Biased WHO-commissioned review claims no cancer link to cellphone use

September 16, 2024 (Updated Sep 20, 2024)

On September 3, the lead author of a new WHO-commissioned systematic review of research on mobile phone use and tumor risk (Karipidis et al., 2024), issued a news release about the study which made the following claims: 

• "This systematic review provides the strongest evidence to date that radio waves from wireless technologies are not a hazard to human health."
• "Overall, the results are very reassuring. They mean that our national and international safety limits are protective. Mobile phones emit low-level radio waves below these safety limits, and there is no evidence exposure to these has an impact on human health."
• "There remains no evidence of any established health effects from exposures related to mobile phones, and that is a good thing."

These assertions are highly irresponsible. Substantial disagreement has existed for decades among experts who study the effects of radio frequency radiation (RFR). The WHO-sponsored systematic reviews of this scientific literature will exacerbate these disagreements rather than alleviate them due to bias in the selection of review teams by the WHO and in the resulting papers which were recently published in a special issue of Environment International prior to publication of a forthcoming WHO monograph on this topic.

Following are concerns I have regarding the Karipidis et al (2024) study:

• All human studies are likely biased toward the null due to exposure misclassification caused by unreliability in study participants' self-reported recall of number of phone calls and call time. Thus, meta-analysis of these studies underestimates the risks of harm.
  
• The cohort studies employed crude assessment of mobile phone use and/or insufficient followup periods, especially the studies of cancer or tumor risk.
• In most studies "regular cellphone use" was defined as at least one cellphone call weekly over the past six months. One would hardly expect to find any adverse effects with such little exposure to RFR; yet, the primary focus in Karipidis et al. used this definition of cellphone use.
• Call time, even if it were based on cellphone company records, has at best a moderate association with radiofrequency radiation (RFR) exposure because numerous factors affect exposure to RFR (e.g., proximity of phone to the body during calls; strength of signal from cell tower).
• Nonetheless, analyses of cumulative call time (CCT) are more useful to examine than analyses of "regular use." For the CCT analyses, Karipidis et al. employed multiple, meta-regression models which were separately conducted for different types of tumors. The resulting J-shaped curves suggested increased tumor risk with greater celllphone use after about 500 hours of cellphone use, but the confidence intervals were large. Karipidis et al. erroneously concluded there was no evidence of increased tumor risk because the results were not statistically significant; however, their analyses were underpowered because most of the individual studies contained relatively few users with substantial exposure. This was particularly problematic because separate analyses were conducted for each tumor type which limited the number of individual studies in any given analysis. 
• In contrast to the current study, in a meta-analysis of 46 case-control studies, my colleagues and I (Choi et al , 2020) employed a more conventional approach to the meta-analysis of the cumulative call time data. We employed data from all tumor types and conducted separate random effects meta-analyses to examine low, medium, and higher-level mobile phone use. We found a significant increased tumor risk in the higher-level mobile phone use analysis which included 8 studies with more than 1000 hours of lifetime mobile phone call time. This analysis found statistically significant evidence for increased risk of tumors in the brain and salivary glands (OR = 1.60 (95% CI = 1.12 , 2.30)). Soon after our study was published, Karipidis and a few of his colleagues published letters to the editor that criticized our meta-analyses; however, we successfully defended our systematic review of the case-control studies in two peer-reviewed letters (see https://www.saferemr.com/2020/11/new-review-study-tumor-risk.html).
  
• In most case-control studies data collection ended by the mid-2000's. Although the results for meningioma were mixed, these studies were largely limited to malignant cases because tumor registries did not begin recording nonmalignant tumors until the mid-2000's. That the age-adjusted incidence of the most common brain tumor, nonmalignant meningioma, has increased substantially in the past two decades should be of great concern; yet, little attention has focused on the factors contributing to this trend.
  
• Most human research to date has focused on either cell phones or cell towers and ignored other sources of exposure (e.g., use of cordless phones or personal wireless devices) resulting in misclassification of individuals' overall RFR exposure. 
• The Karipidis et al. review relied heavily on the Interphone studies which suffered from substantial selection bias; yet, judged these studies to be low risk of bias, and ignored the correction for selection bias in the pooled Interphone study which doubled the glioma risk estimate for mobile phone use > 1640 hours from OR = 1.40 (95% CI = 1.03, 1.89) in the main body of paper to 1.82 (1.15, 2.89) in Appendix 2.
• The justification in Karipidis et al. for excluding study results based on tumor location and laterality was inadequate. Meta-analyses of these results provide significant evidence of increased tumor risk with greater amounts of mobile phone use for brain tumors in the temporal lobe and ipsilateral tumors.
  
• The risk of bias assessment in Karipidis et al. may have been applied in a biased manner to the Hardell studies. Although we used different risk of bias rating criteria, we found in 2009 and again in 2020 the Hardell studies to be stronger methodologically than most other case-control studies.
  
• Karipidis et al. only examined human studies of mobile phone use, most of which likely underestimate the risk of cancer and nonmalignant tumors. They did not address the considerable evidence base of animal and mechanistic studies--the preponderance of which found oxidative effects, DNA damage and/or carcinogenicity from RFR exposure.
  

Limits on the generalizability of most human studies to date on mobile phone use and tumor risk:

• Since most case-control data were collected in the early 2000's and there is a long latency for detection of solid tumors, most studies primarily assessed the effects of GSM (2G) cellphone radiation, the most commonly used cellular technology in Europe where most of the research has been conducted. So little is known about the long-term effects of exposure to subsequent generations of cellular technology.
  
• With the introduction of the smartphone in the mid-2000's, cellphone technology has changed substantially. The phone's cellular transmission antenna was moved from the top to the bottom of the phone exposing the lower head and neck to the greatest radiation instead of the temporal and frontal lobes of the brain. This may increase the risk for tumors of the thyroid and salivary glands.
  
• How cellphones are used has changed over time. More texting, greater use of wired and wireless headsets may have lowered RFR exposure to the head. However, research suggests that exposure to low-intensity RFR may open the blood-brain barrier, exposing the brain to toxic chemicals in the body's circulatory system. The effects of cellphone radiation on a specific organ may depend on the carrier frequency, pulsing and modulation of the signal and is likely non-linear with regard to intensity of the exposure. 
• Cell tower density has increased over time lowering RFR exposure from cellphones. However, with the introduction of "small cells," the proximity of base stations to users increased causing increased full-body 24-7 RFR exposure from towers.
  
• 5G employs different carrier frequencies (including, but not limited to, millimeter waves) and new features including massive MIMO and beamforming that cause brief, intense peak RFR exposures that exceed exposure limits (which are based on time-averaged exposures). Some research suggests that peak exposures are better predictors of harm than averaged exposures. Thus, 5G may pose greater health risks than its predecessors. A comprehensive program of research is essential but funding to study RFR effects has been quite limited. In fact, the U.S. has been grossly negligent in failing to support the research needed to develop safe RFR exposure limits for almost three decades.

In sum, this review suffered from numerous problems. The authors did not adequately deal with heterogeneity, i.e., differences in the original studies’ methods or results.  They ignored the fact that most of the original studies had little power to detect effects due to use of crude measures of exposure and/or inadequate followup time. Tumors can require several decades to be diagnosed.

The only informative results in Karipidis et al. (2024) were the cumulative call time analyses which found that after about 500 hours of cellphone use, the risk of glioma and meningioma increased with call time. However, these results were not statistically significant because the original studies had relatively few users with substantial call time.

In contrast, in our 2020 review paper, we combined studies of different tumor types and found significantly increased risk for tumors in the brain and salivary glands after 1,000 hours of cumulative call time (OR = 1.60; 95% CI = 1.12, 2.30).

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Russian National Committee for Non-Ionizing Radiation Protection Chairman attacks WHO-commissioned review that claims no cellphone-cancer link

Dr. Oleg A. Grigoriev, Sept 11, 2024 

(Dr. Grigoriev, one of the world's leading experts, emailed me this message regarding the Karipidis et al. (2024) review and gave me permission to post it.)

A group of little-known scientists have claimed responsibility for all cases of cancer associated with exposure to radiofrequency electromagnetic fields. These scientists claim that possible, probable, and proven cancer from exposure to radiofrequency electromagnetic fields does not exist and never can exist. Thus, responsibility for misleading consumers, industry, and healthcare systems lies with several specific authors.

They made this conclusion based on an analysis of other people's articles, selected using a methodology not developed by them, using analysis criteria that they also did not develop. These scientists themselves are not known for their affiliation with scientific schools studying the biomedical effects of electromagnetism, their fundamental work in the field of biological effects of electromagnetic fields and hygiene is unknown. For an unknown reason, the scientists speak on behalf of the World Health Organization, whose employees remain silent and, in principle, do not have the authority (and competence) to make such categorical conclusions. As is well known, science has no categorical judgments, even geometry from the obvious Euclidean has become non-Euclidean, the theory of relativity has become relative. We do not discover "laws of nature", but only generalize what is known. The physical nature of the electromagnetic field has been and remains a subject of discussion, as well as human nature and the role of natural electromagnetism and electricity in it.

The discussion of the carcinogenic potential of radio frequencies has become one of the topics of the international electromagnetic project after 1996, and we have repeatedly discussed this issue with the participants of the WHO project. I have been directly involved in discussions since 1997. Every specialist involved in experimental work using several species of animals, with volunteers, with hygiene and epidemiology understands how dangerous it is to make a categorical judgment "this exists" or "this does not exist". We all need to be very careful when meeting the statements of such authors who "know the answer" in such a complex area for research as the bioeffects of the electromagnetic field.

Dr. Oleg A. Grigoriev 

Dr. Sc. (radiobiology), Ph.D.(radiobiology & hygiene of non-ionizing radiation)

Chairman, Russian National Committee for Non-Ionizing Radiation Protection

Member of the Board, Scientific Council for Radiobiology, Russian Academy of Sciences

Chairman, Non-Ionizing Radiation Section, Russian National Radiobiological Society

Chief Expert of the State Commission on Sanitary Rules (retired)

Member of the IAC WHO EMF Int Project - now WHO Non-ionizing Project (since 2004)

Member of the Advisory Group to Recommend Priorities for the IARC Monographs

during 2020–2024

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September 11, 2024 

"Old Wine in New Bottles: Decoding New WHO–ICNIRP Cancer Review; Game Over? Likely Not," Microwave News, Sep 11, 2024. https://microwavenews.com/news-center/old-wine-new-bottles

Microwave News reports on the 20-year history behind the ICNIRP's efforts to convince the scientific community and the public that cellphone radiation cannot cause cancer and the WHO's conflicted relationship with the ICNIRP.

"The fact is that there’s very little new here. The same people have been making similar claims for some 20 years. This is only their latest gambit to make them stick."

 

"In short, the new systematic review is an ICNIRP production.

Indeed, ICNIRP’s scientific secretary, Dan Baaken, is another coauthor of the new review! He serves, with Karipidis, on the Commission’s board of directors. Baaken is on staff at the German Radiation Protection Office (BfS), the principal sponsor of ICNIRP.

ICNIRP has always rejected a cancer risk. No one on ICNIRP has ever broken ranks.* This is not surprising: The Commission is a private, self-perpetuating club. Membership demands swearing allegiance to the no-cancer dogma. Okay, that’s a bit of an exaggeration, but not by much.

The results of this review were never in doubt. The WHO managers, who selected the Karipidis team, knew what to expect —and they got what they wanted." 

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September 3, 2024

Today, many major news outlets are promoting a biased review of the literature commissioned by the World Health Organization (WHO) which claims that cellphone use has no link to cancer.

In my professional opinion, the WHO selected scientists to conduct systematic literature reviews on the biologic and health risks of wireless radiation who had demonstrated their bias through prior publications by either not finding evidence of harm or dismissing any evidence they found. 

Moreover, each WHO team has one or more members of the ICNIRP, a German NGO that issues exposure limits for wireless radiation primarily based on research produced by its own members, their former students and close colleagues. The ICNIRP limits, designed to protect humans only from the acute effects of heating induced by wireless radiation, are promoted by the WHO and are similar to those adopted by the FCC. 

In 2019 investigative journalists from eight European countries published 22 articles in major news media that exposed conflicts of interest in this "ICNIRP cartel." The journalists report that the cartel promotes the ICNIRP guidelines by conducting biased reviews of the scientific literature that minimize health risks from electromagnetic field (EMF) exposure. These reviews have been conducted for the WHO and other government agencies. By preserving the ICNIRP exposure guidelines favored by industry, the cartel ensures that the cellular industry will continue to fund their research. Since then, a former ICNIRP member who served as editor in chief of the Bioelectromagnetics Society journal accused ICNIRP of "groupthink."

Recently, the ICBE-EMF published several peer-reviewed papers refuting the "thermal-only paradigm" upon which the ICNIRP exposure limits are based because the preponderance of peer-reviewed research finds non-thermal effects. 

International Commission on the Biological Effects of Electromagnetic Fields (ICBE-EMF). Scientific evidence invalidates health assumptions underlying the FCC and ICNIRP exposure limit determinations for radiofrequency radiation: implications for 5G. Environmental Health. 2022. 21:92. DOI:10.1186/s12940-022-00900-9. https://ehjournal.biomedcentral.com/articles/10.1186/s12940-022-00900-9

Héroux P, Belyaev I, Chamberlin K, Dasdag S, De Salles AAA, et al. on behalf of the ICBE-EMF. Cell phone radiation exposure limits and engineering solutions. Int. J. Environ. Res. Public Health. 2023, 20, 5398. https://doi.org/10.3390/ijerph20075398

ICBE-EMF also published a critique of another WHO-commissioned review:

Frank, J.W,, Melnick, R.L, Moskowitz, J.M., on behalf of the International Commission on the Biological Effects of Electromagnetic Fields (ICBE-EMF). A critical appraisal of the WHO 2024 systematic review of the effects of RF-EMF exposure on tinnitus, migraine/headache, and non-specific symptoms. Reviews on Environmental Health. 2024. doi: 10.1515/reveh-2024-0069. https://www.degruyter.com/document/doi/10.1515/reveh-2024-0069/html

The WHO-commissioned paper that has revived the controversy about the cancer risks of cellphone radiation is now available:

Karipidis K, Baaken D, Loney T, Blettner M, Brzozek C, Elwood M, Narh C, Orsini N, Röösli M, Paulo MS, Lagorio S. The effect of exposure to radiofrequency fields on cancer risk in the general and working population: A systematic review of human observational studies – Part I: Most researched outcomes. Environment International (2024). https://doi.org/10.1016/j.envint.2024.108983

The paper's main conclusions seem biased (although not nearly as strong as reported in the news media)....

"For near field RF-EMF [radio frequency electromagnetic fields] exposure to the head from mobile phone use, there was moderate certainty evidence that it likely does not increase the risk of glioma, meningioma, acoustic neuroma, pituitary tumours, and salivary gland tumours in adults, or of paediatric brain tumours.

For near field RF-EMF exposure to the head from cordless phone use, there was low certainty evidence that it may not increase the risk of glioma, meningioma or acoustic neuroma."

My colleagues and I arrived at very different conclusions based upon our 2020 systematic review of 46 case-control studies on cellphone use and tumor risk:

Choi Y-J, Moskowitz JM, Myung S-K, Lee Y-R, Hong Y-C. 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

"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."

A preliminary comparison of the differences between our review and the new WHO review indicates that our review:

• examined only case-control studies of tumor risk and cellphone use as we did not consider any occupational, cohort or time-trend studies to be of sufficient quality to warrant consideration;

• our rubric for rating risk of bias of individual studies resulted in very different results;

• and most importantly, we employed a more conventional approach to the analysis of the cumulative call time data that examined the effects of heavy cell phone use.

Furthermore, we successfully rebutted criticisms of our review made by three authors of the new WHO review in letters to the editor:

de Vocht F, Röösli M. 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. https://www.mdpi.com/1660-4601/18/6/3125

Myung S-K, Moskowitz JM, Choi Y-J, Hong Y-C. 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. https://www.mdpi.com/1660-4601/18/6/3326

Brzozek C, Abramson MJ, Benke G, Karipidis K. 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. https://www.mdpi.com/1660-4601/18/10/5459

Moskowitz JM, Myung S-K, Choi Y-J, Hong Y-C. 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.https://www.mdpi.com/1660-4601/18/11/5581

The new WHO review relies heavily on cohort and time-trend studies of cellphone use and cancer risk which we have found to be at least as problematic as case-control studies in terms of drawing causal inferences:

Hardell L, Moskowitz JM. A critical analysis of the MOBI-Kids study of wireless phone use in childhood and adolescence and brain tumor risk. Reviews on Environmental Health. 2022. https://doi.org/10.1515/reveh-2022-0040

Moskowitz JM. RE: Cellular Telephone Use and the Risk of Brain Tumors: Update of the UK Million Women Study. JNCI: Journal of the National Cancer Institute, 2022. Djac109. https://doi.org/10.1093/jnci/djac109

Moskowitz JM, Frank JW, Melnick RL, Hardell L, Belyaev I et al., ICBE-EMF. COSMOS. A methodologically-flawed cohort study of the health effects from exposure to radiofrequency radiation from mobile phone use. Environment International, Volume 190, 2024, 108807, doi: 1016/j.envint.2024.108807. https://www.sciencedirect.com/science/article/pii/S0160412024003933

Although no scientific literature review is perfect, I believe that our 2020 review of cellphone use and tumor risk is less biased and will withstand the test of time better than the new review commissioned by the WHO.