Abstract
Background
To date, the etiology of primary tumors of the central nervous system (mainly gliomas and meningiomas) is poorly understood. The role of sex hormones has been suggested, based on clinical, experimental, biological, and epidemiological data.
Objective
To review the epidemiological studies on the relation between hormonal factors and the occurrence of glioma and meningioma, in order to identify new research developments.
Methods
Articles published until September 2010 were selected by considering exogenous and endogenous exposures and specific brain tumors. Standardized information was collected from 20 articles: 15 concerning gliomas and 13 meningiomas.
Results
An increased glioma risk was observed with later menarche and menopause, while a reduced glioma risk was observed with hormone replacement therapy (HRT) and oral contraceptive use, despite duration of use had no effect on risk. Meningioma risk increased after menopause and with HRT use. No clear association was found with pregnancy and breastfeeding.
Conclusion
Results are globally concordant with the biologic hypothesis assuming that female sex hormones are protective against glioma and may increase the risk of meningioma. However, new epidemiological studies should be conducted in order to confirm these associations and to refine the role of hormonal factors in brain etiology.
Similar content being viewed by others
References
CBTRUS. CBTRUS Statistical Report: primary brain and central nervous system tumors diagnosed in the United States in 2004–2006 central braintumor registry of the United States, Hinsdale, IL; 2010 [updated 2010; cited 2010 Aug 20]; Available from: http://www.cbtrus.org/2010-NPCR-SEER/CBTRUS-WEBREPORT-Final-3-2-10.pdf
Loiseau H, Huchet A, Rue M, Cowppli-Bony A, Baldi I (2009) Epidémiologie des tumeurs cérébrales primitives. Rev Neurol (Paris) 165(8–9):650–670
Wrensch M, Minn Y, Chew T, Bondy M, Berger MS (2002) Epidemiology of primary brain tumors: current concepts and review of the literature. Neuro Oncol 4(4):278–299
Inskip PD, Linet MS, Heineman EF (1995) Etiology of brain tumors in adults. Epidemiol Rev 17(2):382–414
Fisher JL, Schwartzbaum JA, Wrensch M, Wiemels JL (2007) Epidemiology of brain tumors. Neurol Clin 25(4):867–890, vii
Piper JG, Follett KA, Fantin A (1994) Sphenoid wing meningioma progression after placement of a subcutaneous progesterone agonist contraceptive implant. Neurosurgery 34(4):723–725
Bickerstaff ER, Small JM, Guest IA (1958) The relapsing course of certain meningiomas in relation to pregnancy and menstruation. J Neurol Neurosurg Psychiatry 21(2):89–91
Ismail K, Coakham HB, Walters FJ (1998) Intracranial meningioma with progesterone positive receptors presenting in late pregnancy. Eur J Anaesthesiol 15(1):106–109
Michelsen JJ, New PF (1969) Brain tumour and pregnancy. J Neurol Neurosurg Psychiatry 32(4):305–307
Saitoh Y, Oku Y, Izumoto S, Go J (1989) Rapid growth of a meningioma during pregnancy: relationship with estrogen and progesterone receptors-case report. Neurol Med Chir (Tokyo) 29(5):440–443
Wan WL, Geller JL, Feldon SE, Sadun AA (1990) Visual loss caused by rapidly progressive intracranial meningiomas during pregnancy. Ophthalmology 97(1):18–21
Roelvink NC, Kamphorst W, Van Alphen HA, Rao BR (1987) Pregnancy-related primary brain and spinal tumors. Arch Neurol 44(2):209–215
Deipolyi AR, Han SJ, Parsa AT (2010) Development of a symptomatic intracranial meningioma in a male-to-female transsexual after initiation of hormone therapy. J Clin Neurosci 17(10):1324–1326
Gazzeri R, Galarza M, Gazzeri G (2007) Growth of a meningioma in a transsexual patient after estrogen-progestin therapy. N Engl J Med 357(23):2411–2412
Gruber T, Dare AO, Balos LL, Lele S, Fenstermaker RA (2004) Multiple meningiomas arising during long-term therapy with the progesterone agonist megestrol acetate. Case report. J Neurosurg 100(2):328–331
Vadivelu S, Sharer L, Schulder M (2010) Regression of multiple intracranial meningiomas after cessation of long-term progesterone agonist therapy. J Neurosurg 112(5):920–924
Speirs V, Boyle-Walsh E, Fraser WD (1997) Constitutive co-expression of estrogen and progesterone receptor mRNA in human meningiomas by RT-PCR and response of in vitro cell cultures to steroid hormones. Int J Cancer 72(5):714–719
Chamaon K, Stojek J, Kanakis D, Braeuninger S, Kirches E, Krause G et al (2005) Micromolar concentrations of 2-methoxyestradiol kill glioma cells by an apoptotic mechanism, without destroying their microtubule cytoskeleton. J Neurooncol 72(1):11–16
Lis A, Ciesielski MJ, Barone TA, Scott BE, Fenstermaker RA, Plunkett RJ (2004) 2-Methoxyestradiol inhibits proliferation of normal and neoplastic glial cells, and induces cell death, in vitro. Cancer Lett 213(1):57–65
Kang SH, Cho HT, Devi S, Zhang Z, Escuin D, Liang Z et al (2006) Antitumor effect of 2-methoxyestradiol in a rat orthotopic brain tumor model. Cancer Res 66(24):11991–11997
Verzat C, Delisle MB, Courriere P, Hollande E (1990) Influence of host sex on the growth of a human glioblastoma line in athymic mice. Neuropathol Appl Neurobiol 16(2):141–151
Plunkett RJ, Lis A, Barone TA, Fronckowiak MD, Greenberg SJ (1999) Hormonal effects on glioblastoma multiforme in the nude rat model. J Neurosurg 90(6):1072–1077
Barone TA, Gorski JW, Greenberg SJ, Plunkett RJ (2009) Estrogen increases survival in an orthotopic model of glioblastoma. J Neurooncol 95(1):37–48
Carroll RS, Zhang J, Dashner K, Sar M, Black PM (1995) Steroid hormone receptors in astrocytic neoplasms. Neurosurgery 37(3):496–503
Khalid H, Shibata S, Kishikawa M, Yasunaga A, Iseki M, Hiura T (1997) Immunohistochemical analysis of progesterone receptor and Ki-67 labeling index in astrocytic tumors. Cancer 80(11):2133–2140
Konstantinidou AE, Korkolopoulou P, Mahera H, Kotsiakis X, Hranioti S, Eftychiadis C et al (2003) Hormone receptors in non-malignant meningiomas correlate with apoptosis, cell proliferation and recurrence-free survival. Histopathology 43(3):280–290
Korhonen K, Salminen T, Raitanen J, Auvinen A, Isola J, Haapasalo H (2006) Female predominance in meningiomas can not be explained by differences in progesterone, estrogen, or androgen receptor expression. J Neurooncol 80(1):1–7
Pravdenkova S, Al-Mefty O, Sawyer J, Husain M (2006) Progesterone and estrogen receptors: opposing prognostic indicators in meningiomas. J Neurosurg 105(2):163–173
Wahab M, Al-Azzawi F (2003) Meningioma and hormonal influences. Climacteric 6(4):285–292
Helseth A, Mork SJ, Johansen A, Tretli S (1989) Neoplasms of the central nervous system in Norway. IV. A population-based epidemiological study of meningiomas. APMIS 97(7):646–654
Preston-Martin S (1989) Descriptive epidemiology of primary tumors of the brain, cranial nerves and cranial meninges in Los Angeles county. Neuroepidemiology 8(6):283–295
McKinley BP, Michalek AM, Fenstermaker RA, Plunkett RJ (2000) The impact of age and sex on the incidence of glial tumors in New York state from 1976 to 1995. J Neurosurg 93(6):932–939
Custer BS, Koepsell TD, Mueller BA (2002) The association between breast carcinoma and meningioma in women. Cancer 94(6):1626–1635
Schneider B, Pulhorn H, Rohrig B, Rainov NG (2005) Predisposing conditions and risk factors for development of symptomatic meningioma in adults. Cancer Detect Prev 29(5):440–447
Schoenberg BS, Christine BW, Whisnant JP (1975) Nervous system neoplasms and primary malignancies of other sites. The unique association between meningiomas and breast cancer. Neurology 25(8):705–712
Seal S, Thompson D, Renwick A, Elliott A, Kelly P, Barfoot R et al (2006) Truncating mutations in the Fanconi anemia J gene BRIP1 are low-penetrance breast cancer susceptibility alleles. Nat Genet 38(11):1239–1241
Bethke L, Murray A, Webb E, Schoemaker M, Muir K, McKinney P et al (2008) Comprehensive analysis of DNA repair gene variants and risk of meningioma. J Natl Cancer Inst 100(4):270–276
Benson VS, Pirie K, Green J, Casabonne D, Beral V (2008) Lifestyle factors and primary glioma and meningioma tumours in the million women study cohort. Br J Cancer 99(1):185–190
Benson VS, Pirie K, Green J, Bull D, Casabonne D, Reeves GK et al (2010) Hormone replacement therapy and incidence of central nervous system tumours in the million women study. Int J Cancer 127(7):1692–1698
Hatch EE, Linet MS, Zhang J, Fine HA, Shapiro WR, Selker RG et al (2005) Reproductive and hormonal factors and risk of brain tumors in adult females. Int J Cancer 114(5):797–805
Blitshteyn S, Crook JE, Jaeckle KA (2008) Is there an association between meningioma and hormone replacement therapy? J Clin Oncol 26(2):279–282
Cantor KP, Lynch CF, Johnson D (1993) Reproductive factors and risk of brain, colon, and other malignancies in Iowa (United States). Cancer Causes Control 4(6):505–511
Cicuttini FM, Hurley SF, Forbes A, Donnan GA, Salzberg M, Giles GG et al (1997) Association of adult glioma with medical conditions, family and reproductive history. Int J Cancer 71(2):203–207
Custer B, Longstreth WT Jr, Phillips LE, Koepsell TD, Van Belle G (2006) Hormonal exposures and the risk of intracranial meningioma in women: a population-based case-control study. BMC Cancer 6:152–160
Felini MJ, Olshan AF, Schroeder JC, Carozza SE, Miike R, Rice T et al (2008) Reproductive factors and hormone use and risk of adult gliomas. Cancer Causes Control 20:87–96
Huang K, Whelan EA, Ruder AM, Ward EM, Deddens JA, Davis-King KE et al (2004) Reproductive factors and risk of glioma in women. Cancer Epidemiol Biomarkers Prev 13(10):1583–1588
Lambe M, Coogan P, Baron J (1997) Reproductive factors and the risk of brain tumors: a population-based study in Sweden. Int J Cancer 72(3):389–393
Lee E, Grutsch J, Persky V, Glick R, Mendes J, Davis F (2006) Association of meningioma with reproductive factors. Int J Cancer 119(5):1152–1157
Preston-Martin S, Monroe K, Lee PJ, Bernstein L, Kelsey J, Henderson S et al (1995) Spinal meningiomas in women in Los Angeles county: investigation of an etiological hypothesis. Cancer Epidemiol Biomarkers Prev 4(4):333–339
Schlehofer B, Blettner M, Preston-Martin S, Niehoff D, Wahrendorf J, Arslan A et al (1999) Role of medical history in brain tumour development. Results from the international adult brain tumour study. Int J Cancer 82(2):155–160
Schlehofer B, Blettner M, Wahrendorf J (1992) Association between brain tumors and menopausal status. J Natl Cancer Inst 84(17):1346–1349
Silvera SA, Miller AB, Rohan TE (2006) Hormonal and reproductive factors and risk of glioma: a prospective cohort study. Int J Cancer 118(5):1321–1324
Wigertz A, Lonn S, Hall P, Auvinen A, Christensen HC, Johansen C et al (2008) Reproductive factors and risk of meningioma and glioma. Cancer Epidemiol Biomarkers Prev 17(10):2663–2670
Wigertz A, Lonn S, Mathiesen T, Ahlbom A, Hall P, Feychting M (2006) Risk of brain tumors associated with exposure to exogenous female sex hormones. Am J Epidemiol 164(7):629–636
Kabat GC, Park Y, Hollenbeck AR, Schatzkin A, Rohan TE (2011) Reproductive factors and exogenous hormone use and risk of adult glioma in women in the NIH-AARP diet and health study. Int J Cancer 128(4):944–950
Hochberg F, Toniolo P, Cole P, Salcman M (1990) Nonoccupational risk indicators of glioblastoma in adults. J Neurooncol 8(1):55–60
Jhawar BS, Fuchs CS, Colditz GA, Stampfer MJ (2003) Sex steroid hormone exposures and risk for meningioma. J Neurosurg 99(5):848–853
Ryan P, Lee MW, North B, McMichael AJ (1992) Risk factors for tumors of the brain and meninges: results from the Adelaide adult brain tumor study. Int J Cancer 51(1):20–27
Madigan MP, Troisi R, Potischman N, Dorgan JF, Brinton LA, Hoover RN (1998) Serum hormone levels in relation to reproductive and lifestyle factors in postmenopausal women (United States). Cancer Causes Control 9(2):199–207
Ernster VL, Wrensch MR, Petrakis NL, King EB, Miike R, Murai J et al (1987) Benign and malignant breast disease: initial study results of serum and breast fluid analyses of endogenous estrogens. J Natl Cancer Inst 79(5):949–960
MacMahon B, Trichopoulos D, Brown J, Andersen AP, Cole P, de Waard F et al (1982) Age at menarche, urine estrogens and breast cancer risk. Int J Cancer 30(4):427–431
Trichopoulos D, Brown J, MacMahon B (1987) Urine estrogens and breast cancer risk factors among post-menopausal women. Int J Cancer 40(6):721–725
Apter D, Reinila M, Vihko R (1989) Some endocrine characteristics of early menarche, a risk factor for breast cancer, are preserved into adulthood. Int J Cancer 44(5):783–787
Behl C (2002) Estrogen can protect neurons: modes of action. J Steroid Biochem Mol Biol 83(1–5):195–197
Shy H, Malaiyandi L, Timiras PS (2000) Protective action of 17beta-estradiol and tamoxifen on glutamate toxicity in glial cells. Int J Dev Neurosci 18(2–3):289–297
Dhandapani KM, Wade FM, Mahesh VB, Brann DW (2005) Astrocyte-derived transforming growth factor-{beta} mediates the neuroprotective effects of 17{beta}-estradiol: involvement of nonclassical genomic signaling pathways. Endocrinology 146(6):2749–2759
Yague JG, Munoz A, de Monasterio-Schrader P, Defelipe J, Garcia-Segura LM, Azcoitia I (2006) Aromatase expression in the human temporal cortex. Neuroscience 138(2):389–401
Inoue T, Sasano H (2004) Possible effects of progesterone on human central nervous system and neurogenic tumors. J Endocrinol Invest 27(1):76–79
Dhandapani KM, Brann DW (2007) Role of astrocytes in estrogen-mediated neuroprotection. Exp Gerontol 42(1–2):70–75
Camacho-Arroyo I, Guerra-Araiza C, Cerbon MA (1998) Progesterone receptor isoforms are differentially regulated by sex steroids in the rat forebrain. Neuroreport 9(18):3993–3996
Guerra-Araiza C, Villamar-Cruz O, Gonzalez-Arenas A, Chavira R, Camacho-Arroyo I (2003) Changes in progesterone receptor isoforms content in the rat brain during the oestrous cycle and after oestradiol and progesterone treatments. J Neuroendocrinol 15(10):984–990
Inoue T, Akahira J, Suzuki T, Darnel AD, Kaneko C, Takahashi K et al (2002) Progesterone production and actions in the human central nervous system and neurogenic tumors. J Clin Endocrinol Metab 87(11):5325–5331
Brinton RD, Thompson RF, Foy MR, Baudry M, Wang J, Finch CE et al (2008) Progesterone receptors: form and function in brain. Front Neuroendocrinol 29(2):313–339
Chubak J, Tworoger SS, Yasui Y, Ulrich CM, Stanczyk FZ, McTiernan A (2004) Associations between reproductive and menstrual factors and postmenopausal sex hormone concentrations. Cancer Epidemiol Biomarkers Prev 13(8):1296–1301
Key TJ, Pike MC, Wang DY, Moore JW (1990) Long term effects of a first pregnancy on serum concentrations of dehydroepiandrosterone sulfate and dehydroepiandrosterone. J Clin Endocrinol Metab 70(6):1651–1653
Musey VC, Collins DC, Brogan DR, Santos VR, Musey PI, Martino-Saltzman D et al (1987) Long term effects of a first pregnancy on the hormonal environment: estrogens and androgens. J Clin Endocrinol Metab 64(1):111–118
Musey VC, Collins DC, Musey PI, Martino-Saltzman D, Preedy JR (1987) Long-term effect of a first pregnancy on the secretion of prolactin. N Engl J Med 316(5):229–234
Cetin I, Cozzi V, Antonazzo P (2008) Infertility as a cancer risk factor—a review. Placenta 29(Suppl B):169–177
Claus EB, Black PM, Bondy ML, Calvocoressi L, Schildkraut JM, Wiemels JL et al (2007) Exogenous hormone use and meningioma risk: what do we tell our patients? Cancer 110(3):471–476
Grunberg SM (1994) Role of antiprogestational therapy for meningiomas. Hum Reprod 9(Suppl 1):202–207
Grunberg SM, Weiss MH (1990) Lack of efficacy of megestrol acetate in the treatment of unresectable meningioma. J Neurooncol 8(1):61–65
Grunberg SM, Weiss MH, Spitz IM, Ahmadi J, Sadun A, Russell CA et al (1991) Treatment of unresectable meningiomas with the antiprogesterone agent mifepristone. J Neurosurg 74(6):861–866
Jaaskelainen J, Laasonen E, Karkkainen J, Haltia M, Troupp H (1986) Hormone treatment of meningiomas: lack of response to medroxyprogesterone acetate (MPA). A pilot study of five cases. Acta Neurochir (Wien) 80(1–2):35–41
Koide SS (1998) Mifepristone. Auxiliary therapeutic use in cancer and related disorders. J Reprod Med 43(7):551–560
Lamberts SW, Tanghe HL, Avezaat CJ, Braakman R, Wijngaarde R, Koper JW et al (1992) Mifepristone (RU 486) treatment of meningiomas. J Neurol Neurosurg Psychiatry 55(6):486–490
Matsuda Y, Kawamoto K, Kiya K, Kurisu K, Sugiyama K, Uozumi T (1994) Antitumor effects of antiprogesterones on human meningioma cells in vitro and in vivo. J Neurosurg 80(3):527–534
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cowppli-Bony, A., Bouvier, G., Rué, M. et al. Brain tumors and hormonal factors: review of the epidemiological literature. Cancer Causes Control 22, 697–714 (2011). https://doi.org/10.1007/s10552-011-9742-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-011-9742-7