Risk factors 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.


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.


The part of a cell that contains DNA (genetic information).

In humans, each cell contains 23 pairs of chromosomes or 46 chromosomes in total.

Paget disease of the bone

A condition that affects the bone so that it breaks down and regrows faster than normal. Signs and symptoms include pain, deformities and fractures (breaks). Paget disease of the bone increases the risk of osteosarcoma, a type of bone cancer.

Also called osteitis deformans.