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Brain Cancer -- Texas

Because of concern among local physicians in Cooke County, Texas,* about an apparent excess of brain cancers, incidence and mortality rates of these cancers were evaluated. Data were reviewed during 1973-1982 from county death certificates, cancer registry forms for county residents, and hospital records in Cooke and surrounding counties and major referral centers in Dallas. Pathologic diagnoses in medical records or on death certificates coded 191, 192.0-192.3, or 192.9 using either the International Classification of Diseases, Adapted, eighth (ICDA-8) or ninth (ICD-9) revisions, were considered cases of brain cancer. Information on cancer metastatic to the brain was also reviewed. The expected number of cases was calculated by using the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER) incidence and mortality rates for all races and geographic areas (1) and applying them to the 1980 population figures for Cooke County. The number of cancer cases observed were then compared to the number expected.

Brain cancer was recorded as the cause of death on 11 death certificates; cancer at another site in the nervous system was recorded on five. These 16 deaths are slightly, though not significantly, more than would be expected in a population of this age and sex distribution. Twelve residents had newly diagnosed brain cancer, and one had cancer of another nervous-system site. The occurrences of these 13 cancers in this population are not higher than would be expected. Diagnoses of cases occurred relatively randomly over the 10-year period (Figure 1).

The number of persons with brain cancer in Cooke County may have appeared high because: (1) the brain is a frequent site of metastasis, and metastasis to the brain is frequently the cause of death; (2) errors occur in classifying the causes of death on death certificates; (3) residents of rural areas often are more aware of serious illnesses and deaths among the local population than are residents of urban communities. Reported by A Menchetti, Texas Statewide Registry Program, W Barrington, Jr, Bureau of Vital Statistics, CE Alexander, MD, State Epidemiologist, Texas Dept of Health; Div of Field Svcs, Epidemiology Program Office, Cancer Br, Chronic Diseases Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: In 1984, an estimated 12,800 Americans may develop cancers of the brain or other parts of the central nervous system; an estimated 10,400 may be fatal (2). These cancers represent approximately 1.6% of all newly diagnosed cancers and approximately 2.3% of all deaths from cancer in the United States. Whites have higher age-adjusted incidence and mortality rates than persons of other races, and males have higher rates than females. Primary brain cancers occur from five to 25 times more often than primary cancers of other parts of the central nervous system (1).

Although patients with certain rare inherited conditions, such as tuberous sclerosis and von Recklinghausen's neurofibromatosis, are at an increased risk for nervous-system cancers, most patients with these cancers show no evidence for causative genetic factors. Viruses and several chemicals, including the N-nitrosamides and 7,12-dimethylbenz(a)anthracene, produce nervous-system cancers in experimental animals. Rubber workers, vinyl chloride workers, and petrochemical workers appear to have an increased risk of brain cancers (3,4). Exposure to x-ray therapy and immunosuppression may also increase this risk (3). The observed low survival rate for these cancers--despite surgery, radiotherapy, and chemotherapy--indicates a need for further studies to evaluate the risk factors for the various histologic types of nervous-system cancers.

Despite the concern among Cooke County physicians, no statistically significant excess in brain cancer incidence and mortality was found. Incidence was similar to that expected, and the number had not increased recently. The number of deaths was only slightly higher than expected. Death rates from brain and other nervous system cancers among white males and females in Cooke County did not significantly exceed comparable rates in Texas and in the United States from 1950 through 1979 (5). Counting secondary cancers metastatic to the brain as primary brain cancers, classifying nonresidents with previously diagnosed brain cancer as residents, and showing an incorrect cause of death on the death certificate may explain why the observed number of persons with brain cancer appeared excessive to local physicians. This study confirms the need for verifying each diagnosis of cancer in an apparent cluster of cases and counting only those cases among the true population at risk.


  1. Young JL Jr, Percy CL, Asire AJ, eds. Surveillance, epidemiology, and end results: incidence and mortality data, 1973-77. Washington, D.C.: U.S. Government Printing Office. National Institutes of Health publication no. 81-2330, 1981 (monograph 57).

  2. Silverberg E. Cancer statistics, 1984. CA 1984;34:7-23.

  3. Schoenberg BS. Nervous system. In: Schottenfeld D, Fraumeni JF Jr, eds. Cancer epidemiology and prevention. Philadelphia: WB Saunders, 1982:968-83.

  4. Waxweiler RJ, Alexander V, Leffingwell SS, Haring M, Lloyd JW. Mortality from brain tumor and other causes in a cohort of petrochemical workers. J Natl Cancer Inst 1983;70:75-81.

  5. Riggan WB, Van Bruggen J, Acquavella JF, Beaubier J, Mason TJ. U.S. cancer mortality rates and trends, 1950-1979. Vol III. Washington, D.C.: U.S. Government Printing Office, 1983:42, 67-8, 74, 99; EPA-600/1-83-015a. *Cooke County is predominantly rural and is located north of Dallas on the Oklahoma border.

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