Epidemiology of meningiomas post‐Public Law 107‐206: The Benign Brain Tumor Cancer Registries Amendment Act

• Published in: Cancer Vol. 121; no. 14; pp. 2400 - 2410
• Main Authors: Dolecek, Therese A., Dressler, Emily Van Meter, Thakkar, Jigisha P., Liu, Meng, Al‐Qaisi, Abeer, Villano, John L.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15-07-2015
• Subjects: Age; Age Factors; Benign; benign tumor; Black or African American - statistics & numerical data; Brain; Brain cancer; Brain tumors; Cancer; Cancer therapies; Collection; Confidence intervals; Demographics; Diagnostic systems; Epidemiology; Humans; Incidence; Learning curves; Legislation as Topic; malignant tumor; Meningeal Neoplasms - epidemiology; Meningeal Neoplasms - pathology; Meninges; Meningioma; Meningioma - epidemiology; Meningioma - pathology; Oncology; Patients; Population (statistical); Population Surveillance; prognosis; Public law; Quality; Race; Radiation; Registries; SEER Program - legislation & jurisprudence; Statistical analysis; Statistical methods; Surgery; Surveillance; Survival; treatment; trend; Tumors; United States - epidemiology; United States; meningioma; treatment; benign tumor; trend; survival; malignant tumor; incidence; prognosis
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.29379

BACKGROUND
The current analysis follows the implementation of Public Law 107‐260, the Benign Brain Tumor Cancer Registries Amendment Act, which mandated the collection of nonmalignant brain tumors.
METHODS
Meningiomas were selected from the Surveillance, Epidemiology, and End Results (SEER) Program database for the years 2004 to 2011. Demographic and clinical characteristics, initial treatment patterns, and survival outcomes were evaluated using surveillance epidemiology statistical methods.
RESULTS
The average annual age‐adjusted incidence rate per 100,000 population was 7.62 (95 % confidence interval [CI], 7.55‐7.68) for all meningiomas, 7.18 (95% CI, 7.12‐7.25) for benign meningiomas, 0.32 (95% CI, 0.31‐0.33) for borderline malignant meningiomas, and 0.12 (95% CI, 0.11‐0.12) for malignant meningiomas. The annual rates increased for benign and borderline malignant tumors but decreased for malignant tumors. The rates for women exceeded those for men, especially for those with benign meningiomas. Black race was associated with significantly higher rates as was advancing age. Greater than 80% of tumors were located in cerebral meninges. Diagnostic confirmation through pathology occurred for approximately 50% of benign tumors, 90% of borderline malignant tumors, and 80% of malignant tumors. No initial treatment was reported for greater than 60% of benign tumors, 29% of borderline malignant tumors, or 31% of malignant tumors. The 5‐year relative survival estimates for benign tumors, borderline malignant tumors, and malignant tumors were 85.6% (95% confidence interval [CI], 85%‐86.2%), 82.3% (95% CI, 79.3%‐84.8%), and 66% (95% CI, 60.6%‐70.9%), respectively. Predictors of poorer survival were advanced age, being male gender, black race, no initial treatment, and malignant tumor behavior.
CONCLUSIONS
The current analysis demonstrates that there is an increasing incidence of nonmalignant meningiomas, probably because of reporting learning curves associated with the implementation of Public Law 107‐260. The high proportion of cases who receive no initial treatment is a survival outcome concern, especially for patients with malignant meningiomas. Cancer 2015;121:2400–2410. © 2015 American Cancer Society.
Meningioma incidence has increased since the implementation of Public Law 107‐260, the Benign Brain Tumor Cancer Registries Act, which mandates the collection of nonmalignant brain tumors. Current treatments for meningioma are concerning for a significant percentage of patients who do not receive surgical or radiation treatments for higher grade meningiomas.