title: 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.
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Blakey
authors.forename: Richard G
authors.initials: RG
authors.lastname: Feltbower
authors.forename: Roger C
authors.initials: RC
authors.lastname: Parslow
authors.forename: Peter W
authors.initials: PW
authors.lastname: James
authors.forename: Basilio
authors.initials: B
authors.lastname: Gómez Pozo
authors.forename: Charles
authors.initials: C
authors.lastname: Stiller
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Vincent
authors.forename: Paul
authors.initials: P
authors.lastname: Norman
authors.forename: Patricia A
authors.initials: PA
authors.lastname: McKinney
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murphy
authors.forename: Alan W
authors.initials: AW
authors.lastname: Craft
authors.forename: Richard J Q
authors.initials: RJ
authors.lastname: McNally
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001859:Bone Neoplasms / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D005457:Fluoridation / Q000009:adverse effects*; D005459:Fluorides / Q000633:toxicity*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000453:epidemiology* / Q000209:etiology; D011159:Population Surveillance; D012307:Risk Factors; D012512:Sarcoma, Ewing / Q000453:epidemiology* / Q000209:etiology; D012737:Sex Factors; D017062:Small-Area Analysis; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D060766:Drinking Water; D005459:Fluorides
keywords: Ewing sarcoma; Great Britain; Osteosarcoma; artificial fluoridation; bone cancer; children; drinking water; fluoride; small area analysis; young people