Monday, May 24, 2021

New review study finds that heavier cell phone use increases tumor risk

March 24, 2021 (Updated May 24, 2021)

Cellular Phone Use and Risk of Tumors: Is ICNIRP "war-gaming the science"?

The Telecom industry has been "war-gaming the science" since 1994 (Microwave News, January/February 1997; p. 13). In 2019, Investigate Europe, a team of journalists, published 22 news articles in eight countries that alleged the International Commission on Non-Ionizing Radiation Protection (ICNIRP) has serious conflicts of interest. Moreover, these journalists reported that in order to defend ICNIRP's weak radio frequency (RF) exposure limits which are widely promoted by the World Health Organization, members of ICNIRP have been actively engaged in a campaign to undermine the credibility of peer-reviewed science that finds low-intensity RF radiation is harmful (http://bit.ly/ICNIRPcoi).

Last November my colleagues and I published a systematic review and meta-analysis of the case-control research on mobile phone use and tumor risk in the International Journal of Environmental Research and Public Health (IJERPH) (Choi et al., 2020). This study updated our earlier meta-analysis which was published in the Journal of Clinical Oncology (Myung et al., 2009). The takeaway message from our new study is we found evidence that linked cellular phone use to increased tumor risk. Based on our meta-analysis, 1,000 or more hours of cell phone use, or about 17 minutes per day over 10 years, was associated with a statistically significant 60% increase in brain tumor risk.

Shortly after our paper was published by IJERPH, de Vocht and Röösli submitted a letter to the editor that criticized our paper. Martin Röösli is one of the 14 members of the ICNIRP Commission.

My colleagues and I drafted a comprehensive reply that debunked the specious claims made by de Vocht and Röösli. The journal submitted the letter and our reply to peer review.

The two reviewers agreed with us that the de Vocht and Röösli letter made untenable arguments. Moreover, one reviewer called the letter a "scientifically unfounded attack on the Hardell group studies." He also noted that, "Röösli does not report his membership in ICNIRP as a potential conflict of interest."

The journal's editors decided not to publish the de Vocht and Röösli letter due to the negative peer reviews.

Then, this February a second letter attacking our review paper was submitted to IJERPH. The senior author of this letter, Ken Karipidis, is also a current member of the ICNIRP Commission

Although the second letter was shorter, it contained unfounded claims similar to those which appeared in the first letter. Since we did not want to waste our time only to experience the same outcome again, we asked the editor to have the second letter peer-reviewed and decide whether to publish the letter before we prepared a reply.

Instead, the journal decided to ignore the two negative peer reviews of the first letter and published the de Vocht and Röösli letter along with our reply. The journal also published the peer reviewers' comments (see below).

Even though the second letter (Brzozek et al, 2021) was largely redundant with the first letter, the journal decided to publish it and asked us to submit our comments about this letter. To avoid redundancy in our reply, we referred readers to our comments about the first letter and addressed the authors' first allegation, namely that "the INTERPHONE group were unfairly and repeatedly criticized for being funded by the cellular phone industry."

The journal just published the second letter along with our reply.  Following is an excerpt from our comments:

"The Brzozek et al. letter is the second letter to the editor regarding our current study. Ken Karipidis  [1] and Martin Röösli  [4], the senior authors of these two letters, are two of the 14 commissioners on the International Commission on Non-Ionizing Radiation Protection (ICNIRP). Their interest in our paper is not likely coincidental, because the major finding from both of our review studies was that heavier, long-term cell phone use was associated with significantly increased tumor risk [2,3]. Because this finding calls into question the adequacy of ICNIRP’s radio frequency exposure guidelines to protect human health, ICNIRP may have a vested interest in manufacturing doubt about our research.

Since all but one of the concerns in the Brzozek letter were raised in the letter by de Vocht and Röösli  [4], to avoid redundancy, we request that readers see our response to de Vocht and Röösli which addresses these other concerns [5]. Hence, in our reply below, we simply address Brzozek et al.’s unique concern about our paper.

Brzozek et al.’s [1] first concern is that we “unfairly and repeatedly criticized” the INTERPHONE group [6] and many of its investigators for their reliance on cellular phone industry funding. They further criticized us for providing only one reference [7] about possible “’hidden conflicts’ of interest” among the INTERPHONE investigators.

Industry-funded research, especially occupational and environmental health research, has been a topic of concern for decades, because it has often been found to be biased to support industry interests, according to numerous peer-reviewed papers, e.g., [8,9,10,11,12,13,14,15,16,17,18,19]. Moreover, several peer-reviewed papers have raised concerns about bias in industry-funded research on the effects of exposure to radio frequency radiation [20,21,22,23,24].

Multiple papers that reviewed the research on the effects of radio frequency or cell phone radiation have found that industry-funded studies were less likely to report effects [3,25,26,27,28,29,30,31]. For example, in 2007, a review of experimental studies conducted by Martin Röösli and colleagues concluded, “The interpretation of results from studies of health effects of radiofrequency radiation should take sponsorship into account” [25]. In an updated review published three years later they concluded, “Previous findings were confirmed: industry-sponsored studies were least likely to report results suggesting effects… The source of funding and conflicts of interest are important to consider in this area of research” [27]. We are aware of only one review study of the effects of radio frequency radiation that failed to find an association between study outcomes and study sponsorship [32]."

I believe the journal made the right decision to bring into the light of day the "unfounded" claims of these two letters attacking our meta-analysis. These allegations have been part of a long-term "whisper campaign" to discredit the work of a long-standing critic of ICNIRP. Hopefully, our replies and the peer reviewers' comments will put an end to this slander and shed some new light on the effects of industry-funded research.

--

Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis

Yoon-Jung Choi+, Joel M. Moskowitz+, Seung-Kwon Myung*, Yi-Ryoung Lee, Yun-Chul Hong*. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2020, 17(21), 8079; doi: 10.3390/ijerph17218079.

Abstract

We investigated whether cellular phone use was associated with increased risk of tumors using a meta-analysis of case-control studies. PubMed and EMBASE were searched from inception to July 2018. The primary outcome was the risk of tumors by cellular phone use, which was measured by pooling each odds ratio (OR) and its 95% confidence interval (CI). In a meta-analysis of 46 case-control studies, compared with never or rarely having used a cellular phone, regular use was not associated with tumor risk in the random-effects meta-analysis. However, in the subgroup meta-analysis by research group, there was a statistically significant positive association (harmful effect) in the Hardell et al. studies (OR, 1.15—95% CI, 1.00 to 1.33— n = 10), a statistically significant negative association (beneficial effect) in the INTERPHONE-related studies (case-control studies from 13 countries coordinated by the International Agency for Research on Cancer (IARC); (OR, 0.81—95% CI, 0.75 to 0.89—n = 9), and no statistically significant association in other research groups’ studies. Further, cellular phone use with cumulative call time more than 1000 hours statistically significantly increased the risk of tumors. This comprehensive meta-analysis of case-control studies found evidence that linked cellular phone use to increased tumor risk.

+Contributed equally to this study as the first author.    *Correspondence.

https://www.mdpi.com/1660-4601/17/21/8079

--

Comment on Choi, Y.-J., et al. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis

Frank de Vocht, Martin Röösli. Comment on Choi, Y.-J., et al. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18(6), 3125; doi: 10.3390/ijerph18063125.


--

Reply to Comment on Choi, Y.-J., et al. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis

Seung-Kwon Myung, Joel M. Moskowitz, Yoon-Jung Choi, Yun-Chul Hong. Reply to Comment on Choi, Y.-J., et al. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18(6), 3326; doi: 10.3390/ijerph18063326.


--

Comment on Choi et al. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis

Christopher Brzozek, Michael J. Abramson, Geza Benke, Ken Karipidis. Comment on Choi et al. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 8079. Int. J. Environ. Res. Public Health 18(10): 5459. 2021. doi: 10.3390/ijerph18105459.


--

Reply to Brzozek et al. Comment on “Choi et al. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 8079”

Joel M. Moskowitz, Seung-Kwon Myung, Yoon-Jung Choi, Yun-Chul Hong. Reply to Brzozek et al. Comment on “Choi et al. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 8079”. Int. J. Environ. Res. Public Health 2021,18(11), 5581. doi: 10.3390/ijerph18115581.



--

Peer-Review Record

Frank de Vocht, Martin Röösli. Comment on Choi, Y.-J., et al. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18(6), 3125; https://www.mdpi.com/1660-4601/18/6/3125/review_report.

Excerpts from Reviewer 1:

"The claim by Vocht and Röösli that you cannot combine studies aimed at different tumor types is not tenable. A large part of the epidemiology literature studies a relation between one agent and one tumor, mostly because of methodological issues. It is work-intensive to obtain and purify reliable hygiene and tumor data, and focusing on a fraction of the problem decreases costs, while increasing data reliability, and the chance of coming up with useable results."

"The last phrase in Vocht and Röösli's letter is quizzical: "Important, over time, the evidence had reduced the uncertainty regarding the cancer risk of mobile phone use." What does this mean? Has the evidence of harm from EMR become stronger, or weaker? If they Vocht and Röösli believe the evidence of harm is stronger, congratulations to them. If they believe the evidence of harm is weaker, they have not read the National Toxicology Program or Ramazzini Institute studies (reference 33 and 34 of Reply). In such a case, their views are prisoners of the distant past. I would rather eat Choi's fruit salad than Vocht and Roosli's moldy dish."
Excerpts from Reviewer 2:

Re: Comment by de Vocht and Roosli:

"This seems to be a scientifically unfounded attack on the Hardell group studies on this issue. Thus it is not suitable to be published in a scientific journal but should be rejected. There are many statements that are not qualified according to published studies. Inclusion of references is selective without a comprehensive review of the consistent pattern of increased risk."

"Finally Röösli does not report his membership in ICNIRP as a potential conflict of interest.

It should be noted that the Ethical Board at the Karolinska Institute in Stockholm, Sweden concluded already in 2008 that being a member of ICNIRP may be a conflict of interest that should be stated officially whenever a member from ICNIRP makes opinions on health risks from EMF on behalf of another organization, as in this case (Karolinska Institute Diary Number 3753-2008-609)."

Re: Reply by Myung et al

"This is a well-balanced reply. The statements are adequate based on the scientific literature on this issue.

There are no further comments on the reply."


--

February 20, 2021

That the National Cancer Center of South Korea has now decided to issue a press release in Korean and English promoting the results of our study published last November seems significant because the telecom industry in South Korea is very powerful.

Study finds increased risks of tumors from long-term use of cellular phones

English Language Press Release, Feb 20, 2021

By Professor Seung-Kwon Myung, MD, PhD, Dean of National Cancer Center Graduate School of Cancer Science and Policy, South Korea (Corresponding author)

-       Meta-analysis led by Prof. Seung-Kwon Myung of National Cancer Center in Korea in collaboration with research teams from Seoul National University and UC Berkeley

-          A new research finding showed if you use a cellular phone longer, then the risks of benign and malignant tumors would increase.

-          The National Cancer Center in Korea announced this finding from the meta-analysis of case-control studies published from 1999 to 2015, which was conducted by Professor Seung-Kwon Myung (Dean of the National Cancer Center Graduate School of Cancer Science and Policy; MD, PhD, Board-certified Family Physician) in collaboration with research groups from the Department of Preventive Medicine, Seoul National University (Professor Yun-Chul Hong and Dr. Yoon-Jung Choi) and the Center for Family and Community Health, School of Public Health, University of California, Berkeley (Director, Dr. Joel M. Moskowitz).

-          The research team led by Prof. Seung-Kwon Myung performed a meta-analysis of a total of 46 case-control studies searched from the two databases, PubMed and EMBASE. In the meta-analysis of all studies, compared with never or rarely having used a cellular phone, regular use was not associated with tumor risk in the random-effects meta-analysis. However, in the subgroup meta-analysis by research group, there was a statistically significant positive association (harmful effect) in the Hardell et al. studies (odds ratio* = 1.15, 95% confidence interval = 1.00 to 1.33), a statistically significant negative association (beneficial effect) in the INTERPHONE-related studies (multi-national case-control studies coordinated by the International Agency for Research on Cancer; odds ratio = 0.81, 95% confidence interval = 0.75 to 0.89), and no statistically significant association in other research groups’ studies. Further, cellular phone use with cumulative call time more than 1,000 hours statistically significantly increased the risk of tumors (odds ratio = 1.60, 95% confidence interval = 1.12 to 2.30). This comprehensive meta-analysis of case-control studies found evidence that linked cellular phone use to increased tumor risk.

-          In 2009, Prof. Seung-Kwon Myung, the lead author of the new study already reported that the use of cellular phones could increase the risk of tumors in the meta-analysis of 23 case-control studies published in Journal of Clinical Oncology, which is one of the top scientific journal in the oncology field. Since then, the World Health Organization/International Agency for Research on Cancer (IARC) has classified radiofrequency electromagnetic fields (EMFs) as "possibly carcinogenic to humans" (Group 2B) based on the evidence from literature. This recent research updated the findings from the meta-analysis of subsequently published observational studies for another 10 years.

-          “This study supports the research findings from several laboratory studies and animal studies that exposure to radiofrequency electromagnetic fields (EMFs) emitted from cellular phones (ranging from 800 to 2,000 MHz, which fall in the microwave spectrum) promote the development of cancer,” said Prof. Myung.

-          “When we combined all 46 studies, there was no association between the use of cellular phone use and the risk of tumors. Interestingly, however, when we performed the subgroup analysis by type of study group, different findings were obtained. All of the published studies for the past 20 years can be classified into three groups: Hardell et al’s studies from Sweden, the INTERPHONE studies (multi-national case-control studies coordinated by WHO/IARC), and other studies. In the subgroup meta-analysis by type of study group, Hardell et al’s studies showed a harmful effect of cellular phone use on tumor risk, the INTERPHONE studies appeared to have a beneficial effect, and other studies found no significant association,” stated Prof. Myung regarding the different findings by study group.

-          “We identified that the reasons for the discrepancies in findings among the study groups were related to the quality of the study (high vs. low), difference in response rates of study participants to a research questionnaire (smaller vs. larger, by about 15%), and funding sources (cellular phone industry funding vs. not funded). The Hardell studies were not funded by the cellular phone industry, mostly had high quality, mostly reported high response rates (>70%) with smaller differences in response rates between the case group and the control group. On the contrary, all of the INTERPHONE studies were partly funded by the cellular phone industry (precisely, supported by funding from the International Union against Cancer, which received funds from the Mobile Manufacturers’ Forum and Global System for Mobile Communications Association) except for the INTERPHONE-Japan studies; most studies had low quality and larger differences in response rates between the case group and the control group. Thus, Hardell et al’s findings that cellular phone use increases tumor risk are more plausible than those from the INTERPHONE studies,” explained Prof. Myung.

-          “This meta-analysis included only case-control studies, which might have some important biases such as selection bias and recall bias leading to a distortion of facts. Thus, we need to confirm our findings through further prospective cohort studies giving us a higher level of evidence. Nevertheless, based on the ‘precautionary principle’, until the harms of cellular phone use are confirmed in the future, I recommend to use a cellular phone less, avoid its use in elevators and cars where electromagnetic waves are emitted a lot, and use wired earphones or earbuds or keep your cellphone at least 2-3 centimeters or 1 inch away from your head,” emphasized Prof. Myung.

-          This research was published in the journal, International Journal of Environment Research and Public Health in November, 2020.

-          Article link: http://bit.ly/cellphonetumor

*Odd ratio and 95% confidence interval: An odds ratio is a statistic that quantifies the strength of the association between two events, A and B. In this study, A is ‘use of cellular phones’, and B is ‘risk of tumors’. If the odds ratio is greater than 1, the use of cellular phones increases the risk of tumors. If the odds ratio is less than 1, the use of cellular phones decreases the risk of tumors. If a 95% confidence interval includes ‘1’, it means that there is no statistically significant difference, whereas if it doesn’t include ‘1’, it means that there is a statistically significant difference. For example, because 95% confidence intervals from both Hardell et al and the INTERPHONE studies don’t include ‘1’ (1.00 from Hardell et al’s confidence interval is actually 1.00x, which is greater than 1), there is a statistically significant difference, which means that their odds ratios indicate statistically significantly increased or decreased risks of tumors, respectively.

--

February 15, 2021

“The longer the cell phone is used, the higher the risk of cancer.”

Song Soo-yeon, Youth Doctor Newsletter, February 15, 2021     (Google translation from Korean)

National Cancer Center Professor Seung-kwon Myung's team, joint research with Seoul Medical University and UC Berkeley meta-analysis

Research shows that using a mobile phone for a long time increases the risk of developing cancer such as brain tumors.

Prof. Seung-Kwon Myung (President of Graduate School) of National Cancer Center, Professor of Preventive Medicine, Seoul Medical University, and Joel Moskowitz, Director of Center for Family and Community Health, UC Berkeley School of Public Health. It was revealed on the 15th that the meta-analysis of 46 case-control studies published in international journals from 1999 to 2015 revealed the result.

As a result of a meta-analysis of 46 research papers through literature search in the major medical databases, PUBMed and EMBASE, the researchers found the relationship between people who use mobile phones and those who do not did not make a big difference.

However, the results of detailed meta-analysis by major research groups and qualitative levels were different. Sweden's Hardell team, who published the most research on the subject, announced that the use of mobile phones increases the risk of developing tumors.

From left: Corresponding author Seung-kwon Myung, Professor of National Cancer Center, co-first author Dr. Joel Moskowitz, co-author Hong Yun-cheol, Seoul Medical University professor, and first author Choi Yoon-jung, Ph.
From left: Corresponding author Seung-kwon Myung, Professor of National Cancer Center, co-first author Dr. Joel Moskowitz, co-author Hong Yun-cheol, Seoul Medical University professor, and first author Choi Yoon-jung, Ph.D.

Professor Myung, who led the study, emphasized, "This study supports the results of some laboratory and animal studies that show that high-frequency electromagnetic fields (frequency 800-2000 MHz) exposed when using mobile phones can accelerate cancer development."

He said, “As a result of analyzing the reasons for the differences in the results of each research team, it was possible to confirm that the quality of the research, the response rate of the research subjects, and the availability of research funding from the mobile phone company were important factors.” The quality of the study is high, there is little difference in response rate between the patient group and the control group, while research funding is not provided from a mobile phone company, a multinational interphone study organized by the International Cancer Research Organization (IARC) under the World Health Organization The team's research was of low quality, there was a lot of difference in response rate, and the research funding was provided by mobile phone companies.”

He said, “The results of the Hardell research team's research that the use of mobile phones increases the risk of tumors can be interpreted as more convincing,” he said. “Moreover, regardless of the research team, the case of using a mobile phone for more than 1,000 hours* the tumor risk was statistically significantly higher (interval ratio 1.60, 95% confidence interval 1.12-2.30)”.

He continued, “Even before the dangers of cell phones are clearly identified, we recommend that you refrain from using cell phones for a long period of time based on the precautionary principle. It is necessary to reduce the use, and when using a mobile phone, keep it 2~3 centimeters away from the face and use earphones with wires as much as possible.”

The research results were published in the November 2020 issue of the International Journal of Environmental Research and Public Health, an international academic journal of SCIE.

* which corresponds to about 17 minutes per day over 10 years


--

November 2, 2020

A review of research on cell phone use and tumor risk found that cell phone use with cumulative call time more than 1000 hours significantly increased the risk of tumors.

(Berkeley, CA, November 2, 2020)  Today, the International Journal of Environmental Research and Public Health published a systematic review and meta-analysis of the case-control research on cell phone use and tumor risk.

This study updates our original meta-analysis (i.e., quantitative research review) published in the Journal of Clinical Oncology in 2009. The new review examined twice as many studies as our original paper.

"In sum, the updated comprehensive meta-analysis of case-control studies found significant evidence linking cellular phone use to increased tumor risk, especially among cell phone users with cumulative cell phone use of 1000 or more hours in their lifetime (which corresponds to about 17 min per day over 10 years), and especially among studies that employed high quality methods."

The abstract and excerpts from this open access paper appear below:

Yoon-Jung Choi+, Joel M. Moskowitz+, Seung-Kwon Myung*, Yi-Ryoung Lee, Yun-Chul Hong*. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2020, 17(21), 8079; https://doi.org/10.3390/ijerph17218079.

Abstract

We investigated whether cellular phone use was associated with increased risk of tumors using a meta-analysis of case-control studies. PubMed and EMBASE were searched from inception to July 2018. The primary outcome was the risk of tumors by cellular phone use, which was measured by pooling each odds ratio (OR) and its 95% confidence interval (CI). In a meta-analysis of 46 case-control studies, compared with never or rarely having used a cellular phone, regular use was not associated with tumor risk in the random-effects meta-analysis. However, in the subgroup meta-analysis by research group, there was a statistically significant positive association (harmful effect) in the Hardell et al. studies (OR, 1.15—95% CI, 1.00 to 1.33— n = 10), a statistically significant negative association (beneficial effect) in the INTERPHONE-related studies (case-control studies from 13 countries coordinated by the International Agency for Research on Cancer (IARC); (OR, 0.81—95% CI, 0.75 to 0.89—n = 9), and no statistically significant association in other research groups’ studies. Further, cellular phone use with cumulative call time more than 1000 hours statistically significantly increased the risk of tumors. This comprehensive meta-analysis of case-control studies found evidence that linked cellular phone use to increased tumor risk.

+Contributed equally to this study as the first author. *Correspondence.

Excerpts

3.5. Exposure–Response Relationship Between Use of Cellular Phones and Risk of Tumors

Table 3 shows an exposure-response relationship between cellular phone use and tumor risk. In the subgroup meta-analysis by time since first use or latency, overall the risk of tumors by cellular phone use non-significantly increased from an OR of 0.97 to 1.29 as latency increased from less than 5 years to 10 or more years. This finding was observed in each subgroup meta-analysis by research group. Especially, statistically significant increased tumor risk was observed for latency of 10 or more years in the Hardell studies (OR, 1.62; 1.03 to 2.57; n = 5; I2 = 39.9%). Similarly, the use of cellular phones non-significantly increased the risk of tumors as the cumulative or lifetime use in years and the cumulative number of calls increased in all studies and in each study group. Remarkably, in the subgroup meta-analysis of all studies by cumulative call time, cellular phone use greater than 1000 hours statistically significantly increased the risk of tumors (OR, 1.60; 1.12 to 2.30; n = 8; I2 = 74.5%). Interestingly, the use of cellular phones overall and in the Hardell studies (OR, 3.65; 1.69 to 7.85; n = 2, especially in the Hardell studies) non significantly increased the risk of tumors with cumulative call time of 300–1000 h and more than 1000 h, while it decreased the risk of tumors in most subgroup meta-analyses of the INTERPHONE studies.

5. Conclusions

In sum, the updated comprehensive meta-analysis of case-control studies found significant evidence linking cellular phone use to increased tumor risk, especially among cell phone users with cumulative cell phone use of 1000 or more hours in their lifetime (which corresponds to about 17 min per day over 10 years), and especially among studies that employed high quality methods. Further quality prospective studies providing higher level of evidence than case-control studies are warranted to confirm our findings.

This open access paper and supplemental material can be downloaded at http://bit.ly/cellphonetumor.


Related Posts on Electromagnetic Radiation Safety


"Radio Frequency Radiation Health Risks: Implications for 5G" (Grand Rounds presentation, UC San Francisco, video, slides)