CBTRUS Statistical Report: Primary brain and other central nervous system tumors diagnosed in the United States in 2010–2014

Introduction

The objective of the CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2010–2014 is to provide a comprehensive summary of the current descriptive epidemiology of primary brain and other central nervous system (CNS) tumors in the United States (US) population. CBTRUS obtained the latest available population-based data on all newly diagnosed primary brain and other CNS tumors from the Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries (NPCR), and the National Cancer Institute (NCI), Surveillance, Epidemiology, and End Results (SEER) program for diagnosis years 2010–2014. Incidence counts and rates of primary malignant and non-malignant brain and other CNS tumors are documented by histology, sex, age, race, and Hispanic ethnicity. Mortality rates calculated using the National Vital Statistics System (NVSS) data from 2010–2014, and relative survival rates for selected malignant and non-malignant histologies calculated using SEER data for the period 2000–2014 are also presented.

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 US (for more information on CBTRUS see: http://www.cbtrus.org/aboutus.html). CBTRUS was incorporated as a nonprofit 501(c)(3) in 1992 following a study conducted by the American Brain Tumor Association (ABTA) to determine the feasibility of a central registry focused on primary brain and other CNS tumors in the US.

This report represents the twenty-fifth (25 ^th ) anniversary of CBTRUS and the twentieth (20 ^th ) statistical report published by CBTRUS. For this sixth (6^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 primary brain and other CNS tumors by histology, age, sex, race, and Hispanic ethnicity. These data have been organized by clinically relevant histology groupings and reflect the 2007 WHO Classification of Tumours of the Central Nervous System.^1,2CBTRUS recognizes that diagnostic criteria for many histologies has changed significantly with the 2016 WHO Classification of Tumours of the Central Nervous System, and has taken steps to work with its neuropathology team (Drs. Janet Bruner, Roger McLendon, Tarik Tihan, and Daniel Brat) to align its histology grouping scheme with the 2016 edition of the WHO criteria. The implementation schedule of cancer registration in the US affects the timeline for CBTRUS to adopt a revised histology grouping. As a surveillance partner, CBTRUS continues to collaborate with surveillance standard setters to work for a timely resolution. These data provide important information for allocation and planning of specialty healthcare services such as clinical trials, disease prevention and control programs, and research activities. These data may also lead to clues that will stimulate research into the etiology of this group of diseases which cause significant morbidity and mortality.

CBTRUS is currently the only population-based site- specific registry in the US that works in partnership with a public cancer surveillance organization, the CDC’s NPCR, and from which data are directly received under a special agreement. This agreement permits transfer of data through the National Program of Central Registries Cancer Surveillance System (NPCR-CSS) Submission Specifications mechanism³, the system utilized for collection of central (state) cancer data as mandated in 1992 by Public Law 102–515, the Cancer Registries Amendment Act.⁴ This mandate was expanded, with the 2002 passage of Public Law 107–260, to include non-malignant CNS tumors diagnosed starting January 1, 2004.⁵ CBTRUS researchers combine the NPCR data with data from the SEER program⁶ of the NCI, 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 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 further insure that these data are reported as accurately and completely as possible. As a surveillance partner, CBTRUS can, therefore, report high quality data on brain and other CNS tumors with histological specificity useful to the communities it serves. Its database is comprised of the largest histology-specific aggregation of population-based data limited to the incidence of primary brain and other CNS tumors in the US, and it is likely the largest histology-specific aggregation of primary brain and other CNS tumor cases in the world. There are several other brain-specific registry systems in existence, including the Austrian Brain Tumor Registry⁷, the Swedish Brain Tumor Registry,⁸ as well as other population-based epidemiological studies of brain and other central nervous system tumors which cover a smaller population base. Due to the demographics of the US as compared to European countries, CBTRUS includes increased numbers of cases of primary brain and other CNS tumors in non-White persons. Aggregate information on all cancers from all CCR in the US, including primary brain and other CNS tumors, is available from the United States Cancer Statistics.⁹

Technical Notes

Data Collection

CBTRUS does not collect data directly from patients’ medical records. Registration of individual cases is conducted by cancer registrars at the institution where diagnosis occurs and is then transmitted to the CCR, which further transmits this information to NPCR or SEER. 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. Hence, tumor registrars in treatment centers collect these data and send this information to CCR in their states where they are collated, de-identified, and sent to NPCR and SEER. Brain and other CNS tumors are reported using the site definition described in Public Law 107–260.⁵ On an annual basis, NPCR secures permission from CCR to release its data on brain and other CNS tumors to CBTRUS. CCR play an essential role in the collection process. These data are population-based and, therefore, by definition, represent a comprehensive documentation of all cancers diagnosed within a geographic region over a period of time.

CBTRUS obtained incidence data from 52 CCR (47 NPCR and 5 SEER) that include cases of malignant and non-malignant (benign and uncertain) primary brain and other CNS tumors. The population-based CCR include 50 state registries, the District of Columbia, and Puerto Rico. Data were requested for all newly-diagnosed primary malignant and non-malignant tumors from 2010 to 2014 at any of the following anatomic sites: brain, meninges, spinal cord, cranial nerves, and other parts of the central nervous system, pituitary and pineal glands, and olfactory tumors of the nasal cavity (Table 1).¹⁰

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
Frontal lobe of brain	C71.1
Temporal lobe of brain	C71.2
Parietal lobe of brain	C71.3
Occipital lobe of brain	C71.4
Cerebrum	C71.0
Ventricle	C71.5
Cerebellum	C71.6
Brain stem	C71.7
Other brain	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	C72.8-C72.9
Overlapping lesion of brain and central nervous system	C72.8
Nervous system, NOS	C72.9
Meninges (cerebral & spinal)	C70.0-C70.9
Cerebral meninges	C70.0
Spinal meninges	C70.1
Meninges, NOS	C70.9
Pituitary and craniopharyngeal duct	C75.1-C75.2
Pituitary gland	C75.1
Craniopharyngeal duct	C75.2
Pineal gland	C75.3
Olfactory tumors of the nasal cavityb	C30.0

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

^bICD-O-3 histology codes 9522-9523 only.

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NOS, not otherwise specified.

NPCR provided data on 373,388 primary brain and other CNS tumors diagnosed from 2010 to 2014. An additional 15,983 primary brain and other CNS tumor case records for the time period were obtained from SEER. These data were combined into a single dataset for analyses. A total of 9,523 records (2.4%) were deleted from the final analytic dataset for one or more of the following reasons: invalid site/histology combination, duplicate records that included a less accurate reporting source than microscopic confirmation (e.g. radiographic versus microscopic confirmation. Microscopic confirmation may also be referred to as histologic confirmation), duplicate records for bilateral vestibular schwannoma or meningioma, duplicate records for recurrent disease, and errors in time sequence of diagnosis. The final analytic dataset included 379,848 records from all 51 population-based CCR, and an additional 2,297 cases from Puerto Rico. Cases from Puerto Rico were included only in a supplementary analysis (see Supplementary materials online), and these cases are not included in the overall statistics presented by this report.

Age-adjusted incidence rates per 100,000 population for the entire US for selected other cancers were obtained from the United States Cancer Statistics (USCS),⁹ produced by the CDC and the NCI, via CDC Wide-ranging Online Data for Epidemiologic Research (WONDER), for the purpose of comparison with brain and other CNS tumor incidence rates.⁹ This database includes both NPCR and SEER data and represents approximately 100% of the US population.

Survival data for malignant brain and other CNS tumors were obtained from 18 SEER registries for the years 2000 to 2014, and survival data for non-malignant brain and other CNS tumors were obtained from 18 SEER registries for the years 2004 to 2014. This dataset provides population-based information for approximately 26% of the US population,¹¹ and is a subset of the data used for the incidence calculations presented in this report. Survival information derived from active patient follow-up is not available in the data that CBTRUS receives from NPCR registries, so the SEER data are used for the generation of these tables.

Mortality data used in this report are from the National Center for Health Statistics and include deaths where primary brain or other CNS tumor was listed as cause of death on the death certificate for individuals from all 50 states and the District of Columbia. These data were obtained from the National Vital Statistics System¹² (NVSS, which includes death certification data for 100% of the US population) for malignant brain and other CNS tumors and comparison via SEER*Stat (for malignant brain tumors and comparison cancers). NVSS data are not collected through the cancer registration system, and these data are not included under cancer registration mandates. 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 classified as non-cancer deaths.

Definitions

Measures in Surveillance Epidemiology

This report presents the following population-based measures: incidence rates, mortality rates, and relative survival rates (for more information on definitions of terms and measures used see: http://www.cbtrus.org/glossary/glossary1.html).

Comparing incidence rates between statistical reports from different reporting agencies or previous CBTRUS statistical reports is not recommended due to differences in case definition, data collection, rate calculations, and/or reporting delays. Cancer registry data are updated each year with late ascertainment cases, so this statistical report represents the most complete and accurate data and includes updates in cases even for years that have been included in prior reports.

Classification by Behavior, Histology, and WHO Grade

There are over 100 histologically distinct types of primary central nervous system (CNS) tumors, each with its own spectrum of clinical presentations, treatments, and outcomes. This report uses the most recent 2012 CBTRUS histology grouping scheme (Table 2a). The classification scheme utilizes ICD-O-3 codes¹⁰ and may include morp hology codes that were not previously reported to CBTRUS¹³. Tables 2b and 2c list malignant only and non-malignant only histologies by ICD-O-3 codes, respectively. In this report, incidence rates are provided by major histology grouping and specific histology.

Table 2.

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

Histology	ICD-O-3 a Histology Codes b	ICD-O-3 a Histology and Behavior Code b
		Malignant	Non-Malignant
Pilocytic astrocytoma*	9421, 9425c	9421/1c, 9425/3d
Diffuse astrocytoma*	9400, 9410, 9411, 9420	9400/3, 9410/3, 9411/3, 9420/3	None
Anaplastic astrocytoma*	9401	9401/3	None
Unique astrocytoma variants*	9381, 9384, 9424	9381/3, 9424/3	9384/1
Glioblastoma*	9440, 9441, 9442/3e	9440/3, 9441/3, 9442/3	None
Oligodendroglioma*	9450	9450/3	None
Anaplastic oligodendroglioma*	9451, 9460	9451/3, 9460/3	None
Oligoastrocytic tumors*	9382	9382/3	None
Ependymal tumors*	9383, 9391, 9392, 9393, 9394	9391/3, 9392/3, 9393/3	9383/1, 9394/1
Glioma malignant, NOS*	9380 9431e, 9432e	9380/3, 9431/1, 9432/1	None
Choroid plexus tumors	9390	9390/3	9390/0,1
Other neuroepithelial tumors*	9363, 9423, 9430, 9444	9423/3, 9430/3	9363/0, 9444/1
Neuronal and mixed neuronal- glial tumors*	8680, 8681, 8690, 8693, 9412, 9413, 9442/1f, 9492 (excluding site C75.1), 9493, 9505, 9506, 9522, 9523	8680/3, 8693/3, 9505/3, 9522/3, 9523/3	8680/0,1, 8681/1, 8690/1, 8693/1, 9412/1, 9413/0, 9442/1, 9492/0 (excluding site C75.1), 9493/0, 9505/1, 9506/1, 9509/1,
Tumors of the pineal region	9360, 9361, 9362, 9395d	9362/3, 9395/3d	9360/1, 9361/1
Embryonal tumors	8963, 9364, 9470-9474, 9480, 9490, 9500-9502, 9508	8963/3, 9364/3, 9470/3, 9471/3, 9472/3, 9473/3, 9474/3, 9480/3, 9490/3, 9500/3, 9501/3, 9502/3, 9508/3	9490/0
Tumors of Cranial and Spinal 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 spinal nerves	9562	None	9562/0
Tumors of Meninges
Meningioma	9530-9534, 9537-9539	9530/3, 9538/3, 9539/3	9530/0,1, 9531/0, 9532/0, 9533/0, 9534/0, 9537/0, 9538/1, 9539/1
Mesenchymal tumors	8324, 8800-8806, 8810, 8815, 8824, 8830, 8831, 8835, 8836, 8850-8854, 8857, 8861, 8870, 8880, 8890, 8897, 8900-8902, 8910, 8912, 8920, 8921, 8935, 8990, 9040, 9136, 9150, 9170, 9180, 9210, 9241, 9260, 9373	8800/3, 8801/3, 8802/3, 8803/3, 8804/3, 8805/3, 8806/3, 8810/3, 8815/3, 8830/3, 8850/3, 8851/3, 8852/3, 8853/3, 8854/3, 8857/3, 8890/3, 8900/3, 8901/3, 8902/3, 8910/3, 8912/3, 8920/3, 8921/3, 8990/3, 9040/3, 9150/3, 9170/3, 9180/3, 9260/3	8324/0, 8800/0, 8810/0, 8815/0, 8824/0,1, 8830/0,1, 8831/0, 8835/1, 8836/1, 8850/0,1, 8851/0, 8852/0, 8854/0, 8857/0, 8861/0, 8870/0, 8880/0, 8890/0,1, 8897/1, 8900/0, 8920/1, 8935/0,1, 8990/0,1, 9040/0, 9136/1, 9150/0,1, 9170/0, 9180/0, 9210/0, 9241/0, 9373/0
Primary melanocytic lesions	8720, 8728, 8770, 8771	8720/3, 8728/3, 8770/3, 8771/3	8728/0,1, 8770/0, 8771/0
Other neoplasms related to the meninges	9161, 9220, 9231, 9240, 9243, 9370-9372, 9535	9220/3, 9231/3, 9240/3, 9243/3, 9370/3, 9371/3, 9372/3	9161/1, 9220/0,1, 9535/0
Lymphomas and Hemopoietic Neoplasms
Lymphoma	9590, 9591, 9596, 9650-9655, 9659, 9661-9665, 9667, 9670, 9671, 9673, 9675, 9680, 9684, 9687, 9690, 9691, 9695, 9698, 9699, 9701, 9702, 9705, 9714, 9719, 9728, 9729	9590/3, 9591/3, 9596/3, 9650/3, 9651/3, 9652/3, 9653/3, 9654/3, 9655/3, 9659/3, 9661/3, 9662/3, 9663/3, 9664/3, 9665/3, 9667/3, 9670/3, 9671/3, 9673/3, 9675/3, 9680/3, 9684/3, 9687/3, 9690/3, 9691/3, 9695/3, 9698/3, 9699/3, 9701/3, 9702/3, 9705/3, 9714/3, 9719/3, 9728/3, 9729/3	None
Other hemopoietic neoplasms	9727, 9731, 9733, 9734, 9740, 9741, 9750-9758, 9760, 9766, 9823, 9826, 9827, 9832, 9837, 9860, 9861, 9866, 9930, 9970	9727/3, 9731/3, 9733/3, 9734/3, 9740/3, 9741/3, 9750/3, 9754/3, 9755/3, 9756/3, 9757/3, 9758/3, 9760/3, 9823/3, 9826/3, 9827/3, 9832/3, 9837/3, 9860/3, 9861/3, 9866/3, 9930/3	9740/1, 9751/1, 9752/1, 9753/1, 9970/1
Germ Cell Tumors and Cysts
Germ cell tumors, cysts and heterotopias	8020, 8440, 9060, 9061, 9064, 9065, 9070-9072, 9080-9085, 9100, 9101	8020/3, 8440/3, 9060/3, 9061/3, 9064/3, 9065/3, 9070/3, 9071/3, 9072/3, 9080/3, 9081/3, 9082/3, 9083/3, 9084/3, 9085/3, 9100/3, 9101/3	8440/0, 9080/0,1, 9084/0
Tumors of Sellar Region
Tumors of the pituitary	8040, 8140, 8146, 8246, 8260, 8270-8272, 8280, 8281, 8290, 8300, 8310, 8323, 9492 (Site C75.1 only), 9582	8140/3, 8246/3, 8260/3, 8270/3, 8272/3, 8280/3, 8281/3, 8290/3, 8300/3, 8310/3, 8323/3	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, 9492/0 (site C75.1 only), 9582/0
Craniopharyngioma	9350, 9351, 9352	None	9350/1, 9351/1, 9352/1
Unclassified Tumors
Hemangioma	9120-9123, 9125, 9130, 9131, 9133, 9140	9120/3, 9130/3, 9133/3, 9140/3	9120/0, 9121/0, 9122/0, 9123/0, 9125/0, 9130/0,1, 9131/0, 9133/1
Neoplasm, unspecified	8000-8005, 8010, 8021	8000/3, 8001/3, 8002/3, 8003/3, 8004/3, 8005/3, 8010/3, 8021/3	8000/0,1, 8001/0,1, 8005/0, 8010/0
All other	8320, 8452, 8710, 8711, 8713, 8811, 8840, 8896, 8980, 9173, 9503, 9580	8320/3, 8710/3, 8711/3, 8811/3, 8840/3, 8896/3, 8980/3, 9503/3, 9580/3	8452/1, 8711/0, 8713/0, 8811/0, 8840/0, 9173/0, 9580/0

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

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

^cWHO Classification listed as having uncertain behavior (ICD-O-3, behavior code /1) but included in population-based cancer registry reporting as CNS tumor with malignant behavior (ICD-O-3, behavior code /3).

^dHistology not currently used to US cancer registration, will be included starting with diagnosis year 2015. See NAACCR website: http://www.naaccr. org/LinkClick.aspx?fileticket1⁄44Hx-2XJJqFo%3d&tabid1⁄4161&mid1⁄4523.

^eMorphology 9442/3 only.

^fMorphology 9442/1 only.

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

Abbreviations: CBTRUS, Central Brain Tumor Registry of the United States; NOS, not otherwise specified.

Unlike other types of cancer, primary brain and other CNS tumors are not staged. They are classified according to the World Health Organization (WHO) 2000 Classification of Tumours of the Central Nervous System¹⁴ which assigns a grade (grade I through grade IV) based on predicted clinical behavior. Though the WHO classification scheme was also updated in 2007¹ and 2016¹⁵ these updated schema have not been fully implemented by US CCR. Updates made in 2007 may affect diagnostic practices used in characterization of individual tumors included in this report, though the newest revision would not affect any cases included in this report. With the increased recognition of the value of biomarkers for specific brain tumor histologies in classification, the WHO Classification of Tumours of the Central Nervous System has included biomarkers in its 2016 revision. However, implementing the collection of these markers in cancer registration is multi-faceted and is scheduled to begin in the United States in 2018.

WHO grading assignments are recorded by cancer registrars as Collaborative Stage Site-Specific Factor 1 - World Health Organization (WHO) Grade Classification according to the American Joint Commission on Cancer’s (AJCC) Collaborative Staging (CS) schema.¹⁶ Cancer staging is a critical component of determining cancer prognosis and treatment in clinical care and provides a rubric for evaluating how much cancer is in a person’s body and where the cancer is located. The AJCC CS schema provides a consistent framework for recording variables related to staging. This variable has been a required component of cancer registry data collection for brain and other CNS tumors since 2004 for SEER registries, and since 2011 for NPCR registries. A previous study by CBTRUS analyzed the completeness and concordance of WHO grading in SEER data from 2004–2011, and found that both of these factors have improved significantly over the time periods that they have been collected.¹⁷ As a result, CBTRUS reports statistics related to this variable in the CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2010–2014. Completeness of this variable is defined as having a value equal to WHO grade I, II, III, or IV. Cases where WHO grade is marked as not applicable, or not documented are considered to be incomplete.

Gliomas are tumors that arise from glial or precursor cells and include astrocytoma (including glioblastoma), oligodendroglioma, ependymoma, oligoastrocytoma (mixed glioma), malignant glioma, not otherwise specified (NOS), and a few rare histologies. Because there is no standard definition for glioma, CBTRUS defines glioma as ICD-O-3 histology codes 9380–9384, and 9391–9460 as starred inTable 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.

This report also utilizes the International Classification of Childhood Cancer (ICCC) grouping system for pediatric cancers. ICCC categories for this report were generated using the SEER Site/Histology ICCC-3 Recode¹⁸ based on the ICCC, Third edition¹⁹ and 2007 WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (See Supplementary Table 1 for more information on this classifications scheme). The ICCC was developed in 1996 with subsequent changes made to correlate with revisions to ICD-O in order to provide a standard classification of childhood tumors for comparing incidence and survival across regions and time periods. As shown, the Table 17 age-group category total, age 0–19 year age-group count, and age-specific and age-adjusted rates are equivalent to those presented throughout this report, even though the histology grouping scheme differs from that used by CBTRUS. The CBTRUS grouping scheme is specific to brain and other CNS tumors and correlates with the 2000 WHO Classification of Tumours of the Central Nervous System that is the current standard for cancer registration procedures in the US.

Table 17.

Estimated Number of Cases^a,b of Brain and Other Central Nervous System Tumors Overall and by Behavior by Major Histology Grouping and Histology, 2017, 2018

Histology	2017 Estimated New Cases			2018 Estimated New Cases
	All	Malignant	Non-Malignant	All	Malignant	Non-Malignant
Tumors of Neuroepithelial Tissue c	23,000	21,340	1,660	23,280	21,590	1,680
Pilocytic astrocytoma	1,100	1,100	--	1,120	1,120	--
Diffuse astrocytoma	1,410	1,410	--	1,400	1,400	--
Anaplastic astrocytoma	1,570	1,570	--	1,630	1,630	--
Unique astrocytoma variants	260	180	80	270	190	80
Glioblastoma	12,500	12,500	--	12,760	12,760	--
Oligodendroglioma	670	670	--	660	650	--
Anaplastic oligodendroglioma	380	380	--	390	390	--
Oligoastrocytic tumors	460	460	--	440	430	--
Ependymal tumors	1,340	710	630	1,340	690	640
Glioma malignant, NOS	1,400	1,400	--	1,380	1,380	--
Choroid plexus tumors	150	--	120	150	--	120
Other neuroepithelial tumors	--	--	--	--	--	--
Neuronal and mixed neuronal-glial tumors	930	210	710	930	220	710
Tumors of the pineal region	180	90	80	180	100	80
Embryonal tumors	630	600	--	610	590	--
Tumors of Cranial and Spinal Nerves c	7,230	--	7,190	7,400	--	7,360
Nerve sheath tumors	7,220	--	7,180	7,390	--	7,350
Other tumors of cranial and spinal nerves	--	--	--	--	--	--
Tumors of Meninges c	30,040	470	29,560	30,270	470	29,800
Meningioma	29,100	310	28,800	29,320	300	29,020
Mesenchymal tumors	300	90	210	310	90	210
Primary melanocytic lesions	--	--	--	--	--	--
Other neoplasms related to the meninges	600	50	550	600	50	550
Lymphomas and Hematopoietic Neoplasms c	1,690	1,690	--	1,720	1,720	--
Lymphoma	1,630	1,620	--	1,650	1,650	--
Other hematopoietic neoplasms	60	60	--	70	70	--
Germ Cell Tumors and Cysts c	310	210	100	310	210	100
Germ cell tumors, cysts and heterotopias	310	210	100	310	210	100
Tumors of Sellar Region c	13,680	60	13,620	13,840	60	13,770
Tumors of the pituitary	13,060	50	13,000	13,210	60	13,150
Craniopharyngioma	620	--	620	620	--	620
Unclassified Tumors c	4,110	1,440	2,660	4,090	1,460	2,630
Hemangioma	990	--	980	940	--	930
Neoplasm, unspecified	3,100	1,430	1,670	3,130	1,450	1,680
All other	--	--	--	--	--	--
TOTAL d	78,370	23,570	54,800	79,870	24,720	55,150

^aSource: Estimation based on CBTRUS NPCR and SEER 2000-2014 data for malignant tumors, and NPCR and SEER 2006-2014 data for non- malignant tumors.

^bRounded to the nearest 10. Numbers may not add up due to rounding.

^cMajor histology grouping estimates are calculated by summing estimates for all included histologies.

^dTotal estimate is based on overall estimate, histology-specific estimates may not add up to total.

^–Estimated number is less than 50. These cases are included in overall rates.

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.

Anatomic Location of Tumor Sites

Various terms are used to describe the regions of the brain and other central nervous system. The specific sites used in this report are broadly based on the categories and site codes defined in the SEER Site/Histology Validation List.²⁰ See Table 1 for an overview of CBTRUS primary site groupings. The CBTRUS Site/Validation List can be found on the CBTRUS website (http://www.cbtrus.org).

Measurement and Statistical Methods

Counts, means, rates, ratios, proportions, and other relevant statistics were calculated using R 3.3.2 statistical software²¹ and/or SEER*Stat 8.3.4.²² Figures were created in R 3.3.2²¹ using rgeos²³, rgdal²⁴, maptools²⁵, ggplot2²⁶, plotrix²⁷, and SEER2R statistical packages.²⁸ Statistics are suppressed when counts are fewer than 16 within a cell but included in totals except when data are suppressed from only one cell within a category to prevent identification of the number in the suppressed cell. NOTE: reported percentages may not add up to 100% due to rounding.

Population data for each geographic region were obtained from the SEER program website²⁹ for the purpose of rate calculation.

All rates presented in this statistical report are age-adjusted. Crude incidence rates are calculated by dividing the total number of cases by the total population, and cannot be compared to crude rates from other populations where the age distribution is different. 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 was equivalent to a standard population. Age-adjusted incidence rates and 95% confidence intervals³⁰ for malignant and non-malignant tumors and for selected histology groupings by sex, race, Hispanic ethnicity, and pediatric, adolescent, young adult, and adult age-groups were estimated per 100,000 population. Age-adjustment was based on one-year age groupings and standardized to the 2000 US standard population as calculated by the 2000 US census. The age distribution of the 2000 US standard population is shown online in Supplementary Table 2. Combined populations for the regions included in this report are also shown online in Supplementary Table 3 and Supplementary Table 4.

CBTRUS presents statistics on the pediatric and adolescent age-group 0–19 years as suggested by clinicians for clinical relevance and describes specific brain and other CNS tumor patterns in age-groups 0–4, 5–9, 10–14, and 15–19 years. However, the 0–14 year age-group is a standard age category for childhood cancer used by other cancer surveillance organizations and has been included in this report for consistency and comparison purposes. Race categories in this report are all races, White, Black, American Indian/Alaskan Native (AIAN), and Asian/Pacific Islander (API). Other race, unspecified, and unknown race are included in statistics that are not race-specific. 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.³¹

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. There are several methods 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. There are two methods that are used to determine whether a difference between rates is statistically significant in this report. The first is through 95% confidence intervals, which are calculated for all presented rates. A 95% confidence interval is a range around an estimate which, if sampling of the population was repeated, should contain the ‘true’ value for the population 95% of the time. If the confidence intervals of two estimates do not overlap, these values are considered to be significantly different with a less than 5% probability of happening by chance. The second method for determining whether two values are different is through 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 <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.

Brain Tumor Definition Differences

It should be noted that NPCR, SEER, and NAACCR report brain tumors differently from CBTRUS. The definition of brain and other CNS tumors used by these organizations in their published incidence and mortality statistics includes tumors located in the following sites with their ICD-O-3 site codes in parentheses: brain, meninges, and other central nervous system tumors (C70.0–9, C71.0–9, and C72.0–9), but excludes lymphoma and leukemia histologies (9590–9989) from all brain and other CNS sites.²

In contrast, CBTRUS reports data on all tumor morphologies located within the Consensus Conference site definition including lymphoma and other hematopoietic histologies (9590–9989), as well as olfactory tumors of the nasal cavity [C30.0 (9522–9523)].¹³ Additionally, CBTRUS reports data on all brain and other CNS tumors irrespective of behavior, whereas many reporting organizations may only publish rates for malignant brain and other CNS tumors. These differences in definition, therefore, influence the direct comparison of published rates.

In the US, 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.

Estimation of Expected Numbers of Brain and Other CNS Tumors in 2017 and 2018

Estimated numbers of expected malignant and non-malignant brain and other CNS tumors were calculated for 2017 and 2018. To project estimates of newly diagnosed brain and other CNS tumors in 2017 and 2018, age-adjusted annual brain tumor incidence rates were generated for 2000–2014 for malignant tumors, and 2006–2014 for non-malignant tumors. These were generated by state, age, and histologic type. Joinpoint 4.2.0.2³² was used to fit regression models to these incidence rates,³³ which were used to predict numbers of cases in future years using the parameter from the selected models. Joinpoint regression allows for multiple lines to be fit to incidence data across time, rather than assuming a consistent trend across the whole period. The points where these lines intersect are called ‘joinpoints’. The models allowed for a maximum of 2 joinpoints (1 for non-malignant tumors), a minimum of 3 observations from a joinpoint to either end of the data, and a minimum of 3 observations between joinpoints.³⁴ Modified Bayesian Information Criterion procedures included in Joinpoint were used to select the best fitting model. Overall total rates presented are based on total malignant and non-malignant incidence, and the presented stratified rates may not add up to these totals. Estimated numbers of cases are highly dependent on input data. Different patterns of incidence within strata can significantly affect the projected estimates, especially when the number of cases within a strata is low. As a result, strata-specific estimates may not equal the total estimate presented. Caution should be used when utilizing these estimates.

Estimation of Mortality Rates for Brain and Other CNS Tumors

Age-adjusted mortality rates for deaths resulting from all malignant brain and other CNS tumors were calculated using the mortality data available in SEER*Stat Online Database provided by the National Center for Health Statistics (NCHS) per 100,000 population.¹² In addition to the total age-adjusted rate for the US, age-adjusted rates are presented by sex and state.

Estimation of Survival Rates

SEER*Stat 8.3.2 statistical software was used to estimate one-, two-, three-, four-, five-, and ten-year relative survival rates for primary malignant CNS tumor cases diagnosed between 2000–2014 in eighteen SEER areas^35,36 and for primary non-malignant CNS tumor cases diagnosed between 2004–2014. This software utilizes life-table (actuarial) methods to compute survival estimates and accounts for current follow-up. Survival was estimated for brain (C71.0-C71.9), meninges (C70.0-C70.9), spinal cord, cranial nerves, and other parts of the central nervous system (C72.0-C72.9), pituitary and pineal glands (C75.1-C75.3), and olfactory tumors of the nasal cavity [C30.0 (9522–9523)]. Second or later primary tumors, cases diagnosed at autopsy, cases in which race or sex is coded as other or unknown, and cases known to be alive but for whom follow-up time could not be calculated, were excluded from the SEER survival data analyses. For selected non-malignant brain and other CNS tumors relative survival rates were estimated for one-, two-, five-, and ten- years using the 18 SEER areas for 2004–2014. Relative survival for NCI age-groups and selected non-malignant histologies was also estimated for one, two, and five years.

Estimation of Time Trends

Joinpoint 4.2.0.2³² was used to estimate incidence time trends, and generate annual percentage change (APC) and 95% confidence intervals. The models allowed for a maximum of 2 joinpoints (1 for non-malignant tumors), a minimum of 3 observations from a joinpoint to either end of the data, and a minimum of 3 observations between joinpoints.³⁴ Annual percent change (APC) is the average percent change in incidence per year over the time period included in the trend segment. Time trends analysis methods are used to estimate if the APC is significantly different from 0% (meaning no change in incidence from year to year). The 95% confidence interval is a range around an estimate that, if sampling of the population was repeated, should contain the ‘true’ value for the population 95% of the time. If the 95% confidence interval contains 0, we 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 trend 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 data.

Data Interpretation

The 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 in collection and data refinement aimed to improve completeness and accuracy. Therefore, 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 2010–2014. This current report supersedes all previous Reports in terms of coverage of the US population with the most up-to-date information, making these data the most accurate and timely to reference.

Random fluctuations in annual Average rates are common, especially for rates based on small case counts. The CBTRUS policy to suppress data presentation for cells with counts of fewer than 16 cases is consistent with the NPCR policy.

As noted in the 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 and in the 2013 CBTRUS Statistical Report, the policy change enacted in 2007 guiding the Veterans Health Administration (VHA) had resulted in underreporting of cancer data—especially for men—to central cancer registries. The ongoing process to clarify this policy indicates that underreporting for VHA facilities has diminished over time, and that the Veterans Affairs Central Cancer Registry (VACCR) now captures approximately 87–90% of cases.^37,38

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.^39,40 The SEER program allows for reporting delay of up to 22 months prior to public data release, but additional cases may still be discovered after that point.⁴¹ 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. CBTRUS also recognizes that 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, and collection has only been mandatory as of January 1, 2004. Type of diagnostic confirmation may also lead to increased reporting delay, with histologically confirmed tumors being subject to less reporting delay than radiographically confirmed tumors.

CBTRUS editing practices are conducted yearly. These practices are aimed at refining the data for accuracy and clinical relevance and play a role in interpreting these Report data. Exclusion of site and histology combinations considered to be invalid by the consulting neuropathologists who revised the CBTRUS site/histology validation list in 2012 may have the impact of underestimating the incidence of brain and other CNS tumors. Editing changes, such as reconsidering paired sites as multiple tumors rather than a single bilateral tumor beginning in 2004, also incorporate updates to the cancer registration coding rules that influence case ascertainment and data collection. ²

Population estimates used for denominators affect incidence rates. CBTRUS has utilized population estimates based on the 2000 US Census in this report.

Supplemental Online-Only Data

Beginning with the 2017 Statistical Report, CBTRUS has made supplemental additional figures and tables available online only. These materials are noted in the text as supplementary tables and figures.

Results

Primary Brain and Other CNS Tumors: Incidence and Mortality in Comparison to Other Common Neoplasms in the US

Annual average age-adjusted incidence rates for primary brain and other CNS tumors (2010–2014) and a selection of common cancers (2010–2014) in the US are presented by age in Figure 1A: Children (Age 0–14 Years), Figure 1B: Adolescents and Young Adults (Age 15–39 Years), and Figure 1C: Older Adults (Age 40+ Years). Incidence rates for males only and females only are presented by age in Supplementary Figure 1a and Supplementary Figure 1b, respectively. (Note: the 2017 CBTRUS Statistical Report does not include USCS data from 2014 as these data were not available at time of preparation of this report).

Fig. 1.

Annual average Age-Adjusted Incidence Rates^a of All Primary Brain and Other CNS Tumors in Comparison to Other Common Cancers for A. Children Age 0-14 Years, B. Adolescents and Young Adults Age 15-39 Years, and C. Older Adults Age 40+ Years, CBTRUS Statistical Report: NPCR and SEER 2010-2014, USCS 2010-2013^b

• Brain and other CNS tumors were the most common cancer site among those age 0–14 years, with an annual average age-adjusted incidence rate of 5.54 per 100,000 population.

• Leukemia was the second most common neoplasm in those persons age 0–14 years, with an annual average age-adjusted incidence rate of 4.98 per 100,000 population.

• Testicular cancer was the most common cancer in males age 15–39 years with an annual average age-adjusted incidence rate of 10.44 per 100,000.

• Breast cancer was the most common cancer among females age 15–39 years, with annual average age-adjusted incidence rates of 21.26 per 100,000.

• Brain and other CNS (both malignant and non-malignant tumors) among those age 15–39 years had an annual average age-adjusted incidence of 10.94 per 100,000 population.

• Prostate and breast cancer were the most common cancers among those age 40+ years in the US, with annual average age-adjusted incidence rates of 275.50 per 100,000 population (males only) and 268.00 per 100,000 population (females only), respectively.⁹

• Brain and other CNS (both malignant and non-malignant) tumors among those persons age 40+ years had an annual average age-adjusted incidence of 40.82 per 100,000 population.

Annual average age-adjusted mortality rates for primary brain and other CNS tumors, a selection of common cancers, and the top three non-cancer causes of death in the US are presented by age in Figure 2A: (Age 0–14 Years), Figure 2B: (Age 15–39 Years), and Figure 2C: (Age 40+ Years). Mortality rates for males only and females only are presented by age in Supplementary Figure 2A and Supplementary Figure 2B, respectively.

Fig. 2.

Annual average Age-Adjusted Mortality Rates^a of All Primary Brain and Other CNS Tumors in Comparison to Other Common Cancers and Top Three Non-Cancer Causes of Death for A. Children Age 0-14 Years, B. Adolescents and Young Adults Age 15-39 Years, and C. Older Adults Age 40+ Years, CBTRUS Statistical Report: NVSS 2010-2014

• The most common causes of death in persons age 0–14 years were conditions originating in the perinatal period (19.53 per 100,000). Brain and other CNS tumors among persons age 0–14 years had an annual average age-adjusted mortality rate of 0.71 per 100,000 and were the fourth most common cause of death in this age group.

• Accidents and adverse effects were the leading causes of death in persons age 15–39 years (33.13 per 100,000). Brain and other CNS tumors among persons age 15–39 years had an annual average age-adjusted mortality rate of 0.94 per 100,000 and were the fifth most common cause of death in this age-group.

• Heart disease was the largest contributor to mortality in persons age 40+ years in the US, with an annual average age adjusted mortality rate of 511.23 per 100,000 for major cardiovascular diseases. Brain and other CNS tumors among persons age 40+ years had an annual average age-adjusted mortality rate of 8.94 per 100,000.

Primary Brain and Other CNS Tumors: Distributions and Incidence by Sex, Age, Year, Behavior, WHO Grade, and Central Cancer Registry

Counts and rates from the 379,848 incident brain and other CNS tumors (119,674 malignant; 260,174 non-malignant shown in Figure 4) reported during 2010–2014 by histology and demographic characteristics for all ages are presented in Tables 3–6. Counts and rates are shown by histology and behaviors for selected histologies where there are a sufficient amount of cases to calculate rates. The predominant tumor categories by behavior are presented in Figure 4.

Fig. 4.

Distribution^a of Primary Brain and Other CNS Tumors by Behavior (N=379,848), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Table 3.

Five-Year Total, Annual Average Total^a, and Annual average Age-Adjusted Incidence Rates^b for Brain and Other Central Nervous System Tumors by Major Histology Grouping, Histology, Behavior, and Sex, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Histology	Total						Male						Female
	Five-Year Total	Annual Average	% of All Tumors	Median Age	Rate	95% CI	Five-Year Total	Annual Average	Percent Malignant	Percent Non- Malignant	Rate	95% CI	Five-Year Total	Annual Average	Percent Malignant	Percent Non- Malignant	Rate	95% CI
Tumors of Neuroepithelial Tissue	109,245	21,849	28.8%	57.0	6.57	6.53-6.61	61,239	12,248	93.1%	6.9%	7.73	7.67-7.79	48,006	9,601	92.5%	7.5%	5.56	5.51-5.61
Pilocytic astrocytoma	5,249	1,050	1.4%	12.0	0.36	0.35-0.37	2,687	537	100.0%	0.0%	0.36	0.35-0.37	2,562	512	100.0%	0.0%	0.35	0.34-0.37
Diffuse astrocytoma	7,793	1,559	2.1%	48.0	0.48	0.47-0.49	4,314	863	100.0%	0.0%	0.55	0.54-0.57	3,479	696	100.0%	0.0%	0.42	0.41-0.43
Anaplastic astrocytoma	6,537	1,307	1.7%	53.0	0.40	0.39-0.41	3,584	717	100.0%	0.0%	0.46	0.44-0.47	2,953	591	100.0%	0.0%	0.35	0.33-0.36
Unique astrocytoma variants	1,090	218	0.3%	23.0	0.07	0.07-0.08	596	119	68.5%	31.5%	0.08	0.07-0.08	494	99	66.2%	33.8%	0.06	0.06-0.07
Malignant	735	147	0.2%	32.0	0.05	0.04-0.05	408	82	--	--	0.05	0.05-0.06	327	65	--	--	0.04	0.04-0.05
Non-Malignant	355	71	0.1%	11.0	0.02	0.02-0.03	188	38	--	--	0.03	0.02-0.03	167	33	--	--	0.02	0.02-0.03
Glioblastoma	56,421	11,284	14.9%	64.0	3.20	3.17-3.23	32,506	6,501	100.0%	0.0%	3.99	3.95-4.03	23,915	4,783	100.0%	0.0%	2.52	2.49-2.56
Oligodendroglioma	3,753	751	1.0%	43.0	0.24	0.23-0.25	2,105	421	100.0%	0.0%	0.28	0.26-0.29	1,648	330	100.0%	0.0%	0.21	0.20-0.22
Anaplastic oligodendroglioma	1,718	344	0.5%	50.0	0.11	0.10-0.11	966	193	100.0%	0.0%	0.12	0.11-0.13	752	150	99.9%	0.1%	0.09	0.09-0.10
Oligoastrocytic tumors	2,989	598	0.8%	41.0	0.19	0.18-0.20	1,713	343	100.0%	0.0%	0.22	0.21-0.23	1,276	255	99.9%	0.1%	0.16	0.15-0.17
Ependymal tumors	6,816	1,363	1.8%	45.0	0.43	0.42-0.44	3,864	773	56.5%	43.5%	0.49	0.48-0.51	2,952	590	63.8%	36.2%	0.37	0.36-0.38
Malignant	4,065	813	1.1%	42.0	0.26	0.25-0.27	2,182	436	--	--	0.28	0.27-0.29	1,883	377	--	--	0.24	0.23-0.25
Non-Malignant	2,751	550	0.7%	47.0	0.17	0.16-0.18	1,682	336	--	--	0.21	0.20-0.22	1,069	214	--	--	0.13	0.12-0.14
Glioma malignant, NOS	7,238	1,448	1.9%	36.0	0.46	0.45-0.47	3,700	740	100.0%	0.0%	0.49	0.48-0.51	3,538	708	100.0%	0.0%	0.44	0.42-0.45
Choroid plexus tumors	814	163	0.2%	20.0	0.05	0.05-0.06	409	82	16.4%	83.6%	0.05	0.05-0.06	405	81	16.1%	84.0%	0.05	0.05-0.06
Malignant	132	26	--	1.0	0.01	0.01-0.01	67	13	--	--	0.01	0.01-0.01	65	13	--	--	0.01	0.01-0.01
Non-Malignant	682	136	--	24.5	0.04	0.04-0.05	342	68	--	--	0.04	0.04-0.05	340	68	--	--	0.04	0.04-0.05
Other neuroepithelial tumors	93	19	0.0%	37.0	0.01	0.00-0.01	33	7	48.5%	51.5%	0.00	0.00-0.01	60	12	75.0%	25.0%	0.01	0.01-0.01
Malignant	61	12	--	22.0	0.00	0.00-0.01	16	3	--	--	0.00	0.00-0.00	45	9	--	--	0.01	0.00-0.01
Non-Malignant	32	6	--	41.5	0.00	0.00-0.00	17	3	--	--	0.00	0.00-0.00	--	--	--	--	--	--
Neuronal and mixed neuronal-glial tumors	4,476	895	1.2%	27.0	0.29	0.28-0.30	2,383	477	21.8%	78.2%	0.31	0.30-0.32	2,093	419	17.9%	82.1%	0.27	0.26-0.29
Malignant	893	179	--	52.0	0.05	0.05-0.06	519	104	--	--	0.06	0.06-0.07	374	75	--	--	0.05	0.04-0.05
Non-Malignant	3,583	717	--	22.0	0.24	0.23-0.24	1,864	373	--	--	0.24	0.23-0.26	1,719	344	--	--	0.23	0.22-0.24
Tumors of the pineal region	715	143	0.2%	34.0	0.05	0.04-0.05	292	58	66.8%	33.2%	0.04	0.03-0.04	423	85	44.9%	55.1%	0.05	0.05-0.06
Malignant	385	77	--	26.0	0.03	0.02-0.03	195	39	--	--	0.03	0.02-0.03	190	38	--	--	0.03	0.02-0.03
Non-Malignant	330	66	--	40.5	0.02	0.02-0.02	97	19	--	--	0.01	0.01-0.02	233	47	--	--	0.03	0.03-0.03
Embryonal tumors	3,543	709	0.9%	9.0	0.24	0.23-0.25	2,087	417	97.7%	2.4%	0.28	0.27-0.29	1,456	291	95.1%	5.0%	0.20	0.19-0.21
Tumors of Cranial and Spinal Nerves	32,000	6,400	8.4%	56.0	1.89	1.86-1.91	15,418	3,084	0.7%	99.3%	1.90	1.87-1.93	16,582	3,316	0.7%	99.3%	1.88	1.85-1.91
Nerve sheath tumors	31,974	6,395	8.4%	56.0	1.88	1.86-1.91	15,402	3,080	0.7%	99.3%	1.90	1.87-1.93	16,572	3,314	0.7%	99.3%	1.88	1.85-1.91
Malignant	229	46	--	51.0	0.01	0.01-0.02	110	22	--	--	0.01	0.01-0.02	119	24	--	--	0.01	0.01-0.02
Non-Malignant	31,745	6,349	--	56.0	1.87	1.85-1.89	15,292	3,058	--	--	1.88	1.85-1.91	16,453	3,291	--	--	1.87	1.84-1.90
Other tumors of cranial and spinal nerves	26	5	0.0%	53.5	0.00	0.00-0.00	16	3	0.0%	100.0%	0.00	0.00-0.00	--	--	0.0%	100.0%	--	--
Tumors of Meninges	144,068	28,814	37.9%	65.0	8.41	8.36-8.45	39,766	7,953	2.9%	97.1%	5.15	5.10-5.20	104,302	20,860	1.3%	98.7%	11.26	11.19-11.33
Meningioma	139,694	27,939	36.8%	66.0	8.14	8.09-8.18	37,464	7,493	1.9%	98.1%	4.86	4.81-4.91	102,230	20,446	1.0%	99.0%	11.01	10.94-11.08
Malignant	1,747	349	--	65.0	0.10	0.10-0.11	726	145	--	--	0.09	0.09-0.10	1,021	204	--	--	0.11	0.10-0.12
Non-Malignant	137,947	27,589	--	66.0	8.03	7.99-8.08	36,738	7,348	--	--	4.77	4.72-4.82	101,209	20,242	--	--	10.90	10.83-10.97
Mesenchymal tumors	1,307	261	0.3%	49.0	0.08	0.08-0.09	625	125	35.5%	64.5%	0.08	0.07-0.09	682	136	28.5%	71.6%	0.08	0.08-0.09
Primary melanocytic lesions	128	26	0.0%	57.5	0.01	0.01-0.01	81	16	79.0%	21.0%	0.01	0.01-0.01	47	9	48.9%	51.1%	0.01	0.00-0.01
Other neoplasms related to the meninges	2,939	588	0.8%	49.0	0.18	0.17-0.19	1,596	319	9.0%	91.0%	0.20	0.19-0.21	1,343	269	8.9%	91.1%	0.16	0.15-0.17
Lymphomas and Hematopoietic Neoplasms	7,738	1,548	2.0%	66.0	0.45	0.44-0.46	3,952	790	99.7%	0.3%	0.50	0.48-0.52	3,786	757	99.7%	0.3%	0.41	0.40-0.42
Lymphoma	7,481	1,496	2.0%	66.0	0.44	0.43-0.45	3,816	763	100.0%	0.0%	0.48	0.47-0.50	3,665	733	100.0%	0.0%	0.40	0.38-0.41
Other hematopoietic neoplasms	257	51	0.1%	48.0	0.02	0.01-0.02	136	27	91.2%	8.8%	0.02	0.01-0.02	121	24	90.9%	9.1%	0.01	0.01-0.02
Germ Cell Tumors and Cysts	1,502	300	0.4%	16.0	0.10	0.10-0.11	1,024	205	77.1%	23.0%	0.14	0.13-0.14	478	96	48.3%	51.7%	0.06	0.06-0.07
Germ cell tumors, cysts and heterotopias	1,502	300	0.4%	16.0	0.10	0.10-0.11	1,024	205	77.1%	23.0%	0.14	0.13-0.14	478	96	48.3%	51.7%	0.06	0.06-0.07
Malignant	1,020	204	--	15.0	0.07	0.06-0.07	789	158	--	--	0.10	0.10-0.11	231	46	--	--	0.03	0.03-0.04
Non-Malignant	482	96	--	28.0	0.03	0.03-0.03	235	47	--	--	0.03	0.03-0.04	247	49	--	--	0.03	0.03-0.04
Tumors of Sellar Region	64,606	12,921	17.0%	51.0	3.98	3.95-4.01	29,325	5,865	0.4%	99.6%	3.69	3.65-3.74	35,281	7,056	0.2%	99.8%	4.34	4.29-4.38
Tumors of the pituitary	61,634	12,327	16.2%	51.0	3.79	3.76-3.82	27,885	5,577	0.4%	99.6%	3.51	3.47-3.55	33,749	6,750	0.2%	99.8%	4.15	4.10-4.19
Malignant	172	34	--	55.5	0.01	0.01-0.01	101	20	--	--	0.01	0.01-0.02	71	14	--	--	0.01	0.01-0.01
Non-Malignant	61,462	12,292	--	51.0	3.78	3.75-3.81	27,784	5,557	--	--	3.50	3.45-3.54	33,678	6,736	--	--	4.14	4.10-4.19
Craniopharyngioma	2,972	594	0.8%	43.0	0.19	0.18-0.19	1,440	288	0.4%	99.6%	0.18	0.17-0.19	1,532	306	0.1%	99.9%	0.19	0.18-0.20
Unclassified Tumors	20,689	4,138	5.4%	63.0	1.24	1.22-1.26	9,353	1,871	34.2%	65.8%	1.23	1.21-1.26	11,336	2,267	30.3%	69.7%	1.26	1.23-1.28
Hemangioma	6,138	1,228	1.6%	50.0	0.38	0.37-0.39	2,614	523	0.5%	99.5%	0.33	0.32-0.34	3,524	705	0.2%	99.8%	0.42	0.41-0.44
Neoplasm, unspecified	14,447	2,889	3.8%	69.0	0.86	0.84-0.87	6,682	1,336	47.5%	52.5%	0.90	0.87-0.92	7,765	1,553	43.9%	56.1%	0.83	0.81-0.85
Malignant	6,580	1,316	--	76.0	0.38	0.37-0.39	3,173	635	--	--	0.43	0.42-0.45	3,407	681	--	--	0.34	0.33-0.36
Non-Malignant	7,867	1,573	--	62.0	0.47	0.46-0.48	3,509	702	--	--	0.46	0.45-0.48	4,358	872	--	--	0.49	0.47-0.50
All other	104	21	0.0%	61.0	0.01	0.01-0.01	57	11	26.3%	73.7%	0.01	0.01-0.01	47	9	31.9%	68.1%	0.01	0.00-0.01
TOTAL c	379,848	75,970	--	59.0	22.64	22.56-22.71	160,077	32,015	41.4%	58.6%	20.34	20.24-20.44	219,771	43,954	24.3%	75.7%	24.77	24.67-24.88
Malignant	119,674	23,935	31.5%	59.0	7.15	7.10-7.19	66,300	13,260	--	--	8.39	8.32-8.45	53,374	10,675	--	--	6.06	6.01-6.11
Non-Malignant	260,174	52,035	68.5%	60.0	15.49	15.43-15.55	93,777	18,755	--	--	11.95	11.87-12.03	166,397	33,279	--	--	18.72	18.62-18.81

^aAnnual average cases are calculated by dividing the five year total by five.

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

^cRefers to all brain tumors including histologies not presented in this table.

^dRates and counts do not include histologies for which cases were suppressed.

-Counts are not presented when fewer than 16 cases were reported for the specific histology category.

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 by Sex and Behavior

• Overall, 42.1% of all tumors diagnosed between 2010 and 2014 occurred in males (160,077 tumors) and 57.9% in females (219,771 tumors) (Table 3).

• Approximately 55.4% of the malignant tumors occurred in males (66,300 tumors between 2010 and 2014) and 44.6% in females (53,374 tumors between 2010 and 2014). Please see Supplementary Figure 3A for the predominant tumor categories in malignant tumors only.

• Approximately 36.0% of the non-malignant tumors occurred in males (93,777 tumors between 2010 and 2014) and 64.0% in females (166,397 tumors between 2010 and 2014). Please see Supplementary Figure 3B for the predominant tumor categories in malignant tumors only.

Incidence Rates by Age

The overall annual average age-adjusted incidence rate for 2010–2014 for all primary brain and other CNS tumors was 22.64 per 100,000 population (Table 3). The overall incidence rate was 5.81 per 100,000 population for children and adolescents age 0–19 years, 5.54 per 100,000 population for children age 0–14 years (Table 4), and 29.41 per 100,000 population for adults age 20+ years (Table 5). The overall incidence rates of tumors by behavior and age-group (age 0–19 years and 20+ years) are shown in Figure 3 and Table 5.

Table 4.

Five-Year Total, Annual Average Total^a, and Annual Average Age-Adjusted Incidence Rates^b for Children and Adolescents (Age 0-19 Years), Brain and Other Central Nervous System Tumors by Major Histology Grouping, Histology, and Age at Diagnosis, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Histology									Age At Diagnosis
	0-14 Years				0-19 Years				0-4 Years				5-9 Years				10-14 Years				15-19 Years
	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI
Tumors of Neuroepithelial Tissue	12,475	2,495	4.08	4.01-4.15	15,556	3,111	3.78	3.72-3.84	4,915	983	4.92	4.79-5.06	3,976	795	3.89	3.77-4.01	3,584	717	3.47	3.36-3.59	3,081	616	2.88	2.78-2.98
Pilocytic astrocytoma	3,085	617	1.01	0.97-1.04	3,751	750	0.91	0.88-0.94	1,087	217	1.09	1.02-1.15	1,052	210	1.03	0.97-1.09	946	189	0.91	0.86-0.98	666	133	0.62	0.58-0.67
Diffuse astrocytoma	768	154	0.25	0.23-0.27	1,062	212	0.26	0.24-0.27	284	57	0.28	0.25-0.32	224	45	0.22	0.19-0.25	260	52	0.25	0.22-0.28	294	59	0.27	0.24-0.31
Anaplastic astrocytoma	294	59	0.10	0.09-0.11	409	82	0.10	0.09-0.11	75	15	0.08	0.06-0.09	108	22	0.11	0.09-0.13	111	22	0.11	0.09-0.13	115	23	0.11	0.09-0.13
Unique astrocytoma variants	359	72	0.12	0.11-0.13	468	94	0.11	0.1-0.12	101	20	0.10	0.08-0.12	123	25	0.12	0.10-0.14	135	27	0.13	0.11-0.15	109	22	0.10	0.08-0.12
Malignant	146	29	0.05	0.04-0.06	218	44	0.05	0.05-0.06	21	4	0.92	0.01-0.03	51	10	0.05	0.04-0.07	74	15	0.07	0.06-0.09	72	14	0.07	0.05-0.08
Non-Malignant	213	43	0.07	0.06-0.08	250	50	0.06	0.05-0.07	80	16	0.08	0.06-0.10	72	14	0.07	0.06-0.09	61	12	0.06	0.05-0.08	37	7	0.03	0.02-0.05
Glioblastoma	481	96	0.16	0.14-0.17	721	144	0.17	0.16-0.19	119	24	0.12	0.10-0.14	174	35	0.17	0.15-0.20	188	38	0.18	0.16-0.21	240	48	0.22	0.20-0.25
Oligodendroglioma	110	22	0.04	0.03-0.04	199	40	0.05	0.04-0.06	18	4	0.02	0.01-0.03	40	8	0.04	0.03-0.20	52	10	0.05	0.04-0.07	89	18	0.08	0.07-0.10
Anaplastic oligodendroglioma	--	--	--	--	29	6	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--	19	4	0.02	0.01-0.03
Oligoastrocytic tumors	62	12	0.02	0.02-0.03	123	25	0.03	0.02-0.04	16	3	0.02	0.01-0.03	20	4	0.02	0.01-0.03	26	5	0.03	0.02-0.04	61	12	0.06	0.04-0.07
Ependymal tumors	978	196	0.32	0.03-0.34	1,226	245	0.30	0.28-0.31	495	99	0.50	0.45-0.54	245	49	0.24	0.21-0.27	238	48	0.23	0.20-0.26	248	50	0.23	0.20-0.26
Malignant	867	173	0.28	0.26-0.30	1,023	205	0.25	0.23-0.26	476	95	0.48	0.43-0.52	221	44	0.22	0.19-0.25	170	34	0.16	0.14-0.19	156	31	0.15	0.12-0.17
Non-Malignant	111	22	0.04	0.03-0.04	203	41	0.05	0.04-0.06	19	4	0.02	0.01-0.03	24	5	0.02	0.02-0.03	68	14	0.06	0.05-0.08	92	18	0.09	0.07-0.11
Glioma malignant, NOS	2,355	471	0.77	0.74-0.80	2,724	545	0.66	0.64-0.69	923	185	0.92	0.86-0.98	865	173	0.84	0.79-0.90	567	113	0.55	0.51-0.60	369	74	0.35	0.31-0.38
Choroid plexus tumors	354	71	0.12	0.10-0.13	403	81	0.10	0.09-0.11	249	50	0.25	0.22-0.28	51	10	0.05	0.04-0.07	54	11	0.05	0.04-0.07	49	10	0.05	0.03-0.06
Malignant	99	20	0.03	0.03-0.04	102	20	0.02	0.02-0.03	84	17	0.08	0.07-0.10	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	255	51	0.08	0.07-0.09	301	60	0.07	0.06-0.08	165	33	0.17	0.14-0.19	43	9	0.04	0.03-0.06	47	9	0.05	0.04-0.06	46	9	0.04	0.03-0.06
Other neuroepithelial tumors	24	5	0.01	0.01-0.01	30	6	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Malignant	21	4	0.01	0.00-0.01	25	5	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Neuronal and mixed neuronal-glial tumors	1,153	231	0.38	0.36-0.40	1,687	337	0.41	0.39-0.43	291	58	0.29	0.26-0.33	334	67	0.33	0.29-0.36	528	106	0.51	0.47-0.55	534	107	0.50	0.46-0.54
Malignant	61	12	0.02	0.02-0.03	90	18	0.02	0.02-0.03	22	4	0.02	0.01-0.03	18	4	0.02	0.01-0.03	21	4	0.02	0.01-0.03	29	6	0.03	0.02-0.04
Non-Malignant	1,092	218	0.36	0.34-0.38	1,597	319	0.39	0.37-0.41	269	54	0.27	0.24-0.30	316	63	0.31	0.28-0.35	507	101	0.49	0.45-0.53	505	101	0.47	0.43-0.52
Tumors of the pineal region	151	30	0.05	0.04-0.05	197	39	0.05	0.04-0.06	62	12	0.06	0.05-0.08	42	8	0.04	0.03-0.06	47	9	0.05	0.03-0.06	46	9	0.04	0.03-0.06
Malignant	130	26	0.04	0.04-0.05	157	31	0.04	0.03-0.04	54	11	0.05	0.04-0.07	37	7	0.04	0.03-0.05	39	8	0.04	0.03-0.05	27	5	0.03	0.02-0.04
Non-Malignant	21	4	0.01	0.00-0.01	40	8	0.01	0.01-0.01	--	--	--	--	--	--	--	--	--	--	--	--	19	4	0.02	0.01-0.03
Embryonal tumors	2,291	458	0.75	0.72-0.78	2,527	505	0.62	0.59-0.64	1,182	236	1.18	1.12-1.25	689	138	0.67	0.62-0.72	420	84	0.41	0.37-0.45	236	47	0.22	0.19-0.25
Medulloblastoma c	1,444	289	0.47	0.45-0.50	1,611	322	0.39	0.37-0.41	528	106	0.53	0.48-0.58	573	115	0.56	0.51-0.61	343	69	0.33	0.30-0.37	167	33	0.16	0.13-0.18
Primitive neuroectodermal tumor d	279	56	0.09	0.08-0.10	319	64	0.08	0.07-0.09	176	35	0.18	0.15-0.20	60	12	0.06	0.04-0.08	43	9	0.04	0.03-0.06	40	8	0.04	0.03-0.05
Atypical teratoid/rhabdoid tumor e	368	74	0.12	0.11-0.13	375	75	0.09	0.08-0.10	324	65	0.33	0.29-0.36	30	6	0.03	0.02-0.04	--	--	--	--	--	--	--	--
Other embryonal histologies f	200	40	0.07	0.06-0.07	222	44	0.05	0.05-0.06	154	31	0.15	0.13-0.18	26	5	0.03	0.02-0.04	20	4	0.02	0.01-0.03	22	4	0.02	0.01-0.03
Tumors of Cranial and Spinal Nerves	804	161	0.26	0.25-0.28	1,202	240	0.29	0.27-0.31	262	52	0.26	0.23-0.30	252	50	0.25	0.22-0.28	290	58	0.28	0.25-0.31	398	80	0.37	0.34-0.41
Nerve sheath tumors	804	161	0.26	0.25-0.28	1,199	240	0.29	0.27-0.31	262	52	0.26	0.23-0.30	252	50	0.25	0.22-0.28	290	58	0.28	0.25-0.31	395	79	0.37	0.33-0.41
Malignant	18	4	0.01	0.00-0.01	24	5	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	786	157	0.26	0.24-0.28	1,175	235	0.28	0.27-0.30	256	51	0.26	0.23-0.29	246	49	0.24	0.21-0.27	284	57	0.27	0.24-0.31	389	78	0.36	0.33-0.40
Other tumors of cranial and spinal nerves	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Tumors of Meninges	509	102	0.17	0.15-0.18	1,054	211	0.25	0.24-0.27	153	31	0.15	0.13-0.18	119	24	0.12	0.10-0.14	237	47	0.23	0.20-0.26	545	109	0.51	0.47-0.55
Meningioma	268	54	0.09	0.08-1.00	632	126	0.15	0.14-0.16	61	12	0.06	0.05-0.08	63	13	0.06	0.05-0.08	144	29	0.14	0.12-0.16	364	73	0.34	0.30-0.38
Malignant	18	4	0.01	0.00-0.01	32	6	0.01	0.01-0.01	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	250	50	0.08	0.07-0.09	600	120	0.14	0.13-0.16	57	11	0.06	0.04-0.07	58	12	0.06	0.04-0.07	135	27	0.13	0.11-0.15	350	70	0.33	0.29-0.36
Mesenchymal tumors	168	34	0.05	0.05-0.06	217	43	0.05	0.05-0.06	84	17	0.08	0.07-0.10	47	9	0.05	0.03-0.06	37	7	0.04	0.03-0.05	49	10	0.05	0.03-0.06
Primary melanocytic lesions	--	--	--	--	9	2	0.00	0.00-0.00	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Other neoplasms related to the meninges	67	13	0.02	0.02-0.03	196	39	0.05	0.04-0.05	--	--	--	--	--	--	--	--	54	11	0.05	0.04-0.07	129	26	0.12	0.10-0.14
Lymphomas and Hematopoietic Neoplasms	80	16	0.03	0.02-0.03	122	24	0.03	0.02-0.04	--	--	--	--	34	7	0.03	0.02-0.05	32	6	0.03	0.01-0.03	42	8	0.04	0.03-0.05
Lymphoma	26	5	0.01	0.01-0.01	55	11	0.01	0.01-0.02	--	--	--	--	--	--	--	--	--	--	--	--	29	6	0.03	0.02-0.04
Other hematopoietic neoplasms	54	11	0.02	0.01-0.02	67	13	0.02	0.01-0.02	--	--	--	--	26	5	0.03	0.02-0.04	17	3	0.02	0.01-0.03	--	--	--	--
Germ Cell Tumors and Cysts	645	129	0.21	0.20-0.23	922	184	0.22	0.21-0.24	163	33	0.16	0.14-0.19	167	33	0.17	0.14-0.19	315	63	0.31	0.27-0.34	277	55	0.26	0.23-0.29
Germ cell tumors, cysts and heterotopias	645	129	0.21	0.20-0.23	922	184	0.22	0.21-0.24	163	33	0.16	0.14-0.19	167	33	0.17	0.14-0.19	315	63	0.31	0.27-0.34	277	55	0.26	0.23-0.29
Malignant	476	95	0.16	0.14-0.17	722	144	0.18	0.16-0.19	63	13	0.06	0.05-0.08	128	26	0.13	0.11-0.15	285	57	0.28	0.24-0.31	246	49	0.23	0.20-0.26
Non-Malignant	169	34	0.06	0.05-0.06	200	40	0.05	0.04-0.06	100	20	0.10	0.08-0.12	39	8	0.04	0.03-0.05	30	6	0.03	0.02-0.04	31	6	0.03	0.02-0.04
Tumors of Sellar Region	1,466	293	0.28	0.46-0.51	3,678	736	0.88	0.85-0.91	173	35	0.17	0.15-0.20	511	102	0.50	0.46-0.55	782	156	0.75	0.70-0.81	2,212	442	2.06	1.98-2.15
Tumors of the pituitary	799	160	0.26	0.24-0.28	2,841	568	0.67	0.65-0.70	38	8	0.04	0.03-0.05	193	39	0.19	0.16-0.22	568	114	0.54	0.50-0.90	2,042	408	1.90	1.82-1.99
Malignant	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	798	160	0.26	0.24-0.28	2,837	567	0.67	0.65-0.70	38	8	0.04	0.03-0.05	193	39	0.19	0.16-0.22	567	113	0.54	0.50-0.59	2,039	408	1.90	1.82-1.99
Craniopharyngioma	667	133	0.22	0.20-0.24	837	167	0.20	0.19-0.22	135	27	0.13	0.11-0.16	318	64	0.31	0.28-0.35	214	43	0.21	0.18-0.24	70	14	0.16	0.14-0.19
Unclassified Tumors	962	192	0.32	0.30-0.34	1,468	294	0.35	0.34-0.37	331	66	0.33	0.30-0.37	247	49	0.24	0.21-0.27	384	77	0.37	0.33-0.41	506	101	0.47	0.43-0.52
Hemangioma	329	66	0.11	0.10-0.12	551	110	0.13	0.12-0.14	128	26	0.13	0.11-0.15	73	15	0.07	0.06-0.09	128	26	0.12	0.10-0.15	222	44	0.21	0.18-0.24
Neoplasm, unspecified	613	123	0.20	0.19-0.22	893	179	0.22	0.20-0.23	196	39	0.20	0.17-0.23	169	34	0.17	0.14-0.19	248	50	0.24	0.21-0.27	280	56	0.26	0.23-0.29
Malignant	164	33	0.05	0.05-0.06	204	41	0.05	0.04-0.06	65	13	0.07	0.05-0.08	47	9	0.05	0.03-0.06	52	10	0.05	0.04-0.07	40	8	0.04	0.03-0.05
Non-Malignant	449	90	0.15	0.13-0.16	689	138	0.17	0.15-0.18	131	26	0.13	0.11-0.16	122	24	0.12	0.10-0.14	196	39	0.19	0.16-0.22	240	48	0.22	0.20-0.25
All other	20	4	0.01	0.00-0.01	24	5	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
TOTAL g	16,941	3,388	5.54	5.46-5.63	24,002	4,800	5.81	5.73-5.88	6,011	1,202	6.02	5.87-6.18	5,306	1,061	5.19	5.05-5.33	5,624	1,125	5.44	5.30-5.80	7,061	1,412	6.59	6.44-6.75
Malignant	11,589	2,318	3.79	3.72-3.84	14,337	2,867	3.48	3.43-3.54	4,548	910	4.55	4.42-4.69	3,747	749	3.66	3.55-3.78	3,294	659	3.19	3.09-3.30	2,748	550	2.57	2.47-2.67
Non-Malignant	5,352	1,070	1.75	1.71-3.86	9,665	1,933	2.32	2.28-2.37	1,463	293	1.47	1.39-1.55	1,559	312	1.53	1.45-1.61	2,330	466	2.24	2.15-2.34	4,313	863	4.02	3.90-4.15

^aAnnual average cases are calculated by dividing the five year total by five.

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

^cICD-O-3 histology codes: 9470/3, 9471/3, 9472/3, 9474/3.

^dICD-O-3 histology code: 9473/3.

^eICD-O-3 histology code: 9508/3.

fICD-O-3 histology codes: 8963/3, 9364/3, 9480/3, 9490/0, 9490/3, 9500/3, 9501/3, 9502/3.

^gRefers to all brain tumors including histologies not presented in this table.

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

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.

Table 5.

Annual Average Age-Adjusted Incidence Rates^a for Brain and Other Central Nervous System Tumors by Age, Behavior, and Central Cancer Registry, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

State	0-19 Years						20+ Years						All Ages
	Malignant		Non-Malignant		All Tumors		Malignant		Non-Malignant		All Tumors		Malignant		Non-Malignant		All Tumors
	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI
Alabama	3.26	2.83-3.74	1.17	0.92-1.47	4.43	3.92-4.99	8.41	8.00-8.30	13.48	12.95-14.02	21.88	21.21-22.57	6.93	6.61-7.26	9.95	9.56-10.34	16.88	16.38-17.39
Alaska	2.92	1.98-4.15	4.08	2.94-5.52	7.00	5.49-8.81	8.67	7.46-10.03	22.16	20.16-24.31	30.84	28.47-33.34	7.02	6.11-8.04	16.98	15.50-18.55	24.00	22.25-25.84
Arizona	3.13	2.78-3.52	2.41	2.10-2.75	5.54	5.07-6.05	8.57	8.21-8.94	19.53	18.98-20.09	28.10	27.43-28.77	7.01	6.73-7.29	14.62	14.21-15.03	21.63	21.13-22.13
Arkansas	3.41	2.86-4.04	2.39	1.93-2.93	5.80	5.08-6.61	8.98	8.43-9.54	16.43	15.68-17.21	25.41	27.43-28.77	7.38	6.96-7.82	12.40	11.85-12.97	19.78	19.09-20.50
California	3.02	2.87-3.17	1.92	1.80-2.04	4.94	4.75-5.13	8.11	7.96-8.27	19.63	19.39-19.87	27.74	27.46-28.03	6.65	6.54-6.77	14.55	14.38-14.72	21.20	20.99-21.41
Colorado	3.46	3.03-3.93	2.04	1.71-2.40	5.49	4.95-6.08	8.51	8.09-8.95	26.92	26.17-27.69	35.43	34.57-36.31	7.06	6.74-7.40	19.78	19.24-20.34	26.84	26.21-27.49
Connecticut	3.72	3.17-4.33	2.31	1.89-2.79	6.02	5.33-6.79	8.97	8.48-9.48	18.93	18.20-19.67	27.90	27.02-28.80	7.46	7.08-7.87	14.16	13.63-14.71	21.62	20.96-22.30
Delaware	3.99	2.92-5.32	2.78	1.90-3.93	6.77	5.35-8.46	8.13	7.22-9.13	16.46	15.14-17.85	24.59	22.98-26.28	6.94	6.21-7.73	12.53	11.56-13.57	19.48	18.25-20.76
District of Columbia	4.55	2.99-6.62	3.87	2.41-5.86	8.41	6.21-11.13	8.20	7.04-9.50	21.58	19.65-23.64	29.78	27.51-32.18	7.15	6.19-8.22	16.50	15.05-18.05	23.65	21.90-25.50
Florida	3.49	3.25-2.75	2.67	2.46-2.89	6.16	5.84-6.49	8.41	8.21-8.61	22.30	21.90-22.56	30.64	30.26-31.03	7.00	6.84-7.16	16.62	16.38-16.86	23.62	23.33-23.91
Georgia	3.40	3.10-3.72	2.24	2.00-2.51	5.64	5.25-6.05	7.99	7.69-8.29	23.18	22.66-23.70	31.16	30.57-31.76	6.67	6.44-6.91	17.17	16.80-17.55	23.84	23.40-24.28
Hawaii	2.12	1.48-2.94	1.55	1.01-2.28	3.67	2.81-4.71	5.72	5.10-6.39	17.60	16.49-18.77	23.32	22.03-24.66	4.69	4.20-5.21	13.00	12.18-13.85	17.68	16.73-18.67
Idaho	3.27	2.59-4.08	1.46	1.01-2.04	4.73	3.90-5.69	8.65	7.90-9.45	18.63	17.51-19.80	27.28	25.93-28.68	7.11	6.54-7.71	13.70	12.89-14.55	20.81	19.81-21.84
Illinois	3.28	3.01-3.56	2.48	2.25-2.73	5.76	5.40-6.13	8.64	8.38-8.91	21.85	21.43-22.28	30.49	30.00-30.99	7.10	6.90-7.31	16.30	15.99-16.61	23.40	23.03-23.77
Indiana	3.75	3.36-4.18	2.40	2.09-2.74	6.15	5.64-6.68	8.95	8.58-9.34	19.66	19.10-20.23	28.61	27.94-29.29	7.46	7.17-7.76	14.71	14.30-15.12	22.17	21.66-22.68
Iowa	3.96	3.38-4.62	3.50	2.95-4.12	7.46	6.65-8.35	9.51	8.96-10.08	22.90	22.03-23.79	32.41	31.38-33.46	7.92	7.49-8.36	17.33	16.69-17.99	25.25	24.48-26.06
Kansas	3.52	2.97-4.15	2.29	1.85-2.81	5.81	5.09-6.60	9.21	8.64-9.80	18.82	18.00-19.68	28.03	27.02-29.06	7.58	7.14-8.03	14.08	13.48-14.70	21.66	20.91-22.42
Kentucky	4.23	3.71-4.80	3.04	2.60-3.52	7.27	6.59-8.01	9.67	9.21-10.16	26.87	26.08-17.68	36.55	35.63-37.48	8.11	7.75-8.49	20.03	19.46-20.36	28.15	27.46-28.85
Louisiana	3.67	3.21-4.18	2.03	1.69-2.42	5.70	5.12-6.33	7.72	7.30-8.15	21.69	20.99-22.42	29.41	28.59-30.25	6.56	6.23-6.90	16.05	15.54-16.58	22.61	22.00-23.24
Maine	3.81	2.88-4.94	1.52	0.97-2.26	5.32	4.22-6.62	9.73	8.92-10.6	15.12	14.08-16.22	24.85	23.53-26.24	8.03	7.39-8.72	11.22	10.46-12.02	19.25	18.25-20.30
Maryland	3.45	3.05-3.90	1.46	1.20-1.76	4.92	4.43-5.44	8.33	7.95-8.72	18.37	17.80-18.95	26.70	26.01-27.40	6.93	6.64-7.24	13.52	13.11-13.92	20.45	19.94-20.97
Massachusetts	3.94	3.51-4.40	2.25	1.93-2.60	6.18	5.65-6.75	8.91	8.55-9.28	15.53	15.06-16.02	24.44	23.85-25.06	7.49	7.20-7.78	11.72	11.37-12.08	19.21	18.75-19.67
Michigan	3.59	3.27-3.94	1.93	1.70-2.18	5.52	5.12-5.94	8.54	8.24-8.83	18.87	18.43-19.31	27.40	26.88-27.94	7.12	6.89-7.35	14.01	13.69-14.33	21.12	20.73-21.52
Minnesota	3.89	3.45-4.38	1.79	1.50-2.13	5.68	5.14-6.26	9.25	8.83-9.68	14.77	14.24-15.32	24.02	23.34-24.71	7.71	7.38-8.05	11.05	10.66-11.45	18.76	18.25-19.28
Mississippi	2.94	2.44-3.50	2.69	2.21-3.24	5.62	4.93-6.39	8.60	8.06-9.17	18.70	17.89-19.54	29.53	26.32-28.31	6.98	6.56-7.41	14.11	13.51-14.72	21.08	20.36-21.83
Missouri	3.78	3.36-4.23	1.70	1.43-2.02	5.48	4.98-6.02	8.60	8.23-8.99	20.93	20.34-21.54	29.53	28.83-30.25	7.22	6.93-7.52	15.42	14.99-15.58	22.63	22.11-23.16
Montana	2.55	1.74-3.60	1.56	0.95-2.41	4.10	3.06-5.38	10.16	9.18-11.22	18.80	17.44-20.23	28.96	27.28-30.72	7.98	7.24-8.78	13.85	12.87-14.89	21.83	20.59-23.13
Nebraska	4.34	3.58-5.23	3.51	2.82-4.31	7.85	6.81-9.01	9.26	8.55-10.01	15.66	14.30-16.64	24.92	23.75-26.14	7.85	7.30-8.43	12.17	11.48-12.90	20.02	19.13-20.95
Nevadab	2.46	1.93-3.10	1.40	1.00-1.90	3.86	3.18-4.64	7.60	7.01-8.22	11.90	11.15-12.68	19.50	18.54-20.49	6.12	5.67-6.60	8.89	8.34-9.46	15.01	14.30-15.75
New Hampshire	4.83	3.78-6.08	2.55	1.84-3.44	7.38	6.09-8.86	9.42	8.60-10.29	16.82	15.71-18.00	26.24	24.85-27.69	8.10	7.44-8.81	12.73	11.90-13.60	20.83	19.77-21.94
New Jersey	3.80	3.45-4.18	2.64	2.35-2.96	6.44	5.99-6.93	9.29	8.97-9.62	20.98	20.49-21.47	30.27	29.69-30.86	7.72	7.46-7.97	15.72	15.36-16.08	23.43	23.00-23.88
New Mexico	2.54	1.98-3.19	1.59	1.16-2.12	4.12	3.41-4.94	6.88	6.31-7.48	18.10	17.15-19.09	24.98	23.87-26.13	5.63	5.19-6.10	13.36	12.67-14.08	18.99	18.17-19.84
New York	3.81	3.57-4.07	3.41	3.18-3.65	7.22	6.89-7.57	8.63	8.42-8.85	24.37	24.02-24.73	33.00	32.59-33.42	7.25	7.08-7.42	18.36	18.10-18.52	25.61	25.30-25.92
North Carolina	3.16	2.86-3.49	2.10	1.85-2.36	5.26	4.87-5.67	8.45	8.16-8.76	21.62	21.14-22.10	30.07	29.51-30.64	6.94	6.71-7.17	16.02	15.67-16.37	22.95	22.54-23.38
North Dakota	2.17	1.32-3.36	--	--	3.70	2.56-5.18	8.74	7.66-9.95	15.26	13.76-16.88	24.01	22.14-25.99	6.86	6.04-7.76	11.32	10.23-12.50	18.18	16.80-19.64
Ohio	3.75	3.45-4.08	2.49	2.24-2.75	6.24	5.85-6.65	8.70	8.43-8.97	17.08	16.70-17.48	25.78	25.31-26.26	7.28	7.07-7.50	12.90	12.61-13.19	20.18	19.82-20.54
Oklahoma	3.14	2.68-3.66	2.19	1.80-2.63	5.33	4.72-5.99	8.59	8.12-9.08	18.90	18.18-19.64	27.49	26.63-28.37	7.03	6.66-7.41	14.11	13.58-14.64	21.13	20.49-21.79
Oregon	3.60	3.08-4.18	2.48	2.06-2.97	6.08	5.40-6.82	9.71	9.22-10.22	15.68	15.04-16.33	25.38	24.58-26.21	7.95	7.57-8.35	11.89	11.34-12.38	19.85	19.24-20.47
Pennsylvania	4.28	3.96-4.62	2.28	2.05-2.53	6.56	6.16-6.97	9.30	9.04-9.57	23.38	22.96-23.81	32.69	32.19-33.19	7.86	7.65-8.08	17.33	17.02-17.64	25.19	24.82-25.57
Rhode Island	2.50	1.69-3.57	1.77	1.12-2.67	4.28	3.20-5.60	8.63	7.75-9.58	16.13	14.92-17.40	24.75	23.26-26.33	6.87	6.19-7.60	12.01	11.13-12.95	18.88	17.76-20.05
South Carolina	2.92	2.50-3.38	1.83	1.51-2.20	4.74	4.21-5.33	8.61	8.19-9.05	20.54	19.87-21.21	29.15	28.36-29.95	6.98	6.65-7.31	15.17	14.69-15.66	22.15	21.56-22.74
South Dakota	3.59	2.58-4.85	1.87	1.17-2.84	5.46	4.20-6.98	9.24	8.20-10.37	18.59	17.08-20.20	27.83	25.99-29.77	7.62	6.82-8.49	13.79	12.69-14.96	21.41	20.04-22.85
Tennessee	3.59	3.19-4.02	2.71	2.37-3.09	6.30	5.77-6.86	8.37	8.01-8.74	23.52	22.91-24.14	31.89	31.19-32.61	7.00	6.72-7.29	17.55	17.11-18.01	24.55	24.02-25.09
Texas	3.59	3.40-3.78	2.43	2.27-2.59	6.01	5.77-6.26	8.40	8.21-8.61	23.50	23.17-23.83	31.90	31.52-32.28	7.02	6.87-7.17	17.45	17.22-17.69	24.47	24.20-24.76
Utah	2.91	2.46-4.43	2.85	2.38-3.38	5.76	5.10-6.48	9.52	8.87-10.20	30.90	29.71-32.11	40.42	39.06-41.81	7.63	7.14-8.13	22.85	21.99-23.73	30.48	29.49-31.48
Vermont	2.30	1.31-3.74	3.23	2.08-4.79	5.53	3.96-7.52	9.88	8.67-11.22	22.36	20.50-24.35	32.24	30.01-34.60	7.71	6.79-8.72	16.87	15.50-18.34	24.58	22.91-26.34
Virginia	3.15	2.82-3.51	1.67	1.44-1.94	4.83	4.41-5.27	8.18	7.86-8.51	16.65	16.19-17.11	24.83	24.27-25.40	6.74	6.49-7.00	12.35	12.02-12.69	19.09	18.68-19.52
Washington	3.92	3.52-4.35	3.35	2.98-3.75	7.27	6.72-7.85	9.58	9.21-9.97	29.02	28.36-29.70	38.60	37.84-39.38	7.96	7.66-8.26	21.66	21.17-22.15	29.61	29.05-30.19
West Virginia	3.83	3.04-4.75	2.22	1.64-2.94	6.05	5.06-7.18	8.39	7.75-9.07	16.52	15.61-17.48	24.91	23.79-26.07	7.08	6.56-7.62	12.42	11.74-13.13	19.50	18.65-20.38
Wisconsin	3.54	3.12-3.99	2.46	2.11-2.84	5.99	5.45-6.58	9.67	9.26-10.09	23.51	22.87-24.17	33.18	32.41-33.96	7.91	7.59-8.23	17.47	17.00-17.95	25.38	24.81-25.96
Wyoming	2.94	1.86-4.41	--	--	4.15	2.83-5.86	9.79	8.49-11.23	17.75	15.96-19.68	27.54	25.31-29.91	7.82	6.84-8.91	13.00	11.71-14.40	20.83	19.19-22.57
TOTAL	3.48	3.43-3.54	2.32	2.28-2.37	5.81	5.73-5.88	8.62	8.57-8.67	20.79	20.70-20.87	29.41	29.31-29.50	7.15	7.10-7.90	15.49	15.43-15.55	22.64	22.56-22.71

^aRates are per 100,000 and are age-adjusted to the 2000 United States standard population.

^bFor Nevada only, data was not available from 2011.

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.

Fig. 3.

Annual average Age-Adjusted Incidence Rates^a of Primary Brain and Other CNS Tumors by Age and Behavior, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Median Age at Diagnosis

The median age at diagnosis for all primary brain and other CNS tumors was 59 years (Table 3).

• The histology-specific median ages ranged from 9 years for embryonal tumors to 69 years for neoplasm, unspecified.

• Pilocytic astrocytoma, choroid plexus tumors, neuronal and mixed neuronal-glial tumors, tumors of the pineal region, embryonal tumors, and germ cell tumors and cysts were histologies with younger median ages at diagnosis compared to other histologies.

• Meningioma and glioblastoma were primarily diagnosed at older ages (median age of 66 and 64 years, respectively).

Incidence Rates by Year and Behavior

Figure 5 presents the overall annual age-adjusted incidence rates of all primary brain and other CNS tumors by year, 2010–2014, and behavior. The incidence rates for all primary brain and other CNS tumors, 2010–2014, did not differ significantly by year (both overall and by behavior).

Fig. 5.

Annual Age-Adjusted Incidence Rates^a of Primary Brain and Other CNS Tumors by Year and Behavior, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Distribution and Incidence Rates by CCR, Age, WHO Grade, Diagnostic Confirmation, and Behavior

The overall number of reported tumors is listed by CCR in Table 6. The annual average combined 2010–2014 pop ulation of 314,100,628 covered by the central cancer registries with data available for this report represents approximately 99.9% of the US population for those years. While most malignant tumors are diagnosed by histologic confirmation (where the patient receives surgery, and diagnosis is confirmed 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).

Table 6.

Characteristics of All Brain and Other Central Nervous System Tumors by Central Cancer Registry and Behavior, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

State	Five -Year Total	Annual Average	Total		Malignant				Non-Malignant				Annual Average 2010-2014 Population
			Histologically Confirmed (%)	Radio- graphically Confirmed (%)	Five-Year Total	% Malignant	Histologically Confirmed (%)	Radio- graphically Confirmed (%)	Five-Year Total	% Non-Malignant	Histologically Confirmed (%)	Radio- graphically Confirmed (%)
Alabama	4,486	897	70.1%	25.6%	1,836	40.9%	85.6%	5.9%	2,650	59.1%	59.3%	39.2%	4,815,860
Alaska	811	162	49.9%	47.2%	241	29.7%	80.9%	14.1%	570	70.3%	36.8%	61.2%	728,491
Arizona	7,634	1,527	59.7%	34.6%	2,488	32.6%	81.9%	8.7%	5,146	67.4%	48.9%	47.2%	6,557,957
Arkansas	3,190	638	59.5%	35.6%	1,200	37.6%	79.1%	12.8%	1,990	62.4%	47.7%	49.4%	2,947,045
California	40,952	8,190	62.1%	33.7%	12,880	31.5%	86.6%	8.8%	28,072	68.5%	50.8%	45.2%	38,059,317
Colorado	7,055	1,411	49.9%	47.3%	1,865	26.4%	82.0%	12.1%	5,190	73.6%	38.3%	60.0%	5,197,237
Connecticut	4,303	861	67.0%	31.2%	1,476	34.3%	86.8%	10.8%	2,827	65.7%	56.7%	41.9%	3,590,989
Delaware	992	198	68.4%	28.2%	349	35.2%	84.0%	10.6%	643	64.8%	60.0%	37.8%	917,225
District of Columbia	723	145	63.3%	33.1%	215	29.7%	87.9%	5.1%	508	70.3%	53.0%	44.9%	634,063
Florida	27,412	5,482	55.4%	41.4%	7,989	29.1%	86.0%	9.9%	19,423	70.9%	42.9%	54.4%	19,361,496
Georgia	11,699	2,340	54.0%	42.0%	3,285	28.1%	85.4%	11.3%	8,414	71.9%	41.8%	54.0%	9,906,413
Hawaii	1,372	274	56.6%	35.1%	362	26.4%	85.4%	8.6%	1,010	73.6%	46.2%	44.7%	1,392,774
Idaho	1,714	343	64.3%	32.6%	596	34.8%	83.9%	12.6%	1,118	65.2%	53.8%	43.3%	1,599,762
Illinois	15,870	3,174	58.3%	39.6%	4,798	30.2%	87.9%	8.5%	11,072	69.8%	45.4%	53.0%	12,870,013
Indiana	7,705	1,541	54.7%	42.2%	2,583	33.5%	85.4%	11.3%	5,122	66.5%	39.1%	57.8%	6,542,823
Iowa	4,300	860	58.1%	39.7%	1,351	31.4%	86.4%	11.0%	2,949	68.6%	45.1%	52.9%	3,078,885
Kansas	3,304	661	58.5%	38.3%	1,166	35.3%	85.8%	10.0%	2,138	64.7%	43.5%	53.7%	2,882,432
Kentucky	6,673	1,335	48.8%	46.8%	1,926	28.9%	80.0%	13.4%	4,747	71.1%	36.2%	60.4%	4,381,921
Louisiana	5,416	1,083	60.6%	35.7%	1,576	29.1%	86.3%	9.6%	3,840	70.9%	50.0%	46.4%	4,600,098
Maine	1,520	304	63.7%	33.2%	633	41.6%	84.8%	10.6%	887	58.4%	48.6%	49.3%	1,328,775
Maryland	6,406	1,281	66.7%	28.8%	2,146	33.5%	87.3%	6.1%	4,260	66.5%	56.3%	40.3%	5,886,941
Massachusetts	7,106	1,421	71.7%	25.5%	2,720	38.3%	88.6%	7.4%	4,386	61.7%	61.3%	36.8%	6,659,709
Michigan	11,601	2,320	61.4%	35.1%	3,887	33.5%	86.0%	8.5%	7,714	66.5%	49.1%	48.5%	9,891,530
Minnesota	5,394	1,079	80.8%	15.0%	2,195	40.7%	92.3%	4.0%	3,199	59.3%	73.0%	22.5%	5,383,426
Mississippi	3,298	660	62.5%	33.9%	1,096	33.2%	85.0%	11.1%	2,202	66.8%	51.2%	45.2%	2,983,679
Missouri	7,498	1,500	55.6%	40.4%	2,387	31.8%	86.9%	8.0%	5,111	68.2%	41.0%	55.5%	6,027,928
Montana	1,251	250	56.3%	40.4%	455	36.4%	86.2%	10.1%	796	63.6%	39.2%	57.8%	1,006,240
Nebraska	1,972	394	61.2%	35.5%	776	39.4%	84.0%	9.9%	1,196	60.6%	46.4%	52.2%	1,856,132
Nevadab	1,751	350	65.6%	28.4%	719	41.1%	83.9%	5.6%	1,032	58.9%	52.9%	44.3%	2,761,156
New Hampshire	1,547	309	69.7%	28.1%	598	38.7%	89.3%	7.4%	949	61.3%	57.4%	41.1%	1,321,420
New Jersey	11,354	2,271	61.4%	33.9%	3,693	32.5%	87.7%	9.3%	7,661	67.5%	48.7%	45.8%	8,873,587
New Mexico	2,125	425	64.5%	30.7%	640	30.1%	87.3%	8.3%	1,485	69.9%	54.6%	40.4%	2,080,043
New York	27,196	5,439	55.2%	42.3%	7,616	28.0%	86.4%	11.6%	19,580	72.0%	43.1%	54.3%	19,594,599
North Carolina	12,014	2,403	59.8%	36.7%	3,630	30.2%	85.8%	9.9%	8,384	69.8%	48.5%	48.3%	9,748,569
North Dakota	686	137	59.0%	37.8%	265	38.6%	85.3%	10.6%	421	61.4%	42.5%	54.9%	705,157
Ohio	12,908	2,582	65.2%	30.3%	4,659	36.1%	82.9%	8.5%	8,249	63.9%	55.1%	42.7%	11,561,444
Oklahoma	4,285	857	51.7%	44.7%	1,438	33.6%	79.8%	12.2%	2,847	66.4%	37.5%	61.1%	3,819,383
Oregon	4,286	857	69.7%	26.6%	1,731	40.4%	85.4%	7.2%	2,555	59.6%	59.1%	39.8%	3,901,031
Pennsylvania	18,520	3,704	54.6%	41.6%	5,696	30.8%	83.5%	10.8%	12,824	69.2%	41.8%	55.2%	12,761,462
Rhode Island	1,130	226	69.2%	29.1%	404	35.8%	91.1%	5.7%	726	64.2%	57.0%	42.1%	1,053,046
South Carolina	5,768	1,154	55.3%	38.1%	1,825	31.6%	84.3%	8.9%	3,943	68.4%	41.9%	51.7%	4,725,525
South Dakota	969	194	56.2%	40.0%	349	36.0%	84.0%	11.7%	620	64.0%	40.6%	56.0%	834,759
Tennessee	8,596	1,719	54.5%	43.1%	2,450	28.5%	86.5%	9.7%	6,146	71.5%	41.8%	56.4%	6,450,874
Texas	30,546	6,109	52.4%	41.3%	8,923	29.2%	81.3%	13.0%	21,623	70.8%	40.5%	53.0%	26,093,664
Utah	3,783	757	57.7%	41.2%	974	25.7%	86.4%	12.1%	2,809	74.3%	47.7%	51.3%	2,859,278
Vermont	879	176	58.8%	39.6%	276	31.4%	93.1%	5.8%	603	68.6%	43.1%	55.1%	626,593
Virginia	8,288	1,658	65.8%	30.3%	2,894	34.9%	85.6%	6.9%	5,394	65.1%	55.2%	42.9%	8,185,183
Washington	10,839	2,168	50.8%	46.1%	2,924	27.0%	85.2%	11.1%	7,915	73.0%	38.1%	59.0%	6,900,006
West Virginia	2,119	424	60.7%	36.2%	763	36.0%	88.2%	7.7%	1,356	64.0%	45.3%	52.3%	1,853,438
Wisconsin	7,970	1,594	55.4%	41.7%	2,489	31.2%	86.1%	10.0%	5,481	68.8%	41.4%	56.1%	5,725,886
Wyoming	632	126	67.6%	31.8%	241	38.1%	85.9%	13.3%	391	61.9%	56.3%	43.2%	575,360
TOTAL	379,848	75,970	58.6%	37.6%	119,674	31.5%	85.4%	11.4%	260,174	68.5%	46.3%	50.4%	314,100,628

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

^bCases and estimated population is for 2010, and 2012-2014 only.

-Counts 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.

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.

• Approximately 69% of tumors were non-malignant, but there was variation by cancer registry (range: 58.4%-74.3%).

• Overall, a larger proportion of malignant tumors were histologically confirmed (84.5%) compared to non-malignant tumors (46.3%).

• A slight majority of non-malignant brain and other CNS tumors were radiographically confirmed (50.4%).

The overall annual average age-adjusted incidence rates by age, behavior, and CCR are presented in Table 5, Figures 6A and 6B.

Fig. 6.

Annual average Age-Adjusted Incidence Ratesa of A. Malignant Primary Brain and Other CNS Tumors by Central Cancer Registry, and B. Non-Malignant Primary Brain and Other CNS Tumors by Central Cancer Registry, CBTRUS Statistical Report: NPCR and SEER, 2010-2014^b

• There was less variation by region for malignant tumor incidence rates compared to incidence rates for non-malignant tumors. CCR and regional variations likely reflect differences in reporting and case ascertainment practices.

• The overall annual average age-adjusted incidence rates of all tumors (malignant and non-malignant) for each individual CCR ranged from 15.01 to 30.48 per 100,000 population. Please see Supplementary Figure 4 for combined incidence of malignant and non-malignant tumors by CCR.

• Annual average age-adjusted incidence rates of all primary malignant tumors ranged from 4.69 to 8.11 per 100,000 population, and annual average age-adjusted incidence rates of all primary non-malignant tumors ranged from 8.89 to 22.85 per 100,000 population.

• Among adults 20 years of age and older, CCR-specific incidence rates ranged from 5.72 to 10.16 per 100,000 population for malignant tumors and from 11.90 to 30.90 per 100,000 population for non-malignant tumors.

• In persons less than 20 years of age, incidence rates listed ranged from 2.12 to 4.83 per 100,000 population for malignant tumors and from 1.17 to 4.08 per 100,000 population for non-malignant tumors.

Distribution of Tumors in Puerto Rico

The distribution of brain and other CNS tumors diagnosed in Puerto Rico by histology is shown in online Supplementary Figure 5.

• Approximately 42% of tumors were malignant, and 58% were non-malignant.

• Non-malignant meningioma was the most common tumor type (26.7%), followed by glioblastoma (17.0%).

Primary Brain and Other CNS Tumors: Incidence by Site, Histology, WHO Grade, Sex, Race, Hispanic Ethnicity, and Age

Distribution of Tumors by Site and Histology

The distribution of brain and other CNS tumors by site is shown in Figures 7A–C.

Fig. 7.

Distribution^a of A. All Primary Brain and Other CNS Tumors by Site (N=379,848), B. Malignant Primary Brain and Other CNS Tumors by Site (N=119,674), and C. Non-Malignant Primary Brain and Other CNS Tumors by Site (N=260,174), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

• Overall, the most common tumor site was the meninges, representing 36.8% of all tumors.

• Frontal (8.3%), temporal (6.1%), parietal (3.7%), and occipital lobes (1.0%) accounted for 19.1% of all tumors.

• Tumors with locations coded as cerebrum (not including frontal, temporal, parietal, and occipital lobes), ventricle, cerebellum, and brain stem tumors accounted for 6.8% of all tumors.

• Brain stem tumors accounted for 1.6% of all tumors and 3.8% of all malignant tumors.

• The cranial nerves and the spinal cord/cauda equina accounted for 10.1% of all tumors.

• The pituitary and craniopharyngeal duct accounted for 17.3% of all tumors.

• For malignant tumors, frontal (23.7%), temporal (17.4%), parietal (10.5%), and occipital (2.7%) lobes accounted for 54.3% of tumors.

• For non-malignant tumors, 52.9% of all occurred in the meninges.

Distribution of brain and other CNS tumors by site in males only is shown in Supplementary Figures 6A-C, and distribution of brain and other CNS tumors by site in females only is shown in Supplementary Figures 7A-C.

The distribution by brain and other CNS histologies is shown in Figure 8A.

Fig. 8.

Distribution^a of A. All Primary Brain and Other CNS Tumors by CBTRUS Histology Groupings and Histology (N=379,848), B. Malignant Primary Brain and Other CNS Tumors by CBTRUS Histology Groupings and Histology (N=119,674), and C. Non-Malignant Primary Brain and Other CNS Tumors by CBTRUS Histology Groupings and Histology (N=260,174), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

• The most frequently reported histology overall was meningioma (36.8%), followed by tumors of the pituitary (16.2%) and glioblastoma (14.9%).

• Tumors of the pituitary and nerve sheath tumors combined accounted for slightly less than one-fourth of all tumors (24.6%), the vast majority of which were non-malignant.

The distribution of malignant and non-malignant brain and other CNS tumors by histology are shown in Figures 8B and 8C, respectively, as well as in Table 3.

• The most common of all malignant CNS tumors was glioblastoma (47.1%).

• The most common of all non-malignant tumors was meningioma (53.0%).

• The most common non-malignant nerve sheath tumor (based on multiple sites in the brain and other CNS) was vestibular schwannomas (defined by histology code 9560, also formerly called acoustic neuromas) (95.2%).

Distribution of brain and other CNS tumors by histology in males only is shown in Supplementary Figures 8A-C, and distribution of brain and other CNS tumors by histology in females only is shown in Supplementary Figures 9A-C.

The broad category glioma (ICD-O-3 histology codes 9380–9384, 9391–9460, please see Table 2 for more information) represents approximately 26.5% of all primary brain and other CNS tumors (Figure 8A) and 80.7% of malignant tumors (Figure 8B). The distribution of gliomas by histology and site are shown in Figures 9 and 10, respectively.

Fig. 9.

Distribution^a of Primary Brain and Other CNS Gliomas^b by Histology Subtypes (N=100,619), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Fig. 10.

Distribution of Primary Brain and Other CNS Gliomas^a by Site (N=100,619), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

• Glioblastoma accounted for the majority of gliomas (56.1%).

• Other astrocytomas and glioblastoma combined accounted for about 75.5% of all gliomas.

• The majority of gliomas occurred in the frontal, temporal, parietal, and occipital lobes combined (60.8%). Only a very small proportion of gliomas occurred outside the brain.

The distribution of reported tumors with histologically confirmed diagnosis from 2011 to 2014 is listed by histology and reported WHO grade in Table 7. The WHO Classification of Tumours of the Central Nervous System designates a grading system for most histologic types, which correlates with predicted prognosis and malignancy of tumor. There are many reasons that this information may not be included in the patients record.¹⁷ It is not possible to conclusively determine WHO grade, which is based on the appearance of tumor cells, when a tumor is radiograph ically confirmed only. Some tumor types (including tumors of the pituitary and lymphomas) are not assigned a grade within the WHO system. This information may also be assigned but not included in the pathology report.

Table 7.

Distribution of Histologically Confirmed Brain and Other Central Nervous System Tumors by WHO Grade and Major Histology Grouping, CBTRUS Statistical Report: NPCR and SEER, 2011-2014

Histology	Number of newly diagnosed tumors	Histologically Confirmed	Complete WHO grade Information a	Assigned Grade
				Grade I	Grade II	Grade III	Grade IV
Tumors of Neuroepithelial Tissue	87,651	89.4%	84.5%	10.9%	14.7%	13.8%	60.7%
Pilocytic astrocytoma	4,168	92.5%	85.3%	92.8%	6.1%	0.8%	0.4%
Diffuse astrocytoma	6,006	92.4%	85.9%	4.3%	60.1%	21.1%	14.6%
Anaplastic astrocytoma	5,310	99.4%	94.1%	0.1%	1.1%	90.0%	8.8%
Unique astrocytoma variants	908	77.5%	77.7%	25.4%	54.7%	15.5%	4.4%
Malignant	619	87.1%	78.7%	4.2%	70.0%	20.0%	5.7%
Non-Malignant	289	57.1%	74.5%	98.4%	1.6%	0.0%	0.0%
Glioblastoma	45,613	93.1%	86.3%	0.2%	0.2%	1.0%	98.7%
Oligodendroglioma	2,924	96.3%	92.8%	1.6%	85.3%	6.5%	6.5%
Anaplastic oligodendroglioma	1,394	99.2%	95.2%	0.2%	3.0%	87.8%	9.0%
Oligoastrocytic tumors	2,350	99.6%	95.4%	0.9%	51.3%	39.5%	8.4%
Ependymal tumors	5,421	90.4%	83.7%	35.0%	50.2%	14.1%	0.7%
Malignant	3,215	94.0%	87.6%	2.9%	74.3%	21.8%	1.0%
Non-Malignant	2,206	85.0%	77.4%	93.5%	6.3%	0.1%	0.1%
Glioma malignant, NOS	5,872	32.4%	49.9%	23.8%	27.4%	21.1%	27.7%
Choroid plexus tumors	640	87.7%	73.8%	65.0%	17.6%	16.7%	0.7%
Malignant	105	97.1%	80.4%	8.5%	3.7%	84.1%	3.7%
Non-Malignant	535	85.8%	72.3%	78.9%	21.1%	0.0%	0.0%
Other neuroepithelial tumors	78	94.9%	45.9%	5.9%	55.9%	26.5%	11.8%
Malignant	51	100.0%	33.3%	5.9%	17.6%	52.9%	23.5%
Non-Malignant	27	85.2%	73.9%	5.9%	94.1%	0.0%	0.0%
Neuronal and mixed neuronal-glial tumors	3,576	93.6%	61.6%	79.4%	15.9%	3.9%	0.8%
Malignant	735	98.5%	15.1%	17.4%	7.3%	64.2%	11.0%
Non-Malignant	2,841	92.3%	74.5%	82.8%	16.4%	0.6%	0.2%
Tumors of the pineal region	586	75.8%	70.0%	23.8%	22.2%	15.4%	38.6%
Malignant	319	94.7%	75.2%	2.2%	24.7%	20.3%	52.9%
Non-Malignant	267	53.2%	59.2%	82.1%	15.5%	2.4%	0.0%
Embryonal tumors	2,805	98.1%	72.5%	1.3%	0.2%	1.3%	97.3%
Tumors of Cranial and Spinal Nerves	26,038	51.6%	32.0%	99.0%	0.5%	0.3%	0.2%
Nerve sheath tumors	26,016	51.6%	32.1%	99.0%	0.5%	0.3%	0.2%
Malignant	183	83.1%	19.1%	55.2%	10.3%	24.1%	10.3%
Non-Malignant	25,833	51.4%	32.2%	99.3%	0.4%	0.1%	0.1%
Other tumors of cranial and spinal nerves	22	45.5%	10.0%	100.0%	0.0%	0.0%	0.0%
Tumors of Meninges	116,086	43.3%	77.2%	81.1%	16.8%	2.0%	0.2%
Meningioma	112,582	42.0%	79.0%	81.3%	16.9%	1.7%	0.1%
Malignant	1,416	79.2%	81.8%	24.4%	16.0%	58.3%	1.3%
Non-Malignant	111,166	41.5%	78.9%	82.7%	17.0%	0.2%	0.1%
Mesenchymal tumors	1,074	71.2%	49.3%	8.2%	48.5%	37.7%	5.6%
Primary melanocytic lesions	95	91.6%	11.5%	60.0%	20.0%	10.0%	10.0%
Other neoplasms related to the meninges	2,335	92.2%	50.9%	98.8%	0.8%	0.1%	0.3%
Lymphomas and Hematopoietic Neoplasms	6,186	93.9%	4.6%	100.0%	0.0%	0.0%	0.0%
Lymphoma	5,991	94.0%	4.7%	100.0%	0.0%	0.0%	0.0%
Other hematopoietic neoplasms	195	90.3%	0.6%	100.0%	0.0%	0.0%	0.0%
Germ Cell Tumors and Cysts	1,174	81.9%	3.7%	19.4%	16.7%	13.9%	50.0%
Germ cell tumors, cysts and heterotopias	1,174	81.9%	3.7%	19.4%	16.7%	13.9%	50.0%
Malignant	790	89.0%	4.6%	9.4%	16.7%	15.6%	56.3%
Non-Malignant	384	67.2%	1.6%	100.0%	0.0%	0.0%	0.0%
Tumors of Sellar Region	52,116	51.2%	7.5%	96.5%	2.1%	0.3%	1.2%
Tumors of the pituitary	49,750	49.7%	4.8%	94.8%	2.8%	0.4%	1.9%
Malignant	143	65.0%	7.5%	71.4%	0.0%	0.0%	28.6%
Non-Malignant	49,607	49.6%	4.8%	94.9%	2.9%	0.4%	1.8%
Craniopharyngioma	2,366	83.6%	40.3%	99.0%	0.9%	0.1%	0.0%
Unclassified Tumors	16,622	17.5%	6.3%	66.7%	7.1%	11.5%	14.8%
Hemangioma	4,981	28.4%	3.3%	95.7%	0.0%	2.1%	2.1%
Neoplasm, unspecified	11,553	12.6%	8.7%	55.9%	10.2%	14.2%	19.7%
Malignant	5,303	9.0%	10.9%	17.3%	7.7%	28.8%	46.2%
Non-Malignant	6,250	15.7%	7.6%	82.7%	12.0%	4.0%	1.3%
All other	88	45.5%	22.5%	66.7%	0.0%	22.2%	11.1%
TOTAL	305,873	58.4%	62.7%	40.5%	14.6%	8.9%	36.1%
Malignant	96,062	85.3%	77.8%	6.7%	14.7%	15.4%	63.2%
Non-Malignant	209,811	46.0%	49.8%	85.2%	14.4%	0.3%	0.1%

^aCompleteness 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.

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, 62.7% of tumors had complete WHO grade information, but there was substantial variation by histology.

• The histologic types with the highest WHO grade completeness were anaplastic oligodendroglioma (95.2%) and oligoastrocytic tumors (95.4%).

Incidence Rates by Site and Sex

Incidence counts and annual average age-adjusted rates for brain and other CNS tumors by site and sex are provided in Table 8.

Table 8.

Five-Year Total, Annual Average Total^a, and Annual Average Age-Adjusted Incidence Rates^b for Brain and Other Central Nervous System Tumors by Site^c and Sex, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

ICD-O-3 Code	Site	Total				Male				Female
		Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI
C71.1-C71.4	Frontal, temporal, parietal, and occipital lobes of the brain	72,447	14,489	4.28	4.25-4.31	40,337	8,067	5.06	5.01-5.11	32,110	6,422	3.60	3.56-3.64
	C71.1 - Frontal lobe	31,378	6,276	1.87	1.85-1.90	16,692	3,338	2.11	2.07-2.14	14,686	2,937	1.67	1.64-1.70
	C71.2 - Temporal lobe	23,298	4,660	1.37	1.35-1.39	13,866	2,773	1.73	1.70-1.76	9,432	1,886	1.05	1.03-1.08
	C71.3 - Parietal lobe	13,971	2,794	0.81	0.80-0.83	7,644	1,529	0.95	0.93-0.98	6,327	1,265	0.69	0.68-0.71
	C71.4 - Occipital lobe	3,800	760	0.22	0.21-0.23	2,135	427	0.27	0.26-0.28	1,665	333	0.18	0.17-0.19
C71.0	Cerebrum	6,662	1,332	0.41	0.40-0.42	3,543	709	0.45	0.44-0.47	3,119	624	0.37	0.35-0.38
C71.5	Ventricle	4,161	832	0.27	0.26-0.27	2,263	453	0.29	0.28-0.30	1,898	380	0.24	0.23-0.25
C71.6	Cerebellum	8,614	1,723	0.55	0.54-0.57	4,584	917	0.60	0.58-0.62	4,030	806	0.51	0.49-0.53
C71.7	Brain stem	5,932	1,186	0.39	0.38-0.40	3,191	638	0.42	0.40-0.43	2,741	548	0.36	0.34-0.37
C71.8-C71.9	Other brain	33,621	6,724	1.99	1.97-2.01	17,562	3,512	2.24	2.21-2.28	16,059	3,212	1.77	1.74-1.80
C72.0-C72.1	Spinal cord and cauda equina	11,722	2,344	0.72	0.71-0.73	6,021	1,204	0.76	0.74-0.78	5,701	1,140	0.68	0.66-0.70
C72.2-C72.5	Cranial nerves	26,549	5,310	1.56	1.55-1.58	12,585	2,517	1.55	1.52-1.57	13,964	2,793	1.59	1.56-1.62
C72.8-C72.9	Other nervous system	2,380	476	0.14	0.14-0.15	1,228	246	0.16	0.15-0.17	1,152	230	0.13	0.12-0.14
C70.0-C70.9	Meninges (cerebral & spinal)	139,710	27,942	8.14	8.09-8.18	37,662	7,532	4.88	4.83-4.93	102,048	20,410	10.99	10.92-11.06
C75.1-C75.2	Pituitary and craniopharyngeal duct	65,694	13,139	4.04	4.01-4.08	29,755	5,951	3.75	3.71-3.80	35,939	7,188	4.42	4.37-4.46
C75.3	Pineal	1,655	331	0.11	0.10-0.11	929	186	0.12	0.11-0.13	726	145	0.09	0.09-0.10
C30.0d	Olfactory tumors of the nasal cavity	701	140	0.04	0.04-0.05	417	83	0.05	0.05-0.06	284	57	0.03	0.03-0.04
TOTAL		379,848	75,970	22.64	22.56-22.71	160,077	32,015	20.34	20.24-20.44	219,771	43,954	24.77	24.67-24.88

^aAnnual average cases are calculated by dividing the five year total by five.

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

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

^dICD-O-3 histology codes 9522-9523 only.

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.

• Incidence rates were highest for tumors located in the meninges (8.14 per 100,000 population).

• Incidence rates were lowest for olfactory tumors of the nasal cavity (0.04 per 100,000 population).

• Incidence rates were higher in females than in males for tumors located in the meninges, pituitary and craniopharyngeal duct, and cranial nerves.

• Males had higher incidence rates of tumors located in the frontal lobe, occipital lobe, temporal lobe, parietal lobe, cerebrum, ventricle, cerebellum, brain stem, other brain, spinal cord and cauda equina, other nervous system, pineal, and olfactory tumors of the nasal cavity compared to females.

Incidence Rates by Major Histology Grouping Specific Histologies, and Behavior

Incidence rates overall by major histology grouping, specific histology, and behavior are provided in Table 3.

• Among CBTRUS major histology groupings, incidence rates were highest for tumors of the meninges (8.41 per 100,000 population), followed by tumors of the neuroepithelial tissue (6.57 per 100,000 population), tumors of the sellar region (3.98 per 100,000 population), and tumors of the cranial and spinal nerves (1.89 per 100,000 population).

• Among CBTRUS specific histology groupings, incidence rates were highest for meningiomas (8.14 per 100,000 population), tumors of the pituitary (3.98 per 100,000 population), glioblastomas (3.20 per 100,000 population), and nerve sheath tumors (1.88 per 100,000 population).

• For malignant tumors, the incidence rate was highest for glioblastoma (3.20 per 100,000 population), followed by diffuse astrocytoma (0.48 per 100,000 population) and lymphoma (0.44 per 100,000 population).

• For non-malignant tumors, the incidence rate was highest for meningioma (8.03 per 100,000 population), followed by tumors of the pituitary (3.79 per 100,000 population).

Incidence Rates by Sex and Histology

Incidence rates by sex and histology are presented in Table 3. Incidence rates for all primary brain and other CNS tumors combined were higher among females (24.77 per 100,000 population) than males (20.34 per 100,000 population).

• The incidence rate of tumors of neuroepithelial tissue was higher in males (7.73 per 100,000 population) than in females (5.56 per 100,000 population).

• The incidence rate of tumors of the meninges was higher in females (11.26 per 100,000 population) than in males (5.15 per 100,000 population).

Incidence rate ratios (male:female) for selected histologies and histology groupings are shown in Figure 11.

Fig. 11.

Incidence Rate Ratios of Brain and Other CNS Tumors by Sex (Males:Females) for Selected CBTRUS Histology Groupings and Histology, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

• Incidence was higher in males for many histologies, such as germ cell tumors (p<0.001), most glial tumors, lymphomas (p<0.001), and embryonal tumors (p<0.001).

• In addition to non-malignant (p<0.001) and malignant (p=0.0005) meningiomas, tumors of the pituitary (p<0.001) were also more common in females than in males.

Incidence Rates by Race and Histology

Incidence rates by race and histology are shown in Table 9.

Table 9.

Five-Year Total, Annual Average Total^a, and Annual Average Age-Adjusted Incidence Rates^b for Brain and Other Central Nervous System Tumors by Major Histology Grouping, Histology, and Race^c, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Histology	White				Black				AIAN				API
	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI
Tumors of Neuroepithelial Tissue	96,120	19,224	7.09	7.05-7.14	8,157	1,631	3.98	3.89-4.07	612	122	3.22	2.95-3.51	3,537	707	4.08	3.95-4.22
Pilocytic astrocytoma	4,309	862	0.38	0.37-0.39	606	121	0.26	0.24-0.28	37	7	0.14	0.10-0.20	252	50	0.29	0.26-0.33
Diffuse astrocytoma	6,829	1,366	0.53	0.51-0.54	596	119	0.29	0.26-0.31	58	12	0.28	0.21-0.37	253	51	0.28	0.25-0.32
Anaplastic astrocytoma	5,817	1,163	0.44	0.43-0.45	423	85	0.21	0.19-0.23	43	9	0.21	0.15-0.29	205	41	0.23	0.20-0.27
Unique astrocytoma variants	853	171	0.07	0.07-0.08	145	29	0.06	0.05-0.08	--	--	--	--	61	12	0.07	0.05-0.09
Malignant	599	120	0.05	0.04-0.05	74	15	0.03	0.03-0.04	--	--	--	--	40	8	0.04	0.03-0.06
Non-Malignant	254	51	0.02	0.02-0.03	71	14	0.03	0.02-0.04	--	--	--	--	21	4	0.02	0.01-0.04
Glioblastoma	51,092	10,218	3.46	3.43-3.49	3,431	686	1.79	1.73-1.85	221	44	1.47	1.26-1.69	1,332	266	1.61	1.52-1.70
Oligodendroglioma	3,308	662	0.27	0.26-0.28	229	46	0.11	0.10-0.13	30	6	0.13	0.09-0.19	147	29	0.16	0.13-0.19
Anaplastic oligodendroglioma	1,512	302	0.12	0.11-0.12	94	19	0.05	0.04-0.06	--	--	--	--	91	18	0.10	0.08-0.12
Oligoastrocytic tumors	2,642	528	0.21	0.20-0.22	178	36	0.09	0.07-0.10	19	4	0.09	0.05-0.14	116	23	0.12	0.10-0.15
Ependymal tumors	5,856	1,171	0.46	0.45-0.48	555	111	0.26	0.24-0.28	55	11	0.25	0.19-0.33	297	59	0.32	0.29-0.36
Malignant	3,427	685	0.27	0.26-0.28	384	77	0.18	0.16-0.20	32	6	0.15	0.10-0.21	191	38	0.21	0.18-0.24
Non-Malignant	2,429	486	0.19	0.18-0.20	171	34	0.08	0.07-0.10	23	5	0.11	0.07-0.16	106	21	0.11	0.09-0.13
Glioma malignant, NOS	6,043	1,209	0.49	0.47-0.50	792	158	0.38	0.35-0.41	48	10	0.22	0.16-0.30	298	60	0.35	0.31-0.39
Choroid plexus tumors	679	136	0.06	0.05-0.06	81	16	0.03	0.03-0.04	--	--	--	--	35	7	0.04	0.03-0.05
Malignant	99	20	0.01	0.01-0.01	18	4	0.01	0.00-0.01	--	--	--	--	--	--	--	--
Non-Malignant	580	116	0.05	0.04-0.05	63	13	0.03	0.02-0.04	--	--	--	--	25	5	0.03	0.02-0.04
Other neuroepithelial tumors	78	16	0.01	0.01-0.01	--	--	--	--	--	--	--	--	--	--	--	--
Malignant	51	10	0.00	0. 00-0.01	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	27	5	0.00	0.00-0.00	--	--	--	--	--	--	--	--	--	--	--	--
Neuronal and mixed neuronal-glial tumors	3,693	739	0.31	0.30-0.32	472	94	0.21	0.19-0.23	37	7	0.17	0.12-0.24	235	47	0.26	0.23-0.29
Malignant	754	151	0.06	0.05-0.06	67	13	0.03	0.03-0.04	--	--	--	--	52	10	0.06	0.04-0.08
Non-Malignant	2,939	588	0.25	0.24-0.26	405	81	0.18	0.16-0.20	25	5	0.11	0.07-0.17	183	37	0.20	0.17-0.23
Tumors of the pineal region	557	111	0.05	0.04-0.05	120	24	0.06	0.05-0.07	--	--	--	--	26	5	0.03	0.02-0.04
Malignant	275	55	0.02	0.02-0.03	85	17	0.04	0.03-0.05	--	--	--	--	17	3	0.02	0.01-0.03
Non-Malignant	282	56	0.02	0.02-0.03	35	7	0.02	0.01-0.02	--	--	--	--	--	--	--	--
Embryonal tumors	2,852	570	0.25	0.25-0.26	427	85	0.18	0.17-0.20	31	6	0.12	0.08-0.18	186	37	0.21	0.18-0.25
Tumors of Cranial and Spinal Nerves	27,452	5,490	1.98	1.96-2.01	1,930	386	0.95	0.91-1.00	208	42	1.09	0.94-1.26	2,096	419	2.31	2.21-2.41
Nerve sheath tumors	27,432	5,486	1.98	1.96-2.01	1,930	386	0.95	0.91-1.00	207	41	1.09	0.94-1.26	2,092	418	2.30	2.20-2.41
Malignant	175	35	0.01	0.01-0.02	31	6	0.02	0.01-0.02	--	--	--	--	18	4	0.02	0.01-0.03
Non-Malignant	27,257	5,451	1.97	1.95-1.99	1,899	380	0.94	0.90-0.98	206	41	1.09	0.93-1.25	2,074	415	2.28	2.18-2.38
Other tumors of cranial and spinal nerves	20	4	0.00	0.00-0.00	--	--	--	--	--	--	--	--	--	--	--	--
Tumors of Meninges	117,865	23,573	8.22	8.17-8.27	17,886	3,577	9.82	9.67-9.97	830	166	5.39	5.00-5.80	6,623	1,325	8.21	8.01-8.42
Meningioma	114,210	22,842	7.94	7.89-7.98	17,461	3,492	9.61	9.46-9.76	796	159	5.23	4.84-5.64	6,389	1,278	7.96	7.76-8.16
Malignant	1,386	277	0.10	0.09-0.10	256	51	0.14	0.13-0.16	--	--	--	--	86	17	0.11	0.09-0.14
Non-Malignant	112,824	22,565	7.84	7.80-7.89	17,205	3,441	9.47	9.32-9.61	784	157	5.15	4.77-5.55	6,303	1,261	7.85	7.65-8.05
Mesenchymal tumors	1,092	218	0.08	0.08-0.09	122	24	0.06	0.05-0.07	--	--	--	--	75	15	0.08	0.07-0.10
Primary melanocytic lesions	118	24	0.01	0.01-0.01	--	--	--	--	--	--	--	--	--	--	--	--
Other neoplasms related to the meninges	2,445	489	0.19	0.18-0.20	299	60	0.14	0.13-0.16	22	4	0.10	0.06-0.16	155	31	0.17	0.14-0.20
Lymphomas and Hematopoietic Neoplasms	6,572	1,314	0.46	0.44-0.47	641	128	0.33	0.30-0.35	48	10	0.28	0.20-0.37	410	82	0.50	0.45-0.55
Lymphoma	6,356	1,271	0.44	0.43-0.45	615	123	0.31	0.29-0.34	45	9	0.27	0.19-0.36	400	80	0.49	0.44-0.54
Other hematopoietic neoplasms	216	43	0.02	0.01-0.02	26	5	0.01	0.01-0.02	--	--	--	--	--	--	--	--
Germ Cell Tumors and Cysts	1,189	238	0.10	0.10-0.11	150	30	0.07	0.06-0.08	--	--	--	--	147	29	0.17	0.14-0.20
Germ cell tumors, cysts and heterotopias	1,189	238	0.10	0.10-0.11	150	30	0.07	0.06-0.08	--	--	--	--	147	29	0.17	0.14-0.20
Malignant	793	159	0.07	0.07-0.08	97	19	0.04	0.03-0.05	--	--	--	--	118	24	0.14	0.11-0.16
Non-Malignant	396	79	0.03	0.03-0.04	53	11	0.02	0.02-0.03	--	--	--	--	29	6	0.03	0.02-0.05
Tumors of Sellar Region	47,303	9,461	3.62	3.59-3.65	12,398	2,480	6.33	6.21-6.44	580	116	3.09	2.82-3.37	3,850	770	4.26	4.12-4.40
Tumors of the pituitary	45,130	9,026	3.45	3.42-3.48	11,804	2,361	6.05	5.93-6.16	561	112	2.99	2.73-3.27	3,686	737	4.08	3.95-4.22
Malignant	125	25	0.01	0.01-0.01	35	7	0.02	0.01-0.03	--	--	--	--	--	--	--	--
Non-Malignant	45,005	9,001	3.44	3.41-3.47	11,769	2,354	6.03	5.92-6.14	557	111	2.97	2.71-3.25	3,678	736	4.07	3.94-4.21
Craniopharyngioma	2,173	435	0.17	0.17-0.18	594	119	0.28	0.26-0.31	19	4	0.10	0.06-0.16	164	33	0.18	0.16-0.21
Unclassified Tumors	17,497	3,499	1.27	1.25-1.29	2,077	415	1.11	1.06-1.16	176	35	1.07	0.90-1.25	854	171	1.05	0.98-1.13
Hemangioma	5,205	1,041	0.40	0.39-0.41	531	106	0.26	0.24-0.28	69	14	0.36	0.28-0.46	307	61	0.34	0.30-0.38
Neoplasm, unspecified	12,212	2,442	0.86	0.85-0.88	1,528	306	0.85	0.80-0.89	105	21	0.69	0.55-0.85	544	109	0.71	0.65-0.77
Malignant	5,745	1,149	0.39	0.38-0.40	546	109	0.32	0.29-0.35	46	9	0.30	0.21-0.41	221	44	0.30	0.26-0.34
Non-Malignant	6,467	1,293	0.47	0.46-0.48	982	196	0.52	0.49-0.56	59	12	0.39	0.29-0.51	323	65	0.41	0.36-0.46
All other	80	16	0.01	0.00-0.01	18	4	0.01	0.01-0.02	--	--	--	--	--	--	--	--
TOTAL d	313,998	62,800	22.75	22.67-22.83	43,239	8,648	22.58	22.36-22.80	2,463	493	14.18	13.58-14.80	17,517	3,503	20.58	20.27-20.90
Malignant	104,978	20,996	7.64	7.59-7.68	9,073	1,815	4.54	4.44-4.64	670	134	3.67	3.37-3.98	4,091	818	4.83	4.68-4.98
Non-Malignant	209,020	41,804	15.11	15.04-15.18	34,166	6,833	18.05	17.85-18.24	1,793	359	10.51	9.99-11.05	13,426	2,685	15.76	15.48-16.03

^aAnnual average cases are calculated by dividing the five year total by five.

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

^cIndividuals with unknown race were excluded (N = 2,176).

^dRefers to all brain tumors including histologies not presented in this table.

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

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; AIAN, American Indian/Alaskan Native; API, Asian/Pacific Islander.

• Incidence rates for all primary brain and other CNS tumors combined were lower for race groups AIAN (14.18 per 100,000 population) compared to Whites (22.75 per 100,000 population), Blacks (22.58 per 100,000 population), and API (20.58 per 100,000 population).

• Incidence rates for non-malignant primary brain and other CNS tumors were highest in Blacks (18.05 per 100,000) compared to Whites (15.11 per 100,000), AIAN (10.51 per 100,000), and API (15.76 per 100,000).

• Incidence rates for malignant primary brain and other CNS tumors were highest in Whites (7.64 per 100,000) compared to Blacks (4.54 per 100,000), AIAN (3.67 per 100,000), and API (4.83 per 100,000).

• Incidence rates of meningioma, tumors of the pituitary, and craniopharyngioma for Blacks exceeded those observed for Whites, AIAN, and API.

• The annual average incidence rate for tumors of the cranial and spinal nerves in the API group was the highest for all racial groups.

Incidence rate ratios (White:Black) for selected histologies are shown in Figure 12.

Fig. 12.

Incidence Rate Ratios of Brain and Other CNS Tumors by Race (Whites:Blacks) for Selected CBTRUS Histology Groupings and Histologies, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

• Incidence rates for glioblastoma (p<0.0001), all other astrocytoma (p<0.0001), oligoastrocytic tumors (p<0.0001), and nerve sheath tumors (p<0.0001) were approximately 2 times greater in Whites than in Blacks.

• Incidence of oligodendroglioma was approximately 2.5 times greater in Whites than in Blacks (p<0.0001).

• Incidence rates for pilocytic astrocytoma (p<0.0001), ependymal tumors (p<0.0001), embryonal tumors (p<0.0001), lymphoma (p<0.0001), and germ cell tumors (p<0.0001) were also higher among Whites than Blacks.

• Incidence rates for non-malignant (p<0.0001) and malignant (p<0.0001) meningioma and tumors of the pituitary (p<0.0001) were higher among Blacks than Whites.

Incidence rate ratios (White:API) for selected histologies are shown in online Supplementary Figure 10.

• Incidence rates for all other astrocytoma (p<0.0001), astrocytoma (p<0.0001), oligoastrocytic tumors (p<0.0001), were over 2 times greater in Whites than in API.

• Incidence of germ cell tumors was approximately 60% higher in API compared to Whites (p<0.0001).

• Incidence of malignant meningioma (p=0.0481) and nerve sheath tumors (p<0.0001) was approximately 15% higher in API compared to Whites.

Incidence Rates by Hispanic Ethnicity and Histology

Incidence rates by Hispanic ethnicity and histology are shown in Table 10.

Table 10.

Five-Year Total, Annual Average Total^a, and Annual Average Age-Adjusted Incidence Rates^b for Brain and Other Central Nervous System Tumors by Major Histology Grouping, Histology, and Hispanic Ethnicity^c, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Histology	All Hispanic				White Hispanic				Black Hispanic				All Non-Hispanic
	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI
Tumors of Neuroepithelial Tissue	10,830	2,166	5.03	4.93-5.13	10,019	2,004	5.13	5.03-5.24	284	57	2.70	2.35-3.09	98,415	19,683	6.85	6.80-6.89
Pilocytic astrocytoma	802	160	0.25	0.23-0.27	723	145	0.25	0.23-0.27	30	6	0.17	0.11-0.27	4,447	889	0.39	0.38-0.40
Diffuse astrocytoma	836	167	0.37	0.35-0.40	776	155	0.38	0.36-0.41	16	3	0.12	0.06-0.20	6,957	1,391	0.51	0.50-0.52
Anaplastic astrocytoma	609	122	0.28	0.26-0.31	568	114	0.29	0.27-0.32	--	--	--	--	5,928	1,186	0.42	0.41-0.43
Unique astrocytoma variants	153	31	0.05	0.04-0.06	146	29	0.06	0.05-0.07	--	--	--	--	937	187	0.08	0.07-0.08
Malignant	99	20	0.04	0.03-0.05	97	19	0.04	0.03-0.05	--	--	--	--	636	127	0.05	0.04-0.05
Non-Malignant	54	11	0.02	0.01-0.02	49	10	0.02	0.01-0.02	--	--	--	--	301	60	0.03	0.02-0.03
Glioblastoma	4,142	828	2.42	2.35-2.50	3,896	779	2.48	2.40-2.57	109	22	1.43	1.15-1.75	52,279	10,456	3.29	3.26-3.32
Oligodendroglioma	391	78	0.16	0.15-0.18	352	70	0.16	0.15-0.18	--	--	--	--	3,362	672	0.26	0.25-0.27
Anaplastic oligodendroglioma	196	39	0.09	0.08-0.11	184	37	0.09	0.08-0.11	--	--	--	--	1,522	304	0.11	0.10-0.12
Oligoastrocytic tumors	308	62	0.13	0.12-0.15	279	56	0.13	0.12-0.15	--	--	--	--	2,681	536	0.20	0.20-0.21
Ependymal tumors	932	186	0.38	0.35-0.40	843	169	0.37	0.35-0.40	21	4	0.20	0.12-0.32	5,884	1,177	0.44	0.43-0.45
Malignant	607	121	0.23	0.21-0.25	552	110	0.23	0.21-0.26	--	--	--	--	3,458	692	0.26	0.25-0.27
Non-Malignant	325	65	0.14	0.13-0.16	291	58	0.14	0.12-0.16	--	--	--	--	2,426	485	0.18	0.17-0.19
Glioma malignant, NOS	888	178	0.36	0.33-0.39	813	163	0.36	0.34-0.39	31	6	0.22	0.14-0.33	6,350	1,270	0.49	0.48-0.50
Choroid plexus tumors	148	30	0.05	0.04-0.06	137	27	0.05	0.04-0.06	--	--	--	--	666	133	0.05	0.05-0.06
Malignant	29	6	0.01	0.01-0.01	25	5	0.01	0.01-0.01	--	--	--	--	103	21	0.01	0.01-0.01
Non-Malignant	119	24	0.04	0.03-0.05	112	22	0.04	0.04-0.05	--	--	--	--	563	113	0.05	0.04-0.05
Other neuroepithelial tumors	--	--	--	--	--	--	--	--	--	--	--	--	78	16	0.01	0.00-0.01
Malignant	--	--	--	--	--	--	--	--	--	--	--	--	50	10	0.00	0.00-0.01
Non-Malignant	--	--	--	--	--	--	--	--	--	--	--	--	28	6	0.00	0.00-0.00
Neuronal and mixed neuronal-glial tumors	566	113	0.20	0.18-0.22	506	101	0.20	0.18-0.22	16	3	0.11	0.06-0.20	3,910	782	0.31	0.30-0.32
Malignant	101	20	0.04	0.04-0.05	93	19	0.04	0.04-0.05	--	--	--	--	792	158	0.06	0.05-0.06
Non-Malignant	465	93	0.16	0.14-0.17	413	83	0.15	0.14-0.17	--	--	--	--	3,118	624	0.26	0.25-0.27
Tumors of the pineal region	94	19	0.04	0.03-0.04	93	19	0.04	0.03-0.05	--	--	--	--	621	124	0.05	0.05-0.05
Malignant	52	10	0.02	0.01-0.02	51	10	0.02	0.01-0.03	--	--	--	--	333	67	0.03	0.02-0.03
Non-Malignant	42	8	0.02	0.01-0.02	42	8	0.02	0.01-0.03	--	--	--	--	288	58	0.02	0.02-0.02
Embryonal tumors	750	150	0.23	0.22-0.25	688	138	0.24	0.22-0.26	23	5	0.12	0.07-0.19	2,793	559	0.25	0.24-0.25
Tumors of Cranial and Spinal Nerves	2,686	537	1.31	1.25-1.36	2,450	490	1.31	1.26-1.37	65	13	0.67	0.51-0.87	29,314	5,863	1.98	1.96-2.00
Nerve sheath tumors	2,681	536	1.30	1.25-1.36	2,445	489	1.31	1.25-1.36	65	13	0.67	0.51-0.87	29,293	5,859	1.98	1.95-2.00
Malignant	27	5	0.01	0.01-0.02	26	5	0.01	0.01-0.02	--	--	--	--	202	40	0.01	0.01-0.02
Non-Malignant	2,654	531	1.29	1.24-1.35	2,419	484	1.29	1.24-1.35	65	13	0.67	0.51-0.87	29,091	5,818	1.96	1.94-1.99
Other tumors of cranial and spinal nerves	--	--	--	--	--	--	--	--	--	--	--	--	21	4	0.00	0.00-0.00
Tumors of Meninges	13,381	2,676	8.04	7.90-8.19	12,279	2,456	8.04	7.89-8.19	409	82	5.76	5.17-6.41	130,687	26,137	8.49	8.44-8.54
Meningioma	12,811	2,562	7.79	7.65-7.94	11,758	2,352	7.79	7.64-7.94	395	79	5.66	5.06-6.29	126,883	25,377	8.22	8.17-8.26
Malignant	165	33	0.09	0.08-0.11	155	31	0.09	0.08-0.11	--	--	--	--	1,582	316	0.10	0.10-0.11
Non-Malignant	12,646	2,529	7.70	7.56-7.85	11,603	2,321	7.69	7.55-7.84	392	78	5.60	5.01-6.24	125,301	25,060	8.11	8.07-8.16
Mesenchymal tumors	176	35	0.08	0.06-0.09	160	32	0.08	0.07-0.09	--	--	--	--	1,131	226	0.08	0.08-0.09
Primary melanocytic lesions	--	--	--	--	--	--	--	--	--	--	--	--	115	23	0.01	0.01-0.01
Other neoplasms related to the meninges	381	76	0.16	0.15-0.18	350	70	0.17	0.15-0.19	--	--	--	--	2,558	512	0.18	0.18-0.19
Lymphomas and Hematopoietic Neoplasms	843	169	0.48	0.45-0.52	792	158	0.50	0.46-0.54	17	3	0.17	0.10-0.28	6,895	1,379	0.45	0.44-0.46
Lymphoma	797	159	0.46	0.43-0.50	751	150	0.48	0.44-0.52	16	3	0.16	0.09-0.27	6,684	1,337	0.43	0.42-0.44
Other hematopoietic neoplasms	46	9	0.02	0.01-0.03	41	8	0.02	0.01-0.03	--	--	--	--	211	42	0.02	0.01-0.02
Germ Cell Tumors and Cysts	296	59	0.10	0.09-0.11	268	54	0.10	0.09-0.11	--	--	--	--	1,206	241	0.10	0.10-0.11
Germ cell tumors, cysts and heterotopias	296	59	0.10	0.09-0.11	268	54	0.10	0.09-0.11	--	--	--	--	1,206	241	0.10	0.10-0.11
Malignant	214	43	0.07	0.06-0.08	195	39	0.07	0.06-0.08	--	--	--	--	806	161	0.07	0.06-0.07
Non-Malignant	82	16	0.03	0.02-0.04	73	15	0.03	0.02-0.04	--	--	--	--	400	80	0.03	0.03-0.04
Tumors of Sellar Region	9,757	1,951	4.47	4.38-4.57	8,759	1,752	4.43	4.33-4.53	307	61	3.14	2.76-3.56	54,849	10,970	3.92	3.88-3.95
Tumors of the pituitary	9,289	1,858	4.29	4.20-4.38	8,336	1,667	4.24	4.15-4.34	290	58	3.04	2.66-3.45	52,345	10,469	3.73	3.70-3.76
Malignant	29	6	0.01	0.01-0.02	26	5	0.02	0.01-0.02	--	--	--	--	143	29	0.01	0.01-0.01
Non-Malignant	9,260	1,852	4.28	4.18-4.37	8,310	1,662	4.23	4.13-4.33	289	58	3.03	2.65-3.44	52,202	10,440	3.72	3.69-3.75
Craniopharyngioma	468	94	0.18	0.17-0.20	423	85	0.18	0.17-0.20	17	3	0.11	0.06-0.18	2,504	501	0.19	0.18-0.20
Unclassified Tumors	2,385	477	1.30	1.24-1.36	2,216	443	1.33	1.27-1.39	58	12	0.63	0.45-0.84	18,304	3,661	1.25	1.23-1.26
Hemangioma	795	159	0.37	0.34-0.40	737	147	0.38	0.35-0.41	--	--	--	--	5,343	1,069	0.39	0.37-0.40
Neoplasm, unspecified	1,572	314	0.92	0.87-0.97	1,463	293	0.94	0.89-1.00	43	9	0.48	0.33-0.67	12,875	2,575	0.85	0.84-0.87
Malignant	569	114	0.37	0.34-0.40	527	105	0.38	0.34-0.41	--	--	--	0.04-0.23	6,011	1,202	0.38	0.37-0.39
Non-Malignant	1,003	201	0.55	0.51-0.59	936	187	0.57	0.53-0.61	35	7	0.36	0.24-0.53	6,864	1,373	0.47	0.46-0.48
All other	18	4	0.01	0.01-0.02	16	3	0.01	0.00-0.02	--	--	--	--	86	17	0.01	0.00-0.01
TOTAL d	40,178	8,036	20.73	20.51-20.95	36,783	7,357	20.84	20.61-21.07	1,152	230	13.15	12.30-14.04	339,670	67,934	23.03	22.95-23.11
Malignant	11,769	2,354	5.74	5.63-5.85	10,921	2,184	5.87	5.75-5.99	300	60	2.94	2.56-3.35	107,905	21,581	7.38	7.34-7.43
Non-Malignant	28,409	5,682	14.99	14.80-15.18	25,862	5,172	14.97	14.78-15.17	852	170	10.21	9.46-11.01	231,765	46,353	15.65	15.58-15.71

^aAnnual average cases are calculated by dividing the five year total by five.

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

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

^dRefers to all brain tumors including histologies not presented in this table.

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

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.

• The overall incidence rate for primary brain and other CNS tumors was 20.73 per 100,000 population among Hispanics and 23.03 per 100,000 population among non-Hispanics.

• Tumors of the pituitary, neoplasm unspecified, and other hematopoietic neoplasms were the only histologies that were higher in Hispanics than in non-Hispanics.

Incidence Rates by Age and Histology

The age-adjusted incidence rates by age and histology at diagnosis are presented in Table 11, Figure 13 (Age 20+ Years), and Figure 14 (Age 0–19 Years).

Table 11.

Annual Average Age-Adjusted and Age-Specific Incidence Rates^a for Brain and Other Central Nervous System Tumors by Major Histology Grouping, Histology, and Age at Diagnosis, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Histology	Age At Diagnosis
	0-19 Years		20-34 Years		35-44 Years		45-54 Years		55-64 Years		65-74 Years		75-84 Years		85+ Years
	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI
Tumors of Neuroepithelial Tissue	3.78	3.72-3.84	3.45	3.39-3.52	4.52	4.43-4.62	6.92	6.81-7.03	11.74	11.58-11.90	17.22	16.97-17.47	19.68	19.34-20.03	12.47	12.06-12.89
Pilocytic astrocytoma	0.89	0.86-0.92	0.24	0.22-0.26	0.12	0.11-0.14	0.09	0.08-0.10	0.08	0.07-0.10	0.06	0.04-0.07	0.07	0.05-0.09	--	--
Diffuse astrocytoma	0.27	0.26-0.29	0.50	0.48-0.53	0.56	0.53-0.60	0.58	0.55-0.61	0.76	0.72-0.80	0.96	0.90-1.02	1.07	0.99-1.15	0.60	0.51-0.70
Anaplastic astrocytoma	0.09	0.08-0.10	0.30	0.28-0.32	0.41	0.38-0.44	0.46	0.44-0.49	0.65	0.61-0.69	0.92	0.86-0.98	0.91	0.84-0.99	0.41	0.34-0.49
Unique astrocytoma variants	0.11	0.10-0.12	0.07	0.06-0.08	0.04	0.03-0.05	0.04	0.03-0.05	0.04	0.03-0.05	0.05	0.04-0.07	0.07	0.05-0.10	0.07	0.04-0.11
Malignant	0.05	0.04-0.06	0.05	0.04-0.06	0.03	0.02-0.04	0.03	0.02-0.04	0.04	0.03-0.05	0.05	0.04-0.07	0.07	0.05-0.10	0.07	0.04-0.11
Non-Malignant	0.06	0.06-0.07	0.02	0.02-0.03	0.01	0.01-0.02	--	--	--	--	--	--	--	--	--	--
Glioblastoma	0.16	0.15-0.17	0.43	0.40-0.45	1.21	1.16-1.26	3.56	3.48-3.64	8.12	7.99-8.26	13.11	12.90-13.33	15.28	14.98-15.59	9.16	8.81-9.52
Oligodendroglioma	0.05	0.05-0.06	0.31	0.29-0.33	0.46	0.43-0.49	0.40	0.38-0.43	0.31	0.28-0.33	0.21	0.19-0.24	0.19	0.16-0.23	0.11	0.07-0.15
Anaplastic oligodendroglioma	0.01	0.00-0.01	0.08	0.07-0.09	0.17	0.15-0.19	0.19	0.17-0.20	0.21	0.19-0.23	0.17	0.14-0.19	0.11	0.09-0.14	--	--
Oligoastrocytic tumors	0.03	0.03-0.04	0.30	0.29-0.32	0.33	0.31-0.36	0.28	0.26-0.31	0.26	0.24-0.29	0.21	0.18-0.24	0.15	0.12-0.18	--	--
Ependymal tumors	0.29	0.27-0.31	0.38	0.36-0.40	0.50	0.47-0.53	0.63	0.59-0.66	0.58	0.54-0.61	0.60	0.55-0.65	0.44	0.39-0.49	0.19	0.14-0.25
Malignant	0.24	0.23-0.26	0.21	0.20-0.23	0.28	0.26-0.30	0.35	0.33-0.38	0.34	0.31-0.37	0.35	0.32-0.39	0.26	0.22-0.30	0.08	0.05-0.12
Non-Malignant	0.05	0.04-0.06	0.17	0.15-0.18	0.22	0.20-0.24	0.27	0.25-0.30	0.24	0.22-0.26	0.25	0.22-0.28	0.18	0.15-0.21	0.11	0.07-0.15
Glioma malignant, NOS	0.67	0.65-0.70	0.26	0.24-0.28	0.28	0.25-0.30	0.30	0.28-0.32	0.37	0.34-0.40	0.61	0.56-0.66	1.10	1.02-1.18	1.70	1.55-1.86
Choroid plexus tumors	0.10	0.09-0.11	0.03	0.03-0.04	0.03	0.02-0.04	0.04	0.03-0.05	0.03	0.03-0.04	0.04	0.03-0.05	0.05	0.03-0.07	--	--
Malignant	0.02	0.02-0.03	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	0.08	0.07-0.09	0.03	0.02-0.04	0.03	0.02-0.04	0.03	0.03-0.04	0.03	0.02-0.04	0.04	0.03-0.05	0.05	0.03-0.07	--	--
Other neuroepithelial tumors	0.01	0.01-0.01	0.01	0.00-0.01	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--
Malignant	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Neuronal and mixed neuronal-glial tumors	0.39	0.38-0.41	0.32	0.30-0.34	0.25	0.23-0.27	0.23	0.21-0.25	0.22	0.20-0.24	0.20	0.17-0.23	0.17	0.14-0.21	0.06	0.04-0.10
Malignant	0.02	0.02-0.02	0.04	0.03-0.04	0.06	0.05-0.07	0.07	0.06-0.09	0.10	0.08-0.11	0.10	0.08-0.12	0.10	0.08-0.13	--	--
Non-Malignant	0.37	0.36-0.39	0.29	0.27-0.31	0.19	0.17-0.21	0.15	0.14-0.17	0.12	0.11-0.14	0.10	0.08-0.12	0.07	0.05-0.10	--	--
Tumors of the pineal region	0.05	0.04-0.05	0.05	0.04-0.06	0.05	0.04-0.06	0.04	0.04-0.05	0.04	0.03-0.05	0.04	0.03-0.05	0.03	0.02-0.04	--	--
Malignant	0.04	0.03-0.04	0.02	0.02-0.03	0.02	0.01-0.03	0.02	0.02-0.03	0.02	0.01-0.03	0.02	0.01-0.03	--	--	--	--
Non-Malignant	0.01	0.01-0.01	0.03	0.02-0.04	0.03	0.02-0.04	0.02	0.01-0.03	0.02	0.02-0.03	0.02	0.01-0.03	--	--	--	--
Embryonal tumors	0.65	0.62-0.67	0.17	0.15-0.18	0.11	0.10-0.13	0.08	0.07-0.09	0.05	0.04-0.06	0.04	0.03-0.05	0.03	0.02-0.05	--	--
Tumors of Cranial and Spinal Nerves	0.31	0.29-0.33	0.86	0.83-0.90	1.90	1.84-1.96	3.01	2.94-3.09	4.26	4.17-4.36	4.89	4.76-5.03	3.75	3.60-3.90	1.80	1.65-1.97
Nerve sheath tumors	0.31	0.29-0.33	0.86	0.83-0.90	1.89	1.83-1.95	3.01	2.94-3.08	4.26	4.16-4.35	4.89	4.76-5.02	3.75	3.60-3.90	1.80	1.64-1.96
Malignant	0.01	0.00-0.01	0.01	0.01-0.01	0.01	0.01-0.01	0.02	0.01-0.02	0.02	0.02-0.03	0.03	0.02-0.04	0.04	0.03-0.06	--	--
Non-Malignant	0.31	0.29-0.32	0.85	0.82-0.89	0.85	0.82-0.89	2.99	2.92-3.07	4.23	4.14-4.33	4.86	4.73-5.00	3.70	3.56-3.86	1.78	1.62-1.94
Other tumors of cranial and spinal nerves	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Tumors of Meninges	0.24	0.22-0.25	1.69	1.65-1.74	5.38	5.28-5.48	9.81	9.68-9.94	15.94	15.76-16.12	27.81	27.49-28.13	40.95	40.46-41.44	53.16	52.30-54.02
Meningioma	0.15	0.13-0.16	1.44	1.40-1.49	5.03	4.94-5.13	9.42	9.29-9.55	15.47	15.29-15.65	27.31	27.00-27.62	40.51	40.03-41.00	52.95	52.10-53.82
Malignant	0.01	0.00-0.01	0.02	0.02-0.03	0.06	0.05-0.07	0.11	0.09-0.12	0.21	0.19-0.23	0.37	0.33-0.40	0.46	0.41-0.51	0.67	0.58-0.77
Non-Malignant	0.14	0.13-0.15	1.42	1.38-1.46	4.97	4.88-5.07	9.31	9.19-9.44	15.26	15.08-15.44	26.94	26.63-27.26	40.06	39.57-40.54	52.29	51.44-53.14
Mesenchymal tumors	0.05	0.04-0.06	0.06	0.05-0.07	0.10	0.09-0.11	0.11	0.09-0.12	0.15	0.13-0.17	0.14	0.12-0.17	0.12	0.09-0.15	0.07	0.04-0.10
Primary melanocytic lesions	--	--	--	--	--	--	0.01	0.01-0.01	0.02	0.01-0.02	0.02	0.01-0.03	0.03	0.02-0.05	--	--
Other neoplasms related to the meninges	0.04	0.03-0.05	0.19	0.17-0.20	0.24	0.22-0.26	0.27	0.25-0.29	0.31	0.28-0.33	0.33	0.30-0.37	0.28	0.24-0.33	0.12	0.08-0.17
Lymphomas and Hematopoietic Neoplasms	0.03	0.02-0.03	0.11	0.10-0.12	0.27	0.25-0.29	0.43	0.41-0.46	0.89	0.85-0.93	1.83	1.75-1.92	2.41	2.29-2.53	1.20	1.07-1.34
Lymphoma	0.01	0.01-0.02	0.10	0.09-0.12	0.26	0.24-0.28	0.42	0.39-0.45	0.87	0.82-0.91	1.80	1.72-1.88	2.39	2.27-2.52	1.19	1.06-1.32
Other hematopoietic neoplasms	0.01	0.01-0.02	0.01	0.00-0.01	0.01	0.01-0.02	0.01	0.01-0.02	0.02	0.02-0.03	0.04	0.03-0.05	--	--	--	--
Germ Cell Tumors and Cysts	0.22	0.21-0.24	0.10	0.09-0.11	0.05	0.04-0.06	0.03	0.03-0.04	0.02	0.02-0.03	0.03	0.02-0.05	0.03	0.02-0.05	--	--
Germ cell tumors, cysts and heterotopias	0.22	0.21-0.24	0.10	0.09-0.11	0.05	0.04-0.06	0.03	0.03-0.04	0.02	0.02-0.03	0.03	0.02-0.05	0.03	0.02-0.05	--	--
Malignant	0.17	0.16-0.19	0.07	0.06-0.08	0.02	0.01-0.02	--	--	--	--	--	--	--	--	--	--
Non-Malignant	0.05	0.04-0.05	0.03	0.02-0.03	0.03	0.03-0.04	0.03	0.02-0.04	0.02	0.01-0.03	0.03	0.02-0.04	0.02	0.01-0.04	--	--
Tumors of Sellar Region	0.84	0.81-0.87	3.61	3.54-3.68	4.90	4.80-4.99	5.15	5.06-5.25	5.92	5.80-6.03	7.98	7.81-8.15	7.89	7.67-8.11	5.02	4.76-5.29
Tumors of the pituitary	0.64	0.62-0.67	3.49	3.42-3.55	4.73	4.64-4.83	4.93	4.84-5.03	5.67	5.57-5.78	7.72	7.55-7.88	7.66	7.45-7.88	4.91	4.65-5.18
Malignant	--	--	--	--	0.01	0.01-0.02	0.01	0.01-0.02	0.01	0.01-0.02	0.02	0.02-0.04	--	--	--	--
Non-Malignant	0.64	0.62-0.67	3.49	3.42-3.55	4.72	4.63-4.81	4.92	4.83-5.02	5.66	5.55-5.77	7.69	7.53-7.86	7.64	7.43-7.86	4.89	4.63-5.16
Craniopharyngioma	0.20	0.18-0.21	0.12	0.11-0.14	0.16	0.15-0.18	0.22	0.20-0.24	0.24	0.22-0.26	0.26	0.23-0.29	0.23	0.19-0.27	0.11	0.07-0.15
Unclassified Tumors	0.34	0.32-0.36	0.64	0.61-0.67	0.92	0.88-0.96	1.15	1.11-1.19	1.62	1.57-1.68	2.63	2.53-2.73	5.26	5.08-5.43	11.71	11.31-12.12
Hemangioma	0.12	0.11-0.14	0.31	0.29-0.33	0.43	0.40-0.46	0.49	0.46-0.52	0.54	0.51-0.58	0.58	0.54-0.63	0.59	0.53-0.65	0.54	0.46-0.63
Neoplasm, unspecified	0.21	0.20-0.22	0.33	0.31-0.35	0.48	0.45-0.51	0.66	0.63-0.69	1.07	1.03-1.12	2.03	1.95-2.12	4.65	4.49-4.82	11.13	10.74-11.53
Malignant	0.05	0.04-0.05	0.06	0.06-0.07	0.12	0.10-0.13	0.24	0.22-0.26	0.47	0.44-0.50	1.01	0.95-1.07	2.68	2.55-2.80	6.64	6.34-6.95
Non-Malignant	0.16	0.15-0.18	0.26	0.25-0.28	0.36	0.34-0.39	0.42	0.39-0.45	0.61	0.57-0.64	1.02	0.96-1.08	1.98	1.87-2.09	4.49	4.24-4.74
All other	0.01	0.00-0.01	--	--	--	--	--	--	--	--	0.01	0.01-0.02	--	--	--	--
TOTAL c	5.76	5.69-5.83	10.47	10.36-10.59	17.93	17.75-18.12	26.51	26.29-26.72	40.39	40.10-40.68	62.39	61.92-62.87	79.96	79.28-80.65	85.39	84.30-86.49
Malignant	3.48	3.42-3.53	3.23	3.17-3.29	4.58	4.48-4.67	7.29	7.18-7.41	13.00	12.84-13.17	20.18	19.91-20.45	25.10	24.72-25.49	20.89	20.36-21.44
Non-Malignant	2.28	2.23-2.33	7.24	7.15-7.34	13.36	13.20-13.52	19.22	19.03-19.40	27.39	27.15-27.63	42.21	41.82-42.60	54.86	54.29-55.43	64.50	63.55-65.45

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

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

^cRefers to all brain tumors including histologies not presented in this table.

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

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.

Fig. 13.

Age-Adjusted Incidence Rates^a of Brain and Other CNS Tumors by Selected Histologies and Age-Group (Age 20+ Years), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Fig. 14.

Age-Adjusted Incidence Rates^a of Brain and Other CNS Tumors in Children and Adolescents by Selected Histologies and Age-Group (Age 0-19 Years), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

• The incidence rate for all brain and other CNS tumors was highest among age 85+ years (85.39 per 100,000 population) and lowest among children and adolescents age 0–19 years (5.76 per 100,000 population).

• Incidence rates of pilocytic astrocytoma, germ cell tumors, and embryonal tumors were higher in the younger age-groups and decreased with advancing age.

• Incidence rate of meningioma increased with age.

• Incidence rates declined with increasing age for those age 0–19 years, particularly for the gliomas and embry onal tumors (primitive neuroectodermal tumor (PNET) and medulloblastoma).

• After peaking in the 0–9 year age-group, incidence rates of pilocytic astrocytoma decreased in the age-groups 10–14, and 15–19 years.

• The incidence of tumors of the pituitary increased substantially between the 10–14 years age-group and 15–19 years age-group.

• The incidence rate of PNET peaked in the 0–4 years age-group.

• The incidence of medulloblastoma peaked in those age 9 years and younger.

The distribution patterns of histologies within age-groups differed substantially as is apparent in Figure 15, which shows the four most common brain and other CNS tumor histologies by age at diagnosis group.

Fig. 15.

Most Common Primary Brain and Other Central Nervous System Tumors by Age-Group, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Childhood and Adolescence: Incidence and Distribution of Primary Brain and Other CNS Tumors by Site, Histology, Sex, and Age

Distribution of Tumors by Site and Histology in Children and Adolescents (Age 0–19 Years)

Brain and other CNS tumors are the most common form of solid tumors in children,^42,43 and account for the majority of cancer mortality in this age-group.⁴⁴ About 6% of the reported brain and other CNS tumors during 2010–2014 occurred in children and adolescents age 0–19 years, and approximately 5% of all reported tumors occurred in children age 0–14 years. The distribution of brain and other CNS tumors for children and adolescents age 0–19 years by site is shown in Figure 16A.

Fig. 16.

Distribution^a in Children and Adolescents (Age 0-19 Years) of Primary Brain and CNS Tumors by A. Site (N=21,002), and B. CBTRUS Histology Groupings and Histology (N= 21,002), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

• The largest percentages of tumors in childhood and adolescence were located in the pituitary and pineal glands (18.3%).

• A similar proportion of tumors were located within the frontal, temporal, parietal, and occipital lobes of the brain combined (16.7%).

• Cerebrum, ventricle, brain stem, and cerebellum tumors accounted for 5.3%, 5.7%, 11.0%, and 13.0% of all brain and other CNS tumors in childhood and adolescence, respectively.

• Tumors of the meninges represented 2.8% of all tumors in childhood and adolescence.

• The cranial nerves and the spinal cord and cauda equina accounted for 7.1% and 4.8% of all brain and other CNS tumors in childhood and adolescence, respectively.

Figure 16B presents the most common brain and other CNS histologies in children and adolescents age 0–19 years.

• For children and adolescents age 0–19 years, pilocytic astrocytomas, glioma malignant, NOS, and embryonal tumors accounted for 15.6%, 11.3%, and 10.5%, respectively.

• Tumors of the pituitary were the most common non-malignant histology, and accounted for 11.8% of all tumors in this age-group.

• Gliomas accounted for approximately 47.1% of tumors in children and adolescents age 0–19 years.

• Medulloblastoma accounted for 63.6% of all embryonal tumors in this age-group.

Distribution of Tumors by Site and Histology in Children (Age 0–14 Years)

The distribution of brain and other CNS tumors for children age 0–14 years by site is shown in Figure 17A.

Fig. 17.

Distribution^a in Children (Age 0-14 Years) of Primary Brain and Other CNS Tumors by A. Site (N=16,941), and B. CBTRUS Histology Groupings and Histology (N=16,941), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

• Tumors of other brain (15.8%) comprised the largest proportion of tumors followed by the cerebellum (15.2%) and brain stem (13.4%).

Figure 17B presents the most common brain and other CNS histologies in children age 0–14 years.

• For children age 0–14 years, pilocytic astrocytomas, glioma malignant, NOS, and embryonal tumors accounted for 18.2%, 13.9%, and 13.5%, respectively.

• Gliomas accounted for approximately 52.8% of tumors in children age 0–14 years.

• Of embryonal tumors, medulloblastoma, atypical teratoid/ rhabdoid tumor (ATRT), and primitive neuroectodermal tumor (PNET) accounted for 62.9%, 16.1%, and 12.2%, respectively.

Distribution of Tumors by Site and Histology in Adolescents (Age 15–19 Years)

About 2% of all brain and other CNS tumors occurred in adolescents age 15–19 years for a total of 7,061 tumors diagnosed between 2010 and 2014 (Table 4). The distribution of these tumors by site is presented in Figure 18A.

Fig. 18.

Distribution^a in Adolescentsb (Age 15-19 Years) of Primary Brain and Other CNS Tumors by A. Site (N=7,061), and B. Histology (N=7,061), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

• 32.1% of these tumors were diagnosed in the pituitary and craniopharyngeal duct.

• The frontal lobe, temporal lobe, occipital lobe, and parietal lobe accounted for 19.8% of tumors in adolescents age 15–19 years.

The distribution of brain and other CNS tumors in adolescents age 15–19 years by histology is presented in Figure 18B.

• The most common histology in adolescents was tumors of the pituitary (28.9%).

• Gliomas accounted for approximately 34% of tumors in adolescents. Of these gliomas, the histology pilocytic astrocytoma accounted for 9.4% of all tumors in this age-group.

Incidence Rates by Histology, Histology Groupings, and Sex in Children and Adolescents (Age 0–19 Years)

The incidence rates of the most common brain and other CNS tumors in children and adolescents by major histology grouping, histology, and sex are shown in Table 12.

Table 12.

Five-Year Total, Annual Average Total^a, and Annual Average Age-Adjusted Incidence Rates^b for Brain and Other Central Nervous System Tumors in Children and Adolescents (Age 0-19 Years), by Major Histology Grouping, Histology, and Sex, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Histology	Total				Male				Female
	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI
Tumors of Neuroepithelial Tissue	15,556	3,111	3.78	3.72-3.84	8,367	1,673	3.98	3.89-4.06	7,189	1,438	3.57	3.49-3.65
Pilocytic astrocytoma	3,751	750	0.91	0.88-0.94	1,926	385	0.92	0.88-0.96	1,825	365	0.91	0.87-0.95
Diffuse astrocytoma	1,062	212	0.26	0.24-0.27	565	113	0.27	0.25-0.29	497	99	0.25	0.23-0.27
Anaplastic astrocytoma	409	82	0.10	0.09-0.11	216	43	0.10	0.09-0.12	193	39	0.10	0.08-0.11
Unique astrocytoma variants	468	94	0.11	0.10-0.12	269	54	0.13	0.11-0.14	199	40	0.10	0.09-0.11
Malignant	218	44	0.05	0.05-0.06	128	26	0.06	0.05-0.07	90	18	0.04	0.04-0.05
Non-Malignant	250	50	0.06	0.05-0.07	141	28	0.07	0.06-0.08	109	22	0.05	0.04-0.07
Glioblastoma	721	144	0.17	0.16-0.19	392	78	0.19	0.17-0.20	329	66	0.16	0.15-0.18
Oligodendroglioma	199	40	0.05	0.04-0.06	100	20	0.05	0.04-0.06	99	20	0.05	0.04-0.06
Anaplastic oligodendroglioma	29	6	0.01	0.00-0.01	--	--	--	--	16	3	0.01	0.00-0.01
Oligoastrocytic tumors	123	25	0.03	0.02-0.04	61	12	0.03	0.02-0.04	62	12	0.03	0.02-0.04
Ependymal tumors	1,226	245	0.30	0.28-0.31	681	136	0.32	0.30-0.35	545	109	0.27	0.25-0.29
Malignant	1,023	205	0.25	0.23-0.26	571	114	0.27	0.25-0.29	452	90	0.22	0.20-0.25
Non-Malignant	203	41	0.05	0.04-0.06	110	22	0.05	0.04-0.06	93	19	0.05	0.04-0.06
Glioma malignant, NOS	2,724	545	0.66	0.64-0.69	1,371	274	0.65	0.62-0.69	1,353	271	0.67	0.64-0.71
Choroid plexus tumors	403	81	0.10	0.09-0.11	228	46	0.11	0.09-0.12	175	35	0.09	0.07-0.10
Malignant	102	20	0.02	0.02-0.03	52	10	0.02	0.02-0.03	50	10	0.02	0.02-0.03
Non-Malignant	301	60	0.07	0.06-0.08	176	35	0.08	0.07-0.10	125	25	0.06	0.05-0.07
Other neuroepithelial tumors	30	6	0.01	0.00-0.01	--	--	--	--	25	5	0.01	0.01-0.02
Malignant	25	5	0.01	0.00-0.01	--	--	--	--	22	4	0.01	0.01-0.02
Non-Malignant	--	--	--	--	--	--	--	--	--	--	--	--
Neuronal and mixed neuronal-glial tumors	1,687	337	0.41	0.39-0.43	932	186	0.44	0.41-0.47	755	151	0.37	0.35-0.40
Malignant	90	18	0.02	0.02-0.03	52	10	0.02	0.02-0.03	38	8	0.02	0.01-0.03
Non-Malignant	1,597	319	0.39	0.37-0.41	880	176	0.42	0.39-0.45	717	143	0.36	0.33-0.38
Tumors of the pineal region	197	39	0.05	0.04-0.06	98	20	0.05	0.04-0.06	99	20	0.05	0.04-0.06
Malignant	157	31	0.04	0.03-0.04	87	17	0.04	0.03-0.05	70	14	0.03	0.03-0.04
Non-Malignant	40	8	0.01	0.01-0.01	--	--	--	--	29	6	0.01	0.01-0.02
Embryonal tumors	2,527	505	0.62	0.59-0.64	1,510	302	0.72	0.68-0.76	1,017	203	0.51	0.48-0.54
Medulloblastomac	1,611	322	0.39	0.37-0.41	1,024	205	0.49	0.46-0.52	587	117	0.29	0.27-0.32
Primitive neuroectodermal tumord	319	64	0.08	0.07-0.09	170	34	0.08	0.07-0.09	149	30	0.07	0.06-0.09
Atypical teratoid/rhabdoid tumore	375	75	0.09	0.08-0.10	201	40	0.10	0.08-0.11	174	35	0.09	0.07-0.10
Other embryonal histologiesf	222	44	0.05	0.05-0.06	115	23	0.05	0.05-0.07	107	21	0.05	0.04-0.06
Tumors of Cranial and Spinal Nerves	1,202	240	0.29	0.27-0.31	633	127	0.30	0.28-0.32	569	114	0.28	0.26-0.31
Nerve sheath tumors	1,199	240	0.29	0.27-0.31	630	126	0.30	0.28-0.32	569	114	0.28	0.26-0.31
Malignant	24	5	0.01	0.00-0.01	--	--	--	--	--	--	--	--
Non-Malignant	1,175	235	0.28	0.27-0.30	620	124	0.29	0.27-0.32	555	111	0.27	0.25-0.30
Other tumors of cranial and spinal nerves	--	--	--	--	--	--	--	--	--	--	--	--
Tumors of Meninges	1,054	211	0.25	0.24-0.27	521	104	0.24	0.22-0.27	533	107	0.26	0.24-0.28
Meningioma	632	126	0.15	0.14-0.16	299	60	0.14	0.12-0.16	333	67	0.16	0.15-0.18
Malignant	32	6	0.01	0.01-0.01	17	3	0.01	0.00-0.01	--	--	--	--
Non-Malignant	600	120	0.14	0.13-0.16	282	56	0.13	0.12-0.15	318	64	0.16	0.14-0.17
Mesenchymal tumors	217	43	0.05	0.05-0.06	114	23	0.05	0.04-0.07	103	21	0.05	0.04-0.06
Primary melanocytic lesions	--	--	--	--	--	--	--	--	--	--	--	--
Other neoplasms related to the meninges	196	39	0.05	0.04-0.05	101	20	0.05	0.04-0.06	95	19	0.05	0.04-0.06
Lymphomas and Hematopoietic Neoplasms	122	24	0.03	0.02-0.04	75	15	0.04	0.03-0.04	47	9	0.02	0.02-0.03
Lymphoma	55	11	0.01	0.01-0.02	36	7	0.02	0.01-0.02	19	4	0.01	0.01-0.01
Other hematopoietic neoplasms	67	13	0.02	0.01-0.02	39	8	0.02	0.01-0.03	28	6	0.01	0.01-0.02
Germ Cell Tumors and Cysts	922	184	0.22	0.21-0.24	637	127	0.30	0.28-0.33	285	57	0.14	0.13-0.16
Germ cell tumors, cysts and heterotopias	922	184	0.22	0.21-0.24	637	127	0.30	0.28-0.33	285	57	0.14	0.13-0.16
Malignant	722	144	0.18	0.16-0.19	531	106	0.25	0.23-0.27	191	38	0.10	0.08-0.11
Non-Malignant	200	40	0.05	0.04-0.06	106	21	0.05	0.04-0.06	94	19	0.05	0.04-0.06
Tumors of Sellar Region	3,678	736	0.88	0.85-0.91	1,175	235	0.55	0.52-0.59	2,503	501	1.22	1.17-1.27
Tumors of the pituitary	2,841	568	0.67	0.65-0.70	758	152	0.35	0.33-0.38	2,083	417	1.01	0.97-1.06
Malignant	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	2,837	567	0.67	0.65-0.70	756	151	0.35	0.33-0.38	2,081	416	1.01	0.97-1.06
Craniopharyngioma	837	167	0.20	0.19-0.22	417	83	0.20	0.18-0.22	420	84	0.21	0.19-0.23
Unclassified Tumors	1,468	294	0.35	0.34-0.37	728	146	0.34	0.32-0.37	740	148	0.37	0.34-0.39
Hemangioma	551	110	0.13	0.12-0.14	278	56	0.13	0.12-0.15	273	55	0.13	0.12-0.15
Neoplasm, unspecified	893	179	0.22	0.20-0.23	438	88	0.21	0.19-0.23	455	91	0.23	0.20-0.25
Malignant	204	41	0.05	0.04-0.06	104	21	0.05	0.04-0.06	100	20	0.05	0.04-0.06
Non-Malignant	689	138	0.17	0.15-0.18	334	67	0.16	0.14-0.18	355	71	0.18	0.16-0.19
All other	24	5	0.01	0.00-0.01	--	--	--	--	--	--	--	--
TOTAL g	24,002	4,800	5.81	5.73-5.88	12,136	2,427	5.75	5.65-5.86	11,866	2,373	5.87	5.76-5.97
Malignant	14,337	2,867	3.48	3.43-3.54	7,829	1,566	3.72	3.64-3.80	6,508	1,302	3.23	3.16-3.31
Non-Malignant	9,665	1,933	2.32	2.28-2.37	4,307	861	2.03	1.97-2.10	5,358	1,072	2.63	2.56-2.70

^aAnnual average cases are calculated by dividing the five year total by five.

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

^cICD-O-3 histology codes: 9470/3, 9471/3, 9472/3, 9474/3.

^dICD-O-3 histology code: 9473/3.

^eICD-O-3 histology code: 9508/3.

^fICD-O-3 histology codes: 8963/3, 9364/3, 9480/3, 9490/0, 9490/3, 9500/3, 9501/3, 9502/3.

^gRefers to all brain tumors including histologies not presented in this table.

- Counts and rates are not presented when fewer than 16 cases were reported for the specific histology category. Suppressed cases are included in the total counts and rates.

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.

• Annual average incidence rates were highest for tumors of neuroepithelial tissue (3.78 per 100,000 population). Among these tumors, the most common histologies were pilocytic astrocytoma (0.91 per 100,000 population), glioma malignant, NOS (0.66 per 100,000 population), and embryonal tumors (0.62 per 100,000 population).

• There were notable differences in incidence rates between males and females for ependymal tumors, embryonal tumors, germ cell tumors, and tumors of the pituitary.

Incidence Rates by Histology and Race in Children and Adolescents (Age 0–19 Years)

Table 13 shows incidence rates for brain and other CNS tumors by histology and race for children and adolescents age 0–19 years.

Table 13.

Five-Year Total, Annual Average Total^a, and Annual Average Age-Adjusted Incidence Rates^b for Brain and Other Central Nervous System Tumors in Children and Adolescents (Age 0-19 Years), by Major Histology Grouping, Histology, and Race^c, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

	White				Black				AIAN				API
	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI
Tumors of Neuroepithelial Tissue	12,399	2,480	3.98	3.91-4.05	2,009	402	2.93	2.80-3.06	148	30	1.93	1.63-2.27	832	166	3.45	3.22-3.70
Pilocytic astrocytoma	3,029	606	0.97	0.94-1.01	466	93	0.68	0.62-0.75	29	6	0.37	0.25-0.54	187	37	0.77	0.67-0.89
Diffuse astrocytoma	849	170	0.27	0.25-0.29	138	28	0.20	0.17-0.24	--	--	--	--	54	11	0.23	0.17-0.30
Anaplastic astrocytoma	331	66	0.11	0.10-0.12	51	10	0.08	0.06-0.10	--	--	--	--	23	5	0.10	0.06-0.15
Unique astrocytoma variants	343	69	0.11	0.10-0.12	81	16	0.12	0.09-0.15	--	--	--	--	28	6	0.12	0.08-0.17
Malignant	169	34	0.05	0.05-0.06	27	5	0.04	0.03-0.06	--	--	--	--	--	--	--	--
Non-Malignant	174	35	0.06	0.05-0.07	54	11	0.08	0.06-0.10	--	--	--	--	16	3	0.07	0.04-0.11
Glioblastoma	558	112	0.18	0.16-0.19	93	19	0.14	0.11-0.17	--	--	--	--	48	10	0.20	0.15-0.27
Oligodendroglioma	155	31	0.05	0.04-0.06	23	5	0.03	0.02-0.05	--	--	--	--	--	--	--	--
Anaplastic oligodendroglioma	23	5	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--
Oligoastrocytic tumors	95	19	0.03	0.02-0.04	21	4	0.03	0.02-0.05	--	--	--	--	--	--	--	--
Ependymal tumors	996	199	0.32	0.30-0.34	139	28	0.20	0.17-0.24	--	--	--	--	65	13	0.27	0.21-0.34
Malignant	818	164	0.26	0.25-0.28	129	26	0.19	0.16-0.22	--	--	--	--	55	11	0.23	0.17-0.29
Non-Malignant	178	36	0.06	0.05-0.07	--	--	--	--	--	--	--	--	--	--	--	--
Glioma malignant, NOS	2,190	438	0.71	0.68-0.74	359	72	0.53	0.47-0.58	26	5	0.34	0.22-0.50	128	26	0.53	0.44-0.63
Choroid plexus tumors	316	63	0.10	0.09-0.11	54	11	0.08	0.06-0.10	--	--	--	--	24	5	0.10	0.06-0.15
Malignant	74	15	0.02	0.02-0.03	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	242	48	0.08	0.07-0.09	39	8	0.06	0.04-0.08	--	--	--	--	--	--	--	--
Other neuroepithelial tumors	23	5	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--
Malignant	20	4	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Neuronal and mixed neuronal- glial tumors	1,362	272	0.44	0.41-0.46	207	41	0.30	0.26-0.35	--	--	--	--	94	19	0.39	0.32-0.48
Malignant	69	14	0.02	0.02-0.03	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	1,293	259	0.41	0.39-0.44	193	39	0.28	0.24-0.32	--	--	--	--	89	18	0.37	0.30-0.46
Tumors of the pineal region	132	26	0.04	0.04-0.05	51	10	0.08	0.06-0.10	--	--	--	--	--	--	--	--
Malignant	99	20	0.03	0.03-0.04	46	9	0.07	0.05-0.09	--	--	--	--	--	--	--	--
Non-Malignant	33	7	0.01	0.01-0.01	--	--	--	--	--	--	--	--	--	--	--	--
Embryonal tumors	1,997	399	0.64	0.62-0.67	321	64	0.47	0.42-0.52	25	5	0.32	0.21-0.48	148	30	0.61	0.51-0.72
Medulloblastomac	1,288	258	0.42	0.39-0.44	188	38	0.28	0.24-0.32	16	3	0.21	0.12-0.34	97	19	0.40	0.32-0.49
Primitive neuroectodermal tumord	249	50	0.08	0.07-0.09	50	10	0.07	0.05-0.09	--	--	--	--	--	--	--	--
Atypical teratoid/ rhabdoid tumore	290	58	0.09	0.08-0.11	53	11	0.08	0.06-0.10	--	--	--	--	25	5	0.10	0.07-0.15
Other embryonal histologiesf	170	34	0.05	0.05-0.06	30	6	0.04	0.03-0.06	--	--	--	--	--	--	--	--
Tumors of Cranial and Spinal Nerves	927	185	0.30	0.28-0.32	157	31	0.23	0.19-0.27	17	3	0.22	0.13-0.35	85	17	0.35	0.28-0.44
Nerve sheath tumors	924	185	0.30	0.28-0.31	157	31	0.23	0.19-0.27	17	3	0.22	0.13-0.35	85	17	0.35	0.28-0.44
Malignant	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	909	182	0.29	0.27-0.31	152	30	0.22	0.19-0.26	17	3	0.22	0.13-0.35	83	17	0.35	0.27-0.43
Other tumors of cranial and spinal nerves	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Tumors of Meninges	839	168	0.27	0.25-0.28	138	28	0.20	0.17-0.23	--	--	--	--	60	12	0.25	0.19-0.32
Meningioma	485	97	0.15	0.14-0.17	103	21	0.15	0.12-0.18	--	--	--	--	32	6	0.13	0.09-0.19
Malignant	24	5	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	461	92	0.15	0.13-0.16	98	20	0.14	0.11-0.17	--	--	--	--	29	6	0.12	0.08-0.18
Mesenchymal tumors	182	36	0.06	0.05-0.07	--	--	--	--	--	--	--	--	17	3	0.07	0.04-0.11
Primary melanocytic lesions	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Other neoplasms related to the meninges	163	33	0.05	0.04-0.06	20	4	0.03	0.02-0.04	--	--	--	--	--	--	--	--
Lymphomas and Hematopoietic Neoplasms	99	20	0.03	0.03-0.04	--	--	--	--	--	--	--	--	--	--	--	--
Lymphoma	40	8	0.01	0.01-0.02	--	--	--	--	--	--	--	--	--	--	--	--
Other hematopoietic neoplasms	59	12	0.02	0.01-0.02	--	--	--	--	--	--	--	--	--	--	--	--
Germ Cell Tumors and Cysts	709	142	0.23	0.21-0.25	92	18	0.13	0.11-0.16	--	--	--	--	111	22	0.47	0.39-0.56
Germ cell tumors, cysts and heterotopias	709	142	0.23	0.21-0.25	92	18	0.13	0.11-0.16	--	--	--	--	111	22	0.47	0.39-0.56
Malignant	554	111	0.18	0.16-0.19	70	14	0.10	0.08-0.13	--	--	--	--	90	18	0.38	0.31-0.47
Non-Malignant	155	31	0.05	0.04-0.06	22	4	0.03	0.02-0.05	--	--	--	--	21	4	0.09	0.05-0.13
Tumors of Sellar Region	2,769	554	0.87	0.84-0.91	551	110	0.79	0.73-0.86	51	10	0.68	0.50-0.89	272	54	1.14	1.01-1.29
Tumors of the pituitary	2,155	431	0.67	0.65-0.70	395	79	0.56	0.51-0.62	44	9	0.58	0.42-0.78	220	44	0.93	0.81-1.06
Malignant	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	2,153	431	0.67	0.65-0.70	395	79	0.56	0.51-0.62	43	9	0.57	0.41-0.77	219	44	0.92	0.81-1.05
Craniopharyngioma	614	123	0.20	0.18-0.21	156	31	0.23	0.20-0.27	--	--	--	--	52	10	0.22	0.16-0.28
Unclassified Tumors	1,162	232	0.37	0.35-0.39	167	33	0.24	0.21-0.28	26	5	0.34	0.22-0.50	106	21	0.44	0.36-0.54
Hemangioma	447	89	0.14	0.13-0.16	52	10	0.07	0.06-0.10	--	--	--	--	42	8	0.17	0.13-0.24
Neoplasm, unspecified	695	139	0.22	0.21-0.24	113	23	0.17	0.14-0.20	16	3	0.21	0.12-0.35	63	13	0.26	0.20-0.34
Malignant	152	30	0.05	0.04-0.06	29	6	0.04	0.03-0.06	--	--	--	--	18	4	0.08	0.04-0.12
Non-Malignant	543	109	0.17	0.16-0.19	84	17	0.12	0.10-0.15	--	--	--	--	45	9	0.19	0.14-0.25
All other	20	4	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--	--	--
TOTAL h	18,904	3,781	6.04	5.96-6.13	3,126	625	4.54	4.38-4.70	260	52	3.41	3.01-3.85	1,473	295	6.14	5.83-6.46
Malignant	11,384	2,277	3.66	3.59-3.73	1,832	366	2.67	2.55-2.80	147	29	1.92	1.62-2.25	824	165	3.43	3.20-3.67
Non-Malignant	7,520	1,504	2.39	2.33-2.44	1,294	259	1.87	1.77-1.97	113	23	1.49	1.23-1.79	649	130	2.72	2.51-2.93

^aAnnual average cases are calculated by dividing the five year total by five.

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

^cIndividuals with unknown race were excluded (N = 1).

^dICD-O-3 histology codes: 9470/3, 9471/3, 9472/3, 9474/3.

^eICD-O-3 histology code: 9473/3.

^fICD-O-3 histology code: 9508/3.

^gICD-O-3 histology codes: 8963/3, 9364/3, 9480/3, 9490/0, 9490/3, 9500/3, 9501/3, 9502/3.

^hRefers to all brain tumors including histologies not presented in this table.

-Counts and rates are not presented when fewer than 16 cases were reported for the specific histology category. Suppressed cases are included in the total counts and rates.

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; AIAN, American Indian/Alaskan Native; API, Asian/Pacific Islander.

• Incidence rates were highest among API (6.14 per 100,000 population) compared to Whites (6.04 per 100,000 population), Blacks (4.54 per 100,000 population), and AIAN (3.41 per 100,000 population).

Incidence Rates by Histology and Hispanic Ethnicity in Children and Adolescents (Age 0–19 Years)

Incidence rates of brain and other CNS tumors for children and adolescents age 0–19 years by Hispanic ethnicity are shown in Table 14.

Table 14.

Five-Year Total, Annual Average Total^a, and Annual Average Age-Adjusted Incidence Rates^b for Brain and Other Central Nervous System Tumors in Children and Adolescents (Age 0-19 Years), by Major Histology Grouping, Histology, Hispanic Ethnicity^c, and Race, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Histology	All Hispanic				White Hispanic				Black Hispanic				All Non-Hispanic
	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI
Tumors of Neuroepithelial Tissue	2,844	569	2.89	2.78-3.00	2,599	520	2.98	2.87-3.10	95	19	1.61	1.30-1.97	12,712	2,542	4.05	3.98-4.12
Pilocytic astrocytoma	632	126	0.64	0.59-0.69	564	113	0.65	0.60-0.70	28	6	0.49	0.33-0.71	3,119	624	0.99	0.96-1.03
Diffuse astrocytoma	152	30	0.16	0.13-0.18	142	28	0.17	0.14-0.20	--	--	--	--	910	182	0.29	0.27-0.31
Anaplastic astrocytoma	87	17	0.09	0.07-0.11	81	16	0.10	0.08-0.12	--	--	--	--	322	64	0.10	0.09-0.11
Unique astrocytoma variants	94	19	0.10	0.08-0.12	90	18	0.11	0.09-0.13	--	--	--	--	374	75	0.12	0.11-0.13
Malignant	48	10	0.05	0.04-0.07	48	10	0.06	0.04-0.08	--	--	--	--	170	34	0.05	0.05-0.06
Non-Malignant	46	9	0.05	0.03-0.06	42	8	0.05	0.03-0.07	--	--	--	--	204	41	0.07	0.06-0.08
Glioblastoma	161	32	0.17	0.14-0.20	150	30	0.18	0.15-0.21	--	--	--	--	560	112	0.18	0.16-0.19
Oligodendroglioma	25	5	0.03	0.02-0.04	22	4	0.03	0.02-0.04	--	--	--	--	174	35	0.05	0.05-0.06
Anaplastic oligodendroglioma	--	--	--	--	--	--	--	--	--	--	--	--	24	5	0.01	0.00-0.01
Oligoastrocytic tumors	18	4	0.02	0.01-0.03	--	--	--	--	--	--	--	--	105	21	0.03	0.03-0.04
Ependymal tumors	275	55	0.28	0.24-0.31	256	51	0.29	0.26-0.33	--	--	--	--	951	190	0.30	0.28-0.32
Malignant	785	157	0.25	0.23-0.27	224	45	0.25	0.22-0.29	--	--	--	--	785	157	0.25	0.23-0.27
Non-Malignant	166	33	0.05	0.04-0.06	32	6	0.04	0.03-0.05	--	--	--	--	166	33	0.05	0.04-0.06
Glioma malignant, NOS	466	93	0.47	0.43-0.51	421	84	0.48	0.43-0.53	20	4	0.33	0.20-0.51	2,258	452	0.72	0.69-0.76
Choroid plexus tumors	91	18	0.09	0.07-0.11	84	17	0.09	0.08-0.12	--	--	--	--	312	62	0.10	0.09-0.11
Malignant	23	5	0.02	0.01-0.03	20	4	0.02	0.01-0.03	--	--	--	--	79	16	0.03	0.02-0.03
Non-Malignant	68	14	0.07	0.05-0.09	64	13	0.07	0.06-0.09	--	--	--	--	233	47	0.07	0.07-0.09
Other neuroepithelial tumors	--	--	--	--	--	--	--	--	--	--	--	--	23	5	0.01	0.00-0.01
Malignant	--	--	--	--	--	--	--	--	--	--	--	--	19	4	0.01	0.00-0.01
Non-Malignant	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Neuronal and mixed neuronal-glial tumors	261	52	0.27	0.24-0.31	238	48	0.28	0.25-0.32	--	--	--	--	1,426	285	0.45	0.43-0.47
Malignant	16	3	0.02	0.01-0.03	16	3	0.02	0.01-0.03	--	--	--	--	74	15	0.02	0.02-0.03
Non-Malignant	245	49	0.26	0.22-0.29	222	44	0.26	0.23-0.30	--	--	--	--	1,352	270	0.43	0.40-0.45
Tumors of the pineal region	33	7	0.03	0.02-0.05	32	6	0.04	0.03-0.05	--	--	--	--	164	33	0.05	0.04-0.06
Malignant	28	6	0.03	0.02-0.04	27	5	0.03	0.02-0.04	--	--	--	--	129	26	0.04	0.03-0.05
Non-Malignant	--	--	--	--	--	--	--	--	--	--	--	--	35	7	0.01	0.01-0.02
Embryonal tumors	537	107	0.53	0.49-0.58	492	98	0.55	0.50-0.60	18	4	0.28	0.17-0.45	1,990	398	0.64	0.61-0.67
Medulloblastomad	327	65	0.33	0.29-0.37	302	60	0.34	0.30-0.38	--	--	--	--	1,284	257	0.41	0.39-0.44
Primitive neuroecto dermal tumore	60	12	0.06	0.05-0.08	54	11	0.06	0.05-0.08	--	--	--	--	259	52	0.08	0.07-0.09
Atypical teratoid/ rhabdoid tumorf	109	22	0.10	0.09-0.13	99	20	0.11	0.09-0.13	--	--	--	--	266	53	0.09	0.08-0.10
Other embryonal histologiesg	41	8	0.04	0.03-0.05	37	7	0.04	0.03-0.06	--	--	--	--	181	36	0.06	0.05-0.07
Tumors of Cranial and Spinal Nerves	196	39	0.20	0.18-0.23	173	35	0.20	0.17-0.24	--	--	--	--	1,006	201	0.32	0.30-0.34
Nerve sheath tumors	195	39	0.20	0.18-0.23	172	34	0.20	0.17-0.24	--	--	--	--	1,004	201	0.32	0.30-0.34
Malignant	--	--	--	--	--	--	--	--	--	--	--	--	20	4	0.01	0.00-0.01
Non-Malignant	191	38	0.20	0.17-0.23	168	34	0.20	0.17-0.23	--	--	--	--	984	197	0.31	0.29-0.33
Other tumors of cranial and spinal nerves	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Tumors of Meninges	198	40	0.21	0.18-0.24	180	36	0.22	0.19-0.25	--	--	--	--	856	171	0.26	0.25-0.28
Meningioma	104	21	0.11	0.09-0.14	96	19	0.12	0.09-0.14	--	--	--	--	528	106	0.16	0.15-0.18
Malignant	--	--	--	--	--	--	--	--	--	--	--	--	24	5	0.01	0.00-0.01
Non-Malignant	96	19	0.10	0.08-0.13	88	18	0.11	0.09-0.13	--	--	--	--	504	101	0.15	0.14-0.17
Mesenchymal tumors	41	8	0.04	0.03-0.06	35	7	0.04	0.03-0.06	--	--	--	--	176	35	0.06	0.05-0.07
Primary melanocytic lesions	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Other neoplasms related to the meninges	51	10	0.05	0.04-0.07	47	9	0.06	0.04-0.08	--	--	--	--	145	29	0.04	0.04-0.05
Lymphomas and Hematopoietic Neoplasms	31	6	0.03	0.02-0.05	29	6	0.03	0.02-0.05	--	--	--	--	91	18	0.03	0.02-0.04
Lymphoma	--	--	--	--	--	--	--	--	--	--	--	--	42	8	0.01	0.01-0.02
Other hematopoietic neoplasms	18	4	0.02	0.01-0.03	16	3	0.02	0.01-0.03	--	--	--	--	49	10	0.02	0.01-0.02
Germ Cell Tumors and Cysts	208	42	0.22	0.19-0.25	190	38	0.23	0.20-0.26	--	--	--	--	714	143	0.23	0.21-0.24
Germ cell tumors, cysts and heterotopias	208	42	0.22	0.19-0.25	190	38	0.23	0.20-0.26	--	--	--	--	714	143	0.23	0.21-0.24
Malignant	175	35	0.19	0.16-0.22	160	32	0.19	0.16-0.22	--	--	--	--	547	109	0.17	0.16-0.19
Non-Malignant	33	7	0.03	0.02-0.05	30	6	0.03	0.02-0.05	--	--	--	--	167	33	0.05	0.05-0.06
Tumors of Sellar Region	930	186	1.01	0.94-1.07	817	163	0.99	0.93-1.06	32	6	0.59	0.40-0.83	2,748	550	0.84	0.81-0.88
Tumors of the pituitary	735	147	0.80	0.75-0.86	637	127	0.78	0.72-0.84	23	5	0.44	0.28-0.66	2,106	421	0.64	0.61-0.67
Malignant	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--
Non-Malignant	733	147	0.80	0.74-0.86	636	127	0.78	0.72-0.84	23	5	0.44	0.28-0.66	2,104	421	0.64	0.61-0.67
Craniopharyngioma	195	39	0.20	0.18-0.23	180	36	0.21	0.18-0.25	--	--	--	--	642	128	0.20	0.19-0.22
Unclassified Tumors	282	56	0.29	0.26-0.33	253	51	0.30	0.26-0.34	--	--	--	--	1,186	237	0.37	0.35-0.39
Hemangioma	104	21	0.11	0.09-0.13	95	19	0.11	0.09-0.14	--	--	--	--	447	89	0.14	0.13-0.15
Neoplasm, unspecified	172	34	0.18	0.15-0.21	152	30	0.18	0.15-0.21	--	--	--	--	721	144	0.23	0.21-0.24
Malignant	48	10	0.05	0.04-0.07	43	9	0.05	0.04-0.07	--	--	--	--	156	31	0.05	0.04-0.06
Non-Malignant	124	25	0.13	0.11-0.16	109	22	0.13	0.11-0.16	--	--	--	--	565	113	0.18	0.16-0.19
All other	--	--	--	--	--	--	--	--	--	--	--	--	18	4	0.01	0.00-0.01
TOTAL h	4,689	938	4.85	4.71-4.99	4,241	848	4.96	4.81-5.11	157	31	2.73	2.31-3.19	19,313	3,863	6.10	6.02-6.19
Malignant	2,734	547	2.78	2.68-2.89	2,500	500	2.88	2.76-2.99	96	19	1.65	1.33-2.02	11,603	2,321	3.70	3.63-3.77
Non-Malignant	1,955	391	2.07	1.98-2.17	1,741	348	2.08	1.98-2.18	61	12	1.08	0.82-1.38	7,710	1,542	2.40	2.35-2.46

^aAnnual average cases are calculated by dividing the five year total by five.

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

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

^dICD-O-3 histology codes: 9470/3, 9471/3, 9472/3, 9474/3.

^eICD-O-3 histology code: 9473/3.

^fICD-O-3 histology code: 9508/3.

^gICD-O-3 histology codes: 8963/3, 9364/3, 9480/3, 9490/0, 9490/3, 9500/3, 9501/3, 9502/3.

^hRefers to all brain tumors including histologies not presented in this table.

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

Abbreviations: CBTRUS, Central Brain umor 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 non-Hispanics (6.10 per 100,000 population, 19,313 total tumors) were higher than those for Hispanics (4.85 per 100,000 population, 4,689 total tumors).

• The largest differences between non-Hispanics and Hispanics were in incidence rates of tumors of neuroepithelial tissue and tumors of cranial and spinal nerves.

Incidence Rates by Age and Histology in Children and Adolescents (Age 0–19 Years)

The detailed age-adjusted incidence rates for brain and other CNS tumors by histology for childhood age 0–14 years overall, childhood and adolescence age 0–19 years overall, and age-groups 0–4 years, 5–9 years, 10–14 years, and 15–19 years are shown in Table 4.

• Overall, incidence rates for age-groups 0–4 years (6.02 per 100,000 population) and 15–19 years (6.59 per 100,000 population) significantly exceeded those observed in age-groups 5–9 years (5.19 per 100,000 population) and 10–14 years (5.44 per 100,000 population).

• Individual histology distributions varied substantially within these age-groups.

• Incidence rates of pilocytic astrocytoma, glioma malignant, NOS, ependymal tumors, choroid plexus tumors, and embryonal tumors decreased with increasing age.

Incidence Rates by Histology Defined by ICCC in Children and Adolescents (Age 0–19 Years)

Table 15 presents the CBTRUS brain and other CNS tumor data for children and adolescents used for this report according to the International Classification of Childhood Cancer (ICCC) grouping system for pediatric cancers (See Supplementary Table 1 online for more additional information on the ICCC classification scheme). ¹⁹

Table 15.

Five-Year Total, Annual Average Total^a, and Age-Adjusted and Age-Specific Incidence Rates^b for Brain and Other Central Nervous System Tumors in Children and Adolescents, (Age 0-19 Years), by International Classification of Childhood Cancer (ICCC),^c CBTRUS Statistical Report: NPCR and SEER, 2010-2014

ICCC Category	0-14 c years				0-19 c years				< 1 year		1-4 years		5-9 years		10-14 years		15-19 years
	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI	Rate	95% CI
II Lymphomas and reticuloendothelial neoplasms	72	14	0.02	0.02-0.03	111	22	0.03	0.02-0.03	--	--	--	--	0.03	0.02-0.04	0.03	0.02-0.04	0.04	0.03-0.05
III CNS and misc. intracranial and intraspinal neoplasms	14,526	2,905	4.75	4.67-4.83	20,223	4,045	4.89	4.83-4.96	4.70	4.41-5.02	5.32	5.16-5.48	4.56	4.43-4.70	4.52	4.39-4.65	5.32	5.18-5.46
III(a) Ependymomas and choroid plexus tumor	1,332	266	0.43	0.41-0.46	1,629	326	0.39	0.38-0.41	0.98	0.85-1.13	0.69	0.63-0.75	0.29	0.26-0.32	0.28	0.25-0.32	0.28	0.25-0.31
III(b) Astrocytomas	5,734	1,147	1.88	1.83-1.92	7,194	1,439	1.75	1.71-1.79	1.39	1.23-1.56	2.30	2.20-2.41	1.86	1.77-1.94	1.67	1.59-1.75	1.37	1.30-1.44
III(c) Intracranial and intraspinal embryonal tumors	2,113	423	0.69	0.66-0.72	2,331	466	0.57	0.54-0.59	1.08	0.94-1.23	1.03	0.96-1.10	0.65	0.61-0.71	0.40	0.36-0.44	0.20	0.18-0.23
III(d) Other gliomas	1,815	363	0.59	0.57-0.62	2,324	465	0.56	0.54-0.59	0.28	0.21-0.36	0.58	0.53-0.64	0.70	0.65-0.75	0.56	0.51-0.61	0.48	0.44-0.52
III(e) Other specified intracranial and intraspinal neoplasms	2,919	584	0.96	0.92-0.99	5,853	1,171	1.40	1.37-1.44	0.65	0.54-0.77	0.56	0.51-0.61	0.90	0.84-0.96	1.37	1.30-1.45	2.74	2.64-2.84
III(f) Unspecified intracranial and intraspinal neoplasms	613	123	0.20	0.19-0.22	892	178	0.22	0.20-0.23	0.33	0.25-0.42	0.16	0.14-0.19	0.17	0.14-0.19	0.24	0.21-0.27	0.26	0.23-0.29
IV Neuroblastoma and other peripheral nervous cell tumors	146	29	0.05	0.04-0.06	158	32	0.04	0.03-0.04	0.28	0.21-0.37	0.07	0.06-0.10	--	--	0.02	0.01-0.03	--	--
IX Soft tissue and other extraosseous sarcomas	68	14	0.02	0.02-0.03	96	19	0.02	0.02-0.03	--	--	0.02	0.01-0.03	0.02	0.01-0.03	0.02	0.01-0.03	0.03	0.02-0.04
X(a) Intracranial & intraspinal germ cell tumors	645	129	0.21	0.20-0.23	922	184	0.22	0.21-0.24	0.40	0.31-0.49	0.11	0.08-0.13	0.17	0.14-0.19	0.31	0.27-0.34	0.26	0.23-0.29
All other categories	17	3	0.01	0.00-0.01	25	5	0.01	0.00-0.01	--	--	--	--	--	--	--	--	--	--
Not classified by ICCC	1,464	293	0.48	0.46-0.50	2,464	493	0.59	0.57-0.62	0.75	0.63-0.88	0.44	0.39-0.48	0.40	0.36-0.44	0.55	0.50-0.59	0.93	0.88-0.99
TOTAL e	16,941	3,388	5.54	5.46-5.63	24,002	4,800	5.81	5.73-5.88	6.19	5.85-6.55	5.98	5.81-6.15	5.19	5.05-5.33	5.44	5.30-5.58	6.59	6.44-6.75

^aAnnual average cases are calculated by dividing the five year total by five.

^bRates are per 100,000.

^cSee Supplementary Table 1 for additional information on this classification scheme.

^dRates are age-adjusted to the 2000 U.S. standard population.

^eRefers to all brain tumors including histologies not presented in this table.

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

Abbreviations: ICCC, International Classification of Childhood Cancer; 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.

Primary Brain and Other CNS Tumors: Estimated Numbers of Expected Cases, Mortality Rates, and Relative Survival

Estimated Numbers of Expected Cases of All Primary Brain and Other CNS Tumors by State

Overall total rates presented are based on total malignant and non-malignant incidence, and the presented stratified rates may not add up to these totals. Estimated numbers of cases are highly dependent on input data. Different patterns of incidence within strata can significantly affect the projected estimates, and strata-specific estimates may not equal the total estimate presented. Caution should be used when utilizing these estimates.

The estimated number of cases of all primary brain and other CNS tumors for 2017 and 2018 by state and behavior are shown in Table 16. The estimated number of cases of malignant and non-malignant tumors projected using age-adjusted annual CNS tumor incidence rates were generated for 2000–2014 for malignant tumors, and 2006–2014 for non-malignant tumors.

Table 16.

Estimated Number of Cases^a,b of Brain and Other Central Nervous System Tumors Overall and by Behavior by State, 2017, 2018

STATE	2017 Estimated New Cases			2018 Estimated New Cases
	All	Malignant	Non-Malignant	All	Malignant	Non-Malignant
Alabama	980	400	580	1,000	400	590
Alaska	160	--	130	160	--	130
Arizona	1,280	520	760	1,240	520	720
Arkansas	700	280	420	710	290	420
California	8,590	2,760	5,830	8,670	2,790	5,880
Colorado	1,560	420	1,140	1,590	420	1,160
Connecticut	800	300	500	790	300	490
Delaware	170	80	90	160	80	80
District of Columbia	130	--	90	130	50	80
Florida	5,920	1,670	4,250	6,020	1,690	4,330
Georgia	2,110	690	1,420	2,050	700	1,350
Hawaii	280	80	200	280	80	200
Idaho	390	130	260	400	130	270
Illinois	3,380	1,010	2,370	3,420	1,020	2,400
Indiana	1,680	550	1,130	1,710	560	1,160
Iowa	740	290	460	720	290	430
Kansas	760	240	520	780	240	530
Kentucky	1,270	440	830	1,250	450	800
Louisiana	1,290	330	970	1,340	330	1,010
Maine	320	130	190	330	130	200
Maryland	1,290	450	840	1,290	460	830
Massachusetts	1,260	550	710	1,230	550	670
Michigan	2,080	800	1,290	2,040	800	1,240
Minnesota	1,420	480	940	1,510	490	1,010
Mississippi	730	230	500	750	240	510
Missouri	1,500	510	990	1,500	520	980
Montana	250	100	150	250	100	150
Nebraska	420	160	250	420	170	250
Nevada	440	200	240	440	210	240
New Hampshire	340	130	200	340	140	210
New Jersey	2,690	760	1,930	2,790	770	2,020
New Mexico	500	140	360	510	140	370
New York	5,930	1,520	4,400	6,020	1,520	4,500
North Carolina	2,430	670	1,760	2,440	660	1,780
North Dakota	150	60	100	160	60	100
Ohio	3,010	1,000	2,010	3,100	1,000	2,100
Oklahoma	1,140	300	840	1,210	300	900
Oregon	920	380	530	930	390	540
Pennsylvania	4,040	1,210	2,840	4,110	1,220	2,890
Rhode Island	210	80	130	200	80	130
South Carolina	1,390	410	980	1,450	420	1,020
South Dakota	230	70	160	240	70	170
Tennessee	1,630	450	1,180	1,620	450	1,170
Texas	6,290	1,930	4,360	6,330	1,960	4,360
Utah	1,050	220	830	1,130	230	900
Vermont	160	60	100	160	60	100
Virginia	1,680	670	1,010	1,680	690	1,000
Washington	2,380	640	1,740	2,430	650	1,780
West Virginia	430	160	270	430	150	270
Wisconsin	1,820	460	1,360	1,870	450	1,410
Wyoming	150	50	90	150	50	100
United States c	78,370	23,570	54,800	79,870	24,720	55,150

^aSource: Estimation based on CBTRUS NPCR and SEER 2000-2014 data for malignant tumors, and NPCR and SEER 2006-2014 data for non-malignant tumors.

^bRounded to the nearest 10. Numbers may not add up due to rounding.

^cTotal estimate is based on overall estimate, histology-specific estimates may not add up to total.

^–Estimated number is less than 50. These cases are included in overall rates.

• The total number of new cases of primary brain and other CNS tumors for all 50 states and the District of Columbia in 2017 was estimated to be 78,370, with 23,570 malignant tumors and 54,800 non-malignant tumors.

• For 2018, the estimate was 79,870 new cases of primary brain and other CNS tumors of which 24,720 and 55,150 are expected to be malignant and non-malignant, respectively.

Estimated Number of Expected Cases of All Primary Brain and Other CNS Tumors by Histology, Histology Grouping, and Age

The estimated number of cases of all primary brain and other CNS tumors for 2017 and 2018 by histology are shown in Table 17.

• Meningiomas had the highest number of all estimated new cases, with 29,100 cases projected in 2017 and 29,320 in 2018.

• Tumors of the pituitary had the second highest number of all estimated cases, with 13,060 cases in 2017 and 13,210 in 2018.

• Glioblastoma had the highest number of cases of all malignant tumors, with 12,500 cases projected in 2017 and 12,760 in 2018.

The estimated numbers of cases for 2017 and 2018 by age are presented in Table 18.

Table 18.

Estimated Number of Cases^a,b of Brain and Other Central Nervous System Tumors by Age, Major Histology Grouping, and Histology, 2017, 2018

Histology	2017 Estimated New Cases					2018 Estimated New Cases
	0-14	0-19	15-39	40-64	65+	0-14	0-19	15-39	40-64	65+
Tumors of Neuroepithelial Tissue c	2,520	3,140	3,660	8,640	8,270	2,530	3,150	3,680	8,700	8,480
Pilocytic astrocytoma	660	790	300	100	30	670	800	300	110	30
Diffuse astrocytoma	140	190	420	420	320	130	190	410	400	310
Anaplastic astrocytoma	70	100	380	630	540	70	100	390	650	590
Unique astrocytoma variants	80	110	90	50	40	80	110	100	50	40
Glioblastoma	110	170	550	5,480	6,340	120	170	550	5,580	6,490
Oligodendroglioma		--	260	320	80	--	--	250	320	80
Anaplastic oligodendroglioma		--	80	200	50	--	--	80	200	50
Oligoastrocytic tumors		--	270	180	70	--	--	270	170	80
Ependymal tumors	200	240	380	520	260	200	240	380	510	280
Glioma malignant, NOS	420	510	340	330	380	420	500	350	340	380
Choroid plexus tumors	70	80	--	--	--	70	80	--	--	--
Other neuroepithelial tumors	--	--	--	--	--	--	--	--	--	--
Neuronal and mixed neuronal-glial tumors	250	370	340	240	90	260	370	340	250	90
Tumors of the pineal region	--	--	50	60	--	--	--	60	60	--
Embryonal tumors	450	490	170	--	--	440	490	160	--	--
Tumors of Cranial and Spinal Nerves c	130	240	1,070	3,820	2,240	130	250	1,100	3,890	2,340
Nerve sheath tumors	130	220	1,050	3,810	2,240	130	220	1,070	3,880	2,340
Other tumors of cranial and spinal nerves	--	--	--	--	--	--	--	--	--	--
Tumors of Meninges c	120	240	1,970	12,050	16,450	120	250	1,960	12,090	16,770
Meningioma	50	140	1,700	11,630	16,270	50	140	1,690	11,680	16,580
Mesenchymal tumors	50	60	70	120	60	50	60	70	120	70
Primary melanocytic lesions	--	--	--	--	--	--	--	--	--	--
Other neoplasms related to the meninges	--	50	190	270	120	--	50	190	270	120
Lymphomas and Hematopoietic Neoplasms c	--	--	100	600	940	--	--	100	600	970
Lymphoma	--	--	80	580	930	--	--	80	590	960
Other hematopoietic neoplasms	--	--	--	--	--	--	--	--	--	--
Germ Cell Tumors and Cysts c	140	190	130	--	--	140	190	130	--	--
Germ cell tumors, cysts and heterotopias	140	190	130	--	--	140	190	130	--	--
Tumors of Sellar Region c	340	740	3,830	5,830	3,810	350	740	3,850	5,870	3,940
Tumors of the pituitary	200	560	3,690	5,600	3,680	210	560	3,710	5,640	3,800
Craniopharyngioma	140	170	130	230	130	140	170	130	230	130
Unclassified Tumors c	260	340	500	1,220	1,970	280	350	470	1,190	1,970
Hemangioma	100	120	270	390	260	110	120	260	360	250
Neoplasm, unspecifieda	150	220	230	820	1,710	160	220	210	830	1,710
All other	--	--	--	--	--	--	--	--	--	--
TOTAL d	3,320	4,650	11,150	31,750	33,590	3,310	4,610	11,140	31,840	34,340

^aSource: Estimation based on CBTRUS NPCR and SEER 2006-2014 data.

^bRounded to the nearest 10. Numbers may not add up due to rounding.

^cMajor histology grouping estimates are calculated by summing estimates for all included histologies.

^dTotal estimate is based on overall estimate, histology-specific estimates may not add up to total.

^–Estimated number is less than 50. These cases are included in overall rates.

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.

• For 2017, the highest number of new cases was predicted in those age 65+ years, with 33,590 cases. For 2018, the highest number of new cases was estimated to be in those age 65+ years, with 34,340 cases.

• For 2017 and 2018, children age 0–14 years were estimated to have 3,320 and 3,310 new cases of primary brain and other CNS tumors each year, respectively.

• For 2017 and 2018, children age 0–19 years were estimated to have 4,650 and 4,610 new cases of primary brain and other CNS tumors each year, respectively.

Estimated Mortality Rates for Malignant Brain and Other CNS Tumors by State and Sex

Table 19 and Figure 19 show annual average age-adjusted mortality rates for primary malignant brain and other CNS tumors in the US during 2010–2014 by state and sex.

Table 19.

Five-Year Total, Annual Average Total^a, and Annual Average Age-Adjusted Mortality Rates^b for Malignant Brain and Other Central Nervous System Tumors Overall and by State and Sex, United States, 2010-2014^b,c

State	TOTAL				Males				Females
	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI	Five-Year Total	Annual Average	Rate	95% CI
Alabama	1,391	278	5.01	4.74-5.28	776	155	6.14	5.71-6.61	615	123	4.06	3.74-4.41
Alaska	142	28	4.39	3.64-5.24	87	17	5.64	4.37-7.13	55	11	3.31	2.45-4.36
Arizona	1,582	316	4.32	4.11-4.54	879	176	5.10	4.77-5.46	703	141	3.62	3.35-3.91
Arkansas	825	165	4.84	4.51-5.19	465	93	6.03	5.48-6.62	360	72	3.90	3.50-4.33
California	8,322	1,664	4.28	4.19-4.37	4,700	940	5.25	5.10-5.40	3,622	724	3.45	3.34-3.57
Colorado	1,182	236	4.45	4.19-4.71	641	128	5.14	4.74-5.57	541	108	3.84	3.52-4.19
Connecticut	882	176	4.17	3.89-4.46	485	97	5.08	4.63-5.57	397	79	3.37	3.03-3.73
Delaware	218	44	4.03	3.50-4.62	110	22	4.54	3.71-5.50	108	22	3.65	2.97-4.44
District of Columbia	89	18	2.98	2.38-3.68	50	10	3.87	2.85-5.14	39	8	2.35	1.66-3.23
Florida	5,201	1,040	4.17	4.06-4.29	2,944	589	5.15	4.96-5.34	2,257	451	3.32	3.18-3.46
Georgia	2,071	414	4.19	4.01-4.38	1,173	235	5.21	4.90-5.53	898	180	3.36	3.15-3.60
Hawaii	213	43	2.55	2.21-2.93	115	23	2.85	2.34-3.44	98	20	2.27	1.83-2.79
Idaho	425	85	4.97	4.50-5.48	275	55	6.80	6.00-7.67	150	30	3.31	2.80-3.90
Illinois	2,884	577	4.12	3.97-4.28	1,618	324	5.08	4.83-5.34	1,266	253	3.32	3.14-3.51
Indiana	1,619	324	4.51	4.29-4.74	923	185	5.57	5.21-5.95	696	139	3.62	3.35-3.91
Iowa	870	174	4.87	4.55-5.22	509	102	6.14	5.61-6.71	361	72	3.77	3.38-4.20
Kansas	823	165	5.17	4.82-5.54	468	94	6.34	5.77-6.95	355	71	4.20	3.76-4.67
Kentucky	1,169	234	4.73	4.45-5.01	653	131	5.66	5.22-6.13	516	103	3.90	3.56-4.26
Louisiana	1,039	208	4.22	3.96-4.49	573	115	5.16	4.73-5.62	466	93	3.43	3.12-3.77
Maine	434	87	4.97	4.50-5.48	258	52	6.36	5.58-7.23	176	35	3.75	3.19-4.39
Maryland	1,294	259	4.06	3.84-4.29	732	146	5.10	4.73-5.50	562	112	3.21	2.94-3.49
Massachusetts	1,613	323	4.19	3.98-4.40	902	180	5.18	4.84-5.54	711	142	3.37	3.12-3.63
Michigan	2,673	535	4.64	4.47-4.83	1,514	303	5.68	5.39-5.98	1,159	232	3.74	3.53-3.97
Minnesota	1,350	270	4.54	4.30-4.80	804	161	5.74	5.34-6.16	546	109	3.48	3.18-3.79
Mississippi	822	164	5.05	4.71-5.42	433	87	6.01	5.44-6.62	389	78	4.35	3.92-4.81
Missouri	1,514	303	4.36	4.14-4.59	848	170	5.32	4.96-5.70	666	133	3.53	3.27-3.82
Montana	294	59	4.76	4.21-5.36	155	31	5.30	4.47-6.25	139	28	4.22	3.52-5.02
Nebraska	515	103	5.06	4.62-5.52	287	57	6.15	5.45-6.92	228	46	4.08	3.55-4.66
Nevada	615	123	4.24	3.91-4.60	369	74	5.25	4.71-5.83	246	49	3.31	2.90-3.76
New Hampshire	382	76	4.78	4.30-5.30	226	45	6.10	5.30-6.99	156	31	3.64	3.07-4.28
New Jersey	1,951	390	3.89	3.72-4.07	1,099	220	4.89	4.60-5.20	852	170	3.07	2.86-3.29
New Mexico	420	84	3.62	3.27-3.99	235	47	4.30	3.76-4.90	185	37	3.00	2.58-3.48
New York	4,188	838	3.80	3.68-3.92	2,264	453	4.60	4.41-4.79	1,924	385	3.16	3.01-3.30
North Carolina	2,394	479	4.45	4.27-4.64	1,319	264	5.47	5.17-5.78	1,075	215	3.61	3.40-3.84
North Dakota	168	34	4.26	3.62-4.97	100	20	5.41	4.38-6.62	68	14	3.27	2.52-4.18
Ohio	3,003	601	4.46	4.30-4.63	1,707	341	5.53	5.27-5.81	1,296	259	3.54	3.34-3.74
Oklahoma	978	196	4.64	4.35-4.95	551	110	5.61	5.14-6.11	427	85	3.77	3.41-4.15
Oregon	1,157	231	5.10	4.80-5.41	669	134	6.23	5.75-6.73	488	98	4.07	3.71-4.46
Pennsylvania	3,300	660	4.23	4.08-4.38	1,820	364	5.11	4.87-5.35	1,480	296	3.49	3.30-3.68
Rhode Island	267	53	4.31	3.80-4.88	151	30	5.42	4.57-6.39	116	23	3.41	2.80-4.12
South Carolina	1,195	239	4.43	4.18-4.70	703	141	5.78	5.35-6.24	492	98	3.29	3.00-3.61
South Dakota	264	53	5.42	4.77-6.13	156	31	6.74	5.70-7.91	108	22	4.24	3.45-5.16
Tennessee	1,739	348	4.79	4.56-5.02	965	193	5.86	5.48-6.25	774	155	3.88	3.61-4.17
Texas	5,070	1,014	4.06	3.95-4.18	2,841	568	4.90	4.72-5.09	2,229	446	3.35	3.21-3.49
Utah	543	109	4.44	4.06-4.83	316	63	5.46	4.86-6.12	227	45	3.52	3.07-4.01
Vermont	218	44	5.59	4.85-6.43	132	26	7.10	5.90-8.49	86	17	4.23	3.35-5.29
Virginia	1,789	358	4.03	3.84-4.23	950	190	4.68	4.37-4.99	839	168	3.53	3.29-3.78
Washington	1,898	380	5.02	4.79-5.25	1,071	214	5.99	5.63-6.37	827	165	4.15	3.86-4.45
West Virginia	519	104	4.34	3.96-4.74	293	59	5.20	4.61-5.86	226	45	3.58	3.11-4.10
Wisconsin	1,610	322	4.92	4.67-5.17	886	177	5.78	5.40-6.18	724	145	4.19	3.88-4.51
Wyoming	147	29	4.65	3.91-5.50	81	16	5.27	4.15-6.61	66	13	4.08	3.13-5.24
United States	75,271	15,054	4.33	4.30-4.36	42,281	8,456	5.30	5.25-5.35	32,990	6,598	3.51	3.47-3.55

^aAnnual average deaths are calculated by dividing the five year total by five.

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

^cEstimated by CBTRUS using Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Mortality ^-All COD, Aggregated With State, Total U.S. (1990-2014) <Katrina/Rita Population Adjustment>, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017. Underlying mortality data provided by NCHS (www.cdc.gov/nchs).

^-Counts and rates are not presented when fewer than 20 cases were reported for the specific category. The suppressed cases are included in the counts and rates for totals.

Abbreviations: NCHS, National Center for Health Statistics; CI, confidence interval.

Fig. 19.

Annual Average Age-Adjusted Mortality Rates^a for Malignant Primary Brain and Other CNS Tumors by Central Cancer Registry, CBTRUS Statistical Report: NCHS, 2010-2014

• The aggregate total number of observed deaths was 75,271, for an annual average age-adjusted mortality rate of 4.33 per 100,000 population.

• There was considerable variation by individual state, which ranged from a low of 2.98 deaths per 100,000 population to a high of 5.59 deaths 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 higher mortality rate for brain and other CNS tumors than females in the US population, with 5.30 per 100,000 population as compared to 3.51 per 100,000 population.

Relative Survival Rates for Malignant Brain and Other CNS Tumors by Site

Relative survival estimates by site are presented in Table 20.

Table 20.

One-, Two-, Five-, and Ten-Year Relative Survival Rates^a for Malignant Brain and Other Central Nervous System Tumors by Site^b, SEER 18 Registries, 2000-2014^c

ICD-O-3 CODE	SITE b	N d	1-Year		2-Year		5-Year		10-Year
			%	95% CI	%	95% CI	%	95% CI	%	95% CI
C71.1	Frontal lobe of the brain	18,052	61.3	60.6-62.1	46.3	45.5-47.0	34.3	33.6-35.1	25.7	24.9-26.6
C71.2	Temporal lobe of the brain	12,902	57.7	56.8-58.6	36.4	35.5-37.3	23.2	22.4-24.1	17.5	16.6-18.4
C71.3	Parietal lobe of the brain	8,331	50.8	49.6-51.9	31.4	30.4-32.5	19.8	18.8-20.8	14.8	13.9-15.9
C71.4	Occipital lobe of the brain	2,094	52.7	50.5-54.9	32.3	30.2-34.4	21.1	19.1-23.1	17.2	15.2-19.3
C71.0	Cerebrum	3,675	51.8	50.1-53.4	37.9	36.3-39.6	28.5	26.9-30.2	24.2	22.5-25.9
C71.5	Ventricle	1,383	75.5	73.1-77.8	69.5	66.8-71.9	62.8	59.9-65.5	58.8	55.6-61.9
C71.6	Cerebellum	4,212	85.0	83.8-86.1	79.0	77.7-80.3	71.2	69.6-72.7	66.7	64.9-68.4
C71.7	Brain stem	3,437	70.5	68.9-72.1	57.8	56.1-59.5	49.7	47.9-51.5	44.8	42.8-46.8
C71.8-C71.9	Other brain	16,301	44.5	43.7-45.3	31.8	31.1-32.6	22.8	22.0-23.5	18.5	17.8-19.3
C72.0-C72.1	Spinal cord and cauda equina	2,587	89.9	88.6-91.0	85.4	83.8-86.8	81.4	79.6-83.1	77.5	75.1-79.7
C72.2-C72.5	Cranial nerves	905	96.6	95.1-97.6	95.1	93.3-96.4	93.1	90.9-94.8	91.4	88.7-93.5
C72.8-C72.9	Other nervous system	676	62.9	59.0-66.5	54.4	50.3-58.3	46.6	42.2-50.8	43.7	38.8-48.5
C70.0-C70.9	Meninges (cerebral and spinal)	1,334	81.9	79.5-84.0	75.2	72.5-77.7	64.7	61.4-67.7	58.3	54.3-62.1
C75.1-C75.2	Pituitary and craniopharyngeal duct	310	86.8	82.1-90.3	84.6	79.5-88.5	75.1	68.7-80.4	70.8	63.4-77.0
C75.3	Pineal	811	88.2	85.7-90.3	81.9	78.9-84.5	76.4	73.0-79.4	72.2	68.1-75.8
C30.0d	Olfactory tumors of the nasal cavity	444	91.1	87.8-93.6	85.4	81.2-88.7	79.4	74.4-83.5	65.8	58.1-72.4
All Codes	All Sites	77,454	59.6	59.3-60.0	45.2	44.8-45.6	34.9	34.6-35.3	29.3	28.9-29.7

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

^bThe sites referred to in this table are loosely based on the categories and site codes defined in the SEER Site/Histology Validation List.

^cEstimated by CBTRUS using Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence ^-SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2015 Sub (2000-2014) <Katrina/Rita Population Adjustment> ^-Linked To County Attributes - Total U.S., 1969-2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017, based on the November 2016 submission.

^dTotal number of case that occurred within the SEER registries between 2000 and 2014.

^dICD-O-3 histology codes 9522-9523 only.

Abbreviation: SEER, Survival, Epidemiology, and End Results; CI, confidence interval.

• The highest five-year survival was for tumors occurring in the cranial nerves (93.1%).

• The lowest five-year survival was for tumors of the parietal lobe (19.8%).

Survival Rates for Malignant Brain and Other CNS Tumors by Histology and Age

Survival estimates for malignant brain and other CNS tumors by histology and age at diagnosis are presented in Tables 21, 22, and 23. The one- through ten-year relative survival rates by histology and age-group are shown in Tables 22 and 23.

Table 21.

One-, Two-, Three-, Four-, Five-, and Ten-Year Relative Survival Rates^a,b for Selected Malignant Brain and Other Central Nervous System Tumors by Histology, SEER 18 Registries, 2000-2014^c

Histology	N d	1-Year		2-Year		3-Year		4-Year		5-Year		10-Year
		%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
Pilocytic astrocytoma	3,896	97.9	97.3-98.3	96.5	95.8-97.0	95.4	94.6-96.1	94.6	93.8-95.4	94.1	93.2-94.9	92.2	91.0-93.3
Diffuse astrocytoma	6,144	74.7	73.5-75.8	63.9	62.7-65.2	57.6	56.3-58.9	53.3	51.9-54.6	50.1	48.7-51.5	39.3	37.8-40.9
Anaplastic astrocytoma	4,177	64.9	63.3-66.3	46.3	44.6-47.9	37.7	36.0-39.3	32.9	31.3-34.5	29.8	28.2-31.4	20.8	19.1-22.5
Glioblastoma	33,951	39.7	39.2-40.3	17.2	16.7-17.6	10.1	9.7-10.4	7.1	6.8-7.4	5.5	5.2-5.8	2.9	2.6-3.1
Oligodendroglioma	3,262	94.5	93.6-95.3	90.4	89.2-91.4	87.1	85.8-88.3	84.1	82.7-85.5	81.3	79.7-82.8	65.7	63.4-67.9
Anaplastic oligodendroglioma	1,397	83.9	81.7-85.8	71.5	68.9-73.9	64.9	62.1-67.6	60.3	57.4-63.1	56.6	53.6-59.5	42.6	39.1-46.0
Ependymal tumors	2,927	94.3	93.4-95.2	90.5	89.2-91.6	87.8	86.4-89.1	85.9	84.4-87.3	84.5	82.8-86.0	79.5	77.3-81.5
Oligoastrocytic tumors	2,154	88.8	87.3-90.1	79.0	77.1-80.8	73.1	71.0-75.1	67.8	65.6-69.9	63.7	61.3-65.9	49.0	46.1-51.9
Glioma malignant, NOS	4,806	65.9	64.4-67.2	55.7	54.2-57.2	52.5	51.0-54.0	50.8	49.3-52.4	49.6	48.0-51.1	44.6	42.8-46.3
Neuronal and mixed neuronal-glial tumors	567	91.5	88.6-93.6	85.4	81.8-88.3	80.7	76.6-84.1	78.2	73.9-81.9	77.7	73.2-81.6	64.3	57.7-70.0
Embryonal tumors	2,943	81.5	80.1-82.9	71.8	70.1-73.5	67.1	65.2-68.8	64.6	62.7-66.4	61.8	59.9-63.7	54.9	52.7-57.0
Medulloblastomae	1,775	89.1	87.5-90.5	82.7	80.8-84.4	78.3	76.2-80.3	75.8	73.6-77.9	73.0	70.6-75.2	64.7	61.8-67.4
Primitive neuroectodermal tumorf	612	74.8	71.1-78.1	58.3	54.1-62.2	52.0	47.8-56.1	48.8	44.5-52.9	46.9	42.6-51.0	40.9	36.5-45.3
Atypical teratoid/ rhabdoid tumorg	263	51.4	45.1-57.3	37.4	31.2-43.5	33.7	27.7-39.8	33.1	27.1-39.3	31.7	25.6-37.9	28.6	22.3-35.3
Other embryonal histologiesh	293	77.5	72.1-82.0	66.2	60.1-71.5	61.5	55.3-67.1	59.2	52.8-64.9	53.8	47.2-59.9	50.2	43.3-56.8
Meningioma	1,172	81.9	79.4-84.2	75.0	72.1-77.7	70.1	66.9-73.0	67.2	63.8-70.3	64.6	61.1-67.9	57.4	53.2-61.4
Lymphoma	4,818	53.0	51.5-54.4	44.5	43.0-46.0	39.3	37.8-40.8	35.7	34.2-37.3	33.5	31.9-35.0	25.9	24.1-27.7
TOTAL: All Brain and Other Nervous System i	77,454	59.6	59.3-60.0	45.2	44.8-45.6	39.7	39.3-40.1	36.8	36.5-37.2	34.9	34.6-35.3	29.3	28.9-29.7

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

^bRates are an estimate of the percentage of patients alive at one, two, five, and ten years, respectively. Rates were not presented for categories with 50 or less cases and were suppressed for rates where less than 16 cases were surviving within a category.

^cEstimated by CBTRUS using Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence ^-SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2016 Sub (2000-2014) <Katrina/Rita Population Adjustment> ^-Linked To County Attributes - Total U.S., 1969-2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017, based on the November 2016 submission.

^dTotal number of case that occurred within the SEER registries between 2000 and 2014.

^eICD-O-3 histology codes: 9470/3, 9471/3, 9472/3, 9474/3.

^fICD-O-3 histology code: 9473/3.

^gICD-O-3 histology code: 9508/3.

^hICD-O-3 histology codes: 8963/3, 9364/3, 9480/3, 9490/0, 9490/3, 9500/3, 9501/3, 9502/3.

ⁱTotal includes histologies not listed in this table.

Abbreviation: SEER, Survival, Epidemiology, and End Results; CI, confidence interval; NOS, not otherwise specified.

Table 22.

One-, Two-, Five-, and Ten-Year Relative Survival Rates^a,b for Selected Malignant Brain and Other Central Nervous System Tumors by Age-Group, SEER 18 Registries, 2000-2014^c

Histology	Age-Group (years)	N d	1-Year		2-Year		5-Year		10-Year
			%	95% CI	%	95% CI	%	95% CI	%	95% CI
Pilocytic astrocytoma	0-19	2,821	98.7	98.1-99.0	98.2	97.6-98.7	96.7	95.8-97.3	95.7	94.6-96.6
	20-44	775	96.6	95.0-97.7	94.5	92.6-96.0	91.7	89.2-93.6	86.3	82.7-89.3
	45-54	149	95.4	90.0-97.9	86.4	79.0-91.3	78.4	69.5-85.1	75.5	65.6-82.9
	55-64	85	96.0	87.6-98.8	90.4	80.4-95.4	82.6	71.0-89.9	76.6	61.1-86.6
	65-74	--	--	--	--	--	--	--	--	--
	75+	--	--	--	--	--	--	--	--	--
Diffuse astrocytoma	0-19	928	93.2	91.3-94.7	87.8	85.3-89.8	83.6	80.8-86.0	81.7	78.7-84.3
	20-44	2,194	93.3	92.1-94.3	87.0	85.4-88.4	68.5	66.3-70.7	49.5	46.7-52.2
	45-54	992	77.0	74.2-79.6	62.6	59.4-65.7	44.3	40.8-47.7	31.8	28.0-35.7
	55-64	885	56.7	53.3-60.0	37.0	33.6-40.4	22.3	19.2-25.5	14.3	11.0-18.1
	65-74	640	42.8	38.8-46.7	26.8	23.2-30.6	11.9	12.6-19.3	11.9	8.5-15.8
	75+	535	26.2	22.4-30.2	13.8	10.7-17.3	6.9	4.3-10.3	1.4	0.2-6.2
Anaplastic astrocytoma	0-19	321	69.0	63.5-73.9	40.7	35.0-46.4	28.2	22.8-33.8	20.1	14.7-26.1
	20-44	1,404	89.4	87.6-91.0	75.4	72.8-77.7	55.1	51.9-58.1	39.7	36.1-43.3
	45-54	734	74.1	70.7-77.2	51.9	48.0-55.7	31.0	27.2-35.0	22.0	17.9-26.4
	55-64	734	54.4	50.6-58.0	30.2	26.7-33.7	13.2	10.4-16.3	6.1	3.7-9.4
	65-74	571	37.0	32.9-41.0	18.0	14.8-21.6	8.0	5.5-11.0	4.9	2.8-7.8
	75+	413	18.7	14.9-22.8	9.4	6.5-12.9	1.2	0.3-3.8	0.7	0.1-3.2
Glioblastoma	0-19	482	58.8	54.2-63.1	34.3	29.8-38.8	17.7	13.9-21.8	13.0	9.3-17.3
	20-44	3,054	69.9	68.2-71.6	40.9	39.1-42.7	19.0	17.4-20.6	11.0	9.6-12.6
	45-54	5,938	57.6	56.3-58.9	25.6	24.4-26.8	7.7	6.9-8.5	4.0	3.3-4.8
	55-64	9,280	46.1	45.1-47.1	18.0	17.2-18.8	4.6	4.1-5.1	1.9	1.5-2.4
	65-74	8,354	29.3	28.3-30.3	29.3	28.3-30.3	2.4	2.0-2.9	1.0	0.6-1.5
	75+	6,843	12.2	11.4-13.1	3.7	3.3-4.3	1.0	0.7-1.4	--	--
Oligodendroglioma	0-19	229	96.4	92.9-98.2	94.5	90.5-96.9	90.5	85.4-93.8	88.6	83.0-92.4
	20-44	1,636	98.7	97.9-99.2	96.4	95.3-97.3	87.9	86.0-89.6	70.6	67.4-73.5
	45-54	734	94.6	92.6-96.1	90.2	87.6-92.3	81.0	77.5-84.0	65.2	60.0-69.8
	55-64	403	88.9	85.1-91.7	78.9	74.2-82.9	69.1	63.4-74.1	53.2	45.4-60.4
	65-74	170	80.7	73.4-86.2	74.1	65.9-80.6	54.6	44.9-63.3	37.0	25.2-48.8
	75+	90	61.8	49.8-71.7	50.5	38.1-61.7	38.3	25.0-51.5	13.1	4.8-25.7
Anaplastic oligodendroglioma	0-19	--	--	--	--	--	--	--	--	--
	20-44	544	94.4	92.0-96.1	85.2	81.7-88.1	71.2	66.7-75.2	55.2	49.6-60.5
	45-54	351	89.3	85.4-92.2	77.9	72.8-82.1	62.8	56.7-68.3	45.2	37.9-52.2
	55-64	288	77.9	72.5-82.5	62.4	56.1-68.0	45.2	38.5-51.6	31.8	24.4-39.4
	65-74	129	55.1	45.8-63.4	35.5	26.8-44.3	19.1	11.5-28.2	13.6	6.6-23.2
	75+	--	--	--	--	--	--	--	--	--
Ependymal tumors	0-19	821	95.0	93.2-96.3	88.0	85.5-90.2	75.8	72.3-78.9	66.9	62.6-70.7
	20-44	912	97.4	96.0-98.3	95.5	93.8-96.8	91.6	89.3-93.5	88.8	85.7-91.3
	45-54	533	95.5	93.2-97.1	93.2	90.4-95.2	89.7	86.1-92.4	87.8	83.4-91.1
	55-64	386	93.0	89.7-95.3	89.7	85.7-92.6	87.1	82.2-90.8	84.3	76.7-89.6
	65-74	184	88.6	82.4-92.8	82.8	75.3-88.2	81.0	72.9-86.9	70.2	55.5-80.8
	75+	91	67.2	55.4-76.5	63.6	50.7-73.9	51.0	35.4-64.6	32.3	13.3-53.1
Oligoastrocytic tumors	0-19	120	94.9	88.9-97.7	89.6	82.3-94.0	83.6	74.9-89.4	78.1	68.0-85.3
	20-44	1,152	96.8	95.5-97.7	90.9	88.9-92.5	73.4	71.4-76.3	55.5	51.4-59.4
	45-54	433	89.4	85.9-92.0	78.3	73.8-82.1	65.8	60.5-70.6	48.2	41.0-55.0
	55-64	248	74.5	68.3-79.7	52.1	45.2-58.5	35.9	29.0-43.0	30.0	21.9-38.5
	65-74	140	66.6	57.7-74.1	47.2	38.0-55.9	25.3	17.2-34.2	15.9	8.2-25.9
	75+	--	--	--	--	--	--	--	--	--
Glioma malignant, NOS	0-19	1,814	77.8	75.8-79.7	67.3	65.0-69.5	64.1	61.7-66.4	62.4	59.9-64.8
	20-44	968	88.3	86.0-90.2	79.8	77.0-82.4	69.5	66.1-72.6	55.8	51.3-60.1
	45-54	481	74.9	70.6-78.6	60.4	55.6-64.8	50.6	45.5-55.4	41.2	35.4-46.9
	55-64	409	57.6	52.4-62.4	43.1	37.9-48.3	33.3	28.0-38.6	28.3	22.2-34.5
	65-74	396	38.6	33.6-43.5	24.9	20.5-29.6	17.2	13.0-21.8	14.2	9.7-19.6
	75+	738	17.6	14.8-20.6	13.2	10.6-16.1	9.7	7.0-12.9	8.0	4.6-12.6
Neuronal and mixed neuronal-glial tumors	0-19	73	94.2	85.1-97.8	89.2	78.6-94.8	85.8	74.2-92.4	85.8	74.2-92.4
	20-44	148	95.3	90.2-97.8	89.5	82.9-93.6	77.8	69.2-84.2	62.7	51.1-72.2
	45-54	131	94.1	88.0-97.2	90.2	83.0-94.5	84.3	75.6-90.1	74.6	60.5-84.3
	55-64	114	91.3	83.6-95.5	81.9	72.0-88.6	68.7	56.5-78.1	50.6	34.3-64.8
	65-74	63	84.8	71.9-92.1	82.8	68.6-91.0	80.0	64.3-89.4	--	--
	75+	--	--	--	--	--	--	--	--	--
Embryonal tumors	0-19	2,175	81.1	79.3-82.7	71.2	69.2-73.1	62.3	60.0-64.4	56.0	53.5-58.4
	20-44	595	86.7	83.6-89.2	79.5	75.8-82.7	66.7	62.3-70.8	59.1	54.0-63.8
	45-54	89	82.8	72.8-89.4	70.1	58.8-79.0	57.5	44.7-68.4	38.7	23.7-53.5
	55-64	--	--	--	--	--	--	--	--	--
	65-74	--	--	--	--	--	--	--	--	--
	75+	--	--	--	--	--	--	--	--	--
Meningioma	0-19	--	--	--	--	--	--	--	--	--
	20-44	143	95.2	89.9-97.7	94.6	89.1-97.4	87.8	80.4-92.5	78.0	68.6-85.0
	45-54	186	92.8	87.8-95.8	85.2	78.9-89.8	76.7	69.1-82.7	69.7	60.8-77.0
	55-64	274	88.7	84.0-92.1	80.9	75.3-85.4	68.6	61.8-74.5	59.5	51.4-66.6
	65-74	253	80.2	74.3-84.9	70.1	63.3-75.9	53.5	45.5-60.8	48.9	38.6-58.3
	75+	300	62.9	56.5-68.7	56.1	49.0-62.5	48.8	40.0-56.9	39.5	27.3-51.4
Lymphoma	0-19	68	83.7	72.5-90.7	76.1	63.9-84.6	71.2	58.5-80.6	66.5	52.8-77.1
	20-44	784	56.7	53.1-60.2	50.7	47.1-54.3	44.4	40.7-48.1	39.2	35.1-43.2
	45-54	737	62.3	58.6-65.7	53.4	49.6-57.1	41.6	37.6-45.5	31.5	27.2-35.8
	55-64	1,045	62.3	59.2-65.3	53.4	50.1-56.5	38.7	35.3-42.1	28.7	24.8-32.7
	65-74	1,183	50.3	47.3-53.2	41.3	38.2-44.3	27.6	24.5-30.7	17.4	13.9-21.3
	75+	1,001	33.6	30.5-36.7	24.0	16.4-22.2	15.4	12.5-18.6	12.0	8.0-17.0
TOTAL: All Brain and Other Nervous System e	0-19	11,196	87.1	86.5-87.7	79.9	79.1-80.6	73.9	73.0-74.8	70.4	69.4-71.3
	20-44	15,305	86.6	86.0-87.1	75.9	75.1-76.6	61.9	61.0-62.8	49.8	48.8-50.8
	45-54	11,950	69.5	68.6-70.3	48.3	47.3-49.2	33.5	32.6-34.5	26.4	25.3-27.4
	55-64	14,645	53.9	53.1-54.7	31.2	30.4-32.0	18.4	17.6-19.1	13.7	13.0-14.5
	65-74	12,676	36.6	35.7-37.4	20.5	19.7-21.2	11.3	10.7-12.0	8.1	7.4-8.9
	75+	11,682	18.0	17.3-18.8	10.3	9.7-10.9	6.2	5.6-6.8	4.2	3.5-5.0

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

^bRates are an estimate of the percentage of patients alive at one, two, five, and ten years, respectively. Rates were not presented for categories with 50 or less cases and were suppressed for rates where less than 16 cases were surviving within a category.

^cEstimated by CBTRUS using Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2015 Sub (2000-2014) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017, based on the November 2016 submission.

^dTotal number of case that occurred within the SEER registries between 2000 and 2014.

^eTotal includes histologies not listed in this table.

Table 23.

One-, Two-, Five-, and Ten-Year Relative Survival Rates^a,b for Selected Malignant Brain and Other Central Nervous System Tumors by NCI Age-Groups, SEER 18 Registries, 2000-2014^c

Histology	Age-Group (years)	N d	1-Year		2-Year		5-Year		10-Year
			%	95% CI	%	95% CI	%	95% CI	%	95% CI
Pilocytic astrocytoma	Childrene (0-14)	2,328	98.7	98.2-99.1	98.3	97.7-98.8	96.9	96.0-97.6	95.8	94.6-96.7
	AYAf (15-39)	1,168	97.3	96.1-98.1	95.8	04.4-96.9	93.4	91.6-94.9	90.5	88.0-92.5
	Adults (40+)	400	94.6	91.5-96.6	87.3	83.1-90.5	79.7	74.3-84.1	76.2	69.2-81.8
Diffuse astrocytoma	Childrend (0-14)	704	92.2	89.9-94.0	87.2	84.4-89.5	83.0	79.9-85.8	81.3	77.9-84.3
	AYAe (15-39)	1,960	94.3	93.1-95.2	87.8	86.2-89.2	71.4	69.1-73.6	53.3	50.3-56.1
	Adults (40+)	3,480	60.1	58.3-61.7	45.7	44.0-46.5	31.1	29.4-32.8	22.0	20.1-23.9
Anaplastic astrocytoma	Childrend (0-14)	235	63.1	56.4-69.0	35.3	28.9-41.8	23.5	17.7-29.8	17.5	12.0-23.9
	AYAe (15-39)	235	90.4	88.4-92.0	76.1	73.3-78.6	55.4	52.0-58.7	40.5	36.5-44.5
	Adults (40+)	235	54.5	52.6-56.4	34.9	33.0-36.8	19.7	18.0-21.5	12.8	11.1-14.7
Glioblastoma	Childrend (0-14)	327	52.7	47.0-58.0	29.5	24.4-34.8	20.6	15.9-25.7	16.0	11.3-21.4
	AYAe (15-39)	1,875	74.1	72.0-76.0	47.7	45.3-50.1	23.1	20.9-25.3	14.1	12.1-16.3
	Adults (40+)	31,749	37.5	37.0-38.1	15.2	14.7-15.6	4.3	4.0-4.5	2.0	1.8-2.2
Oligodendroglioma	Childrend (0-14)	123	94.9	89.0-97.7	94.0	87.8-97.1	89.1	81.6-93.7	89.1	81.6-93.7
	AYAe (15-39)	1,319	99.0	98.2-99.4	97.1	95.9-97.9	89.4	87.3-91.1	73.0	69.6-76.2
	Adults (40+)	1,820	91.2	89.7-92.5	85.3	83.4-87.0	74.9	72.5-77.2	58.5	55.2-61.6
Anaplastic oligodendroglioma	Childrend (0-14)	--	--	--	--	--	--	--	--	--
	AYAe (15-39)	379	93.5	90.4-95.6	85.1	80.9-88.5	71.6	66.2-76.3	54.9	48.0-61.2
	Adults (40+)	1,006	80.1	77.4-82.6	66.4	63.2-69.4	51.1	47.5-54.6	37.9	33.8-41.9
Ependymal tumors	Childrend (0-14)	686	94.7	92.7-96.2	87.2	84.3-89.6	73.7	69.8-77.2	64.2	59.5-68.5
	AYAe (15-39)	820	96.9	95.4-97.9	94.5	92.6-95.9	90.4	87.9-92.5	87.2	83.7-89.8
	Adults (40+)	1,421	92.6	91.0-94.0	98.7	87.7-91.3	86.3	83.8-88.4	82.7	79.1-85.7
Oligoastrocytic tumors	Childrend (0-14)	71	97.2	88.7-99.3	91.0	80.8-95.9	84.0	72.1-9.2	81.8	69.1-89.7
	AYAe (15-39)	937	97.2	95.9-98.1	91.4	89.2-93.1	75.3	72.0-78.4	56.2	51.6-60.5
	Adults (40+)	1,146	81.3	78.8-83.6	67.1	65.1-70.9	52.7	49.3-55.9	41.0	37.0-45.0
Glioma malignant, NOS	Childrend (0-14)	1,624	76.4	74.2-78.4	65.3	62.9-67.7	62.5	60.0-64.9	60.9	58.2-63.4
	AYAe (15-39)	926	89.6	87.4-91.5	82.6	79.9-85.0	72.6	69.2-75.7	61.0	56.5-65.3
	Adults (40+)	2,256	37.4	35.2-39.5	33.6	31.5-35.8	30.1	27.9-32.3	24.9	22.4-27.4
Neuronal and mixed neuronal-glial tumors	Childrend (0-14)	--	--	--	--	--	--	--	--	--
	AYAe (15-39)	139	94.9	89.5-97.6	88.6	81.6-93.0	78.7	68.9-85.1	71.3	60.2-78.7
	Adults (40+)	384	90.0	86.2-92.8	83.4	78.6-87.1	75.9	70.0-80.8	57.3	48.3-65.4
Embryonal tumors	Childrend (0-14)	1,960	80.2	78.3-81.9	70.5	68.3-72.5	62.3	59.9-64.5	55.9	53.3-58.5
	AYAe (15-39)	749	87.8	85.2-90.0	79.6	76.4-82.4	65.4	61.4-69.0	58.0	53.5-62.2
	Adults (40+)	234	73.3	66.9-78.7	58.3	51.3-64.7	46.8	39.4-53.8	35.0	27.1-43.0
Meningioma	Childrend (0-14)	--	--	--	--	--	--	--	--	--
	AYAe (15-39)	93	97.9	91.3-99.5	97.9	91.3-99.5	89.4	79.8-94.6	83.1	71.4-90.4
	Adults (40+)	1,068	73.0	69.8-75.8	67.8	64.4-71.0	62.3	58.5-65.8	54.9	50.4-59.1
Lymphoma	Childrend (0-14)	--	--	--	--	--	--	--	--	--
	AYAe (15-39)	540	58.3	54.0-62.4	53.2	48.7-57.4	47.5	43.0-51.9	43.9	39.2-48.6
	Adults (40+)	4,239	52.0	50.4-53.5	43.0	42.4-44.6	31.1	29.5-32.8	22.7	20.9-24.6
TOTAL: All Brain and Other Nervous System g	Children d (0-14)	9,069	85.9	85.2-86.6	78.6	77.7-79.5	73.1	72.1-74.1	69.6	68.5-70.7
	AYA e (15-39)	13,252	89.5	89.0-90.0	80.9	80.2-81.6	68.0	67.1-68.9	56.8	55.7-57.9
	Adults (40+)	55,133	48.0	47.6-48.4	30.9	30.5-31.3	20.3	19.1-20.6	15.5	15.1-15.9

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

^bRates are an estimate of the percentage of patients alive at one, two, five, and ten years, respectively. Rates were not presented for categories with 50 or less cases and were suppressed for rates where less than 16 cases were surviving within a category.

^cEstimated by CBTRUS using Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence ^-SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2015 Sub (2000-2014) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017, based on the November 2016 submission.

^dTotal number of case that occurred within the SEER registries between 2000 and 2014.

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

^fAdolescents and Young Adults (AYA), as defined by the National Cancer Institute, see: http://www.cancer.gov/researchandfunding/snapshots/adolescent-young-adult.

^gTotal includes histologies not listed in this table.

Abbreviation: SEER, Survival, Epidemiology, and End Results; CI, confidence interval; NOS, not otherwise specified.

• The estimated five- and ten-year relative survival rates for all malignant brain and other CNS tumors were 34.9% and 29.3%, respectively.

• There was large variation in survival estimates depending upon tumor histology; five-year survival rates were 94.1% for pilocytic astrocytoma but are 5.5% for glioblastoma.

• Survival generally decreased with older age at diagnosis; children and young adults generally had better survival outcomes for most histologies.

Survival Rates for Non-Malignant Brain and Other CNS Tumors by Histology and Age

Survival estimates for non-malignant brain and other CNS tumors by histology and age at diagnosis are presented in Tables 24 and 25. The one- through five-year relative survival rates by histology and age-group are shown in Table 25. Histology-specific rates are presented for the CBTRUS histology groupings which contain a substantial number of incident non-malignant tumors.

Table 24.

One-, Two-, Three-, Five-, and Ten-Year Relative Survival Rates^a,b for Selected Non-Malignant Brain and Other Central Nervous System Tumors by Histology, SEER 18 Registries, 2004-2014^c

Histology	N d	1-Year		2-Year		3-Year		5-Year		10-Year
		%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
Unique astrocytoma variants	240	97.4	94.2-98.9	96.0	92.3-98.0	95.0	90.9-97.3	93.9	89.3-90.9	82.9	69.1-90.9
Ependymal tumors	1,499	97.8	96.2-98.4	97.5	96.2-98.4	97.3	95.8-98.3	97.3	95.8-98.3	95.9	90.7-98.2
Choroid plexus tumors	428	93.5	90.5-95.6	92.8	89.5-95.1	91.9	88.4-94.4	90.9	85.8-92.9	89.8	85.4-92.9
Neuronal and mixed neuronal- glial tumors	2,153	97.1	96.3-97.8	96.3	95.2-97.1	95.0	93.8-96.0	93.6	92.2-94.8	91.6	89.3-93.4
Nerve sheath tumors	17,795	99.5	99.2-99.6	99.4	99.1-99.6	99.4	99.1-99.6	99.4	99.1-99.6	99.4	99.1-92.7
Meningioma	75,225	92.5	92.2-92.7	90.6	90.3-90.9	89.2	88.9-89.5	86.7	86.3-87.1	81.4	80.6-82.2
Mesenchymal tumors	695	97.1	95.1-98.2	96.5	94.2-97.9	95.0	92.3-96.8	92.5	88.7-95.1	80.8	71.3-87.4
Other neoplasms related to the meninges	1,673	95.6	94.3-96.6	94.8	93.3-95.9	94.1	92.4-95.4	92.1	98.9-93.7	88.3	84.3-91.3
Germ cell tumors, cysts and heterotopias	265	94.8	91.0-97.1	94.4	90.1-96.8	94.4	90.1-96.8	94.4	90.1-96.8	92.8	84.9-96.6
Tumors of the pituitary	36,081	98.0	97.8-98.2	97.5	97.3-97.8	97.2	96.9-97.5	96.6	96.2-97.0	95.2	94.3-95.9
Craniopharyngioma	1,744	92.4	91.0-95.7	90.0	88.3-91.5	87.7	85.8-89.4	84.1	81.8-86.2	79.6	76.0-82.7
Hemangioma	2,572	96.2	95.2-97.0	95.2	94.1-96.2	94.6	93.3-95.7	93.6	91.9-95.0	92.2	88.0-95.0
TOTAL: All Non- Malignant Brain and Other Nervous System i	144,593	94.4	94.3-94.5	93.1	93.0-93.3	92.3	92.1-92.5	90.7	90.4-90.9	87.3	86.8-87.8

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

^bRates are an estimate of the percentage of patients alive at one, two, five, and ten years, respectively. Rates were not presented for categories with 50 or less cases and were suppressed for rates where less than 16 cases were surviving within a category.

^cEstimated by CBTRUS using Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence ^-SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2016 Sub (2000-2014) <Katrina/Rita Population Adjustment> ^-Linked To County Attributes - Total U.S., 1969-2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017, based on the November 2016 submission.

^dTotal number of case that occurred within the SEER registries between 2004 and 2014.

^eICD-O-3 histology codes: 9470/3, 9471/3, 9472/3, 9474/3.

^fICD-O-3 histology code: 9473/3.

^gICD-O-3 histology code: 9508/3

^hICD-O-3 histology codes: 8963/3, 9364/3, 9480/3, 9490/0, 9490/3, 9500/3, 9501/3, 9502/3.

ⁱTotal includes histologies not listed in this table.

Abbreviation: SEER, Survival, Epidemiology, and End Results; CI, confidence interval; NOS, not otherwise specified.

Table 25.

One-, Two-, Five-, and Ten-Year Relative Survival Rates^a,b for Selected Non-Malignant Brain and Other Central Nervous System Tumors by NCI Age-Groups, SEER 18 Registries, 2004-2014^c

Histology	Age-Group (years)	N d	1-Year		2-Year		5-Year		10-Year
			%	95% CI	%	95% CI	%	95% CI	%	95% CI
Unique astrocytoma variants	Childrene (0-14)	134	97.7	92.7-99.3	97.7	92.7-99.3	97.7	92.7-99.3	96.6	67.6-97.2
	AYAf (15-39)	91	96.6	89.5-98.9	96.6	89.5-98.9	90.7	80.9-95.6	80.1	55.2-92.1
	Adults (40+)	--	--	--	--	--	--	--	--	--
Ependymal tumors	Childrene (0-14)	71	100.0	**	98.3	87.5-99.8	93.8	81.5-98.0	93.8	81.5-98.0
	AYAf (15-39)	470	99.7	97.9-99.9	98.8	97.4-99.8	98.6	95.9-99.5	98.2	95.1-99.4
	Adults (40+)	958	96.8	95.1-97.9	96.6	94.6-97.8	96.5	94.2-97.9	94.2	85.3-97.8
Choroid plexus tumors	Childrene (0-14)	159	98.9	94.2-99.8	98.1	93.4-99.5	95.3	89.3-98.0	95.3	89.3-98.0
	AYAf (15-39)	127	98.4	93.4-99.6	98.4	93.4-99.6	97.6	91.7-99.3	97.6	91.7-99.3
	Adults (40+)	142	83.0	75.2-88.6	81.5	73.1-87.6	76.5	66.2-84.1	75.7	64.6-83.7
Neuronal and mixed neuronal-glial tumors	Childrene (0-14)	653	98.7	97.4-99.4	98.4	96.9-99.2	97.0	95.1-98.3	94.5	89.6-97.1
	AYAf (15-39)	969	98.3	97.2-99.0	97.8	96.5-98.6	95.3	93.3-96.7	93.9	91.2-05.8
	Adults (40+)	531	93.0	90.2-95.1	90.9	87.6-93.3	86.2	81.7-89.7	82.1	76.4-86.6
Nerve sheath tumors	Childrene (0-14)	467	100.0	**	100.0	**	99.8	95.3-100.0	98.4	95.2-99.5
	AYAf (15-39)	2,758	99.6	99.2-99.8	99.3	99.8-99.6	98.7	98.0-99.2	97.7	96.1-98.6
	Adults (40+)	14,570	99.4	99.1-99.6	99.4	99.0-99.6	99.4	99.0-99.6	99.4	99.0-99.6
Meningioma	Childrene (0-14)	148	97.9	93.4-99.3	97.1	92.2-98.9	97.1	92.2-98.9	97.1	92.2-98.9
	AYAf (15-39)	4,906	98.8	98.4-99.1	98.3	97.9-98.7	96.7	96.0-97.3	94.2	92.8-95.4
	Adults (40+)	70,171	92.0	91.8-92.3	90.0	89.7-90.3	86.0	85.5-86.4	80.4	79.5-81.3
Mesenchymal tumors	Childrene (0-14)	165	99.5	92.2-100.0	98.6	93.2-99.7	96.8	88.3-99.2	93.9	81.4-98.1
	AYAf (15-39)	152	97.9	93.4-99.4	97.9	93.4-99.4	94.3	86.4-97.7	87.7	74.3-94.3
	Adults (40+)	378	95.7	92.5-97.6	95.0	91.2-97.2	90.5	84.6-94.2	73.9	58.9-84.1
Other neoplasms related to the meninges	Childrene (0-14)	--	--	--	--	--	--	--	--	--
	AYAf (15-39)	544	97.3	95.5-98.5	96.8	94.7-98.0	95.9	93.5-97.4	92.5	88.0-95.4
	Adults (40+)	1,094	94.6	92.8-95.9	93.6	91.5-95.2	89.9	86.9-92.3	86.6	80.8-90.8
Germ cell tumors, cysts and heterotopias	Childrene (0-14)	90	94.0	85.9-97.5	94.0	85.9-97.5	94.0	85.9-97.5	94.0	85.9-97.5
	AYAf (15-39)	89	98.9	91.1-99.9	96.3	88.2-98.9	96.3	88.2-98.9	96.3	88.2-98.9
	Adults (40+)	86	91.3	81.6-96.0	91.3	81.6-96.0	91.3	81.6-96.0	86.6	61.9-95.8
Tumors of the pituitary	Childrene (0-14)	424	99.8	98.1-100.0	99.5	97.7-99.9	98.7	96.0-99.6	98.7	96.0-99.6
	AYAf (15-39)	11,152	99.6	99.4-99.7	99.5	99.3-99.7	99.2	98.9-99.4	98.4	97.7-98.9
	Adults (40+)	24,505	97.2	96.9-97.5	96.6	96.2-96.9	95.4	94.8-95.9	93.6	92.3-94.7
Craniopharyngioma	Childrene (0-14)	421	97.2	95.0-98.5	96.4	94.0-97.9	92.6	88.9-95.0	90.9	86.8-93.8
	AYAf (15-39)	415	95.7	93.1-97.3	94.0	91.0-96.0	89.6	85.5-92.6	87.0	82.0-90.6
	Adults (40+)	908	88.7	86.2-90.7	85.2	82.3-87.6	77.6	73.7-80.9	70.4	64.1-75.9
Hemangioma	Childrene (0-14)	161	99.4	94.5-99.9	99.4	94.5-99.9	99.4	94.5-99.9	99.4	94.5-99.9
	AYAf (15-39)	735	99.5	98.4-99.8	99.3	98.0-99.7	99.1	97.4-99.7	97.7	93.7-99.2
	Adults (40+)	1,676	94.4	93.0-95.6	93.0	91.3-94.4	90.6	88.0-92.6	88.6	81.6-93.0
TOTAL: All Non- Malignant Brain and Other Nervous System g	Children d (0-14)	3,230	98.4	97.9-98.8	98.0	97.4-98.4	96.6	95.8-97.3	94.9	93.3-96.1
	AYA e (15-39)	23,272	99.1	99.0-99.2	98.8	98.6-98.9	97.9	97.6-98.1	96.5	96.0-97.0
	Adults (40+)	118,091	93.4	93.2-93.5	91.9	91.7-92.1	89.1	88.7-89.4	85.2	84.5-85.9

^**Confidence interval could not be calculated.

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

^bRates are an estimate of the percentage of patients alive at one, two, five, and ten years, respectively. Rates were not presented for categories with 50 or less cases and were suppressed for rates where less than 16 cases were surviving within a category.

^cEstimated by CBTRUS using Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2015 Sub (2000-2014) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017, based on the November 2016 submission.

^dTotal number of case that occurred within the SEER registries between 2004 and 2014.

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

^fAdolescents and Young Adults (AYA), as defined by the National Cancer Institute, see: http://www.cancer.gov/researchandfunding/snapshots/adolescent-young-adult.

^gTotal includes histologies not listed in this table.

Abbreviation: SEER, Survival, Epidemiology, and End Results; CI, confidence interval; NOS, not otherwise specified.

• Overall, 90.7% of persons with non-malignant tumor survived five years after diagnosis.

• Five-year survival was lowest in craniopharyngioma and meningioma, which had five-year relative survival of 84.1% and 86.7%, respectively.

• Five-year survival was highest in nerve sheath tumors and ependymal tumors, which had five-year relative survival of 99.4% and 97.3%, respectively.

• Overall, five-year survival in adolescents and young adults was highest (97.9%) compared to children (96.6%) and older adults (89.1%).

Descriptive Summary of Spinal Cord Tumors

Although spinal cord tumors account for a relatively small percentage of brain and other CNS tumors, they result in significant morbidity. The most common histologies found in the spinal cord, spinal meninges, and cauda equina are presented in Figures 20A and 20B for both children (age 0–19 years) and adults (age 20+ years), respectively.

Fig. 20.

Distribution^a of Primary Spinal Cord, Spinal Meninges, and Cauda Equina Tumors in A. Children and Adolescents (Age 0-19 Years), and B. Adults (Age 20+ Years), CBTRUS Histology Groupings and Histology (N=16,588) CBTRUS Statistical Report: NPCR and SEER, 2010-2014

• The predominant histology group for those age 0–19 years was ependymal tumors (23.3%) followed by other neuroepithelial tumors (18.0%).

• Tumors of the meninges (38.9%) accounted for the largest proportion of spinal cord tumors among those age 20 years and older.

• Five-year survival after diagnosis with a malignant tumor of the spinal cord and cauda equine was 81.4%, with ten-year survival of 77.5% (Table 20).

• Overall, five-year survival in adolescents and young adults was highest (82.5%) compared to children (78.4%) and older adults (81.7%).

Descriptive Summary of Meningioma, Glioblastoma, and Embryonal Tumors

The data in the CBTRUS Statistical Report 2010–2014 are synthesized to describe the three of the most common histologic types: meningioma and glioblastoma for adults, and embryonal tumors for children and adolescents.

Meningioma

• Meningiomas were the most frequently reported brain and other CNS tumor, accounting for 36.8% of tumors overall (Figure 8A). 79.0% of meningiomas were located in the cerebral meningiomas, 4.2% are located in the spinal meninges, and approximately 16.0% do not have a specific meningeal site specified.

• Non-malignant meningiomas with ICD-O-3 behavior codes /0 (benign) or /1 (uncertain) accounted for 98.7% of meningiomas reported to CBTRUS (Table 3).

• Of meningioma with documented WHO grade (79.0%, Table 7), 81.3% of meningioma were WHO grade I, 16.9% were WHO grade II, and 1.7% were WHO grade III.

• Meningiomas were most common in adults age 65 years and older (Figure 15), and one of the least common in children age 0–14 years (Table 4).

• Incidence of meningiomas increased with age, with a dramatic increase after age 65 years. Even among the population age 85 years and older, these rates continued to be high (Table 11).

• Non-malignant meningiomas overall were 2.3 times more common in females compared to males (Figure 11). Incidence rate ratios were lowest between males and females in persons <20 years old (where incidence rates for males and females were approximately equal), and highest from 35–54, where incidence rates were approximately 3 times higher in females (Supplementary Figure 12).

• Incidence of meningioma was significantly higher in Blacks than in Whites (Figure 12).

• Ten-year relative survival for malignant meningioma was 57.4% (Table 21).

• Age had a large effect on relative survival after diagnosis with malignant meningioma: 10-year survival was 78.0% for age-group 20–44 years, and 39.5% for age 75+ years (Table 22).

• Ten-year relative survival for non-malignant meningioma was 81.4% (Table 24).

• Age had a large effect on relative survival after diagnosis with non-malignant meningioma: 10-year survival was 97.1% in children 0–14, 94.2% in AYA, and 80.4% in adults 40+ years old (Table 25).

• Site of meningioma had an effect on relative survival after diagnosis with meningioma. For non-malignant meningioma, 10-year survival was 80.7% for tumors in the cerebral meninges, but 94.1% for tumors in the spinal meninges. Survival was also higher in malignant meningioma for spinal tumors, where 10-year relative survival was 70.2%. as compared to 55.4% for tumors in the cerebral meninges (Supplementary Figure 13).

Glioblastoma

• Glioblastoma was the third most frequently reported CNS histology and the most common malignant tumor overall (Table 3).

• Glioblastoma accounted for 14.9% of all primary brain and other CNS tumors (Figure 8A) and 47.1% of primary malignant brain tumors (Figure 8B).

• Glioblastoma was more common in older adults (Table 11) and was less common in children; these tumors comprised approximately 3.0% of all brain and other CNS tumors reported among age 0–19 years (Figure 16B).

• Incidence of glioblastoma increased with age, with rates highest in the age 75-84 years (Table 11).

• Glioblastoma was 1.58 times more common in males compared to females (Figure 11).

• Glioblastoma was about 1.93 times higher among Whites compared to Blacks (Figure 12).

• Relative survival estimates for glioblastoma were quite low; 5.5% of patients survived five years post diagnosis (Table 21). These survival estimates were somewhat higher for the small number of patients who were diagnosed under age 20 years (Table 22).

Embryonal Tumors

• Embryonal tumors were the most frequently reported brain and other CNS tumor histology grouping in children age 0–4 years, and the second most common tumor type overall in children and adolescents age 0–19 years (Table 4, Figure 15).

• Embryonal tumors accounted for 13.5% of all primary brain and other CNS tumors in children age 0–14 years (Figure 17B), 10.5% of tumors in children and adolescents age 0–19 years (Figure 16B), and 0.9% of tumors diagnosed overall (Figure 8A).

• Embryonal tumors within the CBTRUS histologic grouping scheme includes multiple different histologies: primitive neuroectodermal tumor (PNET) (ICD-O-3 histology code 9473), medulloblastoma (ICD-O-3 histology codes 9470–9472), atypical teratoid/rhabdoid tumor (ATRT) (ICD-O-3 histology code 9508), and several other histologies (Table 2).

• Incidence of medulloblastoma decreased with age. Incidence was 0.53 per 100,000 population, 0.56 per 100,000 population, 0.33 per 100,000 population, and 0.16 per 100,000 population in children age-groups 0–4, 5–9, 10–14 years, and adolescents age 15–19 years, respectively (Table 4).

• Incidence of PNET was 0.18 per 100,000 population, 0.06 per 100,000 population, 0.04 per 100,000 population, and 0.04 per 100,000 population in children age-groups 0–4, 5–9, 10–14 years, and adolescents age 15–19 years, respectively (Table 4).

• Incidence of ATRT was 0.33 per 100,000 population and 0.03 per 100,000 population in children age-groups 0–4 and 5–9 years, respectively. There were too few of these cases in older age-groups to report (Table 4).

• Relative survival estimates for embryonal tumors were low but varied significantly by histology. 10-year survival was 64.7% for medulloblastoma, 40.9% for PNET, and 28.6% for ATRT (Table 21).

• Embryonal tumors were more common in males than females (Table 4). This difference was most pronounced in medulloblastoma, which occurred 1.7 times as frequently in males 0–14 years as compared to females in this age group (Supplementary Figure 14). Incidence of ATRT and PNET in children 0–14 was not significantly different between males and females.

Descriptive Summary of Adolescent and Young Adult Primary Brain and Other CNS Tumors (Age 15–39 Years)

Brain and other CNS tumors were less common in adolescents and young adults (AYA; age 15–39 years)⁴⁵ compared to older adults (Table 26). These tumors were the third most commonly occurring cancer in persons age 15–39 years in the US, and the third most common cause of cancer death.⁴⁶

Table 26.

Annual Average Age-Adjusted Incidence Rates^a,b of Brain and Other Central Nervous System Tumors by Major Histology Grouping, Histology, and NCI Age-Groups, CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Histology	Age at Diagnosis
	Children c (0-14)		AYA d (15-39)		Adults (40+)
	Rate	(95% CI)	Rate	(95% CI)	Rate	(95% CI)
Tumors of Neuroepithelial Tissue	4.08	4.01-4.15	3.45	3.40-3.50	10.39	10.32-10.47
Pilocytic astrocytoma	1.01	0.97-1.04	0.29	0.27-0.30	0.09	0.08-0.09
Diffuse astrocytoma	0.25	0.23-0.27	0.44	0.42-0.46	0.64	0.62-0.66
Anaplastic astrocytoma	0.10	0.09-0.11	0.30	0.29-0.32	0.63	0.61-0.65
Unique astrocytoma variants	0.12	0.11-0.13	0.07	0.06-0.08	0.05	0.04-0.05
Malignant	0.05	0.04-0.06	0.05	0.04-0.06	0.04	0.04-0.05
Non-Malignant	0.07	0.06-0.08	0.02	0.02-0.03	0.00	0.00-0.01
Glioblastoma	0.16	0.14-0.17	0.51	0.49-0.53	6.93	6.87-6.99
Oligodendroglioma	0.04	0.03-0.04	0.28	0.27-0.30	0.31	0.30-0.32
Anaplastic oligodendroglioma	--	--	0.09	0.08-0.10	0.17	0.16-0.18
Oligoastrocytic tumors	0.02	0.02-0.03	0.25	0.24-0.27	0.22	0.21-0.24
Ependymal tumors	0.32	0.30-0.34	0.36	0.35-0.38	0.54	0.52-0.55
Malignant	0.28	0.26-0.30	0.19	0.18-0.21	0.30	0.28-0.31
Non-Malignant	0.04	0.03-0.04	0.17	0.16-0.18	0.24	0.23-0.25
Glioma malignant, NOS	0.77	0.74-0.80	0.27	0.26-0.29	0.47	0.45-0.48
Choroid plexus tumors	0.12	0.10-0.13	0.04	0.03-0.04	0.04	0.03-0.04
Malignant	0.03	0.03-0.04	--	--	0.00	0.00-0.00
Non-Malignant	0.08	0.07-0.09	0.04	0.03-0.04	0.03	0.03-0.04
Other neuroepithelial tumors	0.01	0.01-0.01	0.01	0.00-0.01	0.01	0.00-0.01
Malignant	0.01	0.00-0.01	0.00	0.00-0.01	0.00	0.00-0.00
Non-Malignant	--	--	--	--	0.00	0.00-0.00
Neuronal and mixed neuronal-glial tumors	0.38	0.36-0.40	0.34	0.32-0.35	0.21	0.20-0.22
Malignant	0.02	0.02-0.03	0.04	0.03-0.04	0.09	0.08-0.09
Non-Malignant	0.36	0.34-0.38	0.30	0.29-0.32	0.12	0.11-0.13
Tumors of the pineal region	0.05	0.04-0.06	0.05	0.04-0.06	0.04	0.04-0.05
Malignant	0.04	0.04-0.05	0.02	0.02-0.03	0.02	0.01-0.02
Non-Malignant	0.01	0.00-0.01	0.03	0.02-0.03	0.02	0.02-0.03
Embryonal tumors	0.75	0.72-0.78	0.16	0.15-0.17	0.06	0.05-0.06
Tumors of Cranial and Spinal Nerves	0.26	0.25-0.28	0.97	0.94-0.99	3.45	3.41-3.50
Nerve sheath tumors	0.26	0.25-0.28	0.96	0.94-0.99	3.45	3.41-3.49
Malignant	0.01	0.00-0.01	0.01	0.01-0.01	0.02	0.02-0.03
Non-Malignant	0.26	0.24-0.28	0.96	0.93-0.98	3.43	3.39-3.47
Other tumors of cranial and spinal nerves	--	--	--	--	0.00	0.00-0.00
Tumors of Meninges	0.17	0.15-0.18	2.05	2.01-2.09	17.76	17.67-17.86
Meningioma	0.09	0.08-0.10	1.81	1.77-1.84	17.37	17.28-17.47
Malignant	0.01	0.00-0.01	0.03	0.02-0.03	0.21	0.20-0.22
Non-Malignant	0.08	0.07-0.09	1.78	1.74-1.82	17.16	17.07-17.26
Mesenchymal tumors	0.05	0.05-0.06	0.06	0.05-0.07	0.11	0.10-0.12
Primary melanocytic lesions	--	--	0.00	0.00-0.01	0.01	0.01-0.02
Other neoplasms related to the meninges	0.02	0.02-0.03	0.18	0.17-0.19	0.26	0.25-0.28
Lymphomas and Hematopoietic Neoplasms	0.03	0.02-0.03	0.11	0.10-0.12	0.95	0.92-0.97
Lymphoma	0.01	0.01-0.01	0.10	0.09-0.11	0.93	0.90-0.95
Other hematopoietic neoplasms	0.02	0.01-0.02	0.01	0.01-0.01	0.02	0.02-0.02
Germ Cell Tumors and Cysts	0.21	0.20-0.23	0.12	0.11-0.13	0.03	0.02-0.03
Germ cell tumors, cysts and heterotopias	0.21	0.20-0.23	0.12	0.11-0.13	0.03	0.02-0.03
Malignant	0.16	0.14-0.17	0.09	0.09-0.10	0.00	0.00-0.01
Non-Malignant	0.06	0.05-0.06	0.03	0.02-0.03	0.02	0.02-0.03
Tumors of Sellar Region	0.48	0.46-0.51	3.60	3.55-3.65	6.03	5.98-6.09
Tumors of the pituitary	0.26	0.24-0.28	3.47	3.42-3.52	5.82	5.76-5.87
Malignant	--	--	0.01	0.00-0.01	0.02	0.02-0.02
Non-Malignant	0.26	0.24-0.28	3.46	3.41-3.51	5.80	5.74-5.85
Craniopharyngioma	0.22	0.20-0.24	0.13	0.12-0.14	0.22	0.21-0.23
Unclassified Tumors	0.32	0.30-0.34	0.64	0.62-0.66	2.20	2.16-2.23
Hemangioma	0.11	0.10-0.12	0.32	0.30-0.34	0.56	0.54-0.58
Neoplasm, unspecified	0.20	0.19-0.22	0.32	0.30-0.33	1.63	1.60-1.66
Malignant	0.05	0.05-0.06	0.07	0.06-0.08	0.81	0.79-0.83
Non-Malignant	0.15	0.13-0.16	0.25	0.24-0.26	0.82	0.80-0.84
All other	0.01	0.00-0.01	--	--	0.01	0.01-0.01
TOTAL d	5.54	5.46-5.63	10.94	10.85-11.03	40.82	40.67-40.96
Malignant	3.79	3.72-3.86	3.24	3.19-3.29	12.04	11.96-12.12
Non-Malignant	1.75	1.71-1.80	7.69	7.62-7.77	28.77	28.65-28.90

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

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

^cAdolescents and Young Adults (AYA), as defined by the National Cancer Institute, see: http://www.cancer.gov/researchandfunding/snapshots/adolescent-young-adult.

^dRefers to all brain tumors including histologies not presented in this table.

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

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.

• There were 56,039 primary brain and other CNS tumors diagnosed in AYA between 2010 and 2014, representing 14.8% of all brain and other CNS tumors (Figure 21A–B).

• The overall incidence rate in this age-group was 10.94 per 100,000 population (Table 26). Incidence of non-malignant tumors was 7.69 per 100,000, and incidence of malignant tumors was 3.24 per 100,000.

• Tumors of the sellar region had the highest incidence (3.60 per 100,000 population), followed by tumors of neuroepithelial tissue (3.45 per 100,000 population) (Table 26).

• The most common histology in AYA was tumors of the pituitary (3.47 per 100,000 population), followed by meningioma (1.81 per 100,000 population) and nerve sheath tumors (0.96 per 100,000 population) (Table 26).

• The majority of AYA brain and other CNS tumors occurred in the pituitary and craniopharyngeal duct (33.8%), followed by the meninges (15.8%) (Figure 21A).

• Approximately 20% of tumors diagnosed in AYA were located within the frontal, temporal, parietal, and occipital lobes of the brain combined (Figure 21A).

• Cerebrum, ventricle, cerebellum, and brain stem tumors combined accounted for about 11% of all AYA tumors (Figure 21A).

• The predominately non-malignant tumors of the pituitary (32.0%), meningioma (15.7%), and nerve sheath (8.7%) represented over half of CNS tumors diagnosed in AYA. (Figure 21B).

• Glioma accounted for approximately 27.2% of all brain and other CNS tumors in AYA, and about 81.3% of all malignant tumors. (Figure 21B).

• AYA were estimated to have 11,250 new primary brain and other CNS tumors in 2017 and 11,270 in 2018 (Table 18).

• AYA had higher rates of relative survival than adults greater than 40 years old for all histologic types. Though 1-year relative survival for most tumor types was higher for AYA than children, 5- and 10-year survival were usually higher for children as compared to AYA (Table 23).

Fig. 21.

Distribution^a in Adolescents and Young Adultsb (Age 15-39 Years) of Primary Brain and Other CNS Tumors by A. Site (N=56,039), and B. Histology (N=56,039), CBTRUS Statistical Report: NPCR and SEER, 2010-2014

Descriptive Summary of Time Trends in Primary Brain and Other CNS Tumors

Time trends in cancer incidence rates are an important measure of the changing burden of cancer in a population over time. Incidence rates of cancer overall, and many specific cancer histologies, have decreased over time.⁴⁷ Overall, changes in incidence rates of brain and other CNS tumors between 2000 and 2014 (2004 and 2014 for non-malignant tumors), have been small. There are many things that can affect incidence rates over time that are not related to ‘true’ changes in incidence of these tumors, including demographic changes, changes in histologic classification, and changes in cancer registration procedures. CBTRUS has previously reported that there was increasing incidence of non-malignant brain tumors during the first years of their mandatory collection (2004–2006).⁴⁸

Many factors may lead to fluctuations in rates over time and all of these must be considered when interpreting time trends results. When assessing trends in incidence over time it is critical to use the most recent data available, as delay in reporting may cause small fluctuations in incidence. Time trends analysis methods are used to estimate if the Annual Percent Change (APC) is significantly different from 0% (meaning no change in incidence from year to year). The 95% confidence interval (95% CI) is a range around an estimate that, if sampling of the population was repeated, should contain the ‘true’ value for the population 95% of the time. If the 95% confidence interval contains 0, we cannot be confident that the ‘true’ population APC value is significantly different from 0%. In addition to assessing statistical significance of changes in incidence over time, the size of this change must also be considered because with datasets as large as CBTRUS, a very small fluctuations in incidence over time may be statistically significant but not truly represent a large change in proportion of individuals over time.

• From 2008–2014, there was a slight decrease in incidence of malignant brain tumors (Annual percentage change [APC] of -1.0% [95% CI: -1.2%, -0.7%], Figure 22). There was a small but statistically significant increase in incidence in children (age 0–14 years, APC=0.6% [95% CI: 0.3%, 0.9%], Figure 23), and a small but statistically significant decrease in AYA (APC=-0.4% [95% CI: -0.6%, -0.2%], Figure 23) from 2000–2014, and a small but statistically significant decrease in older adults from 2008–2014 (APC=-1.2% [95% CI: -1.6%, -0.8%], Figure 23).

• There was a slight increase in incidence of glioma between 2000 and 2008 (APC=0.8% [95% CI: 0.4%, 1.3%], Figure 24), followed by a small but significant decrease in incidence from 2008–2014 (APC=-0.9% [95% CI: -1.5%, -0.2%], Figure 24). There was a significant increase in incidence in children (age 0–14 years, APC=1.5% [95% CI: 1.0%, 2.0%], Figure 24) from 2000–2014, and a significant increase in incidence in AYA from 2000–2006 (APC=2.3% [95% CI: 0.7%, 3.8%], Figure 24). Incidence of glioma in older adults (age 40+ years) was relatively stable: there was a statistically significant increase from 2000–2007 (APC=0.6%, [95% CI: 0.2%, 1.1%] Figure 24), followed by a statistically significant decrease from 2007–2014 (APC=-0.9% [95% CI: -1.4%, -0.5%], Figure 24).

• There was a significant decrease in incidence of malignant meningioma between 2000 and 2013 (APC=-4.6% [95% CI: -5.5%,-3.6%], Figure 25). Changes were made to histological classification of meningioma in both the 2000 and 2007 revisions of the WHO classification, and gradual uptake of these classification changes may result in changing incidence of these tumors.⁴⁹

• There was a significant increase in incidence of non-malignant brain tumors from 2004–2009 (APC=5.0% [95% CI: 2.9%, 7.0%], Figure 22), and no significant change between 2009 and 2014. There was a small but statistically significant increase in incidence of these tumors in children (2004–2009, APC=3.8% [95% CI: 1.5%, 6.2%], Figure 23), in AYA (2004–2009, APC=6.2% [95% CI: 3.3%, 9.2%], Figure 22), and older adults (2004–2009, APC=4.8% [95% CI: 2.9%, 6.7%], Figure 23). When analysis was limited to histologically confirmed tumors only, there was a small but significant increase in incidence of non-malignant brain and other CNS tumors from 2004–2009 (APC=1.6% [95% CI: 0.4%, 2.7%]), followed by a small but significant decrease from 2009–2013 (APC=-1.7% [95% CI: -2.8%, -0.6%]). There was a statistically significant increase in incidence of radiographically confirmed non-malignant tumors from 2004–2009 (APC=9.2% [95% CI: 5.8%, 12.7%]), with no significant change from 2009–2013. The increases in incidence in the non-malignant tumors are partially attributable to improved collection of radiographically diagnosed cases as well as improvement in collection of non-malignant cases in general over time.

• There was a significant increase of non-malignant meningioma between 2004 and 2009 (APC=4.9% [95% CI: 3.3%, 6.6%], Figure 26), but no significant change after 2009. When analysis was limited to histologically confirmed cases, there was no substantial change in incidence from 2004–2009 and a slight decrease (APC=-2.1% [95% CI: -3.3%, -1.0%]) from 2009–2014. There was a significant increase in incidence of radiographically diagnosed cases from 2004–2009 (APC=8.7% [95% CI: 5.8%, 11.8%]) with no significant change between 2009 and 2014. The increases in incidence in these non-malignant tumors are partially attributable to improved collection of radiographically diagnosed cases as well as improvement in collection of non-malignant cases in general over time.

• There was a small but significant increase in the incidence of non-malignant nerve sheath tumors between 2004 and 2014 (APC=0.8% [95% CI: 0.1%, 1.5%], Figure 26). When analysis was limited to histologically confirmed cases only, there was no significant change in incidence (APC=-0.6% [95% CI: -1.4%, 0.2%]) from 2004–2013. There was a significant increase in incidence of radiographically diagnosed tumors (APC=14.1%, [95% CI: 3.9%, 25.3%]) between 2004 and 2006, with a smaller but still significant increase in incidence from 2006–2014 (APC=1.5%, [95% CI: 0.6%, 2.4%]). The increases in incidence in these non-malignant tumors are partially attributable to improved collection of radiographically diagnosed cases as well as improvement in collection of non-malignant cases in general over time.

• There was a significant increase in non-malignant tumors of the pituitary from 2004–2009 (APC=7.2% [95% CI: 4.6%, 9.9%], Figure 26), but no significant change in incidence from 2009–2013. When analysis was limited to histologically confirmed tumors only, there was a significant increase (APC=4.4% [95% CI: 3.5%, 5.4%]) from 2004–2009, followed by a small but significant decrease from 2009–2014 (APC=-2.2% [95% CI: -3.0%, -1.3%]). There was a significant increase in incidence of radiographically diagnosed tumors of the pituitary from 2004–2012 (APC=8.2% [95% CI: 6.1%, 10.3%]), with no significant change in incidence from 2012–2014. The increases in incidence in these non-malignant tumors are partially attributable to improved collection of radiographically diagnosed cases as well as improvement in collection of non-malignant cases in general over time.

Fig. 22.

Annual Age-Adjusted Incidence Rates of Primary Brain and Other CNS Tumors, and Incidence Trends by Behavior, CBTRUS Statistical Report: NPCR and SEER, 2000-2014 (varying)

Fig. 23.

Annual Age-Adjusted Incidence Rates of Primary Brain and Other CNS Tumors, and Incidence Trends by Behavior and Age-Group, CBTRUS Statistical Report: NPCR and SEER, 2000-2014 (varying)

Fig. 24.

Annual Age-Adjusted Incidence Rates of Primary Brain and Other CNS Gliomas, and Incidence Trends by Age-Group, CBTRUS Statistical Report: NPCR and SEER, 2000-2014

Fig. 25.

Annual Age-Adjusted Incidence Rates of Selected Malignant Primary Brain and Other CNS Tumors, and Incidence Trends by Histology, CBTRUS Statistical Report: NPCR and SEER, 2004-2014

Fig. 26.

Annual Age-Adjusted Incidence Rates of Selected Non-Malignant Primary Brain and Other CNS Tumors, and Incidence Trends by Histology, CBTRUS Statistical Report: NPCR and SEER, 2000-2014

Prevalence of Primary Malignant Brain and Other CNS Tumors

Prevalence is an estimate of the total number of individuals with a disease that currently exist within a population, as compared to incidence which is a calculation based on new diagnoses only. CBTRUS previously estimated the 2010 prevalence rate for all primary malignant brain and other CNS tumors to be 47.6 per 100,000 population, or a total of 103,634 cases.⁵⁰ Prevalence in children (0–14 years old) was estimated to be 22.31 per 100,000 population (13,657 cases), while prevalence in AYA (15–39 years old) was estimated to be 48.49 per 100,000 (31,299 cases). These ages represent age at time of prevalence calculation and not the age at which individuals were diagnosed. Please refer to Zhang, et al.⁵⁰ for more details.

Lifetime Risk of Primary Malignant Brain and Other CNS Tumors

From birth, a person in the US has a 0.62% chance of ever being diagnosed with a primary malignant brain and other CNS tumor (excluding lymphomas, leukemias, tumors of the pituitary and pineal glands, and olfactory tumors of the nasal cavity) and a 0.46% chance of dying from a primary malignant brain/other CNS tumor.^51–54

• For males (all races), the risk of developing a primary malignant brain/other CNS tumor is 0.69%, and the risk of dying from a primary malignant brain/CNS tumor is 0.51%.

• For females (all races), the risk of developing a primary malignant brain/other CNS tumor is 0.55%, and the risk of dying from a primary malignant brain/CNS tumor is 0.41%.

• For White non-Hispanics (both sexes), the risk of developing a primary malignant brain/other CNS tumor is 0.71%, and the risk of dying from a primary malignant brain/CNS tumor is 0.53%.

• For Whites Hispanics (both sexes), the risk of developing a primary malignant brain/other CNS tumor is 0.56%, and the risk of dying from a primary malignant brain/CNS tumor is 0.36%.

• For Blacks (both sexes), the risk of developing a primary malignant brain/other CNS tumor is 0.35%, and the risk of dying from a primary malignant brain/CNS tumor is 0.25%.

• For API (both sexes), the risk of developing a primary malignant brain/other CNS tumor is 0.39%, and the risk of dying from a primary malignant brain/CNS tumor is 0.28%.

Risk Factors for Primary Brain and Other CNS Tumors

Many environmental and behavioral risk factors have been investigated for brain and other CNS tumors. The only well-validated factors are increased risk for these tumors (particularly meningiomas) with exposure to ionizing radiation⁵⁵ (the type of radiation generated by atomic bombs, therapeutic radiation treatment, CT scans, and X-rays) and decreased risk for these tumors (particularly glioma) in persons with a history of allergy or other atopic disease⁵⁶ (including eczema, psoriasis, and asthma). Several recent review articles have elaborated on the current state of risk factor research in primary brain and other CNS tumors.^57–59

Biomarkers for Primary Brain and Other CNS Tumors

Primary brain and other CNS tumors are a highly heterogeneous group of diseases, and characterization of unique tumor histologies within this group has been refined over time. The development of technologies for characterizing DNA, RNA, and DNA methylation has led to the discovery of several factors (known as ‘biomarkers’) that can be used to more accurately classify these tumors than histologic appearance alone.

Gliomas, as the most common malignant primary brain and other CNS tumor type, have been subject to the greatest amount of investigation. A recent review has described in detail the current state of research in glioma biomarker research.⁶⁰ One of the earliest discoveries in glioma biomarkers was that oligodendrogliomas often had large deletions (missing parts of the chromosome, also known as loss of heterozygosity) in the short arm of chromosome 1 (1p) and the long arm of chromosome 19 (19q).⁶¹ In general, these deletions significantly predict positive response to chemotherapy and radiation treatment in oligodendroglioma and anaplastic oligodendroglioma.^62–64 Mutations to the genes in isocitrate dehydrogenase 1 (IDH1) and in isocitrate dehydrogenase 2 (IDH2) have also been shown to be associated with improved prognosis in glioma. These mutations are common in lower grade gliomas (WHO grade II and WHO grade III), but are rare in glioblastoma.⁶⁵ Both of these alterations are thought to occur relatively early in the development of gliomas; the prevalence of this mutation varies by anatomic location in the brain. Recent analyses of data collected by the Cancer Genome Atlas have demonstrated that the combination of these two factors can be used to more accurately stratify glioma by prognosis than the previously utilized histological criteria,^66,67 and have been incorporated into the definition of oligodendroglioma and astrocytoma in the 2016 revision to the WHO classification.¹⁵These classification changes are not reflected in the data presented in this report, which was collected prior to the adoption of these biomarkers as diagnostic criteria. These new biomarkers are expected to begin to be collected in the United States starting in 2018.

Another alteration that is associated with improved survival in glioma is increased methylation (where methyl molecules are bonded to the DNA) of the promotor region of the gene O-6-methylguanine-DNA methyltransferase (MGMT).^68,69 The promoter region of a gene is located upstream of the coding part of the gene and exerts control over whether a gene is transcribed into RNA. Methylation of this region effectively silences the gene, and prevents transcription into RNA. MGMT is a DNA repair protein, and it is assumed that the decreases in protein levels increase sensitivity to the alkylating chemotherapies (e.g. temozolomide) often used in the treatment of gliomas that combat tumor growth through DNA damage.⁷⁰ This alteration is common in glioblastoma and less common in lower grade glioma. Recent analyses of data generated by The Cancer Genome Atlas have shown that genome-wide DNA methylation predicts improved prognosis in addition to methylation of specific genes.⁶⁶ Persons whose tumor has a higher proportion of methylation across the genome are termed to have glioma-CpG island methylator phenotype (G-CIMP).⁷¹ G-CIMP and MGMT methylation are correlated,⁷² but G-CIMP is much rarer in glioblastoma than MGMT methylation.

Medulloblastoma is another tumor type that has been subject to significant molecular analysis. Using an analysis of gene expression (based on quantity of RNA transcribed from a gene), medulloblastoma was able to be subdivided into four distinct subtypes: wingless (WNT), sonic hedgehog (SHH), group 3 (also called group C), and group 4 (also called group D).⁷³ These groups are associated with specific age-groups, with SHH being most common in infants and adults, and all other groups being more common in childhood. Several review articles have elaborated on the details of these subgroups and their implications for diagnosis and treatment.^74,75

Diffuse intrinsic pontine glioma (DIPG) is an aggressive tumor of the brain stem that occurs primarily in children, and accounts for ~75% of brain stem tumors in children. Survival is very poor after diagnoses with these tumors. Due to the location of these tumors, they are often not biopsied and, therefore, have not been molecularly characterized to the extent of many other primary brain and other CNS tumor types. Recently, biopsy and autopsy protocols have allowed for collection of primary tumor samples that have been used for genomic profiling.^76,77 These tumors have been found to be highly heterogeneous. Mutations in histone H3, Activin A receptor, type I (ACVR1), tumor protein p53 (TP53), platelet-derived growth factor receptor A (PDGFRA), phosphatidylinositol 3-kinase catalytic subunit alpha (PIK3CA), and Myc (MYC) have been identified as characteristic of these tumors.^77–79 A recent review further summarized recent developments in the genomics of DIPG.⁸⁰

As of 2011, SEER registries currently collect information on three validated biomarkers for primary brain and other CNS tumors as Site Specific Factors (SSF): promoter methylation status of MGMT (SSF 4), deletion of the 1p (SSF 5), and deletion of 19q (SSF 6).⁸¹ Completeness of these biomarker data varies significantly by histology, but is gradually improving over time.

Strengths and Limitations of Cancer Registry Data

CBTRUS is the largest population-based registry focused exclusively on primary brain and other CNS tumors in the US and represents cases collected from 99.9% of the US population (for 2011 only, data were available for 50 out of 51 registries). The CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2010–2014 contains the most up-to-date population-based data on primary brain tumor and other CNS tumors available through the surveillance system in the US.

Registration of individual cases is conducted by cancer registrars at the institution where diagnosis occurs and is then transmitted to the central cancer registry, which further transmits this information to NPCR or SEER. Central cancer registries (both NPCR and SEER) only report cases to the CDC and NCI for persons that are residents of that particular state, so duplicate records should not occur for persons that may have traveled across state lines for treatment. As a result, the CBTRUS dataset is a complete recording of all cases for the time period examined (with the exception of cases not-available from one registry in 2011) 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 US via the cancer registry system. SEER registries are specifically funded to collect active follow-up on patients, and as a result, have highly accurate survival data for patients who are diagnosed within the geographic regions covered by these registries. The SEER 18 population dataset used for the survival analyses is a subset of the larger CBTRUS dataset used to generate incidence (99.9% of the US population)¹¹ and covers approximately 26% of the US population. Survival estimates obtained from the SEER dataset may be less reliable as representations of ‘real’ relative survival rates for the US than if they were based on data from a larger portion of the population. Survival data are collected by NPCR registries—primarily through linkage with death records—and the feasibility of these data for use in survival studies has been evaluated,^82,83 and these data are currently available for public use from a limited number of NPCR registries.

No mechanism currently exists for central pathology review of cases within the US cancer registry system, and histology code assignment at case registration is based on histology information contained in the patient’s medical record. The WHO Classification of Tumours of the Central Nervous System underwent revision in 1993,⁸⁴ 2000,¹⁴ 2007,¹ and 2016.¹⁵ The US cancer registry system is currently using the 2000 classification for data abstraction, but tumors included in this report may have been diagnosed using any of the available classifications prior to 2013 due to the variation in adoption of new standards by individual physicians and medical practices. As a result, histologies are reflective of the prevailing criteria for a histology at the time of registration. This means that despite changes to the histology schema that may occur over time, it is not possible without additional variables to go back and re-classify any tumors based on new criteria. In addition to changes in histologic criteria over time, there is significant inter-rater variability in histopathological diagnosis of glioma.^85,86 This also means that incomplete, incorrect, or alternatively stated diagnoses included in a pathology report or other medical record can result in an incorrect reporting of the details of an individual case. For example, an anaplastic oligodendroglioma recorded in a pathology record as oligodendroglioma WHO grade III may be incorrectly recorded as an oligodendroglioma when the accurate category is an anaplastic oligodendroglioma.

US cancer registration requires the reporting of cases that are confirmed by any type of diagnostic procedure, including both histologic confirmation (where surgery was performed and the diagnosis confirmed by a pathologist) and radiographic confirmation (where diagnosis was made based solely on imaging criteria, such as an MRI, CT scan, or X-ray). Only histologic confirmation allows certainty on the assignment of a specific histology as well as for an assignment of a WHO grade. Many tumors have unique characteristics that make them identifiable on imaging, and thereby qualify as a valid type of diagnostic procedure, but it is important to consider the lower level of certainty of specifying the correct histology in these tumors.

The 2016 WHO Classification of Tumours of the Central Nervous System¹⁵ contains significant revision to diagnostic criteria for glioma. Oligoastrocytoma has been long considered an entity that is distinct from astrocytoma and oligodendroglioma, and is included as a unique histologic grouping within the CBTRUS classification scheme. Due to recent molecular analyses that have suggested that these tumors are not molecularly distinct from oligodendrogliomas or astrocytomas⁸⁷ and can be separated into as astrocytoma and oligodendroglioma using molecular markers, the diagnosis of oligoastrocytoma is strongly discouraged and qualified with a “not otherwise specified” designation under the 2016 revision to the WHO Classification of Tumours of the Central Nervous System. With this recent revision to the WHO criteria for central nervous system tumors,¹⁵IDH1/2 mutation and 1p/19q codeletion will become the primary factors by which gliomas are classified. Data on IDH1/2 mutation status are not currently collected in the US cancer registry system, and while 1p/19q deletion data are collected, these data vary significantly in completeness by histology.⁸¹ Though the coding changes contained within this revision are not currently adopted by the US cancer registry system (scheduled to begin in 2018), it is likely that these changes to diagnostic criteria may affect the incidence of these tumor types in future years.

Concluding Comment

The CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2010–2014 comprehensively describes the current population-based incidence, mortality, and relative survival of primary malignant and non-malignant brain and other CNS tumors collected and reported by central cancer registries covering approximately 99.9% of the US population (for 2011 only, data was available for 50 out of 51 registries). This report aims to serve as a useful resource for researchers, clinicians, patients, and families. In keeping with its mission, 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, the 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.

Abbreviations

AIAN

American Indian/Alaskan Native

AJCC

American Joint Commission on Cancer

APC

Annual Percent Change

API

Asian or Pacific Islander

AYA

Adolescents and Young Adults

ATRT

Atypical Teratoid Rhabdoid Tumor

CBTRUS

Central Brain Tumor Registry of the United States

CCR

Central Cancer Registry

CDC

Centers for Disease Control and Prevention

CS

Collaborative Staging

CSS

Cancer Surveillance System

CI

Confidence interval

CNS

Central nervous system

ICD-O-3

– International Classification of Diseases for Oncology, Third Edition

ICCC

International Classification of Childhood Cancer

IDH1/2

Isocitrate dehydrogenase 1/2

MGMT

O-6-methylguanine-DNA methyltrans‑ferase

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

PNET

Primitive Neuroectodermal Tumor

SEER

Surveillance, Epidemiology, and End Results

US

United States

USCS

United States Cancer Statistics

VHA

Veteran’s Health Administration

WHO

World Health Organization