Elsevier

Environmental Research

Volume 167, November 2018, Pages 673-683
Environmental Research

Cancer epidemiology update, following the 2011 IARC evaluation of radiofrequency electromagnetic fields (Monograph 102)

https://doi.org/10.1016/j.envres.2018.06.043Get rights and content

Highlights

  • Increased risk of brain, vestibular nerve and salivary gland tumors are associated with mobile phone use.

  • Nine studies (2011–2017) report increased risk of brain cancer from mobile phone use.

  • Four case-control studies (3 in 2013, 1 in 2014) report increased risk of vestibular nerve tumors.

  • Concern for other cancers: breast (male & female), testis, leukemia, and thyroid.

  • Based on the evidence reviewed it is our opinion that IARC's current categorization of RFR as a possible human carcinogen (Group 2B) should be upgraded to Carcinogenic to Humans (Group 1).

Abstract

Epidemiology studies (case-control, cohort, time trend and case studies) published since the International Agency for Research on Cancer (IARC) 2011 categorization of radiofrequency radiation (RFR) from mobile phones and other wireless devices as a possible human carcinogen (Group 2B) are reviewed and summarized. Glioma is an important human cancer found to be associated with RFR in 9 case-control studies conducted in Sweden and France, as well as in some other countries. Increasing glioma incidence trends have been reported in the UK and other countries. Non-malignant endpoints linked include acoustic neuroma (vestibular Schwannoma) and meningioma. Because they allow more detailed consideration of exposure, case-control studies can be superior to cohort studies or other methods in evaluating potential risks for brain cancer. When considered with recent animal experimental evidence, the recent epidemiological studies strengthen and support the conclusion that RFR should be categorized as carcinogenic to humans (IARC Group 1). Opportunistic epidemiological studies are proposed that can be carried out through cross-sectional analyses of high, medium, and low mobile phone users with respect to hearing, vision, memory, reaction time, and other indicators that can easily be assessed through standardized computer-based tests. As exposure data are not uniformly available, billing records should be used whenever available to corroborate reported exposures.

Introduction

With rapidly increasing applications for wireless devices targeting populations of all ages, exposures to the associated radiofrequency radiation (RFR) are increasing in number and diversity. Radiation sources include communications devices such as mobile (cell) or cordless phones, laptops and tablets, baby monitors, wearable devices and associated infrastructure (e.g. routers, antennae on towers, and distributed antennae systems (DAS) that can employ directional couplers or wireless amplifiers to enhance accessibility). Thus, the technology entails direct and growing personal exposures to an expanding array of wireless transmitting devices (WTDs).

In 2011, a Working Group of the World Health Organization's International Agency for Research on Cancer (IARC) classified RFR as a possible human carcinogen (Group 2B) (IARC, 2013). In this paper we review the human epidemiology and some other relevant studies published since the IARC Working Group meeting.

The principal sources of exposure of humans to RFR are cell and cordless phones. The radiated power and technologies for cell phones have evolved over the years, as summarized in Table 1 (Hardell and Carlberg, 2015).

Section snippets

Case-control studies; glioma

Aydin et al. (2011) reported the results of CEFALO, a multicenter case–control study conducted in Denmark, Sweden, Norway, and Switzerland that included children and adolescents aged 7–19 years (median age 13 years) diagnosed with a brain tumor between 2004 and 2008. In person interviews were conducted with 352 case patients (participation rate: 83%) and 646 control subjects (participation rate: 71%) and their parents. The authors concluded that there was no consistent evidence of increased

Case-control studies; meningioma

Little increased risk of meningioma was found in the five country Interphone analysis, except for the highest category of exposure in those with 7 or more years of use (Table 9).

Carlberg et al. (2013) reported on risk of meningioma from exposure to wireless phone radiation between the years 2007 and 2009, but found no overall association.

Table 10 summarizes the results for meningioma from the report on the French CERENAT case-control study (Coureau et al., 2014). There was only significant

Case-control studies of other cancers and other tumors

Case-control studies have also been performed on other cancers suspected as being associated with RFR exposure. Those examining thyroid and skin cancers are not considered here, as over-diagnosis of thyroid cancer and sun exposure, respectively, result in uncontrolled confounding. As limited studies have been reported thus far on leukemia risks tied with mobile phones, we do not consider these risks here.

In a population-based case-control study of children Li et al. (2012) included 939 leukemia

Cohort studies

In an update of the Danish cohort study of fewer than half a million persons over more than a decade, Frei et al. (2011) reported that when analyses were restricted to individuals with the longest mobile phone use, ≥ 13 years of subscription, the incidence rate ratio was 1.03 (95% CI 0.83–1.27) in men and 0.91 (0.41–2.04) in women. Among those with subscriptions of ≥ 10 years, ratios were 1.04 (0.85–1.26) in men and 1.04 (0.56–1.95) in women for glioma and 0.90 (0.57–1.42) in men and 0.93

Brain tumor incidence, descriptive and trend analyses

Tos et al. (2004) examined Danish incidence rates of vestibular Schwannoma from 1996 to 2001. There is a slow and steady increase from 1976 to 1990, then from 1990 to 1995 a marginal increase followed by a significant increase with a mean incidence per 100,000 population of 1.74 in 1996–2001.

Lehrer et al. (2011) reported a significant correlation between number of cell phone subscriptions and brain tumors in nineteen US states (r = 0.950, P < 0.001) for years 2000–2004 using 2007 cellphone

Case series

West et al. (2013) reported multiple primary breast cancers in young women who had regularly placed a cellphone in their bras (Table 20). Tumors were reported to have occurred subcutaneously directly under the antennas of the phones. Subsequently, a number of other such cases have come to light with unusually located breast tumors relative to reported cell phone storage in the bra.

Peleg (2012) discussed a cancer cluster among young workers at an Israeli Antenna Range Facility. It was believed

Discussion

Because they allow more detailed consideration of exposure and more precision of diagnoses, case-control studies can be superior to prospective cohort studies, or other methods, in evaluating potential risks for cancers. Carrying out a credible, statistically valid cohort study with sufficient power to find a change in rate of a rare cancer such as glioma that occurs at between 7 and 10 per 100,000 in industrialized countries would require a costly detailed prospective study following cellphone

Synthesis and conclusions

The Epidemiological studies reported since the 2011 IARC Working Group meeting are adequate to consider RFR as a probable human carcinogen (Group 2 A). However, they must be supplemented with the recently reported animal data as performed at the Ramazzini Institute and the US National Toxicology Program as well as by mechanistic studies. These experimental findings together with the epidemiology reviewed here are sufficient in our opinion, to upgrade the IARC categorization of RFR to Group 1,

Funding

The Israel Institute for Advanced Study, Environmental Health Trust, the National Institute of Environmental Health Sciences, Rutgers University School of Public Health, in part funded our participation in the Expert Forum from which this paper was prepared.

Acknowledgments

The authors acknowledge the important contributions of the participants in the Epidemiology Working Group: Amir Borenstein, Irit Livneh, Moe Mellion, Michael Peleg, Elihu Richter, Yael Stein

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    This paper was prepared for and revised with the Epidemiology Working Group of the Expert Forum: Wireless Radiation and Human Health at the Hebrew University, January 23–26, 2017. sponsored by the Israel Institute for Advanced Study and Environmental Health Trust, with support from the U.S. National Institutes of Health/ National Institute of Environmental Health Sciences and Dr. Lucy R. Wiletzky.

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