Intracranial tumors in Canary Islands. An epidemiological survey

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Intracranial tumors in Canary Islands. An epidemiological survey
Intracranial tumors in Canary Islands. An epidemiological survey (19761985)
J.M. Granado Peña and M. Sosa Henríquez*
Service of Neurosurgery and Department of General Pathology*. Hospital Insular de Gran Canaria. University of Las Palmas. Las Palmas de Gran Canaria. Canary Islands. Spain.
Summary
Introduction
An epidemiological study on intracranial tumors
The incidence of intracranial tumors has been controwas performed on a population of 741,599 residents in
versible a 10ngtime31 •35 • Frequently data are not related to
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the province
of Lasdescargado
Palmasde (Canary
Islands, Spain),el 23/12/2016.
specific populations, and sometimes the results obtained
over a ten-year period between 1976-1985. During this
about surgical series are interpreted as epidemiological.
period 441 new intracranial tumors were recorded.
The Canary Islands are situated on the 28. o N paraHel
The calculated rate of incidence for all the type of tuof latitude, in the Atlantic Ocean, close to the Africa comors was 5.9 per 100,000 population/year (males: 6.4
asto It is our opinion that they have sorne special condiand females 5.4), and 5.2 per 100,000 population/year
tions for carrying out reliable epidemiological studies.
for the primary ones. A significant correlation between
Although sorne features of the primitive pre-hispanic pogeographic latitude and the incidence rates reported in
pulation can be nowadays observed in sorne individuals 3.3ó ,
the literature was found. This feature has not been rethe majority of the population faH into the caucassian tyported previously.
pe, and its way of life, its culture, and language is typiKEY WORDS: Brain tumors. Epidemiology. Canary Islands. Spain.
Resumen
Se realizó un estudio epidemiológico descriptivo sobre tumores intracraneales en la provincia de Las Palmas (Islas Canarias, España). La encuesta comprendió
a una población de 741.599 habitantes de derecho,
abarcando un período de 10 años (1976-1985).
,
Durante este período se diagnosticaron un total de
441 nuevos tumores intracraneales en la provincia. La
tasa de incidencia calculada para todo~ los tipos de tumor fue de 5,9/100.000 habitantes/año (varones: 6,4 y
mujeres: 5,4). Para los tumores considerados primarios la incidencia fue de 5,2/100.000 habitantes/año. La
frecuencia e incidencia para los diferentes tipos de tumor fue también calculada.
En la revisión de la literatura y comparación con la
presente serie, se observó una correlación significativa
entre la incidencia referida en las diferentes publicaciones y la latitud geográfica de los distintos países en
que las encuestas epidemiológicas fueron realizadas.
Este hallazgo no ha sido constatado previamente en la
literatura.
PALABRAS CLAVE: Tumor cerebral. Epidemiología. Islas Canarias. España.
44
caHy spanish and so, european. Furthermore, the more severe types of pathologies, as happens with intracranial tumors, are handled in just the main two Hospitals where
the information concerning to this matter is very easy to
obtain because every patient with intracranial tumor is referred to one or another.
The purpose of this study was to estimate the actual rate of incidence for intracranial tumorS by sex, group of
age, and type of tumor, as well as to compare the results
with those previously reported in the literature. There are
few studies on the epidemiology of intracranial tumors
performed in Spain and none in the Canary Islands.
TABLE 1
Distribution of the incidence rate of brain tumors
(percent/100.000 population/year) by groups of age
and sex in a series of 441 cases.
AGE
0-15
16-30
31-45
46-60
>60
TOTAL
MALES
FEMALES
TOTAL
2.6
2.4
6.7
. 17.9
13.6
6.4
1.4
3.5
6.8
11.3
10.7
5.4
2
2.9
6.8
14.6
12.1
5.9
I
I
Intracranial tumors in Canary Islands. An epidemiological survey(l976-1985)
Neurocirugía
INCIDENCE (loa.o.oo/TEAR)
>60
;-.1
lZZi
M~S
16.,-------------------,
.
14
FE+LES~
...-.. ~ ..•••__.._
.
12
la
46-60
8
"
6
31-45
.
.
4
2
Oi--r---,---,--.,--r----,--,--,...--.,,---1
16·30
II TOTAL
:IPRIMARY
0-15
0-15
16-30
3t-45
46-60
)60
2.02
2.02
2.95
2.8
6.77
6.19
14.6
11.89
12.01
10.31
GROUPS OF AGE
140 120 100 80 60 40
THOUSAND
20
o
20
40
60
80
THOUSAND
100
120
I -TOTAL
--+- PRIMARY
I
Fig. 2.- Comparative distribution of the incidence rate by
Fig. 1.- Distribution of the population in the Province of Las
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group of age, for the whole of the tumors and the primary ones
Palmas by group ofage and sexo
in a series of 441 intracranial tumors.
Material and methods
This study is based on a population of 741,599 people
living in the province of Las Palmas de Gran Canaria
(Spain). The distribution of the population by sex and age
group is showed in Figure l.
In a ten year period, between 1976-1985,441 new intracranial neoplasms were recorded. The cases were obtained from the records of the Services of Neurosurgery
(98%) and Pathology (2% of the tumors in this series comes from autopsy material) from the two main reference
Hospitals in the province, in which the most impotant intracranial disorders are managed. The private consulting
of aH the neurosurgeons practising in the province were
taken into account and investigated, but no one tumor was
found because aH of them were referred to the main Hospitals when diagnosed. All the vascular malformations as
weH as intracranial tumor occurring among no resident
population were exeluded of this study.
The parameters to evaluate were recorded as follow:
Age: The patients were divided into groups separated
by a 15 year interval (0-15, 16-30,31-45,45-60, and older
than 60).
Diagnostic features: Seven diagnostic groups were defined according to Rubinstein 33, as follow: Glioma (it ineludes all the tumors arising from glial cells, with all types
and grades, and mixed tumors). Meningioma. Schwanoma
(ineluding Neurofibroma). Pituitary Adenoma. Metástasis.
ather tumors (This group ineludes mainly tumors of the
TABLE2
Comparison betwen relevant data about intracranial
tumors of different series reported in the literature.
TABLE3
Comparison betwen relevant data about .intracranial
tumors of diffetent series reported in the literature.
Author
Kurland" G. Ferial' Brewis4 Gudmundson l5
City/Country Rochester Sweden Carlisle Iceland
Year
1957
1964
1966
1970
Heshmat 17 Schoemberg34
Author
Leibowitz25 Percy3l
City/Country Israel
Rochester Washington Connetticut
Year
1971
1972
1976
1976
No Cases
Incidence
Gliomas
Meningiomas
Neurinomas
Pito Adenom.
Metastasis
ather tumors
No verified
50
9.2
16%
16%
4%
14%
32%
8%
10%
172
11.4
50%
17%
6%
20%
5%
Pit. Adenom.= Pituitary Adenomas.
60
6
25%
6.6%
45%
234
7.8
32%
15.8%
6.4%
5.1%
20.5%
20%
No Cases
Incidence
Gliomas
Meningiomas
Neurinomas
Pito Adenom.
Metastasis
ather tumors
Not verified
1034
9.8
33%
20%
4%
6.7%
160
14.4
33%
38%
5.6%
10.6%
990
4.3
68%
9.3%
0.6%
9%
3210
4.9
47%
12.5%
1.5%
9%
7%
29%
9.4%
3.1%
12%
9%
24.5%
Pit. Adenom.= Pituitary Adenomas.
45
IntracraniaI tumors in Canary IsIands. An epidemiologicaI survey (1976- 1985)
Neurocirugía
%
70
60
so
40
30
20
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10
o
•
MALES
l7J FEMALES D TOTAL
N.V.T.=NO VERIFIED TUMORS
Fig. 3.- Distribution by type oftumor and sex in a serie of 441 intracranial tumors.
infancy and childhood, such as M~dulloblastoma and Prirnitive Neuroectodermal Tumors 30 as well as some rare tumors of adults such as Chondrosarcoma of the skull base,
Osteosarcoma of the cranial vault and others, and no verified tumors (those diagnosed by clinical and radiological
tests, whose were not histologically verified because of
several reasons).
The Incidence rate (100,000 people/year) for ea~h sex,
age and type of tumor was calculated and the results were
compar~d with those reported in the literature. The statistical study was performed in a PC-compatible computer
with the Statistical Package for the ~Social Sciences
(SPSS) software. We consider significant at the level of
confidence of 95% (P<0.05).
Results
The mean age, at the time of the diagnosis, in this series was 43· years (SD 18). There were no differences between both sexes. Tumors were significantly more frequent in men (55.4%) than in women (44.6%), (P<0.05).
The Incídence rate for all the tumors was 5.9/100,000 population/year, and for the primary intracranial tumors was
5.2/100,000 population/year. The relevant data are showed on Table 1 and Figures 2 to 5.
46
Discussion
In Tables 2 to 4 are represented the relevant data reported previously in the literature in a comparative fashion.
TABLE4
Comparison betwen relevant data about intracranial
tumors of different series reported in the literature.
Author
City/Country
Year
No Cases
Incidence
Gliomas
Meningiomas
Neurinomas
Pito Adenom.
Metastasis
Other tumors
Not verified
Abuh-Salih l Fohelholm 1o Kepes 21
Sudan
Finland
Taiwan
1984
1988
1984
123
27.9%
45.5%
0.8%
10.6%
6.5%
3.2%
0%
326
12.3
15.6%
17.2%
6.1%
16.5%
20%
12.8%
17%
Pit. Adenom.= Pituitary Adenomas.
1012
26.6%
22.4%
10.4%
4.5%
Huang l9
China
1982
22454
1.14
42.8%
16.6%
9.5%
9.5%
6.8%
13%
Intracranial tumors in Canary Islands. Ari epidemiological survey (1976-1985)
Neurocirugía
Meningiomas were the second most frequent tumors in
this series. ¡he incidence rate for this group increases ste4
adly with age (Fig. 4). Females were significantly more
3
-GUOMA
affected than males(P<Ü.05) with a ratio 2: 1 (Fig. 3). This
2
- MENINGIOMA
feature has been largely reported in the literature6.22 , and
*-ADENOMA
probably an hormonal factor is involved8.1!.27. Although
O
-NEURINOMA
these tumors are uncommon during infancy and
0-15 16-30 31-45 45-60 >60
*- METASTASIS
3
4
chilhood
Z, in this series 1,5% of them were diagnosed in
2,6
4,5
GUOMA
1
1
-OTHERS
2,1
1,9
0,4
1,7
MENINGIOMA 0,05
patients
below
15 years, becoming 2.3% of the whole of
0,3
0,6
1
ADENOMA
0,4
~NVT
tumors
in
this
group
of age. This figure is slightly higher
° 0,1 0,5 0,2 0,1
0,1
NEURINOMA
2,7
1,7
0,1
0,6
METASTASIS
than the one previously reportedI3.27.29.
° 0,5 0,5 1,3 0,4
0,5
OTHERS
In the group of patients with Metastases are only in3,4
0,5
0,3
0,3
2,7
NVT
cluded those patients who were evaluated for neurosurgiNVT = NO VERIFIED TUMORS
cal treatment. Therefore, it is not representative for the
troe incidence of Metastases, because many patients with
Fig. 4.- Comparative distribution of incidence rate for diffethis
pathology are not referred to the neurosurgical serviintracranial
tumor
by groups of age in a serieselof
rent kinds of
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ces,
when the physicians decide that a surgical procedure
441 intracranial tumors.
is not worthwhile.
Pituitary Adenomas in this series were significantly
In our series the incidence rate for aH the tumors incremore frequent in men than in women (P<0.05) (Fig. 3).
ases along with age until a maximum of 60 years old, and
This figure differs from those published in other reports 38 .
decreases slightly aboye this age (Fig. 2). This distribution
2
In the group of Neurinomas both sexes were affected
agrees with most of the reports in the literature .28.34.
in the same way. Nevertheless, it seems to be a low freThe type of tumor was studied. Glioma was the comquency figure.
monest type of tumor in our series and its frequency was
As much as 16.8% of the tumors were histologicaHy
significantly higher in men than in women, (P<0.05) (Fig.
not verified. More or less 40% of them showed antece3) as it has been pointed out by other authors l8 . The rate of
dents of another previous neoplasm and most of them weincidence for this tumor is significantly lower than those
re multiple, suggesting a metastatic disorder. The remaifigures reported in North Europe I6 .20. An increase with age
ning 60% were diagnosed in elderly patients, and its inciwas observed (Fig. 4) until the 60 years limit was reached
dence rate increased steadily with advancing age (Fig. 4).
for slightly decreasing thereafter.
They could be meningiomas too.
Although racial factors are involved in the developTABLE5
ment of the intracranial neoplasms 5.l7·'5, no significant difGeographic latitude and incidence rate of brain tuferences in ratios of several types of tumor were found
mors in different series reported in the literature.
between the present series and those carried out on caucasian populations (Tables 2, 3 and 4).
Latitude
Incidence
Citr/Country
FinaHy, the geographic latitude was calculated for different places in which the incidence rate for intracranial
Iceland (1963)15
65°N
7.8
tumors was previously reported in the literature (Tab. 5).
Goteborg (1964)12
57°N
11.4
Statistically significant relationships between latitude and
Carlisle (1966)4
54°N
6
incidence rate were found (r=0.57, p<0.05) (Fig. 5). SeveIsrael (1971)25
31°N
9.8
ral hypothesis might be argued to explain this finding, aH
Rochester (USA) (1971)31
44°N
14.4
of them hazardous. On one hand it is possible that the
Mexico (1976)30
19°N
3
amount of diagnosis is higher in the countries situated in
Connetticut (1976)34
41°N
4.9
the northem hemisphere because their better socio-econoWashington (1976)17
38°N
4.3
mical conditions, which affords better health care and
Shangai (1982)19
3l o N
1.1
highly sophisticated technology. Nevertheless, we have
Central Finland (1984)10
65°N
12.3
compared the results at this time with those obtained on
Trento (1986)9
46°N
8.5
the same population, reported twelve years ago 14 and sigBolzano (1988)26
46°N
8.4
nificant differences were not found in spite of the conside28°N
5.2
Las Palmas GC (1994)*
rable technological and social advances that have taken
place meantime. A dramatic increase of the incidence of
* = This series.
brain tumors in elderly people, in United States and in
INCIDENCf 100,000
PEap~ElYE.AR
5
47
Intracranial tumors in Canary Islands. An epidemiological survey (1976-1985)
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8
",
"
~
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6
..
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O' - - - - - ' - - - - ' -_ _-'---_ _L - _ - - l ._ _-'-_--.J
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10
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Copia para uso
se prohíbe(SLEN).
la transmisión
de este documento
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