Is fluoride a risk factor for bone cancer? Small area analysis of osteosarcoma and Ewing sarcoma diagnosed among 0-49-year-olds in Great Britain, 1980-2005

Abstract

Background: Artificial fluoridation of drinking water to improve dental health has long been a topic of controversy. Opponents of this public health measure have cited the possibility of bone cancer induction. The study objective was to examine whether increased risk of primary bone cancer was associated with living in areas with higher concentrations of fluoride in drinking water.Methods: Case data on osteosarcoma and Ewing sarcoma, diagnosed at ages 0–49 years in Great Britain (GB) (defined here as England, Scotland and Wales) during the period 1980–2005, were obtained from population-based cancer registries. Data on fluoride levels in drinking water in England and Wales were accessed through regional water companies and the Drinking Water Inspectorate. Scottish Water provided data for Scotland. Negative binomial regression was used to examine the relationship between incidence rates and level of fluoride in drinking water at small area level.Results: The study analysed 2566 osteosarcoma and 1650 Ewing sarcoma cases. There was no evidence of an association between osteosarcoma risk and fluoride in drinking water [relative risk (RR) per one part per million increase in the level of fluoride = 1·001; 90% confidence interval (CI) 0·871, 1·151] and similarly there was no association for Ewing sarcoma (RR = 0·929; 90% CI 0·773, 1·115).Conclusions: The findings from this study provide no evidence that higher levels of fluoride (whether natural or artificial) in drinking water in GB lead to greater risk of either osteosarcoma or Ewing sarcoma.

Bone cancer incidence by morphological subtype: a global assessment

“…The patterns of incidence of ES across countries concur with the published literature [2] with rates somewhat higher among males than females up to the early peak in female incidence (at ages [10][11][12][13][14] which occurs 5 years earlier on average than in men; women have higher rates at ages 15-24. Although the cause of ES remains unknown, some clues regarding its etiology have emerged from the few case-control studies reported. Parental exposure to environmental factors [6,[11][12][13] leading to the disruption of normal embryological development of tissues by hormonal, environmental, or genetic factors during pregnancy has been implicated in its etiology [15].…”

Community water fluoridation and health outcomes in England: a cross‐sectional study

“…A recent UK ward‐level ecological study using a broadly similar method to this study found no association between measured fluoride levels in drinking water and osteosarcoma .…”

Water fluoridation: It really is this simple

“…Blakey et al [164] 2014 Ecological analysis using high-quality population-based data on osteosarcoma and Ewing sarcoma cases diagnosed in Great Britain between 1980 and 2005. Fluoride levels were assigned on a small-area basis, allowing improved classification of exposure.…”

“…The analysis, which is more informative than those of previous ecological studies, found no correlation between fluoridated water consumption and these cancers. [164] • A recent Water Fluoridation Health Monitoring report published by Public Health England [95] found no evidence of a positive association between fluoridation and osteosarcoma or other forms of cancer.…”