title: Cancer incidence and mortality in workers exposed to fluoride.
abstract: BACKGROUND
  Although a recent bioassay showed increased frequency of bone cancer in rats with high oral intake of fluoride, the data are reported as equivocal evidence of carcinogenicity. In humans, occupational fluoride exposure may cause skeletal fluorosis, and our earlier follow-up of fluoride-exposed workers showed increased incidence of respiratory cancers.
  
  
  OBJECTIVE
  To further evaluate occupational fluoride exposure as a carcinogenic risk factor, we extended by approximately one decade the follow-up of a cohort of 425 men and 97 women employed for at least 6 months in the period 1924-1961 at the Copenhagen cryolite processing plant. Cryolite ore contains about 50% fluoride.
  
  
  METHODS
  Cancer mortality was determined for the period 1941-1989, and incidence for 1943-1987. For comparison, we used national mortality rates and cancer incidence rates for the Copenhagen area.
  
  
  RESULTS
  Among the men, 300 deaths occurred; 223 were expected. Respiratory (lung and laryngeal) cancers and violent death were responsible for most of this excess; rates for mortality from cardiovascular disease were close to the rates expected. Of the 423 male workers, 119 developed cancers; 103.6 were expected. There was excess incidence of cancers of the lungs (35 men; standard incidence ratio [SIR] = 1.35), larynx (5 men; SIR = 2.29), and urinary bladder (17 men; SIR = 1.84). Maximum incidence occurred after 10-19 years of employment, but otherwise, no stable relationship between cancer incidence and duration of employment was observed. The incidence of respiratory and urinary cancers was particularly high in men less than 35 years old at first employment. Cancers in female workers were too few to allow detailed evaluation.
  
  
  CONCLUSIONS
  The increased incidence of respiratory cancers suggests that cigarette smoking was frequent in this cohort, despite the unremarkable cardiovascular mortality, but the disproportionate increase in the incidence of bladder cancer is difficult to explain by smoking habits alone. Because this industrial cohort was exposed to high concentrations of fluoride dust, heavy respiratory exposure to fluoride may have contributed to the increased cancer risk. If these workers inhaled a carcinogenic substance partly excreted in the urine, an increased incidence of respiratory and bladder cancers would not be inconceivable.
  
  
  CONCLUSIONS
  The potential role of fluoride as a cause of bladder cancer needs to be explored.
authors.affiliation: Department of Environmental Medicine, Odense University, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Grandjean
authors.forename: J H
authors.initials: JH
authors.lastname: Olsen
authors.forename: O M
authors.initials: OM
authors.lastname: Jensen
authors.forename: K
authors.initials: K
authors.lastname: Juel
mesh_terms: D000328:Adult; D005260:Female; D005459:Fluorides / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D009784:Occupational Diseases / Q000139:chemically induced*; D016273:Occupational Exposure; D012516:Osteosarcoma / Q000139:chemically induced; D012142:Respiratory Tract Neoplasms / Q000139:chemically induced; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced
chemical_list: D005459:Fluorides