POSSIBLE EFFECTS OF ELECTROMAGNETIC FIELDS (EMF) ON HUMAN HEALTH

ABSTRACT
This work on ”Possible effects of Electromagnetic Fields (EMF), Radio Frequency Fields
(RF) and Microwave Radiation on human health”, with respect to whether or not
exposure to electromagnetic fields (EMF) is a cause of disease or other health effects.
The conclusion is primarily based on scientific articles, published in English language
peer-reviewed scientific journals. Only studies that are considered relevant for the
task are cited and commented upon in the literature. The opinion is divided into
frequency (f) bands, namely: radio frequency (RF) (100 kHz < f ≤ 300 GHz),
intermediate frequency (IF) (300 Hz < f ≤ 100 kHz), extremely low frequency (ELF)
(0< f ≤ 300 Hz), and static (0 Hz) (only static magnetic fields are considered in this
opinion). There is a separate section for environmental effects.
Radio Frequency Fields (RF fields)
Since 2001 opinion extensive research has been conducted regarding possible health
effects of exposure to low intensity RF fields, including epidemiologic, in vivo, and in
vitro research. In conclusion, no health effect has been consistently demonstrated at
exposure levels below the limits of ICNIRP (International Committee on Non Ionising
Radiation Protection) established in 1998. However, the data base for evaluation
remains limited especially for long-term low-level exposure.
Intermediate Frequency Fields (IF fields)
Experimental and epidemiological data from the IF range are very sparse. Therefore,
assessment of acute health risks in the IF range is currently based on known hazards
at lower frequencies and higher frequencies. Proper evaluation and assessment of
possible health effects from long-term exposure to IF fields are important because
human exposure to such fields is increasing due to new and emerging technologies.
Extremely low frequency fields (ELF fields)
The previous conclusion that ELF magnetic fields are possibly carcinogenic, chiefly
based on occurrence of childhood leukaemia, is still valid. For breast cancer and
cardiovascular disease, recent research has indicated that an association is unlikely.
For neurodegenerative diseases and brain tumours, the link to ELF fields remains
uncertain. No consistent relationship between ELF fields and self-reported symptoms
(sometimes referred to as electrical hypersensitivity) has been demonstrated.
Static Fields
Adequate data for proper risk assessment of static magnetic fields are very sparse.
Developments of technologies involving static magnetic fields, e.g. with MRI (Magnetic
Resonance Imaging) equipment require risk assessments to be made in relation to
occupational exposure.
Environmental Effects
There are insufficient data to identify whether a single exposure standard is
appropriate to protect all environmental species from EMF. Similarly the data are
inadequate to judge whether the environmental standards should be the same or
significantly different from those appropriate to protect human health.
 CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
For the general public, Council Recommendation of 12 July 1999 (2) on the limitation
of exposure of the general public to electromagnetic fields (0 Hz to 300 GHz) fixes
basic restrictions and reference levels to electromagnetic fields (EMFs). These
restrictions and reference levels are based on the guidelines published by the
International Commission on Non Ionising Radiation Protection (ICNIRP) 3(3). The ICNIRP
guidelines had been endorsed by the Scientific Steering Committee (SSC)(4) in its
opinion on health effects of EMFs of 25–26 June 1998(5).
The motivation for this work is derived from the increasing exposure to EMF
consequent to the further growth in the use of electricity, from the continuous
development of the telecommunications industry, and to a rapid increase in the
installation of transmitter masts used as radiotelephone base stations. In addition to
domestic, industrial and medical electrical appliances and devices, the high voltage
overhead transmission lines (and to a lesser extent underground cables) are major
sources of exposure to Extremely Low Frequencies (ELF) in the environment. The
CSTEE opinion “on Possible effects of Electromagnetic Fields (EMF), Radio Frequency
Fields (RF) and Microwave Radiation on human health”(8), of 30 October 2001,
concluded that the information that had become available since the SSC opinion of
June 1999 did not justify revision of the exposure limits recommended by the
Council(9).
A substantial number of scientific publications and reviews on the possible health
effects of EMF (focusing mostly on mobile telephones) have become available since
the CSTEE opinion of 2001, for example the 2002 Dutch report(10) the 2003 AGNIR
report(11) and the 2004 British National Radiological Protection Board (NRPB) report
on “Mobile phones and health”(12) which is the most recent of them. The NRPB
provided a detailed review of the recent literature and useful contribution to the
discussions on whether there are health effects related to the use of mobile phones.
The report concluded that there is no hard evidence at present that the health of the
public is being adversely affected by mobile phone technologies but uncertainties
remain and a continued precautionary approach is recommended until the situation is
clarified.
Additional results are expected shortly from Community funded research and
development (R&D) activities, from national programmes, and from work within the
International EMF Project of the World Health Organisation (WHO).
As part of its mission to protect public health and in response to public concern over
health effects of EMF exposure, WHO established the International EMF Project(16) 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.
1.2 STATEMENT OF THE PROBLEM
It is well recognized that there are established biophysical mechanisms that can lead
to health effects as a consequence of exposure to sufficiently strong fields. For
frequencies up to, say, 100 kHz the mechanism is stimulation of nerve and muscle
cells due to induced currents and, for higher frequencies, tissue heating is the main
mechanism. These mechanisms lead to acute effects. Existing exposure guidelines,
such as those issued by ICNIRP, protect against these effects. The current issue is the
possibility that health effects occur at exposure levels below those where the
established mechanisms play a role and in particular as effects of long term exposure
at low level. No further consideration is given to thermal effects.
1.3 AIMS AND OBJECTIVES OF THE STUDY
The objective of this project is to:
(1) To have an overview of the scientific literature concerning the health
effects of EMF;
(2) To draw attention to significant new scientific findings;
(3) To provide a review of the literature in the light of significant new
evidence;
(4) To determine Possible effects of Electromagnetic Fields (EMF), Radio
Frequency Fields (RF) and Microwave Radiation on human health
1.4 RESEARCH QUESTIONS
In reviewing and evaluating the studies on the potential health effects of EMF, the
study seeks to answer the following questions:
1. What is the nature of EMF studies, i.e., epidemiology, laboratory biology (in
vivo vs. in vitro), clinical examinations (heart function, sleep
 electrophysiology, immune system, blood chemistry, hormones including
melatonin, etc.), and theory;
2. What is the characterization of risks, in particular, nature and magnitude of
damage, likelihood of occurrence (expressed preferably in terms of natural
frequencies rather than probabilities), uncertainty, geographical
distribution, persistence over time, reversibility, delay, possible violation of
equity, potential for public mobilization etc.; and
3. How is the identification and physical characterization of existing and
foreseeable sources of exposure to EMF, e.g., electromagnetic vs.
magnetic including magnetic resonance imagery (MRI), from AC vs. DC
current, new frequency ranges, higher transmission power, etc.
1.5 SIGNIFICANCE OF THE STUDY
The purpose of this study is in respect to whether or not exposure to electromagnetic
fields (EMF) is a cause of disease or other health effects. Recommendations regarding
exposure guidelines or other risk management tools, including application of the
precautionary principle are beyond the scope of the opinion. The methods that were
used for the preparation of the opinion are explained below.
1.6 SCOPE AND LIMITATIONS OF THE STUDY
Following the CSTEE general principles, only studies published in peer reviewed
journals have been considered. The section is divided into four sub-sections according
to frequency (f) range: radio frequency (RF) (100 kHz < f ≤ 300 GHz), intermediate
frequency (IF) (300 Hz < f ≤ 100 kHz), extremely low frequency (ELF) (0< f ≤ 300 Hz),
and static (0 Hz) (only static magnetic fields are considered in this opinion). These
frequency ranges are discussed in order of decreasing frequency, RF, IF, ELF, and
static. For each frequency range the review begins with a description of sources and
exposure to the population. This is followed, for each frequency range, by a discussion
that is organized according to outcome. For each outcome relevant human, in vivo,
and in vitro data are covered.
Table 1 below illustrates some typical artificial sources of electromagnetic fields with
frequency and intensity. Natural sources like the magnetic field of the earth are not
included. Note, however, that big variations occur. For an explanation of some of the
terminology used please be referred to the next chapter.
Table 1: Typical sources of electromagnetic fields
Frequency Frequencies Some examples of exposure sources
range
Static 0 Hz VDU (video displays); MRI and other diagnostic /
scientific instrumentation; Industrial electrolysis;
Welding devices
ELF 0-300 Hz Powerlines; Domestic distribution lines, Domestic
appliances; Electric engines in cars, train and
tramway; Welding devices
IF 300 Hz – 100 kHz VDU; anti theft devices in shops, hands free access
control systems, card readers and metal detectors;
MRI; Welding devices
RF 100 kHz – 300 GHz Mobile telephony; Broadcasting and TV; Microwave
oven; Radar, portable and stationary radio
transceivers, personal mobile radio; MRI
The Committee has been made aware of the military use of certain radiofrequency
devices. Further consideration of this is outside the scope of this opinion.
 CHAPTER TWO
REVIEW OF RELEVANT LITERATURE
RADIO FREQUENCY FIELDS (RF FIELDS)
Sources and distribution of exposure in the population
Nowadays the use of RF sources is widespread in our society. Prominent examples are
mobile communication, broadcasting or medical and industrial applications.
Information on emissions arising from RF sources is often available and can be used
for compliance assessment or similar applications such as in-situ measurements. It
has to be taken into account that information on the exposure of individual persons is
scarce; such information is mainly needed for epidemiological studies, there is
therefore a need to optimize methodology to assess individual exposure, e.g. by using
and further developing existing dosimeters. The existing RF sources are operated in
different frequency bands and can be subdivided in several categories.
Sources operated close to the human body
Many devices of this type are mobile RF transmitters. One of the examples is mobile
phones; more than 2 billion people are using mobile phones worldwide. The most
common mobile communication technologies in Europe are the digital technologies
GSM 900, GSM 1800 and UMTS, analogue technologies are nowadays almost not in
use any longer in Europe. Mobile phone use is common in Europe and the proportion
of users can reach values of 80 % or more. Before mobile phones can be brought into
the European market they have to show compliance with the requirements of
European directives, i.e., it has to be shown that the limits for the amount of power
absorbed in the human body are not exceeded. Standardized methods specified by
the European Committee for Electrical Standardisation (CENELEC) are used to test
mobile phones in Europe. The limit for mobile phone use is the specific absorption rate
(SAR) of 2 W/kg for the human head. Mobile phones are tested under worst case
conditions, i.e. at the highest power level, e.g., 2 W peak power corresponding to 250
mW maximum time averaged transmitted power for GSM at 900 MHz. Maximum local
SAR values averaged over 10 gram of tissue range typically between 0.2 and 1.5
W/kg, depending on the type of mobile phone. It has to be taken into account that the
emitted power is often orders of magnitude lower than the maximum power leading to
much lower exposure due to power control and discontinuous transmission mode for
GSM and UMTS phones. The power control of a GSM phone automatically reduces the
emitted power by up to a factor of 1,000 for GSM and about 100.000.000 for UMTS if
the intensity is not needed for stable transmission. No exposure occurs from a mobile
phone being switched off. Phones operated in the standby mode cause typically much
lower exposure compared to mobile phones operated with maximum power, but an
accurate figure for this lower exposure depends on the exact details of the
transmission path to base stations and on the traffic requested by the communication
protocol and by incoming / outgoing SMS.
In addition to mobile phones, other wireless applications like cordless phones, e.g.
DECT, or WLAN systems are very common. Due to the fact that they are usually
operated with lower output power compared to mobile phones the exposure is
typically below the level of mobile phones. The maximum time averaged power level
of a DECT base station is 250 mW (worst case for a professional application handling
communication with 25 handsets in parallel, a typical household application
communicating with one handset has a time averaged power of 10 mW), for a DECT
handset 10mW. The peak value of a WLAN terminal is 200 mW, however the averaged
power depends on the traffic and is usually considerable lower. The exposure from
such systems is therefore typically below that of mobile phones, however under
certain circumstances, e.g. closeness to WLAN access points, exposure due to WLAN
or DECT systems can become superior compared to the exposure from GSM or UMTS
mobile phones. For example, close to a WLAN system exposure is typically below 0.5
mW/m². Anti-theft devices have become more and more common during recent years.
They are typically operated at the exits of shops or similar areas to prevent theft of
goods. Some of the existing systems are operated in the RF range; the exposure
depends on the type of system and is, as long as the systems are operated according
to the manufacturer’s requirements, below the exposure limits. Several industrial
appliances are operated in the RF and microwave range, for example for heating (e.g.
RF sealers) or maintenance of broadcasting stations. The exposure of the worker
operating such systems can reach values close or even above the limits of the
Directive 2004/40/EC.
Sources operated far away from the human body
Such sources are typically fixed installed RF transmitters. An example is base stations
that are an essential part of mobile communication networks necessary to establish
the link between the mobile telephone and the rest of the network. In most European
countries, base stations have became ubiquitous to guarantee connectivity in large
areas of the respective countries; e.g., 18,000 base stations are operated in Austria.
The so called reference level for the exposure of the general population at 900 MHz,
an important frequency for mobile communication given in the European Council
Recommendation 1999/519/EC is 4.5 W/m². This reference level is given as an
example, it has to be taken into account that the reference levels are frequency
dependent and that other limits have to be applied at other frequencies. The range of
exposure of the general population due to GSM signals is typically between some
hundred nW/m² and some tens of mW/m². The reasons for this large variation are both
technical and environmental factors including distance. For UMTS, the available
measurements are limited and so far the traffic is rather low compared to GSM. Values
slightly over 1 mW/m² have been measured in a few cases, while minimum levels are
a few hundred nW/m². Other important RF sources are broadcasting systems (AM and
FM). The maximum values measured in areas accessible for the public are typically
below 10 mW/m². Close to the fences of very powerful transmitters, exposure of about
300 mW/m² can be expected in some cases. Looking at the new digital TV technology
(DVB- T), exposures between around 40 mW/m² and 0.003 mW/m² were registered in
an Austrian study. The range of exposure is similar compared to analogue TV systems.
However, the digital systems require more transmitters than the older analogue
systems; therefore somewhat higher average exposure levels can be expected. In
some countries digital audio broadcasting systems are already in operation. Other
examples of sources relevant for far field exposure of the general population are civil
and military radar systems, private mobile radio systems, or new technologies like
WiMAX.
Medical applications
Several medical applications use electromagnetic fields in the RF range. Therapeutic
applications such as soft tissue healing appliances, hyperthermia for cancer
treatment, or diathermy expose the patient well above the recommended limit values
to achieve the intended biological effects. These include heating of tissue (analgetic
applications) or burning cells (to kill cancer cells). In these cases exposure of
therapists or other medical personnel needs to be controlled to avoid that their
exposure exceeds the exposure limit values foreseen by Directive 2004/40/EC for
occupational exposure. Diagnostic applications, like magnetic resonance imaging
(MRI), are allowed to exceed the basic restrictions of Council Recommendation
1999/519/EC as there is a benefit for the patient. Usual frequencies are those allowed
for industrial, scientific, and medical applications similar to most industrial sources: 27
MHz, 433 MHz and 2.45 GHz. Magnetic resonance imaging devices in medical
diagnostics use RF fields in addition to static and variable fields. Most actual clinical
MRI devices work at 63 MHz.
Cancer
Studies on cancer in relation to mobile telephony have focused on intracranial
tumours because deposition of energy from RF fields from a mobile phone is mainly
within a small area of the skull near the handset. When whole body exposure is
considered, as in some occupational and environmental studies, also other forms of
cancer have been investigated.
Epidemiology What was already known on this subject?
At the time of the previous CSTEE opinion of 2001, most epidemiological studies on
exposure to RF fields had examined exposures at the workplace. The overall evidence
did not suggest consistent cancer excesses. With regard to mobile phones, only few
studies were available at the time of the previous opinion and the short exposure
period in these studies did not allow any firm conclusions. The few studies on
residential exposure to RF fields from transmitters had serious methodological
limitations.
What has been achieved since then?
In total, about 30 papers of original studies on mobile phone use and cancer were
published in the last five years. Results are summarized in Table 2 for brain tumours
and in Table 3 for acoustic neuroma. All but one study were case-control studies,
mostly on brain tumours, some on salivary gland tumours or uveal melanoma. One
was a large cohort study of all Danish mobile phone subscribers between 1982 and
1995 who were followed up for a variety of cancers; no increased risk for any cancer
was observed but follow up time was short (Johansen et al. 2001). A recent update of
the cohort study with an average follow up time of 8.5 years yielded 14,249 cancer
cases observed in the cohort versus 15,001 expected cases based on cancer rates
observed in the rest of the Danish adult population (Schüz et al. 2006b). The deficit
was mainly attributable to smoking-related cancers, suggesting a healthy cohort
effect. The overall relative risk estimates for brain tumours and leukaemia were close
to one, however, only 28 brain tumour cases occurred in subscribers of a mobile
phone of 10 years or more, whereas 42.5 cases were expected.
The Interphone study is a multinational case-control study coordinated by the
International Agency for Research on Cancer (IARC). It is a population-based study
with prospective ascertainment of incident cases and face-to-face interviews for
exposure assessment. With regard to brain tumours, results from the first four
components of the Interphone study suggest no risk increase for meningioma or
glioma. This is consistently so among subjects with less than 10 years of use. For
regular mobile phone users of 10 years or more, no indications of risk increases were
seen in three out of four components, namely in Sweden (Lönn et al. 2005), Denmark
(Christensen et al. 2005) and the UK (Hepworth et al. 2006), but the German
component does reveal a somewhat raised relative risk estimate for glioma (Schüz et
al. 2006a). This increase, however, is based on small numbers and due to the wide
confidence interval the result is not in contradiction with the other Interphone
components.
In contrast, a Swedish group not participating in the Interphone-study, conducting
several case-control studies using self-administered questionnaires for exposure
assessment, has repeatedly observed increased relative risk estimates for brain
tumours. In 2006, the group revisited their previously published studies and reported
statistically significant risk increases for both analogue and digital mobile phones as
well as cordless phones already after one year of use (Hardell et al. 2006). After ten
years of use they observed about a doubling of the relative risk estimates, with the
strongest increase for high grade glioma.
Acoustic neuromas, benign tumours that develop very slowly, arise from the Schwann
cells, which enfold the vestibulocochlear nerve (VIII. cranial nerve). They are of
particular interest because of their location. The Hardell-group from Sweden has in
several studies reported raised relative risk estimates for acoustic neuroma, also with
very short induction periods (Hardell et al. 2005b). Three of the Interphone
components, Denmark, Sweden, and Japan, have reported their country specific
acoustic neuroma results (Christensen et al. 2004, Lönn et al. 2004, Takebayashi et al.
2006). Lönn et al. (2004) reported a doubling of the relative risk estimate after ten
years of regular mobile phone use compared to subjects who never used a mobile
phone regularly. This association became stronger when the analysis was restricted to
preferred phone use at the same side as the tumour. Christensen’s and Takebayashi’s
results did not support this, but they were based on fewer long-term users. Five of
thirteen countries of the Interphone study (including Denmark, Finland, Norway,
Sweden, and the UK) were pooled for a joint analysis to examine the association
between mobile phone use and risk of acoustic neuroma (Schoemaker et al. 2005).
While no overall association was seen among all long-term users (see Table 3), the
data suggest that there may be an increased risk when the preferred side of the head
of use is considered in the analysis. For 10+ years of use of mobile phones, the
relative risk for acoustic neuroma at the preferred side of use was 1.8 (95%-CI 1.1-
3.1). Because of methodological inter-study differences it would have been of
considerable interest to compare the results across the six studies, but small numbers
in most of the centres preclude that analysis.
All those studies are facing limitations in their exposure assessment, which was either
a list of subscribers from the operators or self-reported mobile phone use. While the
first method is an objective measure, it has limitations because subscription predicts
use of a mobile phone only to some extent. Recent validation studies in volunteers
comparing current self-reported use with traffic records from network operators show
a moderate agreement, but it cannot be excluded that agreement is worse with
respect to past mobile phone use or among patients with brain tumours (Vrijheid et al.
2006). Especially patients with high stage glioma showed some memory performance
problems in the Danish Interphone study (Christensen et al. 2005). What seems to be
reassuring despite these shortcomings is, that once the amount of mobile phone use is
estimated with some validity, this is a satisfactory proxy for RF field exposure from
these devices, as was shown in studies recording output power of mobile phones
during operation (Berg et al. 2005). Laterality (side) of use is not easy to obtain in a
retrospective study, as early symptoms may affect the side of use. Although some
results are now available for long- term users, their numbers are still small and the
results of the whole Interphone dataset should be awaited before drawing conclusions.
No striking new results appeared for studies on occupational and residential RF fields
exposures since the previous opinion. While some positive associations have been
reported from occupational studies, the overall picture is far from clear (Ahlbom et al.
2004). Many studies lack individual exposure assessment and only job titles or
branches were used as exposure proxies. Studies on exposure from transmitters are
limited by crude exposure measures and small numbers of exposed subjects, and the
ecological nature of most studies.
Discussion
Mobile phones in relation to health are now being studied with great effort and in
comprehensive studies, particularly in the Interphone Study. The results of the
Interphone Study will soon become available. It has to be doubted, however, that the
results will be entirely conclusive, as the first results from published national
components of this study already raise a number of questions with respect to the
potential of bias. Another limitation is that also in the current studies, long-term
mobile phone users have had hardly more than 10 years of regular use of mobile
phones, which still may be a relatively short latency period, particularly for slowly
growing benign tumours. Among those long-term users, most were initially users of
analogue mobile phone and thus, the number of long-term users of the digital
technology is even smaller. Prospective long term follow up studies overcome both the
limitations of retrospective exposure assessment and the latency problem and are
recommended as a powerful long-term surveillance system for a variety of potential
endpoints, including cancer, to fill current gaps in knowledge.
TABLE 2: Results of epidemiological studies on mobile phone use and brain
tumours17.
Study Brain tumours Brain tumours Brain tumours longer
short latency latency
Number RR18 Number RR Number RR
exposed estimate exposed estimate exposed estimate
Cases (95% cases (95% CI) cases (95%
CI19) CI)
Hardell et al. 78 1.0 (0.7- 78 1.0 (0.7- 34 0.8 (0.5-
1999 1.4) 1.4) 1.4) >5 yr
>1 yr 16
1.2 (0.6-
2.6) >10 yr
Muscat et al. 66 0.8 (0.6- 28 1.1 (0.6- 17 0.7 (0.4-
2000 1.2) 2.0) 1.4) >4 yr
2-3 yr
Inskip et al. 139 0.8 (0.6- 51 1.0 (0.6- 54 1.0 (0.6-
2001 1.1) 1.6) 1.6) > 3 yr
0.5-3 yr 22
0.7 (0.4-
1.4) >5 yr
Johansen et 154 1.0 (0.8- 87 1.1 (0.9- 24 1.0 (0.7-
al. 2001 1.1) 1.3) 1.6) >5 yr
1-4 yr
Auvinen et al. 40 analogue, 1.3 (0.9- 15 1.2 (0.7- 17 1.5 (0.9-
2002 16 digital 1.8) analogue, 2.0) analogue, 2.5) >2 yr
11 digital 1-2 yr 1 digital
Hardell et al. 188* analogue 1.3 (1.0- 188* 1.3 (1.0- 46* 1.3 (0.8-
2002 1.6) analogue 1.6) analogue 2.3) >10 yr
>1 yr
224* digital
1.0 (0.8- 224* digital 1.0 (0.8- 33* digital 0.9 (0.6-
1.2) 1.2) 1.5) >5 yr
>1 yr
Christensen et 47 low-grade 1.1 (0.6- 19 0.9 (0.4- 6 1.6 (0.4-
al. 2005 glioma 2.0) 1.8) 6.1) >10 yr
1-4 yr
59 high-grade 24 8
glioma 0.6 (0.4- 0.6 (0.3- 0.5 (0.2-
0.9) 1.0) 1.3) >10 yr
67 meningioma 35 1-4 yr 6

0.8 (0.5- 0.8 (0.5- 1.0 (0.3-

1.3) 1.3) 3.2) >10 yr
1-4 yr
Lönn et al. 214 glioma 0.8 (0.6- 112 0.8 (0.6- 25 0.9 (0.5-
2005 1.0) 1.1) 1.5) >10 yr
1-4 yr
118 64 12
meningioma 0.7 (0.5- 0.6 (0.4- 0.9 (0.4-
0.9) 0.9) 1.9) >10 yr
1-4 yr
Hardell et al. 68 malignant, 2.6 (1.5- 20 analogue 1.8 (0.9- 48 3.5 (2.0-
2005a, analogue 4.3) 3.5) analogue 6.4) >10 yr
Hardell et al. 6-10 yr†
2005b 198 malignant, 100 digital
digital 1.9 (1.3- 1.6 (1.1- 19 digital 3.6 (1.7-
2.7) 2.4) 7.5) >10 yr
35 meningioma, 1 analogue 1-5 yr
analogue 20 analogue
1.7 (1.0- 1.2 (0.1- 2.1 (1.1-
151 3.0) 96 digital 12) 4.3) >10 yr
meningioma, 1-5 yr 8 digital
digital
1.3 (0.9- 1.2 (0.8- 1.5 (0.6-
1.9) 1.8) 3.9) >10 yr
1-5 yr
Hepworth et 508 glioma 0.9 (0.8- 271 glioma 0.9 (0.7- 170 glioma 1.0 (0.8-
al. 2006 1.1) 1.1) 1.3) 5-9 yr
66 glioma
1.5-4yr 0.9 (0.6-
1.3) >10yr
Schüz et al. 138 glioma 1.0 (0.7- 82 glioma 0.9 (0.6– 51 glioma 1.1 (0.8–
1.3) 1.2) 1.7) >5yr
2006a 1–4 yr 12 glioma
2.2 (0.9-
23 5.1) >10yr
104 0.8 (0.6- 73 0.9 (0.6– meningiom 0.9 (0.5-
meningioma 1.1) meningioma 1.2) a 1.5) >5yr
1–4 yr
5 1.1 (0.4-
meningiom 3.4) >10yr
a
Schüz et al. 580 1.0 (0.9- 266 1.0 (0.9– 28 0.7 (0.4-
1.1) 1.2) 1.0) >10yr
2006b 1-4 yr
235 1.0 (0.8–
1.1)
5-9 yr
 * Discordant pairs
† No cases had shorter than 6 years latency
Table 3: Results of epidemiological studies on mobile phone use and
acoustic neuroma.20
Study Acoustic neuroma Acoustic neuroma short Acoustic neuroma
latency longer latency
Number RR21 (95% Number Number
exposed CI22) exposed RR (95% CI) exposed RR (95% CI)
cases cases cases
Hardell et 5 0.8 (0.1-
al. 1999 4.2)
Inskip et al. 22 1.0 (0.5- 8 1.8 (0.7-4.5) 5 1.9 (0.6-5.9)
2001 1.9) 0.5-2 yr
Johansen et 7 0.6 (0.3-
al. 2001 1.3)
Muscat et 7 0.5 (0.2-1.3) 1-2 11 1.7 (0.5-5.1) 3-6
al. 2002 yr yr
Hardell et 38* 3.5 (1.8- 12* 3.0 (1.0-9.3) 1-5 7* 3.5 (0.7-16.8)
al. 2002 analogue 6.8) analogue yr analogu >10 yr
e
23* digital 1.2 (0.7- 21* digital 1.2 (0.6-2.2) 1-5 2.0 (0.2-22.1)
2.2) yr 2* >5 yr
digital
Lönn et al. 89 1.0 (0.6- 44 0.8 (0.5-1.3) 1-4 14 1.9 (0.9-4.1)
2004 1.5) yr >10 yr
Christensen 45 0.9 (0.5- 23 0.9 (0.5-1.6) 1-4 2 0.2 (0.0-1.1)
et al. 2004 1.6) yr >10 yr
Hardell et 20 4.2 (1.8- 2 9.9 (1.4-69) 1-5 11 5.1 (1.9-14) 5-
al. 2005a analogue 10) analogue yr analogu 10 yr
e
53 digital 2.0 (1.0- 29 digital 1.7 (0.9-3.5) 1-5 2.6 (0.9-8.0)
3.8) yr 7 >10 yr
analogu
e 2.7 (1.3-5.7) 5-
 10 yr
23
digital
Schoemake 360 0.9 (0.7- 174 0.8 (0.7-1.0) 139 0.9 (0.7-1.2) 5-9
r et al. 1.1) 1.5-4 yr yr
2005† 47
1.0 (0.7-1.5)
>10 yr
Schüz et al. 32 0.7 (0.5-
2006b 1.0)
Takebayas 97 0.7 (0.4- 21 0.8 (0.4-1.5) 4-7 4 0.8 (0.2-2.7)
hi et al. 1.2) yr >8yr
2006
* Discordant pairs
† Partly overlapping with Lönn et al. (2004) and Christensen et al. (2004)
IN VIVO: WHAT WAS ALREADY KNOWN ON THIS SUBJECT?
The possible carcinogenicity of RF field exposure had been investigated in a number of
experimental systems. Results had been essentially negative. An interesting exception
is that of Repacholi et al. (1997), who had induced a two-fold increase in lymphoma
incidence in a strain of lymphoma-prone transgenic mice (Eµ-Pim1) following exposure
(2x30 min daily for up to 18 months) to 900 MHz RF fields with a signal similar to the
GSM modulation (pulse repetition frequency of 217 Hz and a pulse width of 0.6 ms).
No attempt to replicate this finding had been published at the time of publication of
the previous opinion.
What has been achieved since then?
Utteridge et al. (2002) failed to confirm the results of the Repacholi et al. (1997) study.
Utteridge and co-workers found that exposure to RF fields (898 MHz; GSM modulation;
0.25/1.0/2.0/4.0 W/kg; 1 hour/day, 5 days/week for 104 weeks) had no statistically
significant effect (95%-CI) on the incidence of lymphoma. Utteridge et al. (2002) used
the same strain of mouse as the earlier study and they were obtained from same
supplier; the investigators also fed the same food to the mice. The later study had
some refinements in experimental design: four SAR levels were used instead of one in
the original study, animals were restrained during the exposure for better control of
variations in exposure level, and full necropsy was performed on all mice at the end of
the study. Other differences from the Repacholi et al study were that animals were
exposed once per day instead of during two episodes of 30 minutes 5 days per week.
Several other recent studies have evaluated carcinogenicity of RF fields in a variety of
experimental models. Several studies have tested whether RF fields alone induce any
type of cancer in normal or genetically predisposed animals (Zook and Simmens 2001,
La Regina et al. 2003, Anderson et al. 2004, Sommer et al. 2004b), and several other
studies investigated whether exposure to RF fields could enhance the development of
tumours induced by chemical carcinogens, X-rays or UV radiation (Zook and Simmens
2001, Anane et al. 2003a, Bartsch et al. 2002, Imaida et al. 2001, Huang et al. 2005,
Shirai et al. 2005, Heikkinen et al. 2001, Heikkinen et al. 2003, Heikkinen et al. 2006).
No statistically significant increase of tumour incidence has been reported in any of
these studies.
Most of the recent and earlier co-carcinogenicity studies on RF fields have used
initiation- promotion protocols, which, however, may not be sufficient to test all
aspects of co- carcinogenicity (Juutilainen et al. 2000). In addition, most of the
carcinogenicity studies have used only one, relatively low, RF field exposure level.
IN VITRO: WHAT WAS ALREADY KNOWN ON THIS SUBJECT?
Various biological endpoints have been investigated after RF field exposure in vitro.
Much of the work had focused on genotoxic effects, although there was no prior
indication that non-thermal RF fields induce DNA damage. However, since some
reports indicated genotoxic effects from RF fields, the earlier CSTEE opinion
recommended the confirmation of these findings.
What has been achieved since then?
Genotoxic effects
The photon energy of radiation from mobile phones is much lower than the energy
necessary to break chemical bonds. It is therefore generally accepted that RF fields do
not directly damage DNA. However, it is possible that certain cellular constituents
altered by exposure to EMF, such as free radicals, indirectly affect DNA. In most
studies, the genotoxic effects have been investigated after short-term exposure (for
review see Moulder et al. 1999, Vijayalaxmi and Obe 2004).
The REFLEX study performed by twelve research groups in seven European countries,
investigated basic mechanisms induced by EMF using toxicological and molecular
biological technologies at cellular and sub-cellular levels in vitro. One of the REFLEX
investigators (Diem et al. 2005) reported DNA strand breaks (measured by both the
neutral and alkaline versions of the “comet” assay) in human diploid fibroblasts and
cultured rat granulosa cells after RF field exposure (1800 MHz; SAR 1.2 or 2 W/kg;
different modulations; during 4, 16 and 24h; intermittent 5 min on/10 min off or
continuous wave), whereas it is not clear if continuous exposure of non-modulated or
modulated 1800 MHz was used. Statistically significant increases in micronucleus
formation and in chromosomal aberrations were observed in fibroblasts as well. In a
recent replication study, (Speit et al. 2007) continuous wave with intermittent
exposure (1800 MHz; SAR 2 W/kg) was applied using the same cell system and clearly
negative results were obtained. Nikolova et al. (2005) reported after a 6-h but not
after a 48-h RF field exposure a low and transient increase of DNA strand breaks in
embryonic stem cell- derived neural progenitor cells.
Non-genotoxic effects
Several studies investigated the influence of RF fields on cell cycle kinetics, but in the
majority of the investigations no effects were detected (Vijayalaxmi et al. 2001,
Higashikubo et al. 2001, Zeni et al. 2003, Miyakoshi et al. 2005, Lantow et al. 2006c).
Alteration in cell proliferation was described only in a few reports (Pacini et al. 2002,
Capri et al. 2004b).
Programmed cell death which is also called apoptosis is a physiological mode of cell
death occurring in development and cell differentiation and in response to mild
damaging stimuli. It is an important protection mechanism against cancer, as it
removes potential tumour cells. Several reports have investigated whether RF fields
can induce apoptosis in human peripheral blood mononuclear cells (Capri et al.
2004a), lymphoblastoid cells (Marinelli et al. 2004), epidermis cancer cells (Caraglia et
al. 2005), human Mono Mac 6 cells (Lantow et al. 2006c) and in Molt4 cells (Hook et al.
2004). No difference in apoptosis induction was detected between sham-exposed and
RF field exposed cells. On the other hand, Marinelli et al. reported better survival rate
of T lymphoblastoid leukaemia cells exposed to 900 MHz non-modulated RF fields and
Caraglia et al. (2005) found apoptosis induction in human epidermoid cancer cells
after exposure to 1.95 GHz RF fields.
Participants of the REFLEX-study reported no effects of RF fields on cell cycle, cell
proliferation, cell differentiation, apoptosis induction, DNA synthesis, and immune cell
functionality. The authors described some findings after RF fields exposure on the
transcript level of genes related to apoptosis and cell cycle control; however, these
responses were not associated with detectable changes of cell physiology (Nikolova et
al. 2005). Analysis on whole-genome cDNA arrays showed alterations in gene
expression after various RF exposure conditions using different cell types, but no
consistent RF- signature such as stress response could be identified (Remondini et al.
2006) Heat-shock proteins (HSP) are an important group of cell response proteins.
They act primarily as molecular chaperones to eliminate unfolded or miss-folded
proteins, which can also appear from cellular stress. This stress response can be
induced by many different external factors, including temperature, chemicals,
oxidative stress, heavy metals, ionizing and non-ionizing radiation and ultrafine carbon
black particles. Hsp70 has been shown to interfere with post-mitochondrial events to
prevent free radical mediated apoptosis (Gotoh et al. 2001). An increased expression
level of Hsp70 can thus confer protection against cellular stress. On the other hand, it
is discussed that heat- shock proteins are also involved in oncogenic processes (Jolly
et al. 2000, Inoue et al. 1999, French et al. 2001). Some investigators have described
increased heat-shock protein level after RF field exposure (Leszczynski et al. 2002,
Kwee et al. 2001, de Pomerai et al. 2000). However, these results are controversial,
because there are other negative findings (for a review see Cotgreave (2005)).
Interestingly, de Pomerai and his co-workers could not confirm their earlier findings,
and the new data indicate that small temperature differences may have contributed to
the earlier results (Dawe et al. 2006). Nikolova et al. (2005), authors of the REFLEX-
study, described modulation in gene regulation after RF fields exposure at a SAR of 1.5
W/kg in p53-deficient embryonic stem cells. Proteomic analyses of human endothelial
cell lines showed RF fields induced changes in the expression and phosphorylation
state of numerous proteins including the heat shock protein hsp27.
Free radicals are able to interact with DNA or other cellular components and are
involved in many cell regulatory processes.
In leukocytes, physiological activation is associated with the onset of phagocytosis and
leads to increased formation of reactive oxygen species (ROS). These cells exert a
wide variety of functions including the regulation of the immune response (pro and
anti inflammatory processes), scavenging of senescent cells, phagocytosis of infected
or malignant cells, wound healing, repair, and detoxification, but also the generation
of free radicals to kill invading micro-organisms. Each type and source of free radicals
enhances important physiological processes, e.g., signal transduction of various
membrane receptors and further immunological functions. An imbalance between
excessive formation of reactive oxygen species and the limited antioxidant defense,
known as oxidative burst (Sies and Cadenas 1985), can cause damage to nucleic
acids, membranes, proteins, lipids and polysaccharides (Beckman and Ames 1998).
During healthy conditions free radicals are neutralized by an elaborate defense
system. Only a few publications are available describing the capacity of RF fields to
affect free radical dependent processes in cells. In recent studies (Lantow et al. 2006a,
Lantow et al. 2006b, Simkó et al. 2006) no increased free radical level was detected.

Influences on immune system cells were investigated in a few studies. No significant

effects were observed on intracellular production of interleukin-2 (IL-2) and interferon
(INF) gamma in lymphocytes, IL-1 and tumour necrosis factor (TNF)-alpha in
monocytes, on immune-relevant genes (IL 1-alpha and beta, IL-2, IL-2-receptor, IL-4,
macrophage colony stimulating factor (MCSF)-receptor, TNF-alpha, TNF-alpha-
receptor) (Tuschl et al. 2005, Black and Heynick 2003).
Discussion
Effects of RF fields on different biological systems have been investigated. Although
the majority of studies have found no evidence of genotoxic effects, there are a few
positive findings that should be followed up. Some in vitro studies provide evidence
that gene expression is affected at RF exposure close to the guidelines. If these
studies are confirmed they will be important for a mechanistic understanding of the
interaction of RF fields with cellular tissue. Overall, there is little evidence of any
health-relevant in vitro effects of RF electromagnetic fields below guidelines. While it
seems appropriate to perform experimental studies using pure experimental RF fields,
it may be needed to emulate the complex modulation patterns and intensity variations
typical to real mobile phone use in future studies. This way data can be obtained
which are better suited for comparison to epidemiologic studies.
Symptoms
What was already known on this subject?
In the 2001 opinion it was concluded that the knowledge was insufficient for the
implementation of measures aimed at the identification and protection of a highly
sensitive sub-group of the population. With regard to reports of subjective symptoms
from individuals (possibly “hypersensitive”), the limited number of studies on
volunteers had found no connection between reported symptoms and exposure to
electromagnetic fields. There was a lack of information on the role of conditions of
exposure (frequency, concentration duration etc) and possible biological mechanism.
While epidemiological studies had not shown any consistent evidence of effects on
humans, it was pointed out that this could not be taken to mean that RF field exposure
does not pose any hazard to human health.
What has been achieved since then?
A variety of non-specific self-reported symptoms (for example headache, fatigue,
dizziness and concentration difficulties) have been suggested to be triggered by
exposure to RF fields. These possible health effects have been discussed and studied
mainly from two different aspects: 1) a possible increase in symptoms in populations
living close to mobile communication base stations and 2) reports from individuals
that exposure to RF from mobile phones (and sometimes also base stations) triggers
symptoms. In the latter case, some individuals attribute their health problems to an
increased sensitivity (hypersensitivity) to electromagnetic fields. The term
“electromagnetic hypersensitivity” (EHS) has been used to describe such cases of
non-specific medically unexplained health problems attributed by the afflicted
individuals to electromagnetic fields (in many cases including ELF fields) or to being in
the vicinity of electrical equipment (see also the section on ELF fields 3.5.3
Symptoms).
There have only been a few attempts to study symptom prevalence and symptom
severity in relation to exposure to RF fields from base stations. The methodological
limitations of these cross-sectional epidemiological studies preclude conclusions
regarding a possible causal relationship between increase in symptoms and exposure
to RF. One study by Hutter et al. (2006) performed measurements of RF fields in the
bedrooms of the participants. In this Austrian study, inhabitants of homes in the
vicinity (distance 20-600m) of ten selected base stations (five in Vienna and five in a
rural area, Carinthia) were invited to participate in a study on environment and health.
Mobile communication base stations were not mentioned in the invitation. Spot
measurements were done after the questionnaires and computer based tests were
completed. The participants were classified into three exposure groups based on
calculations of the theoretical maximal power density from the selected base stations
(i.e. when the base station is using 100% of its capacity). The mean power densities
were 0.04, 0.23 and 1.3 mW/m 2 in the respective groups. Three out of 14 self-reported
symptoms (headache, cold hands or feet and difficulties to concentrate) were
significantly more commonly reported in the highest exposure group. The results were
adjusted for age, sex, region, regular use of mobile phone and fear of adverse effects
of the base station, but not for socio-demographic factors. Exposure from other
sources (e.g. other base stations) was not reported. The results should be replicated
before any conclusions on a causal relationship between RF exposure and the reported
effect on some symptoms may be drawn. Provocation studies on symptoms should
also be considered. Compared to epidemiological studies provocation studies may
have the advantage of better controlled exposure conditions and randomization. The
focus is however somewhat different in provocation studies, which will assess only
acute effects while epidemiological studies may include long term effects on well-
being.
A relationship between RF and symptoms in healthy volunteers was investigated in
one provocation study (Koivisto et al. 2001). No increase in symptoms was observed
during RF exposure as compared to sham exposure. The limited number of studies on
detection of RF at exposure levels relevant to mobile communication systems under
blind conditions has not provided any consistent proof of ability to detect the fields,
neither in healthy individuals nor in subjects who report EHS.
Health complaints described as EHS and reported to be triggered by mobile phones
have also been studied in a limited number of provocation studies. A WHO Workshop
on Electrical Hypersensitivity (WHO 2005) and recent reviews of the literature on
subjective health complaints associated with electromagnetic fields of mobile phone
communication (Seitz et al. 2005) and provocation studies including subjects reporting
EHS (Rubin et al. 2005) have presented similar conclusions. The main conclusion is
that although symptoms described as EHS are real and may be severe and disabling, a
relationship between symptoms and RF field exposure has not been proven. Most
likely, the health problems described as EHS are not related to the physical presence
of EMF and more research is needed to learn more about the conditions inducing EHS.
The studies published after the WHO workshop and the reviews mentioned above
have not provided any information that would contradict these conclusions. The
influence of a base station-like exposure of 2140 MHz RF fields on well-being that was
reported already in 2003 (Zwamborn et al. 2003) was not confirmed in a follow-up
study (Regel et al. 2006). In a study published by the TNO-Institute 23 (the so called
TNO study), only available as grey cover report Zwamborn et al. (2003) found a
decrease in well-being (based on an index of 23 items from subscales of anxiety,
somatic symptoms, inadequacy, depression and hostility) during exposure to 2140
MHz RF fields (UMTS). The decrease in well-being was shown in the group of subjects
who were recruited based on self-reported sensitivity to RF fields as well as in the non-
symptomatic control group. No effect on symptoms was observed in any of the groups
for 945 MHz or 1840 MHz RF fields (GSM). The study, while reporting an effect of UMTS
exposure, thus failed to confirm the reported belief in the group with self-reported
sensitivity that GSM exposure triggered symptoms. The TNO study was widely
discussed since a possible health effect of UMTS might have large implications on the
introduction and use of the third generation of mobile networks (UMTS). Follow-up
studies were initiated in several countries and in 2006 the first results were published
(Regel et al. 2006). The experimental protocol was improved as compared to the TNO-
study, e.g. a larger study group, better dosimetry and longer intervals between the
exposure sessions. Two exposure levels of RF fields (E-fields strength of 1 V/m –as in
the TNO study- and 10 V/m) were applied, in order to assess any possible dose-
response relationship. Peak spatial SARs in the brain (averaged over 10 g) were 45
and 4500 µW/kg. Well-being was assessed in two standard questionnaires (including
the one used in the TNO study). No effect on symptoms was observed, neither in the
group of subjects with self-reported RF- related symptoms nor in the non-symptomatic
control group. There was no association between perceived field strengths and actual
RF exposure.
Discussion
Scientific studies have failed to provide support for a relationship between RF
exposure and self-reported symptoms sometimes referred to as EHS. Present
knowledge suggests that symptoms are not correlated to RF field exposure, but few
studies have addressed this issue directly. The exposure levels from base stations are
very low compared to the exposure during the use of a mobile phone. Research
regarding health effects from base stations where exposure is significantly lower than
for mobile phone users is mainly driven by concern in the general population
The symptoms attributed to ELF and RF fields are similar and in many cases the
afflicted subjects report both ELF and RF fields to trigger symptoms. There are more
studies on self-reported symptoms and exposure to ELF fields, but also in this case the
scientific studies have failed to confirm a causal relationship.
Nervous system effects: What was already known on this subject?
Due to the proximity of mobile phones to the head, public concerns were raised
regarding a potentially toxic effect of RF on the central nervous system. Five aspects
are usually considered in toxicology regarding the nervous system: morphology, brain
function, electrophysiology, behaviour and development (which is addressed in a later
paragraph).
Several studies had been published concerning the potential neurotoxic effects of
radiofrequencies emitted by the mobile phones. Transient minor effects were
observed on the electroencephalogram (EEG), sleep structure, and on cognitive
processes in human subjects (Mann and Röschke 1996, Preece et al. 1999, Huber et
al. 2000, Koivisto et al. 2000a, Koivisto et al. 2000b, Krause et al. 2000). Some of the
observations could not be replicated (Wagner et al. 1998, Wagner et al. 2000), and
studies with negative outcomes were also published (Röschke and Mann 1997).
In animals, some previous studies did show disturbance of work memory in rats
exposed to RF (Lai et al. 1994, Wang and Lai 2000). However, the most surprising
effect was that very low SAR values (mW/kg) caused increased permeability of the
blood-brain-barrier (BBB) in rats (Salford et al. 1994, Persson et al. 1997). Alterations
of the BBB had also been found in another study (Neubauer et al. 1990), but not by
Tsurita et al. (2000). In rats exposed to 2 W/kg Fritze and co-workers demonstrated
effects on the BBB only at SAR levels above 7.5 W/kg (Fritze et al. 1997). The BBB
isolates the CNS from the rest of the organism, controls molecule fluxes, and protects
the brain (Purves et al. 2001). Increased permeability of the BBB can allow unwanted
substances to reach the CNS, with possible pathological consequences (inflammation,
neurone death).
What has been achieved since then?
Human studies
In humans, transitory minor effects (both positive and negative) have been observed
on EEG patterns, sleep structure, and cognitive processes (D’Costa et al. 2003, Cook
et al. 2002, Hossmann and Hermann 2003, Sienkiewicz et al. 2005). Also studies
where no effects were documented have been published, even after a repeated
exposure (Besset et al. 2005). Since the ear is very close to the exposure source,
some studies have checked the auditory system under or after exposure, and even
after repeated cumulative exposure. No effect has been observed (Ozturan et al.
2002, Arai et al. 2003, Bak et al. 2003, Parazzini et al. 2005, Uloziene et al. 2005).
Animal studies
Slight changes in EEG activity and neurotransmitters have been observed in animals
at low SARs (reviewed by Sienkiewicz et al. 2005). Regarding cognitive functions, a
recent report showed that a disturbance of learning and memory in rats exposed at
2.45 GHz CW could be inhibited by a magnetic field (incoherent noise) (Lai 2004a).
Results from earlier studies on learning and memory at non-thermal RF levels have
not been corroborated (Dubreuil et al. 2003, Yamaguchi et al. 2003, Cobb et al. 2004,
Cassel et al. 2004). No morphological effects have been observed below thermal
thresholds (D’Andrea et al. 2003). Salford and co-workers published another work
showing changes in BBB permeability at low SAR (Salford et al. 2003), whereas others
did not find any such alteration (Finnie et al. 2001), even with repeated exposures up
to 2 years (Finnie et al. 2002).
No effects have been seen on auditory system function (Aran et al. 2004) or on
development of multiple sclerosis in rats (Anane et al. 2003b).
What are the overall conclusions?
Overall analyses do not show any clear neurotoxic effect, at any level studied. Slight
changes in electrical activity or neurotransmitter biochemistry have been observed.
Those changes do not act on cognitive processes, behaviour or memory and do not
suggest pathological hazards. Furthermore, no clear role of modulation has appeared.
Although extrapolation from animals to humans raises some difficulty, the rat or the
mouse are common models to look for toxicity and the few studies showing significant
alterations are to be considered carefully. For all cognitive experiments in animals,
stress effects due to restraint must be clearly identified and prevented when looking
at effects of RF fields.
Miscellaneous human
Initial observations of a blood pressure decrease after mobile phone exposure have
not been replicated (Braune et al. 1998, Braune et al. 2002). The only effects on
cardio- vascular functions that have been replicated are increased blood-flow in the
external ear (Monfrecola et al. 2003, Roelandts 2003). Local temperature increases
during exposure have been reported (Paredi et al. 2001, Curcio et al. 2004), possibly
related to vasodilation caused by heating of mobile phone electronics and battery.
Reproduction and development
Epidemiological studies of adverse pregnancy outcomes following exposure to RF
fields have been reviewed by Verschaeve and Maes (1998), Heynick and Merrit (2003)
and Feychting (2005a). The evidence on possible effects of RF fields on pregnancy
outcomes is virtually limited to occupational exposures among physiotherapists. The
endpoints studied include spontaneous abortions, birth weight, gender ratio, and
congenital malformations. Although some positive findings have been reported, no
specific type of malformation or other adverse outcome has been consistently
reported. Several of the studies have limited statistical power, especially for rare
outcomes such as malformation, and there is a potential for recall bias. The available
results do not allow any definite conclusions.
Numerous studies have evaluated developmental effects of RF fields on mammals,
birds, and other non-mammalian species. These studies, reviewed recently by Heynick
and Merritt (2003) and Juutilainen (2005), have clearly shown that RF fields are
teratogenic at exposure levels that are sufficiently high to cause significant increase of
temperature and exceed reference levels from exposure guidelines. There is no
consistent evidence of effects at nonthermal exposure levels. However, only a few
studies have evaluated possible effects on postnatal development using sensitive
endpoints, such as behavioural effects.
Sensitivity of children
Concerns about the potential vulnerability of children to RF fields have been raised
because of the potentially greater susceptibility of their developing nervous system; in
addition, their brain tissue is more conductive than that of adults since it has a higher
water content and ion concentration, RF penetration is greater relative to head size,
and they have a greater absorption of RF energy in the tissues of the head at mobile
telephone frequencies. Finally, they will have a longer lifetime exposure.
Few relevant epidemiological or laboratory studies have addressed the possible
effects of RF field exposure on children. Owing to widespread use of mobile phones
among children and adolescents and relatively high exposures to the brain,
investigation of the potential effect of RF fields in the development of childhood brain
tumour is warranted. The characteristics of mobile phone use among children, their
potential biological vulnerability and longer lifetime exposure make extrapolation from
adult studies problematic.
There is an ongoing debate on possible differences in RF absorption between children
and adults during mobile phone usage, e.g. due to differences in anatomy (Wiart et al.
2005,
Christ and Kuster 2005). Several scientific questions like possible differences of the
dielectric tissue parameters remain open.
The anatomical development of the nervous system is finished around 2 years of age,
when children do not yet use mobile phones although baby phones have recently been
introduced.
Functional development, however, continues up to adult age and could be disturbed
by RF fields.
Conclusions about RF fields
Since the adoption of the 2001 opinion, extensive research has been conducted
regarding possible health effects of exposure to low intensity RF fields. This research
has investigated a variety of possible effects and has included epidemiologic, in vivo,
and in vitro research. The overall epidemiologic evidence suggests that mobile phone
use of less than 10 years does not pose any increased risk of brain tumour or acoustic
neuroma. For longer use, data are sparse, since only some recent studies have
reasonably large numbers of long-term users. Any conclusion therefore is uncertain
and tentative. From the available data, however, it does appear that there is no
increased risk for brain tumours in long-term users, with the exception of acoustic
neuroma for which there is limited evidence of a weak association. Results of the so-
called Interphone study will provide more insight, but it cannot be ruled out that some
questions will remain open.
Scientific studies have failed to provide support for a relation between RF exposure,
lower than the reference values in the present ICNIRP guidelines and self-reported
symptoms (sometimes referred to as electromagnetic hypersensitivity). Available
studies suggest that self-reported symptoms are not correlated to an acute exposure
to RF fields, but the limited number of studies does not allow any firm conclusion.
Currently available studies on neurological effects and reproductive effects have not
indicated any health risks at exposure levels below guidelines.
Animal cancer studies have not provided evidence that RF radiation could induce
cancer, enhance the effects of known carcinogens, or accelerate the development of
transplanted tumours. The open questions include adequacy of the experimental
models used and scarcity of data at high exposure levels. These questions are
addressed by the still ongoing and planned carcinogenicity studies.
There is no reliable indication from in vitro research that RF fields affect cells at
nonthermal exposure. However, recent results suggesting genotoxic effects need to
be better understood. Thus, no health effect has been consistently demonstrated at
exposure levels below existing exposure guidelines for the general public. However,
data on long term exposure and intracranial tumours are still sparse and in particular
for acoustic neuroma some data indicate that an association with RF fields from
mobile telephony is possible. For diseases other than cancer, very little epidemiologic
data are available. A particular consideration is mobile phone use by children. While
no specific evidence exists, there is a general concern that children or adolescents
may be more sensitive to RF field exposure than adults. Children, as adults, will
probably have a higher cumulative exposure compared to today’s adults. To date no
epidemiologic studies on children are available.
The technical development is very fast and sources of RF exposure become
increasingly common. Yet, there is a profound lack of mechanistic understanding of
effects below the guidelines and of information on individual RF exposure and the
relative contribution of different sources to the overall exposure.
EXTREMELY LOW FREQUENCY FIELDS (ELF FIELDS)
Sources and distribution of exposure in the population
The exposure due to electric fields and magnetic flux densities in the ELF range arises
from a wide variety of sources (IARC 2002). The most prominent frequencies are 50
and 60 Hz and their harmonics, often called power frequencies. For residential
exposure, the major sources are household appliances, nearby power and high
voltages transmission lines, and domestic installations. In some cases trains have to
be considered, too. Looking at occupational exposure, installations of the electric
power industry, welding, induction heaters and electrified transporting systems are
important examples of ELF exposure sources. The highest electric field strengths
typically occur close to high voltage transmission lines and can reach 5 kV/m and in a
few cases more. The highest magnetic flux densities can be found close to induction
furnaces and welding machines. Levels of a few mT are possible.
It needs to be mentioned that the maximum possible exposure next to a specific
source often differs by some orders of magnitude from the average individual
exposure of a person (to specify time weighted average exposure in many cases the
arithmetic mean or the geometric mean or the median value are applied). To evaluate
the distribution of the exposure in the population, meters are used. For assessment of
compliance with exposure limits, the maximum possible exposure next to devices
must be measured. An example might be a lineman: the average exposure due to
magnetic flux density could be about 4 µT (IARC 2002), but the maximum exposure
close to a transmission line can reach 40 µT or more. For the general population even
larger variations between maximum and average exposure can be expected.
Information on ELF exposure is mainly based on data from the United States and
Western Europe.
Exposure of the general population
Several fixed installed sources are operated in our environment. Prominent examples
are high voltage transmission lines operated between 110 and 400 kV at 50 or 60 Hz.
The exposure of bypassing people can typically reach values of 2 to 5 kV/m for the
electric field strength. The exposure due to magnetic flux density depends on the
actual current on the line; fields up to 40 µT are possible but are usually lower. It is
important to notice that such exposure levels occur only directly below the lines;
exposure decreases with the square of distance to the lines. In addition, intermediate
voltage transmission lines
(10 kV to 30 kV) and distribution lines (400 V) have to be considered; exposure levels
are in such cases much lower. Typically values of 100 to 400 V/m and 0.5 to 3 µT can
be reached, the exposure is usually instantaneous. Another approach to establish
power supply is the use of underground buried cables. Electric field strength exposure
can be neglected in this case; the distribution of the magnetic flux density differs
compared to power lines. Substations and power plants are usually not accessible to
the general public. Railway power supply installations are often operated at 16 2/3 Hz.
The exposure decreases linearly with the distance. The exposure levels in areas
accessible for the general public are below the limits. The highest magnetic flux
densities can be found close to several domestic appliances that incorporate motors,
transformers, and heaters. Such exposure levels are very local and decrease rapidly
with the distance, exposure is instantaneous. An example is a vacuum cleaner: at a
distance of 5 cm magnetic flux densities of about 40 µT can occur, but at 1 m the
exposure will be around 0.2 µT. Looking at the individual exposure of persons, a few
percent of the European population are in their homes exposed above a median
magnetic flux density above 0.2 µT.
Exposure of workers
In a few locations in installations of the electric power industry the exposure limits
given in the directive 2004/40/EC for occupational exposure can be reached or
exceeded. Safety measures for such areas have to be implemented. An example is a
peak electric field strength of more than 20 kV/m that was measured in a power
station. Other examples of industrial applications in the ELF range are induction and
light arc ovens or welding devices. The frequencies of such applications fall both in the
ELF and in the intermediate frequency range. Exposure of workers has to be controlled
for such devices. Next to welding devices maximum flux densities of several hundred
µT are possible, depending on the welding current and the type of application.
Medical applications
Bone growth stimulation is used as a therapeutic application in the ELF range. In this
case coils are applied where the fracture is located to stimulate the healing process.
Other applications include Transcranial Magnetic Stimulation, wound healing, or pain
treatment. A diagnostic application is the bioimpedance measurement for cancer
detection.
CANCER: EPIDEMIOLOGY WHAT WAS ALREADY KNOWN ON THIS SUBJECT?
In 2002, the International Agency on Research on Cancer (IARC) published a
monograph on the evaluation of carcinogenic risks of static and extremely low-
frequency (ELF) electric and magnetic fields to humans (IARC, 2002). ELF magnetic
fields were classified into group “2B” (“possibly carcinogenic to humans”). While the
outcome of this evaluation was already known at the time of the last opinion, the IARC
reasons for this decision were not yet published. The justification states limited
evidence in humans based on consistent results from sound epidemiological studies
showing an association with an increased leukaemia risk in children at average field
strengths above 0.3/0.4 µT (Ahlbom et al. 2000, Greenland et al. 2000), but bias could
explain some of the raised risk. The findings from observational studies are not
supported by studies in experimental animals, which provide inadequate evidence of
carcinogenicity.
Furthermore, the IARC monograph concluded, there was no evidence for an
association of ELF magnetic fields with any other type of cancer. ELF electric fields
were grouped into “3” (“is not classifiable as to its carcinogenicity to humans”).
What has been achieved since then?
Only a few studies on childhood leukaemia have been conducted since the adoption of
the previous opinion, and they did not add anything substantial to the previous
studies. At a workshop of WHO in 2004, possible explanations for the childhood
leukaemia finding have been put forward (summarized in Kheifets et al. (2005)). None
of them reaches a level beyond hypothesis. One recent study has observed a
decreased survival in children with leukaemia being exposed to average ELF magnetic
fields above 0.3 µT (Foliart et al. 2006). This finding, however, is based on small
numbers and no mechanism has been proposed, so confirmation studies have to be
awaited before conclusions should be drawn. Most new ELF studies have been looking
into breast cancer or brain tumour risk. Breast cancer caught particular interest
because of experimental results suggesting that melatonin synthesis was related to
ELF field exposure and because melatonin might play a role in the development of
breast cancer. Several studies also reported an increased breast cancer risk among
subjects with elevated ELF exposure. However, later big and well controlled studies
have been entirely negative and the hypothesis of a link between ELF field exposure
and breast cancer risk is essentially written off (Forssen et al. 2005). While some new
data on brain tumours have appeared since the previous opinion, firm conclusions can
still not be drawn.
Discussion
Little data that have an impact on the evaluation have appeared since the previous
opinion. Therefore, the previous assessments stay the same. The fact that the
epidemiologic results for childhood leukaemia have little support from known
mechanisms or experimental studies is intriguing and it is of high priority to reconcile
these data.
In vivo: What was already known on this subject?
The previous opinion did not evaluate evidence of carcinogenicity from animal studies.
However, such data were included in the monograph by IARC that classified ELF
magnetic fields into group 2B, “possibly carcinogenic to humans”, based on
epidemiological studies showing an association between residential ELF magnetic
fields and childhood leukaemia (IARC 2002). The long-term animal carcinogenicity
studies reviewed by IARC provided very little evidence that exposure to ELF magnetic
fields alone could induce any type of cancer, including hemopoietic, mammary, brain
and skin tumours. Negative results were also obtained from studies that evaluated the
effects of ELF magnetic fields on growth of transplanted tumour cells. Animal studies
that combined magnetic fields with known carcinogenic agents produced more
equivocal results, although also these co-carcinogenicity studies were mostly
negative. Among the few positive findings are enhanced development of UV-induced
mouse skin tumours in one study (Kumlin et al. 1998) and accelerated development of
rat mammary tumours induced by 7,12-dimethylbenz(a)anthracene (DMBA) in several
experiments by a German research group (Löscher et al. 1993, Baum et al. 1995,
Mevissen et al. 1996, Mevissen et al. 1998, Thun-Battersby et al. 1999). The latter
findings were not substantiated in independent replication studies (Anderson et al.
1999, Boorman et al. 1999), but there are differences in experimental details that
could potentially explain the differences in results (Anderson et al. 2000, Löscher
2001). Based on the available experimental studies, IARC concluded that there is
inadequate evidence for carcinogenicity of ELF magnetic fields in experimental
animals.
What has been achieved since then?
Motivated by the epidemiological findings of increased leukaemia risk in children,
Sommer and Lerchl (2004a) investigated the influence of 50 Hz (1 or 100 µT) magnetic
fields in the AKR/J mouse strain genetically predisposed to thymic lymphoblastic
lymphoma. There was no effect of magnetic field exposure on survival, and the time to
lymphoma development did not differ between exposed and sham-exposed animals.
The results do not support the hypothesis that chronic exposure to 50 Hz magnetic
fields increases the risk of hemopoietic malignancy in this experimental model.
However, the relevance of the model to human childhood leukaemia is limited.
New results have been published by German researchers who have reported
accelerated development of DMBA-induced rat mammary tumours. In their most
recent study (Fedrowitz et al. 2004) they tested the hypothesis that use of different
sub strains of SD rats explains the difference between their previous results and those
of the replication studies. The results were consistent with the hypothesis: exposure to
a 100 µT, 50 Hz magnetic field enhanced mammary tumour development in one sub
strain of SD rats, but not in another sub strain obtained from the same breeder. The
tumour data were supported by the finding that exposure to MF increased cell
proliferation in the mammary gland of the MF-sensitive strain, but no such effect was
seen in the insensitive sub strain. The finding is potentially important for explaining
the inconsistent results, if the sub strain-specific effect of MF exposure is confirmed in
further independent experiments.
Although short-term animal studies are considered less relevant for cancer risk
assessment than long-term carcinogenicity and co-carcinogenicity studies, they can
provide important contributions to understanding the mechanisms of carcinogenic
effects. Genotoxicity of ELF magnetic fields was studied by Lai and Singh (2004b), who
reported significantly increased DNA damage after exposure to a 60 Hz, 10 µT
magnetic field for 24 or 48 hours. Although the effect was relatively small, it was seen
in several independent experiments. The effects were blocked by treatment with a
radical scavenger, a nitric oxide synthase inhibitor and an iron chelator, suggesting
involvement of free radicals and iron in the effects of magnetic fields. The same
authors have previously reported similar effects after short (2 hour) exposure to
higher magnetic flux densities of 0.1-0.25 mT. Environmental agents can promote the
development of cancer also through non-genotoxic mechanisms such as stimulation of
cell proliferation and inhibition of apoptosis. In support of their previous results
suggesting co-carcinogenic effects of ELF magnetic fields (described above), two
research groups have reported increase in cell proliferation markers in rat mammary
gland (Fedrowitz et al. 2002) and inhibition of UV radiation-induced apoptosis in
mouse skin (Kumlin et al. 2002) after short-term exposure to magnetic fields at 100
µT. The results of the short-term animal studies are interesting and, if confirmed in
further independent experiments, potentially important for understanding possible
cancer-related effects of magnetic fields.
Discussion
Overall there is no evidence from animal studies that ELF magnetic field exposure
alone causes tumours or that it enhances the growth of implanted tumours. There is
some inconsistent evidence that ELF magnetic fields of about 100 µT may enhance the
development of tumours induced by known carcinogens, but the majority of studies
evaluating such co-carcinogenic effects have been negative. Results from recent
studies are potentially helpful for explaining mechanisms and inconsistencies of
previous findings, but they lack confirmation in independent experiments, and are not
sufficient to challenge IARC’s evaluation that the experimental evidence for
carcinogenicity of ELF magnetic fields is inadequate.
In vitro: What was already known on this subject?
There are many observations of cellular responses induced by ELF magnetic fields in
vitro. A large number of cellular components, cellular processes, and cellular systems
can conceivably be affected by EMF exposure. However, because evidence from
theoretical and experimental studies suggest that ELF fields are unlikely to induce
DNA damage directly, most studies have been conducted to examine effects on the
cell membrane, general and specific gene expression, and signal transduction
pathways. In addition, a large number of studies have been performed to investigate
effects on processes such as cell proliferation, cell cycle regulation, cell differentiation,
metabolism, and various physiological characteristics of cells.
Summaries of in vitro studies are found in Portier and Wolfe (1998) and IARC (2002).
In particular, studies focusing on cell cycle kinetics, proliferation, differentiation, gene
expression, DNA damage, signal transduction pathways, apoptosis and membrane
characteristics have received attention and are useful in carcinogen evaluation.
What has been achieved since then?
It is generally accepted that ELF fields do not transfer energy to cells in sufficient
amounts to cause direct DNA damage and subsequent genotoxic effects. However, it
is possible that certain cellular processes, such as DNA repair, are altered by exposure
to EMF, which could indirectly affect the structure of DNA causing strand breaks and
other chromosomal aberrations, including sister chromatid exchange, or micronucleus
formation.
A recent review of genotoxic effects after ELF field exposure (Vijayalaxmi and Obe
2005) analysed studies published 1990-2003 and found a very mixed picture. Overall,
studies with positive or negative, or inconclusive, findings were more or less equal in
frequency.
By analyzing studies using combinations of ELF and other factors (chemical as well as
physical) with known carcinogenic or mutagenic effects, a recent review suggests that
effects of these co-exposures are far more frequently appearing in the literature than
effects of pure ELF exposure (Juutilainen et al. 2006). This finding suggests a possible
interaction of ELF magnetic fields with other agents. Furthermore, this review suggests
that since effects frequently appear from 0.10 mT and higher, the radical pair
mechanism (Brocklehurst and McLaughlan 1996) could explain the presence of
positive findings at such flux densities.

Regarding more recent experimental findings, studies on genotoxic effects performed

as part of the REFLEX project have received considerable attention. Different types of
human and other mammalian cells (including human fibroblasts and lymphocytes)
were exposed to a range of frequencies, flux densities and exposure regimes
(Ivancsits et al. 2003a, Ivancsits et al. 2003b, Ivancsits et al. 2005, Winker et al.
2005). Chromosomal damage (DNA strand breaks, micronucleus formation) due to
exposure was found in some, but not all cell types (e.g. lymphocytes not affected),
after intermittent but not after continuous exposure. Flux density, frequency, and
exposure time were important for observed effects, as well as age of cell donors.
Similar studies have been performed to ascertain the replicability of the results. The
outcome of these studies are at present not completely available and do thus not
allow for final interpretation of the data, although at least one study could not confirm
the initial findings (Scarfi et al. 2005). Other recent studies using human cells have
also shown inconsistent results regarding DNA damage after ELF exposure (alone or in
combination with chemical or other physical agents). These studies vary considerable
both in exposure conditions and in techniques employed to test for clastogenic effects,
making it difficult to draw firm conclusions at present. However, Mairs et al. (2007)
recently showed that by using the very sensitive microsatellite sequence analysis, 50
Hz EMF at 1 mT could alone increase mutation rate in human glioma cells, as well as
increase the mutagenic capacity of ionizing radiation. Also a study by Wahab et al.
(2006) has recently indicated genotoxic actions of exposure to 50 Hz EMF. In this
study it was seen that frequencies of sister chromatide exchanges were elevated in
EMF exposed human lymphocytes. Any mechanism responsible for these possible
genotoxic effects is not shown. During the last years, there has been increased
attention towards effects by ELF fields on free radical homeostasis as an indirect
mechanism for several biological responses (Simkó and Mattsson 2004). Experiments
with several cellular systems have shown that exposure leads to increased radical
levels (e.g. Simkó et al. 2001, Rollwitz et al. 2004, Lupke et al. 2004). Interestingly,
DNA damage in human cells (Wolf et al. 2005) exposed to ELF magnetic fields was
counteracted by addition of antioxidants, suggesting that ELF magnetic fields can
indirectly, possibly via changes in radical homeostasis, affect integrity of DNA.
Finally, based on data obtained with modern high-throughput screening methods and
real-time PCR, Lupke et al. (2006) have suggested a comprehensive pathway by which
ELF fields could influence cells of the immune system. The suggested pathway
includes that membrane-associated events are affected by the fields, causing changes
in radical homeostasis, and leading to down-stream events that include changes in
gene expression, which could be of importance for regulation of proliferation.

Other biological endpoints relevant for carcinogenesis (e.g. cell cycle regulation,
proliferation, apoptosis, gene expression) have been investigated in a number of
studies. There are mixtures of positive and negative findings, not allowing for a
general conclusion to be made regarding the overall potency for ELF fields to
participate in the carcinogenic process. However, an interesting exception is three
replication studies of an older study showing that low intensity 60 Hz MF can inhibit
the antiproliferative effect of tamoxifen on a specific subclone of human MCF-7 breast
cancer cells (Blackman et al. 2001, Ishido et al. 2001, Girgert et al. 2005). These are
among the few EMF studies that have yielded reproducible results in several
independent laboratories.
Discussion
The value of in vitro studies is in providing information on mechanisms of damage to
cells and tissues. Published in vitro studies cannot explain epidemiological findings,
but do not contradict them either. There is a need for independent replication of
certain studies suggesting genotoxic effects and for better understanding of combined
effects of ELF magnetic fields with other agents, their effects on free radical
homeoastasis, as well as of the possible implications of ELF field inhibition of
tamoxifen effects. Studies with improved design are also needed.
Symptoms
What was already known on this subject?
A variety of symptoms (dermatological symptoms such as redness, tingling and
burning sensations as well as for example fatigue, headache, concentration
difficulties, nausea, heart palpitation) have been suggested to be caused by ELF field
exposure. The term “electromagnetic hypersensitivity” (EHS) has come into common
usage based on the reported experience by the afflicted individuals that electric
and/or magnetic fields, or vicinity to activated electrical equipment trigger the
symptoms.
In the CSTEE opinion of 2001, the possibility of hypersensitivity in some individuals
was said to require confirmation and the reports of such health problems did not
provide a basis for changes in exposure limits.
What has been achieved since then?
Since the CSTEE opinion of 2001 only few new provocation studies have been
published on symptoms and ELF fields (for EHS and RF fields see Chapter 3.3.3). As
stated in the WHO Fact sheet on electromagnetic hypersensitivity, well controlled and
conducted double-blind studies have not shown any correlation between symptoms
and EMF (WHO 2005). Rubin et al. (2005) reviewed 31 provocation studies (using
different frequencies and EMF sources) testing more than 700 individuals reporting
EHS (Rubin et al. 2005). The results in 24 of these studies did not support a
relationship between the health problems and EMF. In seven of the other studies some
supporting evidence was found,
but in two cases the same research group failed to replicate their own findings. For
another three studies Rubin and co-authors suspected that the results were statistical
artefacts and in the final two studies the results were mutually incompatible.
Discussion
A relationship between ELF field exposure and symptoms has not been shown in
scientific studies. From these results it seems clear that ELF field exposure is neither a
necessary nor a sufficient factor to trigger health complaints in individuals reporting
symptoms. Whether ELF fields may be a contributing factor under some conditions
remains to be determined.
Other Health Effects
Epidemiology
Following the initial epidemiological study on childhood cancer a great number of
other diseases have also been studied in relation to ELF fields. These diseases include
cardiovascular disease, neurodegenerative disease and psychiatric disorders. An
effect of heart rate variability seen in laboratory studies was the basis for a hypothesis
that ELF exposure might affect the risk of cardiovascular disease and some initial
epidemiologic results supported this. However, later well controlled studies have
dismissed this hypothesis. For several of the other outcomes the support was never
strong. Nevertheless, several neurodegenerative diseases are still considered worthy
of study in this respect, and this refers particularly to ALS (amyotrophic lateral
sclerosis) and Alzheimer disease (Ahlbom et al. 2001).
In vivo: What was already known on this subject?
The previous opinion did not evaluate evidence of health effects from animal studies.
However, such data have been reviewed by IARC (2002) and ICNIRP (Bernhardt et al.
2003).
Nervous system and behavior: While strong ELF fields are known to affect nerve and
muscle cells and can be perceived, little evidence was found for effects on the nervous
system or behaviour at environmental exposure levels. Effects of ELF magnetic fields
on the EEG, cognition, behaviour and neurotransmitter levels have been described in a
few studies, but there are inconsistencies in these data.

Reproduction and development: Several independent studies have suggested effects

of ELF magnetic fields on the embryonic development of birds and other non-
mammalian species, but the results are inconsistent. The evidence in mammalian
species is restricted to minor skeletal anomalies seen in some studies with rats and
mice. No consistent effects have been seen in any other reproductive or
developmental endpoints in mammals. Minor skeletal variations are relatively common
findings in teratological studies on rodents and often considered biologically
insignificant.
Endocrine system: There is limited evidence of effects on melatonin production in
experimental animals exposed to ELF magnetic fields, but such effects are not
supported by other animal studies, and no statistically significant effects 24 have been
seen on human volunteers under controlled laboratory conditions.
Other effects: No consistent evidence has been found for cardiovascular or immune
system effects of ELF fields. 24 5%-significance level
What has been achieved since then?
Two recent animal studies have provided evidence that ELF magnetic field exposure
may affect melatonin production by modifying the response of dairy cows to the
length of photoperiod (Rodriguez et al. 2004) and by affecting the sensitivity of mice
to circadian light variations (Kumlin et al. 2005). The results of two new studies are
interesting biological observations suggesting EMF interactions with the effects of light
(photoperiod) on melatonin production. These observations may help to explain the
inconsistencies of earlier research on EMFs and melatonin. However, the results of
both studies are only suggestive and should be confirmed in further experiments. The
suggested EMF effects on melatonin are subtle and apparently observable only in
specific conditions. For these reasons, these results are not helpful for human health
risk assessment.
Discussion
Although some studies have described ELF magnetic field effects on the nervous
system, animal development and melatonin production, the evidence for such effects
is weak and ambiguous. No conclusions concerning possible human health risks can
be drawn from these data.
In vitro: What was already known on this subject?
Very few in vitro studies have been directed at answering the question if ELF fields are
involved in the onset of other diseases than cancer (Portier and Wolfe 1998).
Naturally, many basic cell and molecular studies were performed, mostly to
understand more about fundamental interaction mechanisms, but also to understand
how certain ELF fields can be used for therapeutic purposes (bone and wound healing
especially).
What has been achieved since then and discussion
Few studies are available that directly address any specific disease or group of
disease. This is partly due to that few diseases are characterised in such a way that
specific disease models exist on the cell level, but also due to that ELF fields have not
been convincingly shown to be involved in specific non-cancerous diseases. However,
continuously there are reports showing that ELF fields during certain circumstances
can give rise to cellular responses that are relevant for diseases of the nervous
system, the immune system, endocrine organs, the skeleto-muscular apparatus, etc.
Such studies do not at the present time allow extrapolation from the in vitro finding to
any specific health state.
Conclusions about ELF fields
The previous opinion came to a similar conclusion regarding carcinogenicity of ELF
fields as IARC’s evaluation, namely that ELF magnetic fields are possibly carcinogenic.
This conclusion was mainly based on epidemiologic results indicating that exposure to
ELF fields might be a cause of childhood leukaemia. This assessment is still valid. The
fact that the epidemiological results for childhood leukaemia have little support from
known mechanisms or experimental studies is intriguing and it is a high research
priority to reconcile these data.
For some other diseases, notably breast cancer and cardiovascular diseases, later
research has indicated that an association is unlikely. For yet some other diseases,
such as neurodegenerative disease and brain cancer, the issue of an association to
ELF fields remains open and more research is called for. A relation between ELF fields
and symptoms has not been demonstrated. Of current interest is to arrive at a better
understanding of recently published genotoxicity results including those from the
REFLEX study.
STATIC FIELDS
Sources and distribution of exposure in population
The number of artificial sources of static magnetic fields is small but there is a rapid
development of technologies using static magnetic fields. The number of people with
implants that can be affected by static magnetic fields is also growing. Static magnetic
fields up to some mT are found in certain occupational settings, e.g., in the aluminium
and chloralkali industries, in welding processes, and certain railway and underground
systems. A very prominent application is MRI: different types of tissue in the human
body can be identified and located by using static magnetic fields, magnetic gradients
and RF fields. Close to the device a few hundred mT can be reached. Recently
developed devices, currently only used by some research and specialised teams for
specific applications, can use up to 10 T.
Health effects
There are only a few epidemiological studies available and the majority of these have
focused on cancer risks. There are some reports on reproductive outcomes, and
sporadic studies of other outcomes. Overall, few occupational studies have focused
specifically on effects of static magnetic fields and exposure assessment has been
poor. In summary, the available evidence from epidemiological studies is not sufficient
to draw any conclusions about potential health effects of static magnetic field
exposure (Feychting 2005b).
A large number of biological studies have been carried out in an effort to detect
biological effects of static magnetic fields. The studies include in vitro and in vivo
laboratory studies as well as studies on human volunteers. This research has been
reviewed comprehensively in UNEP/WHO (2006). Known effects of magnetic fields are
orientation of forces applied on biological molecules with magnetic properties:
haemoglobin, rhodopsin (visual pigment), free radicals, nitric oxide; these effects are
detectable at field levels of about 1 T, without known health consequences.
Conclusions about static fields
Adequate data for proper risk assessment of static magnetic fields are almost totally
lacking. The advent of new technology, and in particular MRI equipment, makes it a
priority for research.
Environmental Effects
What was already known on this subject?
The CSTEE opinion did not consider possible environmental impacts of EMF. It is noted
that the majority of the relatively few published studies on environmental effects at
the time of the CSTEE opinion were laboratory based using short exposure periods, in
a single species. In addition some field investigations were reported around intense
point sources of EMF, in particular overhead power cables.

Certain species have been recognised as likely to be particularly sensitive to EMF

namely:
  species that are strongly dependent on magnetic fields for
orientation/migration (migratory birds, certain fish and insects, bats etc)
and/or possess electric sense organs (e.g. sharks and rays).
 species with a high vulnerability to stress due to poorly developed or
impaired defence mechanisms. For example animals with poor
thermoregulation may be more vulnerable to the effects of high frequency
EMF.
Nonetheless data to characterise this vulnerability and its implications have been very
limited. Foster and Repacholi (2000) in their important review of the published data
concluded that: ‘attempts at environmental analysis of the effects of environmental
EMF, with few exceptions have been scattered in focus, sporadic in publication and
uneven in quality’.
The available data thus provided a seriously inadequate basis to assess the risk of EMF
to environmental species. However, apart from some local minor effects no significant
effects of EMF on environmental species were identified.
What has been achieved since then?
Despite the obvious need for some definitive studies there has been no significant
increase in the volume or general quality of research activity in this area since. The
majority of these studies have focussed on ELF fields.

There has however been a substantial shift in the form of the studies, in particular in
the nature of the endpoints examined. Thus the majority of studies published before
2000 used visible endpoints that are obviously associated with an adverse effect.
These had the advantage that their interpretation is quite straightforward. However
such endpoints in many cases lack sensitivity. In the last few years an increasing
number of studies on the effects of EMF have concentrated on the measurement of
more sensitive biomarkers.
These have included:
 antioxidant status/ antioxidant enzyme measurements
 stress markers e.g. alanine (plants) and heat shock proteins (animals)
 changes in cell growth (e.g. meristems in plants)
 DNA changes (e.g. using the comet assay).
The majority of the few publications on the impact of EMF on environmental species
have been in plants. The paper by Monselise et al. (2003) illustrates the use of new
markers of cell/tissue change. These authors found that in duck weed, exposed in the
laboratory to low intensity sinusoidally varying magnetic fields at 60 and 100Hz, an
accumulation of alanine occurred. Alanine accumulation is found as a stress signal
following many other kinds of stress. (NB This effect may have parallels with the
formation of heat shock proteins in the mammalian kidney in response to various
stressors). The authors postulate that this effect arose from free radical generation by
the EMF.
Regoli et al. (2005) have reported the effect in snails of low frequency 50Hz EMF fields
both in the laboratory and under overhead power cables. A range of biological markers
was employed. They demonstrated that the EMF had particular effects on markers of
oxidative stress such as catalase and glutathione reductase both in the laboratory and
in the field situations. The time to an effect was shown to be dose dependant with
effects in the field occurring even at low levels (after 40 days at 0.75T). The authors
attribute the effects to the generation of free radicals by the low frequency
electromagnetic fields. The authors also observed a reduction in lysosomal stability
and of DNA integrity (at 2.88T under field conditions). However, no physical damage
to the snails was reported.
These biomarkers do appear to be detecting changes at low, much more
environmentally relevant field strengths. However, their interpretation in terms of
species and ecosystem health is more challenging. Unfortunately these techniques
have not focussed particularly on species that would be expected to be among the
most sensitive to EMF.
Using more classical endpoints Zaidi and Khatoon (2003) have studied the impact on
pollen production of plants growing under overhead power cables using plants grown
nearby as a control group. They found that plants growing under the high tension lines
at higher voltages (132000 and 220000 volts) had some decrease in pollen fertility
and that the pollen had a higher percentage of diads and diploid pollen grains which is
an indicator of genetic change. This finding needs to be examined further.
Several studies have examined the impact of co-exposure to EMF and other stressors
in plants. Thus Tafforeau et al. (2004) describe the impact of exposure to EMF
combined with calcium deprivation, from either a GSM telephone or a single 2h
exposure to 105GHz (from a Gunn oscillator) on meristem production in flax seedlings
(i.e. increase in actively dividing cells in the hypocotyls of the growing seedling). An
increase in meristem production was observed from each of these EMF sources. It
should be noted however that no visible damage to the seedlings was observed in
these studies and that other environmental stressors can also produce an increase in
meristem production.
Yao et al. (2005) have examined the impact of EMF (0.2 and 0.45T) together with UV-B
radiation on cucumber seedling growth. EMF alone produced an increase in seedling
germination, seedling growth in parallel with an increase in lipid peroxidation.
However in combination with UV-B seedling growth and development were
significantly decreased.
These studies raise the question as to whether the impact of EMF may be additive with
other significant environmental stressors in the field situation and if so, what are the
practical consequences of this for individual plants and ecosystems. The data
presently available are inadequate to assess this.
Discussion
The continued lack of good quality data in relevant species means that there are
insufficient data to identify whether a single exposure standard is appropriate to
protect all environmental species from EMF. Similarly the data are totally inadequate
to judge whether the environmental standard(s) should be the same or significantly
different from those appropriate to protect human health.
The demonstration that the impact of EMF may be additive with some other
environmental stressors at least in plants needs further examination to gauge its
practical significance.
At present it is not possible to draw any conclusions regarding human health from this
data base. Nonetheless, long-term monitoring of the viability of carefully selected
species and/or ecosystems may be valuable to gauge the potential of EMF to influence
human health.
 CHAPTER THREE
RESEARCH METHODOLOGY
3.1 RESEARCH DESIGN
The methodologies used in this research work are, in the main, doctrinal or library
research in nature. The doctrinal method of the research, which is mainly theory-
based, would enable this writer to consult, refer to, review, study and fill the gaps in
the works of authors, contained in textbooks, journals, and the internet. The data
collected through library research in which the researcher reads, writes and gathers
pertinent information related to the topic of this project. After having information from
relate d documents such as international legal instrument, books, scientific journals,
and others regarding the main problem as the object of this research, then the
researcher tries to make conclusion.
3.2 DATA GATHERING METHOD
The data we collected through library research in which the researcher reads, writes
and gathers pertinent information related to the topic of this project. After having
information from related documents such as international legal instrument, books,
scientific journals, and others regarding the main problem as the object of this
research, then the researcher tries to make conclusion.

3.3 SAMPLE SIZE AND SAMPLING TECHNIQUE

As a general rule, scientific reports that are published in English language peer-
reviewed scientific journals are considered primarily. This does not imply that all
published articles are considered to be equally valid and relevant for health risk
assessment. On the contrary, a main task is to evaluate and assess the articles and
the scientific weight that is to be given to each of them. Only studies that are
considered relevant for the task are commented upon in the opinion. Many more
reports were considered than are cited in the reference list. However, only articles
that contribute significantly to the update of the opinion are cited and commented
upon. In some areas where the literature is particularly scarce it has been considered
important to explain why the results of certain studies do not add useful information to
the data base. The focus is on articles presented after the year 2000.
Relevant research for EMF health risk assessment can be divided into broad sectors
such as epidemiologic studies, experimental studies in humans, experimental studies
in animals, and cell culture studies. Also studies on biophysical mechanisms,
dosimetry, and exposure assessment are considered. In a report of this nature it is not
possible to consider the experiences of individuals. Nonetheless, such information
often triggers a scientific study.
A health risk assessment evaluates the evidence within each of these sectors and then
weighs together the evidence across the sectors to a combined assessment. This
combined assessment should address the question of whether or not a hazard exists
i.e., if there exists a causal relation between exposure and some adverse health effect.
The answer to this question is not necessarily a definitive yes or no, but may express
the weight of the evidence for the existence of a hazard. If such a hazard is judged to
be present, the risk assessment should also address the magnitude of the effect and
the shape of the dose-response function, i.e., the magnitude of the risk for various
exposure levels and exposure patterns. A full risk assessment also includes exposure
characterization in the population and estimates of the impact of exposure on burden
of disease.
Epidemiological and experimental studies are subject to similar treatment in the
evaluation process. It is of equal importance to evaluate positive and negative studies,
i.e., studies indicating that EMF has an effect and studies not indicating the existence
of such an effect. In the case of positive studies the evaluation focuses on alternatives
to causation as explanation to the positive result: With what degree of certainty can
one rule out the possibility that the observed positive result is produced by bias, e.g.
confounding or selection bias, or chance. In the case of negative studies one assesses
the certainty with which it can be ruled out that the lack of an observed effect is the
result of (masking) bias, e.g., because of too small exposure contrasts or too crude
exposure measurements; one also has to evaluate the possibility that the lack of an
observed effect is the result of chance, a possibility that is a particular problem in
small studies with low statistical power. Obviously, the presence or absence of
statistical significance is only one factor in this evaluation. Rather, the evaluation
considers a number of characteristics of the study. Some of these characteristics are
rather general, such as study size, assessment of participation rate, level of exposure,
and quality of exposure assessment. Particularly important aspects are the observed
strength of association and the internal consistency of the results including aspects
such as dose response relation. Other characteristics are specific to the study in
question and may involve dosimetry, method for assessment of biological or health
endpoint, the relevance of any experimental biological model used etc. Regarding
experimental studies, additional important characteristics that are taken into
consideration are the types of controls that have been used and to what degree
replication studies have been performed. For a further discussion of aspects of study
quality, refer for example to the Preamble to the IARC Monograph Series (IARC 2006).
It is worth noting that the result of this process is not an assessment that a specific
study is unequivocally negative or positive or whether it is accepted or rejected.
Rather, the assessment will result in a weight that is given to the findings of a study
The step that follows the evaluation of the individual studies within a sector of
research is the assessment of the overall evidence from that sector with respect to a
given outcome. This implies integrating the results from all relevant individual studies
into a total assessment. This is based on the evaluations of the individual studies and
takes into account, for each study, both the observed magnitude of the effect and the
quality of the study. Note again, that for this process to be valid, all studies must be
considered equally irrespective of their outcome.
In the final overall evaluation phase, the available evidence is integrated over various
sectors of research. This phase involves combining the existing relevant pieces of
evidence on a particular end-point from studies in humans, from animal models, in
vitro studies, and from other relevant areas. The integration of the separate lines of
evidence should take place as the last, overall evaluation stage, after the critical
assessment of all (relevant) available studies for particular end-points. In the first
phase, epidemiological studies should be critically evaluated for quality irrespective of
the putative mechanisms of biological action of a given exposure. In the final
integrative stage of evaluation, however, the plausibility of the observed or
hypothetical mechanism(s) of action and the evidence for that mechanism(s) is a
factor to be considered. The overall result of the integrative phase of evaluation,
combining the degree of evidence from across epidemiology, animal studies, in vitro
and other data depends on how much weight is given on each line of evidence from
different categories.
3.5 Data Analysis
In this study, the researcher uses qualitative prescriptive analysis in which the
researcher analyzes and gives interpretation or disclosure of subject and object of
research undertaken.
 CHAPTER FOUR
DISCUSSION OF RESEARCH
4.1 INTRODUCTION
This chapter contains detailed presentation of opinions and literature on the findings
and discussion for this study.
4.2 OPINION
Radio Frequency Fields (RF fields)
In its opinion from 2001 the CSTEE concluded regarding radiofrequency (RF)
electromagnetic fields: “The additional information which has become available on
carcinogenic and other nonthermal effects of radiofrequency and microwave radiation
frequencies in the last years does not justify a revision of exposure limits set by the
Commission on the basis of the conclusions of the 1998 opinion of the Steering
Scientific Committee. In particular, in humans, no evidence of carcinogenicity in either
children or adults has resulted from epidemiological studies (the size of some of which
was very large, although the period of observation was not long enough for a
definitive statement). A relatively large series of laboratory studies has not provided
evidence of genotoxicity. Subjective symptoms affecting some individuals possibly
exist, but not enough information is available on: the levels of exposure producing
such effect, on the features underlying individual susceptibility, on the possible
biological mechanisms or the prevalence of susceptible individuals in different
populations. Thus, current knowledge is insufficient for the implementation of
measures aimed at the identification and protection of a highly sensitive sub-group of
the population.”
Based on the scientific rationale presented above the research discusses the following
in regard to non-thermal effects:
The balance of epidemiologic evidence indicates that mobile phone use of less than 10
years does not pose any increased risk of brain tumour or acoustic neuroma. For
longer use, data are sparse and any conclusions therefore are uncertain. From the
available data, however, it does appear that there is no increased risk for brain
tumours in long- term users, with the exception of acoustic neuroma for which there
are some indications of an association.
For diseases other than cancer, very little epidemiologic data are available.
A particular consideration is mobile phone use by children. While no specific evidence
exists, children or adolescents may be more sensitive to RF field exposure than adults
in view of their continuing development. Children of today may also experience a
much higher cumulative exposure than previous generations. To date no
epidemiologic studies on children are available.
RF exposure has not consistently been shown to have an effect on self-reported
symptoms (e.g. headache, fatigue, dizziness and concentration difficulties) or well-
being.
Studies on neurological effects and reproductive effects have not indicated any health
risks at exposure levels below the ICNIRP-limits established in 1998.
Animal studies have not provided evidence that RF fields could induce cancer,
enhance the effects of known carcinogens, or accelerate the development of
transplanted tumours. The open questions include adequacy of the experimental
models used and scarcity of data at high exposure levels.
There is no consistent indication from in vitro research that RF fields affect cells at the
nonthermal exposure level.
In conclusion, no health effect has been consistently demonstrated at exposure levels
below the ICNIRP-limits established in 1998. However, the data base for this
evaluation is limited especially for long-term low-level exposure.
INTERMEDIATE FREQUENCY FIELDS (IF FIELDS)
In its opinion from 2001 the CSTEE did not comment specifically on intermediate
frequencies (IF).
Based on the scientific rationale presented above the SCENIHR, however, updates the
2001 opinion with the following statement regarding intermediate frequencies:
Experimental and epidemiological data from the IF range are very sparse. Therefore,
assessment of acute health risks in the IF range is currently based on known hazards
at lower frequencies and at higher frequencies. Proper evaluation and assessment of
possible health effects from long term exposure to IF fields are important because
human exposure to such fields is increasing due to new and emerging technologies.
EXTREMELY LOW FREQUENCY FIELDS (ELF FIELDS)
In its 2001 the CSTEE reached the following conclusions regarding extremely low
frequency (ELF) fields:
 "Combined analyses of the epidemiological studies on the association
between exposure to ELF and childhood leukaemia have strengthened the
evidence of an association. However, given some inconsistencies in
exposure measurements and the absence of other criteria commonly
used in assessing causality (particularly a plausible explanation of
underlying biological mechanisms, see above), the association does not
meet adequate criteria for being considered causal. Thus the overall
evidence for 50/60 Hz magnetic fields to produce childhood leukaemia
must be regarded as being limited.
 The effect, if any, seems to be limited to exposures above 0.4 µT. In
European countries, the proportion of children exposed to such levels is
less than 1%. Assuming that the risk is doubled among the exposed, in
the general population this would roughly correspond to an excess
incidence of less than 1% childhood leukaemia. To put this in context, in
European countries, the incidence of leukaemia is around 45 per million
children (age 0-14) per year.
 Whether changes of recommended exposure limits to 50/60 Hz magnetic
fields
(12) ought to be recommended on this basis is a problem for risk managers, falling
beyond the remit of the CSTEE.
 There is no convincing suggestion of any other carcinogenic effect of ELF
on either children or adults. Current information on this respect does not
provide clues for reconsidering exposure limits.
 Reports on possibly hypersensitive individuals require confirmation and
do not provide a basis for proposing changes in the exposure limits.”
Based on the scientific rationale presented above the project updates the previous
opinion and concludes the following:
The previous conclusion that ELF magnetic fields are a possible carcinogen, chiefly
based on childhood leukaemia results, is still valid. There is no generally accepted
mechanism to explain how ELF magnetic field exposure may cause leukaemia. Animal
studies have not provided adequate evidence for a causal relationship.

No consistent relationship between ELF fields and self-reported symptoms (sometimes

referred to as electrical hypersensitivity) has been demonstrated. In addition, for
breast cancer and cardiovascular disease, recent research has indicated that an
association is unlikely. For neurodegenerative diseases and brain tumours, the link to
ELF fields remains uncertain.
Static fields
In its opinion from 2001 the CSTEE did not comment specifically on static magnetic
fields. Based on the scientific rationale presented above the SCENIHR, however,
updates the 2001 opinion with the following statement regarding static magnetic
fields:
Adequate data for proper risk assessment of static magnetic fields are very sparse.
Developments of technologies involving static magnetic fields, e.g. with MRI
equipment require risk assessments to be made in relation to the exposure of
personnel.
Environmental Effects
The CSTEE did not consider environmental effects in its opinion of 2001.
The continued lack of good quality studies in relevant species means that there are
insufficient data to identify whether a single exposure standard is appropriate to
protect all environmental species from EMF. Similarly the data are inadequate to judge
whether the environmental standards should be the same or significantly different
from those appropriate to protect human health.
In most cases the data available are very limited. Some of these issues will be
addressed in further opinions as more data become available.
 CHAPTER 5
CONCLUSION AND RECOMMENDATIONS
5.1 SUMMARY
An overview of the Possible effects of Electromagnetic Fields (EMF), Radio Frequency
Fields (RF) and Microwave Radiation on human health. Scientific data, published since
the previous opinion, have been reviewed and their impact on the conclusions of the
previous opinion has been assessed. The main focus of the opinion is whether health
effects might occur at exposure levels below those of established biological
mechanisms and, in particular, in relation to long term exposure at such low levels.
The present opinion is divided according to frequency band. A separate section
discusses environmental effects.
Radio Frequency Fields (RF fields)
Since the adoption of the 2001 opinion extensive research has been conducted
regarding possible health effects of exposure to low intensity RF fields, including
epidemiologic, in vivo, and in vitro research.
The balance of epidemiologic evidence indicates that mobile phone use of less than 10
years does not pose any increased risk of brain tumour or acoustic neuroma. For long-
term use, data are sparse, and the following conclusions are therefore uncertain and
tentative. However, from the available data it does appear that there is no increased
risk for brain tumours in long-term users, with the exception of acoustic neuroma for
which there is some evidence of an association. For diseases other than cancer, very
little epidemiologic data are available.
A particular consideration is mobile phone use by children. While no specific evidence
exists, children or adolescents may be more sensitive to RF field exposure than adults.
Children of today will also experience a much higher cumulative exposure than
previous generations. To date no epidemiologic studies on children are available.
RF field exposure has not convincingly been shown to have an effect on self-reported
symptoms or well-being.
Studies on neurological effects and reproductive effects have not indicated any health
risks at exposure levels below the ICNIRP-limits established in 1998.
Animal studies have not provided evidence that RF fields could induce cancer,
enhance the effects of known carcinogens, or accelerate the development of
transplanted tumours. The open questions include adequacy of the experimental
models used and scarcity of data at high exposure levels.
There is no consistent indication from in vitro research that RF fields affect cells at the
nonthermal exposure level.
The technical development is very fast and sources of RF field exposure become
increasingly common. Yet, there is a lack of information on individual RF field
exposure and the relative contribution of different sources to the overall exposure.

In conclusion, no health effect has been consistently demonstrated at exposure levels

below the ICNIRP-limits established in 1998. However, the data base for this
evaluation is limited especially for long-term low-level exposure.
Intermediate Frequency Fields (IF fields)
Experimental and epidemiological data from the IF range are very sparse. Therefore,
assessment of acute health risks in the IF range is currently based on known hazards
at lower frequencies and higher frequencies. Proper evaluation and assessment of
possible health effects from long term exposure to IF fields are important because
human exposure to such fields is increasing due to new and emerging technologies.
Extremely low frequency fields (ELF fields)
The previous conclusion that ELF magnetic fields are possibly carcinogenic, chiefly
based on childhood leukaemia results, is still valid. There is no generally accepted
mechanism to explain how ELF magnetic field exposure may cause leukaemia.
For breast cancer and cardiovascular disease, recent research has indicated that an
association is unlikely. For neurodegenerative diseases and brain tumours, the link to
ELF fields remains uncertain. A relation between ELF fields and symptoms (sometimes
referred to as electromagnetic hypersensitivity) has not been demonstrated.
Static Fields
Adequate data for proper risk assessment of static magnetic fields are very sparse.
Developments of technologies involving static magnetic fields, e.g. with MRI
equipment require risk assessments to be made in relation to the exposure of
personnel.
Environmental Effects
The continued lack of good quality data in relevant species means that there are
insufficient data to identify whether a single exposure standard is appropriate to
protect all environmental species from EMF. Similarly the data are inadequate to judge
whether the environmental standards should be the same or significantly different
from those appropriate to protect human health
CONCLUSION AND RESEARCH RECOMMENDATIONS
In view of the identified important gaps in knowledge the following research
recommendations are being made.
RF fields
 A long term prospective cohort study. Such a study would overcome problems
that were discussed in relation to existing epidemiological studies, including
the Interphone study. These problems include recall bias and other aspects of
exposure assessment, selection bias due to high proportions of non-
responders, too short induction period, and restriction to intracranial tumours.
 Health effects of RF exposure in children. To date no study on children exists.
This issue can also be addressed by studies on immature animals. This
research has to take into consideration that dosimetry in children may differ
from that in adults.
 Exposure distribution in the population. The advent of personal dosimeters
has made it possible to describe individual exposure in the population and to
assess the relative contribution of different sources to the total exposure.
Such a project would require that groups of people with different
characteristics are selected and that they wear dosimeters for a defined
period of time. There are several experimental studies that need to be
replicated. Examples are studies on genotoxicity and cognition involving
sleep quality parameters. For studies on biomarkers it is essential that the
impact on human health is considered. Valid exposure assessment including
all relevant sources of exposure is essential. A general comment is that all
studies must use high quality dosimetry.
IF fields
 Data on health effects from IF fields are sparse. This issue should be
addressed both through epidemiologic and experimental studies.

ELF fields
 Epidemiological results indicate an increased risk of leukaemia in children
exposed to high levels of ELF magnetic fields, however, this is not supported
by animal data. The mechanisms responsible for the childhood leukaemia and
the reasons for the discrepancy are unknown and require a better
understanding and clarification.
Static fields
 A cohort study on personnel dealing with equipment that generates strong
magnetic fields is required. The start of this would have to be a thorough
feasibility study.
 Relevant experimental studies such as studies on carcinogenicity,
genotoxicity as well as developmental and neurobehavioural effects would
have to be conducted as well.
Additional considerations
 Studies including exposure to combinations of frequencies as well as
combinations of electromagnetic fields and other agents need to be
considered.
REFRENCES
Ahlbom A, Day N, Feychting M, Roman E, Skinner J, Dockerty J, et al. A pooled
analysis of magnetic fields and childhood leukaemia. Br J Cancer
2000; 83:692-698.
Ahlbom A. Neurodegenerative diseases, suicide and depressive symptoms in
relation to EMF. Bioelectromagnetics 2001; Suppl 5:S132-43.
Ahlbom A, Green A, Kheifets L, Savitz D, Swerdlow A (ICNIRP Standing
Committee on Epidemiology). Epidemiology of health effects of
radiofrequency exposure. Environ Health Perspect 2004; 112:1741-
54.
Baum A, Mevissen M, Kamino K, Mohr U, Löscher W. A histopathological study
on alterations in DMBA-induced mammary carcinogenesis in rats
with 50 Hz, 100 muT magnetic field exposure. Carcinogenesis 1995;
16:119-25.
Beckman KB, Ames BN. The free radical theory of aging matures. Physiol Rev
1998; 78:547-81.
Berg G, Schüz J, Samkange-Zeeb F, Blettner M. Assessment of radiofrequency
exposure from cellular telephone daily use in an epidemiological
study: German Validation study of the international case-control
study of cancers of the brain-INTERPHONE-Study. J Expo Anal
Environ Epidemiol 2005; 15:217-24.
Cassel JC, Cosquer B, Galani R, Kuster N. Whole-body exposure to 2.45 GHz
electromagnetic fields does not alter radial-maze performance in
rats. Behav Brain Res 2004; 155:37-43.
Christ A, Kuster N. Differences in RF energy absorption in the heads of adults
and children. Bioelectromagnetics 2005; Suppl 7:S31-44.
Christensen HC, Schüz J, Kosteljanetz M, Poulsen HS, Thomsen J, Johansen C.
Cellular telephone use and risk of acoustic neuroma. Am J Epidemiol
2004; 159:277-83.

Dubreuil D, Jay T, Edeline JM. Head only exposure to GSM 900 MHz EMF does
not alter rats memory in spatial and non spatial tasks. Behav Brain
2003; 145:51-61.
Fedrowitz M, Westermann J, Löscher W. Magnetic field exposure increases cell
proliferation but does not affect melatonin levels in the mammary
gland of female Sprague Dawley rats. Cancer Res 2002; 62:1356-63.
Fedrowitz M, Kamino K, Löscher W. Significant differences in the effects of
magnetic field exposure on 7,12-dimethylbenz(a)anthracene-
induced mammary carcinogenesis in two substrains of Sprague-
Dawley rats. Cancer Res 2004; 64:243-51.
Gotoh T, Terada K, Mori M. hsp70-DnaJ chaperone pairs prevent nitric oxide-
mediated apoptosis in RAW 264.7 macrophages. Cell Death Differ
2001; 8:357-66.
Hardell L, Carlberg M, Mild KH. Case-control study of the association between
the use of cellular and cordless telephones and malignant brain
tumours diagnosed during 2000- 2003. Environ Res 2005b; 100:232-
41.
Hardell L, Mild KH, Carlberg M, Söderqvist F. Tumour risk associated with use
of cellular telephones or cordless desktop telephones. World J Surg
Oncol 2006; 4:74.

Hepworth SJ, Schoemaker MJ, Muir KR, Swerdlow AJ, van Tongeren MJ,
McKinney PA. Mobile phone use and risk of glioma in adults: case-
control study. BMJ 2006; 332:883-7.
Heynick LN, Merritt JH. Radiofrequency fields and teratogenesis.
Bioelectromagnetics 2003; Suppl 6:S174-86.
Higashikubo R, Ragouzis M, Moros EG, Straube WL, Roti JL. Radiofrequency
electromagnetic fields do not alter the cell cycle progression of C3H
10T and U87MG cells. Radiat Res 2001; 156:786-95.
Hook GJ, Zhang P, Lagroye I, Li L, Higashikubo R, Moros EG, et al.
Measurement of DNA damage and apoptosis in Molt-4 cells after in
vitro exposure to radiofrequency radiation. Radiat Res 2004;
161:193-200.
IARC (International Agency for Research on Cancer). IARC Monographs on the
Evaluation of Carcinogenic Risks to Humans – Preamble. 2006
http://monographs.iarc.fr/ENG/Preamble/CurrentPreamble.pdf
(accessed 24.4.2007)
Imaida K, Kuzutani K, Wang J, Fujiwara O, Ogiso T, Kato K, et al. Lack of
promotion of 7,12-dimethylbenz[a]anthracene-initiated mouse skin
carcinogenesis by 1.5 GHz electromagnetic near fields.
Carcinogenesis 2001; 22:1837-41.
Ivancsits S, Diem E, Jahn O, Rudiger HW. Age-related effects on induction of
DNA strand breaks by intermittent exposure to electromagnetic
fields. Mech Ageing Dev 2003a; 124:847-50.
Juutilainen J, Kumlin T, Naarala J. Do extremely low frequency magnetic fields
enhance the effects of environmental carcinogens? A meta-analysis
of experimental studies. Int J Radiat Biol 2006; 82:1-12.
Koivisto M, Haarala C, Krause CM, Revonsuo A, Laine M, Hämäläinen H. GSM
phone signals does not produce subjective symtoms.
Biolelectromagnetics 2001; 22:212-5.
Krause CM, Sillanmaki L, Koivisto M, Haggqvist A, Saarela C, Revonsuo A, et
al. Effects of electromagnetic field emitted by cellular phones on the
EEG during a memory task. Neuroreport 2000; 11:761-4.
Lantow M, Viergutz T, Weiss DG, Simkó M. Comparative study of cell cycle
kinetics and induction of apoptosis or necrosis after exposure to
radiofrequency radiation in human Mono Mac 6 cells. Radiat Res
2006c; 166:539-43.
Leszczynski D, Joenvaara S, Reivinen J, Kuokka R. Non-thermal activation of
the hsp27/p38MAPK stress pathway by mobile phone radiation in
human endothelial cells: molecular mechanism for cancer and blood-
brain barrier-related effects. Differentiation 2002; 70:120-9.
Muscat JE, Malkin MG, Thompson S, Shore RE, Stellman SD, McRee D, et al.
Handheld cellular telephone use and risk of brain cancer. JAMA 2000;
284:3001-7
Muscat JE, Malkin MG, Shore RE, Thompson S, Neugut AI, Stellman SD, et al.
Handheld cellular telephones and risk of acoustic neuroma.
Neurology 2002; 58:1304-6.
Ozturan O, Erdem T, Miman MC, Kalcioglu MT, Oncel S. Effects of the
electromagnetic field of mobile telephones on hearing. Acta
Otolaryngol 2002; 122:289-93.
Preece AW, Iwi G, Davies-Smith A, Wesnes K, Butler S, Lim E, et al. Effect of a
915-MHz simulated mobile phone signal on cognitive function in
man. Int J Radiat Biol 1999; 75:447-56.
Purves D, Augustine GJ, Fitzpatrick D, Katz LC, LaMantia AS, McNamara JO, et
al. Neuroscience. 2nd ed. Sunderland (MA): Sinauer Associates, Inc.;
2001.
Scarfi MR, Sannino A, Perrotta A, Sarti M, Mesirca P, Bersani F. Evaluation of
genotoxic effects in human fibroblasts after intermittent exposure to
50 Hz electromagnetic fields: a confirmatory study. Radiat Res
2005; 164:270-6.
Schoemaker MJ, Swerdlow AJ, Ahlbom A, Auvinen A, Blaasaas KG, Cardis E, et
al. Mobile phone use and risk of acoustic neuroma: results of the
Interphone case-control study in five North European countries. Br J
Cancer 2005; 93:842-8.
Schüz J, Böhler E, Berg G, Schlehofer B, Hettinger I, Schlaefer K, et al. Cellular
phones, cordless phones, and the risk of glioma and meningioma
(Interphone study group, Germany). Am J Epidemiol 2006a; 163:512-
20.
Schüz J, Jacobsen R, Olsen JH, Boice JD Jr, McLaughlin JK, Johansen C. Cellular
telephone use and cancer risk: update of a nationwide Danish
cohort. J Natl Cancer Inst 2006b; 98:1707-13.
Seitz H, Stinner D, Eikmann Th, Herr C, Röösli M. Electromagnetic
hypersensitivity (EHS) and subjective health complaints associated
with electromagnetic fields of mobile phone communication – a
literature review published between 2000 and 2004. Sci Total Envir
2005; 349:45-55.
Shirai T, Kawabe M, Ichihara T, Fujiwara O, Taki M, Watanabe S, et al. Chronic
exposure to a 1.439 GHz electromagnetic field used for cellular
phones does not promote N- ethylnitrosourea induced central
nervous system tumors in F344 rats. Bioelectromagnetics 2005;
26:59-68.
SSI’s Independent Expert Group on Electromagnetic Fields. Recent Research
on EMF and Health Risks. Third annual report from SSI’s Independent
Expert Group on ElectromagneticFields. Stockholm: SSI; 2005.
Tafforeau M, Verdus MC, Norris V, White GJ, Cole M, Demarty M, et al. Plant
sensitivity to low intensity 105GHz electromagnetic radiation.
Bioelectromagnetics 2004; 25:403-7.
UNEP/WHO (United Nations Environmental Programme/World Health
Organization). Static Fields. Environmental Health Criteria 232.
Geneva: World Health Organization; 2006.
Utteridge TD, Gebski V, Finnie JW, Vernon-Roberts B, Kuchel TR. Long-term
exposure of E-mu-Pim1 transgenic mice to 898.4 MHz microwaves
does not increase lymphoma incidence. Radiat Res 2002; 158:357-
64.
Verschaeve L, Maes A. Genetic, carcinogenic and teratogenic effects of
radiofrequency fields. Mutat Res 1998; 410:141-65.
Vrijheid M, Cardis E, Armstrong BK, Auvinen A, Berg G, Blaasaas KG, et al.
Validation of Short-Term Recall of Mobile Phone Use for the
Interphone Study. Occup Environ Med 2006; 63:237-43.
Winker R, Ivancsits S, Pilger A, Adlkofer F, Rudiger HW. Chromosomal damage
in human diploid fibroblasts by intermittent exposure to extremely
low-frequency electromagnetic fields. Mutat Res 2005; 585:43-9.
Wolf FI, Torsello A, Tedesco B, Fasanella S, Boninsegna A, D'Ascenzo M, et al.
50-Hz extremely low frequency electromagnetic fields enhance cell
proliferation and DNA damage: possible involvement of a redox
mechanism. Biochim Biophys Acta 2005, 1743:120-9
Zwamborn APM, Vossen SHJA, van Leersum BJAM, Ouwens MA, Mäkel WN.
Effects of global communication system radio-frequency fields on
well being and cognitive functions of human subjects with and
without subjective complaints. The Hague: TNO Physics and
Electronics Laboratory; 2003 (TNO-report FEL-03-C148). Available
from URL:
http://home.scarlet.be/milieugezondheid/dossiers/gsm/TNO_rapport_
Nederland_sept_20 03.pdf . See also www.gr.nl/pdf.php?ID=1042 .
(accessed 24 April 2007).