Brain/CNS Cancer Incidence is Increasing in Navarre (Spain), 1973-2008
Joel Moskowitz, UC Berkeley lecture, Health and Social Behavior (PH200), Apr 8, 2015
Brain and Central Nervous System Cancer Incidence in Navarre (Spain), 1973-2008 and Projections for 2014
Etxeberria J, San Román E, Burgui R, Guevara M, Moreno-Iribas C, Urbina MJ, Ardanaz E. Brain and Central Nervous System Cancer Incidence in Navarre (Spain), 1973-2008 and Projections for 2014. J Cancer 2015; 6(2):177-183. doi:10.7150/jca.10482. Available from http://www.jcancer.org/
Different studies have pointed out Navarre as one of the regions of Spain with the highest incidence rates of brain and other central nervous system (CNS) cancer. Trend analysis for cancer incidence rates for long periods of time, might help determining risk factors as well as, assessing prevention actions involved in this disease.
The objective of this study was to describe the incidence of brain and CNS cancer using data from the population-based cancer registry of Navarre, (Spain) during the period 1973-2008 and provide forecast figures up to-2014.
Crude and age-standardized (world population) incidence rates of brain cancer per 100,000 person-years were calculated by the direct method separately by gender, area (Pamplona and others), and age-groups. Penalized splines for smoothing rates in the temporal dimensions were applied in order to estimate and forecast cancer incidence rates.
Age-adjusted incidence rates showed an increase over the study and forecast periods in both sexes more marked in women than in men. Higher incidence rates were observed in men compared with women but the differences became smaller with time. The increase was due to the rise of rates in the oldest age groups since the rates for younger age groups remained stable or decreased over time.
As the entire aetiology of brain and other CNS cancer is not still clear, keep promoting healthful lifestyles for cancer primary prevention among the whole population is necessary.
Table 2 shows the average annual percentage of change of overall brain cancer incidence rates. These results indicate a slightly increase of rates during 1973 to 2008 by an AAPC of 0.5% (CI95% 0.048%-1.005%). By gender, a significant increase of rates was also observed for women by an AAPC of 1.199% (CI95% 0.187%-2.220%). The AAPC was not significant for male. The increase was also significant among 65-74 and 75+ age-groups, for which the highest AAPC were observed, 2.605% (CI95% 1.016%-4.218%) and 5.885% (CI95% 3.215%-8.625%) respectively.
... In 2003-2008 the following rates per 100,000 inhabitants were observed for each morphological group: gliomas 5.795, unspecific malignant neoplasms 0.546, embryonal tumours 0.412 and other specific 0.120. In this last period 315 gliomas were identified from which 69.8% were astrocytic tumours, 7.9% were oligodendroglial tumours and mixed gliomas, 2.8% ependymal tumours and 19.7% were other gliomas.
... Our findings also showed a higher brain cancer incidence rates in urban areas (city of Pamplona) comparing with rural areas. Although many agricultural chemicals and pesticides used in rural areas are believed to be brain cancer risk factors, we could say that their effects in our region are small since the rates in rural areas are lower than in urban ones. Mobility of the population, mainly elderly people to urban areas, may be a reason for these differences between urban and rural incidence rates.
Some studies suggested that an exposure to electromagnetic fields or the use of mobile phones could be in association with brain cancer development. But most of the studies conclude that the association is small or non-significant. It has been also indicated that hereditary syndromes, diet and vitamins play an important role in adult brain cancers . Neither diet, tobacco smoking or alcohol consumption has been found strongly associated with increased risk or protective effects for brain cancer in adults . The brain cancer incidence rate has increased in recent years in the industrialized countries and survival is generally poor compared to many other cancers .
To summarize, age-adjusted incidence rates for brain cancer showed an increase over the study and forecast period in both sexes. This increase is mainly a reflection of the increase of rates in the oldest age groups since the rates for younger age groups remained stable or decreased over time. Few causal factors are established as a brain cancer risk factor and many others have been hypothesized. In this context it is necessary to continue promoting healthful lifestyles for primary prevention among all the population of Navarre.
Joel M. Moskowitz, Ph.D., Director
Center for Family and Community Health
School of Public Health
University of California, Berkeley
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