Malignant bone tumors constitute approximately 6% of all childhood malignancies. In the United States, the annual incidence in children under 20 years of age is 8.7 per million. Osteosarcoma (56%) and Ewing sarcoma (34%) comprise the most frequently encountered malignant bone tumors in children and adolescents. In the United States 650-700 children are diagnosed with malignant bone tumors each year. There are approximately 400 cases of osteosarcoma and 200 cases of Ewing sarcoma per year.
The peak incidence of bone cancer is age 15, coincident with the adolescent growth spurt, after which rates show a decline (Figure 21-1). Osteosarcoma incidence has a bimodal age distribution with peaks in early adolescence and in adults over 65 years of age. Ewing sarcoma is a disease of children and young adults; it is very rare in older adults.
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