Lead Author(s): 

Obinna Adigweme, MD
Charles L. Nelson, MD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

Primary sarcomas represent the least common malignancies in bone, although osteosarcoma represents the most common nonhemoapoietic primary tumor of bone. Osteosarcoma is a primary malignant bone-producing tumor. In a review by Ottaviani, osteosarcoma had a higher incidence in African-Americans (AA) (6.8 per million persons per year] and Hispanics (6.5 per million) than in whites (4.6 per million).1 The reason for a potential higher incidence in blacks may be due to genetic factors, but it has not been determined.

Ewing sarcoma is a malignant tumor of bone and soft tissue. Race is an important factor in the incidence of ES, with Caucasians more likely to develop ES than African Americans or Asians. In a database study, Worch et al showed that ES is 8 times more likely to occur in the white population compared with African Americans and 1.9 times more likely to occur in the white population compared with Asian-Americans and Native Americans.2 Another database study by Worch et al., however, showed overall survival was significantly worse for patients. These results suggest a genetic component to the disease.3

Soft tissue sarcomas are the sixth most common primary cancer among young adults and adolescents aged 15-29.4,5 Musculoskeletal tumors included in this group include rhabdomyosarcoma, synovial sarcoma, and liposarcoma. Hsieh et al. showed that AA had the highest incidence rates of fibromatous neoplasms, rhabdomyosarcoma, and Kaposi sarcoma among all racial/ethnic groups. This study also revealed that Hispanic males and females had significantly higher liposarcoma rates than other racial/ethnic groups.6 A database study by Alamanda et al found that African Americans encounter death due to soft tissue sarcomas at a much larger proportion and faster rate than their respective white counterparts. African Americans frequently presented with a larger size tumor, do not undergo surgical resection, or receive radiation therapy as frequently as compared with their white peers.7,8

Multiple myeloma is a cancer of plasma cells and is the most common malignancy arising in bone. Multiple myeloma (MM) is the most common hematologic malignancy among blacks in the US and the second most common hematologic malignancy in the country.9 A large database study concluded that blacks have an earlier onset and a higher incidence of MM This study also found African-Americans to have better survival rates, which is different than most conditions found in the literature.10 These results suggest a different disease biology. Fiala et al performed a database study regarding racial disparities in multiple myeloma treatment. After controlling for overall health and potential access barriers, black patients were found to be 37% less likely to undergo stem cell transplantation, and 21% less likely to be treated with bortezomib, an antineoplastic agent which is considered the gold standard in chemotherapy treatment of MM. Moreover, the authors found that the underuse of these treatments was associated with an increase in the incidence of death among black patients.11 The difference in treatment may be due to patient preference, patient education, or implicit biases in management. More research is needed to examine these factors.

Musculoskeletal Cancers

Incidence of musculoskeletal cancers is reported in BMUS based on data published by the National Cancer Institute’s Surveillance, Epidemiology and End Results Program (SEER). Data is shown for bones and joints cancers but is not broken down for specific types of sarcomas. Myeloma (multiple myeloma) is a cancer of plasma cells in the bone marrow. Based on SEER data 2010-2014, non-Hispanic whites have a higher incidence of bones and joints cancers than do non-Hispanic blacks and those of Hispanic ethnicity, but all have very low incidence. Non-Hispanic white males had the highest incidence at 12 cases per one million persons. Myeloma has a higher incidence, with non-Hispanic blacks higher than non-Hispanic whites. Incidence was not reported for those of Hispanic ethnicity. SEER reported death rates for musculoskeletal cancers follow the same pattern as incidence rates but are much lower. (Reference Table 7D.7 PDF CSV)

  • 1. Ottaviani G, Jaffe N. The epidemiology of osteosarcoma. Cancer Treat Res 2009;152:3-13.[\fn] Another study examined the epidemiology of osteosarcoma in New York (NY) state and found higher incidence in AA in NY residents.Polednak AP. Primary bone cancer incidence in black and white residents of New York State. Cancer 1985;55(12):2883-2888.
  • 2. Worch J, Cyrus J, Goldsby R, et al. Racial differences in the incidence of mesenchymal tumors associated with EWSR1 translocation. Cancer Epidemiol Biomarkers Prev 2011;20(3):449-453.
  • 3. 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.
  • 4. Bleyer A, O’Leary M, Barr R, Ries LAG. Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975–2000 (NIH Publication No. 06-5767). Bethesda, MD: National Cancer Institute; 2006. 2.
  • 5. Albritton KH. Sarcomas in adolescents and young adults. Hematol Oncol Clin North Am 2005;19(3):527–546.
  • 6. Hsieh MC, Wu XC, Andrews PA, Chen VW. Racial and ethnic disparities in the incidence and trends of soft tissue sarcoma among adolescents and young adults in the United States, 1995-2008. J Adolesc Young Adult Oncol 2013;2(3):89-94.
  • 7. Alamanda VK, Song Y, Schwartz HS, Holt GE. Racial disparities in extremity soft-tissue sarcoma outcomes: a nationwide analysis. Am J Clin Oncol 2015;38(6):595-599.
  • 8. Lazarides AL, Visgauss JD, Nussbaum DP, et al. Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities. BMC Cancer 2018;18(1):488.
  • 9. Benjamin M, Reddy S, Brawley OW. Myeloma and race: a review of the literature. Cancer Metastasis Rev 2003;22(1):87-93.
  • 10. Waxman AJ, Mink PJ, Devesa SS, et al. Racial disparities in incidence and outcome in multiple myeloma: a population-based study. Blood 2010;116(25):5501-5506.
  • 11. Fiala MA, Wildes TM. Racial disparities in treatment use for multiple myeloma. Cancer 2017;123(9):1590-1596.


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