Introduction Primary bone cancers (PBC) occur most often in young people. Osteosarcoma and Ewing sarcoma family of bone tumours (ESFT) are most commonly diagnosed in children but aetiology remains unclear. Fluoride has been proposed as a potential causal agent for PBC. The study investigated whether incidence of PBC was linked with fluoride in drinking water.

Method Incidence data on cases aged <50 years diagnosed during 1980–2005 were obtained from all ten regional cancer registries in Great Britain (GB). These data were combined with small-area population census, digital boundary and fluoride monitoring data. Negative binomial regression was used to examine the relationship between incidence rates and census small-area fluoride levels. These models were fitted to small-area census data aggregated into three age bands and by gender with the logarithm of the ‘at risk’ population as an offset.

Results There were 2566 osteosarcoma cases aged 0–49 years: 817 aged 0–14; 1315 aged 15–29 and 434 aged 30–49 years. For ESFT there were 1650 cases aged 0–49 years: 659 aged 0–14; 800 aged 15–29 and 191 aged 30–49 years. After adjustment for age and gender, no statistically significant association was found between osteosarcoma or ESFT and fluoride: RR for one part per million increase in fluoride level =0.993; 95% CI 0.843 to 1.171 and 0.860; 95% CI 0.696 to 1.064 respectively.

Conclusions This is the first study to analyse putative associations between PBC and fluoride in drinking water across GB at small-area level. No statistically significant relationships were found.