The epidemiology of sarcoma

Zachary Burningham, Mia Hashibe, Logan Spector, Joshua D Schiffman, Zachary Burningham, Mia Hashibe, Logan Spector, Joshua D Schiffman

Abstract

Sarcomas account for over 20% of all pediatric solid malignant cancers and less than 1% of all adult solid malignant cancers. The vast majority of diagnosed sarcomas will be soft tissue sarcomas, while malignant bone tumors make up just over 10% of sarcomas. The risks for sarcoma are not well-understood. We evaluated the existing literature on the epidemiology and etiology of sarcoma. Risks for sarcoma development can be divided into environmental exposures, genetic susceptibility, and an interaction between the two. HIV-positive individuals are at an increased risk for Kaposi's sarcoma, even though HHV8 is the causative virus. Radiation exposure from radiotherapy has been strongly associated with secondary sarcoma development in certain cancer patients. In fact, the risk of malignant bone tumors increases as the cumulative dose of radiation to the bone increases (p for trend <0.001). A recent meta-analysis reported that children with a history of hernias have a greater risk of developing Ewing's sarcoma (adjusted OR 3.2, 95% CI 1.9, 5.7). Bone development during pubertal growth spurts has been associated with osteosarcoma development. Occupational factors such as job type, industry, and exposures to chemicals such as herbicides and chlorophenols have been suggested as risk factors for sarcomas. A case-control study found a significant increase in soft tissue sarcoma risk among gardeners (adjusted OR 4.1, 95% CI 1.00, 14.00), but not among those strictly involved in farming. A European-based study reported an increased risk in bone tumors among blacksmiths, toolmakers, or machine-tool operators (adjusted OR 2.14, 95% CI 1.08, 4.26). Maternal and paternal characteristics such as occupation, age, smoking status, and health conditions experienced during pregnancy also have been suggested as sarcoma risk factors and would be important to assess in future studies. The limited studies we identified demonstrate significant relationships with sarcoma risk, but many of these results now require further validation on larger populations. Furthermore, little is known about the biologic mechanisms behind each epidemiologic association assessed in the literature. Future molecular epidemiology studies may increase our understanding of the genetic versus environmental contributions to tumorigenesis in this often deadly cancer in children and adults.

Figures

Figure 1
Figure 1
Distribution of new sarcoma cases by histology (2008).
Figure 2
Figure 2
Distribution of ages at diagnosis, 2004-2008.
Figure 3
Figure 3
Distribution of ages at death, 2003-2007.
Figure 4
Figure 4
Incidence of malignant bone tumors vs. soft tissue sarcomas by age (2004-2008).

References

    1. SEER*Stat Database: Incidence - SEER 9 Regs Research Data, Nov 2010 Sub (1973–2008) <Katrina/Rita Population Adjustment> − Linked To County Attributes - Total U.S., 1969–2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011, based on the November 2010 submission. Surveillance, Epidemiology, and End Results (SEER) Program ( )
    1. Lahat G, Lazar A, Lev D. Sarcoma epidemiology and etiology: potential environmental and genetic factors. Surg Clin North Am. 2008;88(3):451–481. doi: 10.1016/j.suc.2008.03.006.
    1. A Snapshot of Sarcoma. National Cancer Institute. Sept 2010; .
    1. Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK, (eds) SEER Cancer Statistics Review, 1975–2008. National Cancer Institute. Bethesda, MD,; based on November 2010 SEER data submission, posted to the SEER web site, 2011.
    1. Pukkala E. et al.Occupation and cancer - follow-up of 15 million people in five Nordic countries. Acta Oncol. 2009;48(5):646–790. doi: 10.1080/02841860902913546.
    1. Woods JS, Polissar L, Severson RK, Heuser LS, Kulander BG. Soft tissue sarcoma and non-Hodgkin's lymphoma in relation to phenoxyherbicide and chlorinated phenol exposure in western Washington. J Natl Cancer Inst. 1987;78(5):899–910.
    1. Hardell L, Eriksson M. The association between soft tissue sarcomas and exposure to phenoxyacetic acids, A new case-referent study. Cancer. 1988;62(3):652–656. doi: 10.1002/1097-0142(19880801)62:3<652::AID-CNCR2820620334>;2-4.
    1. Wingren G, Fredrikson M, Brage HN, Nordenskjöld B, Axelson O. Soft tissue sarcoma and occupational exposures. Cancer. 1990;66(4):806–811. doi: 10.1002/1097-0142(19900815)66:4<806::AID-CNCR2820660435>;2-U.
    1. Smith JG, Christophers AJ. Phenoxy herbicides and chlorophenols: a case control study on soft tissue sarcoma and malignant lymphoma. Br J Cancer. 1992;65(3):442–448. doi: 10.1038/bjc.1992.90.
    1. Hoar SK, Blair A, Holmes FF, Boysen CD, Robel RJ, Hoover R, Fraumeni JF Jr. Agricultural herbicide use and risk of lymphoma and soft-tissue sarcoma. JAMA. 1986;256(9)):1141–1147. Erratum in: JAMA 1986 Dec 26;256(24):3351.
    1. Johnson KJ, Carozza SE, Chow EJ, Fox EE, Horel S, McLaughlin CC, Mueller BA, Puumala SE, Reynolds P, Von Behren J, Spector LG. Parental age and risk of childhood cancer: a pooled analysis. Epidemiology. 2009;20(4):475–483. doi: 10.1097/EDE.0b013e3181a5a332.
    1. Merletti F, Richiardi L, Bertoni F, Ahrens W, Buemi A, Costa-Santos C, Eriksson M, Guénel P, Kaerlev L, Jöckel KH, Llopis-Gonzalez A, Merler E, Miranda A, Morales-Suárez-Varela MM, Olsson H, Fletcher T, Olsen J. Occupational factors and risk of adult bone sarcomas: a multicentric case–control study in Europe. Int J Cancer. 2006;118(3):721–727. doi: 10.1002/ijc.21388.
    1. Kedes DH, Operskalski E, Busch M, Kohn R, Flood J, Ganem D. The seroepidemiology of human herpesvirus 8 (Kaposi's sarcoma-associated herpesvirus): distribution of infection in KS risk groups and evidence for sexual transmission. Nat Med. 1996;2(8):918–924. doi: 10.1038/nm0896-918.
    1. Valery PC, McWhirter W, Sleigh A, Williams G, Bain C. A national case–control study of Ewing's sarcoma family of tumours in Australia. Int J Cancer. 2003;105(6):825–830. doi: 10.1002/ijc.11129.
    1. Valery PC, Holly EA, Sleigh AC, Williams G, Kreiger N, Bain C. Hernias and Ewing's sarcoma family of tumours: a pooled analysis and meta-analysis. Lancet Oncol. 2005;6(7):485–490. doi: 10.1016/S1470-2045(05)70242-4.
    1. Longhi A, Pasini A, Cicognani A, Baronio F, Pellacani A, Baldini N, Bacci G. Height as a risk factor for osteosarcoma. J Pediatr Hematol Oncol. 2005;27(6):314–318. doi: 10.1097/01.mph.0000169251.57611.8e.
    1. Pearce MS, Hammal DM, Dorak MT, McNally RJ, Parker L. Paternal occupational exposure to electro-magnetic fields as a risk factor for cancer in children and young adults: a case–control study from the North of England. Pediatr Blood Cancer. 2007;49(3):280–286. doi: 10.1002/pbc.21021.
    1. Buckley JD, Pendergrass TW, Buckley CM, Pritchard DJ, Nesbit ME, Provisor AJ, Robison LL. Epidemiology of osteosarcoma and Ewing's sarcoma in childhood: a study of 305 cases by the Children's Cancer Group. Cancer. 1998;83(7):1440–1448. doi: 10.1002/(SICI)1097-0142(19981001)83:7<1440::AID-CNCR23>;2-3.
    1. Engels EA, Biggar RJ, Marshall VA, Walters MA, Gamache CJ, Whitby D, Goedert JJ. Detection and quantification of Kaposi's sarcoma-associated herpesvirus to predict AIDS-associated Kaposi's sarcoma. AIDS. 2003;17(12):1847–1851. doi: 10.1097/00002030-200308150-00015.
    1. Kogevinas M, Kauppinen T, Winkelmann R, Becher H, Bertazzi PA, Bueno-de-Mesquita HB, Coggon D, Green L, Johnson E, Littorin M. et al.Soft tissue sarcoma and non-Hodgkin's lymphoma in workers exposed to phenoxy herbicides, chlorophenols, and dioxins: two nested case–control studies. Epidemiology. 1995;6(4):396–402. doi: 10.1097/00001648-199507000-00012.
    1. Hoppin JA, Tolbert PE, Flanders WD, Zhang RH, Daniels DS, Ragsdale BD, Brann EA. Occupational risk factors for sarcoma subtypes. Epidemiology. 1999;10(3):300–306. doi: 10.1097/00001648-199905000-00019.
    1. Troisi R, Masters MN, Joshipura K, Douglass C, Cole BF, Hoover RN. Perinatal factors, growth and development, and osteosarcoma risk. Br J Cancer. 2006;95(11):1603–1607. doi: 10.1038/sj.bjc.6603474.
    1. Pendergrass TW, Foulkes MA, Robison LL, Nesbit ME. Stature and Ewing's sarcoma in childhood. Am J Pediatr Hematol Oncol. 1984;6(1):33–39.
    1. Operskalski EA, Preston-Martin S, Henderson BE, Visscher BR. A case–control study of osteosarcoma in young persons. Am J Epidemiol. 1987;126(1):118–126.
    1. Li FP, Fraumeni JF Jr. Soft-tissue sarcomas, breast cancer, and other neoplasms. A familial syndrome? Ann Intern Med. 1969;71:747–752.
    1. Moore PS, Kingsley LA, Holmberg SD, Spira T, Gupta P, Hoover DR, Parry JP, Conley LJ, Jaffe HW, Chang Y. Kaposi's sarcoma-associated herpesvirus infection prior to onset of Kaposi's sarcoma. AIDS. 1996;10(2):175–180. doi: 10.1097/00002030-199602000-00007.
    1. Renwick N, Halaby T, Weverling GJ, Dukers NH, Simpson GR, Coutinho RA, Lange JM, Schulz TF, Goudsmit J. Seroconversion for human herpesvirus 8 during HIV infection is highly predictive of Kaposi's sarcoma. AIDS. 1998;12(18):2481–2488. doi: 10.1097/00002030-199818000-00018.
    1. Ognjanovic S, Carozza SE, Chow EJ, Fox EE, Horel S, McLaughlin CC, Mueller BA, Puumala S, Reynolds P, Von Behren J, Spector L. Birth characteristics and the risk of childhood rhabdomyosarcoma based on histological subtype. Br J Cancer. 2010;102(1)):227–231. Epub2009 Dec 8.
    1. Cope JU, Tsokos M, Helman LJ, Gridley G, Tucker MA. Inguinal hernia in patients with Ewing sarcoma: a clue to etiology. Med Pediatr Oncol. 2000;34(3):195–199. doi: 10.1002/(SICI)1096-911X(200003)34:3<195::AID-MPO6>;2-B.
    1. Gelberg KH, Fitzgerald EF, Hwang S, Dubrow R. Growth and development and other risk factors for osteosarcoma in children and young adults. Int J Epidemiol. 1997;26(2):272–278. doi: 10.1093/ije/26.2.272.
    1. Rubino C, Shamsaldin A, Lê MG, Labbé M, Guinebretière JM, Chavaudra J, de Vathaire F. Radiation dose and risk of soft tissue and bone sarcoma after breast cancer treatment. Breast Cancer Res Treat. 2005;89(3):277–288. doi: 10.1007/s10549-004-2472-8.
    1. Hum L, Kreiger N, Finkelstein MM. The relationship between parental occupation and bone cancer risk in offspring. Int J Epidemiol. 1998;27(5):766–771. doi: 10.1093/ije/27.5.766.
    1. Schüz J, Kaatsch P, Kaletsch U, Meinert R, Michaelis J. Association of childhood cancer with factors related to pregnancy and birth. Int J Epidemiol. 1999;28(4):631–639. doi: 10.1093/ije/28.4.631.
    1. Cotterill SJ, Wright CM, Pearce MS, Craft AW. UKCCSG/MRC Bone Tumour Working Group, Stature of young people with malignant bone tumors. Pediatr Blood Cancer. 2004;42(1):59–63. doi: 10.1002/pbc.10437.
    1. Tucker MA, D'Angio GJ, Boice JD Jr, Strong LC, Li FP, Stovall M, Stone BJ, Green DM, Lombardi F, Newton W. et al.Bone sarcomas linked to radiotherapy and chemotherapy in children. N Engl J Med. 1987;317(10):588–593. doi: 10.1056/NEJM198709033171002.
    1. Valery PC, McWhirter W, Sleigh A, Williams G, Bain C. Farm exposures, parental occupation, and risk of Ewing's sarcoma in Australia: a national case–control study. Cancer Causes Control. 2002;13(3):263–270. doi: 10.1023/A:1015036109130.
    1. Fioretti F, Tavani A, Gallus S, Negri E, Franceschi S, La Vecchia C. Menstrual and reproductive factors and risk of soft tissue sarcomas. Cancer. 2000;88(4):786–789. doi: 10.1002/(SICI)1097-0142(20000215)88:4<786::AID-CNCR8>;2-M.
    1. Mirabello L, Pfeiffer R, Murphy G, Daw NC, Patiño-Garcia A, Troisi RJ, Hoover RN, Douglass C, Schüz J, Craft AW, Savage SA. Height at diagnosis and birth-weight as risk factors for osteosarcoma. Cancer Causes Control. 2011;22(6):899–908. doi: 10.1007/s10552-011-9763-2.
    1. Ognjanovic S, Olivier M, Bergemann TL, Hainaut P. Sarcomas in TP53 germline mutation carriers: a review of the IARC TP53 database. Cancer. 2012;118(5):1387–1396. doi: 10.1002/cncr.26390.
    1. Winn DM, Li FP, Robison LL, Mulvihill JJ, Daigle AE, Fraumeni JF Jr. A case–control study of the etiology of Ewing's sarcoma. Cancer Epidemiol Biomarkers Prev. 1992;1(7)):525–532.
    1. Kleinerman RA. J Natl Cancer Inst. 2000. pp. 2037–2039.
    1. Hansen MF, Koufos A, Gallie BL. et al.Osteosarcoma and retinoblastoma: a shared chromosomal mechanism revealing recessive predisposition. Proc Natl Acad SciUS A. 1985;82:6216–6220. doi: 10.1073/pnas.82.18.6216.
    1. Calvert G, Randall LR, Jones KB. et risk populations for osteosarcoma: the syndromes and beyond. Sarcoma. 2000;9:1155–1165. In press.
    1. Randall RL, Lessnick SL, Jones KB, Gouw LG, Cummings JE, Cannon-Albright L, Schiffman JD. Is There a Predisposition Gene for Ewing's Sarcoma? J Oncol. 2010;2010:97632. Epub 2010 Mar 15.
    1. Serraino D, Franceschi S, La Vecchia C, Carbone A. Occupation and soft-tissue sarcoma in northeastern Italy. Cancer Causes Control. 1992;3(1):25–30. doi: 10.1007/BF00051908.
    1. Hoppin JA, Tolbert PE, Herrick RF, Freedman DS, Ragsdale BD, Horvat KR, Brann EA. Occupational chlorophenol exposure and soft tissue sarcoma risk among men aged 30–60 years. Am J Epidemiol. 1998;148(7):693–703. doi: 10.1093/aje/148.7.693.
    1. Li FP, Fraumeni JF Jr, Mulvihill JJ. et al.A cancer family syndrome in twenty-four kindreds. Cancer Res. 1988;48:5358–5362.
    1. Balarajan R, Acheson ED. Softtissue sarcomas in agriculture and forestry workers. J Epidemiology Community Health. 1984;38(2):113–116. doi: 10.1136/jech.38.2.113.
    1. Hawkins MM, Wilson LM, Burton HS, Potok MH, Winter DL, Marsden HB, Stovall MA. Radiotherapy, alkylating agents, and risk of bone cancer after childhood cancer. J Natl Cancer Inst. 1996;88(5):270–278. doi: 10.1093/jnci/88.5.270.
    1. Yu CL. J Natl Cancer Inst. 2009. pp. 581–591.
    1. Hartley AL, Birch JM, McKinney PA, Teare MD, Blair V, Carrette J, Mann JR, Draper GJ, Stiller CA, Johnston HE. et al.The Inter-Regional Epidemiological Study of Childhood Cancer (IRESCC): case control study of children with bone and soft tissue sarcomas. Br J Cancer. 1988;58(6):838–842. doi: 10.1038/bjc.1988.321.
    1. Malkin D, Li FP, Strong LC, Fraumeni JF Jr, Nelson CE, Kim DH. et al.Germ line p53 mutations in a familial syndrome of breast cancer, sarcomas, and other neoplasms. Science. 1990;250:1233–1238. doi: 10.1126/science.1978757.
    1. Das P, Kotilingam D, Korchin B. et al.High prevalence of p53 exon 4 mutations in soft tissue sarcoma. Cancer. 2007;109(11)):2323–2333.
    1. Ziegler J, Newton R, Bourboulia D, Casabonne D, Beral V, Mbidde E, Carpenter L, Reeves G, Parkin DM, Wabinga H, Mbulaiteye S, Jaffe H, Weiss R, Boshoff C. Uganda Kaposi's Sarcoma Study Group. Risk factors for Kaposi's sarcoma: a case–control study of HIV-seronegative peoplein Uganda. Int J Cancer. 2003;103(2):233–240. doi: 10.1002/ijc.10818.
    1. Schüz J, Forman MR. Birthweight by gestational age and childhood cancer. Cancer Causes Control. 2007;18(6)):655–663. Epub 2007 May 15.
    1. Diller L, Sexsmith E, Gottlieb A, Li FP, Malkin D. Germline p53 mutations are frequently detected in young children with rhabdomyosarcoma. J Clin Invest. 1995;95(4):1606–1611. doi: 10.1172/JCI117834.
    1. Grufferman S, Wang HH, DeLong ER, Kimm SY, Delzell ES, Falletta JM. Environmental factors in the etiology of rhabdomyosarcoma in childhood. J Natl Cancer Inst. 1982;68(1):107–113.
    1. Franceschi S, Serraino D. Risk factors for adult soft tissue sarcoma in northern Italy. Ann Oncol. 1992;3(Suppl 2):S85–S88. doi: 10.1093/annonc/3.suppl_2.S85.
    1. Eriksson M, Hardell L, Adami HO. Exposure to dioxins as a risk factor for soft tissue sarcoma: a population-based case–control study. J Natl Cancer Inst. 1990;82(6):486–490. doi: 10.1093/jnci/82.6.486.
    1. Wong FL, Boice JD Jr, Abramson DH. et al.Cancer incidence after retinoblastoma, Radiation dose and sarcoma risk. JAMA. 1997;278:1262–1267. doi: 10.1001/jama.1997.03550150066037.
    1. Postel-Vinay S, Véron AS, Tirode F, Pierron G, Reynaud S, Kovar H, Oberlin O, Lapouble E, Ballet S, Lucchesi C, Kontny U, González-Neira A, Picci P, Alonso J, Patino-Garcia A, de Paillerets BB, Laud K, Dina C, Froguel P, Clavel-Chapelon F, Doz F, Michon J, Chanock SJ, Thomas G, Cox DG, Delattre O. Common variants near TARDBP and EGR2 are associated with susceptibility to Ewing sarcoma. Nat Genet. 2012;44(3)):323–327.
    1. Hartley AL, Birch JM, McKinney PA, Blair V, Teare MD, Carrette J, Mann JR, Stiller CA, Draper GJ, Johnston HE. et al.The Inter-Regional Epidemiological Study of Childhood Cancer (IRESCC): past medical history in children with cancer. J Epidemiol Community Health. 1988;42(3):235–242. doi: 10.1136/jech.42.3.235.
    1. Spector LG, Puumala SE, Carozza SE, Chow EJ, Fox EE, Horel S, Johnson KJ, McLaughlin CC, Reynolds P, Behren JV, Mueller BA. Cancer risk among children with very low birth weights. Pediatrics. 2009;124(1):96–104. doi: 10.1542/peds.2008-3069.
    1. Smith A, Lightfoot T, Simpson J, Roman E. UKCCS investigators. Birth weight, sex and childhood cancer: A report from the United Kingdom Childhood Cancer Study. Cancer Epidemiol. 2009;33(5)):363–367. Epub 2009 Nov 22.
    1. Tinat J, Bougeard G, Baert-Desurmont S. et al.2009 version of the Chompret criteria for Li Fraumeni syndrome. J Clin Oncol. 2009;27:e108–e109. doi: 10.1200/JCO.2009.22.7967.
    1. Worch J, Matthay KK, Neuhaus J, Goldsby R, DuBois SG. Ethnic and racial differences in patients with Ewing sarcoma. Cancer. 2010;116(4):983–988. doi: 10.1002/cncr.24865.
    1. Jawad MU, Cheung MC, Min ES, Schneiderbauer MM, Koniaris LG, Scully SP. Ewing sarcoma demonstrates racial disparities in incidence-related and sex-related differences in outcome: an analysis of 1631 cases from the SEER database, 1973–2005. Cancer. 2009;115(15):3526–3536. doi: 10.1002/cncr.24388.
    1. Guo W, Xu W, Huvos AG, Healey JH, Feng C. Comparative frequency of bone sarcomas among different racial groups. Chin Med J (Engl) 1999;112(12):1101–1104.
    1. Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanue M, Boyle P, editor. Cancer Incidence in Five Continents, Volume IX. IARC Scientific Publications No. 160. IARC, Lyon; 2007.
    1. Pollack IF, Mulvihill JJ. Neurofibromatosis 1 and 2. Brain Pathol. 1997;7:823–836. doi: 10.1111/j.1750-3639.1997.tb01067.x.
    1. Von Behren J, Spector LG, Mueller BA, Carozza SE, Chow EJ, Fox EE, Horel S, Johnson KJ, McLaughlin C, Puumala SE, Ross JA, Reynolds P. Birth order and risk of childhood cancer: a pooled analysis from five US States. Int J Cancer. 2011;128(11):2709–2716. doi: 10.1002/ijc.25593. Epub 2010 Oct 8.
    1. Le Vu B, de Vathaire F, Shamsaldin A, Hawkins MM, Grimaud E, Hardiman C, Diallo I, Vassal G, Bessa E, Campbell S, Panis X, Daly-Schveitzer N, Lagrange JL, Zucker JM, Eschwège F, Chavaudra J, Lemerle J. Radiation dose, chemotherapy and risk of osteosarcoma after solid tumours during childhood. Int J Cancer. 1998;77(3):370–377. doi: 10.1002/(SICI)1097-0215(19980729)77:3<370::AID-IJC11>;2-C.
    1. Hwang SJ, Lozano G, Amos CI, Strong LC. Germline p53 mutations in a cohort with childhood sarcoma: sex differences in cancer risk. Am J Hum Genet. 2003;72(4)):975–983. Epub 2003 Feb 27.
    1. Menu-Branthomme A, Rubino C, Shamsaldin A, Hawkins MM, Grimaud E, Dondon MG, Hardiman C, Vassal G, Campbell S, Panis X, Daly-Schveitzer N, Lagrange JL, Zucker JM, Chavaudra J, Hartman O, de Vathaire F. Radiation dose, chemotherapy and risk of soft tissue sarcoma after solid tumours during childhood. Int J Cancer. 2004;110(1):87–93. doi: 10.1002/ijc.20002.
    1. Virtanen A, Pukkala E, Auvinen A. Incidence of bone and soft tissue sarcoma after radiotherapy: a cohort study of 295,712 Finnish cancer patients. Int J Cancer. 2006;118(4):1017–1021. doi: 10.1002/ijc.21456.
    1. Samartzis D, Nishi N, Hayashi M, Cologne J, Cullings HM, Kodama K, Miles EF, Funamoto S, Suyama A, Soda M, Kasagi F. Exposure to Ionizing Radiation and Development of Bone Sarcoma: New Insights Based on Atomic-Bomb Survivors of Hiroshima and Nagasaki. J BoneJoint Surg Am. 2011;93(11):1008–1015. doi: 10.2106/JBJS.J.00256.
    1. Bassin EB, Wypij D, Davis RB, Mittleman MA. Age-specific fluoride exposure in drinking water and osteosarcoma (United States) Cancer Causes Control. 2006;17(4):421–428. doi: 10.1007/s10552-005-0500-6.
    1. Moss ME, Kanarek MS, Anderson HA, Hanrahan LP, Remington PL. Osteosarcoma, seasonality, and environmental factors in Wisconsin, 1979–1989. Arch Environ Health. 1995;50(3):235–241. doi: 10.1080/00039896.1995.9940393.
    1. Finkelstein MM, Kreiger N. Radium in drinking water and risk of bone cancer in Ontario youths: a second study and combined analysis. Occup Environ Med. 1996;53(5):305–311. doi: 10.1136/oem.53.5.305.
    1. Guse CE, Marbella AM, George V, Layde PM. Radium in Wisconsin drinking water: an analysis of osteosarcoma risk. Arch Environ Health. 2002;57(4)):294–303.
    1. Comba P, Ascoli V, Belli S, Benedetti M, Gatti L, Ricci P, Tieghi A. Risk of soft tissue sarcomas and residence in the neighbourhood of an incinerator of industrial wastes. Occup Environ Med. 2003;60(9):680–683. doi: 10.1136/oem.60.9.680.
    1. Viel JF, Arveux P, Baverel J, Cahn JY. Soft-tissue sarcoma and non-Hodgkin's lymphoma clusters around a municipal solid waste incinerator with high dioxin emission levels. Am J Epidemiol. 2000;152(1):13–19. doi: 10.1093/aje/152.1.13.
    1. Zahm SH, Blair A, Holmes FF, Boysen CD, Robel RJ, Fraumeni JF Jr. A case–control study of soft-tissue sarcoma. Am J Epidemiol. 1989;130(4):665–674.
    1. Serraino D, Franceschi S, Talamini R, Frustaci S, La Vecchia C. Non-occupational risk factors for adult soft-tissue sarcoma in northern Italy. Cancer Causes Control. 1991;2(3):157–164. doi: 10.1007/BF00056208.
    1. Goedert JJ, Vitale F, Lauria C, Serraino D, Tamburini M, Montella M, Messina A, Brown EE, Rezza G, Gafà L, Romano N. Classical Kaposi's Sarcoma Working Group, Risk factors for classical Kaposi's sarcoma. J Natl Cancer Inst. 2002;94(22):1712–1718. doi: 10.1093/jnci/94.22.1712.
    1. Grufferman S, Schwartz AG, Ruymann FB, Maurer HM. Parents' use of cocaine and marijuana and increased risk of rhabdomyosarcoma in their children. Cancer Causes Control. 1993;4(3):217–224.

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