A risk factor is anything that affects your chance of getting a disease such as cancer. Lifestyle-related risk factors are important in many cancers in adults. Examples of lifestyle-related risks include obesity, unhealthy diets, not getting enough exercise, smoking, and drinking too much alcohol. But unlike many adult cancers, lifestyle-related risk factors do not seem to play a large role in childhood cancers, including childhood osteosarcomas. So far, lifestyle-related factors have not been linked to osteosarcomas in adults, either.
Age
The risk of osteosarcoma is highest during the teenage "growth spurt." This suggests there may be a link between rapid bone growth and risk of tumor formation. The risk goes down in young adults, but rises again in older adults (usually over the age of 60). Osteosarcoma in older adults is often linked to another cause, such as a long-standing bone disease.
Height
Children with osteosarcoma usually are tall for their age. This is another indication that osteosarcoma may be related to rapid bone growth.
Gender
Osteosarcoma is more common in males than in females. Females tend to develop it at a slightly earlier age, possibly because they tend to have their growth spurts earlier.
Race/ethnicity
Osteosarcoma is slightly more common in African Americans than in whites.
Radiation to bones
People who were treated with radiation therapy for another cancer may have a higher risk of later developing osteosarcoma. Being treated at a younger age and being treated with higher doses of radiation both increase the risk of developing osteosarcoma.
It is not clear if imaging tests that use radiation, such as x-rays, CT scans, and bone scans, raise the risk of developing osteosarcoma. The amount of radiation used for these tests is many times lower than that used for radiation therapy. If there is any increased risk it is likely to be very small, but doctors try to limit the use of these types of tests in children whenever possible, just in case.
Certain bone diseases
People with certain non-cancerous bone diseases have an increased risk of developing osteosarcoma.
Paget disease of the bone: This is a condition that causes abnormal bone tissue to form in one or more bones. It mostly affects people older than 50. Affected bones are heavy and thick but are weaker than normal bones and are more likely to break. Usually this condition by itself is not life-threatening. But bone sarcomas (mostly osteosarcoma) develop in about 1% of people with Paget disease, usually when many bones are affected.
Multiple hereditary osteochondromas: Osteochondromas are benign bone tumors formed by bone and cartilage. Each osteochondroma has a very slight risk of developing into an osteosarcoma. Most osteochondromas are cured by surgery. However, some people inherit a tendency to develop many osteochondromas, and it may not be possible to remove them all. The more osteochondromas a person has, the greater the risk of developing osteosarcoma.
Inherited cancer syndromes
Children with certain rare, inherited cancer syndromes have an increased risk of developing osteosarcoma.
- Retinoblastoma is a rare eye cancer of 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, including osteosarcoma. If radiation therapy is used to treat the retinoblastoma, the risk of osteosarcoma in the bones around the eye is even higher.
- The Li-Fraumeni syndrome makes people much more likely to develop several types of cancer, including breast cancer, brain cancer, osteosarcoma, and other types of sarcoma. Most of those cases are caused by a mutation of the TP53 tumor suppressor gene.
- Another syndrome that includes bone cancer is the Rothmund-Thompson syndrome. Children with this syndrome are short and tend to have skeletal problems and rashes. They also are more likely to develop osteosarcoma. This syndrome is caused by abnormal changes in the REQL4 gene.
- Other rare inherited conditions, including Bloom syndrome and Werner syndrome, have also been linked to an increased risk of osteosarcoma.
The way in which inherited DNA changes make certain people more likely to develop osteosarcoma is explained in the section, “Do we know what causes osteosarcoma?”
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