Meningiomas Are
Not Significantly Associated With Breast Cancer
Daniel H. Jacobs, MD; Frederick F. Holmes, MD; Michael J. McFarlane, MD \s=b\ We
studied 283
meningiomas
seen
at
the
University of
Kansas, Kansas City, from 1948 through 1984, identifying all
nonmeningeal malignancies and primary brain tumors in these patients and calculating the expected number of additional tumors by the use of a person-year method from age and sex-matched cancer incidence data. We determined expected numbers of total neoplasms in our meningioma population as well as the expected numbers in each major organ system for the sexes independently and together. We then calculated standard morbidity ratios and 95% confidence intervals for each tumor type. The number of breast cancers did not reach statistical significance. We found a significantly increased number of second primary brain tumors in women (standard morbidity ratio, 8.0; 95% confidence interval, 2.2 to 20.4) and an increased number of thyroid cancers in both sexes (standard morbidity ratio, 7.5; 95% confidence interval, 1.5 to 21.9). (Arch Neurol. 1992;49:753-756) additional
and meningioma occurring multiple in Breast single individual have been primary described.1"5 Whether the association between these cancer
as
tumors
a
two
predilection for multiple pri¬ mary tumors in meningioma or breast cancer patients is unknown. This study analyzes the occurrence of addi¬ tional primary tumors in a series of patients with menin¬ gioma seen at a midwestern university hospital over a 36year period. tumors is fortuitous
or a
true
MATERIALS AND METHODS The records of 283 patients with intracranial meningioma were reviewed. These cases included 177 women and 106 men in whom meningioma was diagnosed at the University of Kansas Medical Center, Kansas City, from 1948 through 1984. The cases were identified from the Kansas University Medical Center Tumor Registry and the Kansas Cancer Data Service, the state tumor registry. The diagnoses were confirmed from the hospital records and the pathology reports contained therein. Data were obtained from hospital records and the tumor registries on the occurrence
Accepted for publication February 21, 1992. From the Departments of Neurology (Dr Jacobs)
and Medicine (Dr
Holmes), University of Kansas School of Medicine Kansas City; and Department of Medicine, Case Western Reserve University, Cleveland, Ohio (Dr McFarlane). Reprint requests to University of Kansas School of Medicine, 39th and Rainbow streets, Kansas City, KS 66103 (Dr Holmes).
of additional
meningioma.
neoplasms over the lifetimes of these patients with
Tables were then constructed to compare these data with stan¬ dard age- and sex-matched populations derived from the De¬ partment of Health, Education and Welfare publication, Third National Cancer Survey,6 for the 3-year period 1969 through 1971. The chosen period falls approximately at the midpoint of our study. The person-years at risk were calculated from birth until death or the last follow-up of each patient with meningioma. The person-years at risk were divided into 5-year age brackets (thus, a 14-year-old would contribute 5 person-years in each of three brackets of 5 years: 0 to 4, 5 to 9, and 10 to 14 years). The total number of person-years in each age bracket representing all pa¬ tients with meningioma were multiplied by the population-based incidence of cancer in that age bracket, as given by the reference data from the Third National Cancer Survey. The product of the two gives e, which is the expected number of neoplasms in that age bracket. The sum of es from all of the age brackets gives the ex¬ pected number of tumors in the study population of patients with meningioma. The data were stratified by sex, and also calculated for the sexes together. An expected number of tumors e was cal¬ culated for all tumors as well as for tumors originating in partic¬ ular organ systems (eg, breast or gastrointestinal). 95% confidence intervals (CI) were then calculated for all tumors and for each tu¬ mor type, comparing men, women, and all subjects. The 95% CIs were expressed in terms of the standard morbidity ratio (SMR), a ratio of the observed to expected number of neoplasms. The in¬ clusion of unity within the 95% CIs means that the results could have occurred by chance. Since the Kansas Cancer Data Service episodically surveyed all former Kansas patients with cancer, it is unlikely that we missed any subsequent cancers occurring outside of the state of Kansas. Follow-up data are detailed under the "Results" section. Since the Department of Health, Education, and Welfare data gave inci¬ dence data for sexes individually and for sexes together, we fol¬ lowed their example in our calculation of expected numbers of cancers (Tables 1 through 3). Consequently, the expected values in Table 3 are slightly different from the sum of the expected val¬ ues in Tables 1 and 2. Our report excludes patients who had neu¬ rofibromatosis, since these patients are at risk for multiple types of tumors. We analyze other tumors according to the availability of reference data. Following the Department of Health, Education, and Welfare format, we include all malignancies except basal cell carcinoma and squamous cell carcinoma of the skin. Among nonmalignant tumors, we include primary brain tumors, but we exclude all others.
RESULTS Two hundred were
eighty-three patients
with
meningioma
studied, including 177 women and 106 men. Of these
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Table 1.—Occurrence of Second Primary Neoplasms in 277 Women With Meningioma From tne University of Kansas Medical Center, 1948-1984* Tumor
Type
No. No.
Expectedt
37/29.3 12/8.4 10/6.5 5/6.2 4/0.5 2/0.6 1/1.8 1/0.5 2/1.6
All types Breast
Female genital Gastrointestinal
Primary
Observed/
CNS
Thyroid Respiratory Melanoma
Hematopoietic
SMR
95% CI 0.889-1.701
1.43
0.738-2.495
All types Breast
1.54
0.738-2.829
Gastrointestinal
.81
.262-1.882
8.00
2.180-20.484
3.33
0.404-12.041
Thyroid Respiratory
0.56
0.014-3.095
Melanoma
2.00
0.051-11.143
Hematopoietic
1.25
0.151-4.515
morbidity ratio; CI, confidence interval; and system. calculated from the Third National Cancer Survey.6
tExpected tReached
nervous
rates
significance.
Type
No. No.
Observed/
Expectedt
SMR
95% CI
0.76
0.404-1.300
1.14
0.369-2.652
5.00
0.606-18.062
10.00
0.253-55.716
0.45
0.055-1.642
3.33
0.0843-18.572
Hematopoietic
13/17.1 5/4.4 2/0.4 1/0.1 2/4.4 1/0.3 0/1.3
Genitourinary (prostate)
1/2.6
0.38
All types Gastrointestinal Primary CNS
Thyroid Respiratory Melanoma
0
0-2.838 0.0097-2.143
morbidity ratio; CI, confidence interval; and CNS, central nervous system. tExpected rates calculated from the Third National Cancer Survey.'' ^Reached significance. *SMR indicates standard
patients, 85 (30%) died of their meningioma with an aver¬ age survival of 2.0 years from diagnosis of meningioma (range, 0 to 19 years). Seventy-two patients (25%) died of
other causes, with an average survival from diagnosis of meningioma of 6.8 years (range, 0 to 27 years). Ninety pa¬ tients (32%) survived with their meningiomas to the end of the study period, with an average length of follow-up of 0 to 36 years). Thirty-six patients (12.7%) 15.1 years were eventually unavailable for follow-up after having been followed up for an average of 10.7 years (range, 0 to 36 years). Four of these 36 patients (1.4%) did not have any data available. Of the 283 patients with meningiomas, 42 had 50 addi¬ tional neoplasms. The specific additional neoplasms that we observed included 12 breast cancers, 10 female genital cancers, 10 gastrointestinal cancers, six brain tumors, three cancers each of the thyroid and lung, two hematopoietic malignancies, two melanomas, one carcinoma of the pros¬ tate, and one carcinoma of unknown primary site. Among 177 women with meningiomas, 37 had addi¬ tional tumors (Table 1) that included 12 breast cancers, ten female genital cancers (five of corpus uteri, three of cervix, one of ovary, and one of vagina), four primary brain
(range,
follow-up
Observed/
Expectedt 50/47.2 12/6.8 10/11.1 6/0.9 3/0.4 3/7.4 2/0.8 2/3.8
CNS
SMR
95% CI
1.06
0.786-1.397
1.76
0.912-3.083
0.90
0.432-1.657
6.67
0.330-1.958
7.50
1.547-21.9184
0.41
0.084-1.184
2.50
0.303-9.031
0.53
0.064-1.900
morbidity ratio; CI, confidence interval; and system.
*SMR indicates standard
CNS, central
tExpected
tReached
nervous
rates
calculated from the Third National Cancer
significance.
Survey.6
tumors, five colon
Table 2.—Occurrence of Second Primary Neoplasms in 106 Men With Meningioma From the University of Kansas Medical Center, 1948-1984* Tumor
Primary
No. No.
Type
Tumor
1.26
*SMR indicates standard
CNS, central
Table 3.—Occurrence of Second Primary Neoplasms in 283 Men and Women With Meningioma From the University of Kansas Medical Center, 1948-1984*
cancers, two thyroid cancers, two hematopoietic malignancies, one lung cancer, and one malignant melanoma. Among 106 men (Table 2), 13 were found to have additional neoplasms, including five gas¬ trointestinal cancers (one cancer each of cecum, appendix, esophagus, and stomach and one carcinoid of the ileum), two lung cancers, one thyroid cancer, one prostate cancer, two primary brain tumors, and one unknown primary cancer.
In women with meningiomas, tumors of the central ner¬ vous
system occurred at a significantly higher rate (SMR,
to 20.484). The occurrence of breast did not reach statistical significance (SMR, 1.43; 95% CI, 0.738 to 2.495). In men with meningi¬ oma, no other tumor type occurred at a significantly increased rate. In all subjects (Table 3), the number of total neoplasms observed did not exceed chance. Among specific tumor types, the number of breast cancers did not exceed chance (SMR, 1.76; 95% CI, 0.912 to 3.083). However, the number of thyroid cancers significantly exceeded that expected (SMR, 7.50; 95% CI, 1.547 to 21.918). No other tumor type occurred at a frequency significantly greater than ex¬
8.00; 95% CI, 2.180
cancer
in
women
pected.
Among the six patients with meningiomas and other primary brain tumors, the four women had clinically sig¬ nificant meningioma, ie, detected during life (Table 4), and two men had clinically insignificant meningiomas, noted incidentally at necropsy. The other primary brain tumors were diverse in type, including two glioblastomas, an ependymoma, an anterior pituitary tumor, a posterior pi¬ tuitary granular cell tumor, and a brain-stem glioma. Of particular interest is case 3, in which a patient who survived a brain-stem glioma at the age of 1 year with ra¬ diation therapy, later developed a clinically significant meningioma at the age of 25 years. Also of interest is case 4, a malignant meningioma of the sphenoid ridge contig¬ uous to a granular cell tumor of the posterior pituitary gland, diagnosed at necropsy. COMMENT Breast Cancer Whereas case reports of separate tumors occurring in combination are frequent, it is difficult to know whether these occurrences are random events or, alternatively,
Downloaded From: http://archneur.jamanetwork.com/ by a University of Iowa User on 06/13/2015
Meningioma and
Table Patient
No./
Type of Additional Tumor
Type of Meningioma
Sex/Age,* y
Brain Tumors
4.—Meningioma and Other Primary
1/F/56 (56) 2/F/60 (60) 3/F/25 (1) 4/M/73 (73)
Parietal convexity meningioma
Ependymoma
Parasagittal meningioma Petrous ridge meningioma Sphenoid ridge malignant meningioma
Glioblastoma Brain-stem glioma
at age 1 year
Posterior
pituitary
tumor
5/F/69 (65) 6/M/83 (83)
Unknown site meningioma Frontal meningioma
Pituitary
adenoma
Comment
Received radiation for glioma Incidental meningioma noted at necropsy
Glioblastoma multiforme
Incidental meningioma noted at
*Age
at
diagnosis of meningioma and, parenthetically,
age at
diagnosis of other brain
a unique association among the tumors.7 Our data do not clearly support a relationship between menin¬ giomas and breast cancers. An association between meningiomas and breast can¬ cers has been postulated on the basis of epidemiologie, data. Meningiomas occur more clinical, and commonly in women; in our series, 63% of the patients were women. In certain sites, meningiomas have an even stronger gender association. Sphenoid ridge meningiomas en plaque occur almost exclusively in women, and 80% of spinal canal meningiomas occur in women.8 Previously, we9 described a predilection for multiple primary tumors of the breast and female genital tract, which occurs only in those patients with meningioma who have sphenoid ridge
represent
physiologic
meningiomas.
The presence of
ceptors
on
progesterone and other
meningiomas10
has
sex
steroid
sparked widespread
re¬
re¬
search interest; it also provides a physiologic analogy to breast cancer and a theoretical explanation for epidemio¬ logie data showing a preponderance of meningiomas in female individuals. Our review of the literature shows that, despite the publication of several case reports, only four studies have examined the relationship between meningiomas and breast cancers by means of statistical methods. Schoenberg et al4 studied all cases of multiple primary tumors that were found through a Connecticut population-based tu¬ mor registry. Of 130 cases in which at least one of the tu¬ mors involved the nervous system, eight were the combi¬ nation of breast cancer and meningioma for which the authors found that P
Not Significantly Associated With Breast Cancer
Daniel H. Jacobs, MD; Frederick F. Holmes, MD; Michael J. McFarlane, MD \s=b\ We
studied 283
meningiomas
seen
at
the
University of
Kansas, Kansas City, from 1948 through 1984, identifying all
nonmeningeal malignancies and primary brain tumors in these patients and calculating the expected number of additional tumors by the use of a person-year method from age and sex-matched cancer incidence data. We determined expected numbers of total neoplasms in our meningioma population as well as the expected numbers in each major organ system for the sexes independently and together. We then calculated standard morbidity ratios and 95% confidence intervals for each tumor type. The number of breast cancers did not reach statistical significance. We found a significantly increased number of second primary brain tumors in women (standard morbidity ratio, 8.0; 95% confidence interval, 2.2 to 20.4) and an increased number of thyroid cancers in both sexes (standard morbidity ratio, 7.5; 95% confidence interval, 1.5 to 21.9). (Arch Neurol. 1992;49:753-756) additional
and meningioma occurring multiple in Breast single individual have been primary described.1"5 Whether the association between these cancer
as
tumors
a
two
predilection for multiple pri¬ mary tumors in meningioma or breast cancer patients is unknown. This study analyzes the occurrence of addi¬ tional primary tumors in a series of patients with menin¬ gioma seen at a midwestern university hospital over a 36year period. tumors is fortuitous
or a
true
MATERIALS AND METHODS The records of 283 patients with intracranial meningioma were reviewed. These cases included 177 women and 106 men in whom meningioma was diagnosed at the University of Kansas Medical Center, Kansas City, from 1948 through 1984. The cases were identified from the Kansas University Medical Center Tumor Registry and the Kansas Cancer Data Service, the state tumor registry. The diagnoses were confirmed from the hospital records and the pathology reports contained therein. Data were obtained from hospital records and the tumor registries on the occurrence
Accepted for publication February 21, 1992. From the Departments of Neurology (Dr Jacobs)
and Medicine (Dr
Holmes), University of Kansas School of Medicine Kansas City; and Department of Medicine, Case Western Reserve University, Cleveland, Ohio (Dr McFarlane). Reprint requests to University of Kansas School of Medicine, 39th and Rainbow streets, Kansas City, KS 66103 (Dr Holmes).
of additional
meningioma.
neoplasms over the lifetimes of these patients with
Tables were then constructed to compare these data with stan¬ dard age- and sex-matched populations derived from the De¬ partment of Health, Education and Welfare publication, Third National Cancer Survey,6 for the 3-year period 1969 through 1971. The chosen period falls approximately at the midpoint of our study. The person-years at risk were calculated from birth until death or the last follow-up of each patient with meningioma. The person-years at risk were divided into 5-year age brackets (thus, a 14-year-old would contribute 5 person-years in each of three brackets of 5 years: 0 to 4, 5 to 9, and 10 to 14 years). The total number of person-years in each age bracket representing all pa¬ tients with meningioma were multiplied by the population-based incidence of cancer in that age bracket, as given by the reference data from the Third National Cancer Survey. The product of the two gives e, which is the expected number of neoplasms in that age bracket. The sum of es from all of the age brackets gives the ex¬ pected number of tumors in the study population of patients with meningioma. The data were stratified by sex, and also calculated for the sexes together. An expected number of tumors e was cal¬ culated for all tumors as well as for tumors originating in partic¬ ular organ systems (eg, breast or gastrointestinal). 95% confidence intervals (CI) were then calculated for all tumors and for each tu¬ mor type, comparing men, women, and all subjects. The 95% CIs were expressed in terms of the standard morbidity ratio (SMR), a ratio of the observed to expected number of neoplasms. The in¬ clusion of unity within the 95% CIs means that the results could have occurred by chance. Since the Kansas Cancer Data Service episodically surveyed all former Kansas patients with cancer, it is unlikely that we missed any subsequent cancers occurring outside of the state of Kansas. Follow-up data are detailed under the "Results" section. Since the Department of Health, Education, and Welfare data gave inci¬ dence data for sexes individually and for sexes together, we fol¬ lowed their example in our calculation of expected numbers of cancers (Tables 1 through 3). Consequently, the expected values in Table 3 are slightly different from the sum of the expected val¬ ues in Tables 1 and 2. Our report excludes patients who had neu¬ rofibromatosis, since these patients are at risk for multiple types of tumors. We analyze other tumors according to the availability of reference data. Following the Department of Health, Education, and Welfare format, we include all malignancies except basal cell carcinoma and squamous cell carcinoma of the skin. Among nonmalignant tumors, we include primary brain tumors, but we exclude all others.
RESULTS Two hundred were
eighty-three patients
with
meningioma
studied, including 177 women and 106 men. Of these
Downloaded From: http://archneur.jamanetwork.com/ by a University of Iowa User on 06/13/2015
Table 1.—Occurrence of Second Primary Neoplasms in 277 Women With Meningioma From tne University of Kansas Medical Center, 1948-1984* Tumor
Type
No. No.
Expectedt
37/29.3 12/8.4 10/6.5 5/6.2 4/0.5 2/0.6 1/1.8 1/0.5 2/1.6
All types Breast
Female genital Gastrointestinal
Primary
Observed/
CNS
Thyroid Respiratory Melanoma
Hematopoietic
SMR
95% CI 0.889-1.701
1.43
0.738-2.495
All types Breast
1.54
0.738-2.829
Gastrointestinal
.81
.262-1.882
8.00
2.180-20.484
3.33
0.404-12.041
Thyroid Respiratory
0.56
0.014-3.095
Melanoma
2.00
0.051-11.143
Hematopoietic
1.25
0.151-4.515
morbidity ratio; CI, confidence interval; and system. calculated from the Third National Cancer Survey.6
tExpected tReached
nervous
rates
significance.
Type
No. No.
Observed/
Expectedt
SMR
95% CI
0.76
0.404-1.300
1.14
0.369-2.652
5.00
0.606-18.062
10.00
0.253-55.716
0.45
0.055-1.642
3.33
0.0843-18.572
Hematopoietic
13/17.1 5/4.4 2/0.4 1/0.1 2/4.4 1/0.3 0/1.3
Genitourinary (prostate)
1/2.6
0.38
All types Gastrointestinal Primary CNS
Thyroid Respiratory Melanoma
0
0-2.838 0.0097-2.143
morbidity ratio; CI, confidence interval; and CNS, central nervous system. tExpected rates calculated from the Third National Cancer Survey.'' ^Reached significance. *SMR indicates standard
patients, 85 (30%) died of their meningioma with an aver¬ age survival of 2.0 years from diagnosis of meningioma (range, 0 to 19 years). Seventy-two patients (25%) died of
other causes, with an average survival from diagnosis of meningioma of 6.8 years (range, 0 to 27 years). Ninety pa¬ tients (32%) survived with their meningiomas to the end of the study period, with an average length of follow-up of 0 to 36 years). Thirty-six patients (12.7%) 15.1 years were eventually unavailable for follow-up after having been followed up for an average of 10.7 years (range, 0 to 36 years). Four of these 36 patients (1.4%) did not have any data available. Of the 283 patients with meningiomas, 42 had 50 addi¬ tional neoplasms. The specific additional neoplasms that we observed included 12 breast cancers, 10 female genital cancers, 10 gastrointestinal cancers, six brain tumors, three cancers each of the thyroid and lung, two hematopoietic malignancies, two melanomas, one carcinoma of the pros¬ tate, and one carcinoma of unknown primary site. Among 177 women with meningiomas, 37 had addi¬ tional tumors (Table 1) that included 12 breast cancers, ten female genital cancers (five of corpus uteri, three of cervix, one of ovary, and one of vagina), four primary brain
(range,
follow-up
Observed/
Expectedt 50/47.2 12/6.8 10/11.1 6/0.9 3/0.4 3/7.4 2/0.8 2/3.8
CNS
SMR
95% CI
1.06
0.786-1.397
1.76
0.912-3.083
0.90
0.432-1.657
6.67
0.330-1.958
7.50
1.547-21.9184
0.41
0.084-1.184
2.50
0.303-9.031
0.53
0.064-1.900
morbidity ratio; CI, confidence interval; and system.
*SMR indicates standard
CNS, central
tExpected
tReached
nervous
rates
calculated from the Third National Cancer
significance.
Survey.6
tumors, five colon
Table 2.—Occurrence of Second Primary Neoplasms in 106 Men With Meningioma From the University of Kansas Medical Center, 1948-1984* Tumor
Primary
No. No.
Type
Tumor
1.26
*SMR indicates standard
CNS, central
Table 3.—Occurrence of Second Primary Neoplasms in 283 Men and Women With Meningioma From the University of Kansas Medical Center, 1948-1984*
cancers, two thyroid cancers, two hematopoietic malignancies, one lung cancer, and one malignant melanoma. Among 106 men (Table 2), 13 were found to have additional neoplasms, including five gas¬ trointestinal cancers (one cancer each of cecum, appendix, esophagus, and stomach and one carcinoid of the ileum), two lung cancers, one thyroid cancer, one prostate cancer, two primary brain tumors, and one unknown primary cancer.
In women with meningiomas, tumors of the central ner¬ vous
system occurred at a significantly higher rate (SMR,
to 20.484). The occurrence of breast did not reach statistical significance (SMR, 1.43; 95% CI, 0.738 to 2.495). In men with meningi¬ oma, no other tumor type occurred at a significantly increased rate. In all subjects (Table 3), the number of total neoplasms observed did not exceed chance. Among specific tumor types, the number of breast cancers did not exceed chance (SMR, 1.76; 95% CI, 0.912 to 3.083). However, the number of thyroid cancers significantly exceeded that expected (SMR, 7.50; 95% CI, 1.547 to 21.918). No other tumor type occurred at a frequency significantly greater than ex¬
8.00; 95% CI, 2.180
cancer
in
women
pected.
Among the six patients with meningiomas and other primary brain tumors, the four women had clinically sig¬ nificant meningioma, ie, detected during life (Table 4), and two men had clinically insignificant meningiomas, noted incidentally at necropsy. The other primary brain tumors were diverse in type, including two glioblastomas, an ependymoma, an anterior pituitary tumor, a posterior pi¬ tuitary granular cell tumor, and a brain-stem glioma. Of particular interest is case 3, in which a patient who survived a brain-stem glioma at the age of 1 year with ra¬ diation therapy, later developed a clinically significant meningioma at the age of 25 years. Also of interest is case 4, a malignant meningioma of the sphenoid ridge contig¬ uous to a granular cell tumor of the posterior pituitary gland, diagnosed at necropsy. COMMENT Breast Cancer Whereas case reports of separate tumors occurring in combination are frequent, it is difficult to know whether these occurrences are random events or, alternatively,
Downloaded From: http://archneur.jamanetwork.com/ by a University of Iowa User on 06/13/2015
Meningioma and
Table Patient
No./
Type of Additional Tumor
Type of Meningioma
Sex/Age,* y
Brain Tumors
4.—Meningioma and Other Primary
1/F/56 (56) 2/F/60 (60) 3/F/25 (1) 4/M/73 (73)
Parietal convexity meningioma
Ependymoma
Parasagittal meningioma Petrous ridge meningioma Sphenoid ridge malignant meningioma
Glioblastoma Brain-stem glioma
at age 1 year
Posterior
pituitary
tumor
5/F/69 (65) 6/M/83 (83)
Unknown site meningioma Frontal meningioma
Pituitary
adenoma
Comment
Received radiation for glioma Incidental meningioma noted at necropsy
Glioblastoma multiforme
Incidental meningioma noted at
*Age
at
diagnosis of meningioma and, parenthetically,
age at
diagnosis of other brain
a unique association among the tumors.7 Our data do not clearly support a relationship between menin¬ giomas and breast cancers. An association between meningiomas and breast can¬ cers has been postulated on the basis of epidemiologie, data. Meningiomas occur more clinical, and commonly in women; in our series, 63% of the patients were women. In certain sites, meningiomas have an even stronger gender association. Sphenoid ridge meningiomas en plaque occur almost exclusively in women, and 80% of spinal canal meningiomas occur in women.8 Previously, we9 described a predilection for multiple primary tumors of the breast and female genital tract, which occurs only in those patients with meningioma who have sphenoid ridge
represent
physiologic
meningiomas.
The presence of
ceptors
on
progesterone and other
meningiomas10
has
sex
steroid
sparked widespread
re¬
re¬
search interest; it also provides a physiologic analogy to breast cancer and a theoretical explanation for epidemio¬ logie data showing a preponderance of meningiomas in female individuals. Our review of the literature shows that, despite the publication of several case reports, only four studies have examined the relationship between meningiomas and breast cancers by means of statistical methods. Schoenberg et al4 studied all cases of multiple primary tumors that were found through a Connecticut population-based tu¬ mor registry. Of 130 cases in which at least one of the tu¬ mors involved the nervous system, eight were the combi¬ nation of breast cancer and meningioma for which the authors found that P
