© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 7, 648,
April 7, 1999
© 1999 Oxford University Press
CORRESPONDENCE |
Re: Trends in Reported Incidence of Primary Malignant Brain Tumors in Children in the United States
Correspondence to: Arthur D. Forman, M.D., The University of Texas M. D. Anderson Cancer Center, Clinical Neurobiology and Oncology, 1515 Holcombe Blvd., Box 306, Houston, TX 77030.
I read with some concern the editorial by Black (1) for the article written by Smith et al. (2) reporting on the trends in reported incidence of primary malignant brain tumors in children in the United States. In their article, Smith et al. (2) offer fairly complex statistical arguments that purport to show no increase in the incidence of primary brain tumors in children. The authors (1,2) argue that the increased incidence relates to improved diagnostic techniques. I believe that they overlooked two critical points. Malignant brain tumors of childhood are not silent diseases. If indeed there was an increased sensitivity to diagnosis made in 1984, certainly in the subsequent 10-year interval, those cases that may have been missed would have become clinically evident. This point was not made by either the editorial or the article. Secondly, there is a diminishing, albeit very slight, mortality, and this may be attributable to the considerable improvements that have been made in neurosurgical techniques during this period. The fact that the mortality has not diminished further argues for an increasing incidence.
The Journal highlighted the article by Smith et al. by having an editorial written that states that we would be better off not seeking reasons for this increasing incidence and rather that we should place our efforts elsewhere. This emphasis is all the more troubling to me, since this article appeared in the popular media, in both newspapers and television.
REFERENCES
1
Black WC. Increasing incidence of childhood primary malignant
brain tumors—enigma or no-brainer? [editorial]. J Natl Cancer Inst 1998;90:1249-51.
2
Smith MA, Freidlin B, Ries LA, Simon R. Trends in reported
incidence of primary malignant brain tumors in children in the United States. J Natl
Cancer Inst 1998;90:1269-77.
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