Fluor Y Osteosarcoma

Cancer Causes Control (2006) 17:421–428 DOI 10.1007/s10552-005-0500-6

ORIGINAL PAPER

Age-specific fluoride exposure in drinking water and osteosarcoma (United States)
Elise B. Bassin Æ David Wypij Æ Roger B. Davis Æ Murray A. Mittleman

Received: 24 July 2005 / Accepted: 7 November 2005 Ó Springer 2006

Abstract Objective We explored age-specific and gender-specific effects of fluoridelevel in drinking water and the incidence of osteosarcoma. Methods 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 exposureestimates 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.

Results 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 eachexposure 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. Conclusions Our exploratory analysis found an association between fluoride exposure in drinking water duringchildhood and the incidence of osteosarcoma among males but not consistently among females. Further research is required to confirm or refute this observation. Keywords Osteosarcoma Æ Fluoride Æ Fluoridation Æ Case–control

E. B. Bassin Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, USA e-mail: elise_bassin@post.harvard.edu D. Wypij Department of Pediatrics,Harvard Medical School, USA and Clinical Research Program, Children’s Hospital, USA R. B. Davis Æ D. Wypij Department of Biostatistics, Harvard School of Public Health, USA R. B. Davis (&) Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA M. A. Mittleman Department of Epidemiology, Harvard School of Public Health, USA andCardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, USA

Introduction Osteosarcoma is a very rare primary malignant tumor of bone. Although uncommon, primary malignant bone tumors comprise the sixth most common group of malignant tumors in children and the third most common malignant tumor for adolescents, with an annual incidence rate of 5.6 per million for Caucasianchildren under 15 years old [1]. Osteosarcoma is the most common tumor of bone and for patients less than 20 years old more than 80% of these tumors tend to occur in the long bones of the appendicular skeleton which are undergoing rapid growth [2]. The incidence of osteosarcoma is slightly higher in males than females with an annual incidence rate of approximately 3.5 per million for males and2.9 per million for females under the age of 24 years [3].

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Cancer Causes Control (2006) 17:421–428

The etiology of osteosarcoma is largely unknown [1, 4]. In humans, ionizing radiation is the only environmental agent known to cause bone cancer and is thought to have an effect in approximately 3% of cases from either external high-dose irradiation used in cancer therapy orinternal bone-seeking radioisotopes from occupational or medical use [1, 5, 6]. Alkylating agents used in chemotherapy are thought to increase the risk for osteosarcoma and evidence for other etiologic factors including viruses, antecedent trauma, or radium in drinking water has been suggested but inconclusive [1, 5, 7, 8]. Certain pre-existing bone defects including Paget’s disease have been found...