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Brain, other CNS and intracranial tumours incidence statistics

Incidence statistics for brain, other parts of the central nervous system (CNS) and intracranial tumours by country in the UK, age, tumour aggressiveness and trends over time are presented here. There are also data on the distribution of cases, morphology, lifetime risk, geography, ethnicity, prevalence and metastatic brain tumours.

Find out more about the coding and counting of this data.

By country in the UK

Brain, other CNS and intracranial tumours are the 9th most common cancer in the UK (2011), accounting for 3% of all new cases. They are the 10th most common cancers in males (3% of the male total) and the 8th most common in females (3%).1-4

In 2011, 9,365 new brain, other CNS and intracranial tumour cases were registered in the UK (Table 1.1): 4,650 (50%) in men and 4,715 (50%) in women.1-4 The crude incidence rate shows that there are 15.0 new brain, other CNS and intracranial tumour cases for every 100,000 males in the UK and 14.7 for every 100,000 females (Table 1.1).1-4

The European age-standardised incidence rates (AS rates) are significantly lower in England compared with Northern Ireland, Wales, and (for females only) Scotland. For females, rates are also significantly lower in Scotland compared with Wales (Table 1.1).1-4 It is unknown whether this geographical variation is real or reflects differences in registration practices between the countries.

Table 1.1: Brain, Other CNS and Intracranial Tumours (C70-C72, C75.1-C75.3, D32-D33, D35.2-D35.4, D42-D43, D44.3-D44.5), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2011

England Wales Scotland Northern Ireland UK
Male Cases 3,758 321 422 149 4,650
Crude Rate 14.4 21.3 16.6 16.8 15.0
AS Rate 12.7 17.2 14.4 16.1 13.2
AS Rate - 95% LCL 12.3 15.4 13.0 13.5 12.8
AS Rate - 95% UCL 13.1 19.1 15.8 18.6 13.5
Female Cases 3,732 348 473 162 4,715
Crude Rate 13.8 22.3 17.5 17.5 14.7
AS Rate 11.4 17.4 13.6 14.9 12.0
AS Rate - 95% LCL 11.0 15.6 12.4 12.6 11.6
AS Rate - 95% UCL 11.7 19.3 14.9 17.2 12.3
Persons Cases 7,490 669 895 311 9,365
Crude Rate 14.1 21.8 17.0 17.1 14.8
AS Rate 12.0 17.2 14.0 15.5 12.5
AS Rate - 95% LCL 11.7 15.9 13.1 13.8 12.3
AS Rate - 95% UCL 12.3 18.5 14.9 17.2 12.8

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Under-recording of brain, other CNS and intracranial tumours by cancer registries is possible, though there are presently no reliable data on the extent of this. Two small studies in the 1990s estimated that around 50% of brain, other CNS and intracranial tumours went unrecorded in UK cancer registries;5,6 however, the situation is now thought to have improved.7,8 Fatal and/or heavily-treated cases are more likely to be captured by cancer registries (because data on these cases appear in multiple systems to which the registries have access, including death records). Thus, it is likely that non-fatal or conservatively-treated cases represent the majority of any unrecorded tumours.5 The National Brain Tumour Registry for England has been set up to provide more detailed and consistent information in the future.8,9

section reviewed 28/05/14
section updated 28/05/14

By age

Incidence of brain, other CNS and intracranial tumours is related to age, with the highest incidence rates overall being in older men and women. In contrast to most types, however, brain, other CNS and intracranial tumours occur relatively frequently across all age groups, including children and teenagers and young adults (Figure 1.1).1-4

In the UK between 2009 and 2011, around a quarter (an average of 24%) of brain, other CNS and intracranial tumour cases were diagnosed in men and women aged 75 and over, and 10% were diagnosed in people under age 30 (Figure 1.1).1-4

Age-specific incidence rates remain relatively stable from infancy to around age 25-29, before increasing more sharply (particularly in males) with the highest rates in the older age groups. Incidence rates are higher for males than for females aged 60-64 and over; the gap is not significant in younger age groups (Figure 1.1).1-4

Figure 1.1: Brain, Other CNS and Intracranial Tumours (C70-C72, C75.1-C75.3, D32-D33, D35.2-D35.4, D42-D43, D44.3-D44.5), Average Number of New Cases per Year and Age-Specific Incidence Rates, UK, 2009-2011

cases_crude_allbrain.swf

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section reviewed 28/05/14
section updated 28/05/14

By tumour aggressiveness

Brain, other CNS and intracranial tumours are classified according to different systems by different organisations, between which systems very broad parallels may be drawn (Table 1.2). There is substantial heterogeneity within and between these broad groups, and data categorising brain, other CNS and intracranial tumours along these lines should be interpreted with caution.

Table 1.2: Systems for Classification of Brain & CNS Tumours

Used by cancer registries generally Used by cancer clinicians generally
ICD-10 codes ICD-10 groups WHO Grade Aggressiveness
C70-C72 and C75.1-C75.3 Malignant (sometimes also known as invasive, or cancer) Few Grade I, most Grade II, almost all Grade III-IV More aggressive
D32-D33, D35.2-D35.4, D42-D43, and D44.3-D44.5 Benign, uncertain or unknown behaviour (sometimes also known as non-invasive) Almost all Grade I, few grade II, very few Grade III-IV Less aggressive

UK national data are mainly collected and reported by cancer registries using the WHO International Classification of Diseases, version 10 (ICD-10). ICD-10 codes can be grouped into either (i) malignant (or invasive, or C-codes) or (ii) benign and uncertain or unknown behaviour types (or non-invasive, or D-codes). While this division underestimates the complexity and diversity of these tumours – even ‘benign’ tumours can invade surrounding tissue to some degree, and can be fatal depending on their location and size – these groupings are the best available for UK national data, and so are typically used by organisations which present national-level statistics. ICD-10 codes can also be mapped, very broadly, onto the WHO Classification of Tumours of the Central Nervous System, which is used by clinicians when diagnosing tumours and planning treatment; under this system tumours are assigned WHO Grades ranging from I-IV, with I being the least malignant and IV the most.10 Clinicians may also describe tumours according to their aggressiveness, or how quickly they are growing. In coming years, all UK cancer registries will code tumours according to the WHO International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3), meaning it may be possible to present UK national data by grade in the future.7

In 2011 in the UK, 55% of brain, other CNS and intracranial tumours were malignant and 45% were benign or of uncertain or unknown behaviour. Tumour behaviour varies markedly between the sexes; malignant brain, other CNS and intracranial tumours were more common in males (male:female ratio around 13:10), while benign and uncertain or unknown behaviour tumours were more common in females (male:female ratio around 7:10).1-4

Incidence of malignant tumours increased rapidly from around age 45-49 and drops slightly in the over-75s (Figure 1.2). Incidence of benign and uncertain or unknown behaviour tumours increases steadily from young adulthood then rises more rapidly in older age groups.1-4

Figure 1.2: Brain, Other CNS and Intracranial Tumours, Malignant (C70-C72, C75.1-C75.3) and Benign and Uncertain or Unknown Behaviour (D32-D33, D35.2-D35.4, D42-D43, D44.3-D44.5), Age-Specific Incidence Rates, UK, 2009-2011

cases_rates_byage_brain.swf

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section reviewed 28/05/14
section updated 28/05/14

Trends over time

Trends over time for brain, other CNS and intracranial tumours are heavily influenced by improvements in data collection and diagnostic capabilities, and the extent of this influence varies by tumour behaviour.1-3

For many of the benign and uncertain or unknown behaviour tumours, collection of all relevant ICD-10 codes across all UK registries was not instituted until the late 1990s, and for some codes not until the early 2000s,8,11 and so collection was not consistent across the UK. The apparent trend for these types of tumours reflects the inclusion of a growing number of codes by a growing number of registries. As well as improved recording of data on low-grade tumours, the detection of non-clinically significant benign tumours (such as small meningiomas) using modern radiology, is likely to explain the difference between the increases between the tumour groups.12-14

For all types of brain, other CNS and intracranial tumours, the introduction of new and more accurate diagnostic techniques including computed tomography (CT) scanning and magnetic resonance imaging (MRI) will have increased the incidence rates considerably.12,13 The National Brain Tumour Registry for England will improve future data collection, allowing accurate trends to be observed.7

Brain, other CNS and intracranial tumour recorded incidence trends since 1993 for the UK are shown in Figure 1.3.1-4 Over the last decade (between 2000-2002 and 2009-2011) in males, the European AS rates have remained stable, while in females rates have increased by 4%. However, the increase in the female rates is confined to the benign and uncertain or unknown tumours (these are the types of tumour more likely to be diagnosed in females), indicating that increased collection of these tumours by cancer registries explains the trend.1-4

Figure 1.3:  Brain, Other CNS and Intracranial Tumours (C70-C72, C75.1-C75.3, D32-D33, D35.2-D35.4, D42-D43, D44.3-D44.5), European Age-Standardised Incidence Rates, UK, 1993-2011

inc_asr_uk_allbrain.swf

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Malignant tumours have been collected by cancer registries for many decades, making long-term trends more reliable. Recorded malignant brain, other CNS and intracranial tumour incidence rates have overall increased in Great Britain since the mid-1970s (Figure 1.4).1-3 For males, European AS incidence rates increased by 41% between 1975-1977 and 2009-2011, though rates peaked in 1999-2001 (47% increase between 1975-1977 and 1999-2001) and have since remained stable. For females the rise has been similar, with rates increasing by 39% between 1975-1977 and 2009-2011, though peaking in 1998-2000 (42% increased between 1975-1977 and 1998-2000) and since remaining stable. Diagnostic and data collection improvements account for much of this trend,12,13 as shown by the much smaller increases in mortality rates over the same period.  However, increases in the registration of some specific subtypes (including high-grade astrocytomas and other gliomas) require further investigation.12

Figure 1.4: Malignant Brain, Other CNS and Intracranial Tumours (C70-C72, C75.1-C75.3), European Age-Standardised Incidence Rates, Great Britain, 1975-2011

inc_asr_gb_brain.swf

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Recorded malignant brain, other CNS and intracranial tumour recorded incidence rates have overall increased for most of the broad age groups in Great Britain since the mid-1970s (Figure 1.5).1-3

The largest increases have been in people aged 80+, with European AS incidence rates increasing more than eight fold between 1975-1977 and 2009-2011.1-3 This increase is thought mainly to be due to an increased use of diagnostic techniques, such as better access to CT machines, in older patients.14 In people aged 50-59, rates increased by 17% between 1975-1977 and 1990-1992, but have since decreased by 11%. 

Figure 1.5: Malignant Brain, Other CNS and Intracranial Tumours (C70-C72, C75.1-C75.3), European Age-Standardised Incidence Rates, by Age, Great Britain, 1975-2011

inc_asr_age_p_brain.swf

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section reviewed 28/05/14
section updated 28/05/14

Distribution of cases

The majority of brain, other CNS and intracranial tumours in the UK between 2008 and 2010 were recorded as occurring in the brain itself (58%), with a further 23% in the meninges, 8% in other parts of the CNS, and 11% in the intracranial endocrine glands (Table 1.3).1-3

Marked differences are seen between the registry-recorded locations of more and less aggressive tumours. Almost all (94%) of more aggressive tumours occurred in the brain itself, with very small proportions in the meninges (2%), spinal cord and other parts of the CNS (3%), and intracranial endocrine glands (1%).1-4 In contrast, only 16% of less aggressive tumours were in the brain, with almost half (47%) occurring in the meninges, 14% in other parts of the CNS, and the remaining 23% in the intracranial endocrine glands.1-4

Table 1.3: Brain, Other CNS and Intracranial Tumours (C70-C72, C75.1-C75.3, D32-D33, D35.2-D35.4, D42-D43, D44.3-D44.5), by Location and Behaviour, Proportion of Cases, UK, 2008-2010

  All brain, other CNS and intracranial tumours More aggressive (ICD-10 C codes) Less aggressive (ICD-10 D codes)
Brain (C71, D33.0-D33.2, D43.0-D43.2) 58% 94% 16%
Meninges (C70, D32, D42) 23% 2% 47%
Other CNS (C72, D33, D43) 8% 3% 14%
Endocrine glands (C75.1-C75.3, D35.2-D35.4, D44.3-D44.5) 11% 1% 23%
Total 100% 100% 100%

section reviewed 28/03/13
section updated 28/03/13

By morphology

There are over 130 different types of tumour which can occur in the brain, other parts of the CNS or intracranial region.10 The most common morphological types of brain, other CNS and intracranial tumours recorded in England in 2006-2010 were astrocytomas (34%) and meningiomas (21%) (Table 1.4).7 Around 80% of astrocytomas were the very aggressive subtype glioblastoma (WHO Grade IV). Almost all of the meningiomas were less aggressive (WHO Grade I). Most of the pituitary tumours were adenomas. There were 14% of brain, other CNS and intracranial tumours recorded by registries as unknown or unspecified type; in many cases this may be because pathological samples (required to ascertain cell type) could not be obtained due to the location of the tumour.

Table 1.4: Brain, Other CNS and Intracranial Tumours, by Morphology, Proportion of Cases, England, 2006-2010

Morphological Group % of all Brain, other CNS and intracranial tumour cases % of these more aggressive % of these less aggressive
Astrocytomas 34% 95% 5%
Meningiomas 21% 8% 92%
Pituitary 8% 1-2% 98-99%
Gliomas unspecified 6% * *
Cranial and paraspinal nerve tumours 6% 5% 95%
Oligodendrogliomas 3% * *
Ependymomas 2% 75% 25%
Embryonal tumours 2% 100% 0%
Other tumour types 5% * *
Unknown or unspecified type 14% * *

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*Heterogeneous groups cannot be broken down by levels of aggressiveness. 
Data supplied by Eastern Cancer Registry and Information Centre (ECRIC) from the National Brain Tumour Registry.
7

section reviewed 28/03/13
section updated 28/03/13

Lifetime risk

Lifetime risk is an estimation of the risk that a newborn child has of being diagnosed with cancer at some point during their life. It is a summary of risk in the population but genetic and lifestyle factors affect the risk of cancer and so the risk for every individual is different. In 2010, the lifetime risk of developing a brain and other CNS tumour in the UK was 1 in 77 for both men and women.15

The lifetime risk for brain, other CNS or intracranial tumours has been calculated by the Statistical Information Team using the ‘Adjusted for Multiple Primaries’ (AMP) method; this accounts for the possibility that someone can have more than one diagnosis of brain, other CNS or intracranial tumour over the course of their lifetime.16

section reviewed 28/03/13
section updated 28/03/13

In Europe and worldwide

Brain and other CNS cancer (C70-C72 only) are the 17th most common cancer type in Europe, with around 57,100 new cases diagnosed in 2012 (2% of the total). In Europe (2012), the highest World age-standardised incidence rates for brain and other CNS cancer are in Albania for men and Sweden for women; the lowest rates are in Cyprus for men and Luxembourg for women. UK incidence rates of brain and other CNS cancer are estimated to the 20th lowest in males in Europe, and 11th lowest in females.22 These data are broadly in line with Europe-specific data available elsewhere.23

Brain and other CNS cancer (C70-C72 only) are the 17th most common cancer type worldwide, with more than 256,000 new cases diagnosed in 2012 (2% of the total). Incidence rates for brain and other CNS cancer are highest in Northern Europe and lowest in Western Africa, but this partly reflects varying data quality worldwide.22

Use our interactive map to explore the data for brain and other CNS cancer.

Variation between countries may reflect different prevalence of risk factors, use of screening, and diagnostic methods.

section reviewed 11/06/14
section updated 11/06/14

Secondary brain cancers

There are presently no reliable data on the incidence of secondary brain, other CNS and intracranial cancers – tumours which have metastasised (spread) to these sites from elsewhere in the body. In some patients, brain, other CNS and intracranial metastases may not manifest clinically in the patient’s lifetime, or a formal diagnosis may not be obtained if the patient is extremely unwell with their primary cancer. Therefore current estimates of the number of secondary tumours are thought to be conservative.18 However, data collection is improving, and in coming years it should be possible to report national data for the number of cancers in the brain, other CNS and intracranial region which started elsewhere in the body.7

The best current estimate is that secondary brain cancers occur in at least 6% of all cancer patients, with marked variation by primary cancer site.18 The proportion ranges from less than 1% of patients with thyroid, liver, stomach, prostate, uterine or ovarian cancers, to 20% of those with lung cancer.18,19 Based on this estimate, metastatic brain tumours are thought to outnumber primary malignant brain tumours by at least three to one.18

section reviewed 31/05/13
section updated 31/05/13

By ethnicity

Age-standardised rates for White males with brain cancer (ICD-10 C70-C72 only) range from 8.2 to 8.7 per 100,000. Rates for Asian males significantly lower, ranging from 4.0 to 6.5 per 100,000 and the rates for Black males are also significantly lower, ranging from 2.9 to 5.4 per 100,000. For females there is a similar pattern - the age-standardised rates for White females range from 5.3 to 5.6 per 100,000, and rates for Asian and Black females are also significantly lower, ranging from 2.4 to 4.3 per 100,000 and 2.1 to 4.1 per 100,000 respectively.21

Ranges are given because of the analysis methodology used to account for missing and unknown data. For brain and CNS cancer, 19,012 cases were identified; 17% had no known ethnicity.

section reviewed 28/05/14
section updated 28/05/14

Prevalence

Prevalence refers to the number of people who have previously received a diagnosis of cancer and who are still alive at a given time point. Some patients will have been cured of their disease and others will not.

In the UK more than 9,700 people were still alive at the end of 2006, up to ten years after being diagnosed with a tumour in the brain, or other parts of the CNS (C70-C72) (Table 1.5).20

Table 1.5: Brain and other parts of CNS (C70-C72), One-, Five- and Ten- Year Cancer Prevalence, UK, 31st December 2006

1 Year Prevalence 5 Year Prevalence 10 Year Prevalence
Male 1,448 3,633 5,456
Female 986 2,650 4,252
Persons 2,434 6,283 9,708

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Worldwide, it is estimated that there were around 317,000 patients with these tumours were still alive in 2008, up to five years after their diagnosis of brain or other CNS tumour (C70-C72).17

section reviewed 17/05/13
section updated 17/05/13

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References for brain, other CNS and intracranial tumours incidence statistics

  1. Data were provided by the Office for National Statistics on request, June 2013. Similar data can be found here: http://www.ons.gov.uk/ons/search/index.html?newquery=cancer+registrations
  2. Data were provided by ISD Scotland on request, May 2013. Similar data can be found here: http://www.isdscotland.org/Health-Topics/Cancer/Publications/index.asp
  3. Data were provided by the Welsh Cancer Intelligence and Surveillance Unit on request, June 2013. Similar data can be found here: http://www.wales.nhs.uk/sites3/page.cfm?orgid=242pid=59080
  4. Data were provided by the Northern Ireland Cancer Registry on request, June 2013. Similar data can be found here: http://www.qub.ac.uk/research-centres/nicr/CancerData/OnlineStatistics/
  5. Pobereskin L. The Completeness Of Brain Tumour Registration In Devon And Cornwall. Eur J Epidemiol 2001;17(5):413-416.
  6. Counsell C, Collie D, Grant R. Limitations of using a cancer registry to identify incident primary intracranial tumours. J Neurol Neurosurg Psychiatry 1997;63:94-97.
  7. Eastern Cancer Registry and Information Centre (ECRIC), National Brain Tumour Registry.  Personal communication, February 2013.
  8. UK Cancer Registry representatives. Personal communication, 2008.
  9. National Cancer Intelligence Unit (NCIN). Central Nervous System (CNS) Tumours – developing a national tumour registry. London: NCIN; 2011.
  10. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds). WHO Classification of tumours of the central nervous system. 4th ed. Lyon, France: IARC, 2007.
  11. European Network of Cancer Registries (ENCR). ENCR recommendations of the Working Group on Data Definitions Brain and Central Nervous System Tumours. 2009.
  12. Arora RS, Alston RD, Eden TOB, et al. Are reported increases in incidence of primary CNS tumours real? An analysis of longitudinal trends in England, 1979–2003. Eur J Cancer 2010; 46(9):1607–1616.
  13. Caldarella A, Crocetti E, Paci E. Is the incidence of brain tumors really increasing? A population-based analysis from a cancer registry. J Neuro-Oncol 2011;104(2):589-594.
  14. Central Nervous System Cancers Site-Specific Clinical Reference Group. Personal communication, February 2013.
  15. Lifetime risk was calculated by the Statistical Information Team at Cancer Research UK, 2012
  16. Sasieni PD, Shelton J, Ormiston-Smith N, Thomson CS, Silcocks PB. What is the lifetime risk of developing cancer?: The effect of adjusting for multiple primaries. Br J Cancer 2011;105(3):460-5.
  17. Ferlay J, Shin HR, Bray F, et al. DM GLOBOCAN 2008 v1.2, Cancer incidence and mortality worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from http://globocan.iarc.fr. Accessed May 2011.
  18. Davis FG, Dolecek TA, McCarthy BJ, et al. Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data. Neuro-Oncology 2012;14(9):1171-77.
  19. Barnholtz-Sloan JS, Sloan AE, et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol 2004;22(14):2865-72.
  20. National Cancer Intelligence Network (NCIN). One, Five and Ten Year Cancer Prevalence by Cancer Network, UK, 2006. London: NCIN; 2010.
  21. National Cancer Intelligence Network and Cancer Research UK. Cancer Incidence and Survival by Major Ethnic Group, England, 2002-2006. 2009
  22. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed December 2013.
  23. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, et al.Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. European Journal of Cancer (2013) 49, 1374-1403.
Updated: 28 May 2014