title: Incidence of CNS tumors in Appalachian children.
abstract: Determine whether the risk of astrocytomas in Appalachian children is higher than the national average. We compared the incidence of pediatric brain tumors in Appalachia versus non-Appalachia regions, covering years 2000-2011. The North American Association of Central Cancer Registries (NAACCR) collects population-based data from 55 cancer registries throughout U.S. and Canada. All invasive primary (i.e. non-metastatic tumors), with age at diagnosis 0-19 years old, were included. Nearly 27,000 and 2200 central nervous system (CNS) tumors from non-Appalachia and Appalachia, respectively comprise the cohorts. Age-adjusted incidence rates of each main brain tumor subtype were compared. The incidence rate of pediatric CNS tumors was 8% higher in Appalachia, 3.31 [95% CI 3.17-3.45] versus non-Appalachia, 3.06, [95% CI 3.02-3.09] for the years 2001-2011, all rates are per 100,000 population. Astrocytomas accounted for the majority of this difference, with the rate being 16% higher in Appalachian children, 1.77, [95% CI 1.67-1.87] versus non-Appalachian children, 1.52, [95% CI 1.50-1.55]. Among astrocytomas, World Health Organization (WHO) grade I astrocytomas were 41% higher in Appalachia, 0.63 [95% CI 0.56-0.70] versus non-Appalachia 0.44 [95% CI 0.43-0.46] for the years 2004-2011. This is the first study to demonstrate that Appalachian children are at greater risk of CNS neoplasms, and that much of this difference is in WHO grade I astrocytomas, 41% more common. The cause of this increased incidence is unknown and we discuss the importance of this in relation to genetic and environmental findings in Appalachia.
authors.affiliation: Markey Cancer Center, University of Kentucky, Lexington, KY, 40536, USA.|Kentucky Cancer Registry, Lexington, KY, 40504, USA.
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.affiliation: College of Medicine, University of Kentucky, Lexington, KY, 40536, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Luo
authors.affiliation: Markey Cancer Center, University of Kentucky, Lexington, KY, 40536, USA.|Kentucky Cancer Registry, Lexington, KY, 40504, USA.|College of Medicine, University of Kentucky, Lexington, KY, 40536, USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Durbin
authors.affiliation: Markey Cancer Center, University of Kentucky, Lexington, KY, 40536, USA.|Kentucky Cancer Registry, Lexington, KY, 40504, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Lycan
authors.affiliation: Markey Cancer Center, University of Kentucky, Lexington, KY, 40536, USA.|Kentucky Cancer Registry, Lexington, KY, 40504, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Tucker
authors.affiliation: Markey Cancer Center, University of Kentucky, Lexington, KY, 40536, USA.|Kentucky Cancer Registry, Lexington, KY, 40504, USA.
authors.forename: Quan
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Departments of Pathology and Neurosurgery, Northwestern University, Chicago, IL, 60611, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Horbinski
authors.affiliation: Markey Cancer Center, University of Kentucky, Lexington, KY, 40536, USA. jlvillano@uky.edu.|Division of Medical Oncology, University of Kentucky, 800 Rose Street, CC447, Lexington, KY, 40536-0093, USA. jlvillano@uky.edu.
authors.forename: John L
authors.initials: JL
authors.lastname: Villano
mesh_terms: D000293:Adolescent; D001061:Appalachian Region / Q000453:epidemiology; D001932:Brain Neoplasms / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012042:Registries; D055815:Young Adult
keywords: Appalachia; Astrocytoma; Brain tumor; Pediatric; Pilocytic