Key messages

  • Claims have been made that fluoride is associated with osteosarcoma (bone cancer).
  • International research has disproved this claim.
  • A review of worldwide studies by the International Agency for Research on Cancer concluded there was no evidence of a correlation between cancer rates and fluoridated water.

Claims have been made that fluoride is associated with osteosarcoma. The Department of Health and Human Services has collaborated with Cancer Council Victoria to provide balanced, evidence-based advice about these claims.

Epidemiological studies show no clear association between fluoride in drinking water and osteosarcoma.

Osteosarcoma is a primary bone cancer - a cancer starting in the bone. It usually affects young adults. 

Primary bone cancer is very rare. Less than one per cent of people with bone cancer have primary bone cancer. The causes of primary bone cancer are not known.

In Australia, an average of nine to ten cases of osteosarcoma are diagnosed each year in children under the age of 15 (1). In Victoria, an average of two to three cases are diagnosed each year (2).

Osteosarcoma rates can be compared by calculating the number of new cases per million children aged under 15 per year. Tables 1 and 2 show some comparative rates.  

Table 1: Osteosarcoma rates in Australia

Place

New cases of osteosarcoma per million children aged under 15 per year

Australia – overall (1)

2.2

Melbourne

2.5

New South Wales (3)

2.9

Victoria – overall

2.9

Rural and regional Victoria

3.7

Queensland (4)

4.5

Table 2: Osteosarcoma rates in other countries (1)

Place

New cases of osteosarcoma per million children aged under 15 per year

Denmark

1.8

Scotland

1.9

Japan

2.3

Switzerland

2.5

Hong Kong

2.6

England and Wales

2.6

France

2.7

Sweden

2.7

Canada

2.9

Netherlands

2.9

Finland

3.2

USA

3.3

Italy

3.9

Summary of research

  • A review of worldwide studies by the International Agency for Research on Cancer concluded there was no evidence of a correlation between cancer rates and fluoride (5).
  • The San Francisco Department of Public Health searched relevant peer-reviewed medical literature dating back to September 2005 and identified seven epidemiological studies, none of which showed a relationship between fluoride exposure and osteosarcoma (6).
  • The Australian National Health and Medical Research Council reviewed three small case–control studies of osteosarcoma in 1999. None of these studies found any correlation between fluoride and the risk of osteosarcoma (7).
  • The York Review (2000), a systematic review of 214 studies of varying quality, found no clear association between fluoride and osteosarcoma (8).
  • A study by Hoover et al. found no relationship between osteosarcoma and fluoridation. This study was significant because of the large numbers of people involved (125,000 incident cancers and 2.3 million cancer deaths) (9).
  • In 2002, the British Medical Research Council agreed that, overall, evidence does not suggest that artificially fluoridated water increases cancer risk (10).
  • A review of fluoride by the Scientific Panel on Dietetic Products, Nutrition and Allergies, published by the European Food Safety Authority in 2005, found no increased risk of cancer from drinking fluoridated water (11).
  • A 2008 study that examined carcinogenic risk in developed countries found a significant body of evidence demonstrating that consuming optimally fluoridated water did not present a cancer risk (12).

Harvard study

In 2006, a paper published in the journal Cancer Causes and Control found an association between osteosarcoma and fluoride in drinking water in males, but not in females (13). The authors noted that further studies were required to confirm or refute the findings. In the same issue of the journal, the study’s supervisor published a letter advising caution in interpreting the study’s results for a range of reasons (14).

The second part of the Harvard study, published in 2011, compared the fluoride levels in bones near tumours in people with osteosarcoma to the levels in people with other types of bone tumours. The researchers found no difference between the fluoride levels in the two groups.

In April 2011, the results of an Irish study of osteosarcoma and fluoridation were published (15). A comparison of data on cases of osteosarcoma between 1994 and 2006 in fluoridated and non-fluoridated areas showed no significant differences. The study concluded that osteosarcoma incidence in Ireland is not related to public water fluoridation.

References

1. International Agency for Research on Cancer 1998, International incidence of childhood cancer, IARC publication number 144, volume 2.

2. Victorian Cancer Registry, 1984–2003.

3. International Agency for Research on Cancer, 1988. ‘International Incidence of Childhood Cancer.’ IARC Publication Number 87, Volume 1.

4. Queensland Cancer Registry, 1984–2003.

5. International Agency for Research on Cancer 1982, IARC monographs on the evaluation of carcinogenic risks of chemicals to humans, volume 27.

6. San Francisco Department of Public Health 2005, Current scientific evidence: water fluoridation is not associated with osteosarcoma.

7. Ahokas J, Demos L, Donohue D, Killalea S, McNeil J, Rix C 1999, Review of water fluoridation and fluoride intake from discretionary fluoride supplements: review for NHMRC, Royal Melbourne Institute of Technology and Monash University, Melbourne.

8. McDonagh MS et al. 2000, ‘Systematic review of water fluoridation’, British Medical Journal, vol. 321, pp. 855–859.

9. Hoover RN, Devesa SS, Cantor KP, Fraumeni JF 1991, Time trends for bone and joint cancers and osteosarcomas in the Surveillance, Epidemiology and End Results (SEER) Program, report of the Ad Hoc Subcommittee on Fluoride of the Committee to Coordinate Environmental Health and Related Problems, National Cancer Institute, Washington, DC, pp. F1–F7.

10. Medical Research Council Working Group 2002, Water fluoridation and health, Medical Research Council, United Kingdom.

11. European Food Safety Authority 2005, ‘Opinion of the Scientific Panel on Dietetic Products, Nutrition and Allergies on a request from the Commission related to the tolerable upper intake level of fluoride’, European Food Safety Authority Journal, vol. 192, pp. 1–65.

12. Stewart B 2008, ‘Banding carcinogenic risks in developed countries: a procedural basis for qualitative assessment’, Mutation Research, vol. 658, pp. 124–151.

13. Bassin E, Wypij D, Davis R, Mittleman M 2006, ‘Age-specific fluoride exposure in drinking water and osteosarcoma (United States)’, Cancer Causes Control, vol. 17, pp. 421–428.

14. Douglass CW, Joshipura K 2006, ‘Caution needed in fluoride and osteosarcoma study’, Cancer Causes Control, vol. 17, pp. 481–482.

15. Comber H, Deady S, Montgomery E, Gavin A 2011, ‘Drinking water fluoridation and osteosarcoma incidence on the island of Ireland’, Cancer Causes Control, vol. 22, pp. 919–924.