Epidemiology of Brain Tumours
Brigitte Schlehofer Unit of Environmental-Epidemiology German Cancer Research Centre, Heidelberg
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
The Brain The brain is a soft, spongy mass of nerve cells and supportive tissue.
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Regions of the Brain
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Functions of the Brain
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Primary and Secondary Brain Tumours Primary Brain Tumours • A tumour that starts in the brain (cerebrum, cerebellum, meninges or brain nerves) is a primary brain tumour. • Primary brain tumours are classified by the type of tissue in which they begin (e.g. glioma, meningioma, neurinoma). • Primary brain tumours can be grouped into: - "benign" tumours (e.g. meningioma, neurinoma) and - "malignant" tumours (e.g. glioma)
Secondary Brain Tumours • Tumours that begin in other parts of the body may spread to the brain and cause secondary tumours (e.g. metastases) Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Schematic Figure of Tumours of the Brain
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Meningioma Meningioma is a general name for tumours arising from: - the arachnoidal cells of the meninges or - the tela choriodea of the plexus chorioideus • usually benign, slowly growing tumours • in 1%-3% maligne transformation to anaplastic meningioma • are tumours of middle and old ages • female : male = 2 : 1 • 25% of all primary brain tumours
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Meningioma
Meningioma (lateral view of the right convexity). Large extracerebral tumour strongly depressing the prefrontal region.
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Genetic Aspects in Benign Brain Tumours Genetic changes associated with meningioma progression arachnoidal cell NF2 gene mutation/ chromosome 22q loss ? other loci meningeoma, WHO grade I losses of 1p, 6q, 10q, 14q and 18q gains of 1q, 9q, 12q, 15q, 17q and 20q atypical meningeoma, WHO grade II Losses of 6q, 9p, 10 and 14q 17q amplification Rare mutations: TP53, PTEN Rare deletions: CDKN2A anaplastic (malignant) meningeoma, WHO grade III
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Glioma Glioma is a general name for tumours arising from the neuroglia (glia is the supportive tissue of the brain which help keep the neurons in place and functioning well ). • unlike nerves, glia can reproduce itself
astrocyte cell
There are three types of glial cells that can give rise to different tumours: (astrocytoma, glioblastoma, oligodendroglioma, ependymoma) • usually malignant, fatal tumours • tendency to recur • male : female = 1.5 : 1 • 40% of all primary brain tumours
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Glioma
Glioblastoma (frontal section). Massive necrohaemorrhagic tumour occupying a large portion of the left hemisphere.
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Genetic Aspects in Maligne Brain Tumours Genetic pathways operative in the evolution of primary and secondary glioblastoma:
Differentiated astrocytes or precursor cells P53 mutation (>65%) PDGF-A, PDGFR- overexpression (~60%) Low grade astrocytoma LOH 19q (~50%) RB alteration (~25%) Anaplastic astrocytoma LOH 10q PTEN mutation (5%) DCC loss of expression (~50%) PDGFR- amplification (=46 month
0,0
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Risk for Meningioma due to short /long (< / >= 10 years) use of mobile phones 100,0
_ _
long latency
Relative Risk (95% CI)
10,0
short latency
1,0
0,1
Christensen 2004 HG-Glioma
Lönn 2005
Schüz 2006
Klaeboe 2006 analog
Klaeboe 2006 digital
0,0
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Hours 2007 long: >=46 month
Erice, March/April 2008
Risk for ACN by regulary use* of mobile phones (* once a week for >= 6 month) 100,0
_ digital and / or analog _ digital only _ analog only
Relative Risk (95% CI)
10,0
1,0
0,1
Lönn 2004
Christensen 2004
Schoemaker 2005
Takebayashi 2006
Klaeboe 2006
Schlehofer 2007
Hours 2007
0,0
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Risk for ACN due to short /long (< / >= 10 years) use of mobile phones 100,0
_ _
short latency long latency
Relative Risk (95% CI)
10,0
1,0
0,1
Lönn 2004
Schlehofer 2007
Schoem aker 2005
Christensen 2004
Klaeboe 2006 Klaeboe 2006 analog
digital
short Takebayashi 2006
Hours 2007 long: >=46 m onth
0,0
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Risk for Glioma due to short /long (< / >= 10 years) use of mobile phones 100,0
_ short latency _ long latency
Relative Risk (95% CI)
10,0
1,0
0,1
Hardell 2002 digital
Inskip 2001 Hardell 2002 analog
Hardell 2005 digital Hardell 2005 analog
Lönn 2005 Christensen 2004 HG-Glioma
Klaeboe 2006 digital
Schüz 2006 Hepworth 2006
Klaeboe 2006 analog
Lahkola 2006 analog
0,0
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Auvinen et al. (2002) FIN (a register-based study)
Results: Ever had a mobile phone contract: all: OR 1.3 (95% CI 0.9-1.8) Glioma: OR 1.5 (95% CI 1.0-2.4) Meningioma: OR 1.1 (95% CI 0.5-2.4) Parotid cancer: OR 1.3 (95% CI 0.4-4.7) Analogue mobile phones: Glioma: OR 2.1 (95% CI 1.3-3.4) Digital mobile phones: Glioma: OR 1.0 (95% CI 0.5-2.0)
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Risk for Meningioma due to short /long (< / >= 10 years) use of mobile phones 100,0
_ short latency _ long latency
Relative Risk (95% CI)
10,0
1,0
0,1
Hardell 2002 digital
Inskip 2001
0,0
Hardell 2002 analog
Hardell 2005 digital Hardell 2005 analog
Klaeboe 2006 analog
Lönn 2005 Christense n 2004
Schüz 2006
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Klaeboe 2006 digital
Erice, March/April 2008
Risk for ACN due to short /long (< / >= 10 years) use of mobile phones 100,0
_ _
longer latency
CI)
10,0
Relative Risk (95%
short latency
1,0
0,1
Inskip
Hardell
Hardell
Klaeboe
2001 short/long
2002 analog short/long
2005 analog short/long
2006 analog short/long
Lönn 2004
Schoem aker
Schlehofer 2007
2005 short/long
short/long
short
Cohort M uscat 2002 short
Hardell
Hardell
2002 digital short/long
2005 digital short/long
Klaeboe 2006 digital
Christense n
short/long
2004 h t/l
Takebayashi 2006 short/long
0,0
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Risk for Glioma by ipsi- and contra-lateral use of mobile phones 100,0
_ ipsilateral _ contralateral
Relative Risk (95% CI)
10,0
1,0
0,1
Hepworth 2005
Klaeboe 2006
Lahkola 2007
Lönn 2005
Hours 2007
0,0
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
Brain tumours / The Brain Oh, my goodness!
My brain is gone!
I am hungry!
Electromagnetic Fields and Epidemiology / Descriptive Epidemiology of Brain tumour / B. Schlehofer, DKFZ Heidelberg, Germany
Erice, March/April 2008
