Brain Cancer

By Jack Keeley

The Current Understanding of Brain Cancer

Cancer, or complications due to cancer, is one of the most common causes of death in the United States. In 2017 there were 599,108 deaths directly attributed to cancer or complications due to it, making up 21.3% of all deaths in the United States, with heart disease being the leading cause of death in the United States, with 23% of all deaths occurring due to the disease or complications. As with most other forms of cancer, the exact cause of brain cancer is unknown although many different factors have been found to have links to brain cancer, such as a family history of brain cancer, exposure to high amounts of ionizing radiation, or cancer spreading from another part of the body to the brain. While modern medicine has many different options for the treatment and control of cancers, patients in the past had no such options, and any options that were available were generally reserved for the wealthy and nobles.

Early Understandings

While brain cancers and tumors had been theorized in the 19th century, proper medical research into the topic of brain cancers and tumors did not truly being until the dawn of the 20th century. The term “glioblastoma multiforme” was coined by Percival Bailey and Harvey Cushing to describe the formation of gliomas, a type of tumor that can occur in the spinal cord and parts of the brain, originating in Glial Cells (Stoyanov 1). Many different forms of identifying and categorizing brain cancers and tumors developed throughout the 20th century, with technologies such as EEGs in the 1920s, used to record brain activity, to the development and deployment of CT scanning and MRI technologies as imaging tools to help better assist in the diagnosis and treatment of brain tumors. Cancer immunotherapy has been a hot topic in the 21st century, revolving around the use of the humans’ own immune system to attack cancer cells, while cancer immunotherapy applies to a large number of cancers, in 2016, brain cancer made up only 2.9% of all cancer related deaths in the United States (National Cancer Institute)

 

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© Harvey Cushing – Semantic Scholar

Economic Factors in the Treatment and Diagnosis of Brain Cancers and Tumors

Economic and social status have always played a role in the diagnosis and treatment that someone receives when seeking medical care, dating back to the 19th and early 20th century, where medical services were risky, and generally only available to affluent white families in large cities, with rural areas and minorities going largely ignored during the time. Anthony P. Polednak conducted a study in New York state analyzing the mortality rate in high-income black population cancer patients from 1979 to 1985. While the mortality rates of some types of cancers, mainly cervical and prostate, were lower in the high income black community vs. the national average, the mortality rate was still substantially higher than the average for American whites that were diagnosed with the same cancers (Polednak). Robert K. Plumb performed a study in Buffalo, NY in an attempt to find a connection between income and cancer diagnosis rates. Plumb found that certain types of cancer were more prevalent in the lower third income bracket among the group of 50,000 patients, with preliminary results stating that stomach cancer was more common in low income areas and areas with a lack of fresh, healthy food options, lung cancer being more commonly among people who smoke, especially low income smokers, and breast cancer being most commonly in unmarried women who do not nurse (Plumb).

Barriers to treatment in the 20th century.

While technologies had developed to assist with the diagnosis and treatment of brain cancers and tumors in the early to mid-20th century, many of these technologies were unavailable outside of large metropolitan areas. At a time when the American health insurance business was not yet fully developed, many practitioners and hospitals would require upfront payment of services rendered, or would refuse to diagnose and treat people outside the top income brackets. This essentially led to a barrier to diagnosis and treatment, as even if someone from a rural area was able to make it to a metropolitan area and get a diagnosis from a practitioner, it would have been unlikely that they could afford to treatment at the time, which were often expensive and invasive, requiring extended hospital stays an a long recovery time. Poor understanding of the structure of the human brain combined with relatively new practices meant that many treatments that required surgery were risky, as this was largely uncharted territory at the time.  

© Cushing Tumor Registry – Yale University

Future Prospects in the treatment of Brain Cancers and Tumors

Cancer immunotherapy has been largely touted as viable treatment for many forms of cancer, with multiple different immunotherapy drugs having been approved by the FDA for the treatment of cancers, with two treatments being specifically approved for the treatment of brain and nervous system cancers, with several other immunotherapy options being currently tested in clinical trials (Reardon).

Bibliography

MOH Reports


Croydon 1963 Statistics
Report of the Medical Officer of Health for Croydon

London City counter 1925
Report of the Medical Officer of Health for London County Council

London County Council 1952
Report of the Medical Officer of Health for London County Council

Walthamstow 1961
Report of the Medical Officer of Health for Walthamstow

London County Council 1925
Report of the Medical Officer of Health for London County Council

Bright’s Disease
Report of the Medical Officer of Health for Wandsworth, Metropolitan Borough

Barking 1953
Report of the Medical Officer of Health for Barking

Greenwich 1919
Annual Report for 1919

Croydon 1966
Report of the Medical Officer of Health for Croydon

Hounslow 1968
Report of the Medical Officer of Health for Hounslow

Secondary Sources


Heron, Melonie. “National Vital Statistics Report.” Deaths: Leading Causes for 2017. NVSS, June 24, 2019.

National Cancer Institute, Cancer Stat Facts: Brain and Other nervous system cancers. National Cancer Institute. Accessed November 10, 2019. https://seer.cancer.gov/statfacts/html/brain.html.

Polednak, A P. “Cancer Mortality in a Higher-Income Black Population in New York State. Comparison with Rates in the United States as a Whole.” Cancer mortality in a higher-income black population in New York State. Comparison with rates in the United States as a whole. 1990 Oct 1;66(7):1654-60.

Plumb, Robert K. “Income as Factor in Cancer Sifted: 37,000 Victims are Studied in Buffalo — U. S. Survey Finds Some Connection” New York Times  Feb 22, 1959, p. 44.

Reardon, David A. “Immunotherapy for Brain Cancer.” Cancer Research Institute. Cancer Research Institude. Accessed November 10, 2019.

Stoyanov, George St, and Deyan L Dzhenkov. “On the Concepts and History of Glioblastoma Multiforme – Morphology, Genetics and Epigenetics.” Folia medica. March 1, 2018. 60(1): 48-66.