Electromagnetic fields health the most controversial issues in epidemiological research
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Electromagnetic fields & health: The most controversial issues in epidemiological research . Prof. Dr. Martin Röösli Institute of Social and Preventive Medicine at Swiss Tropical Institute, Basel Associated Institute of the University of Basel. Content. Exposure to power lines:

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Electromagnetic fields & health: The most controversial issues in epidemiological research

Prof. Dr. Martin Röösli

Institute of Social and Preventive Medicine at Swiss Tropical Institute, Basel

Associated Institute of the University of Basel


Content

  • Exposure to power lines:

    • childhood leukaemia

  • Occupational exposure to ELF-MF:

    • leukaemia

    • neurodegenerative diseases

  • Mobile phone exposure:

    • brain tumour

  • All type of electromagnetic fields

    • symptoms (electromagnetic hypersensitivity)


Childhood leukaemia and power lines

From Greenland, 2005


Childhood leukaemia

  • No consistent results from animal research; no biological mechanism.

  • Multiple-bias modelling (Greenland, 2005):

    (a) confounders: uncontrolled shared causes of field exposure and leukaemia,

    (b) sampling and response biases: possible uncontrolled associations of exposure and disease with selection and participation

    (c) measurement errors


Results of multipe bias modelling (OR for >0.3 µT)

†meta-analysis without bias

Greenland, 2005


IARC classification

  • Possibly carcinogenic to humans


Attributable leukaemia cases

  • Attributable fraction due to power lines: 0.1 -5%

  • Number of leukaemia cases in CH (0-15y): 55.

     0.2-2 annual cases due to power lines.

Kheifets, EHP, 2006


Occupational ELF-MF exposure

  • Occupational exposures levels and duration are generally higher than in the everyday environment (e.g. welder, electrician, railway workers).

  • Appealing for epidemiologic research.

  • Limitations: co-exposures, healthy worker effects


Past and new studies of occupational ELF exposure and leukemia

Kheifets et al. JOEM 2008


Past and new studies of occupational ELF exposure and brain tumours

Kheifets et al. JOEM 2008


Occupational ELF-MF exposure and amyotrophic lateral sclerosis (ALS)

Kheifets, OEM, 2009


Occupational ELF-MF exposure and Alzheimer’s disease (AD)

Kheifets, OEM, 2009


Extent of occupational exposure

From Table 1: Hug, Röösli & Rapp, Soz Prav Med, 2006


Exposure levels from power lines

Bafu, 2005


Study on neurodegenerative disease and power line exposure

  • Cohort study of the whole Swiss population

  • All deaths between 2000 and 2005

  • Exposure: distance of place of residence to the nearest powerline (220 and 380 kV)

Huss et al., AJE, 2009


Alzheimer’s disease and distance to power line

* adjusted for sex, educational level, occupational attainment, urban-rural area, civil status, language region, number of apartments per building, and living within 50 m of a major road.


Alzheimer’s disease and distance to power line

Huss et al., AJE, 2009

* adjusted for sex, educational level, occupational attainment, urban-rural area, civil status, language region, number of apartments per building, and living within 50 m of a major road.


Other neurodegenerative diseases (Swiss study)

  • No indication of an association for

    • Parkinson disease

    • Amyotrophic lateral sclerosis

    • Multiple sclerosis


Strengths/limitations

  • Selection bias unlikely

  • Confounding unlikely (control outcomes are not related to power lines: total mortality, lung cancer, alcoholic liver disease, cancer of esophagus)

  • Limited number of cases <100m of power lines

  • No modelling/measurement of exposure

  • Diagnosis misclassification

    from the limitations one rather expects an underestimation of the risk than a spurious association


Review of the EU Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), 2009

SCENIHR Research priorities (2009):


Epidemiological papers about mobile phone exposure

from http://www.emf-portal.de


Why brain tumour?

  • No direct DNA damage (non-ionzing radiation)

  • Hypothetical biological mechanisms discussed (e.g. free radicals, DNA repair mechanism) but no mechanism established for radio- and microwave frequency radiation

  • Head is most exposed part of the body when using a mobile phone

  • But why tumours and not other head related outcomes???


Indication for risk or forrecall bias?

Protective?

No,

indication

of selection

bias

Indication for risk increase?

Indication of recall bias

INTERPHONE: Mobile phone and cancer

SCENIHR

2009


Time trends of male brain tumour cancer rates

Incidence rate per 100,000 in Denmark, Finland, Norway, and Sweden, 1974 – 2003:

Glioma

Meningioma

triangles: 60 – 79 year^s

squares: 40 – 59 years

Circles: 20 – 39 years

Deltour et al., JNCI, 2009


Time trends of female brain tumour cancer rates

Incidence rate per 100,000 in Denmark, Finland, Norway, and Sweden, 1974 – 2003:

Glioma

Meningioma

triangles: 60 – 79 year^s

squares: 40 – 59 years

Circles: 20 – 39 years

Deltour et al., JNCI, 2009


Summary brain tumour

  • Many studies available.

  • Many studies and cancer registries allows to identify a possible risk if present.

  • Inherent uncertainties regarding long term use.


Electromagnetic Hypersensitivity (EHS)

  • Other terms:

    • Electrosensitivity

    • Idiopathic environmental Intolerances (IEI-EMF)

  • EHS is characterized by a variety of non-specific symptoms, which afflicted individuals attribute to exposure to EMF (WHO, fact sheet N° 296).

  • No established biological mechanism


3 different aspects of EHS

  • Perception of low-level fields: sensibility (Leitgeb and Schröttner, 2003)provocation studies

  • Symptoms and RF-EMF: short termprovocation studies / randomized trials / human laboratory study

  • Symptoms and RF-EMF: long termepidemiological/observational studies


Perception of low level RF-EMF under double blind conditions

Röösli, EnvRes 2008


?Ridder-vold 2008o

?Augner? 2008o

Hillert2008*

?Cinel? 2008*

?Eltiti?2007o

Furubaya-shi 2009o

Kleinlogel 2008o

Johansson 2008*

Fritzer2007*

Evidence for nocebo

Koivisto2001*

Wilen2006*

Hietanen2001*

Nocebo not considered

Regel2006o

Oftedal2007*

Rubin2006 *

Symptoms, well-being: acute effects

effect1)

1) at least 1out of several

no effect

*) near field (mobile phone)

o) far field (base station)


Symptoms, well-being: Long term effects

Major Challenge:

  • Most cross-sectional studies based on measured exposure levels do not indicate an increased risk: Hutter et al. 2006, Thomas et al. BioEM, 2008 Berg-Beckhoff et al., 2009, Kühnlein et al. BioEM

  • By design, cross-sectional studies are limited in terms of causality.

Subjective reporting of symptoms

Knowledge about exposure


Evidence

Number of cases

Conclusions

  • childhood leukaemia and exposure to power lines

  • neurodegenerative diseases and ELF-MF

  • adult Leukaemia/brain cancer and ELF-MF

  • brain tumour and use of mobile phones

  • electromagnetic hypersensitivity and EMF


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