Bone sarcoma risk

The estimated lifetime risk of being diagnosed with bone sarcoma is 1 in 1600 (less than 1%) for females, and 1 in 1600 (less than 1%) for males born in 1961 in the UK.¹

These figures have been calculated on the assumption that the possibility of having more than one diagnosis of bone sarcoma over the course of a lifetime is very low ('Current Probability' method).²

See also

Lifetime risk for all cancers combined and cancers compared

Bone sarcoma incidence statistics

How risk is calculated

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About this data

Data is for UK, past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961, ICD-10 C15.

Calculated by the Cancer Intelligence Team at Cancer Research UK, 2023 (as yet unpublished). Lifetime risk of being diagnosed with cancer for people in the UK born in 1961. Based on method from Esteve et al. 1994²

, using projected cancer incidence (using data up to 2018) calculated by the Cancer Intelligence Team at Cancer Research UK and projected all-cause mortality using data up to 2020, with adjustment for COVID impact) calculated by Office for National Statistics. Differences from previous analyses are attributable mainly to slowing pace of improvement in life expectancy, and also to slowing/stabilising increases in cancer incidence.

Last reviewed: 14 December 2023

International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.³

Exposure to ionising radiation increases bone sarcoma risk, and risk appears to increase in line with exposure levels, though most evidence is on absorbed doses between 5 and 20 Gray (Gy), and many studies define bone sarcoma by anatomical site rather than morphology.⁴

Typical sources of exposure are radiotherapy medical diagnostics (e.g. X-rays), and natural background radiation (e.g. radon.)⁵

Radiotherapy for cancer during childhood appears to have the greatest impact on bone sarcoma risk; however confounding is possible because much evidence includes populations with primary retinoblastoma, which in itself is associated with bone sarcoma risk.⁴

⁶ Childhood cancer survivors who received around 20Gy from radiotherapy have around 6-38 times higher bone sarcoma risk compared with those who had no radiotherapy or very low doses; bone sarcoma risk increases with radiation doses received.⁴⁶ Abdominal/pelvic radiotherapy during childhood is associated with 3.1 times increased bone tumour risk, compared with no radiotherapy; radiotherapy to other body sites showed no significant effect in a British cohort study.⁷

Radiotherapy for cancer (other than bone cancer) during adulthood is associated with 2.4 times increased risk of subsequent bone sarcoma compared to the general population analysis of US cancer registry data shows; with higher risk for those diagnosed at younger adult ages.⁴

The risk of osteosarcoma is increased by 5.1 times following radiotherapy, but chondrosarcoma risk is not significantly elevated.⁸ Bone sarcoma risk in patients with prior adult radiotherapy increases with longer time since diagnosis of the first cancer, and younger age at radiotherapy; there is also some evidence the risk varies by site of the primary cancer (hence the site of the radiotherapy).⁴

Atomic bomb survivors (who have lower overall levels of exposure than patients receiving radiotherapy) have around 7.5 times increased bone sarcoma risk per 1Gy exposure, a cohort study showed.⁹

Studies of radiotherapy at doses lower than 5Gy have generally found no increased bone sarcoma risk, but low sample sizes preclude firm conclusions.⁴

IARC classifies radioiodines, including Iodine-131, as possible causes of bone tumours, based on limited evidence.³

Iodine-131 is a radioactive isotope which can be used to treat hyperthyroidism and some types of thyroid cancer.

Exposure to computed tomography (CT) scans during childhood or adolescence is not associated with an increased risk of bone tumours, a large cohort study showed.¹⁰

See also

Find out more about the definitions and evidence for this data

Learn how attributable risk is calculated

Last reviewed: 1 October 2018

People with a parental or sibling history of bone cancer still have only a small risk of developing the disease themselves; less than 1% of bone cancer cases are in people with a first-degree relative with the disease, a large cohort study showed.¹¹

However, children whose sibling had Ewing sarcoma may have a 16.5 times increased risk of being diagnoses with the same disease; though this figure is based on very few patients so should be interpreted cautiously.¹²

Parent/sibling history of some other cancers is associated with increased bone cancer risk, particularly early-onset bone cancers, further evidence from the same cohort shows.¹²

Osteosarcoma risk overall is around doubled in people whose mother or father had rectal cancer or whose father had colon cancer, and increased by 3.6 times in those whose mother had endocrine gland cancer; in people aged under 25 osteosarcoma risk is threefold higher in people whose mother had melanoma, and 1.7 times higher in those whose mother had breast cancer; and in children osteosarcoma risk is around quadrupled when a parent had liver cancer, and doubled with the mother had breast cancer - with around a fivefold increase if the mother was under 45 at her diagnosis.¹² Ewing sarcoma risk too is linked with family history of kidney cancer, with risk 5.6 times higher in children of an affected parent.¹²

See also

Learn how attributable risk is calculated

See more information on how inherited genes can be a cause of cancer

Last reviewed: 1 October 2018

Genetic predisposition syndromes are associated with a small percentage of bone tumours, typically osteosarcomas.¹³

¹⁴

Li-Fraumeni syndrome is a very rare genetic condition associated with increased risk of osteosarcoma and other cancer types.¹⁵

It is usually caused by mutation in the tumour suppressor gene TP53, which is thought to affect 1 in 5,000-20,000 births in the general population.¹⁶ People with TP53 mutation have around 100 times the risk of bone tumours compared with the general population, and bone sarcomas are the most common tumour group in mutation carriers aged 11-20 years.¹⁵

Heritable (hereditary) retinoblastoma a rare eye cancer diagnosed in children, is caused by a mutation in the tumour suppressor gene RB1.¹⁷

Heritable retinoblastoma survivors have around 200 times increased risk of subsequent bone sarcoma, and more than 400 times increased risk of oesteosarcoma specifically, a British cohort study showed.¹⁸ The increased risk of bone sarcomas in this population is thought to be due to a combination of genetic susceptibility and radiotherapy for the primary cancer.¹⁷¹⁸

Hereditary multiple exostoses (also known as multiple osteochondromatosis or diaphyseal aclasis) is a rare (affecting up to 1 in 50,000 people) inherited musculoskeletal condition which causes short stature and deformity.¹⁹

In around 5% of people with this condition, benign bone lesions (osteochondromas) transform to chondrosarcomas, a cohort study showed.²⁰

Neurofibromatoses (NF) are a group of genetic conditions in which benign (non-invasive) growths affect the nervous system. NF type 1 (NF1) is thought to affect around 1 in 2,700 live births in the UK, whilst NF type 2 (NF2) affects around 1 in 33,000.²¹

There is some indication that people with NF1 have an increased risk of bone sarcoma.²²²³

The RecQ syndromes (Rothmund-Thomson, RAPADILINO, Werner and Bloom syndromes, and Diamond blackfan anaemia) are associated with osteosarcoma predisposition; these rare syndromes also cause growth retardation and dermatological changes.¹⁴

Osteosarcoma risk is higher in children and adolescents with Down's syndrome, a cohort study showed.²⁴

See also

Find out more about the definitions and evidence for this data

Learn how attributable risk is calculated

See more information on how inherited genes can be a cause of cancer

Last reviewed: 1 October 2019