Methods The medical librarian searched MEDLINE (PubMed), EMBASE, and the Cochrane Library until 16 December 2020.
Results In these meta-analyses, 19 case-control studies and five cohort studies were included. Ipsilateral users reported a pooled odds ratio (OR) of 1.40 (95% CI 1.21–1.62) compared to non-regular users. Users with years of use over 10 years reported a pooled OR of 1.27 (95% CI 1.08–1.48). When stratified by each type of brain tumor, only meningioma (OR 1.20 (95% CI 1.04–1.39)), glioma (OR 1.45 (95% CI 1.16–1.82)), and malignant brain tumors (OR 1.93 (95% CI 1.55–2.39)) showed an increased OR with statistical significance for ipsilateral users. For users with years of use over 10 years, only glioma (OR 1.32 (95% CI 1.01–1.71)) showed an increased OR with statistical significance. When 11 studies with an OR with cumulative hours of use over 896 h were synthesized, the pooled OR was 1.59 (95% CI 1.25–2.02). When stratified by each type of brain tumor, glioma, meningioma, and acoustic neuroma reported the pooled OR of 1.66 (95% CI 1.13–2.44), 1.29 (95% CI 1.08–1.54), and 1.84 (95% CI 0.78–4.37), respectively. For each individual study that considered cumulative hours of use, the highest OR for glioma, meningioma, and acoustic neuroma was 2.89 (1.41–5.93) (both side use, > 896 h), 2.57 (1.02–6.44) (both side use, > 896 h), and 3.53 (1.59–7.82) (ipsilateral use, > 1640 h), respectively. For five cohort studies, the pooled risk ratios (RRs) for all CNS tumors, glioma, meningioma, and acoustic neuroma, were statistically equivocal, respectively. However, the point estimates for acoustic neuroma showed a rather increased pooled RR for ever-use (1.26) and over 10 years of use (1.61) compared to never-use, respectively.
Excerpts
“In consideration of these rapidly changing mobile phone technologies, the currently used proxies for RF-EMR exposure assessment are crude and insufficient to clarify the relationship between RF-EMR exposure from cell phones and brain tumor incidence.... The usual exposure measures, such as the years of mobile phone use, the cumulative duration of calls, and the number of calls per week, are rough indicators of mobile phone use.... the authors conducted a series of meta-analyses and subgroup analyses using various exposure measuring categories, from crude to more precise ones. In consideration of crude exposure classifications used in previous meta-analyses, this study will give insight into the importance of more precise exposure subcategories in investigating this topic."
"... the authors analyzed the risk of bias regarding selection and recall
bias for the amount of cell phone use and misclassification and recall
bias for ipsilateral/contralateral use. A major reason was that typical
risk of bias rating tools such as the National Toxicology Program Office
of Health Assessment and Translation Risk of Bias rating tool (NTP OHAT
RoB rating tool, Supplementary material B)
were not appropriate for assessing individual studies regarding this
topic." [Note: Karipidis et al. (2024) relied on this rating tool.]
"With the conversion from 2G cellular phones through 3G and 4G mobile phones to current 5G mobile phones, transmission of large data became possible. With the introduction of 3G technology, all aspects of our society and daily lives have changed drastically. Currently, we are using mobile phones nearly continuously and putting mobile phones near our bodies even when we are not using them. For example, if people use their mobile phone for morning-alarming purposes, they might put their mobile phone near the bed, sometimes even beside their head, all night. These changed patterns of mobile phone use could increase exposure to RF-EMR from cellular and mobile phones. Therefore, precise exposure assessment for RF-EMR from mobile phones would become more complex in future studies."
"The results of cumulative meta-analyses according to precision
indicated that the pooled OR was biased downwards with the addition of
studies with lower precision. This indicates that the results of studies
with a lower precision should be interpreted cautiously."
"Because
brain tumors require a latency period to develop [29], an accurate
assessment of brain tumor risk associated with RF-EMR exposure requires a
long observation span. However, each included study did not consider a
sufficient latency period in their study design. This could have led to a
possible underestimation of brain tumor risk. Future studies with long
observation spans might resolve this problem.”
- "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."
-
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.
- 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.
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
==
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"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."
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
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."
- 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.
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/
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