique astrocytoma variants	0-14 years	1,201	97.8 (96.8-98.5)	94.9 (93.4-96.1)	92.0 (89.9-93.7)	436	95.6 (93.1-97.2)	87.2 (83.5-90.2)	81.5 (76.8-85.4)	818	98.8 (97.7-99.4)	98.2 (96.9-98.9)	96.7 (94.6-97.9)
	15-39 years	1,150	96.7 (95.4-97.6)	87.3 (85.0-89.3)	82.8 (80.0-85.3)	854	96.6 (95.1-97.6)	83.2 (80.2-85.7)	78.8 (75.4-81.8)	396	97.0 (94.7-98.3)	94.6 (91.5-96.6)	91.3 (87.0-94.3)
	40+ years	420	84.5 (80.5-87.8)	59.5 (54.0-64.6)	51.5 (45.1-57.5)	355	82.3 (77.8-86.0)	53.1 (47.2-58.7)	48.2 (41.6-54.4)	103	90.4 (82.2-94.9)	82.4 (71.1-89.5)	64.9 (49.2-76.9)
	All ages	2,771	95.4 (94.5-96.1)	86.5 (85.1-87.9)	82.3 (80.4-83.9)	1,645	93.3 (91.9-94.4)	77.9 (75.6-80.0)	73.0 (70.4-75.4)	1,317	97.6 (96.6-98.4)	96.0 (94.6-97.0)	92.9 (90.8-94.5)
Ependymal tumors	0-14 years	2,845	95.9 (95.1-96.6)	81.3 (79.7-82.8)	73.2 (71.2-75.1)	2,950	95.0 (94.1-95.7)	78.0 (76.4-79.6)	68.8 (66.8-70.6)	332	99.4 (97.5-99.9)	97.7 (94.9-98.9)	96.8 (93.6-98.4)
	15-39 years	5,876	98.5 (98.1-98.8)	95.1 (94.5-95.7)	92.4 (91.5-93.2)	3,720	97.4 (96.8-97.9)	91.4 (90.4-92.4)	87.6 (86.2-88.8)	2,668	99.5 (99.1-99.8)	99.3 (98.6-99.6)	98.2 (97.1-98.9)
	40+ years	11,357	95.0 (94.5-95.4)	91.3 (90.5-92.0)	88.2 (87.0-89.2)	6,739	93.2 (92.5-93.8)	86.9 (85.9-87.9)	82.9 (81.5-84.3)	5,540	96.8 (96.2-97.3)	95.4 (94.3-96.3)	93.6 (91.8-95.0)
	All ages	20,078	96.2 (95.8-96.4)	91.0 (90.4-91.4)	87.2 (86.5-87.9)	13,409	94.8 (94.3-95.1)	86.2 (85.5-86.8)	81.1 (80.2-81.9)	8,540	97.7 (97.3-98.1)	96.7 (96.0-97.3)	95.2 (94.1-96.2)
Glioma malignant, NOS	0-14 years	7,359	81.8 (80.9-82.7)	69.0 (67.8-70.0)	67.9 (66.7-69.0)	8,385	81.1 (80.2-81.9)	67.9 (66.8-68.9)	66.7 (65.6-67.8)	--	--	--	--
	15-39 years	4,589	91.1 (90.2-91.9)	77.7 (76.3-78.9)	71.6 (69.9-73.1)	5,151	90.7 (89.9-91.5)	76.9 (75.6-78.1)	70.5 (69.0-71.9)	--	--	--	--
	40+ years	9,574	53.0 (51.9-54.0)	35.5 (34.4-36.6)	29.8 (28.6-31.1)	11,078	51.6 (50.6-52.6)	34.2 (33.2-35.2)	28.6 (27.5-29.7)	--	--	--	--
	All ages	21,522	71.1 (70.5-71.8)	56.3 (55.6-57.0)	52.3 (51.5-53.1)	24,614	70.0 (69.4-70.6)	54.9 (54.3-55.6)	50.9 (50.2-51.6)	--	--	--	--
Other neuroepithelial tumors	0-14 years	79	97.5 (90.1-99.4)	89.0 (79.1-94.4)	89.0 (79.1-94.4)	66	98.5 (89.4-99.8)	88.4 (77.0-94.4)	88.4 (77.0-94.4)	--	--	--	--
	15-39 years	98	95.9 (89.3-98.5)	87.8 (78.5-93.2)	82.8 (71.4-90.0)	72	94.5 (85.8-97.9)	86.8 (75.6-93.0)	78.3 (64.4-87.3)	--	--	--	--
	40+ years	129	74.0 (65.1-80.9)	51.0 (40.7-60.4)	43.4 (32.1-54.2)	68	71.3 (58.4-80.8)	40.9 (28.0-53.4)	30.7 (18.1-44.2)	73	78.3 (66.5-86.4)	58.0 (43.7-69.9)	53.1 (37.3-66.7)
	All ages	306	87.2 (82.7-90.5)	73.1 (67.2-78.2)	68.6 (61.8-74.4)	206	88.2 (82.8-92.0)	72.6 (65.4-78.5)	66.3 (58.2-73.1)	126	86.6 (79.0-91.7)	73.7 (63.8-81.3)	71.3 (60.4-79.7)
Neuronal and mixed neuronal-glial tumors	0-14 years	3,905	98.9 (98.5-99.2)	96.2 (95.5-96.8)	95.3 (94.4-96.1)	338	92.9 (89.5-95.2)	81.3 (76.5-85.2)	79.3 (74.2-83.5)	3,627	99.4 (99.0-99.6)	97.4 (96.8-97.9)	96.6 (95.8-97.3)
	15-39 years	6,083	98.4 (98.1-98.7)	95.7 (95.0-96.2)	93.0 (92.1-93.8)	687	94.0 (92.0-95.6)	79.5 (76.0-82.5)	71.4 (67.2-75.1)	5,482	98.9 (98.6-99.2)	97.6 (97.1-98.1)	95.8 (94.9-96.5)
	40+ years	4,779	93.8 (93.0-94.6)	85.7 (84.4-87.0)	80.5 (78.6-82.2)	1,906	90.8 (89.2-92.1)	78.0 (75.6-80.2)	69.1 (65.9-72.1)	3,099	95.3 (94.4-96.1)	90.0 (88.5-91.3)	86.2 (84.0-88.1)
	All ages	14,767	97.1 (96.8-97.4)	92.6 (92.1-93.1)	89.7 (88.9-90.3)	2,931	91.8 (90.7-92.8)	78.7 (76.9-80.4)	71.1 (68.7-73.2)	12,208	98.2 (97.9-98.4)	95.7 (95.2-96.1)	93.6 (92.9-94.3)
Choroid plexus tumors	0-14 years	1,121	95.7 (94.3-96.8)	90.1 (88.0-91.8)	88.0 (85.7-90.0)	334	88.0 (83.9-91.1)	67.6 (61.9-72.6)	61.6 (55.5-67.2)	827	98.3 (97.1-99.1)	97.4 (95.9-98.4)	96.9 (95.2-98.0)
	15-39 years	692	98.3 (96.9-99.1)	96.4 (94.4-97.7)	93.1 (90.0-95.2)	56	96.4 (85.9-99.1)	80.6 (66.4-89.2)	63.0 (46.4-75.6)	644	98.3 (96.9-99.1)	97.3 (95.5-98.4)	95.3 (92.4-97.1)
	40+ years	797	89.0 (86.5-91.2)	83.9 (80.3-86.9)	79.9 (74.9-84.0)	65	71.4 (58.1-81.2)	59.4 (44.9-71.2)	50.3 (34.9-63.9)	739	90.4 (87.8-92.5)	85.8 (82.2-88.8)	82.6 (77.2-86.7)
	All ages	2,610	94.4 (93.3-95.2)	89.9 (88.4-91.1)	87.0 (85.1-88.6)	455	86.7 (83.1-89.5)	68.0 (63.2-72.3)	59.9 (54.5-64.9)	2,210	95.7 (94.7-96.5)	93.6 (92.2-94.8)	91.8 (89.9-93.4)
Tumors of the pineal region	0-14 years	450	88.9 (85.5-91.5)	67.8 (63.0-72.2)	61.7 (56.3-66.6)	447	85.8 (82.2-88.8)	62.1 (57.1-66.7)	55.3 (50.0-60.3)	66	98.5 (89.2-99.8)	98.5 (89.2-99.8)	96.2 (83.7-99.1)
	15-39 years	822	95.5 (93.8-96.7)	86.4 (83.6-88.8)	81.4 (77.8-84.4)	491	93.4 (90.7-95.3)	74.6 (70.1-78.6)	66.2 (60.8-71.0)	387	97.5 (95.2-98.7)	97.0 (94.3-98.4)	94.7 (90.6-97.0)
	40+ years	904	90.8 (88.5-92.6)	80.1 (76.7-83.1)	70.5 (65.7-74.8)	412	88.1 (84.3-91.0)	69.6 (64.1-74.5)	55.9 (49.0-62.3)	527	92.1 (89.2-94.3)	87.2 (82.9-90.4)	80.7 (74.3-85.6)
	All ages	2,176	92.1 (90.9-93.2)	79.9 (77.9-81.8)	72.9 (70.3-75.3)	1,350	89.3 (87.4-90.8)	68.9 (66.1-71.6)	59.6 (56.2-62.7)	980	94.7 (93.0-96.0)	91.9 (89.5-93.8)	87.6 (83.9-90.4)
Embryonal tumors	0-14 years	7,000	82.5 (81.6-83.4)	64.6 (63.4-65.7)	59.7 (58.4-60.9)	8,206	82.1 (81.3-83.0)	63.8 (62.7-64.9)	59.0 (57.8-60.1)	--	--	--	--
	15-39 years	2,479	91.5 (90.4-92.6)	72.5 (70.6-74.4)	62.4 (60.1-64.6)	2,962	90.8 (89.7-91.8)	71.7 (70.0-73.4)	62.1 (60.0-64.0)	--	--	--	--
	40+ years	893	70.4 (67.2-73.3)	46.9 (43.3-50.4)	37.2 (33.4-41.1)	1,039	70.1 (67.2-72.9)	47.0 (43.7-50.2)	37.3 (33.8-40.7)	--	--	--	--
	All ages	10,372	83.6 (82.9-84.4)	65.0 (64.0-65.9)	58.4 (57.3-59.5)	12,207	83.2 (82.5-83.9)	64.3 (63.4-65.2)	57.9 (56.9-58.9)	--	--	--	--
Nerve sheath tumors	0-14 years	2,468	99.8 (99.4-99.9)	98.8 (98.2-99.2)	97.9 (97.1-98.5)	52	88.4 (75.9-94.6)	74.5 (60.0-84.3)	71.9 (56.9-82.4)	2,424	100.0 (99.0- 100.0)	99.3 (98.7-99.6)	98.5 (97.7-99.0)
	15-39 years	16,002	99.3 (99.2-99.5)	98.5 (98.3-98.7)	97.7 (97.3-98.0)	190	80.9 (74.5-85.9)	68.2 (60.8-74.5)	61.6 (53.6-68.6)	15,851	99.5 (99.4-99.6)	98.8 (98.6-99.1)	98.1 (97.7-98.4)
	40+ years	86,939	99.2 (99.1-99.3)	99.2 (99.1-99.3)	99.2 (99.1-99.3)	548	86.5 (83.1-89.3)	78.2 (73.8-81.9)	74.6 (68.7-79.5)	86,530	99.3 (99.2-99.4)	99.3 (99.2-99.4)	99.3 (99.2-99.4)
	All ages	105,409	99.2 (99.2-99.3)	99.2 (99.2-99.3)	99.2 (99.2-99.3)	790	85.3 (82.5-87.7)	75.6 (72.1-78.8)	71.2 (66.8-75.1)	104,805	99.3 (99.2-99.4)	99.3 (99.2-99.4)	99.3 (99.2-99.4)
Other tumors of cranial and spinal nerves	0-14 years	--	--	--	--	--	--	--	--	--	--	--	--
	15-39 years	--	--	--	--	--	--	--	--	--	--	--	--
	40+ years	64	98.4 (77.8-99.9)	95.4 (74.1-99.3)	89.8 (67.0-97.1)	--	--	--	--	64	98.4 (77.8-99.9)	95.4 (74.1-99.3)	89.8 (67.0-97.1)
	All ages	79	97.4 (86.6-99.5)	93.7 (79.8-98.1)	89.4 (72.1-96.2)	--	--	--	--	79	97.4 (86.6-99.5)	93.7 (79.8-98.1)	89.4 (72.1-96.2)
Meningiomas	0-14 years	811	98.0 (96.8-98.8)	95.2 (93.3-96.6)	91.3 (88.6-93.4)	68	91.1 (81.0-95.9)	78.5 (66.4-86.7)	74.6 (61.7-83.8)	754	98.7 (97.5-99.3)	96.4 (94.6-97.6)	92.6 (89.8-94.6)
	15-39 years	28,762	98.8 (98.6-98.9)	97.1 (96.8-97.3)	94.9 (94.5-95.3)	466	94.1 (91.5-95.9)	84.1 (80.2-87.3)	79.4 (74.9-83.2)	28,398	98.9 (98.7-99.0)	97.2 (97.0-97.5)	95.2 (94.8-95.5)
	40+ years	447,842	92.9 (92.8-93.0)	87.5 (87.3-87.6)	82.4 (82.2-82.7)	5,349	83.2 (82.1-84.3)	65.2 (63.6-66.8)	58.1 (56.1-60.0)	443,538	93.0 (92.9-93.1)	87.7 (87.6-87.9)	82.7 (82.5-83.0)
	All ages	477,415	93.3 (93.2-93.3)	88.1 (88.0-88.3)	83.3 (83.1-83.6)	5,883	84.2 (83.2-85.2)	67.0 (65.5-68.5)	60.1 (58.3-61.9)	472,690	93.4 (93.3-93.4)	88.4 (88.2-88.5)	83.6 (83.4-83.8)
Mesenchymal tumors	0-14 years	1,514	97.9 (97.0-98.6)	94.8 (93.4-95.9)	93.0 (91.3-94.5)	226	85.4 (80.0-89.5)	68.4 (61.4-74.3)	62.3 (54.9-68.9)	1,323	99.6 (98.8-99.8)	98.2 (97.1-98.9)	96.9 (95.3-98.0)
	15-39 years	5,129	98.2 (97.8-98.5)	96.1 (95.4-96.6)	93.8 (92.9-94.7)	631	92.8 (90.4-94.6)	81.4 (77.9-84.4)	73.1 (68.8-77.0)	4,615	98.8 (98.4-99.1)	97.6 (97.1-98.1)	96.0 (95.1-96.7)
	40+ years	12,414	94.2 (93.7-94.7)	89.6 (88.8-90.4)	85.0 (83.8-86.1)	1,517	87.6 (85.7-89.3)	70.3 (67.4-73.0)	53.8 (50.1-57.4)	11,107	95.0 (94.5-95.4)	91.9 (91.1-92.7)	88.5 (87.3-89.7)
	All ages	19,057	95.6 (95.2-95.9)	91.8 (91.3-92.3)	88.1 (87.3-88.9)	2,374	88.8 (87.4-90.1)	73.2 (71.1-75.2)	60.4 (57.7-63.0)	17,045	96.4 (96.0-96.7)	94.0 (93.4-94.5)	91.3 (90.4-92.0)
Primary melanocytic lesions	0-14 years	--	--	--	--	--	--	--	--	--	--	--	--
	15-39 years	--	--	--	--	--	--	--	--	--	--	--	--
	40+ years	226	70.3 (63.5-76.0)	49.3 (41.3-56.7)	31.0 (22.0-40.4)	154	60.2 (51.7-67.7)	33.9 (25.5-42.6)	21.3 (13.0-30.9)	90	87.9 (78.3-93.5)	69.3 (55.2-79.7)	42.2 (25.2-58.2)
	All ages	313	69.2 (63.5-74.1)	49.3 (42.8-55.5)	35.1 (27.9-42.4)	217	57.4 (50.4-63.8)	34.2 (27.3-41.3)	24.1 (17.0-31.8)	122	89.4 (81.8-94.0)	72.3 (61.0-80.8)	52.8 (39.1-64.8)
Lymphoma	0-14 years	201	92.9 (88.2-95.7)	88.3 (82.7-92.2)	83.4 (76.0-88.6)	226	92.8 (88.4-95.5)	88.2 (83.0-91.9)	83.5 (76.9-88.3)	--	--	--	--
	15-39 years	1,735	68.5 (66.2-70.6)	60.3 (57.8-62.6)	55.6 (52.9-58.2)	2,137	64.5 (62.4-66.5)	55.7 (53.5-57.8)	51.4 (49.0-53.7)	--	--	--	--
	40+ years	18,412	55.3 (54.5-56.0)	37.6 (36.8-38.4)	29.3 (28.4-30.3)	21,084	54.5 (53.8-55.2)	36.2 (35.4-36.9)	27.6 (26.8-28.5)	--	--	--	--
	All ages	20,348	56.8 (56.1-57.5)	40.2 (39.4-41.0)	32.5 (31.6-33.3)	23,447	55.8 (55.1-56.5)	38.6 (37.9-39.3)	30.7 (29.9-31.5)	--	--	--	--
Other hemopoietic neoplasms	0-14 years	--	--	--	--	--	--	--	--	--	--	--	--
	15-39 years	--	--	--	--	--	--	--	--	--	--	--	--
	40+ years	162	83.5 (76.3-88.7)	65.3 (56.1-73.1)	60.4 (49.8-69.5)	200	83.4 (77-88.1)	63.0 (54.8-70.2)	57.5 (48.3-65.7)	--	--	--	--
	All ages	183	85.4 (79.0- 90.0)	66.4 (57.8-73.6)	62.1 (52.3-70.5)	229	85.6 (79.9-89.7)	65.6 (58-72.1)	60.9 (52.4-68.3)	--	--	--	--
Germ cell tumors	0-14 years	1,614	93.4 (92.0-94.5)	88.6 (86.8-90.1)	86.1 (84.1-87.9)	1,619	92.9 (91.6-94.1)	87.0 (85.2-88.7)	83.8 (81.7-85.7)	212	93.0 (88.5-95.8)	92.0 (87.3-95.0)	92.0 (87.3-95.0)
	15-39 years	1,810	95.7 (94.6-96.5)	90.2 (88.6-91.6)	88.2 (86.3-89.9)	1,923	94.7 (93.5-95.6)	88.9 (87.2-90.3)	86.5 (84.6-88.2)	145	99.4 (94.1-99.9)	94.1 (87.9-97.2)	91.3 (83.9-95.4)
	40+ years	226	90.6 (85.6-93.9)	82.4 (75.4-87.6)	76.1 (67.5-82.8)	106	81.6 (72.5-88)	66.3 (55.4-75.1)	64.2 (53-73.3)	141	96.0 (90.1-98.4)	90.9 (81.6-95.6)	81.0 (69.3-88.6)
	All ages	3,650	94.3 (93.5-95.0)	89.0 (87.8-90.1)	86.5 (85.2-87.8)	3,648	93.5 (92.6-94.3)	87.4 (86.2-88.5)	84.7 (83.3-86)	498	95.7 (93.3-97.2)	92.3 (89.0-94.7)	88.7 (84.5-91.8)
Tumors of the pituitary	0-14 years	3,004	99.7 (99.5-99.9)	99.5 (99.0-99.7)	99.0 (98.2-99.4)	--	--	--	--	3,001	99.7 (99.5-99.9)	99.5 (99.0-99.7)	99.0 (98.2-99.4)
	15-39 years	65,932	99.7 (99.7-99.8)	99.4 (99.3-99.5)	98.8 (98.7-99.0)	--	--	--	--	65,849	99.7 (99.7-99.8)	99.4 (99.3-99.5)	98.9 (98.7-99.0)
	40+ years	143,546	97.6 (97.5-97.7)	96.0 (95.8-96.2)	93.7 (93.3-94.1)	415	88.2 (84.3-91.2)	78.2 (72.7-82.7)	68.9 (61.7-75)	143,203	97.6 (97.5-97.7)	96.1 (95.9-96.3)	93.8 (93.4-94.1)
	All ages	212,482	98.3 (98.2-98.4)	97.1 (97.0-97.3)	95.5 (95.2-95.7)	535	90.4 (87.2-92.8)	81.0 (76.5-84.8)	74.0 (68.2-79)	212,053	98.3 (98.2-98.4)	97.2 (97.0-97.3)	95.5 (95.3-95.7)
Craniopharyngioma	0-14 years	2,104	98.6 (98.0-99.0)	95.9 (94.8-96.7)	92.5 (91.0-93.8)	--	--	--	--	2,094	98.7 (98.0-99.1)	95.9 (94.9-96.7)	92.6 (91.0-93.8)
	15-39 years	2,222	96.4 (95.5-97.1)	91.8 (90.4-93.0)	88.1 (86.4-89.7)	--	--	--	--	2,219	96.4 (95.5-97.1)	91.9 (90.5-93.0)	88.2 (86.4-89.8)
	40+ years	5,102	89.4 (88.4-90.3)	78.7 (77.2-80.1)	69.7 (67.7-71.6)	--	--	--	--	5,091	89.4 (88.5-90.3)	78.7 (77.3-80.1)	69.7 (67.7-71.6)
	All ages	9,428	93.1 (92.6-93.7)	85.8 (84.9-86.6)	79.6 (78.4-80.8)	--	--	--	--	9,404	93.1 (92.6-93.7)	85.8 (85.0-86.7)	79.6 (78.5-80.8)
Hemangioma	0-14 years	768	99.5 (98.6-99.8)	98.4 (97.0-99.1)	98.4 (97.0-99.1)	--	--	--	--	768	99.5 (98.6-99.8)	98.4 (97.0-99.1)	98.4 (97.0-99.1)
	15-39 years	3,295	99.6 (99.3-99.8)	98.6 (97.9-99.0)	97.0 (95.9-97.8)	--	--	--	--	3,289	99.6 (99.3-99.8)	98.6 (98.0-99.1)	97.0 (96.0-97.8)
	40+ years	6,899	96.0 (95.4-96.5)	92.0 (90.9-92.9)	89.8 (88.1-91.3)	--	--	--	--	6,892	96.0 (95.4-96.6)	92.0 (90.9-93.0)	89.9 (88.1-91.4)
	All ages	10,962	97.3 (97.0-97.7)	94.5 (93.8-95.1)	92.7 (91.6-93.7)	--	--	--	--	10,949	97.4 (97.0-97.7)	94.5 (93.8-95.1)	92.8 (91.7-93.7)
Neoplasm, unspecified	0-14 years	1,636	89.1 (87.5-90.5)	85.8 (84.0-87.4)	84.3 (82.2-86.1)	449	67.5 (62.9-71.6)	57.3 (52.4-61.9)	54.0 (49.0-58.8)	1,237	95.6 (94.3-96.6)	94.6 (93.2-95.8)	93.7 (92.0-95.1)
	15-39 years	4,835	93.7 (93.0-94.4)	90.2 (89.3-91.1)	88.0 (86.8-89.0)	974	80.1 (77.4-82.5)	67.2 (64.0-70.2)	62.2 (58.7-65.5)	4,039	96.2 (95.5-96.7)	94.3 (93.5-95.1)	92.5 (91.4-93.4)
	40+ years	24,533	53.9 (53.2-54.6)	45.0 (44.3-45.7)	40.1 (39.2-41.0)	11,255	26.7 (25.9-27.6)	17.1 (16.3-17.9)	14.7 (13.8-15.5)	15,111	71.1 (70.3-71.8)	62.3 (61.3-63.3)	56.0 (54.8-57.2)
	All ages	31,004	62.2 (61.6-62.8)	54.6 (53.9-55.2)	50.5 (49.7-51.2)	12,678	32.5 (31.6-33.3)	22.6 (21.8-23.5)	20.0 (19.1-20.9)	20,387	77.7 (77.1-78.3)	70.9 (70.2-71.7)	66.1 (65.2-67.0)
All other	0-14 years	475	90.7 (87.6-93.0)	85.7 (82.1-88.7)	85.7 (82.1-88.7)	141	62.6 (53.9-70.1)	41.7 (33.0-50.3)	40.5 (31.7-49.1)	353	99.5 (97.4-99.9)	99.5 (97.4-99.9)	99.5 (97.4-99.9)
	15-39 years	432	98.0 (96.0-99.0)	94.9 (92.0-96.8)	93.8 (90.0-96.1)	--	--	--	--	390	99.3 (97.5-99.8)	98.3 (95.6-99.3)	97.0 (93.0-98.7)
	40+ years	652	87.9 (84.7-90.4)	83.0 (78.3-86.7)	72.8 (66.2-78.3)	--	--	--	--	622	89.2 (86.1-91.7)	84.6 (79.8-88.4)	74.3 (67.4-79.9)
	All ages	1,559	91.5 (89.9-92.9)	87.2 (84.9-89.1)	83.1 (80.1-85.7)	227	67.2 (60.5-73.0)	46.3 (39.1-53.1)	43.7 (36.2-50.9)	1,365	94.8 (93.3-96.0)	92.6 (90.3-94.3)	88.1 (84.9-90.7)
Total ⁱ	0-14 years	53,468	91.8 (91.6-92.1)	83.4 (83.1-83.7)	80.9 (80.5-81.3)	40,582	87.7 (87.4-88.0)	75.3 (74.9-75.8)	72.2 (71.7-72.7)	18,626	99.0 (98.8-99.1)	97.7 (97.5-97.9)	96.5 (96.2-96.8)
	15-39 years	186,377	97.1 (97.0-97.2)	91.2 (91.1-91.4)	87.4 (87.2-87.6)	60,542	90.9 (90.7-91.2)	72.2 (71.8-72.6)	62.0 (61.5-62.4)	134,827	99.3 (99.2-99.3)	98.4 (98.3-98.5)	97.2 (97.1-97.3)
	40+ years	958,967	83.4 (83.3-83.5)	73.1 (73.0-73.2)	69.2 (69.1-69.4)	272,928	49.6 (49.4-49.8)	21.1 (20.9-21.2)	16.8 (16.6-17.0)	723,082	94.3 (94.2-94.3)	90.5 (90.4-90.7)	87.0 (86.8-87.2)
	All ages	1,198,812	85.9 (85.9-86.0)	76.5 (76.4-76.6)	72.7 (72.6-72.9)	374,052	60.6 (60.4-60.7)	35.7 (35.5-35.8)	30.6 (30.4-30.8)	876,535	95.2 (95.1-95.2)	92.0 (91.9-92.1)	88.9 (88.8-89.1)

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^a The cohort analysis of survival rates was utilized for calculating the survival estimates presented in this table. Long-term cohort-based survival estimates reflect the survival experience of individuals diagnosed over the time periods, and they may not necessarily reflect the long-term survival outlook of newly diagnosed cases.

^b Rates are an estimate of the percentage of cases alive at one, two, five, and ten years, respectively.

^c Assigned behavior code of /3 (see Tables 2).

^d Assigned behavior code of /0 or /1 (see Table 2).

^e Total number of cases that occurred within the included NPCR and SEER registries between 2004 and 2020.

^f Total number of cases that occurred within the included NPCR and SEER registries between 2001 and 2020.

^g Children as defined by the National Cancer Institute, see: http://www.cancer.gov/researchandfunding/snapshots/pediatric.

^h Adolescents and Young Adults as defined by the National Cancer Institute, see: http://www.cancer.gov/cancertopics/aya.

ⁱ Total includes histopathologies not listed in this table.

- Rates were not presented for categories with 50 or fewer cases and were suppressed for rates where fewer than 16 cases were surviving within a category.

^** Confidence interval could not be calculated

Data Source: CBTRUS Statistical Report: U.S. Cancer Statistics – CDC’s NPCR, 2001-2020 (varying)

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NPCR, National Program of Cancer Registries; SEER, Surveillance, Epidemiology, and End Results Program; CI, confidence interval; NOS, not otherwise specified

There was large variation in survival estimates for all ages depending upon tumor histopathology; five-year survival rates were 99.2% for nerve sheath tumors and 7.1% for glioblastoma.
Survival generally decreased with older age at diagnosis; children and young adults generally had better survival outcomes for most histopathologies.
Among predominantly non-malignant histopathologies, five-year survival was lowest in neoplasm unspecified which had five-year relative survival of 70.9%.
Among predominantly non-malignant histopathologies, five-year survival was highest in nerve sheath tumors which had five-year relative survival of 99.3%.
In general, relative survival in most histopathologies was higher in AYA ages 15-39 years as compared to children and adults of all other ages.
Though one-year relative survival for most tumor types was higher for AYA than children, five- and ten-year survival were usually higher for children as compared to AYA (Table 18).

Strengths and Limitations of Cancer Registry Data

CBTRUS, in collaboration with the CDC and NCI, is the largest population-based registry focused exclusively on primary brain and other CNS tumors in the United States and represents cases collected from the entire US population. The CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017–2021 contains the most up-to-date population-based data on all primary brain tumor and other CNS tumors available through the cancer surveillance system in the United States.

Registration of individual cases is conducted by cancer registrars at the institution where diagnosis (assignment of a specific histopathology) or treatment occurs and is then transmitted to the CCR, which further transmits this information to NPCR and/or SEER. Those CCRs contributing data to NPCR and to SEER only report cases to the CDC and NCI for persons who are residents of that specific state, so duplicate records should not occur for persons who may have traveled across state lines for treatment. As a result, the CBTRUS dataset is a complete recording of all reported cases for the time-period examined, 2017-2021, with minimal duplicates.

Currently, there is no publicly available data source for the collection of survival and outcomes data from all geographic regions in the United States via the cancer registry system. Survival data used for this report are collected by NPCR for 43 of the 51 CCRs in the United States—primarily through linkage with death certificate and other administrative records—and by SEER for the remaining CCRs—through active and passive methods—and the feasibility of these data for use in survival studies has been evaluated^49,50 and shown to produce reliable and robust estimates of cancer survival. Use of passive follow-up with record linkage may result in overestimation of survival in some populations, such as those whose members are more likely to leave the state or country.

No mechanism currently exists for central pathology review of cases within the US cancer registry system, and histopathology code assignment at case registration is based on histopathology information contained in the patient’s medical record. The WHO Classification of Tumours of the Central Nervous System was revised in 1993, 2000, 2007, 2016, and 2021.^2,51-54 As of 2018, the US cancer registry system uses the 2016 classification for data abstraction, but tumors included in this report may have been diagnosed using any of the available classifications prior to 2016 due to the variation in adoption of new standards by individual physicians and medical practices. As a result, histopathologies are reflective of the prevailing criteria for the histopathology at the time of case registration. This means that despite changes to the histopathology schema that may occur over time, it is not possible, without additional variables, to go back and reclassify tumors based on the new criteria. In addition to changes in histopathologic criteria over time, there is significant inter-rater variability in histopathological diagnosis of glioma.^55,56 This also means that incomplete, incorrect, or alternatively stated diagnoses included in a pathology report or other medical record may result in an incorrect reporting of the details of an individual case.

US cancer registration requires the reporting of cases that are confirmed by different types of diagnostic procedures, including both histopathologic confirmation (where surgery was performed and the diagnosis confirmed on a tissue specimen by a pathologist) and radiographic confirmation (when pathologic confirmation is not available and diagnosis was made based solely on imaging criteria, such as an MRI, CT scan, or X-ray). Only histopathologic confirmation allows certainty on the assignment of a specific histopathology as well as for an assignment of a WHO grade. Many tumors have unique characteristics that make them identifiable in imaging, and thereby qualify as a valid type of diagnostic procedure. It is important to consider the decreased level of certainty of specifying the correct histopathology in these tumors.

TECHNICAL NOTES

Variable Completeness in Cancer Registration

Obtaining the most accurate and complete cancer registration data possible are essential to generate accurate population-level statistics to guide public health planning. Agencies such as NAACCR and IARC have developed stringent standards for evaluation of cancer registry data quality, and they evaluate each specific registry by multiple metrics before including it in analytic datasets.^57,58 While many measures of quality and completeness are assessed across all cancer sites, some variables are pertinent only to specific sites and/or histopathologies and require special care. In the case of primary brain and other CNS tumors, variables such as CNS WHO grade are not relevant to certain histopathologies (e.g. many tumors of the pituitary) that are not assigned a CNS WHO grade. Similarly, the BMM variable is applicable only to specific histopathologies. Variables like CNS WHO grade or BMM may not be found in the patient record for those cases that had diagnosis confirmed via radiography as compared to histopathological examination. The 2024 CBTRUS Report evaluates the completeness of multiple variables, including: CNS WHO grade (applicable to specific brain and other CNS sites and histopathologies only), BMM (applicable to specific histopathologies only), extent of surgical resection, and radiation treatment.

Measures in Surveillance Epidemiology

The CBTRUS Statistical Report presents the following population-based measures: incidence rates, mortality rates, prevalence, observed survival (median survival time and hazard ratios), and relative survival rates (for more information on definitions of terms and measures used see: https://cbtrus.org/cbtrus-glossary/).

CBTRUS presents statistics on the pediatric and adolescent age group 0-19 years as suggested by clinicians for clinical relevance. However, the 0-14 years age group is a standard age category for childhood cancer used by other cancer surveillance organizations and has been included in this report for consistency and comparison purposes.

Defining Average Annual Age-Adjusted Incidence Rates (AAAIR), Average Annual Age-Adjusted Mortality Rates (AAAMR) and Incidence Rate Ratios (IRR)

Crude rates (both incidence and mortality) are calculated by dividing the total number of cases or deaths by the total population and cannot be compared to crude rates from other populations where the age distribution is different. These rates are adjusted to allow for comparison across populations that vary in age structure, by generated age-specific rates which are then projected to a standard distribution of population by ages (in this report, the 2000 US census population). Age-adjustment is a technique that is used to enable comparison between groups with different age distributions, such as rates between different states. Rates that have been age-adjusted are estimates of what the crude rate would be if the age distribution is equivalent to a standard population. This technique is applied to generate both AAAIR and AAAMR.

IRR were generated based on these age-adjusted incidence rates. When comparing two rates to one another, it is important to consider whether they are truly different or whether the difference in the estimates may be due to random error. Two methods are used in this report for determining whether two values are “significantly different,” meaning whether the evidence meets a level of strength (usually a 5% chance of error) where the difference can be assumed to not be due to random error. The first is the use of a 95% CI, which was calculated for all presented rates in this Report. A 95% CI is a range around an estimate, which, if sampling of the population were to be repeated, should contain the “true” value for the population 95% of the time. If the CI of two estimates do not overlap, these values are considered significantly different with a less than 5% probability of happening by chance. The second method used is the calculation of p-values. A p-value is the probability of finding the observed or more extreme results by chance alone, and a p-value of <0.05 (or <5% chance of results being due to chance) is conventionally used as a cut-off for considering a value statistically significant. Therefore, a p-value of <0.0001 could be interpreted as meaning the observed value (or a more extreme value) had a <0.01% chance of occurring by chance alone, and the difference can be considered statistically significant at the 0.01% level.

Defining Incidence Time Trends

Rather than calculating a single consistent slope of change over an entire period of time, Joinpoint allows for points where the slope of the trend can change during the time period (joinpoints). This method starts with a model that assumes one consistent trend over time, and tests whether the addition of these “joinpoints” results in a model which has a fit that represents a statistically significant improvement over the model with no joinpoints. These models are tested through use of Monte Carlo permutations, e.g., the program repeats the same analysis multiple times using random samples to identify the ‘true’ proportion of times that a comparison is statistically significant. The models allowed for a maximum of three joinpoints (two for non-malignant tumors), a minimum of three observations from a joinpoint to either end of the time-period, and a minimum of three observations between joinpoints.⁵⁹ The best fitting model is selected and may include anywhere from one to four trend periods depending on identified inflection points (maximum of three for non-malignant tumors) and number of years included in the model.

APC is the annual percent change in incidence per year over the period included in the trend segment. Time trends analysis methods were used to estimate if the APC was significantly different from 0% (meaning no change in incidence from year to year). The 95% CI is a range around an estimate that, if sampling of the population were to be repeated, should contain the “true” value for the population 95% of the time. If the 95% CI contains zero, one cannot be confident that the ‘true’ population APC value is significantly different from 0%. The joinpoint regression program fits a linear regression to annual incidence rates to test significance of changes overtime, with different trends lines connected at “joinpoints,” where there are changes in the direction of incidence trends. The best fitting model was determined through permutation tests, with a minimum of three observations required between two joinpoints, as well as a minimum of three observations required between a joinpoint and either end of the time-period.

Defining Survival Measures

Relative survival is a way of presenting survival patterns at a population level that is commonly used in cancer statistics reporting. This measure is presented as a percentage of people living a period of time (e.g., five years after their diagnosis). Relative survival is calculated using observed survival (the percentage of people diagnosed with cancer that live to the period of time for which relative survival is calculated) and relative survival (the percent of the general population of the same age that is expected to survive after being followed for that same period of time). This adjustment for estimated survival attempts to exclude deaths that would otherwise have occurred due to other causes. For example, if five-year relative survival for glioblastoma is 5%, that means that out of every 100 people diagnosed with glioblastoma, five will be living five years after diagnosis, excluding deaths attributed to other causes. SEER*Stat statistical software utilizes life-table (actuarial) methods to compute survival estimates and accounts for current follow-up.

Median survival time is another way of presenting survival patterns in a population. This measure is calculated using a method called a Kaplan-Meier estimator, which is used to estimate the proportion of individuals within a set that are alive at particular time points. The median survival time is the point at which exactly 50% of individuals have either died or been “censored,” meaning that their further survival status is unknown beyond a particular date. NAACCR data item #1787, survival months presumed alive, was used to ascertain follow-up information.

The hazard ratio (HR) is a measure of how often an event (in this case, death) occurs in one group as compared to another group over time. A hazard ratio of one means that survival is equal in both groups, while a ratio of less than one means that survival is better in the comparison group than in the reference group. A ratio of greater than one means that survival is worse in the comparison group than in the reference group.

Data Interpretation

CBTRUS works diligently to support the broader surveillance efforts aimed at improving the collection and reporting of primary brain and other CNS tumors. CCR data provided to NPCR, and SEER and, subsequently, to CBTRUS vary from year-to-year due to ongoing updates to cases from all cancer diagnosis years, as well as changes in collection and data refinement aimed to improve completeness and accuracy. It is important to note that data from previous CBTRUS Reports cannot be compared to data in this current report, CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017–2021.This current report supersedes all previous reports in terms of coverage of the US population and completeness with the most up-to-date population-based information available, making these data the most accurate and timely to reference.

Several factors should be considered when interpreting the data presented in this report:

Incident counts of cases represent individual tumors and not persons. A single person could contribute multiple primary tumor cases to the data included in this report. The 467,894 tumors included in this report came from 462,187 individuals. Of these 462,187 individuals, there were 5,477 individuals (1.2%) that contributed information on multiple tumors (two or more) to this report.
Data may be excluded from individual CCRs for specific years due to incomplete case ascertainment.
Random fluctuations in average annual rates are common, especially for rates based on small case counts. The CBTRUS policy to suppress data in cells with counts of fewer than 16 cases is consistent with the NPCR policy.
A 2007 policy change guiding the Veterans Health Administration may have resulted in probable underreporting of cancer data—especially for males—to CCRs. Recent investigations suggest that underreporting for Veterans Health Administration facilities has diminished over time, and that the Veterans Affairs Central Cancer Registry (VACCR) now captures approximately 87-90% of cases.^60,61 It is important to note that improved reporting to VACCR does not necessarily mean that reporting to the state CCR has improved. The VACCR does not submit data directly to NPCR or SEER. The Counting Veterans Act, which would require reporting of cancer diagnoses at VA facilities to state CCRs, was introduced by Senators Mark Kelly and Thom Tillis on June 14, 2023, and aims to solve the above challenges to completeness of data.
Delays in reporting and late ascertainment are a reality and a known issue influencing registry completeness and, consequently, rate underestimations occur, especially for the most recent years.^62,63, The SEER and NPCR programs allow for reporting delay of up to 22-23 months prior to public data release, but additional cases may still be discovered after that point. On average across all cancer sites, the submissions for the most recent diagnosis year are approximately 4% lower than the total number of cases that will eventually be submitted. This problem may be even more likely to occur in the reporting of non-malignant brain and other CNS tumors, where reporting often comes from non-hospital-based sources, such as free-standing clinics or outpatient facilities. Delays may also vary by CCR due to variation in data collection and reporting by state.
Type of diagnostic confirmation may also lead to increased reporting delay, with histopathologically-confirmed tumors being subject to less reporting delay than radiographically-confirmed tumors. In 2016, a study assessing the incidence of non-malignant brain and other CNS tumors corroborated the large variation in incidence between CCRs reported in this statistical report. The reasons for this variation remain inconclusive, but what is consistently noted is the correlation between high incidence and high proportion of non-malignant cases collected without microscopic confirmation or surgery, in other words, clinically diagnosed cases of non-malignant brain tumors. At this current time, given the variation across CCRs, there is evidence of potential underreporting of non-malignant brain and other CNS tumors, the extent to which cannot be quantified at this time, but which is under investigation.
Population estimates used for denominators affect incidence rates. CBTRUS has utilized population estimates based on the 2000 US Census for calculation of incidence and mortality rates in this report, as is standard practice in US cancer registry reporting.^64,65

CBTRUS editing practices are reviewed, revised, and conducted yearly. These practices are aimed at refining the data for accuracy and clinical relevance and play a role in interpreting these report data. They also include the exclusion of site and histopathology combinations considered invalid by the CBTRUS consulting neuropathologists who revised the CBTRUS site/histopathology validation list in 2021. Editing changes, such as the Multiple Primary and Histology Rules issued in 2007 and revised in 2018, also incorporate updates to the cancer registration coding rules that influence case ascertainment and data collection.²⁴

CONCLUDING COMMENT

The CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017–2021 comprehensively describes the most up-to-date (October 2024) population-based incidence, mortality, and relative survival of primary malignant and non-malignant brain and other CNS tumors collected and reported by CCRs covering the entire US population. This report aims to serve as a useful resource for researchers, clinicians, patients, and families. CBTRUS continually revises its reports to reflect the current collection and reporting practices of the broader surveillance community in which it works, while integrating the input it receives from the clinical and research communities, especially from neuropathologists, when possible. In this way, CBTRUS facilitates communication between the cancer surveillance and the brain tumor research and clinical communities and contributes meaningful insight into the descriptive epidemiology of all primary brain and other CNS tumors in the United States.⁶⁶

CBTRUS Mission

CBTRUS is a not-for-profit corporation committed to providing a resource for gathering and disseminating current epidemiologic data on all primary brain and other CNS tumors, benign and 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.

Supplementary material

Supplementary material is available online at Neuro-Oncology (https://academic.oup.com/neuro-oncology).

Supplementary Table 1. Coding Definitions for the Brain Molecular Markers Data Item (NAACCR Data Item #3816)

Supplementary Table 2. Five-Year Total, Annual Average Total, and Average Annual Age-Adjusted Incidence Rates with 95% Confidence Intervals for Brain and Other Central Nervous System Tumors Among Children and Adolescents (Ages 0-19 Years) by Histopathology and Age Group at Diagnosis

Supplementary Table 3. Five-Year Total, Annual Average Total, and Average Annual Age-Adjusted Incidence Rates with 95% Confidence Intervals for Brain and Other Central Nervous System Tumors Among Adults (Ages 20+ Years) by Histopathology and Age at Diagnosis

Supplementary Table 4. Five-Year Total, Annual Average Total, Average Annual Age-Adjusted Incidence Rates with 95% Confidence Intervals for Brain and Other Central Nervous System Tumors by Age at Diagnosis, Behavior, and Central Cancer Registry

Supplementary Figure 1. Annual Delay- and Age-Adjusted Incidence Rates Per 100,000 Population and Percent Change from 2019 to 2020 and from 2020 to 2021 for All Primary Brain and Other Central Nervous System Tumors

Supplementary Figure 2. Distribution of Primary Brain and Other Central Nervous System Tumors by Behavior and by A) Males and B) Females

Supplementary Figure 3. Average Annual Age-Adjusted Incidence Rates^a of Malignant and Non-Malignant Primary Brain and Other Central Nervous System Tumors Combined by Central Cancer Registry

Supplementary Figure 4. Distribution of All Primary Brain and Other Central Nervous System Tumors Diagnosed in Puerto Rico by Behavior (Five-Year Total=1,972; Annual Average Cases=394)

noae145_suppl_Supplementary_Materials

noae145_suppl_supplementary_materials.docx^{(756.3KB, docx)}

Acknowledgments

This report was prepared by the CBTRUS Co-Scientific Principal Investigator, Quinn T. Ostrom, Ph.D., M.P.H. from Duke University School of Medicine and her research team in collaboration with Co-Scientific Principal Investigator Jill S. Barnholtz-Sloan, Ph.D., her research staff affiliated with the NCI, DCEG, whose services were provided by DCEG, and CBTRUS President and Chief Mission Officer, Carol Kruchko, and CBTRUS Research Analyst, Mackenzie Price, collectively known as the CBTRUS Team. The CBTRUS data presented in this report were provided through an agreement with the CDC, NPCR. In addition, CBTRUS used data from the research data files of the NCI, SEER Program. CBTRUS acknowledges and appreciates these contributions to this report and to cancer surveillance in general.

We acknowledge the efforts of the tumor registrars at hospitals and treatment centers, the CCRs, and the staff from the NPCR and SEER programs, whose efforts to collect accurate and complete data have made this report possible. We are also grateful to our Consulting Neuropathologists, our Board of Directors and Advisors, and especially Drs. Melissa Bondy, Stephen Francis, and Sonia Partap, and to Claudia Smits, L.L.M., Reda J. Wilson, M.P.H., O.D.S., and Mary Elizabeth O’Neil, M.P.H.

Glossary

ABBREVIATIONS:

AAAIR: Average Annual Age-Adjusted Incidence Rate
AAAMR: Average Annual Age-Adjusted Mortality Rate
AJCC: American Joint Commission on Cancer
APC: Annual Percent Change
AYA: Adolescents and Young Adults
BMM: Brain Molecular Marker
CBTRUS: Central Brain Tumor Registry of the United States
CCR: Central Cancer Registry
CDC: Centers for Disease Control and Prevention
CI: Confidence Interval
CNS: Central Nervous System
CSSSF: Collaborative State Site-Specific Factor
DCEG: Division of Cancer Epidemiology and Genetics
IACR: International Association of Cancer Registries;ICD-O-3, International Classification of Diseases for Oncology, Third Edition;IDH1/2, Isocitrate Dehydrogenase 1/2
IRR: Incidence Rate Ratio
MGMT: O-6-Methylguanine-DNA Methyltransferase
NAACCR: North American Association of Central Cancer Registries
NCHS: National Center for Health Statistics
NCI: National Cancer Institute
NOS: Not Otherwise Specified
NPCR: National Program of Cancer Registries
NVSS: National Vital Statistics System
SEER: Surveillance, Epidemiology, and End Results
SHH: Sonic Hedgehog
SSDI: Site-Specific Data Items
SSF: Site-Specific Factors;TP53- Tumor Protein p53
UDS: Uniform Data Standards
USCS: United States Cancer Statistics
VACCR: Veterans Affairs Central Cancer Registry
WHO: World Health Organization
WNT: Wingless

Contributor Information

Mackenzie Price, Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A.

Christine Ballard, Department of Neurosurgery, Duke University School of Medicine, Durham, NC, U.S.A; Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A.

Julia Benedetti, Department of Neurosurgery, Duke University School of Medicine, Durham, NC, U.S.A; Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A.

Corey Neff, Department of Neurosurgery, Duke University School of Medicine, Durham, NC, U.S.A; Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A.

Gino Cioffi, Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, U.S.A; Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A.

Kristin A Waite, Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, U.S.A; Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A.

Carol Kruchko, Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A.

Jill S Barnholtz-Sloan, Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A; Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, U.S.A; Center for Biomedical Informatics & Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, MD, U.S.A.

Quinn T Ostrom, Department of Neurosurgery, Duke University School of Medicine, Durham, NC, U.S.A; Central Brain Tumor Registry of the United States, Hinsdale, IL, U.S.A; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, U.S.A; Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A.

Disclaimer

CBTRUS is a not-for-profit corporation which gathers and disseminates epidemiologic data on primary brain and other CNS tumors to facilitate research and establish awareness of the disease. CBTRUS makes no representations or warranties and gives no other assurances or guarantees, express or implied, with respect to the accuracy or completeness of the data presented. The information provided in this report is not intended to assist in the evaluation, diagnosis, or treatment of individual diseases. Persons with questions regarding individual diseases should contact their own physician to obtain medical assistance. The contents in this report are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or of the NCI.

Jill S. Barnholtz-Sloan, Ph.D. is a full-time paid employee of the NIH/NCI and acting director of the Center for Biomedical Informatics and Information Technology. Gino Cioffi M.P.H. and Kristin A. Waite, Ph.D. are full-time contractors of the NIH/NCI. They receive no remuneration from CBTRUS.

Funding

CBTRUS is honored to be included among the research awardees of the following organizations which have contributed to the analyses resulting from the CBTRUS database: the Centers for Disease Control and Prevention under Contract No. 75D30123P17556, the American Brain Tumor Association, the Musella Foundation for Brain Tumor Research & Information, Inc., the National Brain Tumor Society, the National Cancer Institute (NCI), Neuro-Oncology Branch under Contract No.75N91024P00091, the Pediatric Brain Tumor Foundation, The Sontag Foundation, the Uncle Kory Foundation, and the Josephine F. DeAngelis Memorial Fund, as well as from private and in-kind donations. The research services of Jill S. Barnholtz-Sloan, Kristin A Waite, and Gino Cioffi were provided by the Division of Cancer Epidemiology and Genetics of the NCI.

The CBTRUS Scientific Team

Quinn T. Ostrom, Ph.D., M.P.H., CBTRUS Co-Scientific -Principal Investigator, Assistant Professor, The Preston Robert Tisch Brain Tumor Center at Duke University Medical Center and Department of Neurosurgery, Duke University School of Medicine, Durham, NC

Jill S. Barnholtz-Sloan, Ph.D., CBTRUS Co-Scientific Principal Investigator, Acting Director and Senior Investigator, Center for Biomedical Informatics and Information Technology and Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD

Gino Cioffi, M.P.H., Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD

Christine Ballard, M.P.H., Department of Neurosurgery, Duke University School of Medicine, Durham, NC

Mackenzie Price, M.P.H., Central Brain Tumor Registry of the United States, Hinsdale, IL

Julia Benedetti, M.B.S., Department of Neurosurgery, Duke University School of Medicine, Durham, NC

Kristin A. Waite, Ph.D., Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD

The CBTRUS Consulting Neuropathologists

Daniel J. Brat, M.D., Ph.D., Professor and Chair, Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL

Janet M. Bruner, M.D., MD Anderson Cancer Center, Houston, TX (Retired)

Tarik Tihan, M.D., Ph.D., Professor, Neuropathology Division, Department of Pathology, School of Medicine, University of California San Francisco, San Francisco, CA

The CBTRUS Board of Directors

Carol Kruchko, President & Chief Mission Officer, Central Brain Tumor Registry of the United States, Hinsdale, IL

Steven Brem, M.D., Professor, Department of Neurosurgery; Penn Neuroscience Center-Neurosurgery Penn Brain Tumor Center, Glioblastoma Translational Center of Excellence, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA

Donald Segal, J.D., Treasurer, Segal McCambridge Singer & Mahoney, Ltd., Chicago, IL

Elizabeth B. Claus, M.D., Ph.D., Professor, Director of Medical Research, Yale University School of Public Health, New Haven, CT, Attending Neurosurgeon and Director of Stereotactic Radiosurgery, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA

Fred H. Hochberg, M.D., Visiting Scientist, Department of Neurosurgery, University of California at San Diego, San Diego, CA

Margaret R. Wrensch, Ph.D., Professor, Neuroepidemiology Division, Department of Neurological Surgery, School of Medicine, University of California-San Francisco, San Francisco, CA

Darell D. Bigner, M.D., Ph.D. (Emeritus Member), Edwin L. Jones, Jr. and Lucille Finch Jones Cancer Research Professor, Director, The Preston Robert Tisch Brain Tumor Center, Chief, Preuss Laboratory for Brain Tumor Research, Duke University Medical Center, Durham, NC

The CBTRUS Board of Advisors

Hoda Anton-Culver, Ph.D., Distinguished Professor, Department of Medicine; Principal Investigator, All of Us Precision Medicine Research Program; Director, Genetic Epidemiology Research Institute, University of California-Irvine, Irvine, CA

Melissa Bondy, Ph.D., Professor and Chair, Department of Epidemiology and Population Health, Assistant Director, Population Sciences, Stanford Cancer Center, Stanford, CA

Jennifer Cullen, Ph.D., M.P.H., Associate Director for Cancer Population Science, Case Comprehensive Cancer Center, Professor, Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH

Faith Davis, Ph.D., Professor Emeritus, School of Public Health, University of Alberta, Edmonton, Canada

Roberta McKean-Cowdin, Ph.D., Associate Professor, Department of Epidemiology, University of Southern California, Los Angeles, CA

Nancy Stroup, Ph.D., Epidemiologist (Retired), Atlanta, GA

John Villano, M.D., Ph.D., Professor, Division of Medical Oncology, University of Kentucky Markey Cancer Center, Lexington, KY

Selected CBTRUS Scientific Publications

Dong M, et al. “Sex Differences in Cancer Incidence and Survival: A Pan-Cancer Analysis.” Cancer Epidemiol Biomarkers Prev. 2020 Jul;29(7):1389-1397. doi: 10.1158/1055-9965.EPI-20-0036. PMID: 32349967.

This analysis uses a pan-cancer approach to interrogate sex differences in cancer incidence and survival, with a special focus on brain and other CNS tumors.

Cioffi G, et al. “The impact of COVID-19 on 2020 monthly incidence trends of primary brain and other CNS tumors.” Neuro-Oncology, 2024 April; 26(4): 764–774. doi: 10.1093/neuonc/noad235.

This manuscript assesses the effect of the COVID-19 pandemic on incidence of brain and other CNS tumors in the United States.

Forjaz G, et al. “An updated histology recode for the analysis of primary malignant and nonmalignant brain and other central nervous system tumors in the Surveillance, Epidemiology, and End Results Program.” Neurooncol Adv. 2020 Dec 8;3(1):vdaa175. doi: 10.1093/noajnl/vdaa175.

This manuscript describes the development of an updated classification scheme for brain and other CNS tumors for inclusion in the SEER*explorer system and other SEER data products.

Iorgulescu JB, et al. “Molecular Biomarker-Defined Brain Tumors: Epidemiology, Validity, and Completeness in the United States.” Neuro Oncol. 2022 Nov 2;24(11):1989-2000. doi: 10.1093/neuonc/noac113. PMID: 35460555 PMCID: PMC9629432

This analysis investigated the completeness and validity of the novel brain molecular markers (BMM) site-specific data item after its first year of collection.

Kruchko C, et al. “Cancer collection efforts in the United States provide clinically relevant data on all primary brain and other CNS tumors.” Neurooncol Pract. 2019 Sep;6(5):330-339. doi: 10.1093/nop/npz029.

A summary of cancer registration efforts and data sources in the United States.

Kruchko C, et al. “The CBTRUS story: providing accurate population-based statistics on brain and other central nervous system tumors for everyone.” Neuro Oncol. 2018 Feb 19;20(3):295-298. doi: 10.1093/neuonc/noy006.

A summary of the history and mission of the Central Brain Tumor Registry of the United States.

Neff C, et al. “Complete prevalence of primary malignant and non-malignant brain tumors in comparison to other cancers in the United States.” 2023 Aug 15;129(16):2514-2521. doi: 10.1002/cncr.34837.

This analysis included the first complete estimates for the prevalence of both primary malignant and non-malignant brain and other central nervous system tumors in the United States as of 2019, an update to previous results.

Ostrom QT, et al. “CBTRUS Statistical Report: Pediatric Brain Tumor Foundation Childhood and Adolescent Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014-2018.” Neuro Oncol. 2022 Sep 6;24(Suppl 3):iii1-iii38. doi: 10.1093/neuonc/noac161.

This special report, funded by the Pediatric Brain Tumor Foundation, presents incidence and survival statistics for children 0-14 using histopathology groupings that were re-organized to be a more accurate representation of clinical behavior in pediatric brain tumors.

Ostrom QT, et al. “National-level overall survival patterns for molecularly-defined diffuse glioma types in the United States.” Neuro Oncol. 2023 Apr 6;25(4):799-807. doi: 10.1093/neuonc/noac198. vival observed in common molecularly defined brain and other CNS histopathologies using newly defined ICD-O-3 histology codes and brain molecular marker (BMM) data, and it emphasizes the importance of collecting these data for cancer surveillance.

Ostrom Q, et al. “The Central Brain Tumor Registry of the United States Histopathological Grouping Scheme Provides Clinically Relevant Brain and other Central Nervous System Categories for Cancer Registry Data.” J Registry Manag. 2022 Winter;49(4):139-152.

This analysis confirms that patterns of brain and other CNS tumor incidence are largely consistent across independent cancer registry databases, including those from CBTRUS and CiNA, when using the CBTRUS histopathology grouping, which further supports the use of this grouping in CNS cancer surveillance and research.

Ostrom QT, et al. “Pilocytic astrocytomas: where do they belong in cancer reporting?” Neuro Oncol. 2020 Feb 20;22(2):298-300. doi: 10.1093/neuonc/noz202.

This letter describes the history of inclusion of pilocytic astrocytoma in cancer registry reporting, and the effect of varying behavior classification for these tumors on incidence and survival patterns.

Patil N, et al. “Epidemiology of Brainstem High-Grade Gliomas in Children and Adolescents in the United States, 2000-2017.” Neuro Oncol. 2020 Dec 21:noaa295. doi: 10.1093/neuonc/noaa295. PMID: 33346835.

This manuscript details the descriptive epidemiology, including incidence, survival and prevalence, for gliomas of the brainstem in children and adolescents.

Price M, et al. “CBTRUS Statistical Report: American Brain Tumor Association & NCI Neuro-Oncology Branch Adolescent and Young Adult Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2016-2020.” Neuro Oncol. 2024 May; 26 Supp (Supplement_3):iii1-iii53. doi: 10.1093/neuonc/noae047.

This special report, funded by the American Brain Tumor Association and NCI Neuro-Oncology Branch, presents incidence and survival statistics for AYA (ages 15-39).

Price M, et al. “Capturing evolving definitions of 12 select rare CNS tumors: a timely report from CBTRUS and NCI-CONNECT.” J Neurooncol. 165(2):279-290. DOI: 10.1007/s11060-023-04480-7. PMID: 37980692

This analysis, completed in collaboration with the National Cancer Institute’s NCI-CONNECT program, presents incidence, survival, and prevalence estimates for a selection of rare tumor histopathologies that are the focus of the NCI-CONNECT program.

Price M, et al. “Childhood, adolescent, and adult primary brain and central nervous system tumor statistics for practicing healthcare providers in neuro-oncology, CBTRUS 2015-2019.” Neurooncol Pract. 28;11(1):5-25. DOI: 10.1093/nop/npad061. PMID: 38222052 PMCID: PMC10785588 (available on 2024-09-28)

A special, condensed CBTRUS Statistical Report designed to be a streamlined and useful resource for practicing clinicians.

Wang G, et al. “Importance of the intersection of age and sex to understand variation in incidence and survival for primary malignant gliomas.” Neuro Oncol. 2022 Feb 1;24(2):302-310. doi: 10.1093/neuonc/noab199. PMID: 34387331; PMCID: PMC8804884.

This manuscript assesses the relationship between age and sex on primary malignant glioma incidence and survival.

Waite KA, et al. “Aligning the Central Brain Tumor Registry of the United States (CBTRUS) histology groupings with current definitions.” Neurooncol Pract. 2022 Mar 24;9(4):317-327. doi: 10.1093/nop/npac025. PMID: 35859542; PMCID: PMC9290890.

This manuscript traces the rationale for changes made to the CBTRUS histopathology grouping scheme in order to better align it with modern diagnostic criteria.

Walsh KM, et al. “The joint impacts of sex and race/ethnicity on incidence of grade 1 versus grades 2-3 meningioma across the lifespan.” Neurooncol Adv. 2023 Jun 3;5(Suppl 1):i5-i12. doi: 10.1093/noajnl/vdad020. PMID: 37287573; PMCID: PMC10243865.

This manuscript assesses the relationship between sex, age, and race/ethnicity on the incidence of grade 1 and grades 2-3 meningioma in the United States.

References

1. Kruchko C, Ostrom QT, Gittleman H, Barnholtz-Sloan JS.. The CBTRUS story: providing accurate population-based statistics on brain and other central nervous system tumors for everyone. Neuro Oncol. 2018; 20(3):295-298. [DOI] [PMC free article] [PubMed] [Google Scholar]
2. Louis DN OH, Wiestler OD, Cavanee WK, ed WHO Classification of Tumours of the Central Nervous System. Lyon, France: International Agency for Research on Cancer; 2016. [Google Scholar]
3. Waite KA, Cioffi G, Kruchko C, et al. Aligning the Central Brain Tumor Registry of the United States (CBTRUS) histology groupings with current definitions. Neurooncol. Pract. 2022; 9(4):317-327. [DOI] [PMC free article] [PubMed] [Google Scholar]
4. Centers for Disease Control and Prevention (CDC). National Program of Cancer Registries Cancer Surveillance System Rationale and Approach. 1999; http://www.cdc.gov/cancer/npcr/pdf/npcr_css.pdf. Accessed July 21, 2020. [Google Scholar]
5.Cancer Registries Amendment Act, 102nd Cong. § 515 (1992). https://www.govinfo.gov/content/pkg/STATUTE-106/pdf/STATUTE-106-Pg3372.pdf. Accessed July 21, 2020. [Google Scholar]
6.Benign Brain Tumor Cancer Registries Amendment Act, 107th Cong. § 260 (2002). http://www.gpo.gov/fdsys/pkg/PLAW-107publ260/pdf/PLAW-107publ260.pdf. Accessed July 21, 2020. [Google Scholar]
7. National Cancer Institute. Overview of the SEER Program. http://seer.cancer.gov/about/overview.html. Accessed July 21, 2020. [Google Scholar]
8. National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program SEER*Stat Database: NPCR and SEER Incidence—U.S. Cancer Statistics Public Use Research Database, 2023 submission (2001–2021). United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Released June 2024. Available at www.cdc.gov/united-states-cancer-statistics/public-use/.2024. [Google Scholar]
9. Ostrom QT, Bauchet L, Davis FG, et al. The epidemiology of glioma in adults: a “state of the science” review. Neuro-Oncology. 2014; 16(7):896-913. [DOI] [PMC free article] [PubMed] [Google Scholar]
10. Johnson KJ, Cullen J, Barnholtz-Sloan JS, et al. Childhood Brain Tumor Epidemiology: A Brain Tumor Epidemiology Consortium Review. Cancer Epidemiology Biomarkers & Prevention. 2014; 23(12):2716-2736. [DOI] [PMC free article] [PubMed] [Google Scholar]
11. Ostrom QT, Fahmideh MA, Cote DJ, et al. Risk factors for childhood and adult primary brain tumors. Neuro-Oncology. 2019; 21:1357-1375. [DOI] [PMC free article] [PubMed] [Google Scholar]
12. Wiemels J, Wrensch M, Claus EB.. Epidemiology and etiology of meningioma. J Neurooncol. 2010; 99(3):307-314. [DOI] [PMC free article] [PubMed] [Google Scholar]
13. Centers for Disease Control and Prevention National Center for Health Statistics. National Program of Cancer Registries and Surveillance, Epidemiology, and End Results SEER*Stat Database: U.S. Cancer Statistics Incidence Analytic Database – 2001-2020. United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Based on the November 2022 submission. 2023.
14. Surveillance Epidemiology and End Results (SEER) Program. SEER*Stat Database: Mortality - All COD, Aggregated With State, Total U.S. (1969-2022) <Katrina/Rita Population Adjustment>, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2024. Underlying mortality data provided by NCHS (www.cdc.gov/nchs). 2024. [Google Scholar]
15. Fritz A PC, Jack A, Shanmugaratnam K, Sobin L, Perkin DM, Whelan S ed International Classification of Diseases for Oncology, Third edition: World Health Organization; 2000. [Google Scholar]
16. McCarthy BJ, Surawicz T, Bruner JM, Kruchko C, Davis F.. Consensus Conference on Brain Tumor Definition for registration. November 10, 2000. Neuro Oncol. 2000;4(2):134-145. http://www.ncbi.nlm.nih.gov/pubmed/11916506. [DOI] [PMC free article] [PubMed] [Google Scholar]
17. Forjaz G, Barnholtz-Sloan JS, Kruchko C, et al. An updated histology recode for the analysis of primary malignant and nonmalignant brain and other central nervous system tumors in the Surveillance, Epidemiology, and End Results Program. Neurooncol Adv. 2021; 3(1):vdaa175. [DOI] [PMC free article] [PubMed] [Google Scholar]
18. Ostrom Q, Kruchko C, Neff C, Firth A, Sherman R.. The Central Brain Tumor Registry of the United States Histopathological Grouping Scheme Provides Clinically Relevant Brain and other Central Nervous System Categories for Cancer Registry Data. J. Registry. Manag. 2022; 49(4). [PMC free article] [PubMed] [Google Scholar]
19. Ostrom QT, Gittleman H, Kruchko C, et al. Completeness of required site-specific factors for brain and CNS tumors in the Surveillance, Epidemiology and End Results (SEER) 18 database (2004-2012, varying). J. Neurooncol. 2016; 130(1):31-42. [DOI] [PMC free article] [PubMed] [Google Scholar]
20. Iorgulescu JB, Sun C, Neff C, et al. Molecular biomarker-defined brain tumors: Epidemiology, validity, and completeness in the United States. Neuro Oncol. 2022; 24(11):1989-2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
21. Cancer AJCo. Collaborative Stage Data Collection System Version 02.052020. [Google Scholar]
22. Adamo M DL, Ruhl J.. SEER Program Coding and Staging Manual 2018. National Cancer Institute, Bethesda, MD 20892. U.S. Department of Health and Human Services National Institutes of Health National Cancer Institute; 2018. [Google Scholar]
23. Lym RL, Ostrom QT, Kruchko C, et al. Completeness and concordancy of WHO grade assignment for brain and central nervous system tumors in the United States, 2004-2011. J. Neurooncol. 2015; 123(1):43-51. [DOI] [PMC free article] [PubMed] [Google Scholar]
24. Ostrom QT, Gittleman H, Liao P, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. Neuro Oncol. 2014; 16Suppl 4(Suppl 4):iv1-63. [DOI] [PMC free article] [PubMed] [Google Scholar]
25. Group NI-O-UIW. GUIDELINES FOR 2024 ICD-O-3.2 HISTOLOGY CODE AND BEHAVIOR UPDATE, Effective January 1, 2024 2018. [Google Scholar]
26. Ostrom QT, Kruchko C, Barnholtz-Sloan JS.. Pilocytic astrocytomas: where do they belong in cancer reporting? Neuro Oncol. 2020; 22(2):298-300. [DOI] [PMC free article] [PubMed] [Google Scholar]
27. Ostrom QT, Price M, Ryan K, et al. CBTRUS Statistical Report: Pediatric Brain Tumor Foundation Childhood and Adolescent Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States 2014-2018. Neuro Oncol. 2022. [DOI] [PMC free article] [PubMed] [Google Scholar]
28. States CBTRotU. SEER*Stat Database: CBTRUS Analytic File 1995-2021 (Includes PR and County-level data) - Linked To County Attributes - Total U.S., 1969-2022 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. 2024. [Google Scholar]
29. Tiwari RC, Clegg LX, Zou Z.. Efficient interval estimation for age-adjusted cancer rates. Stat. Methods Med. Res. 2006;15(6):547-569. http://www.ncbi.nlm.nih.gov/pubmed/17260923. [DOI] [PubMed] [Google Scholar]
30. Tiwari RC CL, Zou Z.. Efficient interval estimation for age-adjusted cancer rates.. Stat Methods Med Res 2006; 15(6):547-569. [DOI] [PubMed] [Google Scholar]
31. Program SEaERS. SEER*Stat Database: Populations - Total U.S. (1990-2022) <Katrina/Rita Adjustment> - Linked To County Attributes - Total U.S., 1969-2022 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released February 2024. 2024. [Google Scholar]
32. Fay MP. Approximate confidence intervals for rate ratios from directly standardized rates with sparse data. Communications in Statistics - Theory and Methods. 1999; 28(9):2141-2160. [Google Scholar]
33. Joinpoint Regression Program, Version 5.2.0 - May 2024; Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute. 2024. [Google Scholar]
34. Kim HJ FM, Feuer EJ, Midthune DN.. Permutation tests for joinpoint regression with applications to cancer rates. Statistics in Medicine. 2000(19):335-351. [DOI] [PubMed] [Google Scholar]
35. Luo J. SEER2R: reading and writing SEER*STAT data files. R package version 1.0. 2012; http://CRAN.R-project.org/package=SEER2R. Accessed July 21, 2020. [Google Scholar]
36. Gohel D, Hangler F, Sander L, et al. officer: Manipulation of Microsoft Word and PowerPoint Documents. 2020; https://cloud.r-project.org/web/packages/officer/index.html. Accessed July 21, 2020. [Google Scholar]
37. Gohel D, Fazilleau Q, Nazarov M, Robert T, Barrowman M, Yasumoto A. flextable: Functions for Tabular Reporting. 2020; https://davidgohel.github.io/flextable/. Accessed July 21, 2020. [Google Scholar]
38. Wickham H, Averick M, Bryan J, et al. Welcome to the Tidyverse. Journal of Open Source Software 2019; 1686. Available at: 10.21105/joss.01686. Accessed 43, 4. [DOI] [Google Scholar]
39. Sievert C. Interactive Web-Based Data Visualization with R, plotly, and shiny. 2020; https://plotly-r.com. Accessed July 21, 2020. [Google Scholar]
40. Xie Y. knitr: A General-Purpose Package for Dynamic Report Generation in R. R package version 1.29.. 2020; https://yihui.org/knitr/. Accessed July 21, 2020. [Google Scholar]
41. Walker K, Rudis B. tigris: Load Census TIGER/Line Shapefiles. 2020; https://github.com/walkerke/tigris. Accessed May 27, 2022. [Google Scholar]
42. Kassambara A, Kosinski M, Biecek P, Fabian S. survminer: Drawing Survival Curves using “ggplot2.” 2020; https://rpkgs.datanovia.com/survminer/index.html. Accessed May 27, 2022. [Google Scholar]
43. Pebesma E. Simple Features for R: Standardized Support for Spatial Vector Data. The R Journal 2018; 439–446. Available at: <Go to ISI>://WOS:000440997400030. Accessed 1, 10. [Google Scholar]
44. Ostrom QT, Price M, Neff C, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2015-2019. Neuro Oncol. 2022; 24(Suppl 5):v1-v95. [DOI] [PMC free article] [PubMed] [Google Scholar]
45. Ostrom QT, Price M, Neff C, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2016—2020. Neuro-Oncology. 2023; 25(Supplement_4):iv1-iv99. [DOI] [PMC free article] [PubMed] [Google Scholar]
46. Ostrom QT, Rubin JB, Lathia JD, Berens ME, Barnholtz-Sloan JS.. Females have the survival advantage in glioblastoma. Neuro-oncology. 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
47. Ostrom QT, Cote DJ, Ascha M, Kruchko C, Barnholtz-Sloan JS.. Adult Glioma Incidence and Survival by Race or Ethnicity in the United States From 2000 to 2014. JAMA Oncol. 2018; 4(9):1254-1262. [DOI] [PMC free article] [PubMed] [Google Scholar]
48. Gittleman H, Ostrom QT, Stetson LC, et al. Sex is an important prognostic factor for glioblastoma but not for nonglioblastoma. Neuro-Oncology Practice. 2019. [DOI] [PMC free article] [PubMed] [Google Scholar]
49. Weir HK, Johnson CJ, Mariotto AB, et al. Evaluation of North American Association of Central Cancer Registries’ (NAACCR) data for use in population-based cancer survival studies. Journal of the National Cancer Institute: Monographs. 2014; 2014(49):198-209. [DOI] [PMC free article] [PubMed] [Google Scholar]
50. Wilson RJ, O’Neil ME, Ntekop E, Zhang K, Ren Y.. Coding completeness and quality of relative survival-related variables in the National Program of Cancer Registries Cancer Surveillance System, 1995-2008. J. Registry. Manag. 2014; 41(2):65-71; quiz 96-67. [PMC free article] [PubMed] [Google Scholar]
51. Louis D, Wiestler O, Cavanee W, eds. WHO Classification of Tumours of the Central Nervous System. Lyon, France: International Agency for Research on Cancer; 2007. [Google Scholar]
52. Kleihues P, Cavenee W, eds. Tumours of the nervous system: World Health Organization classification of tumours. Lyon, France: IARC Press; 2000. [Google Scholar]
53. Kleihues P, Burger PC, Scheithauer BW.. The new WHO classification of brain tumours. Brain Pathol. 1993; 3(3):255-268. [DOI] [PubMed] [Google Scholar]
54. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021; 23(8):1231-1251. [DOI] [PMC free article] [PubMed] [Google Scholar]
55. van den Bent MJ. Interobserver variation of the histopathological diagnosis in clinical trials on glioma: a clinician’s perspective. Acta Neuropathol. 2010; 120(3):297-304. [DOI] [PMC free article] [PubMed] [Google Scholar]
56. Aldape K, Simmons ML, Davis RL, et al. Discrepancies in diagnoses of neuroepithelial neoplasms: the San Francisco Bay Area Adult Glioma Study. Cancer. 2000; 88(10):2342-2349. [PubMed] [Google Scholar]
57. Standards for Cancer Registries Volume III: Standards for Completeness, Quality, Analysis, Management, Security and Confidentiality of Data. 2008; https://www.naaccr.org/wp-content/uploads/2016/11/Standards-for-Completeness-Quality-Analysis-Management-Security-and-Confidentiality-of-Data-August-2008PDF.pdf. Accessed July 21, 2020. [Google Scholar]
58. Bray F, Ferlay J.. Data Comparability and Quality. Cancer Incidence in Five Continents, Vol. XI 2017; https://ci5.iarc.fr/CI5-XI/Pages/Chapter5.aspx. Accessed July 21, 2020. [Google Scholar]
59. Zhu L, Pickle LW, Ghosh K, et al. Predicting US- and state-level cancer counts for the current calendar year: Part II: evaluation of spatiotemporal projection methods for incidence. Cancer. 2012; 118(4):1100-1109. [DOI] [PubMed] [Google Scholar]
60. Edwards BK, Noone AM, Mariotto AB, et al. Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2014; 120(9):1290-1314. [DOI] [PMC free article] [PubMed] [Google Scholar]
61. Zullig LL, Jackson GL, Dorn RA, et al. Cancer incidence among patients of the U.S. Veterans Affairs Health Care System. Mil. Med. 2012; 177(6):693-701. [DOI] [PMC free article] [PubMed] [Google Scholar]
62. Clegg LX, Feuer EJ, Midthune DN, Fay MP, Hankey BF.. Impact of reporting delay and reporting error on cancer incidence rates and trends. J. Natl. Cancer Inst. 2002;94(20):1537-1545. http://www.ncbi.nlm.nih.gov/pubmed/12381706. [DOI] [PubMed] [Google Scholar]
63. Midthune DN, Fay MP, Clegg LX, Feuer EJ.. Modeling Reporting Delays and Reporting Corrections in Cancer Registry Data. J. Am. Stat. Assoc. 2005; 100(469):61-70. [Google Scholar]
64. Anderson RN, Rosenberg HM.. Report of the Second Workshop on Age Adjustment Dec 1998. 0083-2073 (Print); 0083-2073. [PubMed] [Google Scholar]
65. Anderson RN, Rosenberg HM.. Age standardization of death rates: implementation of the year 2000 standard. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 1998; 47(3):1-16, 20. [PubMed] [Google Scholar]
66. Kruchko C, Gittleman H, Ruhl J, et al. Cancer collection efforts in the United States provide clinically relevant data on all primary brain and other CNS tumors. Neurooncol. Pract. 2019; 6(5):330-339. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

noae145_suppl_Supplementary_Materials

noae145_suppl_supplementary_materials.docx^{(756.3KB, docx)}

[CIT0001] 1. Kruchko C, Ostrom QT, Gittleman H, Barnholtz-Sloan JS.. The CBTRUS story: providing accurate population-based statistics on brain and other central nervous system tumors for everyone. Neuro Oncol. 2018; 20(3):295-298. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0002] 2. Louis DN OH, Wiestler OD, Cavanee WK, ed WHO Classification of Tumours of the Central Nervous System. Lyon, France: International Agency for Research on Cancer; 2016. [Google Scholar]

[CIT0003] 3. Waite KA, Cioffi G, Kruchko C, et al. Aligning the Central Brain Tumor Registry of the United States (CBTRUS) histology groupings with current definitions. Neurooncol. Pract. 2022; 9(4):317-327. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0004] 4. Centers for Disease Control and Prevention (CDC). National Program of Cancer Registries Cancer Surveillance System Rationale and Approach. 1999; http://www.cdc.gov/cancer/npcr/pdf/npcr_css.pdf. Accessed July 21, 2020. [Google Scholar]

[CIT0005] 5.Cancer Registries Amendment Act, 102nd Cong. § 515 (1992). https://www.govinfo.gov/content/pkg/STATUTE-106/pdf/STATUTE-106-Pg3372.pdf. Accessed July 21, 2020. [Google Scholar]

[CIT0006] 6.Benign Brain Tumor Cancer Registries Amendment Act, 107th Cong. § 260 (2002). http://www.gpo.gov/fdsys/pkg/PLAW-107publ260/pdf/PLAW-107publ260.pdf. Accessed July 21, 2020. [Google Scholar]

[CIT0007] 7. National Cancer Institute. Overview of the SEER Program. http://seer.cancer.gov/about/overview.html. Accessed July 21, 2020. [Google Scholar]

[CIT0008] 8. National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program SEER*Stat Database: NPCR and SEER Incidence—U.S. Cancer Statistics Public Use Research Database, 2023 submission (2001–2021). United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Released June 2024. Available at www.cdc.gov/united-states-cancer-statistics/public-use/.2024. [Google Scholar]

[CIT0009] 9. Ostrom QT, Bauchet L, Davis FG, et al. The epidemiology of glioma in adults: a “state of the science” review. Neuro-Oncology. 2014; 16(7):896-913. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0010] 10. Johnson KJ, Cullen J, Barnholtz-Sloan JS, et al. Childhood Brain Tumor Epidemiology: A Brain Tumor Epidemiology Consortium Review. Cancer Epidemiology Biomarkers & Prevention. 2014; 23(12):2716-2736. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0011] 11. Ostrom QT, Fahmideh MA, Cote DJ, et al. Risk factors for childhood and adult primary brain tumors. Neuro-Oncology. 2019; 21:1357-1375. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0012] 12. Wiemels J, Wrensch M, Claus EB.. Epidemiology and etiology of meningioma. J Neurooncol. 2010; 99(3):307-314. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0013] 13. Centers for Disease Control and Prevention National Center for Health Statistics. National Program of Cancer Registries and Surveillance, Epidemiology, and End Results SEER*Stat Database: U.S. Cancer Statistics Incidence Analytic Database – 2001-2020. United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Based on the November 2022 submission. 2023.

[CIT0014] 14. Surveillance Epidemiology and End Results (SEER) Program. SEER*Stat Database: Mortality - All COD, Aggregated With State, Total U.S. (1969-2022) <Katrina/Rita Population Adjustment>, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2024. Underlying mortality data provided by NCHS (www.cdc.gov/nchs). 2024. [Google Scholar]

[CIT0015] 15. Fritz A PC, Jack A, Shanmugaratnam K, Sobin L, Perkin DM, Whelan S ed International Classification of Diseases for Oncology, Third edition: World Health Organization; 2000. [Google Scholar]

[CIT0016] 16. McCarthy BJ, Surawicz T, Bruner JM, Kruchko C, Davis F.. Consensus Conference on Brain Tumor Definition for registration. November 10, 2000. Neuro Oncol. 2000;4(2):134-145. http://www.ncbi.nlm.nih.gov/pubmed/11916506. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0017] 17. Forjaz G, Barnholtz-Sloan JS, Kruchko C, et al. An updated histology recode for the analysis of primary malignant and nonmalignant brain and other central nervous system tumors in the Surveillance, Epidemiology, and End Results Program. Neurooncol Adv. 2021; 3(1):vdaa175. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0018] 18. Ostrom Q, Kruchko C, Neff C, Firth A, Sherman R.. The Central Brain Tumor Registry of the United States Histopathological Grouping Scheme Provides Clinically Relevant Brain and other Central Nervous System Categories for Cancer Registry Data. J. Registry. Manag. 2022; 49(4). [PMC free article] [PubMed] [Google Scholar]

[CIT0019] 19. Ostrom QT, Gittleman H, Kruchko C, et al. Completeness of required site-specific factors for brain and CNS tumors in the Surveillance, Epidemiology and End Results (SEER) 18 database (2004-2012, varying). J. Neurooncol. 2016; 130(1):31-42. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0020] 20. Iorgulescu JB, Sun C, Neff C, et al. Molecular biomarker-defined brain tumors: Epidemiology, validity, and completeness in the United States. Neuro Oncol. 2022; 24(11):1989-2000. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0021] 21. Cancer AJCo. Collaborative Stage Data Collection System Version 02.052020. [Google Scholar]

[CIT0022] 22. Adamo M DL, Ruhl J.. SEER Program Coding and Staging Manual 2018. National Cancer Institute, Bethesda, MD 20892. U.S. Department of Health and Human Services National Institutes of Health National Cancer Institute; 2018. [Google Scholar]

[CIT0023] 23. Lym RL, Ostrom QT, Kruchko C, et al. Completeness and concordancy of WHO grade assignment for brain and central nervous system tumors in the United States, 2004-2011. J. Neurooncol. 2015; 123(1):43-51. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0024] 24. Ostrom QT, Gittleman H, Liao P, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. Neuro Oncol. 2014; 16Suppl 4(Suppl 4):iv1-63. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0025] 25. Group NI-O-UIW. GUIDELINES FOR 2024 ICD-O-3.2 HISTOLOGY CODE AND BEHAVIOR UPDATE, Effective January 1, 2024 2018. [Google Scholar]

[CIT0026] 26. Ostrom QT, Kruchko C, Barnholtz-Sloan JS.. Pilocytic astrocytomas: where do they belong in cancer reporting? Neuro Oncol. 2020; 22(2):298-300. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0027] 27. Ostrom QT, Price M, Ryan K, et al. CBTRUS Statistical Report: Pediatric Brain Tumor Foundation Childhood and Adolescent Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States 2014-2018. Neuro Oncol. 2022. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0028] 28. States CBTRotU. SEER*Stat Database: CBTRUS Analytic File 1995-2021 (Includes PR and County-level data) - Linked To County Attributes - Total U.S., 1969-2022 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. 2024. [Google Scholar]

[CIT0029] 29. Tiwari RC, Clegg LX, Zou Z.. Efficient interval estimation for age-adjusted cancer rates. Stat. Methods Med. Res. 2006;15(6):547-569. http://www.ncbi.nlm.nih.gov/pubmed/17260923. [DOI] [PubMed] [Google Scholar]

[CIT0030] 30. Tiwari RC CL, Zou Z.. Efficient interval estimation for age-adjusted cancer rates.. Stat Methods Med Res 2006; 15(6):547-569. [DOI] [PubMed] [Google Scholar]

[CIT0031] 31. Program SEaERS. SEER*Stat Database: Populations - Total U.S. (1990-2022) <Katrina/Rita Adjustment> - Linked To County Attributes - Total U.S., 1969-2022 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released February 2024. 2024. [Google Scholar]

[CIT0032] 32. Fay MP. Approximate confidence intervals for rate ratios from directly standardized rates with sparse data. Communications in Statistics - Theory and Methods. 1999; 28(9):2141-2160. [Google Scholar]

[CIT0033] 33. Joinpoint Regression Program, Version 5.2.0 - May 2024; Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute. 2024. [Google Scholar]

[CIT0034] 34. Kim HJ FM, Feuer EJ, Midthune DN.. Permutation tests for joinpoint regression with applications to cancer rates. Statistics in Medicine. 2000(19):335-351. [DOI] [PubMed] [Google Scholar]

[CIT0035] 35. Luo J. SEER2R: reading and writing SEER*STAT data files. R package version 1.0. 2012; http://CRAN.R-project.org/package=SEER2R. Accessed July 21, 2020. [Google Scholar]

[CIT0036] 36. Gohel D, Hangler F, Sander L, et al. officer: Manipulation of Microsoft Word and PowerPoint Documents. 2020; https://cloud.r-project.org/web/packages/officer/index.html. Accessed July 21, 2020. [Google Scholar]

[CIT0037] 37. Gohel D, Fazilleau Q, Nazarov M, Robert T, Barrowman M, Yasumoto A. flextable: Functions for Tabular Reporting. 2020; https://davidgohel.github.io/flextable/. Accessed July 21, 2020. [Google Scholar]

[CIT0038] 38. Wickham H, Averick M, Bryan J, et al. Welcome to the Tidyverse. Journal of Open Source Software 2019; 1686. Available at: 10.21105/joss.01686. Accessed 43, 4. [DOI] [Google Scholar]

[CIT0039] 39. Sievert C. Interactive Web-Based Data Visualization with R, plotly, and shiny. 2020; https://plotly-r.com. Accessed July 21, 2020. [Google Scholar]

[CIT0040] 40. Xie Y. knitr: A General-Purpose Package for Dynamic Report Generation in R. R package version 1.29.. 2020; https://yihui.org/knitr/. Accessed July 21, 2020. [Google Scholar]

[CIT0041] 41. Walker K, Rudis B. tigris: Load Census TIGER/Line Shapefiles. 2020; https://github.com/walkerke/tigris. Accessed May 27, 2022. [Google Scholar]

[CIT0042] 42. Kassambara A, Kosinski M, Biecek P, Fabian S. survminer: Drawing Survival Curves using “ggplot2.” 2020; https://rpkgs.datanovia.com/survminer/index.html. Accessed May 27, 2022. [Google Scholar]

[CIT0043] 43. Pebesma E. Simple Features for R: Standardized Support for Spatial Vector Data. The R Journal 2018; 439–446. Available at: <Go to ISI>://WOS:000440997400030. Accessed 1, 10. [Google Scholar]

[CIT0044] 44. Ostrom QT, Price M, Neff C, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2015-2019. Neuro Oncol. 2022; 24(Suppl 5):v1-v95. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0045] 45. Ostrom QT, Price M, Neff C, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2016—2020. Neuro-Oncology. 2023; 25(Supplement_4):iv1-iv99. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0046] 46. Ostrom QT, Rubin JB, Lathia JD, Berens ME, Barnholtz-Sloan JS.. Females have the survival advantage in glioblastoma. Neuro-oncology. 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0047] 47. Ostrom QT, Cote DJ, Ascha M, Kruchko C, Barnholtz-Sloan JS.. Adult Glioma Incidence and Survival by Race or Ethnicity in the United States From 2000 to 2014. JAMA Oncol. 2018; 4(9):1254-1262. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0048] 48. Gittleman H, Ostrom QT, Stetson LC, et al. Sex is an important prognostic factor for glioblastoma but not for nonglioblastoma. Neuro-Oncology Practice. 2019. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0049] 49. Weir HK, Johnson CJ, Mariotto AB, et al. Evaluation of North American Association of Central Cancer Registries’ (NAACCR) data for use in population-based cancer survival studies. Journal of the National Cancer Institute: Monographs. 2014; 2014(49):198-209. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0050] 50. Wilson RJ, O’Neil ME, Ntekop E, Zhang K, Ren Y.. Coding completeness and quality of relative survival-related variables in the National Program of Cancer Registries Cancer Surveillance System, 1995-2008. J. Registry. Manag. 2014; 41(2):65-71; quiz 96-67. [PMC free article] [PubMed] [Google Scholar]

[CIT0051] 51. Louis D, Wiestler O, Cavanee W, eds. WHO Classification of Tumours of the Central Nervous System. Lyon, France: International Agency for Research on Cancer; 2007. [Google Scholar]

[CIT0052] 52. Kleihues P, Cavenee W, eds. Tumours of the nervous system: World Health Organization classification of tumours. Lyon, France: IARC Press; 2000. [Google Scholar]

[CIT0053] 53. Kleihues P, Burger PC, Scheithauer BW.. The new WHO classification of brain tumours. Brain Pathol. 1993; 3(3):255-268. [DOI] [PubMed] [Google Scholar]

[CIT0054] 54. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021; 23(8):1231-1251. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0055] 55. van den Bent MJ. Interobserver variation of the histopathological diagnosis in clinical trials on glioma: a clinician’s perspective. Acta Neuropathol. 2010; 120(3):297-304. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0056] 56. Aldape K, Simmons ML, Davis RL, et al. Discrepancies in diagnoses of neuroepithelial neoplasms: the San Francisco Bay Area Adult Glioma Study. Cancer. 2000; 88(10):2342-2349. [PubMed] [Google Scholar]

[CIT0057] 57. Standards for Cancer Registries Volume III: Standards for Completeness, Quality, Analysis, Management, Security and Confidentiality of Data. 2008; https://www.naaccr.org/wp-content/uploads/2016/11/Standards-for-Completeness-Quality-Analysis-Management-Security-and-Confidentiality-of-Data-August-2008PDF.pdf. Accessed July 21, 2020. [Google Scholar]

[CIT0058] 58. Bray F, Ferlay J.. Data Comparability and Quality. Cancer Incidence in Five Continents, Vol. XI 2017; https://ci5.iarc.fr/CI5-XI/Pages/Chapter5.aspx. Accessed July 21, 2020. [Google Scholar]

[CIT0059] 59. Zhu L, Pickle LW, Ghosh K, et al. Predicting US- and state-level cancer counts for the current calendar year: Part II: evaluation of spatiotemporal projection methods for incidence. Cancer. 2012; 118(4):1100-1109. [DOI] [PubMed] [Google Scholar]

[CIT0060] 60. Edwards BK, Noone AM, Mariotto AB, et al. Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2014; 120(9):1290-1314. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0061] 61. Zullig LL, Jackson GL, Dorn RA, et al. Cancer incidence among patients of the U.S. Veterans Affairs Health Care System. Mil. Med. 2012; 177(6):693-701. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CIT0062] 62. Clegg LX, Feuer EJ, Midthune DN, Fay MP, Hankey BF.. Impact of reporting delay and reporting error on cancer incidence rates and trends. J. Natl. Cancer Inst. 2002;94(20):1537-1545. http://www.ncbi.nlm.nih.gov/pubmed/12381706. [DOI] [PubMed] [Google Scholar]

[CIT0063] 63. Midthune DN, Fay MP, Clegg LX, Feuer EJ.. Modeling Reporting Delays and Reporting Corrections in Cancer Registry Data. J. Am. Stat. Assoc. 2005; 100(469):61-70. [Google Scholar]

[CIT0064] 64. Anderson RN, Rosenberg HM.. Report of the Second Workshop on Age Adjustment Dec 1998. 0083-2073 (Print); 0083-2073. [PubMed] [Google Scholar]

[CIT0065] 65. Anderson RN, Rosenberg HM.. Age standardization of death rates: implementation of the year 2000 standard. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 1998; 47(3):1-16, 20. [PubMed] [Google Scholar]

[CIT0066] 66. Kruchko C, Gittleman H, Ruhl J, et al. Cancer collection efforts in the United States provide clinically relevant data on all primary brain and other CNS tumors. Neurooncol. Pract. 2019; 6(5):330-339. [DOI] [PMC free article] [PubMed] [Google Scholar]

PERMALINK

CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017–2021

Mackenzie Price, M.P.H

Christine Ballard, M.P.H

Julia Benedetti, M.B.S

Corey Neff, M.P.H

Gino Cioffi, M.P.H

Kristin A Waite, Ph.D

Carol Kruchko, B.A

Jill S Barnholtz-Sloan, Ph.D

Quinn T Ostrom, , Ph.D., M.P.H

Abstract

EXECUTIVE SUMMARY

Incidence: Newly Diagnosed Primary Brain and Other CNS Tumors, 2017-2021

Time Trends in Primary Brain and Other CNS Tumors Incidence, 2004-2021, excluding 2020

Mortality: Deaths Due to Primary Brain and Other CNS Tumors, 2017-2021

Survival: From Diagnosis to One-, Five-, and Ten-Years Beyond, 2001-2020 (varying)

INTRODUCTION

BACKGROUND

Risk Factors for Primary Brain and Other CNS Tumors

Data Collection and classification

Figure 1.

Table 1.

Figure 2.

Anatomic Location of Tumor Sites

Classification by Histopathology and Behavior

Table 2.

Classification by Brain Molecular Markers (BMM)

Classification by WHO Grade

Brain Tumor Definition Differences

STATISTICAL METHODS

Estimation of Incidence Rates and Time Trends

Estimation of Mortality Rates, Relative Survival Rates, Overall Survival, and Adjusted Hazard Ratios

Variable Definitions

Statistical Software

Impact of the COVID-19 Pandemic on 2020 Cancer Data

Cancer Incidence Rates Relative to 2019 and 2021 Rates

Figure 3.

Exclusion of 2020 Incidence Data from Trends

RESULTS

Supplemental Data

Incidence and Mortality in Comparison to Other Common Neoplasms in the United States, 2017-2021

Figure 4.

Incidence and Completeness for Molecularly-Defined Brain and Other CNS Tumor Histopathologies

Completeness of Brain Molecular Markers Variable Data Collection, 2018-2021

Table 3.

Figure 5.

Frequency and Incidence of Molecularly-Defined Brain and Other CNS Tumor Histopathologies, 2018-2021

Table 4.

Figure 6.

Figure 7.

Figure 9.

Time Trends in Primary Brain and Other CNS Tumors, 2004-2021, excluding 2020

Figure 8.

Distributions and Incidence by Site, Behavior, and Histopathology

Table 5.

Table 6.

Distribution and Incidence Rates of Tumors by Site

Figure 10.

Distribution and Incidence Rates by Major Histopathology Grouping, Specific Histopathology, and Behavior

Table 7.

Distribution of Tumors by Site, Histopathology, and Behavior

Figure 11.

Figure 12.

Distribution of Gliomas by Site and Histopathology

Figure 13.

Table 8.

Distribution of Spinal Cord Tumors by Age

Figure 14.

Distributions and Incidence by Age at Diagnosis

Incidence Rates by Age at Diagnosis

Figure 15.

Median Age at Diagnosis

Figure 16.

Distribution and Incidence Rates of Tumors by Site, Histopathology, and Age at Diagnosis

Distribution and Incidence Rates of Tumors by Site, Histopathology, and Age at Diagnosis in Children and Adolescents (Ages 0-19 Years)

Table 9.

Figure 17.

Incidence rates for children and adolescents are shown in Table 9. Figure 17B shows the most common brain and other CNS histopathologies in children and adolescents ages 0-19 years.

Distribution of Tumors by Site and Histopathology in Children (Ages 0-14 Years)