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INT ERNATIONAL JOUR NAL OF ONCOLOGY
Abstract. Quickly changing technologies and intensive uses
and uses and exposures to other wireless transmitting devices
CERENAT, a French national study, provides an important
addition to the literature evaluating the use of mobile phones
risk of glioma is consistent with studies that evaluated use of
mobile phones for a decade or longer and corroborate those
that have shown a risk of meningioma from mobile phone
the population of France during the period of this study, was
taken into account, the risks of glioma from mobile phone
researchers in bioelectromagnetics and provide monitoring of
Contents
1. Introduction
2. The CERENAT study
3. Underestimation of risk of glioma in CERENAT
and INTERPHONE
5. Evidence that electromagnetic radiation can act both as
an initiator and a promoter of tumors
7. Conclusions
1. Introduction
In a world where the growth of mobile phone use and other
the issue of brain cancer and radiation from mobile phones
has received considerable attention in the research community
and by the general public. Occupational studies and studies
of atomic bomb survivors indicate that the latency for brain
use resulted in an average use time of ~6 years. Both the
et al
In the past few years a number of investigations have
included those who have used phones for a decade or longer.
a more complete picture of their potential impacts on public
health.
ORs for the highest cumulative hours of exposure for
brain cancer, glioma and acoustic neuroma are doubled or
f particular interest are
cant increases for acoustic neuroma occurred with >2,000
Mobile phone radiation causes brain tumors and should be
classied as a probable human carcinogen (2A) (Review)
12, ANNIE SASCO3 and1
12
3
Correspondence to:
Key words: brain cancer, carcinogen, precautionary principle,
radiofrequency fields
et al
2
studies, increased risks for meningioma were also found at
For studies with greater years of use, acoustic neuroma tumor
2. The CERENAT study
Potential confounders considered were the level of
education, smoking, alcohol consumption, and occupational
exposures to pesticides, extremely low frequency electromag
as a potential confounder, separate analyses of exposures to
in the questionnaire.
of French mobile phone use in 2004, 2005, and 2006 was 73,
Risks were also reported by anatomical region. There was a
mobile phone radiation absorbed by the brain, the temporal
The highest risk reported was among heavy mobile phone
users from environments known to have multiple sources of
Higher risks were found from reported ipsilateral use, OR
tuting a risk factor for glioma, because analogue mobile phones
always radiated maximum power while the digital mobile
phone's adaptive power control circuitry reduces the radiated
power consistent with an acceptable signal to noise ratio.
For several exposure categories there was an increased risk
Consistent with what is expected if there is a causal
association between risks of glioma with different estimated
increased risk.
3. Underestimation of risk of glioma in CERENAT and
INTERPHONE
There are two principal reasons why the CERENAT find
ings as well as those of INTERPHONE are likely to have
underestimated the risks of glioma from mobile phone use.
nor in CERENAT were these exposures evaluated. However
Hardell et al
were listed as a potential confounder, questions were not asked
Industry records reveal that the estimated prevalence of
A second factor that could contribute to an underestima
tion of risk is that the participation rate in CERENAT was
The authors of the INTERPHONE study acknowledged the
possible selection bias from low participation rates and calcu
the overall underestimation of glioma and meningioma risk
the CERENAT authors provided corrected calculations,
By using the
correction the OR for the highest cumulative hours of use for
glioma doubled.
Figure 1. Risks among heavy mobile phone users with increasing years of use.
INT ERNATIONAL JOUR NAL OF ONCOLOGY 3
For glioma, all ipsilateral ORs were greater than contra
meningioma. Because ipsilateral use results in higher exposure
than contralateral, this is consistent what is expected if mobile
phone use is a risk for glioma and meningioma.
4. Meningioma elevated risk in CERENAT
et al
Per 100 h Hardell et al
et al
>2,376 Carlberg et al
et al
Coureau et al
Years of use
10+ Hardell et al
et al
>25 Hardell et al
et al
>20 Hardell et al
Per year Hardell et al
analogue phone
et al
Risk by age used
ipsilateral use
ipsilateral use
ipsilateral use
et al
4
5. Evidence that electromagnetic radiation can act both as
an initiator and a promoter of tumors
For an agent that initiates a tumor, a long time to detection is
expected. Thus, brain tumors generally are believed to have a
average times. In contrast, for an agent that acts at the later
stages of carcinogenesis, an earlier diagnosis of already initi
et a l
et al
increased risk of glioma with >2 years of mobile phone use, OR
1.2
Hardell et al
exposure indicated an early effect in glioma development,
which is an increased risk with long latency. However, we also
found an increased risk with short latency, indicating a late
effect in tumor development...these results could be compatible
rated
in Fig. 2.
6. Discussion
In reviewing the epidemiological evidence on mobile phone use
noted the limited data available from epidemiological studies
at that time though noting that Hardell et al have conducted
the most detailed and largest number of studies on the risks for
et al
radiofrequency fields were possible human carcinogens,
et al
Coureau et al
Exposures Ipsilaterala Contralateralb Ipsilaterala Contralateralb
Cumulative hours
of use
Not regular use Referent Referent Referent Referent
Cumulative hours
of use corrected
Not regular use Referent Referent Referent Referent
aSide of use was considered as ipsilateral if the phone was used on the same side as the tumor or on both sides. b
INT ERNATIONAL JOUR NAL OF ONCOLOGY 5
published of experimental results showing that radiofrequency
with cancer risk. In our view these results and several epide
ipsilateral risk is higher than contralateral risk.
Thus, evidence published since the IARC review provides
additional support, based on IARC criteria, for concluding
At the time of the IARC review it was known that when
mobile phone use began as a teenager, the risks were higher
evidence has accrued of an increased risk to children. In the
CEFALO study, using operator reported data, an OR of 2.15
an ipsilateral risk with >4 years of cumulative duration of
As the young adult brain is not fully myelinated, and
wireless radiation has been shown to induce demyelination
experimentally, it is plausible that wireless radiation could
have a stronger impact on the developing brain than on older
adults.
It has been suggested that if mobile phone use was causing
brain cancer, with so many people using mobile phones there
should be an increase in brain cancer, but there has been
was reported from the United States using data from three
brain cancer for the three
anatomical regions that absorb the greatest proportion of the
Also showing incidence increases is an Australian study
et al
preferred methodology for studying brain cancer risk tied
with mobile phone use, as with any relatively rare disease
with extensive exposure. The latency reported between
known causes of brain cancer and development of the disease
appears to range from 10 to 50 years. Because brain cancer is
a relatively rare disease with a relatively long latency, and the
reported relative risk associated with mobile phone use thus
detect a real increase in risk associated with mobile phone use,
prospective cohort studies would have to include >3 million
studies of glioma a nd mobile phone radiation. Adapted from Fig. 3 in Hardell
APC of
et al
LAC CCR SEER 12
Temporal +2.0 0.010 +1.9 0.026 +1.3 0.027
et al
6
A retrospective cohort study of ~400,000 cell phone users
excluded business users from the exposed contending they
were unable to know if a phone registered to a business user
was solely used by that person, including these same business
users in the unexposed category. This misclassification of
exposure impairs the ability of the study to detect an increase
in risk, while it lacks statistical power, as it involves a small
cohort for which exposure information has not been updated
for 20 years.
7. Conclusions
The CERENAT study corroborates the significant risks
of glioma associated with exposure to radiofrequency
INTERPHONE study, and adds weight to the epidemio
International Agency for Research on Cancer as a Group 2B
brain cancer was found from mobile phone use overall with an
of >10 million, many in the rapidly developing world where
medical treatment problematic. CERENAT also corroborates
those few studies that have shown a risk of meningioma from
mobile phone use.
The growth of mobile phone use worldwide has reached the
level that in many nations there are more phones than adults.
Exposures today can occur simultaneously from a number
that the exposure limit is measured at 20 cm distance from
Until further evidence is available, it is prudent for poli
exposures to the ALARA standard used in pediatric radiology.
The ALARA approach would require hardware and software
regarding simple advisories about safer use within devices.
In the meantime, we urge that serious national programs of
training and research be established to train experts in evalu
ating this technology and establish appropriate monitoring
and surveillance systems such as those in place for pharma
ceuticals and other agents. This program could be funded by
a fee of 2 centsmonth to be paid equally from consumers,
manufacturers, and providers into an independently operated
research and training program.
Acknowledgements
policy institution, for supporting this effort.
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