Cancer Causes & Control

, Volume 9, Issue 1, pp 109–116 | Cite as

Incidence of intracranial tumors following hospitalization for head injuries (Denmark)

  • Peter D. Inskip
  • Lene Mellemkjaer
  • Gloria Gridley
  • Jørgen H. Olsen


The incidence of brain and other intracranial tumors following head trauma was evaluated in a cohort of 228,055 Danish residents hospitalized because of concussion, fractured skull, or other head injury between 1977 and 1992 and followed for an average of eight years (maximum, 17 years). Traffic accidents, falls, and sports-related incidents were the usual causes of the injury. Malignant and benign neoplasms were identified by linking the study roster with records of the Danish Cancer Registry for the years 1977 to 1993. This approachprecludes differential reporting of injuries by study participants as an explanation for any associations seen. Intracranial tumors of the nervous system occurred more often than expected based on incidence rates for the Danish population; however, most of the excess occurred during the first year after the injury and likely was due to the detection of tumors that were present before the injury occurred. Excluding the first year of follow-up, the standardized incidence ratio (SIR) was 1.15 (95 percent confidence interval [CI] = 0.99-1.32). The same general temporal pattern was seen for the major subtypes of brain tumor as for all types combined. SIRs after the first year were 1.0 for glioma (CI = 0.8-1.2), 1.2 for meningioma (CI = 0.8-1.7), and 0.8 for neurilemmoma (CI = 0.4-1.7). However, hemangioblastoma and hemangioma were more frequent than expected, based on 15 cases (SIR = 2.6, CI = 1.4-4.2). Results indicate that head trauma causes, at most, a small increase in the overall risk of brain tumors during the ensuing 15 years; however, a possible association with intracranial vascular tumors warrants further evaluation.

Brain neoplasms Denmark glioma head trauma hemangioblastoma meningioma 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Parker HL, Kernohan JW. The relation of injury and glioma of the brain. JAMA1931; 97: 535–540.Google Scholar
  2. 2.
    Cushing H, Eisenhardt L. Meningiomas: Their Classification, Regional Behavior, Life History, and Surgical End Results. New York, NY (USA): Hafner Publishing, 1962.Google Scholar
  3. 3.
    Inskip PD, Linet MS, Heineman EF. Etiology of brain tumors in adults. Epidemiol Rev1995; 17: 382–414.Google Scholar
  4. 4.
    Preston-Martin S, Paganini-Hill A, Henderson BE, Pike MC, Wood C. Case-control study of intracranial meningiomas in women in Los Angeles County, California. J Natl Cancer Inst1980; 65: 67–73.Google Scholar
  5. 5.
    Preston-Martin S, Yu MC, Henderson BE, Roberts C. Risk factors for meningiomas in men in Los Angeles County. J Natl Cancer Inst1983; 70: 863–6.Google Scholar
  6. 6.
    Preston-Martin S, Mack W, Henderson BE. Risk factors for gliomas and meningiomas in males in Los Angeles County. Cancer Res1989; 49: 6137–43.Google Scholar
  7. 7.
    Hochberg F, Toniolo P, Cole P. Head trauma and seizures as risk factors of glioma. Neurology1984; 34: 1511–4.Google Scholar
  8. 8.
    Burch JD, Craib KJP, Choi BCK, Miller AB, Risch HA, Howe GR. An exploratory case-control study of brain tumors in adults. J Natl Cancer Inst1987; 78: 601–9.Google Scholar
  9. 9.
    Howe GR, Burch JD, Chiarelli AM, Risch HA, Choi BC. An exploratory case-control study of brain tumors in children. Cancer Res1989; 49: 4349–52.Google Scholar
  10. 10.
    Bunin GR, Buckley JD, Boesel CP, Rorke LB, Meadows AT. Risk factors for astrocytic glioma and primitive neuroectodermal tumor of the brain in young children: a report from the Children's Cancer Group. Cancer Epidemiol Biomarkers Prev1994; 3: 197–204.Google Scholar
  11. 11.
    Gurney JG, Preston-Martin S, McDaniel AM, Mueller BA, Holly EA. Head injury as a risk factor for brain tumors in children: results from a multicenter case-control study. Epidemiology1996; 7: 485–9.Google Scholar
  12. 12.
    Morantz RA, Shain W. Trauma and brain tumors: an experimental study. Neurosurgery1978; 3: 181–6.Google Scholar
  13. 13.
    Ludwin SK. Proliferation of mature oligodendrocytes after trauma to the central nervous system. Nature1984; 308: 274–5.Google Scholar
  14. 14.
    Halliwell B, Gutteridge JMC. Oxygen radicals and the nervous system. Trends Neurosci1985; 8: 22–6.Google Scholar
  15. 15.
    Preston-Martin S, Thomas DC, Wright WE, Henderson BE. Noise trauma in the aetiology of acoustic neuromas in men in Los Angeles County, 1978-1985. Br J Cancer1989; 59: 783–6.Google Scholar
  16. 16.
    Preston-Martin S., Pike MC, Ross RK, Jones PA, Henderson BE. Increased cell division as a cause of human cancer. Cancer Res1990; 50: 7415–21.Google Scholar
  17. 17.
    Annegers JF, Lewis ER, Kurland LT, Grabow JD. Head trauma and subsequent brain tumors. Neurosurgery1979; 4: 203–6.Google Scholar
  18. 18.
    Carpenter AV, Flanders WD, Frome EL, Cole P, Fry SA. Brain cancer and nonoccupational risk factors: a case-control study among workers at two nuclear facilities. Am J Public Health1987; 77: 1180–2.Google Scholar
  19. 19.
    Danish National Board of Health. The Activity in the Hospital Care System[in Danish]. Copenhagen, Denmark: Danish National Board of Health, 1981.Google Scholar
  20. 20.
    Danish National Board of Health. Classification of Diseases[in Danish]. Copenhagen, Denmark: Danish National Board of Health, 1976.Google Scholar
  21. 21.
    Nordic Medical Statistical Committee. Nordic Classification for Registration of Accidents[in Danish]. Copenhagen, Denmark: NOMESKO Pub. No. 20, 1985.Google Scholar
  22. 22.
    Storm HH, Manders T, Friis S, Band S. Cancer Incidence in Denmark 1989. Copenhagen, Denmark: Danish Cancer Society, 1992.Google Scholar
  23. 23.
    World Health Organization. International Classification of Diseases for Oncology (ICD-O).Geneva, Switzerland: WHO, 1976.Google Scholar
  24. 24.
    Breslow NE, Day NE. Statistical Methods in Cancer Research. Volume II. The Design and Analysis of Cohort Studies. Lyon, France: International Agency for Research on Cancer, 1987.Google Scholar
  25. 25.
    Kleihues P, Burger PC, Scheithauer BW. Histological Typing of Tumors of the Central Nervous System. New York, NY (USA): Springer-Verlag, 1993.Google Scholar
  26. 26.
    Olsen JH, Boice JD Jr, Jensen JPA, et al. Cancer among epileptic patients exposed to anticonvulsant drugs. J Natl Cancer Inst1989; 81: 803–8.Google Scholar
  27. 27.
    Kepes JJ, Whittaker CK, Watson K, et al. Cerebellar astrocytomas in elderly patients with very long preoperative histories: report of three cases. Neurosurgery1989; 25: 258–64.Google Scholar
  28. 28.
    Radhakrishnan K, Mokri B, Parisi JF, O'Fallon WM, Sunku J, Kurland LT. The trends in incidence of primary brain tumors in the population of Rochester, Minnesota. Ann Neurol1995; 37: 67–73.Google Scholar
  29. 29.
    Danmarks Statistik. Befolkningens Bevægelser 1985. København, Denmark: Danmarks Statistik, 1987.Google Scholar
  30. 30.
    Choi NW, Schuman LM, Gullen WH. Epidemiology of primary central nervous system neoplasms. II. Case-control study. Am J Epidemiol1970; 91: 467–85.Google Scholar
  31. 31.
    Schlehofer B, Blettner M, Becker N, Martinsohn C, Wahrendorf J. Medical risk factors and the development of brain tumors. Cancer1992; 69: 2541–7.Google Scholar
  32. 32.
    Maher ER, Yates JRW, Harries R, et al. Clinical features and natural history of von Hippel-Lindau disease. Quart J Med1990; 283: 1151–63.Google Scholar
  33. 33.
    Latif F, Tory K, Gnarra J, et al. Identification of the von Hippel-Lindau disease tumor suppressor gene. Science1993; 260: 1317–20.Google Scholar
  34. 34.
    Sargent P, Greenfield JG. Haemangiomatous cysts of the cerebellum. Br J Surg1929; 17: 84–101.Google Scholar
  35. 35.
    Perlmutter I, Horrax G, Poppen JL. Cystic hemangioblastomas of the cerebellum. End results in 25 verified cases. Surg Gyn Obstet1950; 91: 89–99.Google Scholar
  36. 36.
    Kley N, Whaley J, Seizinger BR. Neurofibromatosis type 2 and von Hippel-Lindau disease: from gene cloning to function. GLIA1995; 15: 297–307.Google Scholar
  37. 37.
    Resche F, Moisan JP, Mantoura J, et al. Haemangioblastoma, haemangioblastomatosis, and von Hippel-Lindau disease. Adv Tech Stand Neurosurg1993; 20: 197–304.Google Scholar

Copyright information

© Chapman and Hall 1998

Authors and Affiliations

  • Peter D. Inskip
    • 1
  • Lene Mellemkjaer
    • 2
  • Gloria Gridley
    • 3
  • Jørgen H. Olsen
    • 2
  1. 1.Department of Veterinary Anatomy and Public HealthCollege of Veterinary MedicineUSA
  2. 2.Division for Cancer EpidemiologyDanish Cancer SocietyCopenhagenDenmark
  3. 3.Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of HealthBethesdaUSA

Personalised recommendations