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Risks and causes of bone cancer

Men and women discussing bone cancer

This page tells you about the possible risk factors for bone cancer and possible causes. There is information below about

 

A quick guide to what's on this page

Risks and causes of bone cancer

Primary bone cancer is a very rare cancer. It is most common in young people, which is unusual for cancers. Osteosarcoma is the most common type of bone cancer and is generally diagnosed in teenagers or young adults. It is very rare before the teenage years. Numbers rise again after the age of 60. This is mainly because people with Paget’s disease of the bone have a slightly increased risk of bone cancer and Paget’s disease occurs mainly in people over the age of 60.

Another type of bone cancer is called Ewing’s sarcoma. It is also most common between 10 and 20 years old. Other, rarer, types of bone cancer are most often diagnosed in middle age.

Injuries and knocks

People may think that a knock or injury to a bone can cause cancer. But it is more likely that an injury shows up a cancer that is already there. Or that a bone affected by cancer may be weakened and so is more likely to become damaged in an accident.

Other causes of bone cancer

We don’t know exactly what causes bone cancer, but we do know of several factors that increase the risk of developing it. These factors include exposure to radiation, treatment with some chemotherapy drugs, certain bone diseases, and some rare inherited genetic conditions.

 

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How common bone cancer is

Primary bone cancer is very rare. Around 550 cases are diagnosed in the UK each year. Most of these cases are made up of two main types of bone cancer – osteosarcomas and Ewings sarcomas. The rest are mostly spindle cell sarcomas and chondrosarcomas. A handful of cases (around 20) are chordomas

Fewer than 1 in 500 cancers diagnosed in the UK are bone cancers (0.2%). More males are diagnosed with primary bone cancer than females.

 

What a risk factor is

A risk factor is anything that can increase your chance of developing a disease. Different cancers have different risk factors. We don’t know what causes most cases of bone cancer. But there are some factors that may increase your risk of developing bone cancer.

Remember that having one or more risk factors does not mean that you will definitely get a bone cancer. Many people with one or more risk factors never get it. And sometimes people with no risk factors may develop it. Risk factors are only a guide to what may increase the risk.

Not all the factors mentioned below increase your risk of bone cancer. We have included some because people commonly believe that they increase the risk but research has shown that they don't.

 

Age

Unusually for cancer, bone cancer is most common in younger people. Osteosarcoma is generally diagnosed in teenagers or young adults. It is very rare before teenage years and seems to be linked to growth of the bones during puberty. There is also a rise in incidence of osteosarcoma after the age of 60. This is mainly because people with Paget's disease have a slightly increased risk of developing osteosarcoma and Paget's disease occurs mainly in people older than 60.

A type of bone cancer called Ewing's sarcoma is most common in young people between 10 to 20 years of age. But it can occur in children and older adults. Chondrosarcomas and spindle cell sarcomas tend to occur mostly in adults over the age of 40. Chordomas occur mostly in adults between 40 to 60 years of age.

 

Injuries and knocks

People often think that a knock or injury to a bone can cause a cancer. But research studies do not support this. It is more likely that an injury causes swelling, which shows up a cancer that is already there. Or a bone affected by cancer may be weakened and so is more likely to become damaged in an accident. Doctors may then spot the tumour when they are investigating your accident.

 

Cancer treatments

Exposure to radiation can cause bone cancer. If you have had radiotherapy in the past to an area of the body that includes bones, you have an increased risk of getting an osteosarcoma in that area. This is a very small risk for most people. The greatest risk is for people treated at a young age with high doses of radiotherapy. Only 1 person in several hundred treated with radiotherapy will get a bone cancer.

Treatment with some chemotherapy drugs increases the risk of osteosarcoma by up to 8 times, depending on the dose and the drug. These drugs include cyclophosphamide, melphalan, lomustine (CCNU), procarbazine and cisplatin.

People who have had treatment for retinoblastoma and soft tissue sarcoma have an increased risk of bone cancer. One study estimated that over a 20 year period, 12% of retinoblastoma patients and 3% of soft tissue sarcoma patients would go on to develop osteosarcoma. This may not always just be because of cancer treatment though. In retinoblastoma, it may also be linked to gene changes that increase the risk of osteosarcoma and other cancers.

We know from some studies that people have a small increased risk of bone cancer after treatment for Hodgkin lymphoma, non Hodgkin lymphoma, brain tumours, spinal cord tumours, Wilm’s tumour and leukaemia.

 

Other bone diseases

Some types of bone disease can increase the risk of bone cancer. If you have had Paget’s disease of the bone, you have a slightly increased risk of getting an osteosarcoma. This occurs in people older than 60 years.

If you have a type of benign (non cancerous) bone tumour called a chondroma or osteochondroma, you have an increased risk of getting a type of bone cancer called chondrosarcoma.

A rare condition called Ollier's disease (also called enchondromatosis) increases the risk of developing a chondrosarcoma. People with Ollier's disease develop many non cancerous (benign) tumours in their bones. Around 3 out of 10 people with this condition (30%) will develop chondrosarcoma. 

Maffucci's syndrome is a condition similar to Ollier's disease in which people have non cancerous tumours in their bones, as well as abnormally shaped bones. Between 2 to 4 out of 10 people with Maffucci's syndrome (20 to 40%) develop chondrosarcoma.

 

Genetic factors

A condition called Li-Fraumeni syndrome runs in families. It is caused by a gene fault inherited from your parents. If you have Li-Fraumeni syndrome, you have an increased risk of several cancers, including bone cancer. 

There is a type of eye cancer also caused by faulty genes. It is called hereditary retinoblastoma. Children with this gene fault also have an increased risk of osteosarcoma.

Another rare genetic condition called HME (hereditary multiple exostoses) can increase the risk of developing a chondrosarcoma later in life.

People with a mother diagnosed with breast cancer before the age of 45 have almost 5 times the risk of bone cancer compared to the general population. But because bone cancers are relatively rare this is still a small risk.

Some people who have relatives with particular types of cancer have an increased risk of certain types of bone cancer but this is very rare. This includes

  • Osteosarcoma in people whose father had prostate cancer
  • Giant cell sarcoma in people whose mother had breast cancer
  • Osteosarcoma in people with a parent who had rectal cancer or liver cancer
  • Ewing’s sarcoma in people with a parent who had kidney cancer
  • Ewing's sarcoma in people who have a first degree relative with melanoma, stomach, brain or bone cancer

A first degree relative is someone in your family with the most direct connection to you. So that means your mother, father, brother or sister, or child.

 

Ethnicity

A study of Ewing’s sarcoma over a period of 30 years in America showed that white Americans have a risk of this type of bone cancer that is nine times higher than black Americans. It is not clear why this is.

 

Being born with a hernia

Children born with a hernia of the tummy button (a congenital umbilical hernia) are 3 times more likely to have a Ewing’s sarcoma. An umbilical hernia is caused by a weakness of the muscle around the belly button. Researchers think as the embryo grows, factors that contribute to an umbilical hernia also make the child more likely to develop a Ewing's sarcoma.

 

The work your parents do

Some studies have shown that if one of your parents worked on a farm when your mother became pregnant, or while she was expecting you, you may have a slightly increased risk of getting Ewing’s sarcoma in childhood. Not all the research studies agree, though, so we can't be sure that this is a risk factor for Ewing’s sarcoma.

One study has shown an increased risk of osteosarcoma and chondrosarcoma in adults who have been exposed to pesticides in their work. But this is just one study and we need more evidence before we can say whether pesticides are a risk factor for bone cancer.

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Updated: 27 January 2014