Article

A Case-Control Study of Fluoridation and Osteosarcoma

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Abstract

Public health policy decisions in the United States have resulted in 62.4% of the population having access to fluoridated water. The purpose of this study was to examine the association between community water fluoridation and osteosarcoma. A secondary data analysis was performed with data collected from 2 separate but linked studies. Patients for phase 1 and phase 2 were selected from US hospitals via a matched case-control study design. For both phases, cases included patients diagnosed with osteosarcoma, and controls were patients diagnosed with other bone tumors or nonneoplastic conditions. In phase 1, cases ( n = 209) and controls ( n = 440) were patients of record in the participating orthopedic departments from 1989 to 1993. In phase 2, cases ( n = 108) and controls ( n = 296) were incident patients who were identified and treated by orthopedic physicians from 1994 to 2000. This analysis included all patients who met eligibility criteria on whom we had complete data on covariates, exposures, and outcome. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs for the association of community water fluoridation with osteosarcoma. A modestly significant interaction existed between fluoridation living status and bottled water use ( P = 0.047). The adjusted OR for osteosarcoma and ever having lived in a fluoridated area for nonbottled water drinkers was 0.51 (95% CI, 0.31 to 0.84; P = 0.008). In the same comparison, the adjusted OR for bottled water drinkers was 1.86 (95% CI, 0.54 to 6.41; P = 0.326). Findings from this study demonstrated that community water fluoridation is not associated with an increased risk for osteosarcoma.

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... However, this claim is unfounded. A recent case-control study showed that the risk of having osteosarcoma among individuals exposed to WF was low (18). Furthermore, various reviews reported insufficient evidence to support the adverse effects of fluoride on health as claimed by opponents of WF (7,10,11). ...
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Information regarding water fluoridation (WF) in Malaysia has been substantially documented, but is scattered in various government publications and may be lost to the stakeholders. This paper is a review of water fluoridation in Malaysia and its effect on oral health: a history of WF in Malaysia, the current policy, the evidence of its effectiveness, the challenges and the future directions. A search for relevant physical and electronic documents of WF in Malaysia resulted in the identification of 70 documents for review. WF was gazetted as national policy with an optimal fluoride level of 0.7 parts-per-million (ppm) in 1972, with a reduction of the level to 0.5 ppm in 2005. Evidence showed that WF effectively reduced population dental caries while fluorosis was not a prevalent public health concern. Strong collaboration between stakeholders and the extensive network of piped water supplies resulted in 80% of the population receiving WF in 2013. However, the coverage was reduced to 74.1% in 2018, largely due to the cessation of WF in Pahang. The key challenges in WF included a lack of funding, weak legislation, use of reverse osmosis water filtration system, difficulty to maintaining an optimal level of fluoride in the water, and lack of local data on the impact of WF cessation on oral health, and its cost-effectiveness. This review will provide dental health professionals with scientific evidence on WF and oral health in Malaysia and assist them in answering relevant questions about WF raised by the public.
Chapter
Water pollution is one of the challenges for society, especially for industries working in the water sector. With rapid urbanization, population, and industrial growth, there is a serious threat to water management. New chemicals are released every day, and they are making their way into the water, putting more challenges on water-reuse technologies. Cities occupy less than 3% of the Earth's surface, but there is a significant population density (more than 50% of the global population), industries, and energy use, which results in environmental pollution and degradation. The ecological footprint of cities does not restrict to their boundaries, and the impact is felt from forests, agriculture, water, and other surfaces, which supply resources to their residents. Therefore, cities have an enormous bearing on the surrounding ecosystem, making them centers for water and other environmental pollution. Even though water, sanitation, and access rates are generally higher in urban areas compared to the rural counterparts, it's hard to match this pace with planning and infrastructure in many regions globally. Today, almost 700 million urban people live without proper sanitation, contributing to poor health conditions. The ever-increasing global population, lack of adequate clean water at a global scale, the high-energy demand, the intricate interplay between water and energy, and the environmental impact of contaminated water supplies globally all point toward the challenges that need to be addressed. This chapter will discuss some of the aspects of water pollution, categories of water pollution, impacts of water pollution, socio-economic and environmental challenges, water quality and sustainability goals, and water laws and policies.
Article
This cross-sectional study evaluated the prevalence and severity of dental caries and fluorosis in children and adolescents using fluoridated toothpaste, from areas with and without fluoridated water. Parents of 5-year-old children and 12-year-old adolescents from neighbourhoods that are supplied with and without fluoridated water answered questionnaires for determining socio-economic and demographic characteristics and habits related to oral health. The individuals were examined, and dental caries and fluorosis were measured by dmft/DMFT and TF indexes, respectively. Descriptive, bivariate and logistic regression analyses were performed (p < 0.05). Of 692 participants, 47.7% were 5-year-olds and 52.3% were 12-year-olds. The mean dmft/DMFT in the 5-year-olds/ 12-year-olds from Exposed and Not Exposed fluoridated water groups was 1.53 (± 2.47) and 3.54 (± 4.10) / 1.53 (± 1.81) and 3.54 (± 3.82), respectively. Children (OR = 2.86, 95% CI = 1.71-4.75) and adolescents (OR = 1.95, 95% CI = 1.24-3.05), who did not consume fluoridated water, had greater caries experience. Among adolescents, there was an association between fluoridated water and the prevalence of very mild/mild fluorosis (OR = 5.45, 95% CI: 3.23-9.19) and moderate fluorosis (OR = 11.11, 95% CI = 4.43-27.87). Children and adolescents, who consumed fluoridated water, presented lower prevalence and severity of dental caries compared to those who used only fluoridated toothpaste as the source of fluoride. There is an association between water fluoridation and very mild/mild and moderate fluorosis in adolescents.
Article
Background A relationship between fluoride and osteosarcoma has been hypothesized but not validated. To the authors’ knowledge, there are no published studies examining topical fluoride or dietary fluoride supplements and osteosarcoma risk. The purpose of this study was to examine the association between ever or never use of topical and dietary fluoride supplements and osteosarcoma. Methods The authors performed a secondary data analysis on data from 2 separate but linked studies. Patients for Phase 1 and Phase 2 were selected from US hospitals using a hospital-based matched case-control study design. Case patients were those who had received diagnoses of osteosarcoma, and control patients were those who had received diagnoses of other bone tumors or nonneoplastic conditions. In Phase 1, case patients (N = 209) and control patients (N = 440) were those seeking treatment at orthopedic departments from 1989 through 1993. In Phase 2, incident case patients (N = 108) and control patients (N = 296) were identified and treated by physicians from 1994 through 2000. This analysis included all patients who met eligibility criteria and on whom the authors had complete data on exposure, outcome, and covariates. The authors used conditional logistic regression to estimate odds ratios and 95% confidence intervals (CIs) for the association of topical fluoride use and supplemental fluoride use with osteosarcoma. Results The adjusted odds ratios were 0.94 (95% CI, 0.60 to 1.46) and 0.78 (95% CI, 0.46 to 1.33) for topical fluoride and supplemental fluoride, respectively. Conclusions Neither topical nor dietary fluoride supplements are associated with an increased risk of developing osteosarcoma. Practical Implications Supplemental and topical fluorides used in the dental office and in over-the-counter products are not related to an increased risk of developing osteosarcoma.
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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.
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Population: This cross-sectional study sought to evaluate associations between availability of community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention's Water Fluoridation Reporting System were merged with dental examination data from 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (decayed and filled tooth surfaces [dfs]) was calculated for 7,000 children aged 2 to 8 y and in the permanent dentition (decayed, missing, and filled tooth surfaces [DMFS]) for 12,604 children and adolescents aged 6 to 17 y. Linear regression models estimated associations between % CWF and dental caries experience with adjustment for sociodemographic characteristics: age, sex, race/ethnicity, rural-urban location, head-of-household education, and period since last dental visit. Sensitivity analysis excluded counties fluoridated after 1998. In unadjusted analysis, caries experience in the primary dentition was lower in counties with ≥75% CWF (mean dfs = 3.3; 95% confidence limit [CL] = 2.8, 3.7) than in counties with <75% CWF (mean dfs = 4.6; 95% CL = 3.9, 5.4), a prevented fraction of 30% (95% CL = 11, 48). The difference was also statistically significant, although less pronounced, in the permanent dentition: mean DMFS (95% CL) was 2.2 (2.0, 2.4) and 1.9 (1.8, 2.1), respectively, representing a prevented fraction of 12% (95% CL = 1, 23). Statistically significant associations likewise were seen when % CWF was modeled as a continuum, and differences tended to increase in covariate-adjusted analysis and in sensitivity analysis. These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth.
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Objective: The U.S. water fluoridation recommendations, which have been in place since 1962, were based in part on findings from the 1950s that children's water intake increased with outdoor temperature. We examined whether or not water intake is associated with outdoor temperature. Methods: Using linked data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 and the National Oceanic and Atmospheric Administration, we examined reported 24-hour total and plain water intake in milliliters per kilogram of body weight per day of children aged 1-10 years by maximum outdoor temperature on the day of reported water intake, unadjusted and adjusted for age, sex, race/ethnicity, and poverty status. We applied linear regression methods that were used in previously reported analyses of data from NHANES 1988-1994 and from the 1950s. Results: We found that total water intake was not associated with temperature. Plain water intake was weakly associated with temperature in unadjusted (coefficient 5 0.2, p=0.015) and adjusted (coefficient 5 0.2, p=0.013) linear regression models. However, these models explained little of the individual variation in plain water intake (unadjusted: R(2)=0.005; adjusted: R(2)=0.023). Conclusion: Optimal fluoride concentration in drinking water to prevent caries need not be based on outdoor temperature, given the lack of association between total water intake and outdoor temperature, the weak association between plain water intake and outdoor temperature, and the minimal amount of individual variance in plain water intake explained by outdoor temperature. These findings support the change in the U.S. Public Health Service recommendation for fluoride concentration in drinking water for the prevention of dental caries from temperature-related concentrations to a single concentration that is not related to outdoor temperature.
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The association between fluoride and risk for osteosarcoma is controversial. The purpose of this study was to determine if bone fluoride levels are higher in individuals with osteosarcoma. Incident cases of osteosarcoma (N = 137) and tumor controls (N = 51) were identified by orthopedic physicians, and segments of tumor-adjacent bone and iliac crest bone were analyzed for fluoride content. Logistic regression adjusted for age and sex and potential confounders of osteosarcoma was used to estimate odds ratios (OR) and 95% confidence intervals (CI). There was no significant difference in bone fluoride levels between cases and controls. The OR adjusted for age, gender, and a history of broken bones was 1.33 (95% CI: 0.56-3.15). No significant association between bone fluoride levels and osteosarcoma risk was detected in our case-control study, based on controls with other tumor diagnoses. © 2011 International & American Associations for Dental Research.
Article
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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. 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. 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). 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.
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Osteosarcoma typically occurs during puberty. Studies of the association between height and/or birth-weight and osteosarcoma are conflicting. Therefore, we conducted a large pooled analysis of height and birth-weight in osteosarcoma. Patient data from seven studies of height and three of birth-weight were obtained, resulting in 1,067 cases with height and 434 cases with birth-weight data. We compared cases to the 2000 US National Center for Health Statistics Growth Charts by simulating 1,000 age- and gender-matched controls per case. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between height or birth-weight and risk of osteosarcoma for each study were estimated using logistic regression. All of the case data were combined for an aggregate analysis. Compared to average birth-weight subjects (2,665-4,045 g), individuals with high birth-weight (≥ 4,046 g) had an increased osteosarcoma risk (OR 1.35, 95% CI 1.01-1.79). Taller than average (51st - 89th percentile) and very tall individuals (≥ 90th percentile) had an increased risk of osteosarcoma (OR 1.35, 95% CI 1.18-1.54 and OR 2.60, 95% CI 2.19-3.07, respectively; P (trend) < 0.0001). This is the largest analysis of height at diagnosis and birth-weight in relation to osteosarcoma. It suggests that rapid bone growth during puberty and in utero contributes to OS etiology.
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Recent animal studies of the potential carcinogenicity of fluoride prompted an examination of bone cancer incidence rates. Trends in the incidence of primary bone cancers, including the incidence of osteosarcomas were examined among residents of New York State, exclusive of New York City. Average annual osteosarcoma incidence rates in fluoridated and non-fluoridated areas were also compared. Among persons less than 30 years of age at diagnosis, bone cancer incidence among males demonstrated a significant increase since 1955, while incidence among females has remained unchanged. A significant decrease in bone cancer incidence rates since 1955 was observed among both males and females age 30 years and over at time of diagnosis. Osteosarcoma incidence rates have remained essentially unchanged since 1970, among both younger and older males and females. The average annual age adjusted incidence of osteosarcomas (1976-1987) in areas served by fluoridated water supplies was not found to differ from osteosarcoma incidence rates in non-fluoridated areas. These data do not support an association between fluoride in drinking water and the occurrence of cancer of the bone.
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This study tests the hypothesis that fluoride exposure in a nonoccupational setting is a risk factor for childhood osteosarcoma. A population-based case-control study was conducted among residents of New York State, excluding New York City. Case subjects (n = 130) were diagnosed with osteosarcoma between 1978 and 1988, at age 24 years or younger. Control subjects were matched to case subjects on year of birth and sex. Exposure information was obtained by a telephone interview with the subject, parent, or both. Based on the parents' responses, total lifetime fluoride exposure was not significantly associated with osteosarcoma among all subjects combined or among females. However, a significant protective trend was observed among males. Protective trends were observed for fluoridated toothpaste, fluoride tablets, and dental fluoride treatments among all subjects and among males. Based on the subjects' responses, no significant associations between fluoride exposure and osteosarcoma were observed. Fluoride exposure does not increase the risk of osteosarcoma and may be protective in males. The protective effect may not be directly due to fluoride exposure but to other factors associated with good dental hygiene. There is also biologic plausibility for a protective effect.
Article
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Risk factors for osteosarcoma in young people were investigated in a population-based case-control study among residents of New York State, excluding New York City. Cases (n = 130) were diagnosed between 1978 and 1988 at < or = 24 years of age. Controls were randomly selected from birth certificates and were pair matched to cases on year of birth and sex. Exposure information was obtained by telephone interview with a subject and/or parent, and from birth certificates and school and medical records. A significant positive association was observed with height one year before diagnosis (P-value for trend = 0.02). No significant associations were observed between osteosarcoma and weight of body mass index one year before diagnosis, birth length, birthweight, gestational age, having reached puberty, having begun growth spurt, age at puberty, age growth spurt began, medical x-rays, antenatal exposures, family history of cancer, birth defects, or parental occupation.
Poster
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.
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Cancers arising from bone or cartilage account for about 0.5% of all malignant neoplasms in humans. This chapter reviews the epidemiology of bone cancer. Topics covered include demographic patterns, environmental factors, genetic susceptibility, and prevention.
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BACKGROUND The Children's Cancer Group conducted a case-control study to determine the role of a broad range of environmental and familial factors in the etiology of Ewing's sarcoma and osteosarcoma in children. These factors included radiation exposure and, for children with osteosarcoma, parental exposure to beryllium.METHODS The parents of 152 children with osteosarcoma and 153 children with Ewing's sarcoma were interviewed by telephone. Controls were obtained by random digit dialing and were matched to cases by age and race.RESULTSFemale osteosarcoma patients had earlier onset of breast development (age 11.4 vs. 11.8 years, P = 0.03) and menarche (age 12.1 vs. 12.5 years, P = 0.002) but no significant differences in growth, whereas male osteosarcoma patients were similar in age at the onset of secondary sexual characteristics but reported significantly less weight gain during their growth spurt (6.6 vs. 11.7 kg, P = 0.003). For children with Ewing's sarcoma, the growth spurt began earlier (age 12.1 vs. 12.7 years, P = 0.12) and resulted in less weight and height gain (5.2 vs. 9.7 kg, P = 0.002, and 10.2 vs. 12.7 cm, P=0.02, respectively) for males, but no differences were observed among females. For factors not related to growth and development (including a wide range of occupational, medical, and household exposures), there was little evidence of an etiologic role with respect to either tumor type.CONCLUSIONS Differences between cases and controls with respect to growth and development showed no consistent pattern. This study did not identify any important risk factors for either type of childhood bone tumor. Cancer 1998;83:1440-1448. © 1998 American Cancer Society.
Article
Objective: Recommended fluoride concentrations in US public water systems are between 0.7-1.2 ppm, depending on the mean daily maximum temperature. This range assumes that water intake is higher in warmer than in cooler climates, based on research from the 1950s. The aim of this analysis is to relate fluid consumption among American children aged 1-10 years to the local climate under modern conditions. Methods: The quantities of daily total fluid intake per body weight (ml/kg) and plain water intake per body weight (ml/kg) of children were calculated from the 24-hour recall diet survey in the third National Health and Nutrition Examination Survey (NHANES III, 1988-94). The mean daily maximum temperature from 1961 to 1990, averaged for the month during which the NHANES III exam was conducted, was obtained for each survey location from the US Local Climate Historical Database. Multiple regression analysis was conducted using SAS and SUDAAN. Results: Fluid intake was significantly associated with age, sex, socioeconomic status (SES), and race and ethnicity. No significant association could be found between the amount of either total fluid or plain water intake and mean daily maximum temperature, either before and after controlling for sex, age, SES, and race or ethnicity. Conclusions: Results indicate that there is no evidence that fluid consumption among children is significantly related to mean temperature in modern conditions. This suggests that the national temperature-related guidelines for fluoride concentration in drinking water may be due for reevaluation.
Article
It has been suggested that fluoride in drinking water may increase the risk of osteosarcoma in children and adolescents, although the evidence is inconclusive. We investigated the association between community water fluoridation (CWF) and osteosarcoma in childhood and adolescence in the continental U.S. We used the cumulative osteosarcoma incidence rate data from the CDC Wonder database for 1999-2006, categorized by age group, sex and states. States were categorized as low (≤30%) or high (≥85%) according to the percentage of the population receiving CWF between 1992 and 2006. Confidence intervals for the incidence rates were calculated using the Gamma distribution and the incidence rates were compared between groups using Poisson regression models. We found no sex-specific statistical differences in the national incidence rates in the younger groups (5-9, 10-14), although 15-19 males were at higher risk to osteosarcoma than females in the same age group (p<0.001). Sex and age group specific incidence rates were similar in both CWF state categories. The higher incidence rates among 15-19 year old males vs females was not associated with the state fluoridation status. We also compared sex and age specific osteosarcoma incidence rates cumulated from 1973 to 2007 from the SEER 9 Cancer Registries for single age groups from 5 to 19. There were no statistical differences between sexes for 5-14 year old children although incidence rates for single age groups for 15-19 year old males were significantly higher than for females. Our ecological analysis suggests that the water fluoridation status in the continental U.S. has no influence on osteosarcoma incidence rates during childhood and adolescence.
Article
Osteosarcoma, which is the most common primary bone tumor, occurs most frequently in adolescents, but there is a second incidence peak among individuals aged > 60 years. Most osteosarcoma epidemiology studies have been embedded in large analyses of all bone tumors or focused on cases occurring in adolescence. Detailed descriptions of osteosarcoma incidence and survival with direct comparisons among patients of all ages and ethnicities are not available. Frequency, incidence, and survival rates for 3482 patients with osteosarcoma from the National Cancer Institute's population-based Surveillance, Epidemiology, and End Results (SEER) Program between 1973 and 2004 were investigated by age (ages 0-24 years, 25-59 years, and 60 to > or = 85 years), race, sex, pathology subtype, stage, and anatomic site. There were large differences in incidence and survival rates by age. There was a high percentage of osteosarcoma with Paget disease and osteosarcoma as a second or later cancer among the elderly. There was a high percentage of osteosarcoma among patients with Paget disease and osteosarcoma as a second or later cancer among the elderly. Tumor site differences among age groups were noted. Survival rates varied by anatomic site and disease stage and did not improve significantly from 1984 to 2004. This comprehensive, population-based description of osteosarcoma, identified important differences in incidence, survival, pathologic subtype, and anatomic site among age groups, and quantified the impact of osteosarcoma in patients with Paget disease or as a second cancer on incidence and mortality rates. These findings may have implications in understanding osteosarcoma biology and epidemiology.
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This article disputes claims of anti-fluoridationists linking water fluoridation with Down's syndrome, cardiovascular disease, cancer in humans and animals, and other conditions. Controlled fluoridation of community water has been shown to be the most effective public health measure in reducing caries. Anti-fluoridationists have attempted to link water fluoridation with allergies, Down's syndrome, heart disease, and cancer. There is no evidence that water containing optimal concentrations (0.7–1.2 ppm) of fluoride impairs general health.
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A recent report by the National Health Federation, a private agency, related cancer mortality patterns in the United States to fluoridation of water supplies, triggering much public health concern and some political response. To clarify the issues raised, we studied cancer mortality and incidence statistics for U.S. counties, 1950-69. No trends could be ascribed to the consumption of water that is artificially or naturally fluoridated.
Article
Because osteosarcomas may develop in rats exposed to fluoridated water, water fluoridation might pose a cancer risk to humans. A time trend analysis of the cumulative risk (CR) of bone cancer for the period 1958-1987 for 40 cancer registry areas showed an increased risk for young males in Canada, Europe, and the United States, and a decreased lifetime risk for either sex in Europe. This was unrelated to water fluoridation and may have resulted from changes in coding practices. Bone cancer risk was inversely related to the incidence of cancers of unknown origin, suggesting that bone metastases were erroneously coded as primary bone cancer. In 1968-1972, most areas recorded more bone cancer deaths than new cases of the disease. The mortality/incidence ratio, but not the incidence rate (IR), has dropped sharply since then, which erodes the basis of past inferences relating cancer mortality to fluoridation.
Article
Gender-specific and race-specific incidence and survival rates of osteogenic sarcoma over a 14-year period are presented for persons aged 0 to 24 years from eight Surveillance, Epidemiology, and End Results (SEER) registries. They were no significant gender or racial differences in age at diagnosis. There was no significant gender difference in overall incidence. Although incidence rates were slightly higher in blacks compared with whites, the difference was not significant after controlling for multiple comparisons. Females (median, 74 months) survived longer than males (median, 29 months), although this difference weakened after controlling for stage. No racial differences in survival were observed. White females survived the longest (median, 94 months), followed by black females (median, 41 months), black males (median, 34 months), and white males (median, 29 months). This striking difference in survival should be explored more fully.
Article
To test the hypothesis that fluoride is a risk factor for osteosarcoma, a case control study compared the complete residential fluoride histories of osteosarcoma patients with matched hospital-based controls. Fluoridation was not found to be a risk factor for osteosarcoma in the study population. The trend in the data from this small sample study suggests the hypothesis that a protective effect may exist against the formation of osteosarcoma for individuals consuming fluoridated water.
Article
To determine the carcinogenic potential of sodium fluoride (NaF), we fed Sprague-Dawley rats a diet containing NaF for up to 99 weeks. Rats receiving NaF at a dose of 4, 10, or 25 mg/kg per day added to a low-fluoride diet were compared with controls receiving either a low-fluoride diet or laboratory chow. Each treatment group consisted of 70 rats of each sex. A 30% decrement in weight gain occurred at an NaF dose of 25 mg/kg per day. Evidence of fluoride toxicity was seen in the teeth, bones, and stomach, and the incidence and severity of these changes were related to the dose of NaF and the duration of exposure. Despite clear evidence of toxicity, NaF did not alter the incidence of preneoplastic and neoplastic lesions at any site in rats of either sex. Results from this study indicate that NaF is not carcinogenic in Sprague-Dawley rats.
Article
A study of 64 cases and 124 friend and neighbor controls was conducted to identify factors associated with the occurrence of osteosarcoma in young persons. Two types of information were collected: questionnaire data from telephone interviews with mothers, and data on height since birth from family, physician, and school records. Cases were not taller at the time of diagnosis than controls, nor were growth rates higher--either overall or during the 3-4 years prior to diagnosis. An excess risk, however, was observed among subjects whose birth length was at or below the 25th percentile, based on national standards. An excess risk was also found among subjects born more than one week early, but the positive association with short birth length remained when duration of pregnancy was taken into account. Positive associations were also found for prior trauma to the tumor site; congenital skeletal defects or other treated bone conditions; fetal x-ray; and maternal employment during pregnancy in manufacturing industries.
Article
We estimated the risk of subsequent bone cancer among 9170 patients who had survived two or more years after the diagnosis of a cancer in childhood. As compared with the general population, the patients had a relative risk of 133 (95 percent confidence interval, 98 to 176) and a mean (+/- SE) 20-year cumulative risk of 2.8 +/- 0.7 percent. Detailed data on treatment were obtained on 64 patients in whom bone cancer developed after childhood cancer. As compared with 209 matched controls who had survived cancer in childhood but who did not have bone cancer later, patients who had had radiation therapy had a 2.7-fold risk (95 percent confidence interval, 1.0 to 7.7) and a sharp dose-response gradient reaching a 40-fold risk after doses to the bone of more than 6000 rad. The relative dose-response effect among patients who had been treated for retinoblastoma resembled that among patients with all other types of initial tumors, although the cumulative risk of bone cancer in the retinoblastoma group was higher. Similar numbers of patients were treated with orthovoltage and megavoltage; the patterns of risk among categories of doses did not differ according to the type of voltage. After adjustment for radiation therapy, treatment with alkylating agents was also linked to bone cancer (relative risk, 4.7; 95 percent confidence interval, 1.0 to 22.3), with the risk increasing as cumulative drug exposure rose. We conclude that both radiotherapy and chemotherapy with alkylating agents for childhood cancer increase the subsequent risk of bone cancer.
Article
Proxy exposure measures and readily available data from the Wisconsin Cancer Reporting System were used to contrast 167 osteosarcoma cases with 989 frequency-matched cancer referents reported during 1979-1989. Differences in potential exposure to water-borne radiation and fluoridated drinking water, population size for the listed place of residence, and seasonality were assessed. An association was found between osteosarcoma and residence in a population of less than 9,000 (odds ratio = 1.6, 95% confidence interval = 1.1-2.4). In addition, an association between month of birth (May through July versus other months of birth) and osteosarcoma among individuals who were less than 25 y of age (odds ratio = 1.9, 95% confidence interval = 1.1-3.4). Overall, no association was found between potential exposure to fluoridated drinking water and osteosarcoma (odds ratio = 1.0, 95% confidence interval = 0.6-1.5). The association between osteosarcoma and water-borne radiation was weak and was not significant statistically (odds ratio = 1.5, 95% confidence interval = 0.8-2.8).
Article
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We explored age-specific and gender-specific effects of fluoride level in drinking water and the incidence of osteosarcoma. We used data from a matched case-control study conducted through 11 hospitals in the United States that included a complete residential history for each patient and type of drinking water (public, private well, bottled) used at each address. Our analysis was limited to cases less than 20 years old. We standardized fluoride exposure estimates based on CDC-recommended target levels that take climate into account. We categorized exposure into three groups (<30%, 30-99%, >99% of target) and used conditional logistic regression to estimate odds ratios. Analysis is based on 103 cases under the age of 20 and 215 matched controls. For males, the unadjusted odds ratios for higher exposures were greater than 1.0 at each exposure age, reaching a peak of 4.07 (95% CI 1.43, 11.56) at age 7 years for the highest exposure. Adjusting for potential confounders produced similar results with an adjusted odds ratio for males of 5.46 (95% CI 1.50, 19.90) at age 7 years. This association was not apparent among females. Our exploratory analysis found an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females. Further research is required to confirm or refute this observation.
Epidemiology of osteosarcoma and Ewing’s sarcoma in childhood: a study of 305 cases by the Children’s Cancer Group
  • J D Buckley
  • Pendergrass
  • Tw
  • C M Buckley
  • Pritchard
  • Dj
  • Nesbit
  • Me
  • A J Provisor
  • L L Robison