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Small-area analyses of bone cancer diagnosed in Great Britain provide clues to aetiology

Richard J Q McNally16*, Karen Blakey1, Roger C Parslow2, Peter W James1, Basilio Gómez Pozo1, Charles Stiller3, Tim J Vincent3, Paul Norman4, Patricia A McKinney2, Michael F Murphy3, Alan W Craft5 and Richard G Feltbower2

Author Affiliations

1 Institute of Health and Society, Newcastle University, England, UK

2 Centre for Epidemiology & Biostatistics, University of Leeds, England, UK

3 Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, England, UK

4 School of Geography, University of Leeds, England, UK

5 Northern Institute of Cancer Research, Newcastle University, England, UK

6 Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road Newcastle upon Tyne, NE1 4LP, England, UK

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BMC Cancer 2012, 12:270  doi:10.1186/1471-2407-12-270

Published: 27 June 2012



The aetiology of bone cancers is poorly understood. This study examined geographical patterning in incidence of primary bone cancers diagnosed in 0–49 year olds in Great Britain during 1980–2005 to provide information on factors linked with disease development. We investigated putative associations with deprivation and population density.


Data on osteosarcoma and Ewing sarcoma were obtained from national population-based registries. Negative binomial regression was used to examine the relationship between incidence rates and the Townsend deprivation score (and its component variables) and small-area population density.


The study analyzed 2566 osteosarcoma and 1650 Ewing sarcoma cases. For females with osteosarcoma, statistically significant decreased risk was associated with higher levels of deprivation (relative risk [RR] per unit increase in deprivation score = 0.969; 95% confidence interval [CI] 0.946–0.993). For all Ewing sarcoma combined, statistically significant decreased risk was associated with greater area-level population density and higher levels of non-car ownership (RR per person per hectare increase = 0.984; 95% CI 0.976–0.993, RR per 1% increase in non-car ownership = 0.994; 95% CI 0.991–0.998).


Higher incidence of osteosarcoma was observed for females in areas with lower deprivation levels indicating increased risk is linked to some aspect of affluent living. Higher incidence of Ewing sarcoma occurred in areas of low population density and where more people owned cars, both characteristic of rural environments. The study adds substantially to evidence associating Ewing sarcoma risk with rural environmental exposures. Putative risk factors include agricultural exposures, such as pesticides and zoonotic agents.