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. 2024 Sep:191:108983.

doi: 10.1016/j.envint.2024.108983. Epub 2024 Aug 30.

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• PMID: 39241333
• DOI: 10.1016/j.envint.2024.108983

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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

Ken Karipidis et al. Environ Int. 2024 Sep.

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Abstract

Background: The objective of this review was to assess the quality and strength of the evidence provided by human observational studies for a causal association between exposure to radiofrequency electromagnetic fields (RF-EMF) and risk of the most investigated neoplastic diseases.

Methods: Eligibility criteria: We included cohort and case-control studies of neoplasia risks in relation to three types of exposure to RF-EMF: near-field, head-localized, exposure from wireless phone use (SR-A); far-field, whole body, environmental exposure from fixed-site transmitters (SR-B); near/far-field occupational exposures from use of hand-held transceivers or RF-emitting equipment in the workplace (SR-C). While no restrictions on tumour type were applied, in the current paper we focus on incidence-based studies of selected "critical" neoplasms of the central nervous system (brain, meninges, pituitary gland, acoustic nerve) and salivary gland tumours (SR-A); brain tumours and leukaemias (SR-B, SR-C). We focussed on investigations of specific neoplasms in relation to specific exposure sources (i.e. E-O pairs), noting that a single article may address multiple E-O pairs.

Information sources: Eligible studies were identified by literature searches through Medline, Embase, and EMF-Portal. Risk-of-bias (RoB) assessment: We used a tailored version of the Office of Health Assessment and Translation (OHAT) RoB tool to evaluate each study's internal validity. At the summary RoB step, studies were classified into three tiers according to their overall potential for bias (low, moderate and high).

Data synthesis: We synthesized the study results using random effects restricted maximum likelihood (REML) models (overall and subgroup meta-analyses of dichotomous and categorical exposure variables), and weighted mixed effects models (dose-response meta-analyses of lifetime exposure intensity). Evidence assessment: Confidence in evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

Results: We included 63 aetiological articles, published between 1994 and 2022, with participants from 22 countries, reporting on 119 different E-O pairs. RF-EMF exposure from mobile phones (ever or regular use vs no or non-regular use) was not associated with an increased risk of glioma [meta-estimate of the relative risk (mRR) = 1.01, 95 % CI = 0.89-1.13), meningioma (mRR = 0.92, 95 % CI = 0.82-1.02), acoustic neuroma (mRR = 1.03, 95 % CI = 0.85-1.24), pituitary tumours (mRR = 0.81, 95 % CI = 0.61-1.06), salivary gland tumours (mRR = 0.91, 95 % CI = 0.78-1.06), or paediatric (children, adolescents and young adults) brain tumours (mRR = 1.06, 95 % CI = 0.74-1.51), with variable degree of across-study heterogeneity (I2 = 0 %-62 %). There was no observable increase in mRRs for the most investigated neoplasms (glioma, meningioma, and acoustic neuroma) with increasing time since start (TSS) use of mobile phones, cumulative call time (CCT), or cumulative number of calls (CNC). Cordless phone use was not significantly associated with risks of glioma [mRR = 1.04, 95 % CI = 0.74-1.46; I2 = 74 %) meningioma, (mRR = 0.91, 95 % CI = 0.70-1.18; I2 = 59 %), or acoustic neuroma (mRR = 1.16; 95 % CI = 0.83-1.61; I2 = 63 %). Exposure from fixed-site transmitters (broadcasting antennas or base stations) was not associated with childhood leukaemia or paediatric brain tumour risks, independently of the level of the modelled RF exposure. Glioma risk was not significantly increased following occupational RF exposure (ever vs never), and no differences were detected between increasing categories of modelled cumulative exposure levels.

Discussion: In the sensitivity analyses of glioma, meningioma, and acoustic neuroma risks in relation to mobile phone use (ever use, TSS, CCT, and CNC) the presented results were robust and not affected by changes in study aggregation. In a leave-one-out meta-analyses of glioma risk in relation to mobile phone use we identified one influential study. In subsequent meta-analyses performed after excluding this study, we observed a substantial reduction in the mRR and the heterogeneity between studies, for both the contrast Ever vs Never (regular) use (mRR = 0.96, 95 % CI = 0.87-1.07, I2 = 47 %), and in the analysis by increasing categories of TSS ("<5 years": mRR = 0.97, 95 % CI = 0.83-1.14, I2 = 41 %; "5-9 years ": mRR = 0.96, 95 % CI = 0.83-1.11, I2 = 34 %; "10+ years": mRR = 0.97, 95 % CI = 0.87-1.08, I2 = 10 %). There was limited variation across studies in RoB for the priority domains (selection/attrition, exposure and outcome information), with the number of studies evenly classified as at low and moderate risk of bias (49 % tier-1 and 51 % tier-2), and no studies classified as at high risk of bias (tier-3). The impact of the biases on the study results (amount and direction) proved difficult to predict, and the RoB tool was inherently unable to account for the effect of competing biases. However, the sensitivity meta-analyses stratified on bias-tier, showed that the heterogeneity observed in our main meta-analyses across studies of glioma and acoustic neuroma in the upper TSS stratum (I2 = 77 % and 76 %), was explained by the summary RoB-tier. In the tier-1 study subgroup, the mRRs (95 % CI; I2) in long-term (10+ years) users were 0.95 (0.85-1.05; 5.5 %) for glioma, and 1.00 (0.78-1.29; 35 %) for acoustic neuroma. The time-trend simulation studies, evaluated as complementary evidence in line with a triangulation approach for external validity, were consistent in showing that the increased risks observed in some case-control studies were incompatible with the actual incidence rates of glioma/brain cancer observed in several countries and over long periods. Three of these simulation studies consistently reported that RR estimates > 1.5 with a 10+ years induction period were definitely implausible, and could be used to set a "credibility benchmark". In the sensitivity meta-analyses of glioma risk in the upper category of TSS excluding five studies reporting implausible effect sizes, we observed strong reductions in both the mRR [mRR of 0.95 (95 % CI = 0.86-1.05)], and the degree of heterogeneity across studies (I2 = 3.6 %).

Conclusions: Consistently with the published protocol, our final conclusions were formulated separately for each exposure-outcome combination, and primarily based on the line of evidence with the highest confidence, taking into account the ranking of RF sources by exposure level as inferred from dosimetric studies, and the external coherence with findings from time-trend simulation studies (limited to glioma in relation to mobile phone use). For near field RF-EMF 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. For whole-body far-field RF-EMF exposure from fixed-site transmitters (broadcasting antennas or base stations), there was moderate certainty evidence that it likely does not increase childhood leukaemia risk and low certainty evidence that it may not increase the risk of paediatric brain tumours. There were no studies eligible for inclusion investigating RF-EMF exposure from fixed-site transmitters and critical tumours in adults. For occupational RF-EMF exposure, there was low certainty evidence that it may not increase the risk of brain cancer/glioma, but there were no included studies of leukemias (the second critical outcome in SR-C). The evidence rating regarding paediatric brain tumours in relation to environmental RF exposure from fixed-site transmitters should be interpreted with caution, due to the small number of studies. Similar interpretative cautions apply to the evidence rating of the relation between glioma/brain cancer and occupational RF exposure, due to differences in exposure sources and metrics across the few included studies.

Other: This project was commissioned and partially funded by the World Health Organization (WHO). Co-financing was provided by the New Zealand Ministry of Health; the Istituto Superiore di Sanità in its capacity as a WHO Collaborating Centre for Radiation and Health; and ARPANSA as a WHO Collaborating Centre for Radiation Protection.

Registration: PROSPERO CRD42021236798. Published protocol: [(Lagorio et al., 2021) DOI https://doi.org/10.1016/j.envint.2021.106828].

Keywords: Acoustic neuroma; Base stations; Brain cancer; Broadcast transmitters; Case-control studies; Childhood cancer; Cohort studies; Cordless phones; Epidemiology; Glioma; Leukaemia; Meningioma; Mobile phones; Neoplasms; Occupational exposure; Pituitary tumours; Radiofrequency electromagnetic fields; Salivary gland tumours; Systematic review.

Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ken Karipidis as part of his employment is involved in the provision of advice to the Australian Commonwealth Government, Australian States and Territories and the general public on the risks and health effects of exposure to ionising and non-ionising radiation. He is also a member of the International Commission on Non-Ionizing Radiation Protection where he contributes in the development and dissemination of science-based advice on limiting exposure to non-ionizing radiation. Mark Elwood has given expert advice on topics in electromagnetic fields and health, and on the objective interpretation of epidemiological and other scientific information, over many years to individuals and groups, including government ministries, environmental regulators, community groups, commercial organisations, and formal inquiries by government and professional groups including parliamentary and legal proceedings. Some of this work has been financially supported, by universities, health care organisations, research bodies, or by government, professional or commercial groups. Some work has been reported ‘blind’, with the client being unidentified. Susanna Lagorio was principal investigator (April 2019 – March 2020) of the research project “BRiC 2018/06 - Systematic reviews of exposure to radiofrequency fields and cancer”, supported by the Italian Workers’ Compensation Authority, a public no-profit entity (grant code I85B19000120005). Her employment duties involved provision of advice on health hazards from exposure to RF-EMF to the Italian Ministry of Health and Higher Health Council (she retired on August 1st, 2023). Martin Röösli’s research is entirely funded by public entities or not for profit foundations. He has served as advisor on potential health effects of exposure to non-ionizing radiation to several national and international public advisory and research steering groups, including the World Health Organization, the International Agency for Research on Cancer, the International Commission on Non-Ionizing Radiation Protection, the Swiss Government (member of the working group “Mobile phone and radiation” and chair of the expert group BERENIS), the German Radiation Protection Commission (member of the committee Non-ionizing Radiation (A6) and member of the working group 5G (A630)) and the Independent Expert Group of the Swedish Radiation Safety Authority. From 2011 to 2018, M.R. was an unpaid member of the foundation board of the Swiss Research Foundation for Electricity and Mobile Communication, a non-profit research foundation at ETH Zurich. Neither industry nor nongovernmental organizations are represented on the scientific board of the foundation. Chris Brzozek as part of his employment is involved in the provision of advice to the Australian Commonwealth Government, Australian States and Territories and the general public on the risks and health effects of exposure to ionising and non-ionising radiation. The other authors declare that they have no known conflicts of interest.

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摘要

本研究是一项系统性综述，旨在评估人类观察性研究中射频电磁场(RF-EMF)暴露与癌症风险之间因果关系的证据质量和强度。研究分析了三种RF-EMF暴露类型：手机使用产生的近场头部暴露、固定发射站产生的远场全身环境暴露以及职业暴露。研究纳入了1994-2022年间发表的63篇文章，涉及22个国家的参与者，报告了119种不同的暴露-结果对。

主要结论显示，手机使用(相对于不使用)与胶质瘤、脑膜瘤、听神经瘤、垂体肿瘤、唾液腺肿瘤或儿童脑肿瘤风险增加无显著相关性。随着使用时间增长、累计通话时间增加或累计通话次数增加，主要研究的肿瘤风险也没有明显增加。无绳电话使用同样未与这些肿瘤风险显著相关。来自固定发射站(广播天线或基站)的暴露与儿童白血病或儿童脑肿瘤风险无关，职业RF暴露也未显著增加胶质瘤风险。

研究结论认为，有中等确定性证据表明，来自手机使用的RF-EMF头部暴露可能不会增加成人胶质瘤、脑膜瘤、听神经瘤、垂体肿瘤和唾液腺肿瘤风险，也不会增加儿童脑肿瘤风险。来自固定发射站的全身远场RF-EMF暴露可能不会增加儿童白血病风险(中等确定性证据)，也可能不会增加儿童脑肿瘤风险(低确定性证据)。职业RF-EMF暴露可能不会增加脑癌/胶质瘤风险(低确定性证据)。

与问题相关的信息提取

这项研究是一个全面的系统性综述，专门评估了射频电磁场(RF-EMF)暴露与癌症风险之间的关系，特别关注了手机辐射与癌症风险的关联。研究的主要结论非常明确：

1. 手机辐射与脑癌风险：研究发现，来自手机使用的RF-EMF暴露"可能不会增加"(likely does not increase)胶质瘤、脑膜瘤、听神经瘤、垂体肿瘤和唾液腺肿瘤的风险。这一结论基于中等确定性的证据。具体数据显示，手机使用与胶质瘤的相对风险为1.01(95%置信区间0.89-1.13)，与脑膜瘤的相对风险为0.92(95%置信区间0.82-1.02)，与听神经瘤的相对风险为1.03(95%置信区间0.85-1.24)。

2. 长期使用手机的影响：研究特别分析了长期使用手机(10年以上)的影响，发现在高质量研究(第一层级)中，长期使用手机与胶质瘤的相对风险为0.95(95%置信区间0.85-1.05)，与听神经瘤的相对风险为1.00(95%置信区间0.78-1.29)，表明长期使用也不会增加这些肿瘤的风险。

3. 儿童癌症风险：研究发现，手机使用不会增加儿童、青少年和年轻成人的脑肿瘤风险(相对风险1.06，95%置信区间0.74-1.51)。此外，来自固定发射站(如基站)的RF-EMF暴露可能不会增加儿童白血病风险(中等确定性证据)和儿童脑肿瘤风险(低确定性证据)。

4. 职业暴露：职业性RF-EMF暴露可能不会增加脑癌/胶质瘤风险，这一结论基于低确定性证据。

5. 研究方法学考量：研究团队进行了敏感性分析，发现结果稳健，不受研究聚合变化的影响。他们还识别出一项有影响力的研究，在排除该研究后，胶质瘤风险的相对风险和研究间异质性都显著降低。

6. 时间趋势模拟研究：作为补充证据，时间趋势模拟研究一致表明，某些病例对照研究中观察到的风险增加与多个国家长期观察到的胶质瘤/脑癌实际发病率不符。这些模拟研究一致报告，相对风险>1.5且有10年以上诱导期的估计"绝对不可信"。

总体而言，这项系统性综述提供了强有力的证据，表明手机辐射与癌症风险之间没有明显关联，特别是对于最常被关注的脑部肿瘤。研究结果对公共健康政策和公众对手机安全性的认知具有重要意义。

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Edinburgh Research Explorer The Systematic Review on RF-EMF Exposure and Cancer by Karipidis et al. (2024) has Serious Flaws that Undermine the Validity of the Study's Conclusions
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Frank, JW, Moskowitz, JM, Melnick, RL, Hardell, L, Philips, A, Héroux, P & Kelley, E 2025, 'The Systematic Review on RF-EMF Exposure and Cancer by Karipidis et al. (2024) has Serious Flaws that Undermine the Validity of the Study's Conclusions', Environment International , vol. 195, 109200. https://doi.org/10.1016/j.envint.2024.109200
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Correspondence
The Systematic Review on RF-EMF Exposure and Cancer by Karipidis et al. (2024) has Serious Flaws that Undermine the Validity of the Study ’s Conclusions
To the Editors, Environment International
We write as members of the ICBE-EMF, an international non-profit group of independent multidisciplinary scientists from backgrounds relevant to the safety of radiofrequency electromagnetic fields (RF-EMF) from wireless telecommunication devices and systems (https://icb e-emf.org ). We recently completed a detailed analysis, including an assessment of the epidemiological methodology used, of the systematic review (SR) and meta -analysis by Karipidis et al. (2024) . That review concluded there is “moderate certainty evidence ” that exposure to such telecommunications-related EMFs “does not increase the risk of glioma, meningioma, acoustic neuroma, pituitary tumours, salivary gland tu -

mours or paediatric brain tumours ” (Karipidis et al., 2024 ).
We disagree with that conclusion because the Karipidis et al. (2024)
review does not provide a scientifically valid assessment of the evidence on the risk of these tumors associated with use of mobile phones or other wireless devices, due to critical methodological flaws. These flaws combine to make the conclusions of this review biased, in a direction that systematically understates the potential for causation.
Although Karipidis and his co-authors declared no competing in -

terests, it should be noted that some of them had linkages to the tele -

communications industry and/or were members of ICNIRP, a self-selected organization that promotes its own RF-EMF radiation protec -

tion guidelines based on self-referencing authorships and had previously declared there is no evidence of increased cancer risk from exposure to RF-EMF ( Hardell and Carlberg, 2020; Nordhagen and Flydal, 2022; Nyberg et al., 2023 ).
Five key weaknesses of the Karipidis et al. (2024) SR:

1. Basing conclusions on studies with Flawed Designs
   The authors included several major studies in their meta -analysis which have been shown in peer-reviewed publications to have serious design flaws. In particular, the Interphone case-control studies (Interphone Study Group, 2011 ) have been found by independent re -

viewers (e.g. Choi et al., 2020 ) to have biased controls ’ selection, with over-representation of cell phone users compared to the general popu -

lation, leading to systematic underestimation of the actual strength of association between RF-EMF exposure and cancers, to the extent that most Interphone studies found such exposures to be protective against cancer risk – a hypothesis with no scientific justification.
Two major cohort studies, the Danish cohort study and the Million Woman Study, had serious design flaws. In its assessment and classifi -

cation of brain cancer risk from exposure to radiofrequency radiation, the International Agency for Research on Cancer (IARC, 2013) down -

played the value of the Danish cohort and its updated studies ( Frei et al., 2010, 2011; Schüz et al., 2006a,b ) because they relied on subscriptions to mobile phone providers as a surrogate for mobile phone use: the study
“lacked information on level of mobile-phone use and there were several potential sources of misclassification of exposure “– which will always underestimate the strength of association in cohort studies. The Million Women Study ( Schüz et al., 2022 ) not only had poor exposure assess -

ment, it suffered from high participant attrition and was underpowered (Moskowitz, 2022 ).
2. Excessive Reliance on RF-EMF exposure Categories that do not reflect extent of exposure
In their assessment of potential biases in the primary studies which they included in their meta -analyses, Karipidis et al. (2024) were too lenient in including studies with major weaknesses in their measure -

ment of RF-EMF exposures. In their meta -analysis depicted in Figure 2, no less than three cohort studies and ten case-control studies were included which employed the use of overly simplistic “dosage ” measures for actual phone use, such as “ever ” versus “never, ” and “time since start of use. ” Because this approach does not use actual measures of exposure, it would be expected to create exposure misclassification, which, as already noted, tends to obscure any actual dose –response relationships that might have been observed, again reducing the strength of the evi -

dence for causation ( Hill, 1965; Carlberg and Hardell, 2017 ).
Additionally, Karipidis et al. (2024) use complex biostatistical models – for which critical information is not provided (such as goodness-of-fit to empirical data in the primary studies) – to estimate the dose –response relationship between cumulative call-time (CCT), a bet -

ter estimate of actual RF-EMF dosage. However, their graphs of these models ’ outputs (e.g., Figure 6 for gliomas) show that the primary studies had little statistical power to inform the models ’ estimates of relative risks at high CCT levels. A newly-published meta -analysis ( Moon et al., 2024 ) employs better epidemiological methodology, and – based on almost exactly the same primary studies – finds (in Figure 2) that higher levels of CCT (greater than 896 h) are associated with a statisti -

cally significantly higher relative risk of brain tumors (OR 1.59, 95 % CI 1.25 –2.02).
One especially useful aspect of dose –response studies involves separately analysing tumors which are ipsilateral, versus contralateral, to the side of the head that the cancer patient normally has held his/her phone. Moon et al. ’s (2024) sophisticated analysis reveals that over two dozen primary studies, when pooled, have found a consistently higher odds ratio of 1.40 (95 % CI 1.21 –1.62) for ipsilateral tumors than for contralateral ones (OR 1.04, 95 % CI 0.93 –1.16). Karipidis et al. (2024)
fail to make full use of these studies, again reducing their analysis ’ ca -

pacity to identify important dose –response relationships strongly
Contents lists available at ScienceDirect

Environment International

journal homepage: www.elsevier.com/locate/envint

https://doi.org/10.1016/j.envint.2024.109200
Received 14 October 2024; Received in revised form 29 October 2024; Accepted 9 December 2024 Environment International 195 (2025) 109200
2

suggestive of causation in environmental health ( Hill, 1965 ).
In addition to the recent study by Moon et al., several previously published meta -analyses of case-control studies that were based on cu -

mulative call time found significant increases in brain tumor risk asso -

ciated with heavy and long term use (greater than 10 years) of mobile phones, and the risk was greatest on the side of the head in which the user had held their mobile phone ( Wang and Guo, 2016; Bortkiewicz et al., 2017; Carlberg and Hardell, 2017, Prasad et al., 2017; Yang et al., 2017; Choi et al., 2020 ).
3. Mischaracterization of the evidence on brain cancer Time-Trends
The authors claim that their time-trend simulations provided an external validation of their “moderate ” rating of the certainty of the brain cancer evidence. However, cancer time trends do not capture the unique use and exposure characteristics of the groups in which brain tumor risks were increased in the case-control studies, such as tumor risks in the areas of the brain (temporal lobe) with the highest absorp -

tion of RF radiation emitted from a mobile phone held next to the head. Critically, key studies finding recent increases in population-level inci -

dence for such brain cancers were omitted by Karipidis et al. ( Philips et al., 2018; Hardell and Carlberg, 2017; Zada et al., 2012; Defossez et al., 2019; Davis et al., 2020 ).
4. Understatement of the Considerable uncertainty about cancer risk after longer latent periods following exposure
Several authors of this review had previously written that some un -

certainty remains regarding long latency periods greater than 15 years for cancer development (as would be expected by cancer experts). Those uncertainties were not resolved, nor even fully cited, in Karipidis et al. (2024) . Furthermore, the authors do not give recognition to the evidence we already have that is highly suggestive of causation over long la -

tencies ( Hardell et al., 2013; Hardell and Carlberg, 2015; Carlberg and Hardell, 2017 ) – e.g. for total wireless phone use, the highest risk, while imprecisely estimated (and therefore requiring independent replica -

tion), was calculated for the longest latency time, >20 years (OR 4.4, 95 % CI 2.2 –9.0) ( Hardell et al. 2013 ).
The studies cited by Karipidis et al. lacked sufficient follow-up time to detect and diagnose late-developing cancers. The International Agency for Research on Cancer Monographs ( IARC, 2013 ) preamble states “experience with human cancer indicates that the period from first exposure to the development of clinical cancer is sometimes longer than 20 years; therefore, latent periods substantially shorter than 30 years cannot provide evidence for lack of carcinogenicity. ”.

5. Failure to follow widely used scientific guidance for systematic Reviews and Meta-Analyses
   The authors failed to follow standard guidance for pooling the results of primary studies. They ignored high levels of inconsistency (despite the fact that they document and quantify these inconsistencies across the studies ’ results � - for example, an I-squared value of over 61 % across all the primary studies in their Figure 2, and even higher I-squared values in their Figure 3). Such inconsistency is usually considered a contraindi -

cation to pooling the results across the primary studies ( Ioannidis, 2018 ). They also proceeded in some of their meta -analyses to pool the results of fewer than five primary studies on a given research question, in contravention of widely cited statistical guidance ( Valentine et al., 2017 ). These failings all have the effect of making the scientific certainty of their conclusions appear much greater than it actually is.
Conclusion
Considering these methodological flaws, we find that few, if any, of the RF-EMF exposure/tumor associations examined by Karipidis et al. have been the subject of sufficiently replicated, high-quality primary studies, of adequate power and follow-up time, to warrant any legiti -

mate scientific certainty about the absence of causation, especially when accounting for the animal studies of RF-EMF carcinogenicity ( Falcioni et al., 2018 ; National Toxicology Program, 2018a, 2018b ). The overall GRADE recommendations in this paper appear to reflect biases of the authors. In contrast to the authors ’ rating of the evidence for RF-EMF exposures NOT causing these tumors as being of “moderate certainty, ”

we contend there is no scientific justification for concluding there is any certainty that RF-EMF exposures do not cause cancer.
CRediT authorship contribution statement
John W. Frank: Writing – original draft, Conceptualization. Joel M. Moskowitz: Writing – review & editing, Conceptualization. Ronald L. Melnick: Writing – review & editing, Conceptualization. Lennart Hardell: Writing – review & editing. Alasdair Philips: Writing – review
& editing. Paul H ´eroux: Writing – review & editing. Elizabeth Kelley:
Writing – review & editing.
Funding
Not applicable.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Data availability
No data was used for the research described in the article.
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olrat Electromagnetic fields of all frequencies represent one of the most common and fastest growing environmental influences, about which anxiety and speculation are spreading.

olrat
Electromagnetic fields of all frequencies represent one of the most common and fastest growing environmental influences, about which anxiety and speculation are spreading.

© Credits

• Overview
• WHO Response

Overview

Electromagnetic fields (EMF) of all frequencies represent one of the most common and fastest growing environmental influences, about which anxiety and speculation are spreading. All populations are now exposed to varying degrees of EMF, and the levels will continue to increase as technology advances. Electromagnetic radiation has been around since the birth of the universe; light is its most familiar form. Electric and magnetic fields are part of the spectrum of electromagnetic radiation which extends from static electric and magnetic fields, through radiofrequency and infrared radiation, to X-rays.

WHO Response

As part of its charter to protect public health and in response to public concern over health effects of EMF exposure, the WHO established the International EMF Project in 1996 to assess the scientific evidence of possible health effects of EMF in the frequency range from 0 to 300 GHz. The EMF Project encourages focused research to fill important gaps in knowledge and to facilitate the development of internationally acceptable standards limiting EMF exposure.

Key objectives of the Project are to:

1. provide a coordinated international response to concerns about possible health effects of exposure to EMF,
2. assess the scientific literature and make a status report on health effects,
3. identify gaps in knowledge needing further research to make better health risk assessments,
4. encourage a focused research programme in conjunction with funding agencies,
5. incorporate the research results into WHO's Environmental Health Criteria monographs where formal health risk assessments will be made on exposure to EMF,
6. facilitate the development of internationally acceptable standards for EMF exposure,
7. provide information on the management of EMF protection programmes for national and other authorities, including monographs on EMF risk perception, communication and management, and
8. provide advice to national authorities, other institutions, the general public and workers, about any hazards resulting from EMF exposure and any needed mitigation measures.

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• Radiation: Electromagnetic fields

Electric fields are created by differences in voltage: the higher the voltage, the stronger will be the resultant field. Magnetic fields are created when electric current flows: the greater the current, the stronger the magnetic field. An electric field will exist even when there is no current flowing. If current does flow, the strength of the magnetic field will vary with power consumption but the electric field strength will be constant.

Natural sources of electromagnetic fields

Electromagnetic fields are present everywhere in our environment but are invisible to the human eye. Electric fields are produced by the local build-up of electric charges in the atmosphere associated with thunderstorms. The earth's magnetic field causes a compass needle to orient in a North-South direction and is used by birds and fish for navigation.

Human-made sources of electromagnetic fields

Besides natural sources the electromagnetic spectrum also includes fields generated by human-made sources: X-rays are employed to diagnose a broken limb after a sport accident. The electricity that comes out of every power socket has associated low frequency electromagnetic fields. And various kinds of higher frequency radiowaves are used to transmit information – whether via TV antennas, radio stations or mobile phone base stations.

One of the main characteristics which defines an electromagnetic field (EMF) is its frequency or its corresponding wavelength. Fields of different frequencies interact with the body in different ways. One can imagine electromagnetic waves as series of very regular waves that travel at an enormous speed, the speed of light. The frequency simply describes the number of oscillations or cycles per second, while the term wavelength describes the distance between one wave and the next. Hence wavelength and frequency are inseparably intertwined: the higher the frequency the shorter the wavelength.

A simple analogy should help to illustrate the concept: Tie a long rope to a door handle and keep hold of the free end. Moving it up and then down slowly will generate a single big wave; more rapid motion will generate a whole series of small waves. The length of the rope remains constant, therefore, the more waves you generate (higher frequency) the smaller will be the distance between them (shorter wavelength).

Exposure to electromagnetic fields is not a new phenomenon. However, during the 20th century, environmental exposure to artificial electromagnetic fields has been steadily increasing as growing electricity demand, ever-advancing technologies and changes in social behaviour have created more and more artificial sources. Everyone is exposed to a complex mix of weak electric and magnetic fields, both at home and at work, from the generation and transmission of electricity, domestic appliances and industrial equipment, to telecommunications and broadcasting.

Tiny electrical currents exist in the human body due to the chemical reactions that occur as part of the normal bodily functions, even in the absence of external electric fields. For example, nerves relay signals by transmitting electric impulses. Most biochemical reactions from digestion to brain activities go along with the rearrangement of charged particles. Even the heart is electrically active - an activity that your doctor can trace with the help of an electrocardiogram.

Low-frequency electric fields influence the human body just as they influence any other material made up of charged particles. When electric fields act on conductive materials, they influence the distribution of electric charges at their surface. They cause current to flow through the body to the ground.

Low-frequency magnetic fields induce circulating currents within the human body. The strength of these currents depends on the intensity of the outside magnetic field. If sufficiently large, these currents could cause stimulation of nerves and muscles or affect other biological processes.

Both electric and magnetic fields induce voltages and currents in the body but even directly beneath a high voltage transmission line, the induced currents are very small compared to thresholds for producing shock and other electrical effects.

Heating is the main biological effect of the electromagnetic fields of radiofrequency fields. In microwave ovens this fact is employed to warm up food. The levels of radiofrequency fields to which people are normally exposed are very much lower than those needed to produce significant heating. The heating effect of radiowaves forms the underlying basis for current guidelines. Scientists are also investigating the possibility that effects below the threshold level for body heating occur as a result of long-term exposure. To date, no adverse health effects from low level, long-term exposure to radiofrequency or power frequency fields have been confirmed, but scientists are actively continuing to research this area.

Biological effects are measurable responses to a stimulus or to a change in the environment. These changes are not necessarily harmful to your health. For example, listening to music, reading a book, eating an apple or playing tennis will produce a range of biological effects. Nevertheless, none of these activities is expected to cause health effects. The body has sophisticated mechanisms to adjust to the many and varied influences we encounter in our environment. Ongoing change forms a normal part of our lives. But, of course, the body does not possess adequate compensation mechanisms for all biological effects. Changes that are irreversible and stress the system for long periods of time may constitute a health hazard.

An adverse health effect causes detectable impairment of the health of the exposed individual or of his or her offspring; a biological effect, on the other hand, may or may not result in an adverse health effect.

It is not disputed that electromagnetic fields above certain levels can trigger biological effects. Experiments with healthy volunteers indicate that short-term exposure at the levels present in the environment or in the home do not cause any apparent detrimental effects. Exposures to higher levels that might be harmful are restricted by national and international guidelines. The current debate is centred on whether long-term low level exposure can evoke biological responses and influence people's well being.

Widespread concerns for health

A look at the news headlines of recent years allows some insight into the various areas of public concern. Over the course of the past decade, numerous electromagnetic field sources have become the focus of health concerns, including power lines, microwave ovens, computer and TV screens, security devices, radars and most recently mobile phones and their base stations.

The International EMF Project

In response to growing public health concerns over possible health effects from exposure to an ever increasing number and diversity of electromagnetic field sources, in 1996 the World Health Organization (WHO) launched a large, multidisciplinary research effort. The International EMF Project brings together current knowledge and available resources of key international and national agencies and scientific institutions.

Conclusions from scientific research

In the area of biological effects and medical applications of non-ionizing radiation approximately 25,000 articles have been published over the past 30 years. Despite the feeling of some people that more research needs to be done, scientific knowledge in this area is now more extensive than for most chemicals. Based on a recent in-depth review of the scientific literature, the WHO concluded that current evidence does not confirm the existence of any health consequences from exposure to low level electromagnetic fields. However, some gaps in knowledge about biological effects exist and need further research.

Effects on general health

Some members of the public have attributed a diffuse collection of symptoms to low levels of exposure to electromagnetic fields at home. Reported symptoms include headaches, anxiety, suicide and depression, nausea, fatigue and loss of libido. To date, scientific evidence does not support a link between these symptoms and exposure to electromagnetic fields. At least some of these health problems may be caused by noise or other factors in the environment, or by anxiety related to the presence of new technologies.

Effects on pregnancy outcome

Many different sources and exposures to electromagnetic fields in the living and working environment, including computer screens, water beds and electric blankets, radiofrequency welding machines, diathermy equipment and radar, have been evaluated by the WHO and other organizations. The overall weight of evidence shows that exposure to fields at typical environmental levels does not increase the risk of any adverse outcome such as spontaneous abortions, malformations, low birth weight, and congenital diseases. There have been occasional reports of associations between health problems and presumed exposure to electromagnetic fields, such as reports of prematurity and low birth weight in children of workers in the electronics industry, but these have not been regarded by the scientific community as being necessarily caused by the field exposures (as opposed to factors such as exposure to solvents).

Cataracts

General eye irritation and cataracts have sometimes been reported in workers exposed to high levels of radiofrequency and microwave radiation, but animal studies do not support the idea that such forms of eye damage can be produced at levels that are not thermally hazardous. There is no evidence that these effects occur at levels experienced by the general public.

Electromagnetic fields and cancer

Despite many studies, the evidence for any effect remains highly controversial. However, it is clear that if electromagnetic fields do have an effect on cancer, then any increase in risk will be extremely small. The results to date contain many inconsistencies, but no large increases in risk have been found for any cancer in children or adults.

A number of epidemiological studies suggest small increases in risk of childhood leukemia with exposure to low frequency magnetic fields in the home. However, scientists have not generally concluded that these results indicate a cause-effect relation between exposure to the fields and disease (as opposed to artifacts in the study or effects unrelated to field exposure). In part, this conclusion has been reached because animal and laboratory studies fail to demonstrate any reproducible effects that are consistent with the hypothesis that fields cause or promote cancer. Large-scale studies are currently underway in several countries and may help resolve these issues.

Electromagnetic hypersensitivity and depression

Some individuals report "hypersensitivity" to electric or magnetic fields. They ask whether aches and pains, headaches, depression, lethargy, sleeping disorders, and even convulsions and epileptic seizures could be associated with electromagnetic field exposure.

There is little scientific evidence to support the idea of electromagnetic hypersensitivity. Recent Scandinavian studies found that individuals do not show consistent reactions under properly controlled conditions of electromagnetic field exposure. Nor is there any accepted biological mechanism to explain hypersensitivity. Research on this subject is difficult because many other subjective responses may be involved, apart from direct effects of fields themselves. More studies are continuing on the subject.

The focus of current and future research

Much effort is currently being directed towards the study of electromagnetic fields in relation to cancer. Studies in search for possible carcinogenic (cancer-producing) effects of power frequency fields is continuing, although at a reduced level compared to that of the late 1990's.

The long-term health effects of mobile telephone use is another topic of much current research. No obvious adverse effect of exposure to low level radiofrequency fields has been discovered. However, given public concerns regarding the safety of cellular telephones, further research aims to determine whether any less obvious effects might occur at very low exposure levels.

Key points

• A wide range of environmental influences causes biological effects. 'Biological effect' does not equal 'health hazard'. Special research is needed to identify and measure health hazards.
• At low frequencies, external electric and magnetic fields induce small circulating currents within the body. In virtually all ordinary environments, the levels of induced currents inside the body are too small to produce obvious effects.
• The main effect of radiofrequency electromagnetic fields is heating of body tissues.
• There is no doubt that short-term exposure to very high levels of electromagnetic fields can be harmful to health. Current public concern focuses on possible long-term health effects caused by exposure to electromagnetic fields at levels below those required to trigger acute biological responses.
• WHO's International EMF Project was launched to provide scientifically sound and objective answers to public concerns about possible hazards of low level electromagnetic fields.
• Despite extensive research, to date there is no evidence to conclude that exposure to low level electromagnetic fields is harmful to human health.
• The focus of international research is the investigation of possible links between cancer and electromagnetic fields, at power line and radiofrequencies.

If electromagnetic fields constitute a health hazard, there will be consequences in all industrialized countries. The public demands concrete answers to the ever more pressing question, whether everyday electromagnetic fields cause adverse health effects. The media often seem to have definitive answers. However, one should judge these reports with caution and take into account that the primary interest of the media is not education. A journalist may select and report a story driven by a range of non-technical reasons: journalists compete with one another for time and space and different journals and newspapers compete for circulation numbers. Novel sensational headlines that are relevant to as many people as possible aid them in achieving these goals - bad news is not only the big news, it is often the only news we hear. The large number of studies which suggest that electromagnetic fields are harmless receive little if any coverage. Science cannot provide a guarantee of absolute safety yet but the development of research is reassuring overall.

Different types of studies are needed

A mix of studies in different research areas is essential for the evaluation of a potential adverse health effect of electromagnetic fields. Different types of studies investigate distinct aspects of the problem. Laboratory studies on cells aim to elucidate the fundamental underlying mechanisms that link electromagnetic field exposure to biological effects. They try to identify mechanisms based on molecular or cellular changes that are brought about by the electromagnetic field - such a change would provide clues to how a physical force is converted into a biological action within the body. In these studies, single cells or tissues are removed from their normal living environment which may inactivate possible compensation mechanisms.

Another type of study, involving animals, is more closely related to real life situations. These studies provide evidence that is more directly relevant to establishing safe exposure levels in humans and often employ several different field levels to investigate dose-response relationships.

Epidemiological studies or human health studies are another direct source of information on long-term effects of exposure. These studies investigate the cause and distribution of diseases in real life situations, in communities and occupational groups. Researchers try to establish if there is a statistical association between exposure to electromagnetic fields and the incidence of a specific disease or adverse health effect. However, epidemiological studies are costly. More importantly, they involve measurements on very complex human populations and are difficult to control sufficiently well to detect small effects. For these reasons, scientists evaluate all relevant evidence when deciding about potential health hazards, including epidemiology, animal, and cellular studies.

Interpretation of epidemiological studies

Epidemiological studies alone typically cannot establish a clear cause and effect relationship, mainly because they detect only statistical associations between exposure and disease, which may or may not be caused by the exposure. Imagine a hypothetical study showing a link between electromagnetic field exposure in electrical workers of the company "X-Electricity" and an increased risk of cancer. Even if a statistical association is observed, it could also be due to incomplete data on other factors in the workplace. For example, electrical workers may have been exposed to chemical solvents with the potential to cause cancer. Moreover, an observed statistical association may be due only to statistical effects, or the study itself may have suffered from some problem with its design.

Therefore, finding an association between some agent and a specific disease does not necessarily mean that the agent caused the disease. Establishing causality requires that an investigator consider many factors. The case for a cause-and-effect link is strengthened if there is a consistent and strong association between exposure and effect, a clear dose-response relationship, a credible biological explanation, support provided by relevant animal studies, and above all consistency between studies. These factors have generally been absent in studies involving electromagnetic fields and cancer. This is one of the strongest reasons why scientists have generally been reluctant to conclude that weak electromagnetic fields have health effects.

Difficulties in ruling out the possibility of very small risks

"The absence of evidence of detrimental effects does not seem to suffice in modern society. The evidence of their absence is demanded more and more instead". (Barnabas Kunsch, Austrian Research Centre Seibersdorf)

"There is no convincing evidence for an adverse health effect of electromagnetic fields" or "A cause-effect link between electromagnetic fields and cancer has not been confirmed" are typical of the conclusions that have been reached by expert committees that have examined the issue. This sounds as if science wanted to avoid giving an answer. Then why should research continue if scientists have already shown that there is no effect?

The answer is simple: Human health studies are very good at identifying large effects, such as a connection between smoking and cancer. Unfortunately, they are less able to distinguish a small effect from no effect at all. If electromagnetic fields at typical environmental levels were strong carcinogens, then it would have been easy to have shown that by now. By contrast, if low level electromagnetic fields are a weak carcino ...

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1. 网页内容摘要

该网页介绍了世界卫生组织(WHO)关于电磁场(EMF)的立场和应对措施。网页指出电磁场是最常见且增长最快的环境影响因素之一，引发了公众的焦虑和猜测。随着技术进步，所有人群都暴露于不同程度的电磁场中，且暴露水平将持续增加。电磁辐射自宇宙诞生以来一直存在，光是其最常见的形式。电磁辐射谱包括从静电场和磁场，通过射频和红外辐射，直至X射线的广泛范围。为应对公众对电磁场暴露健康影响的担忧，WHO于1996年建立了"国际电磁场项目"，旨在评估0至300 GHz频率范围内电磁场可能对健康影响的科学证据。该项目有8个关键目标，包括协调国际响应、评估科学文献、确定知识空白、鼓励研究、将研究结果纳入WHO环境健康标准专著、促进国际可接受标准的制定、提供电磁场保护计划管理信息，以及向各方提供有关电磁场暴露危害和缓解措施的建议。

2. 与探究问题相关的信息提取

网页内容提供了WHO关于电磁场(EMF)的总体立场和"国际电磁场项目"的基本信息，但没有直接针对手机辐射与癌症风险的具体官方立场，也没有提及关于手机放在枕头边充电是否会致癌的信息。

网页指出电磁场是一种常见的环境影响因素，引起了公众焦虑，但并未具体评估手机辐射的风险级别。WHO在1996年建立了"国际电磁场项目"，目的是评估0至300 GHz频率范围内电磁场可能的健康影响，这个范围确实包含了手机使用的频率，但网页没有提供具体的研究结论。

该项目的目标包括评估科学文献、确定需要进一步研究的知识空白、促进国际可接受标准的制定，以及提供关于电磁场暴露危害和必要缓解措施的建议，但网页中没有展示这些评估的具体结果，特别是关于手机辐射与癌症风险的结论。

3. 相关性最高的网页链接

1. What are electromagnetic fields? - 这个链接可能提供电磁场的基本信息和健康影响。

2. 5G mobile networks and health - 这个链接专门讨论5G移动网络与健康的关系，与手机辐射问题直接相关。

3. The Global Health Observatory: Legislation on exposure to electromagnetic fields - 这个链接提供关于电磁场暴露的立法信息。

4. The International EMF Project - 这个链接指向WHO的国际电磁场项目，可能包含更详细的研究结果和官方立场。

5. Radiation and health - 这个链接可能提供辐射与健康的综合信息。

4. 有帮助的图片提取

图片1:

• Title: 法国的电力塔 - 电磁场辐射
• Content: 电磁场是最常见且增长最快的环境影响因素之一，引发了公众的焦虑和猜测
• Source: 未知
• Link: https://cdn.who.int/media/images/default-source/imported/radiation/electricity-pylons-in-france-electromagnetic-fields-radiation.tmb-1366v.jpg?sfvrsn=4637e7a5_2%201366w

摘要

本网页内容是世界卫生组织(WHO)关于电磁场辐射的科学解释和健康影响评估。文章首先介绍了电磁场的自然来源和人为来源，解释了电磁场的基本特性如频率和波长。内容指出人体暴露于电磁场并非新现象，但20世纪以来人造电磁场源显著增加。文章详细说明了低频电场和磁场如何影响人体，以及射频场的主要生物效应是加热。WHO强调，根据当前科学证据，低水平电磁场暴露尚未被证实会导致健康问题。文章讨论了公众关注的几个方面，包括一般健康影响、妊娠结果、白内障、癌症风险和电磁过敏症。WHO于1996年启动了国际电磁场项目，汇集了相关研究。总体结论是，尽管进行了广泛研究，目前没有证据表明低水平电磁场暴露对人类健康有害，但研究仍在继续，特别是关于移动电话使用的长期健康影响。

与问题相关的信息提取

根据网页内容，世界卫生组织(WHO)对手机辐射与癌症风险的官方立场如下：

1. 关于手机辐射与癌症的关系：WHO指出，"尽管进行了广泛研究，迄今为止没有证据可以得出低水平电磁场暴露对人类健康有害的结论"。特别是关于电磁场与癌症的关系，WHO表示"如果电磁场确实对癌症有影响，那么任何风险增加都将是极其微小的"。

2. 研究状态：WHO承认"目前许多研究正致力于研究移动电话使用的长期健康影响"，并指出"尚未发现低水平射频场暴露有明显的不良影响"，但"鉴于公众对手机安全性的担忧，进一步研究旨在确定是否可能在非常低的暴露水平下出现任何不太明显的影响"。

3. 科学证据评估：WHO强调，在电磁场非电离辐射的生物效应和医学应用领域，过去30年已发表约25,000篇文章，科学知识比大多数化学物质更广泛。基于对科学文献的深入审查，WHO得出结论认为"当前证据不能确认低水平电磁场暴露会导致任何健康后果"。

4. 关于手机放在枕头边充电是否致癌：网页内容中没有直接提及手机充电与癌症风险的具体关联。WHO的讨论主要集中在电磁场暴露的一般性影响，而非特定的手机充电场景。

5. 国际电磁场项目：WHO于1996年启动了国际电磁场项目，旨在回应公众对电磁场可能健康影响的担忧，该项目汇集了国际和国家机构以及科学机构的当前知识和可用资源。

总体而言，WHO的官方立场是谨慎的，强调目前没有确凿证据表明低水平电磁场暴露(包括手机辐射)会导致健康问题或癌症，但研究仍在继续，特别是关于长期暴露的潜在影响。

相关网页链接

1. HomeWorld Health Organization - WHO官方主页
2. Health Topics - WHO健康主题页面
3. Newsroom - WHO新闻室
4. About WHO - 关于WHO的信息
5. Home - 返回WHO主页链接
6. Newsroom - WHO新闻室(重复)
7. Questions and answers - WHO问答页面，当前页面所属的板块

相关图片

网页内容中没有提供任何图片链接或描述。

LONDON (Reuters) -There is no link between mobile phone use and an increased risk of brain cancer, according to a new World Health Organization-commissioned review of available published evidence worldwide.

Despite the huge rise in the use of wireless technology, there has not been a corresponding increase in the incidence of brain cancers, the review, published on Tuesday, found. That applies even to people who make long phone calls or those who have used mobile phones for more than a decade.

The final analysis included 63 studies from 1994-2022, assessed by 11 investigators from 10 countries, including the Australian government’s radiation protection authority.

The work assessed the effects of radiofrequency, used in mobile phones as well as TV, baby monitors and radar, co-author Mark Elwood, professor of cancer epidemiology at the University of Auckland, New Zealand, said.

"None of the major questions studied showed increased risks," he said. The review looked at cancers of the brain in adults and children, as well as cancer of the pituitary gland, salivary glands and leukemia, and risks linked to mobile phone use, base stations, or transmitters, as well as occupational exposure. Other cancer types will be reported separately.

The review follows other similar work. The WHO and other international health bodies have said previously there is no definitive evidence of adverse health effects from the radiation used by mobile phones, but called for more research. It is currently classified as "possibly carcinogenic", or class 2B, by the International Agency for Research on Cancer (IARC), a category used when the agency cannot rule out a potential link.

The agency's advisory group has called for the classification to be re-evaluated as soon as possible given the new data since its last assessment in 2011.

WHO's evaluation will be released in the first quarter of next year.

(Reporting by Jennifer Rigby; Editing by Sharon Singleton and Ed Osmond)

Copyright 2024 Thomson Reuters.

1. 摘要

这篇文章是一项由世界卫生组织(WHO)委托进行的系统性回顾研究，评估了射频电磁场(RF-EMF)暴露与癌症风险之间的关联。研究分析了三类暴露情况：手机使用的近场暴露、固定发射站的远场环境暴露以及职业暴露。研究纳入了1994-2022年发表的63篇文章，涉及22个国家的参与者，报告了119对不同的暴露-结果组合。

主要发现表明，手机使用与胶质瘤、脑膜瘤、听神经瘤、垂体肿瘤、唾液腺肿瘤或儿童脑肿瘤风险增加无显著关联。随着使用时间延长、累计通话时间增加或累计通话次数增加，这些肿瘤的相对风险并未显著上升。无绳电话使用也未与这些肿瘤风险显著相关。固定发射站(广播天线或基站)的暴露与儿童白血病或儿童脑肿瘤风险无关。职业RF暴露也未显著增加胶质瘤风险。

研究采用了严格的方法学，包括使用OHAT偏倚风险评估工具、随机效应元分析和GRADE方法评估证据可信度。敏感性分析表明，结果稳健且不受研究聚合方式变化的影响。时间趋势模拟研究作为外部有效性的补充证据，显示某些病例对照研究中观察到的风险增加与多个国家长期观察到的胶质瘤/脑癌实际发病率不符。

研究结论认为，手机使用的近场RF-EMF暴露可能不会增加成人的胶质瘤、脑膜瘤、听神经瘤、垂体肿瘤和唾液腺肿瘤风险，或儿童脑肿瘤风险(中等确定性证据)；固定发射站的远场RF-EMF暴露可能不会增加儿童白血病风险(中等确定性证据)；职业RF-EMF暴露可能不会增加脑癌/胶质瘤风险(低确定性证据)。

2. 与问题相关的信息提取

这项2024年WHO委托的系统性回顾研究全面评估了射频电磁场(RF-EMF)暴露与癌症风险之间的关联。研究具有以下特点：

研究背景与目的：

• 研究旨在评估人类观察性研究提供的RF-EMF暴露与最常研究的肿瘤疾病之间因果关联的证据质量和强度
• RF-EMF被IARC归类为可能致癌物(2B组)，基于2011年前的有限证据，此研究提供了更新的系统性评估

研究方法：

• 纳入标准：包括队列研究和病例对照研究，关注三类RF-EMF暴露：无线电话使用的近场暴露(SR-A)、固定发射站的远场环境暴露(SR-B)和职业暴露(SR-C)
• 信息来源：通过Medline、Embase和EMF-Portal数据库识别符合条件的研究
• 偏倚风险评估：使用定制版本的OHAT工具评估每项研究的内部有效性，并将研究分为三个层次(低、中、高偏倚风险)
• 数据合成：使用随机效应REML模型进行元分析，以及加权混合效应模型进行剂量-反应元分析
• 证据评估：使用GRADE方法评估证据可信度

研究结果：

• 纳入63篇1994-2022年发表的文章，涉及22个国家的参与者，报告119对不同的暴露-结果组合
• 手机使用(相对于不使用或非常规使用)与胶质瘤风险无关(mRR=1.01，95%CI=0.89-1.13)，脑膜瘤(mRR=0.92)、听神经瘤(mRR=1.03)、垂体肿瘤(mRR=0.81)、唾液腺肿瘤(mRR=0.91)或儿童脑肿瘤(mRR=1.06)风险也无显著增加
• 随着使用时间延长、累计通话时间增加或累计通话次数增加，胶质瘤、脑膜瘤和听神经瘤的相对风险并未显著上升
• 无绳电话使用与胶质瘤、脑膜瘤或听神经瘤风险无显著相关
• 固定发射站(广播天线或基站)的暴露与儿童白血病或儿童脑肿瘤风险无关
• 职业RF暴露未显著增加胶质瘤风险

敏感性分析与稳健性：

• 在排除一项有影响力的研究后，胶质瘤风险与手机使用的关联显著降低(mRR=0.96)，研究间异质性也减少
• 时间趋势模拟研究表明，某些病例对照研究中观察到的风险增加与多个国家长期观察到的胶质瘤/脑癌实际发病率不符
• 排除报告不可信效应大小的五项研究后，长期使用手机与胶质瘤风险的元分析显示mRR为0.95，研究间异质性大幅降低(I²=3.6%)

结论：

• 手机使用的近场RF-EMF暴露可能不会增加成人的胶质瘤、脑膜瘤、听神经瘤、垂体肿瘤和唾液腺肿瘤风险，或儿童脑肿瘤风险(中等确定性证据)
• 无绳电话使用的近场RF-EMF暴露可能不会增加胶质瘤、脑膜瘤或听神经瘤风险(低确定性证据)
• 固定发射站的远场RF-EMF暴露可能不会增加儿童白血病风险(中等确定性证据)，可能不会增加儿童脑肿瘤风险(低确定性证据)
• 职业RF-EMF暴露可能不会增加脑癌/胶质瘤风险(低确定性证据)

研究资助：

• 该项目由世界卫生组织(WHO)委托并部分资助
• 新西兰卫生部、意大利高级卫生研究所(作为WHO辐射与健康合作中心)和ARPANSA(作为WHO辐射防护合作中心)提供共同资助

3. 相关网页链接

1. https://doi.org/10.1016/j.envint.2021.106828 - 已发表的研究协议(Lagorio et al., 2021)

2. https://www.sciencedirect.com/science/article/pii/S0160412024005816 - 前一篇文章链接

3. https://www.sciencedirect.com/science/article/pii/S0160412024005828 - 下一篇文章链接

4. https://www.sciencedirect.com/journal/environment-international - Environment International期刊主页

5. https://www.sciencedirect.com/journal/environment-international/vol/191/suppl/C - 该期刊第191卷补充C部分

6. http://creativecommons.org/licenses/by-nc-nd/4.0/ - 创作共用许可证链接

4. 相关图片

1. 图片标题: Elsevier
   内容: Elsevier出版社标志
   来源: Elsevier
   链接: https://sciencedirect.elseviercdn.cn/prod/fa191fa8aeebbed354d2d0cbb3fda00f21c7d989/image/elsevier-non-solus.svg

2. 图片标题: Environment International
   内容: Environment International期刊封面
   来源: Elsevier
   链接: https://ars.els-cdn.com/content/image/1-s2.0-S0160412024X00082-cov150h.gif