Safety l Fluoridation Facts 57 in the United States,103-108 Japan,109 the United Kingdom,110-112 Canada113 and Australia.114 In addition, over the years, a number of independent bodies from around the world have conducted extensive reviews of the scientific literature and concluded that there is no relationship between fluoridation and cancer.1,2,4,59,115 At the beginning of the Safety Section in Question 17, a number of recent reviews are listed that have also concluded there is no relationship between fluoridation and cancer.10,11,13,15-18,20,21 Clearly, the best available science indicates there is no association between fluoridation and cancer. Clearly, the best available science indicates there is no association between fluoridation and cancer. Many of the questions about a possible association between fluoride and cancer center around a form of bone cancer called osteosarcoma. This topic is covered in the next question. In October 2011, the California Office of Environmental Health Hazard Assessment (OEHHA) through its Carcinogen Identification Committee (CIC) determined that fluoride does not cause cancer. The review was part of California’s Proposition 65 listing process.116 Proposition 65 was enacted in 1986 with the intent to protect California citizens and the State’s drinking water sources from chemicals known to cause cancer, birth defects or other reproductive harm and to inform citizens about exposure to such chemicals. It requires the Governor to publish, at least annually, a list of chemicals known to the state to cause cancer or reproductive toxicity. The OEHHA administers meetings of the CIC and the list of items to be reviewed through the Proposition 65 process. On May 29, 2009, fluoride was selected by OEHHA for review by the CIC. Due to widespread exposure to fluoride, it was identified as one of five high priority chemicals to be evaluated. A public comment period followed. On July 8, 2011, as the next step in the Proposition 65 process, the CIC released a hazard identification document, “Evidence on the Carcinogenicity of Fluoride and its Salts”. It was used by the CIC in its deliberations on whether fluoride should be listed as a carcinogen under Proposition 65. A second public comment period followed. At a public meeting on October 12, 2011, the CIC heard additional testimony and then voted on the question, “Do you believe that it has been clearly shown, through scientifically valid testing according to generally accepted principles, that fluoride causes cancer?” The CIC’s vote was unanimous (6-0) that fluoride had not been clearly shown to cause cancer.117 On its website, the American Cancer Society (ACS) provides a page titled, “Water Fluoridation and Cancer Risk.”118 In question and answer format, the ACS provides basic information regarding fluoridation as well as information on a number of studies that examined the possible association between fluoridation and cancer — many of which are referenced in the opening paragraph of this Safety Section. Near the bottom of the ACS web page, under the header “Assessments by Expert Groups” is this paragraph: The general consensus among the reviews done to date is that there is no strong evidence of a link between water fluoridation and cancer. However, several of the reviews noted that further studies are needed to clarify the possible link.118 33. Does fluoridated water cause osteosarcoma? Answer. No. The best available scientific evidence shows that fluoridated water does not cause osteosarcoma. Fact. In 2016, the American Society of Clinical Oncology estimated that a total of 1,000 people, including 450 children and teens younger than 20, would be diagnosed with osteosarcoma (a form of bone cancer) in the United States during the year. About 2% of all childhood cancers are osteosarcoma which most often affects those between the ages of 10 and 30. Osteosarcoma is about 50% more common in boys than girls. The 5-year survival rate for children and teens with osteosarcoma that is only in one place at the time of diagnosis is 70%.119 In 2014, researchers from England published the largest study ever conducted examining the possible association between fluoride in drinking water and risk of osteosarcoma or Ewing sarcoma. Analyzing 2,566 osteosarcoma cases and 1,650 Ewing’s sarcoma cases from 1980 to 2005, the study found that higher