Fluoride exposure in public drinking water and childhood and adolescent osteosarcoma in Texas



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.


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.


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.


No relationship was found between fluoride levels in public drinking water and childhood/adolescent osteosarcoma in Texas.

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The authors would like to thank Dr. Melanie Williams, Ann Barnett, Dr. Erin Fox, Suzanne Jaster, Tracy Harbour, Paul Betts, Heather Powell, Dr. Heidi Bojes, and Emily Hall for their help. A special thanks to Dr. Noha Farag for her epidemiological expertise and help with analysis.

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Correspondence to Natalie P. Archer.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Archer, N.P., Napier, T.S. & Villanacci, J.F. Fluoride exposure in public drinking water and childhood and adolescent osteosarcoma in Texas. Cancer Causes Control 27, 863–868 (2016). https://doi.org/10.1007/s10552-016-0759-9

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  • Childhood osteosarcoma
  • Fluoridation
  • Cancer epidemiology
  • Public drinking water