Benign Musculoskeletal Tumors


Lead Author(s): 

William G. Ward, Sr., MD
David J. Sheedy, MPH
Elaine G. Russell, PhD, RN

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

The relative frequency of more common benign bone tumors has been discerned from prior publications and extrapolation from the primary author’s (Ward) case registry of consecutive surgical cases treated between 1991 through 2004. It should be noted that although Dr. Ward's personal tumor registry has been updated since 2004, in 2005 additional providers joined his group and began to share care for this cohort of patients. This, in his opinion, meant accurate incidence estimates could no longer be extrapolated from his personal tumor database. Table 6A.C.1 (PDF CSV) reflects the collected experience reported in the Mayo Clinic publication of 1986, the University of Florida publication from 1983, the J. Mirra experience reported in 1989, and the case series reflecting the practice of Dr. Ward, a full-time solo orthopedic oncologist in practice from 1991 to 2004 at Wake Forest University Health Sciences in Winston-Salem, NC.

The experience of Dr. Ward during the stated time-period is believed to reflect roughly the general prevalence of bone and soft tissue tumors, since he treated a wide variety of benign and malignant bone tumors in a broad referral practice. All cases in his registry reflected his personally treated patients, i.e., none were "consult cases" in which only radiographs or pathology slides were reviewed for outside consulting physicians. The Mayo and Mirra series included consult cases in their registries. The earlier data sets were accumulated during time periods prior to the full development of the subspecialty of orthopedic oncology; thus, only the more unusual cases of bone tumors were referred to major medical centers, making estimates of their incidence less reliable. It is believed, with the exception of bone cysts, non-ossifying fibromas, enchondromas, and osteochondromas, general orthopedic surgeons and other musculoskeletal specialists in North Carolina treated few bone tumors over the period the data was collected, as most were referred to orthopedic oncologists. Practical experience has confirmed that osteosarcoma is the least likely sarcoma to be treated by anyone other than an orthopedic oncologist. Dr. Ward and a small group of orthopedic oncologists treated nearly all patients with osteosarcomas in North Carolina for more than 28 years.

As such, comparing the cases of benign bone tumors relative to the cases of osteosarcoma treated by Dr. Ward provides a relative index that is useful in generating a broad estimate of the prevalence of these benign tumors. By comparing this estimate with the national estimate for the annual occurrence of osteosarcoma, the most commonly encountered primary sarcoma of bone, a rough estimate of the incidence and prevalence of these benign bone tumor diseases was calculated. Because the records only included patients treated surgically, incidence and prevalence estimates include only patients with these disease states that generally require surgical intervention. This selection excludes small benign tumors, thereby artificially lowering the frequency estimates. In addition, this estimation methodology likely grossly underestimates the incidence and prevalence of these tumors as many were and are likely treated by other physicians. (Reference Table 6A.C.1 PDF CSV)


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