Cancer and Other Outcomes After Surgery With Fluoridated Anesthesia

To the Editor I read the article by Perry et al with interest. Several other molecular mechanisms and factors may also play a role in how anesthesia may influence cancer outcomes. First, it is important to distinguish the difference between certain fluoridated anesthesia, such as sevoflurane, from their contribution to higher plasma fluoride levels. For example, it is known that sevoflurane can provide 20-fold the total daily dietary fluoride intake from all sources of fluoridated food and water combined, resulting in peak ionic fluoride levels in the range of 50 μmol/L. Hence, fluoridated anesthesia can result in extremely high plasma fluoride levels. Second, it is important to point out that chronic fluoride exposure has been found to decrease the messenger RNA (mRNA) expression of p16 tumor suppressor gene. Interestingly, a review of published literature will show that loss of p16 predisposes humans to cancer, and p16 inactivation is associated with melanoma, acute lymphocytic leukemia, osteosarcoma, and mesothelioma as well as brain, esophageal, lung, pancreas, bladder, head and neck, breast, ovarian, prostate, and renal carcinoma. However, in add ition to downregulating p16, chronic fluoride exposure has been found to upregulate high-sensitivity C-reactive protein, core-binding factor α 1, chemokine (C-C motif) ligand 2, calcitonin, Smoothened mRNA, Sonic Hedgehog signaling pathway, osteoprotegerin, DiGeorge syndrome chromosomal region 8, c yclooxygenases, and prostagl...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research