Brain Tumors: Myths vs. Facts

There's a lot of fear surrounding the topic of brain tumors - much of it due to widespread myths and misinformation linking brain tumors to everything from cell phones to sweeteners. May is Brain Tumor Awareness Month, and a good time to separate facts from myths.

Host, Jonathan Fialkow, M.D., chief population health officer with Baptist Health, welcomes Michael McDermott, M.D. to the podcast to offer his substantial expertise on the topic.  Dr. McDermott is a neurosurgeon and chief medical executive at Baptist Health's Miami Neuroscience Institute and is considered the number-one expert in the world on meningiomas, the most common primary brain tumors in adults.

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Announcer:

At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist HealthTalk podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.

Dr. Fialkow:

Welcome back, Baptist HealthTalk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a preventative cardiologist and lipidologist at Baptist Health's Miami Cardiac and Vascular Institute, where I'm also chief of cardiology at Baptist Hospital and the chief population health officer at Baptist Health. May is brain tumor awareness month and that's the subject of today's podcast. It's a topic that's surrounded by a great deal of fear and misunderstanding caused in part by widespread myths and misinformation. One goal of this podcast is to bring to you up-to-date factual health information directly from top experts.

Dr. Fialkow:

So to help us bust some common myths about brain tumors, I'm pleased to welcome Dr. Michael McDermott, a neurosurgeon and chief medical executive at Baptist Health's Miami Neuroscience Institute. Dr. McDermott is considered the number one expert in the world on meningiomas, which are the most common primary brain tumor in adults and we'll be hearing more about those. Welcome to the podcast, Mike.

Dr. McDermott:

Thank you, Jonathan.

Dr. Fialkow:

So Mike, before we get through some of the myths and some of the things that my patients, you've been asked, to me as a cardiologist, and I'm sure things that you deal with on a regular basis that our listeners may experience or ask, tell us first about brain tumors in general. Tell us the difference between cancerous and benign brain tumors, and which are more frequent, give us a little information and background that you could about brain tumors.

Dr. McDermott:

Sure. So brain tumors are relatively uncommon. The malignancies occur in about seven patients per hundred thousand, benign tumors are about 16 per hundred thousand, and this is much less common than breast cancer. For example, one in 10, one in 15 women, much less common than prostate cancer in men over the age of 70 where the frequencies pretty much one in two, one in five. So brain tumors are relatively uncommon, and combining malignant tumors and benign tumors that's about 23 people per hundred thousand per year in the population and about 85,000 Americans per year countrywide. So still relatively uncommon condition.

Dr. Fialkow:

No, but it's scary. There're certain things we know that even though it's less likely people fear and they don't feel things in the more likely, why are people afraid of brain tumors? Why do it tend to resonate more with people? Is it certain that when you have a brain tumor it's going to be deadly? What are the differences could be brain tumors and maybe risks of death and survival rates?

Dr. McDermott:

Sure. So there, there is a big difference between a benign and a malignant tumor. And the malignant tumor is the most common form is a tumor from some other body part like lung cancer, breast cancer, melanoma, for example. And then there's primary malignancies that arise from the supporting cells of the brain called gliomas. Both of these types of tumors are very difficult to control but with therapies that can include surgery, radiation and chemo, patients can live better if not longer with standard treatment. I think one of the things as a surgeon that I realized that patients are most afraid of is the concept of a craniotomy. Most of us might regard with all respect to our cardiologists, that the brain is kind of the soul of what we believe is the highest order animal, which is homosapiens because we're the most advanced in terms of our brain development.

Dr. McDermott:

And everybody thinks that there's extremely high risk associated with brain surgery, but it's actually... It's not true. Granted I'm biased because that's part of my regular workday, but with modern techniques and technology, surgery can be extremely safe and very effective. So the benign tumors are not... They're a lifelong condition actually, but even with surgery benign tumors can't be quote cured forever and that's why the patients require long-term follow-up. There might be a 50% recurrence at 25 years after surgery and complete removal of a benign brain tumor. So... That's why we recommended the patients are vigilant with the follow-up recommendations of their doctors.

Dr. Fialkow:

Great information. Brain tumors, though scary, are not that frequent, certainly relative towards the population at large and other medical conditions. While benign tumors need to be treated and addressed, the survival rates are high and even with malignant brain tumors, there's lots of things we can offer patients to help them in terms of treatments and care.

Dr. Fialkow:

What about certain questions that people have regarding brain tumors? And this is maybe the bulk of the conversation regarding the myths. So I'll throw a couple of things at you. What about cell phones and microwaves? And I mean, we always hear about don't put the phones next to your ears causes brain tumors. Is there any, is there any data supporting that or maybe where does that come from?

Dr. McDermott:

No, I don't think so plus the information is confounded because on a daily basis we're exposed to all sorts of electromagnetic radiation coming first from the sun, cosmic radiation. And then just think about the radio frequency waves that are involved with cell phone transmission towers, electrical wires, radio stations, TV signal, etc. So I think there's a lot of different kinds of exposure. It'd be difficult to sort those things out but the key thing about cell phones is number one, the magnetic field induced by the battery or the incoming radio wave to the cell phone allows you to communicate, that energy is so low that there's not a chance it would penetrate the skull with any meaningful impact.

Dr. McDermott:

We know that concrete, which is used as a bunker around radiation therapy machines, relies on the presence of calcium as a great absorber. And, of course, the skull is made of calcium therefore, it'll be a great absorber of electromagnetic radiation of low energy. And if the energy from cell phones was that important, it should affect cells that are passing through the cell cycle on a regular basis and that is one of the most active cell types is the skin. We know that if you don't champion your hair, you get dandruff, those are dead cells debris. And if cell phones were important for brain tumors, we'd have a lot higher incidence of different types of skin cancer, the ear related to cell phone use, and we don't see that.

Dr. Fialkow:

So it's good to know that evolution anticipated cell phones and thick skull to prevent brainwaves coming in. How about dental x-rays something that again comes up quite a bit. And I think of myself, what any relationship between dental x-rays and a benign or malignant brain tumors?

Dr. McDermott:

No. I mean, with current modern technology, the dose related to imaging of your dentition is extremely low. Epidemiologists and the principal author for that study was Elizabeth Claus, who's a neurosurgeon, looks at epidemiologic factors associated with brain tumor development and acknowledges that with the old technology, big large volume feels old fashion or radiation techniques, same kind of machine that you would have an x-ray of your hip for. The dose to the brain with those techniques was much higher than it is now.

Dr. McDermott:

So I went on record for the American Dental Association through my own personal dentist to say that, with current techniques, the risk profile with dental x-rays is trivial and so small that it shouldn't really be considered a risk factor. And one of the things that you deal with, Jonathan, with cardiac disease is assessment of relative risk and recommending treatment. I have to do the same thing with my patients and the great quote that I always like, as you know, they're worried about long-term effects, and I said, well the risk of death driving your car is one in 7,000 per year. And that's my chire over 20 year period than your risk of getting a secondary brain tumor from dental x-ray exposure.

Dr. Fialkow:

Slipping in the shower and cracking your head, and these are the things that we put ourselves at risk for regularly. So a few other ones before we take it to a different... To talk about some of the things where symptoms, treatments, artificial sweeteners. Again going back to my youth, any relationship between these artificial sweeteners that are prevalent in our diet right now. And after that, any other dietary components that have been associated with an increased risk of brain tumors.

Dr. McDermott:

So no evidence currently that artificial sweeteners cause brain tumors, benign, or malignant. No evidence that any type of diet, low cocker, low selenium, a keto diet has any effect on brain tumors. No evidence that laying on of hands has any effect on brain tumor progression. So I was jokingly say, the patients will always ask me about diet and my recommendation is tongue in cheek, no bad food, and no bad wine.

Dr. Fialkow:

If it were only that easy. How about the brain tumors are on families? If a family, if there's a... If someone, a family has a brain tumor, whether it malignant or benign, is family members at an increased risk of the same kind of outcome?

Dr. McDermott:

Well, most brain tumors are sporadic. There are certain genetic conditions like neurofibromatosis which are inherited, Von Hippel-Lindau syndrome associated with human [crosstalk 00:10:25].

Dr. Fialkow:

That was the old elephant man's.

Dr. McDermott:

Yes, there's a two types. NF1 which is elephant man, which is peripheral, and NF2, which is associated with increased incidence of central brain tumors, vestibular schwannoma, meningiomas, and gliomas. But in general, you need to have at least two first degree relatives to think that there might be some associated risk, particularly when you're talking about gliomas, but even for meningiomas, most of these are sporadic. We don't know the exact cause, we know what the molecular profile is, but we don't know that molecular profile is always associated in other individuals with a development of the tumor.

Dr. Fialkow:

Do brain tumors only happen in older people across the age spectrum?

Dr. McDermott:

No. It turns out that, between the ages of one and four, brain tumors are the most common solid organ tumor, which is surprising and obviously devastating [crosstalk 00:11:23]

Dr. Fialkow:

Still rare.

Dr. McDermott:

Yes, rare but surprisingly the most common solid tumor in ages, the pediatric young age group. In adult patients, as we progress in age, obviously we have more exposures to DNA hits if you want to call it that and those are multiple, the incense of primary and secondary malignancies increases.

Dr. Fialkow:

So let's take the conversation to a different direction for the last few minutes. I know this is kind of a loaded question because it's so broad and semi so vague. What are the symptoms that one may experience that might suggest they want to be evaluated for a possible brain tumor and the second part of that is, when one has these symptoms, what's the likelihood it's a brain tumor because I think some of them are going to be things that people experience on a regular basis, not related to brain tumors.

Dr. McDermott:

Right, so no matter what the brain tumor type, the four most common symptoms are headache, seizures, progressive focal neurologic deficit, or change in personality or behavior. Now one headache over two days, it's not a brain tumor. A headache that lasts five, seven days, worse in the morning when you wake up then the evening, headache associated with nausea and vomiting in the morning when you first wake up, relieved by the vomiting actually, those are... That's a headache to be concerned about, but the overwhelming majority of us suffer what we call tension or common migraine headaches and those are ubiquitous and very common.

Dr. McDermott:

And that's not an indication to consider doing a scan to rule out a brain tumor for a patient has a headache one day. Now, there are other types of headache which are acute, sudden onset, worst headache of your life, nausea, vomiting, altered consciousness, those are vascular events. And so we worry about intracranial hemorrhage or subarachnoid hemorrhage. In those cases, those are emergencies. So those patients would be going straight away, even without their own volition to the emergency department, they'd be altered and their family members would call 911 and take them in.

Dr. Fialkow:

So certainly seizure is certainly a weakness of a part of your body or an ability to speak and whatnot. These are things that you want to evaluate right away. Still may not be a brain tumor, but those you don't want to wait for. But I think the headache was the important component, as you said, and most headaches are not brain tumors. Some of the qualifications on the headache again, if it's sore at the back of your neck after you wake up in the morning, you can touch it and rub it or whatnot, more likely muscular, but if you have that severe headache lasting for several days, certainly get it checked out. So with all the information we've gleaned over decades of medical care and science and with your expertise in brain tumor assessment, and more importantly treatment, what services and what are the components of the Miami Neuroscience Institute that make it a leader in evaluation and treatment of brain tumors?

Dr. McDermott:

Well, I think our group includes neurosurgeons, neurologists, neuroradiologists, physiatrists, physical therapists, rehab physicians. I think the important thing is having the individuals who are capable of assisting with confirming a diagnosis by history and physical first, and then we have the appropriate imaging studies, which we do. And then once the diagnosis is made, recommendations for treatment should be evidence-based not, not opinion-based. And I think we try and support that approach. We have a multidisciplinary tumor board for newly diagnosed patients in cooperation with radiation oncologists and neuro-oncologists at the Miami Cancer Institute. And all new patients get presented there for discussion about the best form of treatment and options of treatment. Once, for example, if it's a malignancy for example, after surgery, radiation therapy and chemotherapy can be done. And I must say one of the attractions bringing me to Miami was the cancer institute and the department of radiation oncology because about 30% of my practice, and San Francisco, was radiosurgery.

Dr. McDermott:

And there's no place like the cancer institute in the world with the delivery systems that they have protons, photon delivery systems, multiple linear accelerators, CyberKnife, TomoTherapy, Gamma Knife, MR-linac, and we were just approved to acquire something, another self shielded linear accelerator called the ZAP, which might have great utility for the developing world because you don't have to build the bunker, concrete bunker like I was talking about earlier to absorb the radiation. I think it is absorbed by the steel frame. So I think there's a lot of technology on the operative side, we have all the abilities to do intraoperative, awake, speech mapping, sleep, motor mapping. We also have engaged in and a company called Omniscient, which has a program called Quicktome. So we can actually display all the association subcortical white matter, fiber tracts, and cortical functional areas on the image guided systems that we use for surgery.

Dr. Fialkow:

So multidisciplinary approach to the patient, personalized approach to the patient, using state-of-the-art technologies instead of the medical expertise. And also, I think what's unique is also the care of the patient even after a surgery or a treatment. So we're really dealing with survivorship and the impact as well, which makes it very unique, and we're certainly pleased and an honor to have you join us and help us build a program around those methodologies and philosophies. Great stuff, Mike, and again, brain tumors are serious, though rare, treatment options are extensive not necessarily happening with age; headache, as the most common sign and symptom but at the same time, a unique kind of headache lasting for a long time, nausea. So most people, the headaches should not be thinking it's a brain tumor first-line. We don't want to scare people unnecessarily. Any final thoughts or anything you want to mention before we wrap up?

Dr. McDermott:

No, I just that... I think the future for the patients of Miami and South Florida is great because there's developing facilities, technologies, and as you said, expertise, to ensure that they get the state-of-the-art treatment and the most appropriate treatment for their condition.

Dr. Fialkow:

Well said, thanks again Dr. Michael McDermott, a neurosurgeon, chief medical executive at Baptist Health Miami Neuroscience Institute. To our listeners, you've listened to us talk and now we'd love to hear from you. If you have any comments or suggestions for future topics, please email us at baptisthealthtalk@baptisthealth.net that's baptisthealthtalk@baptisthealth.net. Before you go, please take a moment to subscribe and give this podcast a five star rating on whichever platform you listen to us on. Until next time, stay safe and mask on.

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