Wednesday, February 1, 2017

MOBI-KIDS: Childhood Brain Tumor Risk & Mobile Phone Use Study

Feb, 2017

Research on the adverse effects of mobile phone radiation has focused on the radiofrequency (RF) emissions from cell phones and cordless phones and has ignored the effects of the extremely low frequency fields (ELF) produced by the phones. Yet ELF was labelled "possibly carcinogenic to humans" by the WHO International Agency for Research on Cancer a decade earlier than RF.

The paper below indicates that the MOBI-Kids research team is studying the effects of exposure to ELF as well as RF on children's cancer risk from mobile and cordless phone use.

ELF exposure from mobile and cordless phones 
for the epidemiological MOBI-Kids study

Calderón C, Ichikawa H, Taki M, Wake K, Addison D, Mee T, Maslanyj M, Kromhout H, Lee AK, Sim MR, Wiart J, Cardis E. ELF exposure from mobile and cordless phones for the epidemiological MOBI-Kids study. Environ Int. 2017 Jan 23. pii: S0160-4120(17)30047-8. doi: 10.1016/j.envint.2017.01.005. [Epub ahead of print]

Abstract

This paper describes measurements and computational modelling carried out in the MOBI-Kids case-control study to assess the extremely low frequency (ELF) exposure of the brain from use of mobile and cordless phones. Four different communication systems were investigated: Global System for Mobile (GSM), Universal Mobile Telecommunications System (UMTS), Digital Enhanced Cordless Telecommunications (DECT) and Wi-Fi Voice over Internet Protocol (VoIP). The magnetic fields produced by the phones during transmission were measured under controlled laboratory conditions, and an equivalent loop was fitted to the data to produce three-dimensional extrapolations of the field. Computational modelling was then used to calculate the induced current density and electric field strength in the brain resulting from exposure to these magnetic fields. Human voxel phantoms of four different ages were used: 8, 11, 14 and adult. The results indicate that the current densities induced in the brain during DECT calls are likely to be an order of magnitude lower than those generated during GSM calls but over twice that during UMTS calls. The average current density during Wi-Fi VoIP calls was found to be lower than for UMTS by 30%, but the variability across the samples investigated was high. Spectral contributions were important to consider in relation to current density, particularly for DECT phones. This study suggests that the spatial distribution of the ELF induced current densities in brain tissues is determined by the physical characteristics of the phone (in particular battery position) while the amplitude is mainly dependent on communication system, thus providing a feasible basis for assessing ELF exposure in the epidemiological study. The number of phantoms was not large enough to provide definitive evidence of an increase of induced current density with age, but the data that are available suggest that, if present, the effect is likely to be very small.

https://www.ncbi.nlm.nih.gov/pubmed/28126406


May, 2016

According to the European Commission, the EU-funded project "Risk of brain cancer from exposure to radiofrequency fields in childhood and adolescence" (MOBI-Kids) was "closed" on Feb 29, 2016. The study will make an important contribution to assessing the association, if any, between electromagnetic field exposure due to use of mobile communication devices and the development of brain cancer in youth.

The last Mobi-Kids Consortium meeting was held February 16-17, 2016. The meeting was attended by investigators from 15 countries. Preliminary results from the study were discussed.


From December, 2010 through February, 2015, about 800 cases and 1,600 controls were interviewed for this study.

The project cost 6 million Euros with 3.5 million Euros from the European Commission.


June, 2014

My comments:

This is a difficult case-control study to undertake as it involves 14 nations and about 60 senior investigators. The original goal was to recruit 2,000 cases. The authors revised the original goal to 1,000 cases because recruitment of cases has been much more difficult than anticipated. As of June, 2014, only 686 cases were recruited, and 566 were interviewed. Only six more months remain for participant recruitment. Thus, even the reduced recruitment goal may be difficult to achieve.

I am concerned that the MOBI-Kids study will fail to have adequate statistical power to detect the association between EMF exposure and brain tumor risk. The CEFALO study of brain tumor risk in children was seriously under-powered with 352 cases (Aydin et al., 2011; http://bit.ly/1pW4ulA). The four nation CEFALO study found a 36% increased relative risk of brain tumors with any mobile phone use, but this was not statistically significant due to the small sample size (OR = 1.36; 95% CI = 0.92 to 2.02) so the authors dismissed this overall finding. (See my supplementary comments below because CEFALO found some statistically significant evidence for increased brain tumor risk which the study authors also dismissed.)

Only four of the 58 authors of the MOBI-Kids study declared conflicts of interest (see below). The funding sources for this study are listed below. I will leave it to others to determine how much of the funding originated from industry and whether funneling the funds through intermediary organizations or agencies eliminated potential conflicts of interest.

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The MOBI-Kids Study Protocol: Challenges in Assessing Childhood and Adolescent Exposure to Electromagnetic Fields from Wireless Telecommunication Technologies and Possible Association with Brain Tumor Risk

Sadetzki S, Langer CE, Bruchim R, Kundi M, Merletti F, Vermeulen R, Kromhout H, Lee A-K, Maslanyj M, Sim MR, Taki M, Wiart J, Armstrong B, Milne E, Benke G, Schattner R, Hutter H-P, Woehrer A, Krewski D, Mohipp C, Momoli F, Ritvo P, Spinelli J, Lacour B, Delmas D, Remen T, Radon K, Weinmann T, Klostermann S, Heinrich S, Petridou E, Bouka E, Panagopoulou P, Dikshit R, Nagrani R, Even-Nir H, Chetrit A, Maule M, Migliore E, Filippini G, Miligi L, Mattioli S, Yamaguchi N, Kojimahara N, Ha M, Choi K-H, Mannetje A’, Eng A, Woodward A, Carretero G, Alguacil J, Aragones N, Suare-Varela MM, Goedhart G, Schouten-van Meeteren AAYN, Reedijk AAMJ and Cardis E (2014) The MOBI-Kids study protocol: challenges in assessing childhood and adolescent exposure to electromagnetic fields from wireless telecommunication technologies and possible association with brain tumor risk. Front. Public Health 2:124. Sep 23, 2014. doi: 10.3389/fpubh.2014.00124.

Abstract

The rapid increase in mobile phone use in young people has generated concern about possible health effects of exposure to radiofrequency (RF) and extremely low frequency (ELF) electromagnetic fields (EMF). MOBI-Kids, a multinational case-control study, investigates the potential effects of childhood and adolescent exposure to EMF from mobile communications technologies on brain tumor risk in 14 countries.

The study, which aims to include approximately 1,000 brain tumor cases aged 10-24 years and two individually matched controls for each case, follows a common protocol and builds upon the methodological experience of the INTERPHONE study. The design and conduct of a study on EMF exposure and brain tumor risk in young people in a large number of countries is complex and poses methodological challenges.

This manuscript discusses the design of MOBI-Kids and describes the challenges and approaches chosen to address them, including:
(1) the choice of controls operated for suspected appendicitis, to reduce potential selection bias related to low response rates among population controls;
(2) investigating a young study population spanning a relatively wide age range;
(3) conducting a large, multinational epidemiological study, while adhering to increasingly stricter ethics requirements;
(4) investigating a rare and potentially fatal disease; and (5) assessing exposure to EMF from communication technologies.

Our experience in thus far developing and implementing the study protocol indicates that MOBI-Kids is feasible and will generate results that will contribute to the understanding of potential brain tumor risks associated with use of mobile phones and other wireless communications technologies among young people.

Open Access: http://bit.ly/1pVKGyS

Excerpts

The original expected number of cases in the target age range was of the order of 2,000. With the implementation of the study, however, it became apparent that the number of eligible cases is, in fact, much lower, in large part due to an underestimation of the number of midline tumors in the study population and, to a lesser extent, the failure of busy medical staff to notify eligible patients in some centers. In most centers, it is difficult to know exactly how many cases are ineligible as doctors/hospital staff will generally not inform study staff of ineligible cases. However, centers with access to detailed, reliable registry information or hospital records have excluded from one-third to more than one-half of cases due to an ineligible (midline) diagnosis. Table 1 indicates the revised expected number of eligible cases per year; the revised expected total number of cases to be included in MOBI-Kids is around 1,000, based on each center’s length of time in the field and other factors such as number of participating hospitals and accessibility to eligible cases. Fortunately, the MOBI-Kids study still has sufficient statistical power despite the reduced number of cases (see Study Power below).

Study Power


As discussed above, despite our best efforts to reach the original expected sample size of approximately 2,000 cases, the revised projected number of case is just under 1,000. However, preliminary results on mobile phone use among controls indicate that 77 and 83% of males and females, respectively, were defined as ever using a mobile phone regularly (data not shown). In keeping with the INTERPHONE study, subjects who had used a mobile phone for <1 year were considered “never” regular users. Further, approximately 14% of all subjects in MOBI-Kids have used a mobile phone for 10 years or longer, the threshold for long-term use in INTERPHONE. As this was a higher proportion than originally expected, our power calculations were revised based on the updated expected number of subjects and updated exposure indicators. Assuming that 971 cases are included in matched analyses, the study has 79% power to detect an increased risk of 40% [the estimated increase in the risk of glioma seen in the highest decile of phone use in INTERPHONE (10)], assuming 10% have used a mobile phone for 10 years or longer; power increases to 90% assuming 15% are “long-term” mobile phone users.

Conclusion

In spite of its challenges, the advantages of MOBI-Kids include its large sample size – it will be the largest study to date on this topic in young people – covering 14 participating countries. Subjects are being identified and recruited in a time period in which mobile phone use in young people has become more prevalent, thus, increasing the statistical power and overall representativeness and generalizability of the results. In addition, MOBI-Kids includes extensive exposure assessment work and validation studies using both historical provider records and SMPS to counteract potential recall bias. Despite the various challenges faced by the study team (which have implications for other epidemiological studies), our experience thus far in developing and implementing the study protocol indicates that MOBI-Kids is feasible and will generate results contributing to the understanding of potential brain tumor risks associated with use of mobile phones and other wireless communication technologies among young people.

Conflict of Interest Statement

Daniel Krewski has conducted contract work for the federal government of Canada (specifically, the Public Health Agency of Canada and Industry Canada) involving systematic review and summary of scientific information on potential health effects of radiofrequency fields. Malcolm R. Sim – wife had shares of Cell Phone Company. Masao Taki’s department received a grant to support numerical modeling work under a university–industry partnership. Joe Wiart works at Whist Laboratory funded by Orange. None of this funding was used to support the research described in this paper. The other authors declare that they have no conflict of interest.

Funding: the research leading to these results has received funding from by the European Community’s Seventh Framework Programme (FP7/2007–2013) under grant agreement number 22687 3 – the MOBI-Kids project. International coordination of the project is partly supported by a grant from the Spanish Ministry of Science and Innovation (MICCIN). Australia: Australian participation in MOBI-Kids is supported by the Australian National Health and Medical Research Council with a five-year research grant (grant number: 546130 and Chief Investigators are: Malcolm R. Sim, Bruce Armstrong, Elizabeth Milne, and Geza Benke). Austria: Austrian participation in MOBI-Kids is partly supported by a grant from the Ministry of Science. Canada: Canadian participation in MOBI-Kids is supported by a university–industry partnership grant from the Canadian Institutes of Health Research (CIHR), with the Canadian Wireless Telecommunications Association (CWTA) serving as the industrial partner. CWTA provides technical information on wireless telecommunications in Canada and facilitates access to billing records from Canadian network operators, but has no involvement in the design, conduct, analysis, or interpretation of the MOBI-KIDS study. Health Canada has also provided financial support to facilitate coordination between Canadian and international MOBI-Kids investigators. Daniel Krewski is the Natural Sciences and Engineering Research Council of Canada Chair in Risk Science at the University of Ottawa. France: this project received funds from the French National Agency for Sanitary Safety of Food, Environment and Labour (ANSES, contract FSRF 2008-3), French National Cancer Institute (INCa), Pfizer Foundation and League against cancer. Germany: the German branch of MOBI-Kids is supported by the Federal Office for Radiation Protection. Greece: Greek participation is partially supported by ELKE (Special Account for Research Grants of the National and Kapodistrian University of Athens) and GGET (General Secretariat for Research and Technology). India: MOBI-Kids India is supported by the Board of Research in Nuclear Sciences (BRNS). Italy: Ministry of Health RF-2009-1546284. Japan: Japanese participation in MOBI-Kids is supported by the Ministry of Internal Affairs and Communications. Korea: MOBI-Kids Korea is financially supported by the Ministry of Science, ICT and Future Planning (MSIP), Korea in the ICT R&D Program. New Zealand: MOBI-Kids New Zealand is supported by grants from Cure Kids New Zealand and the New Zealand Health Research Council. Spain: Spanish participation is partially supported by the Spanish Health Research Fund (FIS PI10/02981), the Andalusian Consejeria de Salud (PI-0317/2010) and Conselleria de Sanitat, Generalitat Valenciana under grant number 025/2010. The Netherlands: Dutch participation in MOBI-KIDS is partly supported by The Netherlands Organisation for Health Research and Development (ZonMw) within the program Electromagnetic Fields and Health Research under grant number 85800001, and by the ODAS foundation, a private foundation supporting activities in the field of pediatric oncology and visual disabilities.

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MOBI-Kids Key Facts

Study Design (http://bit.ly/1ycxo9o):

Fourteen participating nations: Australia, Austria, Canada, France, Germany, Greece, India, Israel, Italy, Japan, Korea, Netherlands, New Zealand, and Spain.

Diagnostic period: May, 2010 through December, 2014.

Participation rates (to date) (http://bit.ly/1CYvnO7):
78-83% of cases and 60-69% of controls.

Main characteristics of 566 cases and 1074 controls (thru June, 2014) (http://bit.ly/1BXvbfr):
Sex: 55% male, 45% female.

Years of age: 40% 10-14; 35% 15-19;  24% 20-24.

Most of the cases came from six countries: Spain (145), Italy (106), Germany (71), Israel (65) , France (63), or Greece (42).  The eight other countries have so far only contributed 2 to 23 cases each.

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'Cellphones Don't Increase Kids' Cancer Risk' Study Flawed, Experts Say 

Natalie Wolchover, LiveScience, July 28, 2011 


<SNIP>

"It's a very peculiar paper and even more peculiar that it's published in a journal sponsored by the National Cancer Institute," Joel Moskowitz, director of the Center for Family and Community Health at the University of California-Berkeley, told Life's Little Mysteries. A red flag, he said, is that the research was funded in part by the cellphone industry, and some of the investigators also do other industry-funded research.

In Moskowitz's opinion, the conclusions drawn by study leader Martin Röösli, an environmental epidemiologist at the Swiss Tropical and Public Health Institute, and his colleagues were biased to downplay concerns about cellphone use among children and adolescents.

<SNIP>

In a response sent to the media, Moskowitz pointed out what he considers several flaws in Röösli's logic, starting with how little cellphone use (one call per week) counted as "regular." This parameter flooded the pool of truly regular cellphone users with almost-non-users, he said, skewing the results. "Such a loose definition of regular use would be expected to reduce the association between cellphone use and tumor risk," Moskowitz wrote.  [FAQ: Cellphone Radiation and Brain Cancer]

When a subset of the data corresponding only to heavy cellphone users is analyzed, he pointed out, the results become much more striking. From the journal's paper itself: "[There] was a highly significant association between the time since first subscription and brain tumor risk. Children who used cellphones for at least 2.8 years were more than twice as likely to have a brain tumor than those who never regularly used cellphones." The authors went on to state: "As compared to never regular users, those who used cellphones for 4 or more years based on phone company records were 3.7 to 4.0 times more likely to have brain tumors, and those who made 2,638 or more calls were 2.9 to 4.8 times more likely to have brain tumors."

http://www.livescience.com/15290-cellphones-increase-kids-cancer-risk-study-flawed-experts.html

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MOBI-Kids Original Post (May 10, 2013)


Brain tumors are the second most common cancer in young people under 20 years of age. The incidence has been increasing recently. (1)

CEFALO, a small, four-country, case-control study of brain tumors in children, found in a subgroup for whom phone company data were available that brain tumor risk was related to the number of years the children had a mobile phone subscription. The study found elevated risks (though not statistically significant) for children who used mobile phones in three of the four countries (Denmark, Sweden and Switzerland), but not in Norway or overall. The study had 352 young people 7-19 years of age with brain tumors and 646 healthy young people. (2)


In a case-control study, persons who have developed a disease are identified and their past exposure to potential etiological factors is compared to persons who do not have the disease. (1)

MOBI-KIDS is a large, 16-country, case-control study that will evaluate the association between mobile phone and other communication technology use, other environmental exposures, and the risk of brain tumors in young people. MOBI-KIDS will include about 2.000 young people 10-24 years of age with brain tumors and about 4.000 healthy young people. Results will be available in 2015/2016. (3)


Just like the INTERPHONE study which examined brain tumors in adults, Canada is participating in the MOBI-KIDS study, but the U.S. is not. (4) 

Why has the U.S. failed to participate in these international studies? Why does the U.S. fund so little research on the health risks of exposure to electromagnetic radiation?

http://www.mbkds.com/home



References

(1) Frequently Asked Questions | MOBI-KIDS. http://www.mbkds.com/frequently-asked-questions-0

(2)  Aydin D., et al. Mobile phone use and brain tumors in children and adolescents: a multicenter case-control study.J Natl Cancer Inst. 2011 Aug 17;103(16):1264-76. doi: 10.1093/jnci/djr244. Epub 2011 Jul 27. http://jnci.oxfordjournals.org/content/103/16/1264.long

(3) Welcome | MOBI-KIDS: Study on Communication Technology, Environment, and Brain Tumours in Young People. http://www.mbkds.com/home

(4) Partners | MOBI-KIDS. http://www.mbkds.com/list-of-partners

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Revital Bar-Sade Bruchim, Ph.D., 

Fieldwork Coordinator, Mobi-Kids Israel

May 12, 2015

"Another paper published by Prof. Sadetzki and Prof. Cardis in 2011 entitled: "Indications of possible brain-tumor risk in mobile-phone studies: should we be concerned?" (Occup Environ Med. 2011 Mar;68(3):169-71), discusses the main issues in the interpretation of the findings reported in published studies of brain tumors in relation to mobile-phone use, particularly the largest of these, Interphone, and their potential public-health implications. 

The authors concluded that while more studies are needed to confirm or refute these results, indications of an increased risk in high- and long-term users from Interphone and other studies are of concern. 

Since more than 4 billion people, including children, using mobile phones even a small risk at the individual level could eventually result in a considerable number of tumors and become an important public-health issue. 

The authors suggested that until definitive scientific answers are available, simple and low-cost measures, such as the use of text messages, hands-free kits and/or the loud-speaker mode of the phone should be used to reduce exposure to the brain from mobile phones."


http://www.crealradiation.com/index.php/en/news-about-mobi-kids-project/feature-of-the-month-israel

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Assessment of extremely low frequency magnetic field exposure from GSM mobile phones


Calderón C, Addison D, Mee T, Findlay R, Maslanyj M, Conil E, Kromhout H, Lee AK, Sim MR, Taki M, Varsier N, Wiart J, Cardis E. Assessment of extremely low frequency magnetic field exposure from GSM mobile phones. Bioelectromagnetics. 2014 Apr;35(3):210-21. doi: 10.1002/bem.21827.

Abstract

Although radio frequency (RF) electromagnetic fields emitted by mobile phones have received much attention, relatively little is known about the extremely low frequency (ELF) magnetic fields emitted by phones. This paper summarises ELF magnetic flux density measurements on global system for mobile communications (GSM) mobile phones, conducted as part of the MOBI-KIDS epidemiological study. The main challenge is to identify a small number of generic phone models that can be used to classify the ELF exposure for the different phones reported in the study. Two-dimensional magnetic flux density measurements were performed on 47 GSM mobile phones at a distance of 25 mm. Maximum resultant magnetic flux density values at 217 Hz had a geometric mean of 221 (+198/-104) nT. Taking into account harmonic data, measurements suggest that mobile phones could make a substantial contribution to ELF exposure in the general population. The maximum values and easily available variables were poorly correlated. However, three groups could be defined on the basis of field pattern indicating that manufacturers and shapes of mobile phones may be the important parameters linked to the spatial characteristics of the magnetic field, and the categorization of ELF magnetic field exposure for GSM phones in the MOBI-KIDS study may be achievable on the basis of a small number of representative phones. Such categorization would result in a twofold exposure gradient between high and low exposure based on type of phone used, although there was overlap in the grouping.



Excerpts

From the perspective of the main epidemiological study, thus far the data suggest the most favourable grouping to be based on distinguishing bar phones for given manufacturers and flip/slide phones. The proposed a priori grouping approach is relatively easy to apply and when adopted will result in a reasonable twofold exposure gradient between high and low exposure based on type of phone used.

Because the ELF signal has a burst-like waveform, harmonic components are also an important factor. The relative importance of the harmonics can be considered in terms of the wellestablished biophysical mechanism of electrical stimulation of nervous tissue, which forms the basis for the exposure guidelines of the International Commission on Non-Ionizing Radiation Protection [ICNIRP, 2010].
 
The study demonstrates that the phones emit magnetic flux densities at 217 Hz and associated harmonics, and could contribute substantially to ELF exposure in the general population. It is therefore not unreasonable to include a measure of this exposure in epidemiological studies assessing the potential risk of EMF exposure and brain tumor, particularly for young people, for whom the time weighted average exposure, over lifetime, may be greater than in adults.

Due to the technological advancements in mobile telecommunications during the study period of interest (2000–2013), it will also be necessary to assess 2.5–3.5 G phones; Enhanced Data rates for GSM Evolution (EDGE), Universal Mobile Telecommunications System (UMTS), High Speed Packet Access (HSPA) and Digital Enhanced Cordless Telecommunications (DECT) phones as well as the 2G phones. 

Conflicts of interest: Prof. Masao Taki's department received a grant to support numerical modeling work under a university-industry partnership. Whist Lab is funded by France Telecom. None of this funding was used to support the research described in this paper.