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How Can Cancer Pass Between Identical Twins Before Birth?

Cancer can pass between twins before birth when a shared placenta connects their blood vessels. Here is what the leukemia evidence and a 2026 soft-tissue cancer study establish—and what they do not.
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Cancer can pass between identical twins before birth when they share a placenta with connected blood vessels. Cells from an acquired cancer-related clone in one fetus can cross into the other fetus’s circulation. The best-established examples involve leukemia; a peer-reviewed 2026 study also reconstructed a rare case of a soft-tissue cancer spreading between twins. This is cell transfer, not ordinary inheritance, and identical twins do not all share a placenta.

How does cancer pass between twins in the womb?

The proposed route is a shared placenta. Some identical-twin pregnancies are monochorionic: both fetuses share one placenta, and blood-vessel connections within it can link their circulations. If a cancer-related cell clone develops in one fetus, cells from that clone may travel through those connections and enter the co-twin’s bloodstream.

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The idea is not that a tumor crosses intact from one baby to the other. Rather, individual cells move between fetuses through placental blood flow. In the best-studied examples, the transferred cells are associated with leukemia. Researchers infer that cells from a prenatal clone reached both twins because leukemia cells in each child can contain the same unusual, clone-specific genetic changes.

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This is sometimes described loosely as cancer “passing” or being “transmitted.” Those words need qualification: the evidence concerns the movement of cells between fetuses, not an infectious disease spreading by ordinary contact. The mechanism also depends on placental anatomy; identical-twin status alone does not establish that the twins shared a circulation.

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A clone is a population of cells descended from an earlier cell that acquired particular changes. If a cell from that population enters the other fetus, it can carry the same distinctive genetic markers with it. The transfer is therefore a movement of cancer-related cells through connected fetal blood supplies, not a process in which one twin’s whole tumor grows through the placenta into the other.

Why identical twins do not always share a placenta

Identical, or monozygotic, twins begin when one fertilized egg gives rise to two embryos. The timing of that division is related to whether the twins share a placenta or have separate placentas. Consequently, “identical” describes their origin and close genetic relationship, not a guarantee that their blood circulated through a common placental network.

For the proposed cell-transfer route to apply, there must be a placental connection that permits fetal blood cells to move between the twins. In a monochorionic pregnancy, connected vessels can provide that route. With separate placentas and no shared vascular connection, the mechanism described here is not established simply because the children are identical twins.

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That distinction matters when interpreting a report about twins. A pair’s zygosity and its placental arrangement are different facts. A shared prenatal clone in two children can support cell transfer, but the phrase “identical twins” by itself does not tell a reader whether the necessary placental connections existed.

In other words, the key comparison is not just identical versus non-identical twins. It is whether there was a shared placenta with connected vessels that could allow fetal blood cells to pass between circulations. The fact that two children are monozygotic cannot, on its own, establish that this route was present in their pregnancy.

What the leukemia evidence shows

A shared genetic signature can point to a common prenatal clone

Leukemia in identical twins has provided the clearest evidence for this process. Genetic analyses have found matching acquired, clone-specific alterations in the leukemia cells of both twins. Because these alterations identify a cell lineage, their presence in both children is consistent with a prenatal clone arising in one fetus and some of its cells crossing the placenta to the other.

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The important evidence is not merely that both children developed the same broad type of cancer. Two diagnoses that share a name would not, on their own, prove that cells moved between them. The shared, unusual genetic markers instead support a common cellular origin. A 2018 review describes placental transfer as a way such a prenatal clone could be shared between twins; a 2024 review of cancer transmission during gestation and around birth also discusses the evidence. Greaves, “Cancer cell transmission via the placenta,” 2018; Arakawa et al., “Cross-individual cancer transmission to children during the gestational and perinatal periods,” 2024.

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That distinction between a shared diagnosis and a shared clone is important. Leukemia is not evidence of transfer merely because it appears in both members of a twin pair. The persuasive clue is the match in specific acquired changes that mark the same cell lineage, considered alongside a plausible route through connected placental vessels. The genetic evidence and the placental anatomy answer different parts of the explanation: one points to shared cellular ancestry, the other supplies a possible path between fetuses.

A prenatal clone is not the same as leukemia diagnosed at birth

Cell transfer and clinical disease are separate stages. A clone may begin before birth and be present in both twins, while additional mutations or other changes accumulate later. Those later changes can help determine whether leukemia becomes overt, when it appears, and how it develops in each child.

For that reason, evidence of a shared prenatal clone does not mean both newborns necessarily already had clinically apparent leukemia. It indicates a shared cellular history, not a complete prediction of what will happen in either child. The twins’ later disease courses need not be identical merely because some early cells came from the same clone.

It is useful to keep three events distinct: the original clone forms, cells from it may cross between fetuses, and later changes may contribute to clinically apparent disease. The evidence for a prenatal shared origin speaks to the first two events; it does not mean that every transferred cell inevitably becomes a tumor or that both children will develop disease at the same time.

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What the 2026 soft-tissue cancer study adds

Most of the established discussion has centered on leukemia. A study by Walkowiak, Baskind, Dave, and colleagues extends the evidence to a solid tumor: a soft-tissue cancer in a specific pair of monozygotic twins. The authors analyzed tumor, normal, and placental samples using whole-genome sequencing. Their reconstruction indicated that the tumor originated in one twin, diversified, and then spread across the placenta to the other twin.

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The authors state that their analysis showed “the spread occurred only once.” That describes the reconstructed history in the studied pair; it is not a statistic about how often cancer transfers between twins. The paper, “Embryonic origin of cancer in newborn twins,” was published online on 6 October 2026 in Nature Communications as an early-access accepted version. The publisher notes that this version is expected to be replaced by the final version of record. Read the study.

Using tumor, normal, and placental tissue gives the authors material to compare the cancer cells with non-tumor samples and to reconstruct the relationship among samples from both twins and the placenta. Their conclusion is specific to this pair: the tumor began in one twin, diversified, and crossed to the co-twin once. It is not a claim that the tumor moved back and forth repeatedly, nor is it a measure of how often transfer occurs in twin pregnancies.

The result updates an earlier account of the evidence, but it does not make placental transfer a common explanation for childhood solid tumors. A 2018 review said there was no evidence that pediatric solid-tumor cells spread between twins in this fashion, reflecting the literature available to its authors at the time. The 2026 report is a newer, specific case; it should be understood as a rare documented example, not as evidence that solid tumors commonly travel between fetuses.

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The difference in evidence base matters. Shared clone-specific markers in leukemia have been discussed in specialist literature over time. The soft-tissue cancer finding comes from a recent whole-genome reconstruction of one twin pair. Both bear on the possibility of prenatal cell transfer, but one report cannot establish how often solid-tumor transfer happens or make the two evidence bases equivalent in breadth.

How the explanations and evidence differ

Question Twin leukemia evidence 2026 soft-tissue cancer report
What supports a shared origin? Matching acquired, clone-specific genetic alterations in leukemia cells from both twins. Whole-genome analysis of tumor, normal, and placental samples used to reconstruct the tumor’s origin and spread.
What does the evidence suggest? A prenatal clone formed and cells from it crossed to the co-twin; later changes may contribute to overt leukemia. The cancer originated in one twin, diversified, and crossed the placenta once to the other twin in the studied pair.
How broad is the evidence? A recurring subject of specialist literature on twin leukemia. One reported twin-pair study; it does not establish that solid-tumor transfer is common.
What should not be inferred? A shared clone does not establish that both newborns already have overt disease or will develop it in the same way. The single-case finding is not a population frequency or an individual risk estimate.

These cases also illustrate why the stage being discussed matters. A prenatal clone or the transfer of its cells is not the same thing as a later diagnosis. In leukemia, shared genetic markers support a common early lineage, while subsequent changes may shape disease in each twin. In the 2026 solid-tumor case, whole-genome analysis across tissue types was used to reconstruct the origin and one transfer event. Neither kind of evidence supplies a population probability.

Is this inherited cancer?

Not in the ordinary sense of inheriting a cancer-predisposition variant from a parent. The clone described in these cases is an acquired population of cells: its cancer-associated changes arise in cells during development rather than being passed down as a germline change in the egg or sperm.

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If cells from that clone cross the placenta, the receiving twin can acquire cells carrying the clone’s changes. That is biologically different from inheriting a genetic variant present throughout the body from conception. The twins are already closely related genetically because they came from the same fertilized egg, but that relationship does not explain the presence of a particular acquired cancer-cell clone in both. The proposed transfer does.

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So “the twins share a cancer-related change” can describe two very different things. A germline predisposition is inherited and present broadly in the body; a clone-specific alteration is acquired in a cell lineage and can be carried by the cells descended from it. In the twin-transfer explanation, it is the movement of cells from that acquired clone—not a cancer gene passed from parent to child—that can account for matching markers.

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How common is cancer transfer between identical twins?

The sources available for this question do not establish a population-level incidence or probability for cancer-cell transfer specifically between identical twins. The leukemia literature provides evidence for the mechanism, and the 2026 paper reports one reconstructed solid-tumor case, but those findings do not provide a denominator from which to calculate an individual twin pair’s risk.

In particular, the 2026 study’s finding that spread occurred once refers to the path reconstructed in that pair. It does not mean transfer happens once per pregnancy, once per a given number of twin pregnancies, or at any other population rate. Figures for other kinds of cancer transmission would answer a different question and should not be substituted for a twin-specific estimate.

There is therefore no sound percentage to attach to an individual pair based on these reports. The documented mechanism and cases explain how transfer can happen, not how likely it is in a particular pregnancy. Case findings should not be converted into a personal risk estimate.

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What to take away from the evidence

  • A shared placenta with connected blood vessels can provide a route for fetal cells to move between twins.
  • Identical twins do not necessarily share a placenta, so zygosity alone does not establish that route.
  • Matching clone-specific genetic changes in twin leukemia support a common prenatal cellular origin, while later changes can influence whether overt disease develops.
  • A 2026 whole-genome study documents a rare soft-tissue cancer case involving placental spread; it does not show that solid-tumor transfer is common.
  • Cell transfer is not the same as inheriting a cancer-causing germline variant from a parent.

Frequently Asked Questions

Can one twin pass leukemia to the other in the womb?

It can happen when twins share a placenta with connected blood vessels. Leukemia evidence includes matching acquired, clone-specific genetic changes in both twins, consistent with cells from one prenatal clone crossing into the co-twin. This is cell transfer, not contagious spread through ordinary contact.

Do all identical twins share cancer cells before birth?

No. Identical twins do not always share a placenta, and the proposed route depends on placental connections that allow fetal blood cells to move between them. Identical-twin status alone does not show that such a connection existed.

Does sharing a prenatal cancer clone mean both twins have cancer at birth?

No. A clone can form before birth and be shared, while additional changes may accumulate later and contribute to overt leukemia. Evidence of a shared clone does not establish that both newborns already have clinically apparent disease or that their later courses will match.

Can a solid tumor pass between identical twins?

A 2026 whole-genome study reconstructed a soft-tissue cancer that began in one twin and crossed the placenta once to the other in the studied pair. This is a documented case, not evidence that solid-tumor transfer is common.

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Is cancer-cell transfer between twins inherited from a parent?

The proposed mechanism is transfer of an acquired cell clone between fetuses. That differs from inheriting a cancer-predisposition change in the egg or sperm, which would be present broadly in the body.

How likely is this to happen in a twin pregnancy?

The cited sources do not establish a population-level incidence or probability for cancer-cell transfer specifically between identical twins. The reported cases explain a possible mechanism but do not provide an individual risk estimate.

The Bottom Line

Cancer can pass between twins before birth when connected blood vessels in a shared placenta allow cells from an acquired clone to enter the other twin’s circulation. Twin leukemia provides the strongest established evidence; a 2026 study adds one reconstructed soft-tissue cancer case. The mechanism is rare, is not ordinary inheritance, and cannot be inferred from identical-twin status alone.

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