|Year : 2022 | Volume
| Issue : 2 | Page : 108-113
Epidemiological study of brain cancer in Iran: A systematic review
Fatemeh Hadavand-Siri1, Soheil Hassanipour2, Hamid Salehiniya3
1 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
3 Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
|Date of Submission||23-Nov-2020|
|Date of Decision||23-Sep-2021|
|Date of Acceptance||23-Dec-2021|
|Date of Web Publication||13-May-2022|
Shahid Beheshti University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Introduction: In recent decades, the incidence and mortality rate of brain tumours, especially in adults, has increased. In order to better plan to reduce the burden of this cancer, knowledge of the epidemiological aspects of this disease is essential. Therefore, due to the lack of a comprehensive study on brain cancer in Iran, this study aimed to investigate the epidemiological aspects of this cancer in Iran. Methods: In June 2020, keywords of 'brain tumour', 'nervous system tumours', 'nervous system neoplasm', 'nervous system cancer', 'central nervous system (CNS)' and 'Iran' were searched on Medline/PubMed and Web of Science databases Scopus, Embase, SID, IranMedex, and Google Scholar. The search results were entered Endnotes Version 8; finally, 35 full papers were reviewed and included in the study. Results: The incidence of brain cancer and CNS tumour is lower in children in central Iran. The incidence of CNS cancer was relatively high among children in Golestan province. Furthermore, the standardised incidence of primary CNS tumours in Iran is 5.69 per 100,000, which is lower than in other countries. Nervous system malignancies were more common in men than in women (age-standardized rate 3 versus 2.2 per 100,000 in men and women, respectively). Tehran had the highest incidence of CNS tumours. Meningiomas were the only most common tumour in women. Gliomas were the most common primary brain tumour, and most of the lesions in this subgroup were in low-grade astrocytoma and ependymomas. Brain cancer mortality was higher in men than in women. Age is a potential risk factor, and the incidence of CNS tumours increases with increasing age after 30 years. Conclusion: Nervous system cancers are on the rise in Iran due to lifestyle changes and increased risk factors. Planning to reduce risk factors and early detection of the disease can be helpful in reducing cases and reducing mortality.
Keywords: Brain cancer, epidemiology, incidence, Iran, risk factor
|How to cite this article:|
Hadavand-Siri F, Hassanipour S, Salehiniya H. Epidemiological study of brain cancer in Iran: A systematic review. Adv Hum Biol 2022;12:108-13
| Introduction|| |
Central nervous system (CNS) neoplasms comprise a group of different tumours that are anatomically close but have different clinical behaviour. International Classification of Diseases defines meninges, pituitary gland and nerve tumours as CNS tumours. CNS tumours are rare but cause more deaths than other cancers.
In recent decades, the incidence and mortality rate of brain tumours, especially in adults, has increased. CNS tumours are the leading cause of infant mortality and the second most common childhood cancer after leukaemia.,,,,,,,, CNS tumours are the largest solid neoplasm group in children.,,,,, In addition, it accounts for 20%–25% of all childhood cancers. The incidence of primary CNS tumours in men and women worldwide is 3.9 and 3.2 per person per year, respectively. The overall incidence of primary malignant tumour is 2.74 per 100,000 person, and children under 5 have the highest age-specific incidence (1.86 per 100,000). The annual number of new childhood cancer cases is over 200,000, more than 80% of which occur in developing countries. In 2012, approximately 255,000 new CNS tumours occurred, 30% of them were new cancers worldwide. Although the incidence of this cancer is low, the mortality is high,, and 2.6% of cancer mortality accounted for 2015.,, Overall, little is known about the risk factors for brain cancer, and the aetiology of this cancer remains ambiguous, given the extensive research that epidemiologists have done over the years. There are conflicting results as to the cause of most childhood cancers., However, this cancer is more common in boy than in girls. The incidence of ethnic and religious illnesses may be due to the genetic background of the disease.
In order to better plan to reduce the incidence and survival of patients, knowledge of the epidemiological aspects of this disease is essential. Therefore, due to the lack of a comprehensive study on brain cancer in Iran, this study aimed to investigate the epidemiological aspects of this cancer in Iran.
| Methods|| |
This study is a systematic review, which was performed on the CNS cancer in Iran in June of 2019. The researchers examined seven databases of Medline/PubMed, Web of Science, Scopus, Embase, SID, Iran Medex and Google Scholar to assess the incidence, prevalence, mortality, survival and risk factors of brain tumours in Iran. Selected keywords for databases include 'brain tumour', 'nervous system tumours', 'nervous system neoplasm', 'nervous system cancer', 'CNS' and 'Iran'. The collected data entered the EndNote X8 software, and duplicate articles were automatically deleted.
| Results|| |
At first, after searching in electronic databases, 253 articles were obtained and 5 articles were found manually. The articles such as a letter to the editor and case report were excluded. Moreover, articles published in a language other than English or Persian were excluded. We removed 161 duplicated and irrelevant articles by screening the titles. Then, the title and abstract of the remaining 97 were examined. In the next stage, forty articles were retrieved for further review by abstract and full text, 5 of these articles were omitted due to the lack of research objectives, and finally, 35 full articles were reviewed.
[Table 1] shows the incidence of brain cancer in the previous articles and this stud too. According to the study by Khazaei et al., the incidence of brain cancer and the CNS is low in children of central provinces. The incidence of this cancer in the central regions of Iran is also lower than in the northwest and east. In Beigi et al. study, the average annual ASR for children was 1.43 per 100,000 person and children under 5 had the highest age-specific incidence (1.86 per 100,000), and overall incidence was significantly lower than in Western countries. The incidence of CNS cancer was relatively high among children in Golestan province.
Also, In the study of Hassanipour et al., the highest reported standardized incidence age was in East Azerbaijan between 2006 and 2007 (9.39 for males and 8.06 for females), with the lowest reported in Kurdistan in 2003.(it was 0.5 for men and 0.8 for women per 100,000 person). The standardized incidence of primary CNS tumour in Iran is 5.69 per 100,000. In fact, ASR is lower in Iran for brain tumours than in other countries (4.16 and 3.4 per 100,000 men and women, respectively).
Mohaghegh et al. reported a standardized incidence of CNS tumours for men and women of 6 and 4.5, respectively. The overall incidence of primary malignant tumours in the Jazayeri et al. study was 2.74 per 100,000 person per year. Primary malignant tumours of the spine account for 7.1% of primary malignant tumors of the CNS at 0.21 per 100,000. In the study by Mousavi et al. CNS tumours were more prevalent among boys in Tehran and girls in Ardabil than in other cities.
In the study of Masoompour et al. nervous system malignancies were more common in men than in women (ASR was 3 vs. 2.2 per 100,000 people in men and women, respectively). This malignancy has been associated with an increase and is partly due to the improvement of diagnostic imaging techniques. In the study by Mousavi et al., the age-standardised incidence rates for brain and CNS tumours in men and women in 2003–2004 were 1.88 and 1.26, and in men and women were 2.37 and 1.64 in 2005–2004, respectively and in 2005–2006, it was 2.51 and 1.71, respectively. The relative risk for meningioma in Jewish population in Shiraz was 9.1 and risk of intracranial meningioma among Jewish in this geographic area is increasing. Tehran had the highest incidence of CNS tumours. CNS tumours were more prevalent among boys in Tehran and in girls in Ardabil than in other cities.
Patients with Grade 3 tumours had a lower relative risk (P < 0.05), and patients in the age group (P < 0.001) between 18 and 30 years and men and workers had a higher relative mortality risk (P < 0.05). Nervous system cancers in Iran are expected to increase due to geographical and economic conditions as well as lifestyle changes, and increased risk factors are the leading cause of increased brain cancer incidence in Iran. As the incidence of CNS cancer elevated in 2007–2010 compared to 1998–2002.
The CNS tumour is the second most common cancer in Golestan. In Aghakhani et al. study, the prevalence of pituitary hidden mass in Iranian corpses was 12.6%. In the Beigi et al. study, 93.3% of cancers were brain tumour, 5.1% were spine and cauda equine malignancy and 1.6% of cases were nerves, skulls and other parts of the nervous system cancers. In the study by Mehrazin et al. the prevalence of Primary Intracranial Tumours was higher in males than in females (55.4% and 44.6%, respectively). In this study, meningioma (26%), astrocytoma (23.4%), pituitary adenoma (14.2%), glioblastoma (5.1%) and ependymoma (4.8%) were the five most common cancers in the two sexes, 84% of all cases had tumours. Astrocytoma group, crania pharyngiomas, ependymomas, glioblastomas, medulloblastomas and pituitary adenoma were more common in men and meningiomas were the only tumours that are more common in women (P < 0.05). Approximately 28% of cases occurred in patients younger than 20 years, 45% of cases occurred in 21–45 years, 25% in 46–65 years and 2% in age group over 65 years.
In the study by Alimohamadi et al., primary brain tumours were the most common tumour of gliomas (45%), and unlike in western countries, the most common CNS tumours in women were not found in Iran. Amongst the types of glial tumour subtypes, most lesions are of low grade of astrocytoma and ependymomas. In the study by Jafarzadeh et al. the frequency of CNS tumours increases with an age of more than 30 years. Frequency for spinal cord tumours reaches its highest level at age 51–60, and age distribution curve shows that cancer declines in the age of 70 and over. The incidence of meningioma in women is almost twice than that of men. Some tumours were associated with an increase in all age groups. Overall, the total number of patients over the age of 50–60 years was associated with an increase in Glioblastoma, meningioma, pituitary adenoma, fibrillary astrocytoma, schwannoma. The results of this study showed that medulloblastoma is most prevalent among children. Astrocytes tumours were also higher in males than females but not significant. In the study of Taghipour et al. the prevalence of meningioma in the Jewish population of Shiraz is 259 per 100,000 population. The most common type of tumour in the study of Jazayeri et al. was meningioma, astrocytoma, Glioblastoma and ependymomas, which was more common in men than in women (M/F = 1.48). The ratio of male to female (58.1% to 41.9%) was significantly different (P < 0.05). Most types of brain tumours occurred in children aged 5–15 years (85%). Astrocytoma occurred more frequently in children aged 5–15 years, and males were more affected than females. Craniopharyngioma and medulloblastoma were more common in men. Astrocytoma was the first common tumour in all age groups.
In another study, the most common tumour was gliomas, which included astrocytoma, oligodendroglioma and ependymomas, the most common being astrocytoma. However, many studies have reported astrocytoma as a common childhood tumour, but pathophysiologically, medulloblastoma was the most common type of tumour, with astrocytoma accounting for 83% of all tumours in patients and was more common in children aged from 5 to 9 years; in addition, it is more prevalent in boys than in girls. The neuroepithelial tumour accounts for 10% of spinal cord tumours, which is relatively lower than in Western countries. Nerve sheet cell tumours accounted for 24.5% of spinal canal tumours, and vascular and malignant tumours accounted for 3.8% of primary spinal canal tumours. Congenital tumours account for 1% of spinal canal tumours. Benign osteogenic and chondrogenic spinal tumours are uncommon cause of spinal cord compression. These tumours are 1.67% of spinal canal tumours. A total of 6.6% of vertebral tumours were chordoma and 1% of all spinal canal neoplasms. One patient had 3.3% vertebral hemangioma including spine tumours.
In the study by Moein et al., nerve sheet tumours (NSTs) (33%), ependymoma (22%), meningioma (15%) and astrocytoma (16%) were the most frequent types of tumours. NSTs and ependymoma were both more common in young adults. Indeed, 19% of the tumours were malignant. Ependymoma was more common in children, and astrocytoma was second-one. Intradural intramedullary tumours were more prevalent among children (62%), whereas intradural extramedullary was more common in older people (64%). Malignant tumours were more in extradural than intradural (P < 0.005). In the latter tumour, most malignancies were observed in astrocytoma (P < 0.025).
In the study by Mousavi et al. brain cancer mortality was higher in men than in women (1004 vs. 819), and overall brain cancer mortality rates were 2.7 per 100,000.(2.9 in men and 2.5 in women).
In Sajjadi et al. study, 4% of cancer's mortality in both sexes in the country is due to malignant brain tumours. The standardised mortality rate for brain tumours in Iran is 2.92 per 100 for men and 2.46 per 100 for women., Estimates of Cancer Mortality in the Country for 2005–2004 show that the death rate from brain and meningeal and other CNS cancers is 2.9 in men and 2.5 in 100,000 women. However, the mortality rate of invasive types of brain tumours is high due to a lack of medical facilities. However, in developing countries such as Iran, limited access to resources as a barrier to using advanced and effective methods leads to higher mortality.
In the study by bahoush-mehdiabadi et al. survival rates of major types of brain cancer in children were similar to those in developed countries. The 5-year survival rate was 100% in studied children.
In the study by Zareifar et al. 5-year survival of children was 59%, disease-free survival of 51.7% and 10-year survival of 47%.
In the study of Binesh et al., the median survival of children with cancer was 36 months.
In the study by Arjmandi Rafsanjani et al., 2-year and 5-year survival of children with brain cancer was 74% and 68.5% in children, and event-free survival was 35%. Medulloblastoma had a better prognosis among children with cancer. Overall survival of brain tumours in children has improved dramatically. Survival in pediatric patients in Tashvighi et al. study included overall survival (61% 3-year survival and 47.4% 5-year survival) and progression-free survival (59.5% 3-year survival). The survival rate of patients with malignant tumour in the Zahir et al. study decreased over time (0.807 in the 1st year and 0.358 in the 5th year), which is related to the grade of the tumour. In the study of Akhavan et al., age, sex, primary site and number of brain lesions were not significantly correlated with overall survival. In the study by Dammari et al., there was a significant relationship between the number of family members, education, employment status and age with survival time.(P < 0.001). According to the results of Binesh et al. study, there was no significant relationship between mean survival, age, sex, geographical location and type of treatment, but there was a significant relationship between time of tumour diagnosis and survival. The survival of brain and spinal cord tumours in children and adolescents appears to be multifactorial and is influenced by various factors. Regional and geographic differences influence treatment response, diagnosis, and survival.
Given the higher incidence of this cancer in boys than girls, gender should be considered a risk factor for the disease. Differences in geographical areas can be due to genetic and environmental factors such as nutrition and behavioural and cultural patterns and differences in access to service centres. Possible Causes of Brain Tumour in Iran According to the results of the study by Hassanipour et al. It may be due to socioeconomic status of individuals, existing risk factors and lack of advanced diagnostic methods for brain tumour. Age is a potential risk factor and as the age of 30 increases, the incidence of CNS tumours increases. Gender is also a risk factor, which is twice as high for meningioma in women.
Mehrazin study results showed no significant differences between intracranial tumours and 4 blood groups. But the number of patients with craniopharyngioma was significantly higher than group A (P < 0.05). In the study by jazayeri et al., the incidence of tumours was higher in men than in women. In the zahir study, the frequency of almost all types of tumours was higher in men (P < 0.025).
People who ate fruits and vegetables were less likely to develop gliomas (odds ratio [OR] = 0.28), and a protective relationship was observed between beans and nuts and the risk of gliomas (OR = 0.23), but a significant positive relationship was found between salt intake (OR = 2.87) and meat (OR = 2.6) with gliomas. In the study of Mehrazin and Yavari On children, boys were also more affected than girls.
In a study by Shayanfar et al., the results indicate that a healthy diet includes a high intake of vitamin E, C, calcium and fibre and dietary groups including fruits and vegetables and low-fat milk, nuts and low-fat whole foods, saturated fatty acid and Red meat can have a protective effect against gliomas. In the study by Beigi et al. Men were more likely to develop CNS tumours than women (1.65 vs. 1.21 per 100 people).
In the study of Binesh et al., rain and spinal cord tumours were also more common in males. In the Rafsanjani study, boys were more likely to have the disease than girls. In the study by Moein et al. the ratio of women to men was only significant in ependymoma (P < 0.05). Taghipour et al. study of the high prevalence of certain genetic diseases among Jewish and their family marriage and the genetic basis of meningioma indicate the influence of genetic factors on the increased risk of meningioma amongst Jewish. In the Aghakhani et al. study, there was no relationship between age, sex, BMI and prevalence of hidden pituitary gland tumours (P = 0.380 P = 0.450, and P = 0.884, respectively).
| Conclusion|| |
Men are more likely than women to be affected by and die from central nervous system cancer. Although the incidence of brain tumors and central nervous system in Iran is lower than other countries, but the incidence has increased and this could be due to the improvement of imaging and increased awareness of people. Meningioma was more common in women, medulloblastoma in children, and astrocytes tumors more common in men. Due to the increase in cancer of the brain and central nervous system with age, training programs can reduce the incidence and death of this cancer in high-risk groups.
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Conflicts of interest
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