Prevention of brain tumors: environmental risk factors, occupational exposures, and public health strategies—A narrative review encompassing primary, secondary, and tertiary prevention

Abstract

Primary brain tumors represent a significant public health burden, with increasing incidence rates globally, yet prevention strategies remain underdeveloped compared to other malignancies. This narrative review examines brain tumor prevention through a preventive medicine lens, analyzing established and suspected environmental risk factors, occupational exposures, and potential prevention interventions across all three levels of prevention. We explore the epidemiology of primary brain tumors, including gliomas, meningiomas, and other central nervous system neoplasms, with emphasis on modifiable risk factors amenable to population-level intervention. Ionizing radiation represents the only definitively established environmental risk factor, informing radiation protection policies in medical, occupational, and military settings. Emerging evidence suggests potential associations with pesticide exposures, electromagnetic field exposures, and certain occupational exposures, though findings remain inconsistent and require further investigation and precautionary approaches. While primary prevention constitutes the central focus of this review, secondary prevention through hereditary syndrome surveillance and tertiary prevention through survivorship care are examined to provide a comprehensive prevention framework. Special attention is given to the Saudi Arabian context, including epidemiological comparisons with global data, occupational exposure patterns, radiation safety infrastructure, and integration with Vision 2030 cancer prevention priorities. While definitive prevention strategies remain limited by incomplete etiological understanding, existing evidence supports strengthening radiation protection, reducing pesticide exposures, and enhancing occupational health surveillance. We provide recommendations for preventive medicine specialists, neuro-oncologists, and public health practitioners to develop evidence-based strategies protecting population brain health.