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TBI increases risk of brain cancer



A new study has found that moderate or severe and penetrating traumatic brain injury (TBI) were associated with the subsequent development of brain cancer.

The study, published in JAMA, explored traumatic brain injury and the subsequent risk of brain cancer in more than 1.9 million US veterans of the Iraq and Afghanistan wars.

The research team highlights that primary brain cancer is a relatively rare diagnosis, with the most common brain cancer being glioblastoma. As there is a low incidence of this form of cancer, the researchers note that there is limited evidence regarding potential risk factors. 

The authors write: “One proposed exposure that might increase the risk of brain cancers is traumatic brain injury. However, the current body of evidence with respect to TBI and subsequent brain cancer is conflicting. Some studies have suggested that brain cancer is associated with prior TBI, while other studies have not observed such an association.”

To find out more about this theory, the team set out to examine whether a history of TBI exposure is associated with the subsequent development of brain cancer.

TBI in veterans

Around 20% of Iraq and Afghanistan veterans have experienced a TBI during their service, an injury associated with other health problems such as cardiovascular disease, dementia, epilepsy, and poor mental health.

However, the researchers emphasise that the potential association between TBI and brain cancer has not been examined in a veteran cohort.

This long-term study was conducted from October 1, 2004, to September 20, 2019, and data analysis was performed between January 1 and June 26, 2023, with the median follow-up for the cohort being 7.2 years. 

When analysing the data, the team used standard descriptive statistical tests to compare the baseline characteristics of veterans who did vs did not have an episode of TBI, then used Fine-Gray competing risks models to evaluate the potential risk imparted by TBI on subsequent brain cancer, accounting for the risk of death not associated with brain cancer. 

The team also adjusted for demographic characteristics including age at index date, sex, race and ethnicity, service branch, rank, and component in a nested fashion. 

The results showed that moderate or severe and penetrating traumatic brain injury were associated with the subsequent development of brain cancer, however, mild TBI was not associated with later brain cancer diagnoses. 

The authors wrote: “Given the rarity of brain cancer diagnoses, the main strength of our study was the large size of the cohort, which was followed up for an extended period of time.” 

However, they note several limitations to the study including the inability to control for other potential confounders such as toxic exposures, the results are from predominantly young males which may not translate to the population as a whole, and many veterans were excluded from the study, among other points.

The team concludes that, given how common TBI is during military service, further research is needed to better identify those at risk and develop screening protocols.