Bone cancer incidence by morphological subtype: a global assessment

To better understand the relevance of environmental factors to the changing patterns of bone cancer subtypes, we examine the incidence of osteosarcoma (OS), Ewing sarcoma (ES), and chondrosarcoma (CS) using data from cancer incidence in five continents. Age-specific and age-standardized incidence rates (ASRs) per 100,000 person-years were computed and stratified by country (n = 43), subtype, and sex during 2003-2007. Temporal patterns of ASRs were examined during 1988-2007 (12 countries). Age-period-cohort models were fitted for the USA and UK by subtype. For most countries, OS represented 20-40 % of all bone cancers, ES < 20 %, while CS proportions varied more considerably. Overall ASRs of bone cancers were 0.8-1.2/100,000 in men and 0.5-1.0 in women (0.20-0.35/100,000 for OS and 0.10-0.30/100,000 for CS in both men and women, and < 0.10-0.25/100,000 in men and 0.05-0.25/100,000 in women for ES). The age-specific incidence rates revealed a bimodal peak of OS, one peak of ES in childhood, and a more heterogeneous pattern for CS. The overall bone cancer incidence trends are generally flat, but more heterogeneous for ES and CS. A declining OS incidence was observed in the UK and USA (men), an increase in CS in the UK and USA (female), and an apparent increase in ES, followed by a leveling off in successive US and UK cohorts. Monitoring bone cancer incidence trends with data assembled from a geographically broader range of registries may generate hypotheses about additional risk factors and ensure that high-risk populations are not overlooked in cancer control efforts.