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Fluoridation and county-level secondary bone cancer among cancer patients 18 years or older in New York State


The decision whether to fluoridate drinking water continues to be controversial in some communities. Dental and skeletal fluorosis in response to chronic fluoride overexposure are cited as reasons to avoid community water fluoridation in spite of evidence of the oral and skeletal health benefits fluoridation confers. Community fluoridation of ~ 1 mg/L fluoride has not been found to be associated with primary bone cancer but is associated with improved bone strength. No studies have examined fluoride exposure and secondary bone cancer, a common metastasis with significant morbidity. We hypothesize that fluoridation could diminish the likelihood of secondary bone cancer due to its role in bone fortification. We examined the association between community water fluoridation category and prevalence of secondary bone cancer from 2008 to 2010 among cancer patients of 18 years of age or older in counties in New York State. Relative to counties with less than 25% of the water supply fluoridated, we report no association between secondary bone cancer among cancer patients in counties with 25–75% of the water supply fluoridated (β = 0.02, p = 0.96) and among those in counties with > 75% fluoridated (β = 0.02, p = 0.97). We found no evidence of an association between community water fluoridation category and secondary bone cancer from 2008 to 2010 at the county level in New York State.

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  • Ayoob, S., & Gupta, A. K. (2006). Fluoride in drinking water: A review on the status and stress effects. Critical Reviews in Environmental Science and Technology, 36(6), 433–487.

    Article  CAS  Google Scholar 

  • Beltran-Aguilar, E. D., Griffin, S. O., & Lockwood, S. A. (2002). Prevalence and trends in enamel fluorosis in the United States from the 1930s to the 1980s. Journal of the American Dental Association, 133(2), 157–165.

    Article  Google Scholar 

  • Blakey, K., Feltbower, R. G., Parslow, R. C., James, P. W., Gómez Pozo, B., Stiller, C., et al. (2014). Is fluoride a risk factor for bone cancer? Small area analysis of osteosarcoma and Ewing sarcoma diagnosed among 0–49-year-olds in Great Britain, 1980–2005. International Journal of Epidemiology, 43(1), 224–234.

    Article  Google Scholar 

  • Cauley, J. A., Murphy, P. A., Riley, T. J., & Buhari, A. M. (1995). Effects of fluoridated drinking water on bone mass and fractures: The study of osteoporotic fractures. Journal of Bone and Mineral Research, 10(7), 1076–1086.

    Article  CAS  Google Scholar 

  • Centers for Disease Control and Prevention. (2000). Achievements in public health, 1900–1999: Fluoridation of drinking water to prevent dental caries. JAMA, 283(10), 1283–1286.

    Article  Google Scholar 

  • Chachra, D., Limeback, H., Willett, T., & Grynpas, M. D. (2010). The long-term effects of water fluoridation on the human skeleton. Journal of Dental Research, 89(11), 1219–1223.

    Article  CAS  Google Scholar 

  • Chowdhury, C. R., Shahnawaz, K., Kumari, D., Chowdhury, A., Bedi, R., Lynch, E., et al. (2016). Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: Fluoride-related health effects. Perspectives in Public Health, 136(6), 353–360.

    Article  Google Scholar 

  • Gelberg, K. H., Fitzgerald, E. F., Hwang, S. A., & Dubrow, R. (1995). Fluoride exposure and childhood osteosarcoma: A case-control study. American Journal of Public Health, 85(12), 1678–1683.

    Article  CAS  Google Scholar 

  • Hillier, S., Inskip, H., Coggon, D., & Cooper, C. (1996). Water fluoridation and osteoporotic fracture. Community Dental Health, 13(Suppl 2), 63–68.

    Google Scholar 

  • Iheozor-Ejiofor, Z., Worthington, H. V., Walsh, T., O’Malley, L., Clarkson, J. E., Macey, R., et al. (2015). Water fluoridation for the prevention of dental caries. The Cochrane database of systematic reviews, 18(6), CD010856.

    CAS  Article  Google Scholar 

  • Kim, F. M., Hayes, C., Williams, P. L., Whitford, G. M., Joshipura, K. J., Hoover, R. N., et al. (2011). An assessment of bone fluoride and osteosarcoma. Journal of Dental Research, 90(10), 1171–1176.

    Article  CAS  Google Scholar 

  • Levy, M., & Leclerc, B. S. (2012). Fluoride in drinking water and osteosarcoma incidence rates in the continental United States among children and adolescents. Cancer Epidemiology, 36(2), e83–e88.

    Article  CAS  Google Scholar 

  • Levy, S. M., Warren, J. J., Phipps, K., Letuchy, E., Broffitt, B., Eichenberger-Gilmore, J., et al. (2014). Effects of life-long fluoride intake on bone measures of adolescents: A prospective cohort study. Journal of Dental Research, 93(4), 353–359.

    Article  CAS  Google Scholar 

  • Liu, G., Ye, Q., Chen, W., Zhao, Z., Li, L., & Lin, P. (2015). Study of the relationship between the lifestyle of residents residing in fluorosis endemic areas and adult skeletal fluorosis. Environmental Toxicology and Pharmacology, 40(1), 326–332.

    Article  CAS  Google Scholar 

  • Mahoney, M. C., Nasca, P. C., Burnett, W. S., & Melius, J. M. (1991). Bone cancer incidence rates in New York State: Time trends and fluoridated drinking water. American Journal of Public Health, 81(4), 475–479.

    Article  CAS  Google Scholar 

  • Näsman, P., Ekstrand, J., Granath, F., Ekbom, A., & Fored, C. (2013). Estimated drinking water fluoride exposure and risk of hip fracture: A cohort study. Journal of Dental Research, 92(11), 1029–1034.

    Article  CAS  Google Scholar 

  • National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health. (2016a). Community water fluoridation. Retrieved September 25, 2017 from

  • National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health. (2016b). My water’s fluoride. Retrieved September 25, 2017 from

  • Sowers, M., Whitford, G. M., Clark, M. K., & Jannausch, M. L. (2005). Elevated serum fluoride concentrations in women are not related to fractures and bone mineral density. Journal of Nutrition, 135(9), 2247–2252.

    Article  CAS  Google Scholar 

  • SPARCS Operations, Bureau of Health Informatics, Office of Quality and Patient Safety. (2016). Statewide planning and research cooperative system (SPARCS). Retrieved October 15, 2016 from

  • U. S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. (2015). U.S. Public health service recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Reports, 130(4), 318–331.

    Article  Google Scholar 

  • U. S. Environmental Protection Agency. (2016). Consumer confidence reports (CCR): Annual drinking water quality reports for “New York”.,103:P103_STATE:NY.

  • Wang, C., Gao, Y., Wang, W., Zhao, L., Zhang, W., Han, H., et al. (2012). A national cross-sectional study on effects of fluoride-safe water supply on the prevalence of fluorosis in China. British Medical Journal Open, 2(5), e001564.

    Article  Google Scholar 

  • World Health Organization (2011). Guidelines for drinking-water quality. Chapter 12: Chemical fact sheets. Fluoride, 38(4), 370–373.

    Google Scholar 

  • Yin, X. H., Huang, G. L., Lin, D. R., Wan, C. C., Wang, Y. D., Song, J. K., et al. (2015). Exposure to fluoride in drinking water and hip fracture risk: A meta-analysis of observational studies. PLoS ONE, 10(5), e0126488.

    Article  CAS  Google Scholar 

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We would like to thank: the New York State Department of Health for granting us access to the Statewide Planning and Research Cooperative System (SPARCS) database and NYS GIS Clearinghouse for their shapefile.

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Correspondence to Natalie Crnosija.

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Crnosija, N., Choi, M. & Meliker, J.R. Fluoridation and county-level secondary bone cancer among cancer patients 18 years or older in New York State. Environ Geochem Health 41, 761–768 (2019).

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  • Fluoridation
  • Secondary bone cancer
  • Bone health