Abstract
Purpose
The purpose of this study was to examine the association between fluoride levels in public drinking water and childhood and adolescent osteosarcoma in Texas; to date, studies examining this relationship have been equivocal. Using areas with high and low naturally occurring fluoride, as well as areas with optimal fluoridation, we examined a wide range of fluoride levels in public drinking water.
Methods
This was a population-based case–control study, with both cases and controls obtained from the Texas Cancer Registry. Eligible cases were Texas children and adolescents <20 years old diagnosed with osteosarcoma between 1996 and 2006. Controls were sampled from children and adolescents diagnosed with either central nervous system (CNS) tumors or leukemia during the same time frame. Using geocoded patient addresses at the time of diagnosis, we estimated patients’ drinking water fluoride exposure levels based on the fluoride levels of their residence’s public water system (PWS). Unconditional logistic regression models were used to assess the association between osteosarcoma and public drinking water fluoride level, adjusting for several demographic risk factors.
Results
Three hundred and eight osteosarcoma cases, 598 leukemia controls, and 604 CNS tumor controls met selection criteria and were assigned a corresponding PWS fluoride level. PWS fluoride level was not associated with osteosarcoma, either in a univariable analysis or after adjusting for age, sex, race, and poverty index. Stratified analyses by sex were conducted; no association between PWS fluoride level and osteosarcoma was observed among either males or females.
Conclusions
No relationship was found between fluoride levels in public drinking water and childhood/adolescent osteosarcoma in Texas.
Similar content being viewed by others
References
Mirabello L, Troisi RJ, Savage SA (2009) Osteosarcoma incidence and survival rates from 1973 to 2004: data from the surveillance, epidemiology, and end results program. Cancer 115(7):1531–1543. doi:10.1002/cncr.24121
Tucker MA, D’Angio GJ, Boice JD Jr, Strong LC, Li FP, Stovall M, Stone BJ, Green DM, Lombardi F, Newton W, Hoover RN, Fraumeni JF Jr (1987) Bone sarcomas linked to radiotherapy and chemotherapy in children. N Engl J Med 317:588–593. doi:10.1056/NEJM198709033171002
National Research Council of the National Academies (NRC) (2006) Fluoride in drinking water—a scientific review of EPA’s standards. National Academies Press, Washington
Chavassieux P, Boivin G, Serre CM, Meunier PJ (1993) Fluoride increases rat osteoblast function and population after in vivo administration but not after in vitro exposure. Bone 14:721–725
Centers for Disease Control and Prevention (CDC) (1999) Ten great public health achievements—United States, 1900–1999. MMWR Morb Mortal Wkly Rep 48:241–243
Gelberg KH, Fitzgerald EF, Hwang S-A, Dubrow R (1995) Fluoride exposure and childhood osteosarcoma: a case–control study. Am J Public Health 85(12):1678–1683
Hrudey SE, Soskolne CL, Berkel J, Fincham S (1990) Drinking water fluoridation and osteosarcoma. Can J Public Health 81:415–416
Mahoney MC, Nasca PC, Burnett WS, Melius JM (1991) Bone cancer incidence rates in New York state: time trends and fluoridated drinking water. Am J Public Health 81(4):475–479
McGuire SM, Vanable ED, McGuire MH, Buckwalter JA, Douglass CW (1991) Is there a link between fluoridated water and osteosarcoma? J Am Dent Assoc 122:39–45
Moss ME, Kanarek MS, Anderson HA, Hanrahan LP, Remington PL (1995) Osteosarcoma, seasonality, and environmental factors in Wisconsin, 1979–1989. Arch Environ Health 50(3):235–241
Cohn PD (1992) A brief report on the association of drinking water fluoridation and the incidence of osteosarcoma among young males. New Jersey Department of Environment Protection and New Jersey Department of Health
Hoover RN, Devesa SS, Cantor KP, Lubin JH, Fraumeni JF (1991) Time trends for bone and joint cancers and osteosarcomas in the surveillance, epidemiology and end results (SEER) program. US Public Health Service, Washington
Bassin EB, Wypij D, Davis RB, Mittleman MA (2006) Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes Control 17(4):421–428. doi:10.1007/s10552-005-0500-6
Hudak PF (1999) Fluoride levels in Texas groundwater. J Environ Sci Health A 34(8):1659–1676
Checkoway H, Pearce N, Kriebel D (2004) Research methods in occupational epidemiology, monographs in epidemiology and biostatistics, vol 34, 2nd edn. Oxford University Press, New York
Freni SC, Gaylor DW (1992) International trends in the incidence of bone cancer are not related to drinking water fluoridation. Cancer 70(3):611–618
McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J, Misso K, Bradley M, Treasure E, Kleijnen J (2000) Systematic review of water fluoridation. BMJ 321:855–859
Douglass CW, Joshipura K (2006) Caution needed in fluoride and osteosarcoma study. Cancer Causes Control 17(4):481–482. doi:10.1007/s10552-006-0008-8
Kim FM, Hayes C, Williams PL, Whitford GM, Joshipura KJ, Hoover RN, Douglass CW, National Osteosarcoma Etiology G (2011) An assessment of bone fluoride and osteosarcoma. J Dent Res 90(10):1171–1176. doi:10.1177/0022034511418828
Acknowledgments
The authors would like to thank Dr. Melanie Williams, Ann Barnett, Dr. Erin Fox, Suzanne Jaster, Tracy Harbour, Paul Betts, Heather Powell, Dr. Heidi Bojes, and Emily Hall for their help. A special thanks to Dr. Noha Farag for her epidemiological expertise and help with analysis.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
Rights and permissions
About this article
Cite this article
Archer, N.P., Napier, T.S. & Villanacci, J.F. Fluoride exposure in public drinking water and childhood and adolescent osteosarcoma in Texas. Cancer Causes Control 27, 863–868 (2016). https://doi.org/10.1007/s10552-016-0759-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-016-0759-9