Electromagnetic fields and epidemiology: An overview inspired by the fourth course at the International School of Bioelectromagnetics

The fourth course at the International School of Bioelectromagnetics addressed various aspects of the epidemiology of exposure to electromagnetic fields (EMF). In this overview, inspired by the lectures and the discussions among participants, we summarize current knowledge on exposure to EMF and disease risk, with emphasis on studies of use of mobile phones and brain tumours and exposure to power lines and childhood leukaemia. Sources of bias and error hamper straightforward conclusions in some areas and, in order to move forward, improvements in study design and exposure assessment are necessary. The scientific evidence available to date on possible long‐term effects from exposure to ELF and RF fields is not strong enough to revise current protection limits based on the known acute effects of such exposures. Precautionary measures may be considered to reduce ELF exposure of children or exposure to RF during mobile phone use, keeping in mind that it is unclear whether they involve any preventive benefit. Possible health effects from mobile phone use in adults and in children should be investigated further by prospective epidemiological studies with improved exposure assessment and brain tumour incidence rates should be monitored. Further studies on the relation between childhood leukaemia and ELF magnetic fields would be worthwhile if they focus on heavily exposed groups and attempt to minimize possible selection bias. In conclusion, epidemiological studies conducted with appropriate diligence can play a key role in finding the answers. Bioelectromagnetics 30:511–524, 2009. © 2009 Wiley‐Liss, Inc.     

Impact of random and systematic recall errors and selection bias in case--control studies on mobile phone use and brain tumors in adolescents (CEFALO study)

Whether the use of mobile phones is a risk factor for brain tumors in adolescents is currently being studied. Case--control studies investigating this possible relationship are prone to recall error and selection bias. We assessed the potential impact of random and systematic recall error and selection bias on odds ratios (ORs) by performing simulations based on real data from an ongoing case--control study of mobile phones and brain tumor risk in children and adolescents (CEFALO study). Simulations were conducted for two mobile phone exposure categories: regular and heavy use. Our choice of levels of recall error was guided by a validation study that compared objective network operator data with the self-reported amount of mobile phone use in CEFALO. In our validation study, cases overestimated their number of calls by 9% on average and controls by 34%. Cases also overestimated their duration of calls by 52% on average and controls by 163%. The participation rates in CEFALO were 83% for cases and 71% for controls. In a variety of scenarios, the combined impact of recall error and selection bias on the estimated ORs was complex. These simulations are useful for the interpretation of previous case-control studies on brain tumor and mobile phone use in adults as well as for the interpretation of future studies on adolescents.     

The association between socioeconomic status and exposure to mobile telecommunication networks in children and adolescents

A potential association between socioeconomic status (SES) and self‐reported use of mobile phones has been investigated in a few studies. If measured exposure to mobile phone networks differs by SES in children, it has not yet been studied. Interview data of 1,481 children and 1,505 adolescents on participants' mobile phone use, socio‐demographic characteristics and potential confounders were taken from the German MobilEe‐study. Sociodemographic data was used to stratify participants into three “status groups” (low, middle, high). Using a personal dosimeter, we obtained an exposure profile over 24 h for each of the participants. Exposure levels during waking hours were expressed as mean percentage of the reference level. Children with a low SES were more likely to own a mobile phone (OR 2.1; 95% CI: 1.1–3.9) and also reported to use their mobile phone longer per day (OR 2.4; 95% CI: 1.1–5.4) than children with a high SES. For adolescents, self‐reported duration of mobile phone use per day was also higher with a low SES (OR: 3.4; 95% CI: 1.4–8.4) compared with a high SES. No association between SES and measured exposure to mobile telecommunication networks was seen for children or adolescents. Mobile phone use may differ between status groups with higher use among disadvantaged groups. However, this does not result in higher overall exposure to mobile telecommunication networks. Whether short duration of own mobile phone use or the small numbers of participants with a low SES are causal, have to be investigated in further studies. Bioelectromagnetics 31:20–27, 2010. © 2009 Wiley‐Liss, Inc.     

The effects of 884 MHz GSM wireless communication signals on headache and other symptoms: an experimental provocation study

Findings from prior studies of possible health and physiological effects from mobile phone use have been inconsistent. Exposure periods in provocation studies have been rather short and personal characteristics of the participants poorly defined. We studied the effect of radiofrequency field (RF) on self-reported symptoms and detection of fields after a prolonged exposure time and with a well defined study group including subjects reporting symptoms attributed to mobile phone use. The design was a double blind, cross-over provocation study testing a 3-h long GSM handset exposure versus sham. The study group was 71 subjects age 18-45, including 38 subjects reporting headache or vertigo in relation to mobile phone use (symptom group) and 33 non-symptomatic subjects. Symptoms were scored on a 7-point Likert scale before, after 1(1/2) and 2(3/4) h of exposure. Subjects reported their belief of actual exposure status. The results showed that headache was more commonly reported after RF exposure than sham, mainly due to an increase in the non-symptom group. Neither group could detect RF exposure better than by chance. A belief that the RF exposure had been active was associated with skin symptoms. The higher prevalence of headache in the non-symptom group towards the end of RF exposure justifies further investigation of possible physiological correlates. The current study indicates a need to better characterize study participants in mobile phone exposure studies and differences between symptom and non-symptom groups.     

Mobile communication and health of population: estimation of danger, social and ethical problems

Population lives under new electromagnetic conditions: constant round-the-clock compulsory chronic exposure of all groups of population to modulated wide spectrum of EMF RF during the work of base stations of mobile communication; daily and lifelong (from childhood) exposure of the brain to EMF RF of the mobile phone. Effects of exposure to EMF RF of low levels are presented. Results of research into chronic EMF RF exposure are absent. International recommendations and domestic guidelines do not take into account the changing conditions of EMF RF influence on the population: the brain has become a critical body, and children have been included in the risk group. Population actively continues to use mobile communication. In this situation estimation of the risks from mobile communication has become a social and ethical problem.     

Mobile phone radiation and the developing brain: behavioral and morphological effects in juvenile rats

The increasing use of mobile phones by children and teenagers has raised concerns about their safety. Addressing such concerns is difficult, because no data are available on possible effects from long-term exposure to radiofrequency (RF) fields during the development of the nervous system. Possible morphological and functional changes were evaluated in the central nervous system of young male Wistar rats exposed to 900 MHz mobile phone signal for 2 h/day on 5 days/week. After 5 weeks of exposure at whole-body average specific energy absorption rates of 0.3 or 3.0 W/kg or sham exposure, six rats per group were examined histologically, and the remaining 18 rats per group were subjected to behavioral tests. No degenerative changes, dying neurons, or effects on the leakage of the blood-brain barrier were detected. No group differences were observed in the open-field test, plus maze test or acoustic startle response tests. In the water maze test, however, significantly improved learning (P = 0.012) and memory (P = 0.01) were detected in rats exposed to RF fields. The results do not indicate a serious threat to the developing brain from mobile phone radiation at intensities relevant to human exposure. However, the interesting finding of improved learning and memory warrants further studies.     

Mobile phone use and location of glioma: A case–case analysis

We assessed a new approach for evaluating the glioma risk among users of mobile phones to focus on the part of the brain most heavily exposed to radiofrequency electromagnetic fields from mobile phones. The tumor midpoint was defined from radiological imaging. A case–case analysis with 99 gliomas was performed using logistic regression. The exposed cases were those with the tumor mid‐point within 4.6 cm from the line between the mouth and the external meatus of the ear, representing the most likely location of the mobile phone (the source of exposure). Alternative analyses based on various indicators of mobile phone use as the outcome were also carried out. The majority of cases were regular mobile phone users. A slightly higher proportion of gliomas among mobile phone users than non‐users occurred within 4.6 cm from the presumed location of the mobile phone (28% vs. 14%). Modestly elevated odds ratios were observed for several indicators of mobile phone use, but without an exposure gradient. The highest odds ratios were found for contralateral and short‐term use. Our results, though limited by the small sample size, demonstrate that detailed information on tumor location allows evaluation of the risk related to the most heavily exposed part of the brain, representing direct evaluation of the possible local carcinogenic effects of the radiofrequency fields. However, field strength varies between users and over time also within a given anatomic site, due to the output power of the phone. Collaborative analysis of a larger sample is planned. Bioelectromagnetics 30:176–182, 2009. © 2009 Wiley‐Liss, Inc.     

Mobile phone exposure and spatial memory

Radiofrequency (RF) emission during mobile phone use has been suggested to impair cognitive functions, that is, working memory. This study investigated the effects of a 2 1/2 h RF exposure (884 MHz) on spatial memory and learning, using a double-blind repeated measures design. The exposure was designed to mimic that experienced during a real-life mobile phone conversation. The design maximized the exposure to the left hemisphere. The average exposure was peak spatial specific absorption rate (psSAR10g) of 1.4 W/kg. The primary outcome measure was a "virtual" spatial navigation task modeled after the commonly used and validated Morris Water Maze. The distance traveled on each trial and the amount of improvement across trials (i.e., learning) were used as dependent variables. The participants were daily mobile phone users, with and without symptoms attributed to regular mobile phone use. Results revealed a main effect of RF exposure and a significant RF exposure by group effect on distance traveled during the trials. The symptomatic group improved their performance during RF exposure while there was no such effect in the non-symptomatic group. Until this new finding is further investigated, we can only speculate about the cause.     

Skin temperature increase caused by a mobile phone: a methodological infrared camera study

Mobile phone users often complain about burning sensations or a heating of the ear region. The increase in temperature may be due to thermal insulation by the phone, heating of the mobile phone resulting from its electrical power dissipation, and radio frequency (RF) exposure. The main objective of this study was to use infrared (IR) camera techniques to find how much each of these factors contributes to the increase in skin temperature resulting from the use of one GSM 900 phone. One subject, a healthy male, took part in the study. He was holding the phone in a normal position when the phone was switched off, when it was switched on but with the antenna replaced by a 50 Omega load to eliminate the RF exposure, and when it was transmitting RF fields. The output power could be fixed, and the minimal and the maximal power levels of the phone were used. The study was designed as a double blind experiment. The changes in temperature after 15 and 30 min of mobile phone use were calculated on the exposed side of the head relative to the unexposed side. The insulation and the electrical power dissipation led to statistically significant rises in the skin temperature, while the RF exposure did not.     

Low-level exposure to radiofrequency electromagnetic fields: Health effects and research needs

The World Health Organization (WHO), the International Commission on Non-Ionizing Radiation Protection (ICNIRP), and the German and Austrian Governments jointly sponsored an international seminar in November of 1996 on the biological effects of low-level radiofrequency (RF) electromagnetic fields. For purposes of this seminar, RF fields having frequencies only in the range of about 10 MHz to 300 GHz were considered. This is one of a series of scientific review seminars held under the International Electromagnetic Field (EMF) Project to identify any health hazards from EMF exposure. The scientific literature was reviewed during the seminar and expert working groups formed to provide a status report on possible health effects from exposure to low-level RF fields and identify gaps in knowledge requiring more research to improve health risk assessments. It was concluded that, although hazards from exposure to high-level (thermal) RF fields were established, no known health hazards were associated with exposure to RF sources emitting fields too low to cause a significant temperature rise in tissue. Biological effects from low-level RF exposure were identified needing replication and further study. These included in vitro studies of cell kinetics and proliferation effects, effects on genes, signal transduction effects and alterations in membrane structure and function, and biophysical and biochemical mechanisms for RF field effects. In vivo studies should focus on the potential for cancer promotion, co-promotion and progression, as well as possible synergistic, genotoxic, immunological, and carcinogenic effects associated with chronic low-level RF exposure. Research is needed to determine whether low-level RF exposure causes DNA damage or influences central nervous system function, melatonin synthesis, permeability of the blood brain barrier (BBB), or reaction to neurotropic drugs. Reported RF-induced changes to eye structure and function should also be investigated. Epidemiological studies should investigate: the use of mobile telephones with hand-held antennae and incidence of various cancers; reports of headache, sleep disturbance, and other subjective effects that may arise from proximity to RF emitters, and laboratory studies should be conducted on people reporting these effects; cohorts with high occupational RF exposure for changes in cancer incidence; adverse pregnancy outcomes in various highly RF exposed occupational groups; and ocular pathologies in mobile telephone users and in highly RF exposed occupational groups. Studies of populations with residential exposure from point sources, such as broadcasting transmitters or mobile telephone base stations have caused widespread health concerns among the public, even though RF exposures are very low. Recent studies that may indicate an increased incidence of cancer in exposed populations should be investigated further. Bioelectromagnetics 19:1–19, 1998. © 1998 Wiley-Liss, Inc.     

Systematic review of wireless phone use and brain cancer and other head tumors

We conducted a systematic review of scientific studies to evaluate whether the use of wireless phones is linked to an increased incidence of the brain cancer glioma or other tumors of the head (meningioma, acoustic neuroma, and parotid gland), originating in the areas of the head that most absorb radiofrequency (RF) energy from wireless phones. Epidemiology and in vivo studies were evaluated according to an agreed protocol; quality criteria were used to evaluate the studies for narrative synthesis but not for meta-analyses or pooling of results. The epidemiology study results were heterogeneous, with sparse data on long-term use (≥ 10 years). Meta-analyses of the epidemiology studies showed no statistically significant increase in risk (defined as P < 0.05) for adult brain cancer or other head tumors from wireless phone use. Analyses of the in vivo oncogenicity, tumor promotion, and genotoxicity studies also showed no statistically significant relationship between exposure to RF fields and genotoxic damage to brain cells, or the incidence of brain cancers or other tumors of the head. Assessment of the review results using the Hill criteria did not support a causal relationship between wireless phone use and the incidence of adult cancers in the areas of the head that most absorb RF energy from the use of wireless phones. There are insufficient data to make any determinations about longer-term use (≥ 10 years).     

Factors that influence the radiofrequency power output of GSM mobile phones

Epidemiological studies of mobile phone use and risk of brain cancer have relied on self-reported use, years as a subscriber, and billing records as exposure surrogates without addressing the level of radiofrequency (RF) power output. The objective of this study was to measure environmental, behavioral and engineering factors affecting the RF power output of GSM mobile phones during operation. We estimated the RF-field exposure of volunteer subjects who made mobile phone calls using software-modified phones (SMPs) that recorded output power settings. Subjects recruited from three geographic areas in the U.S. were instructed to log information (place, time, etc.) for each call made and received during a 5-day period. The largest factor affecting energy output was study area, followed by user movement and location (inside or outside), use of a hands-free device, and urbanicity, although the two latter factors accounted for trivial parts of overall variance. Although some highly statistically significant differences were identified, the effects on average energy output rate were usually less than 50% and were generally comparable to the standard deviation. These results provide information applicable to improving the precision of exposure metrics for epidemiological studies of GSM mobile phones and may have broader application for other mobile phone systems and geographic locations.     

Induction of Autophagy in the Striatum and Hypothalamus of Mice after 835 MHz Radiofrequency Exposure

The extensive use of wireless mobile phones and associated communication devices has led to increasing public concern about potential biological health-related effects of the exposure to electromagnetic fields (EMFs). EMFs emitted by a mobile phone have been suggested to influence neuronal functions in the brain and affect behavior. However, the affects and phenotype of EMFs exposure are unclear. We applied radiofrequency (RF) of 835 MHz at a specific absorption rate (SAR) of 4.0 W/kg for 5 hours/day for 4 and 12 weeks to clarify the biological effects on mouse brain. Interestingly, microarray data indicated that a variety of autophagic related genes showed fold-change within small range after 835 MHz RF exposure. qRT-PCR revealed significant up-regulation of the autophagic genes Atg5, LC3A and LC3B in the striatum and hypothalamus after a 12-week RF. In parallel, protein expression of LC3B-II was also increased in both brain regions. Autophagosomes were observed in the striatum and hypothalamus of RF-exposed mice, based on neuronal transmission electron microscopy. Taken together, the results indicate that RF exposure of the brain can induce autophagy in neuronal tissues, providing insight into the protective mechanism or adaptation to RF stress.     

Effects of RF‐EMF on the Human Resting‐State EEG—the Inconsistencies in the Consistency. Part 1: Non‐Exposure‐Related Limitations of Comparability Between Studies

The results of studies on possible effects of radiofrequency electromagnetic fields (RF‐EMFs) on human waking electroencephalography (EEG) have been quite heterogeneous. In the majority of studies, changes in the alpha‐frequency range in subjects who were exposed to different signals of mobile phone‐related EMF sources were observed, whereas other studies did not report any effects. In this review, possible reasons for these inconsistencies are presented and recommendations for future waking EEG studies are made. The physiological basis of underlying brain activity, and the technical requirements and framework conditions for conducting and analyzing the human resting‐state EEG are discussed. Peer‐reviewed articles on possible effects of EMF on waking EEG were evaluated with regard to non‐exposure‐related confounding factors. Recommendations derived from international guidelines on the analysis and reporting of findings are proposed to achieve comparability in future studies. In total, 22 peer‐reviewed studies on possible RF‐EMF effects on human resting‐state EEG were analyzed. EEG power in the alpha frequency range was reported to be increased in 10, decreased in four, and not affected in eight studies. All reviewed studies differ in several ways in terms of the methodologies applied, which might contribute to different results and conclusions about the impact of EMF on human resting‐state EEG. A discussion of various study protocols and different outcome parameters prevents a scientifically sound statement on the impact of RF‐EMF on human brain activity in resting‐state EEG. Further studies which apply comparable, standardized study protocols are recommended. Bioelectromagnetics. 2019;40:291–318. © 2019 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.     

Mobile Phone Use,Blood Lead Levels,and Attention Deficit Hyperactivity Symptoms in Children: A Longitudinal Study

Background

Concerns have developed for the possible negative health effects of radiofrequency electromagnetic field (RF-EMF) exposure to children’s brains. The purpose of this longitudinal study was to investigate the association between mobile phone use and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) considering the modifying effect of lead exposure.

Methods

A total of 2,422 children at 27 elementary schools in 10 Korean cities were examined and followed up 2 years later. Parents or guardians were administered a questionnaire including the Korean version of the ADHD rating scale and questions about mobile phone use, as well as socio-demographic factors. The ADHD symptom risk for mobile phone use was estimated at two time points using logistic regression and combined over 2 years using the generalized estimating equation model with repeatedly measured variables of mobile phone use, blood lead, and ADHD symptoms, adjusted for covariates.

Results

The ADHD symptom risk associated with mobile phone use for voice calls but the association was limited to children exposed to relatively high lead.

Conclusions

The results suggest that simultaneous exposure to lead and RF from mobile phone use was associated with increased ADHD symptom risk, although possible reverse causality could not be ruled out.     

Time trends (1998-2007) in brain cancer incidence rates in relation to mobile phone use in England

Mobile phone use in the United Kingdom and other countries has risen steeply since the early 1990's when the first digital mobile phones were introduced. There is an ongoing controversy about whether radio frequency (RF) exposure from mobile phones increases the risk of brain cancer. However, given the widespread use and nearly two decades elapsing since mobile phones were introduced, an association should have produced a noticeable increase in the incidence of brain cancer by now. Trends in rates of newly diagnosed brain cancer cases in England between 1998 and 2007 were examined. There were no time trends in overall incidence of brain cancers for either gender, or any specific age group. Systematic increases in rates for cancers of the temporal lobe in men (0.04 new cases/year) and women (0.02/year) were observed, along with decreases in the rates of cancers of the parietal lobe (-0.03/year), cerebrum (-0.02/year) and cerebellum (-0.01/year) in men only. The increased use of mobile phones between 1985 and 2003 has not led to a noticeable change in the incidence of brain cancer in England between 1998 and 2007. The observed increase in the rate of cancers in the temporal lobe, if caused by mobile phone use, would constitute <1 additional case per 100,000 people in that period. These data do not indicate a pressing need to implement a precautionary principle by means of population-wide interventions to reduce RF exposure from mobile phones.     

Does acute exposure to mobile phones affect human attention?

Recent studies have indicated that acute exposure to low level radiofrequency (RF) electromagnetic fields generated by mobile phones affects human cognition. However, the relatively small samples used, in addition to methodological problems, make the outcomes of these studies difficult to interpret. In our study we tested a large sample of volunteers (168) using a series of cognitive tasks apparently sensitive to RF exposure (a simple reaction task, a vigilance task, and a subtraction task). Participants performed those tasks twice, in two different sessions. In one session they were exposed to RFs, with half of subjects exposed to GSM signals and the other half exposed to CW signals, while in the other session they were exposed to sham signals. No significant effects of RF exposure on performance for either GSM or CW were found, independent of whether the phone was positioned on the left or on the right side.     

Long‐term digital mobile phone use and cognitive decline in the elderly

Research on long‐term exposure to electromagnetic fields on cognition is lacking. We investigated the associations between frequent digital mobile phone use and global and domain‐specific cognitive changes in older persons, a vulnerable group experiencing age‐associated cognitive decline. We assessed 871 non‐demented Chinese participants in the Singapore Longitudinal Ageing Studies cohort on the frequency of digital mobile phone use, neurocognitive performance and confounding variables at baseline, and neurocognitive performance at the 4‐year follow‐up. Findings showed that digital mobile phone users were typically self‐selected to possess characteristics favoring better cognitive functioning and concomitantly demonstrate better performance on cognitive tasks. There was evidently no significant deleterious effect of digital mobile phone use on cognitive functioning in older people. Findings suggest, however, that digital mobile phone use may have an independent facilitating effect on global and executive functioning. Bioelectromagnetics 33:176–185, 2012. © 2011 Wiley Periodicals, Inc.     

Cancer risks related to low-level RF/MW exposures,including cell phones

For years, radiofrequency (RF) and microwave (MW) radiations have been applied in the modern world. The rapidly increasing use of cellular phones called recent attention to the possible health risks of RF/MW exposures. In 2011, a group of international experts organized by IARC (International Agency for Research on Cancer in Lyon) concluded that RF/MW radiations should be listed as a possible carcinogen (group 2B) for humans. Three meta-analyses of case-control studies have concluded that using cell phones for more than ten years was associated with an increase in the overall risk of developing a brain tumor. The Interphone Study, the largest health-related case-control international study of use of cell phones and head and neck tumors, showed no statistically significant increases in brain cancers related to higher amounts of cell phone use, but excess risk in a small subgroup of more heavily exposed users associated with latency and laterality was reported. So far, the published studies do not show that mobile phones could for sure increase the risk of cancer. This conclusion is based on the lack of a solid biological mechanism, and the fact that brain cancer rates are not going up significantly. However, all of the studies so far have weaknesses, which make it impossible to entirely rule out a risk. Mobile phones are still a new technology and there is little evidence about effects of long-term use. For this reason, bioelectromagnetic experts advise application of a precautionary resources. It suggests that if people want to use a cell phone, they can choose to minimize their exposure by keeping calls short and preferably using hand-held sets. It also advises discouraging children from making non essential calls as well as also keeping their calls short.     

Microarray gene expression profiling of a human glioblastoma cell line exposed in vitro to a 1.9 GHz pulse-modulated radiofrequency field

The widespread use of mobile phones has led to public concerns about the health effects associated with exposure to radiofrequency (RF) fields. The paramount concern of most persons relates to the potential of these fields to cause cancer. Unlike ionizing radiation, RF fields used for mobile telecommunications (800-1900 MHz) do not possess sufficient energy to directly damage DNA. Most rodent bioassay and in vitro genotoxicity/mutation studies have reported that RF fields at non-thermal levels have no direct mutagenic, genotoxic or carcinogenic effects. However, some evidence has suggested that RF fields may cause detectable postexposure changes in gene expression. Therefore, the purpose of this study was to assess the ability of exposure to a 1.9 GHz pulse-modulated RF field for 4 h at specific absorption rates (SARs) of 0.1, 1.0 and 10.0 W/kg to affect global gene expression in U87MG glioblastoma cells. We found no evidence that non-thermal RF fields can affect gene expression in cultured U87MG cells relative to the nonirradiated control groups, whereas exposure to heat shock at 43 degrees C for 1 h up-regulated a number of typical stress-responsive genes in the positive control group. Future studies will assess the effect of RF fields on other cell lines and on gene expression in the mouse brain after in vivo exposure.