Determine whether the risk of astrocytomas in Appalachian children is higher than the national average. We compared the incidence of pediatric brain tumors in Appalachia versus non-Appalachia regions, covering years 2000–2011. The North American Association of Central Cancer Registries (NAACCR) collects population-based data from 55 cancer registries throughout U.S. and Canada. All invasive primary (i.e. non-metastatic tumors), with age at diagnosis 0–19 years old, were included. Nearly 27,000 and 2200 central nervous system (CNS) tumors from non-Appalachia and Appalachia, respectively comprise the cohorts. Age-adjusted incidence rates of each main brain tumor subtype were compared. The incidence rate of pediatric CNS tumors was 8% higher in Appalachia, 3.31 [95% CI 3.17–3.45] versus non–Appalachia, 3.06, [95% CI 3.02–3.09] for the years 2001–2011, all rates are per 100,000 population. Astrocytomas accounted for the majority of this difference, with the rate being 16% higher in Appalachian children, 1.77, [95% CI 1.67–1.87] versus non-Appalachian children, 1.52, [95% CI 1.50–1.55]. Among astrocytomas, World Health Organization (WHO) grade I astrocytomas were 41% higher in Appalachia, 0.63 [95% CI 0.56–0.70] versus non-Appalachia 0.44 [95% CI 0.43–0.46] for the years 2004–2011. This is the first study to demonstrate that Appalachian children are at greater risk of CNS neoplasms, and that much of this difference is in WHO grade I astrocytomas, 41% more common. The cause of this increased incidence is unknown and we discuss the importance of this in relation to genetic and environmental findings in Appalachia.

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Published in Journal of Neuro-Oncology, v. 132, issue 3, p. 507-512.

© Springer Science+Business Media New York 2017

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This is a post-peer-review, pre-copyedit version of an article published in Journal of Neuro-Oncology. The final authenticated version is available online at: https://doi.org/10.1007/s11060-017-2403-2.

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Funding Information

CH was supported by the National Cancer Institute (K08CA155764). The University of Kentucky Biospecimen and Tissue Procurement Shared Resource Facility, Cancer Research Informatics Shared Resource Facility, and Biostatistics and Bioinformatics Shared Resource Facility are supported by the Markey Cancer Center (P30CA177558). The project was also supported by the National Center for Advancing Translational Sciences, through Grant UL1TR000117 and the Centers for Disease Control and Prevention Grant U58DP005400, Enhancing Cancer Registries for Early Case Capture of Pediatric and Young Adult Cases.