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Philips A, et al; Rise in GBM incidence, England 1995–2015; Supplementary File. 19-05-2018 Page 1 of 8
Rise in Glioblastoma Multiforme incidence in England 1995–2015
suggests an adverse environmental or lifestyle factor
Alasdair Philips, Denis L Henshaw, Graham Lamburn, Michael J O’Carroll
Supplementary Information
CONTENTS
S1. Table of data morphology coding and the case numbers used in the study
S2. GBM case numbers and age-specific incidence rate data used in the study
S3. Sample STATA data and DO script
S4. Data-table for Figure 1
S5. Data-table for Figure 5
S6. CT and MRI use in the UK NHS
S7. Some notes on atomic bomb testing and other nuclear fallout in England
Data Sharing
The cancer incidence data used the main paper and in this Supplement were obtained from the UK Office for
National Statistics (ONS) who are the legal owners of the data. Some data are publicly available in the ONS
annual MB1 data series which are freely downloadable from the ONS website, but the main paper uses
updated data, plus ICD–O–3 morphology codes, extracted under personal researcher contract from the ONS
database in September 2017. ONS Data Guardian approval was required for the supply, control and use of
the data. A nominal charge is made by the ONS for such data extraction. We are not permitted to supply the
raw ONS extracted data to anyone else. Other bone–fide researchers can obtain the latest data directly from
the ONS in a similar manner.
Philips A, et al; Rise in GBM incidence, England 1995–2015; Supplementary File. Page 2 of 9
S1/. All ICD10-O-codes in the data-set with descriptions and total case numbers
There are 103 ICD-O-3 codes used in the full dataset. Some detailed descriptions and categories may be
debated slightly by clinicians, but this would make little difference to the overall results of our analyses.
Morphology
group
sub
subsub
Grade
cases
1995-2015
Description
unspecified:
a
Only 1 to 5 cases over the period 1995-29015 inclusive
80001
1
a
neoplasm uncertain if malignant
80003
2
7776
unclassified, malignant, NOS
80006
2
18
neoplasm, metastaic (secondary)
80009
2
19
neoplasm, malignant, uncertain whether metastatic
80013
2
250
carcinoma, metastatic, NOS
80023
2
a
malignant tumour, small cell type
80033
2
a
malignant tumour, giant cell type
80043
2
a
malignant tumour, spindle cell or fusiform cell type
other:
80103
2
536
epithelial tumour, carcinoma, malignant
80106
2
281
carcinoma, metastatic, NOS
80109
2
28
carcinomatosis
80426
2
a
oat cell carcinoma
80463
2
a
carcinoma
80706
2
a
squamous cell carcinoma
81403
2
a
adenocarcinoma NOS
81406
3
26
adenocarcinoma,, metastatic, NOS
82463
2
15
neuroendocrine carcinoma
82466
2
a
? carcinoma
82469
2
a
? carcinoma
82606
2
a
papillary adenocarcinoma
83106
2
a
clear cell adenocarcinoma
84013
2
a
apocrine adenocarcinoma
84816
2
a
mucin producing adenocarcinma
85103
2
a
medullary carinoma NOS
87203
2
9
malignant melanoma NOS
87206
2
a
malignant melanoma
88003
2
24
sarcoma NOS
88013
2
8
spindle cell sarcoma
88023
2
a
giant cell sarcoma
88033
2
a
small cell or round cell sarcoma
88103
2
a
fibrosarcoma
88113
2
a
fibromyxosarcoma
88303
2
a
fibrous malignant histiocytoma
88503
2
a
liposarcoma NOS
88613
2
a
angliolipoma
88903
2
a
leiomyosarcoma
89003
2
a
rhabdomyosarcoma
89103
2
a
embryonal rhabdomyosarcoma
89203
2
a
alveolar rhabdomyosarcoma
89633
2
131
rhabdoid sarcoma
90603
2
a
dysgerminoma
90643
2
106
germ cell neoplasia
90801
1
a
teratoma NOS
90803
2
7
teratoma, malignant, NOS
90853
2
a
mixed germ cell tumour
91003
2
a
choriocarcinoma
91203
2
a
hermangiosarcoma
91313
2
a
capillary herangioma
91333
2
a
epithelioid hermangioendothelioma
91503
2
56
hermangiopericytoma
91613
2
43
hermangioblastoma / angioblastoma
91703
2
a
lymphangiosarcoma
92203
2
a
92313
2
a
myxoid chondrosarcoma
92403
2
a
mesenchymal chondrosarcoma
93643
2
42
peripheral neuroectodermal tumour
93703
2
50
chordoma
95303
3
58
anaplastic meningioma
95313
3
a
meningiotheliomatous meningioma
95603
3
a
neurilemoma, malignant
95613
3
a
triton tumour, malignant / malignant schwannoma
Philips A, et al; Rise in GBM incidence, England 1995–2015; Supplementary File. Page 3 of 9
X
Morphology
group
sub
subsub
Grade
cases
1995-2015
Description
neuroepithelial:
938 to 948 incl. are WHO classed as gliomas
a
Only 1 to 5 cases over the period 1995-2015 inclusive
93803
GLIO
GL2
2
11269
glioma, malignant, NOS, not neoplastic
93813
GLIO
AST
AST3
3
187
gliomatosis cerebri
93823
GLIO
AST
OGL2
2
1298
mixed glioma / oglioastrocytoma
93833
GLIO
AST
EPN
1
8
subependymal glioma / astrocytoma
93843
GLIO
AST
EPN
1
a
subependymal giant cell astrocytoma
93903
GLIO
EPN
3
77
choroid plexus carcinoma
93913
GLIO
EPN
2
1034
ependymoma
93923
GLIO
EPN
3
313
anaplastic ependymoma
93933
GLIO
EPN
3
a
papillary ependymoma
93943
GLIO
EPN
1
a
myxopapillary ependymoma
94003
GLIO
AST
AST2
2
7807
astrocytoma, NOS, diffuse
94013
GLIO
AST
AST3
3
2832
anaplastic astrocytoma (high grade)
94103
GLIO
AST
AST3
3
29
anaplastic astrocytoma
94113
GLIO
AST
AST2
2
331
gemistocytic astrocytoma, diffuse
94203
GLIO
AST
AST2
2
420
fibrillary astrocytoma, diffuse
94213
GLIO
AST
AST1
1
2125
pilocytic astrocytoma
94243
GLIO
AST
AST2
2
106
pleomorphic xantoastrocytoma
94303
GLIO
AST
AST1
1
33
astroblastoma
94403
GLIO
AST
GBM
4
37046
glioblastoma multiforme
94406
GLIO
AST
GBM
4
a
glioblastoma G4 NOS
94413
GLIO
AST
GBM
4
263
giant cell glioblastoma
94423
GLIO
AST
GBM
4
477
gliosarcoma
94433
GLIO
AST
4
a
polar spongioblastoma
94503
GLIO
OGD2
2
2671
oligodendroglioma
94513
GLIO
OGD3
3
1339
anaplastic oligodendroglioma
94603
GLIO
2
54
oligodendroblastoma
94703
Glio?
EMB
4
1178
medulloblastoma
94713
Glio?
EMB
4
106
desmoplastic medulloblastoma
94723
Glio?
EMB
4
16
medullomyoblastoma
94733
Glio?
EMB
4
472
primitive neuroectodermal tumour
94803
GLIO
obsolete
2
a
cerebellar sarcoma
94813
GLIO
obsolete
2
a
monstrocellular sarcoma
94903
EMB
2
a
ganglioneuroblastoma
95003
EMB
4
10
neuroblastoma NOS
95013
EMB
3
a
medulloepithelioma NOS
95033
EMB
3
a
neuroepithelioma NOS
95053
3
43
anaplastic ganglioglioma
95063
3
a
neurocytoma
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Age standardised rate per 100k people
All malignant brain tumours
High-grade (3 & 4) aggressive tumours
low-grade (1 & 2) tumours
All malignant brain tumours in England by diagnosis year
Philips A, et al; Rise in GBM incidence, England 1995–2015; Supplementary File. Page 4 of 9
S2/. Case numbers and age-specific incidence rate data tables for GBM used in the study
Raw case numbers for GBM for all genders and all regions of the brain (Note: a = 1 to 5 cases)
Age
Group
0-
4
5-
9
10-
14
15-
19
20-
24
25-
29
30-
34
35-
39
40-
44
45-
49
50-
54
55-
59
60-
64
65-
69
70-
74
75-
79
80-
84
85+
Totals
1995
a
a
a
a
a
8
12
23
57
79
114
144
167
154
128
55
22
a
983
1996
6
a
a
a
6
14
19
21
51
92
123
150
153
186
149
66
19
a
1064
1997
a
a
a
a
8
14
25
25
55
74
124
186
193
225
159
95
20
14
1232
1998
a
a
a
a
13
15
25
46
43
86
144
153
198
202
170
100
21
9
1238
1999
0
6
a
6
9
11
17
45
62
116
146
186
223
248
166
108
23
7
1384
2000
a
6
a
a
14
14
31
42
59
100
160
186
215
235
208
133
24
12
1449
2001
a
a
a
9
a
23
20
36
62
90
151
203
222
252
187
121
44
15
1449
2002
a
a
a
a
8
8
28
44
56
103
166
217
250
274
195
141
55
19
1576
2003
a
7
a
a
7
19
25
35
49
96
160
222
252
268
239
141
58
16
1605
2004
a
9
6
a
7
7
23
51
58
104
151
225
252
286
253
154
72
21
1686
2005
a
6
8
a
6
14
35
42
87
103
161
259
247
305
273
153
70
23
1802
2006
a
a
a
a
11
20
27
33
78
97
169
272
307
294
248
194
65
35
1866
2007
a
6
a
13
10
13
25
47
76
122
159
268
345
305
293
192
82
34
1998
2008
7
a
a
a
14
17
35
42
76
136
196
264
379
315
322
189
99
50
2152
2009
a
a
a
11
12
13
22
50
67
133
192
255
384
351
273
215
99
63
2152
2010
6
a
a
7
10
15
19
37
67
115
206
225
363
336
299
227
111
60
2111
2011
a
8
7
7
11
18
28
33
84
132
194
273
391
379
288
246
144
70
2314
2012
a
a
a
10
12
21
27
43
62
142
193
241
371
379
330
256
140
92
2330
2013
a
7
a
9
15
20
40
35
79
132
192
258
397
461
361
269
145
89
2518
2014
a
a
a
9
8
18
36
37
77
116
185
246
324
421
352
264
149
98
2349
2015
a
7
6
10
9
29
33
40
83
161
212
259
339
416
356
306
171
90
2531
Philips A, et al; Rise in GBM incidence, England 1995–2015; Supplementary File. Page 5 of 9
Age specific rates (non-adjusted incidence rates per 100,000 people) for GBM for all genders and all regions of the brain
Age
Group
0-4
5-9
10-
14
15-
19
20-
24
25-
29
30-
34
35-
39
40-
44
45-
49
50-
54
55-
59
60-
64
65-
69
70-
74
75-
79
80-
84
85+
Totals
1995
0.13
0.06
0.10
0.14
0.12
0.21
0.31
0.68
1.82
2.31
4.10
5.74
7.20
6.97
6.19
3.77
1.99
0.35
2.03
1996
0.19
0.03
0.10
0.07
0.19
0.37
0.49
0.60
1.62
2.68
4.24
6.02
6.62
8.44
7.40
4.30
1.73
0.34
2.19
1997
0.13
0.12
0.13
0.10
0.27
0.38
0.63
0.70
1.73
2.26
3.95
7.44
8.31
10.26
8.04
5.92
1.87
1.58
2.53
1998
0.07
0.09
0.13
0.13
0.45
0.42
0.64
1.25
1.33
2.71
4.39
6.00
8.41
9.25
8.69
5.95
2.06
0.98
2.54
1999
0.00
0.19
0.16
0.20
0.31
0.31
0.43
1.19
1.87
3.70
4.37
7.09
9.33
11.45
8.53
6.26
2.33
0.75
2.82
2000
0.10
0.19
0.09
0.13
0.48
0.41
0.80
1.09
1.74
3.21
4.74
6.86
8.92
10.88
10.68
7.92
2.29
1.26
2.94
2001
0.14
0.03
0.15
0.30
0.13
0.69
0.52
0.92
1.78
2.88
4.49
7.17
9.27
11.67
9.58
7.36
3.93
1.56
2.93
2002
0.07
0.16
0.12
0.03
0.26
0.25
0.74
1.11
1.56
3.26
5.15
7.09
10.43
12.60
9.99
8.69
4.68
1.99
3.17
2003
0.07
0.23
0.15
0.13
0.22
0.60
0.67
0.88
1.33
2.98
5.13
6.96
10.31
12.17
12.26
8.75
4.71
1.71
3.21
2004
0.10
0.29
0.19
0.12
0.22
0.22
0.63
1.29
1.54
3.16
4.91
6.94
10.03
12.81
13.05
9.56
5.73
2.24
3.36
2005
0.17
0.20
0.25
0.15
0.18
0.43
0.98
1.07
2.25
3.06
5.27
7.92
9.54
13.56
14.09
9.44
5.67
2.33
3.56
2006
0.10
0.10
0.16
0.15
0.33
0.60
0.78
0.85
1.99
2.80
5.51
8.31
11.36
13.21
12.79
11.88
5.34
3.37
3.66
2007
0.13
0.20
0.13
0.39
0.29
0.38
0.74
1.22
1.92
3.43
5.12
8.59
11.80
13.67
14.98
11.67
6.77
3.14
3.89
2008
0.22
0.14
0.16
0.06
0.40
0.48
1.05
1.11
1.92
3.73
6.18
8.71
12.40
13.80
16.16
11.44
8.17
4.50
4.15
2009
0.12
0.14
0.13
0.33
0.35
0.36
0.65
1.35
1.70
3.55
5.92
8.50
12.34
14.88
13.46
12.99
8.10
5.55
4.12
2010
0.18
0.17
0.10
0.21
0.28
0.41
0.55
1.02
1.72
3.00
6.19
7.54
11.52
13.76
14.60
13.64
8.93
5.15
4.01
2011
0.03
0.27
0.23
0.21
0.31
0.49
0.79
0.94
2.16
3.39
5.67
9.09
12.36
14.82
14.16
14.66
11.38
5.87
4.36
2012
0.15
0.13
0.07
0.30
0.33
0.57
0.75
1.26
1.61
3.62
5.48
7.89
12.31
13.57
16.08
15.02
10.87
7.54
4.36
2013
0.12
0.22
0.17
0.28
0.42
0.54
1.09
1.04
2.08
3.36
5.31
8.28
13.50
15.80
17.14
15.43
11.15
7.19
4.67
2014
0.12
0.06
0.10
0.28
0.22
0.48
0.97
1.09
2.08
2.96
4.98
7.72
11.12
14.15
16.09
14.79
11.34
7.68
4.32
2015
0.12
0.21
0.20
0.31
0.25
0.77
0.89
1.15
2.28
4.14
5.56
7.90
11.67
13.79
15.69
16.96
12.89
6.95
4.62
Philips A, et al; Rise in GBM incidence, England 1995–2015; Supplementary File. Page 6 of 9
S3/. Sample simple STATA ® dataset and DO script
Statistical analysis was carried out using STATA ® v12.1 (StataCorp LP, Texas. USA)
Philips A, et al; Rise in GBM incidence, England 1995–2015; Supplementary File. Page 7 of 9
S4/. Data-Table for Figure 1 (Values taken directly from ONS published data)
Figure 1 data table
Year
Male
Female
Combined
D43 1,2,3
Male
Female
Combined
1971
6.4
4.0
5.2
1972
6.2
3.9
5.1
1973
5.6
3.7
4.7
1974
5.9
4.1
5.0
1975
6.0
3.7
4.9
1976
5.9
3.8
4.9
1977
6.0
4.1
5.1
1978
6.1
3.8
5.0
1979
7.2
4.6
5.9
1980
7.2
4.8
6.0
1981
7.5
4.9
6.2
1982
7.2
4.8
6.0
1983
7.7
5.1
6.4
1984
7.9
5.2
6.6
1985
8.3
5.4
6.9
1986
7.9
5.2
6.6
1987
8.5
5.2
6.9
1988
8.4
5.6
7.0
1989
8.5
5.7
7.1
1990
8.7
5.5
7.1
1991
8.9
5.5
7.2
1992
9.5
6.4
8.0
1993
9.3
6.2
7.8
1994
9.4
6.2
7.8
1995
9.7
6.5
8.0
1996
9.7
6.5
7.9
1997
10.6
6.6
8.4
1998
9.9
6.7
8.2
0.9
1999
10.3
6.3
8.1
1.1
2000
10.6
7.0
8.6
1.0
2001
10.2
6.5
8.2
1.1
8.1
5.0
6.6
2002
10.3
6.6
8.3
1.0
7.8
5.0
6.4
2003
10.0
6.2
8.0
1.0
7.9
4.9
6.4
2004
10.2
6.2
8.1
1.0
8.2
4.8
6.5
2005
10.6
6.3
8.3
1.1
8.1
4.7
6.4
2006
10.3
6.5
8.3
1.0
8.1
5.0
6.6
2007
10.3
6.8
8.4
1.0
8.0
5.3
6.7
2008
10.6
7.0
8.7
1.0
8.2
5.0
6.6
2009
10.7
7.0
8.7
0.9
8.3
5.3
6.8
2010
10.4
6.9
8.5
1.0
8.4
5.4
6.9
2011
10.2
7.1
8.6
1.0
8.2
5.5
6.9
2012
10.6
6.5
8.4
0.9
8.8
5.6
7.2
2013
11.0
7.1
8.9
0.9
8.4
5.5
7.0
2014
10.1
6.8
8.4
0.9
8.7
5.4
7.1
2015
10.5
7.0
8.6
0.7
8.5
5.4
7.0
Philips A, et al; Rise in GBM incidence, England 1995–2015; Supplementary File. Page 8 of 9
S5/. Data table for Figure 5
Data for Figure 6 GBM by tumour site, ASRs to ESP-2013
Year
Frontal lobe
ASR
Temporal
lobe ASR
Frontal &
temporal
lobes ASR
Uncertain
or
overlapping
All other
brain
sites ASR
1995
0.41
0.34
0.76
0.89
0.74
1996
0.40
0.36
0.76
1.10
0.71
1997
0.51
0.40
0.91
1.14
0.93
1998
0.50
0.48
0.98
1.00
0.97
1999
0.63
0.48
1.11
1.13
1.04
2000
0.65
0.49
1.14
1.26
1.01
2001
0.67
0.51
1.17
1.22
1.00
2002
0.80
0.63
1.43
1.14
1.10
2003
0.70
0.66
1.37
1.28
1.06
2004
0.74
0.69
1.43
1.40
1.03
2005
0.82
0.71
1.53
1.45
1.09
2006
0.88
0.78
1.66
1.49
1.04
2007
0.98
0.86
1.84
1.40
1.19
2008
1.14
1.04
2.18
1.22
1.31
2009
1.13
1.07
2.20
1.06
1.39
2010
1.10
1.06
2.16
1.11
1.25
2011
1.36
1.05
2.42
1.26
1.19
2012
1.27
1.10
2.37
1.25
1.22
2013
1.38
1.28
2.66
1.25
1.23
2014
1.39
1.21
2.60
0.89
1.23
2015
1.41
1.32
2.73
0.89
1.39
S6/. CT and MRI use in the UK NHS
Source: NHS Imaging and Radio-diagnostic activity in England 2012/13 Release, August 2013
https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/04/KH12-release-2012-13.pdf
Philips A, et al; Rise in GBM incidence, England 1995–2015; Supplementary File. Page 9 of 9
S7/. Ionising radiation in the environment from man-made sources
England lies between the latitudes of 50 and 55 North. The United Nations Scientific Committee on the
Effects of Atomic Radiation UNSCEAR 2000 Report (Reference 24 in the main paper) gives the best
estimates possible of overall fallout from atmospheric bomb testing. It shows that the highest levels of 137Cs
were around latitudes of 50 North and, although the biological half-life is generally less than six months,
the fallout persisted for many years. The Caesium graph is reproduced from page 167 and the Strontium
graph from page 164 of the UNCSEAR 2000 Report, with thanks.
There were extra significant emissions of 137Cs from Chernobyl that were detected in England and in a UK
whole-body radiation scanning study. These are discussed and referenced in a 2010 PhD Thesis by E A
Elessawi, ‘Measurement of Caesium–137 in the Human Body using a Whole Body Counter’.
https://orca.cf.ac.uk/55066/1/U585455.pdf
Both 137Cs and 90Sr are bone-seekers and are most associated with bone cancer and leukaemia.
The USA Health Physics Society has some excellent brief summaries of the effects of 137Cs and 90Sr.
http://hpschapters.org/northcarolina/NSDS/cesium.pdf
http://hpschapters.org/northcarolina/NSDS/strontium.pdf