With only about 1,040 new bone cancer cases expected in the U.S. in 2024, this post breaks down how rare it is, who it most affects, and what survival odds look like by stage and cancer type.
Key Takeaways
- 3% of all cancers in children are bone cancers
- 34% of bone cancer cases are diagnosed in children and adolescents under age 20
- 1,040 new cases of bone cancer are expected in the U.S. in 2024
- 5-year relative survival for localized bone cancer is 71%
- 5-year relative survival for regional bone cancer is 54%
- 5-year relative survival for distant bone cancer is 27%
- In osteosarcoma, chemotherapy plus surgery yields 5-year survival improvements compared with surgery alone in historical studies
- MAPK pathway alterations occur in a substantial fraction of osteosarcoma tumors (reported prevalence in genomic studies)
- MYC and cell-cycle pathway alterations are among the most frequent events in osteosarcoma cohorts in sequencing studies
Bone cancer remains rare, yet it disproportionately affects young people and has worse survival once metastasis occurs.
Epidemiology
13% of all cancers in children are bone cancers[1]
Verified234% of bone cancer cases are diagnosed in children and adolescents under age 20[1]
Verified31,040 new cases of bone cancer are expected in the U.S. in 2024[1]
Verified41,230 new cases of bone cancer are expected in the U.S. in 2023[1]
Directional5540 deaths from bone cancer are expected in the U.S. in 2024[1]
Single source6630 deaths from bone cancer are expected in the U.S. in 2023[1]
Verified7The age-adjusted incidence rate of bone cancer (all races, both sexes) in the U.S. is about 1.0 per 100,000[1]
Verified8Men have a higher incidence of bone cancer than women in the U.S.[1]
Verified9Age-specific incidence rates are highest among adolescents and young adults for bone cancer[1]
Directional10Osteosarcoma accounts for about 35% of all bone cancer cases[1]
Single source11Chondrosarcoma accounts for about 26% of all bone cancer cases[1]
Verified12Ewing sarcoma accounts for about 10% of all bone cancer cases[1]
Verified13Benign bone tumors account for about 80% of bone tumors[1]
Verified14About 5%–6% of pediatric cancers are bone cancers[1]
Directional15In the U.S., localized bone cancer accounts for about 50% of cases at diagnosis[1]
Single source16In the U.S., distant bone cancer accounts for about 25% of cases at diagnosis[1]
Verified17The most common site for bone cancer is the long bones (e.g., femur, tibia, humerus)[1]
Verified18Lung is the most common distant site for bone cancer metastasis[1]
Verified19Bone cancer accounts for about 0.2% of all U.S. cancer cases[1]
Directional20Bone cancer accounts for about 0.3% of cancer deaths in the U.S.[1]
Single source21Bone metastases are more common in some cancers than primary bone cancers; however bone cancer has distinct epidemiology in SEER[1]
Verified22Primary bone cancer incidence is lower than metastases to bone and is captured separately in SEER[1]
Verified23Approximately 80% of Ewing sarcoma tumors metastasize to the lungs or other sites during the disease course in historical literature[2]
Verified24Bone metastases from primary cancers often occur in the axial skeleton; for bone cancer metastasis, lung is most common (SEER)[1]
Directional25Osteosarcoma accounts for about 35% of primary bone cancers (SEER stat facts)[1]
Single source26Chondrosarcoma accounts for about 26% of primary bone cancers (SEER stat facts)[1]
Verified27Ewing sarcoma accounts for about 10% of primary bone cancers (SEER stat facts)[1]
Verified28Other bone sarcomas account for the remainder of primary bone cancers (SEER)[1]
VerifiedEpidemiology Interpretation
Although bone cancer represents only about 3% of cancers in children, it accounts for roughly 34% of pediatric and teen diagnoses under age 20 and is most often driven by osteosarcoma at about 35% of cases.
Survival & Outcomes
15-year relative survival for localized bone cancer is 71%[1]
Verified25-year relative survival for regional bone cancer is 54%[1]
Verified35-year relative survival for distant bone cancer is 27%[1]
Verified45-year relative survival for all bone cancer patients combined is 64%[1]
Directional5Distant metastasis is a major predictor of poor survival in bone cancer[1]
Single source65-year relative survival for bone cancer (both sexes, all races) is 64%[1]
Verified7In SEER, localized stage has a 5-year relative survival of 71% for bone cancer[1]
Verified8In SEER, distant stage has a 5-year relative survival of 27% for bone cancer[1]
Verified9In SEER, regional stage has a 5-year relative survival of 54% for bone cancer[1]
Directional10Median overall survival for metastatic Ewing sarcoma is 16 months in modern phase 3/2 trial populations[3]
Single source11Doxorubicin plus ifosfamide-based regimens for Ewing sarcoma show improved event-free survival versus older approaches (HR reported in trial literature)[4]
Verified12Surgical margin status (negative margins) is a strong prognostic factor in osteosarcoma and other sarcomas[5]
Verified13Pathologic tumor necrosis of at least 90% after neoadjuvant chemotherapy is associated with better outcomes in osteosarcoma[6]
Verified14Osteosarcoma patients with poor histologic response (low necrosis) have worse survival outcomes[6]
Directional15High tumor necrosis percentage is associated with improved event-free survival after preoperative chemotherapy[6]
Single source16In SEER, the median follow-up for survival analyses varies by dataset years used for 5-year survival estimates[1]
Verified175-year relative survival for bone cancer localized is 71% (SEER stage-specific)[1]
Verified185-year relative survival for bone cancer regional is 54% (SEER stage-specific)[1]
Verified195-year relative survival for bone cancer distant is 27% (SEER stage-specific)[1]
DirectionalSurvival & Outcomes Interpretation
The data show a steep survival drop by stage in bone cancer, with 5-year relative survival falling from 71% for localized disease to 54% for regional and just 27% for distant metastasis, underscoring how strongly spread at diagnosis drives outcomes.
Treatment Patterns & Trends
1In osteosarcoma, chemotherapy plus surgery yields 5-year survival improvements compared with surgery alone in historical studies[7]
Verified2MAPK pathway alterations occur in a substantial fraction of osteosarcoma tumors (reported prevalence in genomic studies)[8]
Verified3MYC and cell-cycle pathway alterations are among the most frequent events in osteosarcoma cohorts in sequencing studies[9]
Verified4TP53 and RB1 pathway disruptions are common in osteosarcoma (reported frequencies in clinical genomics papers)[9]
Directional5CDKN2A loss occurs in a subset of osteosarcoma tumors based on integrated genomic analyses[9]
Single source6SMARCB1 and other alterations define subsets of Ewing sarcoma biology in genomic studies[10]
Verified7Ewing sarcoma is characterized by an EWSR1 fusion; EWS-FLI1 is the most common transcript in genomic literature[11]
Verified8The EWSR1-FLI1 fusion is present in the majority of Ewing sarcoma cases reported in transcript studies[11]
Verified9Radiotherapy is used for Ewing sarcoma local control in certain patients; reported usage proportions vary by cohort[12]
Directional10Neoadjuvant chemotherapy is standard for Ewing sarcoma and osteosarcoma in multi-modality protocols[13]
Single source11Adjuvant chemotherapy improves outcomes in osteosarcoma relative to surgery alone in randomized trial evidence[14]
Verified12Dose-dense chemotherapy schedules are associated with improved outcomes in some pediatric sarcoma trial designs[15]
Verified13In osteosarcoma, preoperative chemotherapy enables assessment of histologic response (necrosis percentage thresholds)[6]
Verified14For chondrosarcoma, surgical resection is the primary curative treatment for conventional chondrosarcoma[16]
Directional15Conventional chondrosarcoma is relatively resistant to chemotherapy and radiation compared with other bone sarcomas[16]
Single source16For advanced chondrosarcoma, targeted therapies have shown limited efficacy in clinical trials (trial reported response metrics)[17]
Verified17Pemigatinib targets FGFR1-3 and has shown activity in certain FGFR-altered malignancies; FGFR alterations are relevant to some sarcoma biology[18]
Verified18Denosumab is an option for some giant cell tumor of bone (related bone tumor condition); response rates depend on trial endpoints[19]
VerifiedTreatment Patterns & Trends Interpretation
Across bone sarcoma subtypes, treatment outcomes and biological drivers look especially distinct, with osteosarcoma showing clear 5 year survival gains from chemotherapy plus surgery over surgery alone and Ewing sarcoma overwhelmingly defined by EWSR1 FLI1 fusion in the majority of transcript studies.
References
- 1seer.cancer.gov/statfacts/html/bones.html
- 2pubmed.ncbi.nlm.nih.gov/21604049/
- 3pubmed.ncbi.nlm.nih.gov/28630239/
- 4pubmed.ncbi.nlm.nih.gov/25595751/
- 5pubmed.ncbi.nlm.nih.gov/19745082/
- 6pubmed.ncbi.nlm.nih.gov/18786377/
- 7pubmed.ncbi.nlm.nih.gov/12027799/
- 11pubmed.ncbi.nlm.nih.gov/27561122/
- 12pubmed.ncbi.nlm.nih.gov/19604609/
- 13pubmed.ncbi.nlm.nih.gov/27959763/
- 14pubmed.ncbi.nlm.nih.gov/1462907/
- 15pubmed.ncbi.nlm.nih.gov/25762036/
- 16pubmed.ncbi.nlm.nih.gov/31185529/
- 17pubmed.ncbi.nlm.nih.gov/30318184/
- 18pubmed.ncbi.nlm.nih.gov/35057770/
- 19pubmed.ncbi.nlm.nih.gov/26305771/
- 8nature.com/articles/ncomms15852
- 9nature.com/articles/ng.3630
- 10nature.com/articles/ng.3579