Cell phones and MicroWaves, relation Cancer

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

Stanislaw Szmigielski

Military Institute of Hygiene and Epidemiology, Warsaw, Poland

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 healthrisks 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 shouldbe listed as a possible carcinogen (group 2B) for humans. Three meta-analyses of case-controlstudies have concluded that using cell phones for more than ten years was associated with anincrease 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, showedno 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 andlaterality was reported. So far, the published studies do not show that mobile phones could forsure increase the risk of cancer. This conclusion is based on the lack of a solid biologicalmechanism, and the fact that brain cancer rates are not going up significantly. However, all of thestudies 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. Forthis reason, bioelectromagnetic experts advise application of a precautionary resources. Itsuggests that if people want to use a cell phone, they can choose to minimize their exposure bykeeping calls short and preferably using hand-held sets. It also advises discouraging childrenfrom making non essential calls as well as also keeping their calls short.

Keywords Cancer risks, Carcinogenesis, Radiofrequency/microwave (RF/MW) radiations,Low-level radiation, Cell phones

INTRODUCTION

Radiofrequency (RF) and microwave (MW) radiations, defined as part ofelectromagnetic spectrum at frequencies of 0.1 300,000 MHz are widely used inradio communication, radio location, cellular phones, industry, and households.Absorption of large amounts of RF/MW energy results in development of thermaleffects. Many other physical parameters of exposure have been reported to beimportant for non thermal (specific) biological effects, which are induced by MWs atintensities well below any detectable heating (Baan, 2012; Baan et al., 2011; Belyaevet al., 2000; Jauchem, 2008; Szmigielski and Sobiczewska, 2000; WHO/INIRC, 1993).There are plenty of good, peer-reviewed, scientific reports in the literature showing

Address correspondence to Stanislaw Szmigielski, Military Institute of Hygiene and Epidemiology,4 Kozielska, 01-163 WARSAW, Poland. E-mail: [email protected]

Electromagnetic Biology and Medicine, Early Online: 18, 2012

Copyright Q Informa Healthcare USA, Inc.

ISSN: 1536-8378 print / 1536-8386 online

DOI: 10.3109/15368378.2012.701192

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evidence of biological effects that are likely to lead to adverse effects on health andwell-being (Baan, 2012; Vargo et al., 2012). According to WHO/ICNIRPEnvironmental Health Criteria (1993), non thermal intensities of MWs are presentlyrecognized as a weak factor of biological influence. However, after 30 years ofresearch into this area, there is still insufficient information on the specific biologicalinfluence of non thermal intensity of RF/MW radiation (Jauchem, 2008). The rapidlyincreasing use of cell phones (also known as wireless or mobile telephones),which are in fact weak radio stations applied close to the head and switched on toemit GSM-modulated 850 900 or 1800 MHz MWs, recently called attention topossible health risks of RF/MW exposures, including risk of developing neoplasticdiseases (Szmigielski and Sobiczewska, 2000). The number of cell phone users hasincreased rapidly. As of 2010, there were more than 303 million subscribers to cellphone service in the United States. This is a nearly three-fold increase from the 110million users in 2000. Globally, the number of cell phone subscriptions is estimatedto be 5 billion (Vrgo et al., 2012). In view of this, exposure to MWs, both individuallyand publicly, has increased considerably. Holding a cell phone to the ear to make avoice call can result in high specific absorption-rate (SAR) values in the brain,

depending on the design and position of the phone and its antenna in relation to thehead, how the phone is held, the anatomy of the head, and the quality of the linkbetween the base station and phone (Gandi and Kang, 2002; Christ et al., 2010).

CARCINOGENIC POTENCY OF MW RADIATION

In 2011, a group of international experts from IARC (International Agency forResearch on Cancer in Lyon) reviewed the available literature on experimental andepidemiologic studies of non thermal RF/MW exposures and concluded thatRF/MW radiations should be listed as possible carcinogen (group 2B) for humans

(Baan et al., 2011) on the basis of evidence from epidemiologic studies in cell phoneusers (Baan, 2012). This means that there is some evidence linking mobile phones tocancer, but it is too weak to make any strong conclusions. Specifically, IARCs panelsaid that the evidence that mobile phones pose a health risk was limited for twotypes of brain tumors: glioma and neuroma. The 2B category is used for agents,mixtures, and exposure circumstances for which there is limited evidence ofcarcinogenicity in humans and less than sufficient carcinogenicity in experimentalanimals. It may also be used when there is inadequate evidence of carcinogenicity inhumans but there is sufficient evidence of carcinogenicity in experimental animals.The 2B classification of RF/MWs gave rise to controversies among thebioelectromagnetic community, as only a limited number of studies have shownsome evidence of statistical association of cell phone use and brain tumor risks, butmost studies have found no association.

OCCUPATIONAL EXPOSURE TO MWS AND CANCER

Reports exist that claim that intense prolonged occupational exposure to MWs mayincrease risks for cancer. Actually, Robinette et al. (1980) did not find excessmortality in 20,000 U.S. Korean War Naval Veterans 19541958 exposed to radar.However, when Groves et al. (2002) conducted a follow-up study of Robinettescohort, their data did again not find excess cancer, except in one high-exposure

occupation group out of three, in which non lymphocytic leukemia was significantlyelevated. Recently, Stein et al. (2011) presented a sentinel case series of 47 cancerpatients, with occupational exposures to RF/MW radiation. Richter et al. (2000, 2002)reported exposures in a cluster of radar technicians with brain cancer and latent

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periods below ten years. Szmigielski (1996) collected retrospective data on all Polishmilitary career personnel exposed to RF/MW during a 15-year period. Cancer rateswere analyzed by age groups and higher morbidity rates in the alimentary tract, braintumors and malignancies of the haematopoietic system and lymphatic organs werenoted. The analysis was extended by additional data on military personnel exposedto radar for a period of 20 years (Szmigielski et al., 2001). More recently, Degrave et al.(2005, 2009), in a retrospective cohort study in Belgian male military personnelexposed to anti-aircraft radars in Western Europe between 19601990s, found excessincidence of hemolymphatic cancers. These reports indicated that risks for hemato-lymphatic and brain cancers could be associated with exposures to RF/MWs fromradars. Analysis of results reported in all of the above studies strongly suggest that ameasurable increase of cancer morbidity occurs in workers with multiyear exposureto relatively strong (but still below thermal levels) MW fields with a latency period offew to several years. The IARC Working Group (Baar et al., 2011) noted, however, thatthese studies had methodological limitations and the results were inconsistent. Inreviewing studies that addressed the possible association between occcupationalexposures to RF/MW and cancer, the available evidence was qualified as insufficient

for valid conclusion.

USE OF CELL PHONES AND CANCER

Numerous articles on possible cancer risks in cell phone users have been publishedin the last decade with controversial results (Vargo et al., 2012). The majority arecase-control studies comparing people who already have cancer (cases) withhealthy people (controls) and ask them about how they used their phones in thepast. Three meta-analyses of case-control studies published before 2007 concludedthat using a cell phone for more than ten years was associated with an increase in the

overall risk of developing a brain tumor (Kan et al., 2008; Khurana et al., 2009; Myunget al., 2009). All three found statistically significant brain tumors in people who hadused a cell phone for more than ten years and one study reported a doubling ofglioma on the same (ipsilateral) side the cell phone was used.

Early case-control studies were unable to demonstrate a relationship betweencell phone use and glioma or meningioma (Johansen et al., 2001; Muscat et al.,2000). In contrast, the Hardells groups case control studies have consistentlyfound associations between brain cancer of all kinds and prior prolonged use ofcell phones on the side of the head with the tumor (Hardell et al., 2011). Increaserisk for users with over ten years of usage, regardless of age, was reported.However, another large, case-control study in Sweden did not find an increasedrisk of brain cancer (Lonn et al., 2005). Hardell et al. (2011) did a pooled analysisof two very similar studies of associations between mobile and cordless phone useand glioma, acoustic neuroma, and meningioma. The analysis included 1148glioma cases (ascertained 19972003) and 2438 controls, obtained through cancerand population registries, respectively. Self-administered mailed questionnaireswere followed by telephone interviews to obtain information on the exposures andcovariates of interest, including use of mobile and cordless phones. Participantswho had used a mobile phone for more than 1 year had an OR for glioma of 1.3(95% CI 1.11.6). The OR increased with increasing time since first use and withtotal call time, reaching 3.2 (2.0 5.1) for more than 2000 h of use. ipsilateral use of

the mobile phone was associated with higher risk. Similar findings were reportedfor use of cordless phones.

A cohort study in Denmark linked billing information from more than 420,000 cellphone subscribers with brain tumor incidence data from the Danish Cancer Registry.

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The analyses found no association between cell phone use and the incidence ofglioma, meningioma, or acoustic neuroma, even among people who had been cellphone subscribers for 10 or more years (Schuez et al., 2006; Frei et al., 2011). Thelargest health-related case-control study of the use of cell phones and head and necktumors is the Interphone Study (2010), conducted by a consortium of researchersfrom 13 countries. Most published analyses from this study have shown nostatistically significant increases in brain or central nervous system cancers related tohigher amounts of cell phone use, but they too have found excess risk in a smallsubgroup of more heavily exposed users associated with latency and laterality(Cardis et al., 2007, 2010). Some subgroups of the Interphone study (Cardis et al.,2010, 2011) found similar data, but some chose to interpret these findings in asubgroup as inconsequential. Morgan (2009) and Vargo (2012) called attention tomany methodologic problems with the Interphone study pertaining to selectionbiases and exposure misclassification. However, one recent analysis showed astatistically significant increase in the risk of glioma among the small proportion ofstudy participants who spent the most total time on cell phone calls (Hardell et al.,2009). Cardis and Sadetzki (2011) published an article in which they endorsed

precautionary measures and called attention to potential effects on Public Healthfrom even a small risk at the individual level in over 4 billion people, includingchildren, using cell phones today. They also acknowledged that the Interphone study(2010), like other studies which did not find excess risk, was conducted at a timewhen mobile communication was still a relatively new phenomenon with low levelsof use compared with those of today.

Chinese researchers in Beijing (Duan et al., 2011) reported the highest rates ofcancer ever reported in any cell phone study. They found that long-term, heavy usershave rates of malignant parotid gland tumors that are 7 13 times higher than mightotherwise be expected. A number of aspects of the Chinese article do not fit the

current understanding of cell phone tumor risks. For instance, Duan et al. (2011) didnot see a significant association between the location of the tumor and the preferredside for using a cell phone (known as laterality). In addition, the Chinese team wasunable to look at the possible different effects of digital and analog phones, because,they explain, most regular users did not know their cellular phone type. Theauthors concluded that they cannot exclude the possibility of distortions due to recallor selection bias. They suggested that additional large-scale studies, especially thosewith a prospective design, be performed to reduce the sources of bias and to confirmthe significance of the present results.

In addition, the international CEFALO study, which compared children who werediagnosed with brain cancer between the ages of 7 and 19 with similar children whowere not, found no relationship between their cell phone use and risk for braincancer (Aydin et al., 2011).

In summary, a limited number of studies have shown some evidence of statisticalassociation of cell phone use and brain tumor risks, but most studies have found noassociation. Reasons for these discrepancies include schedule of retrospectiveepidemiologic studies, invalid assessment of MW exposures, based on assessment ofdose (period of phone use and cumulative time of calls), or billing (Morgan, 2009).Recall bias, which may happen when a study collects data about prior habits andexposures using questionnaires administered after disease, inaccurate reporting,which may happen when people say that something has happened more or less often

than it actually did, and/or participation bias, which can happen when people whoare diagnosed with brain tumors are more likely than healthy people to enroll in aresearch study are discussed as the main reasons for the possible underestimation ofcancer risks in multiyear cell phone use. To obtain progress in valid assessment of

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cancer risks related to use of cell phones, prospective studies are required. A largeprospective cohort study of cell phone use and its possible long-term health effectswas launched in the U.K. in March 2010. This study, known as COSMOS(www.ukcosmos.org/index.html), will enroll approximately 250,000 cell phoneusers ages 18 or older and will follow them for 2030 years. Participants in COSMOSwill complete a questionnaire about their health, lifestyle, and current and pastcell phone use. This information will be supplemented with information fromhealth records and cell phone records. Another case-control study, called Mobi-Kids (www.mbkds.net), is underway to examine health effects among children.The challenge of such ambitious studies is to maintain the completeness oftheir cohorts over many decades. Researchers will need to determine whetherparticipants who leave are somehow different from those who remain throughout thefollow-up period.

Another problem which demands attention is whether or not children are moresensitive to MWs and remain at higher cancer risks when using cell phones. Intheory, children have the potential to be at greater risk than adults for developingbrain cancer from cell phones. Their nervous systems are still developing and are

therefore more vulnerable to factors that may cause cancer. Their heads aresmaller than those of adults and therefore have a greater proportional exposure tothe field of radiofrequency radiation that is emitted by cell phones (Gandhi et al.,2002). Additionally, children have the potential of accumulating more years of cellphone exposure than adults do. So far, the data from clinical studies in childrendo not support this theory. The first published analysis came from a large case-control study called CEFALO, which was conducted in Denmark, Sweden, Norway,and Switzerland (Aydin et al., 2011). The study included children who werediagnosed with brain tumors between 2004 and 2008, when their ages ranged from719. Researchers did not find an association between cell phone use and brain

tumor risk in this group of children. However, they noted that their results did notrule out the possibility of a slight increase in brain cancer risk among childrenwho use cell phones, and that data gathered through prospective studies andobjective measurements, rather than participant surveys and recollections, will bekey in clarifying whether there is an increased risk (Aydin et al., 2011).

Public concerns of MW radiation emitted from base stations also exist. Basestation exposures are much less likely to affect our health than phones themselvesas their emissions are many times weaker and usually well below internationalguidelines. Elliott (2010), in the largest study of its kind, found no associationbetween risk of childhood cancers and mobile phone base station exposuresduring pregnancy. The authors conclude that the results should help to placeany future reports of cancer clusters near mobile phone base stations in a widerpublic health context.

BIOLOGICAL PLAUSIBILITY OF MW CARCINOGENESIS

Could cell phone use cause cancer? This is still an open question. Scientists areconfident that tobacco, alcohol, or asbestos can cause cancer because they canexplain how these things could induce transformation of cells. These explanationsare called biological mechanisms play a vital role in establishing that somethingcauses cancer. So far, no one has been able to provide a good biological mechanism

for the link between mobile phones and cancer (Vargo et al., 2012). The howquestion is an open one. The phones give off MW radiation, but this is not powerfulenough to damage our DNA. They mildly heat the body, but again, not enough topose a health risk.



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This imprecise description of MW-related health risks has initiated searches forbiological detectors sensitive enough to measure the weak biological influence ofMWs. One of main candidates is the immune system, which is able to react in ameasurable way to discrete environmental stimuli. As an important part ofhomeostatic neuroendocrine-immune network of the organism, the immune systemis responsible for efficient defense against infections, regenerative support forinjured tissues, and maintenance of immune tolerance toward self or foreign butneutral elements (Deschaux and Kahn, 1995). The role of immune system indevelopment of cancer cells, as well as in modification of course of neoplasticdiseases is well established (Abes and Teillaud, 2011; Sun et al., 2011). Thesedifferent reactions of the immune system can be investigated using in vitro orin vivo tests to evaluate possible influences of external stimuli (e.g., drugs orphysicochemical factors). Unfortunately, available data on the influence of MWs onthe immune system are fragmentary, report on changes of few immune functions,mainly phagocytosis, lymphocyte proliferation, or antibody production, and arefrequently controversial or not confirmed by the results of repeated experiments(Black, and Heynick, 2003). Some authors (Stavrulakis, 2003), reported immuno-

suppressive or immunostimulatory phenomena in animals with long-term exposureto low-level MW fields. In summary, studies of immune reactions in animals exposedto MWs provide controversial results with some articles reporting no measurableresponse, while in others positive results were obtained. The available bulk ofevidence from numerous experimental studies in vivo aimed to assess effects ofshort-term and prolonged low-level MW exposure on function and status of theimmune system clearly indicates that various shifts in number and/or activity ofimmunocompetent cells are possible. However, the results are incoherent; the samefunctions of lymphocytes are reported to be weaken or enhanced in singleexperimets with MW exposures at similar intensities and radiation parameters. There

exist premises that in general, short-term exposure to weak MWs may temporarystimulate certain humoral or cellular immune fuctions, while prolonged irradiationinhibits the same functions. Articles exist which report changes in NK cell activityor TNF release in MW-eposed animals, but clinical relevance or relation tocarcinogenicity of these findings is doubtful.

SUMMARY

It is understandable that people are concerned about mobile phones, especiallybecause they are so widely used. But so far, the published studies do not show thatmobile phones can increase considerably the risk of cancer. This conclusion isbacked up by the lack of a solid biological mechanism, and the fact that brain cancerrates are not going up significantly.

However, all of the studies so far have weaknesses, which make it impossible toentirely rule out a risk. Mobile phones are still a new technology and there is littleevidence about effects of long-term use. For this reason, bioelectromagnetic expertsadvise application of a precautionary resources. It is suggested that if adults want touse a cell phone, they can choose to minimize their exposure by keeping calls shortand preferably using hand-held kits (Morgan, 2009; U.S. Food and DrugAdministration, 2009; Vargo et al., 2012). Additionally, it is advised to discouragechildren under the age of 16 from making non essential calls as well as also keeping

their calls short.

Declaration of interest: The authors report no conflicts of interest. The authorsalone are responsible for the content and writing of the paper.

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Cell phones and MicroWaves, relation Cancer