Risks for childhood bone cancer

A risk factor is something that increases the risk of developing cancer. It could be a behaviour, substance or condition. Most cancers are the result of many risk factors. But sometimes bone cancer develops in children who don’t have any of the risk factors described below.

Osteoscarcoma

Osteosarcoma is the most common type of bone cancer in children. The chance that this cancer will develop is highest during the growth spurt in the teenage years. It occurs slightly more often in boys and in children of African ancestry.

The following are known risk factors for childhood osteosarcoma. All of these risk factors are not modifiable. This means that you can’t change them. Until we learn more about these risk factors, there are no specific ways to reduce the risk of childhood osteosarcoma.

Risk factors are generally listed in order from most to least important. But in most cases, it is impossible to rank them with absolute certainty.

Research shows that that there is likely no link between fluoride and a higher risk of osteosarcoma.

Genetic syndromes

Genetic syndromes are diseases or disorders caused by a change (mutation) in one or more genes. Having the following genetic syndromes can increase a child’s risk of developing osteosarcoma.

 

Familial retinoblastoma is an inherited form of retinoblastoma, which is an eye cancer that occurs in children. It can be passed from parents to a child. Children with the familial retinoblastoma have a higher risk of developing osteosarcoma and soft tissue sarcoma.

Li-Fraumeni syndrome greatly increases the risk of developing several types of childhood cancer, including osteosarcoma, rhabdomyosarcoma and other soft tissue sarcomas, breast cancer, brain tumours and leukemia.

Rothmund-Thomson syndrome affects a child’s growth and causes skeletal problems and skin rashes. Children with this syndrome are more likely to develop osteosarcoma.

Werner syndrome causes children to age very rapidly after puberty. It increases a child’s risk of developing osteosarcoma and other cancers.

Bloom syndrome is caused by a large number of abnormal chromosomes. Children with Bloom syndrome are usually smaller than average, have a high-pitched voice and a characteristic facial appearance. Bloom syndrome increases the risk of developing osteosarcoma and other childhood cancers, including leukemia and Wilms tumour.

Previous radiation therapy

Children who had radiation therapy have a higher risk of developing osteosarcoma in the area that was treated. The risk is greater if higher doses of radiation therapy were used and if the child was treated at a young age. Osteosarcoma typically develops 5–20 years after radiation therapy.

Previous chemotherapy

Children who had certain types of chemotherapy have a higher risk of developing osteosarcoma. This risk may be even higher if the child also received radiation therapy.

Certain bone diseases

Children with Paget disease of the bone or other bone diseases have a higher risk of developing osteosarcoma later in life (usually as an adult).

Ewing sarcoma

Ewing sarcoma is the 2nd most common bone tumour in children. It usually develops during the teenage years and is slightly more common in boys than in girls. Ewing sarcoma is significantly less common in children of African ancestry than those of any other ancestry.

There are no known risk factors for Ewing sarcoma.

Questions to ask your healthcare team

Ask your child’s healthcare team questions about risks.

Expert review and references

  • Archer NP, Napier TS, Villanacci JF . Fluoride exposure in public drinking water and childhood and adolescent osteosarcoma in Texas. Cancer Causes and Control. 2016.
  • Bassin, E. B., Wypij, D., Davis, R. B., et al . Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes & Control. Springer; 2006.
  • Blakey K, Feltbower RG, Parslow RC, James PW, Gomez PB, et al . Is fluoride a risk factor for bone cancer? Small area analysis of osteosarcoma and Ewing sarcoma diagnosed among 0-49 year olds in Great Britain, 1980-2005. International Journal of Epidemiology. 2014.
  • Gorlick R, Bielack S, Teot L, et al . Osteosarcoma: biology, diagnosis, treatment, and remaining challenges. Pizzo, P. A. & Poplack, D. G. (Eds.). Principles and Practice of Pediatric Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2011: 34: pp. 1015-1044.
  • Hawkins DS, Bolling T, Dubois S . Ewing sarcoma. Pizzo, P. A. & Poplack, D. G. (Eds.). Principles and Practice of Pediatric Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2011: 33: pp. 987-1014.
  • International Agency for Research on Cancer (IARC). Volume 75: Ionizing Radiation Part 1: X- and Gamma (y)-Radiation, and Neutrons. 2000: http://monographs.iarc.fr/ENG/Monographs/vol75/mono75.pdf.
  • International Agency for Research on Cancer (IARC). Volume 100D: Radiation: a review of human carcinogens. 2011: http://monographs.iarc.fr/ENG/Monographs/vol100D/mono100D.pdf.
  • Levy M, and Leclerc BS . Fluoride in drinking water and osteosarcoma incidence rates in the continental United States among children and adolescents. Cancer Epidemiology. Elsevier; 2012.
  • Miller RW, Boice JD, Jr & Curtis RE . Bone cancer. Schottenfeld, D. & Fraumeni, J. F. Jr. (eds.). Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press; 2006: 48: pp. 946-958.
  • Ross, J.A. & Spector, L.G . Cancers in children. Schottenfeld, D. & Fraumeni, J. F. Jr. (Eds.). Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press; 2006: 65: 1252-1268.
  • Wang LL, Yustein J, Louis C, et al . Solid tumors of childhood. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011: 123: pp. 1760-92.