Risk Factors for Bone Cancer

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for cancers of the lung, mouth, larynx, bladder, kidney, and several other organs. But having a risk factor, or even several, does not mean that you will get the disease. Most people with bone cancers do not have any apparent risk factors.

Genetic disorders

A very small number of bone cancers (especially osteosarcomas) appear to be hereditary and are caused by defects (mutations) in certain genes. Retinoblastoma is a rare eye cancer in children that can be hereditary. The inherited form of retinoblastoma is caused by a mutation (abnormal copy) of the RB1 gene. Those with this mutation also have an increased risk of developing bone or soft tissue sarcomas. Also, if radiation therapy is used to treat the retinoblastoma, the risk of osteosarcoma in the bones around the eye is even higher.

Finally, there are families with several members who have developed osteosarcoma without inherited changes in any of the known genes. The gene defects that may cause cancers in these families haven’t been discovered yet.

Chondrosarcomas

Multiple exostoses (sometimes called multiple osteochondromas) syndrome is an inherited condition that causes many bumps on a person’s bones. These bumps are made mostly of cartilage. They can be painful and deform and/or fracture bones. This disorder is caused by a mutation in any one of the 3 genes EXT1, EXT2, or EXT3. Patients with this condition have an increased risk of chondrosarcoma.

An enchondroma is a benign cartilage tumor that grows into the bone. People who get many of these tumors have a condition called multiple enchondromatosis. They have an increased risk of developing chondrosarcomas.

Chordomas

Chordomas seem to run in some families. The genes responsible have not yet been found, but familial chordoma has been linked to changes on chromosome 7.

Patients with the inherited syndrome tuberous sclerosis, which can be caused by defects (mutations) in either of the genes TSC1 and TSC2, seem to have a high risk of chordomas during childhood.

Paget disease

Paget disease is a benign (non-cancerous) but pre-cancerous condition that affects one or more bones. It results in formation of abnormal bone tissue and occurs mostly in people older than 50. Affected bones are heavy, thick, and brittle. They are weaker than normal bones and more likely to fracture (break). Most of the time, Paget disease is not life threatening. Bone cancer (usually osteosarcoma) develops in about 1% of those with Paget disease, usually when many bones are affected.

Radiation

Bones that have been exposed to ionizing radiation may also have a higher risk of developing bone cancer. A typical x-ray of a bone is not dangerous, but exposure to large doses of radiation does pose a risk. For example, radiation therapy to treat cancer can cause a new cancer to develop in one of the bones in the treatment area. Being treated when you are younger and/or being treated with higher doses of radiation (usually over 60 Gy) increases your risk of developing bone cancer.

Exposure to radioactive materials such as radium and strontium can also cause bone cancer because these minerals build up in bones.

Non-ionizing radiation, like microwaves, electromagnetic fields from power lines, cellular phones, and household appliances, does not increase bone cancer risk.

Bone marrow transplantation
Osteosarcoma has been reported in a few patients who have undergone bone marrow (stem cell) transplantation.

Injuries

People have wondered if injury to a bone can cause cancer. This has never been proven. Many people with bone cancer remember having hurt that part of their bone. Most doctors believe that these injuries did not cause the cancer. Instead, the cancer caused people to remember the incident or that the injury drew their attention to that bone, making them notice a problem that had already been present for some time.