Osteosarcoma - Safety - Community Water Fluoridation

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CDC Statement on Water Fluoridation and Osteosarcoma

Osteosarcoma is a type of rare bone cancer. About 400 children and adolescents in the United States are diagnosed each year, approximately 250 of whom are males. An observed association between exposure to fluoride in drinking water and the incidence (new cases) of osteosarcoma in young males has been reported in a paper entitled Age-specific Fluoride Exposure in Drinking Water and Osteosarcoma (United States) (Bassin et al., 2006). No apparent association was observed in females. This research, which the author describes as an exploratory analysis, adds to the scientific knowledge base on this topic. The author acknowledges that this study has limitations and further research is required to confirm or refute this observation.

This paper is based on the analysis of an initial set of cases from a 15-year effort to study fluoride and osteosarcoma by the Harvard School of Dental Medicine and collaborating organizations. The principal investigator for the overall study cautions against over interpreting or generalizing the results of the Bassin analysis, stressing that preliminary analysis of a second set of cases does not appear to replicate the findings (Douglass et al., 2006). Publications from the forthcoming analyses are expected to provide further information as to whether and to what extent an association may exist between osteosarcoma and exposure to fluoride.

A number of studies regarding water fluoridation and osteosarcoma have been published in the past. At this time, the weight of the scientific evidence, as assessed by independent committees of experts, comprehensive systematic reviews, and review of the findings of individual studies does not support an association between water fluoridated at levels optimal for oral health and the risk for cancer, including osteosarcoma. In a report issued in March 2006, Fluoride in Drinking Water: A Scientific Review of EPA’s Standard, the National Research Council (NRC, 2006) considered all available evidence on fluoride and osteosarcoma, including pre-publication data from the analysis by Dr. Bassin. The NRC Committee found the overall evidence on osteosarcoma to be tentative and mixed, and no recommendations were made related to this health concern for revising current allowable fluoride levels in drinking water. The report stated that the results of the larger Harvard study, once published, may provide an important and useful addition to the weight of scientific evidence regarding this condition.

CDC’s mission includes monitoring health, detecting and investigating health problems, developing and advocating for sound public health policies, implementing prevention strategies, promoting healthy behaviors, and fostering safe and healthful environments. The overriding goal and concern is protecting the health and well being of the public. CDC continually monitors and evaluates scientific information on fluoridation as part of its responsibility for public health assurance and protection. CDC, along with experts in the scientific community, will review published studies when they become available, will continue to monitor other scientific developments related to water fluoridation, and will provide guidance and recommendations about fluoride to the public.

CDC continues to strongly support community water fluoridation as a safe and effective public health measure to prevent and control tooth decay and to improve overall health. Water fluoridation benefits people of all ages and socioeconomic groups, including those difficult to reach through other public health programs and private dental care. CDC has recognized community water fluoridation as one of 10 great public health achievements of the 20th century. Those wishing to learn more about fluoridation can find CDC’s Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States and other information at www.cdc.gov/oralhealth.

References

Bassin EB, Wypij D, Davis RB, Mittleman MA. Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes and Control 2006;17:421–428.

Douglass CW, Joshipura K. Caution needed in fluoride and osteosarcoma study. Cancer Causes and Control 2006;17:481–482.

National Research Council Committee on Fluoride in Drinking Water. Fluoride in drinking water: A scientific review of EPA’s standards. Washington, D.C: The National Academies Press, 2006.