Risks and causes of bone cancer

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Risks and causes of bone cancer
Last updated 15 December 2008
Cancer Research UK

This page tells you about the possible risk factors for bone cancer and possible causes. We do not know exactly what causes cancer of the bone, but several risk factors have been identified. There is information below on

How common bone cancer is
Age
Injuries and knocks
Cancer treatment as a risk factor
Other bone diseases as a risk factor
Genetic factors
Congenital umbilical hernias
Parental occupation
How common bone cancer is
Primary bone cancer is very rare. Around 500 cases are diagnosed in the UK each year. About 150 of these are osteosarcomas, around 100 are Ewings sarcomas, 80 are spindle cell sarcomas and 80 chrondrosarcoma. Around 20 cases are chordomas. If you compare this with almost 46,000 breast cancers diagnosed each year, you will see how uncommon primary bone cancer is. It accounts for only 2 in every 1,000 cancers diagnosed (0.2%). More males are diagnosed with primary bone cancer than females.

Age
Unusually for cancer, bone cancer is most common in younger people. Osteosarcomas are generally diagnosed in teenagers or young adults. It is very rare before teenage years and seems to be associated with growth of the bones during puberty. There is also a rise in incidence of osteosarcoma after the age of 50. This is mainly because people with Paget's disease have a slightly increased risk of developing osteosarcoma.

A type of bone cancer called Ewing's sarcoma is also most common between 10 to 20 years old. 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 there is no evidence for 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. The accident may then make your doctors aware of the tumour.

Cancer treatment as a risk factor
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 (including cyclophosphamide, melphalan, caryolysine, CCNU, procarbazine, cisplatinum) increases the risk of osteosarcoma by up to eight times depending on the dose given.

People who have had treatment for retinoblastoma, Ewing’s sarcoma, and soft tissue sarcoma have an increased risk of developing bone cancer. One study estimated that over a 20 year period, 12% of retinoblastoma patients, 7% of Ewing’s sarcoma patients and 3% of soft tissue sarcoma patients would go on to develop osteosarcoma. In retinoblastoma, this is probably due to gene changes that increase the risk of osteosarcoma and other cancers, combined with the effect of treatment.

Some studies have shown a small increase in risk of bone cancer following treatment for Hodgkin’s disease, non-Hodgkin’s lymphoma, central nervous system tumours, Wilm’s tumour and leukaemia.

Other bone diseases as a risk factor
Two other bone diseases that are not cancer are related to bone cancer risk. 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. This is particularly likely if you have the rare, inherited condition called HME (hereditary multiple exostoses).

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 tumours in their bones and around 3 out of 10 people with this condition (30%) will develop chondrosarcoma. Maffucci's syndrome is a similar condition 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
If you have a condition called Li-Fraumeni syndrome, you have an increased risk of several cancers, including bone cancer. Li-Fraumeni syndrome runs in families. It is caused by an inherited gene defect.

A type of eye cancer that affects children is also caused by faulty genes, It is called hereditary retinoblastoma and children with this gene defect 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 an almost five times increased risk of bone cancer.

This is very rare but some people who have relatives with particular types of cancer have an increased risk of certain types of bone cancer, including

Prostate cancer in fathers and osteosarcoma
Breast cancer in mothers and giant cell sarcoma
Rectal cancer in a parent and osteosarcoma
Liver cancer in a parent and osteosarcoma
Kidney cancer in a parent and Ewing’s sarcoma
Melanoma, stomach, brain and bone cancer in a first-degree relative and Ewing’s sarcoma
Congenital umbilical hernias
Children who have congenital umbilical hernias are three times more likely to have a Ewing’s sarcoma than children who do not have umbilical hernia. An umbilical hernia is 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.

Parental occupation
Some studies have shown that if your mother or father worked in a farm related job during your conception or your mother's pregnancy your risk of being diagnosed with Ewing’s sarcoma in childhood is increased three times. A few studies support this association but others have not shown an increase in risk so it is difficult to be sure that it is a risk factor for Ewing’s sarcoma.

Copyright Cancer Research UK 2002