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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

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
Content issues in epidemiological research

  • 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 issues in epidemiological research

From Greenland, 2005


Childhood leukaemia
Childhood leukaemia issues in epidemiological research

  • 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 t
Results of multipe bias modelling (OR for >0.3 µT) issues in epidemiological research

†meta-analysis without bias

Greenland, 2005


Iarc classification
IARC classification issues in epidemiological research

  • Possibly carcinogenic to humans


Attributable leukaemia cases
Attributable leukaemia cases issues in epidemiological research

  • 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 ELF-MF exposure issues in epidemiological research

  • 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
Past and new studies of occupational ELF exposure and leukemia

Kheifets et al. JOEM 2008



Occupational elf mf exposure and amyotrophic lateral sclerosis als
Occupational ELF-MF exposure and tumoursamyotrophic lateral sclerosis (ALS)

Kheifets, OEM, 2009


Occupational elf mf exposure and alzheimer s disease ad
Occupational ELF-MF exposure and tumoursAlzheimer’s disease (AD)

Kheifets, OEM, 2009


Extent of occupational exposure
Extent of occupational exposure tumours

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


Exposure levels from power lines
Exposure levels from tumourspower lines

Bafu, 2005


Study on neurodegenerative disease and power line exposure
Study on tumoursneurodegenerative 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
Alzheimer’s disease and distance to power line tumours

* 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 line1
Alzheimer’s disease and distance to power line tumours

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
Other neurodegenerative diseases (Swiss study) tumours

  • No indication of an association for

    • Parkinson disease

    • Amyotrophic lateral sclerosis

    • Multiple sclerosis


Strengths limitations
Strengths/limitations tumours

  • 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
Epidemiological papers about mobile phone exposure Identified Health Risks (SCENIHR), 2009

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


Why brain tumour
Why brain tumour? Identified Health Risks (SCENIHR), 2009

  • 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???


Interphone mobile phone and cancer

Indication for risk or for Identified Health Risks (SCENIHR), 2009recall 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
Time trends of Identified Health Risks (SCENIHR), 2009male 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
Time trends of Identified Health Risks (SCENIHR), 2009female 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
Summary brain tumour Identified Health Risks (SCENIHR), 2009

  • 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
Electromagnetic Hypersensitivity (EHS) Identified Health Risks (SCENIHR), 2009

  • 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
3 different aspects of EHS Identified Health Risks (SCENIHR), 2009

  • 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
Perception of low level RF-EMF under double blind conditions Identified Health Risks (SCENIHR), 2009

Röösli, EnvRes 2008


Symptoms well being acute effects

?Ridder- Identified Health Risks (SCENIHR), 2009vold 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
Symptoms, well-being: Identified Health Risks (SCENIHR), 2009Long 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


Conclusions

Evidence Identified Health Risks (SCENIHR), 2009

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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