Radiation literature survey

Article publication date

September 2025

ARPANSA review date

21 November 2025

Summary

This study updates previous estimates of the proportion of cutaneous melanoma incidence attributable to ultraviolet radiation (UVR) by examining data from 2022. Data on national estimates of cutaneous melanoma cases from 154 countries were extracted from the World Health Organization’s GLOBOCAN 2022 database. Population attributable fractions (PAFs) related to UVR exposure were calculated by sex, age, and country using a minimally exposed Nordic 1930 birth cohort reference population for comparison.The estimates were adjusted for acral lentiginous melanoma, which is not associated with UVR exposure and accounts for about half the cutaneous melanoma cases in dark-skinned populations. The study showed that most of the global cutaneous melanoma burden in 2022 (n=267,353 cases; 57% of them in males) was UVR-attributable. The PAF estimates increased with age; 76% among people aged 30–49 versus 86% among people aged 70 or more years. In Australia/New Zealand, Northern Europe, and North America, more than 95% of cutaneous melanoma cases attributable to UVR exposure. The highest attributable age-standardized rates (per 100,000) were found in regions with populations of lighter skin colour: Australia/New Zealand (76), North Europe (37), and North America (34). The study concluded that excess UVR exposure accounts for more than four-fifths of the global cutaneous melanoma incidence.

Published in

International Journal of Cancer

Link to study

Global burden of cutaneous melanoma incidence attributable to ultraviolet radiation in 2022

ARPANSA commentary

This study provides an updated global estimate of cutaneous melanoma burden for countries and regions categorized by sex and age. Further, the study also improved the earlier methods of estimating PAFs of UVR (Arnold et al., 2018) by adjusting cutaneous melanoma rates to the relative proportion of acral lentiginous melanoma for darker-skinned populations. Regional trends of cutaneous melanoma rates remain similar to earlier estimations (Arnold et al., 2018).  Very high rates in Australia and New Zealand are attributable to high ambient levels of UVR exposure (Xiang et al., 2014; Olsen et al., 2010). As highlighted in the study, most of the global cutaneous melanoma burden is UVR-attributable and hence the role of sun protection remains important in reducing cutaneous melanoma burden. 

The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) measures the UV index in various locations in Australia and publishes this data in real-time. In view of preventing skin cancer occurrences, Australia promotes the world leading SunSmart program, which recommends people to adopt a combination of five sun protection measures whenever the UV index is 3 or above. The sun protection measure includes Slip (on clothing), Slop (on SPF30 or higher), Slap (on a hat), Seek (a shade), Slide (on sunglasses). ARPANSA also provides evidence-based public health messages in relation to UV protection measures, including sun protection factsheets. The SunSmart Global UV app provides real time sun protection advice for Australian and major international cities to inform people about sun protection measures.

Article publication date

October 2025

ARPANSA review date

November  2025

Summary

This commentary discusses the recently published set of systematic reviews that were commissioned by the World Health Organization (WHO) to evaluate various health endpoints in relation to radiofrequency electromagnetic field (RF-EMF) exposure. The commentary presents criticisms of some aspects of each review with a particular focus on those relating to human observational studies (SR1 A & B, SR3A & B, SR5), oxidative stress (SR9) and non-specific symptoms (SR7, SR8). The commentary touches on study selection criteria, purported authorship bias, the use of meta-analysis and other direct criticisms of included studies. The conduct of risk of bias (RoB) and certainty of evidence (CoE) assessments were also the subject of criticisms as well as some additional semantic commentary around phrasing used in GRADE CoE statements. 

Published In

Melnick et al. Environmental Health

Link to study

https://pubmed.ncbi.nlm.nih.gov/41034851/

Commentary by ARPANSA

Cancer in human observational studies (SR1 A and B)
SR1 A and B remain the most comprehensive and highest-quality systematic reviews on human observational studies investigating RF-EMF and cancer; they conclude that RF-EMF does not cause cancer with varying degrees of certainty for different cancers based on the availability of evidence. The primary criticisms of SR1 by Melnick et al., are due to the inclusion of the Danish cohort study which bases exposure on mobile phone subscription. The exposure assessment in the Danish cohort study has been validated, showing a clear distinction between subscribers and non-subscribers, with only 16% of non-subscribers actually using a mobile phone (Schuz & Johansen, 2007), meaning its exposure assessment can be rated very well and far better than previous studies. The conclusions of SR1 on brain cancer, in particular, are supported by the Cosmos study, (Freychting et al., 2024), which is the most comprehensive observational study to date, that includes a large cohort of participants and assesses exposure via questionnaires on mobile phone use and operator data. The Cosmos study found no association between mobile use and brain cancer, but this result was not included in SR1 because it was published after the cut-off date for inclusion.  Melnick et al., also criticised SR1 for how it assessed exposure comparisons saying it was too basic and only used exposure metrics like“ever versus never mobile phone use”. However, SR1 goes beyond simple exposure proxies by analysing duration of use and dose-related metrics such as cumulative call time and number of calls.

Cancer in experimental animals (SR2) 
In contrast to their criticisms of the other systematic reviews, the commentary praised the systematic review on the effect of RF-EMF on cancer in experimental animals despite the significant flaws in the narrative synthesis of SR2. An extensive critique of SR2 can be found on the ARPANSA website. 

Adverse reproductive outcomes (human observational studies) (SR-3 A and B)
The reviews (SR3A and SR3B) provide state-of-the art methods on investigating whether RF-EMF exposure is related to reproductive outcomes in human populations. Melnick et al, comments that the use of surrogate measures of expo­sure (hours of mobile phone use), do not provide reliable information on exposure to the genitalia or the developing foetus. However, this is a valid and widely accepted approach in epidemiological studies when objective exposure data are unavailable (Teschke, 2003). Another criticism of Melnick et al. is that evidence on the effects of RF-RMF on female reproduc­tive outcomes was made without consider­ation of the extensive literature on oxidative stress due to RF-EMF exposures. Although several experimental studies suggest that RF-EMF exposure may induce oxidative stress, the validity of these findings is undermined by heterogeneity, and other methodological limitations that have been described in  the systematic review on oxidative stress (SR9) (Meyer et al., 2024). 

Male fertility in both in-vivo and in-vitro studies (SR4)
The main criticism for SR4 by Melnick et al. was that they believe that for some of the outcomes where effects were found, the certainty of the evidence should not have been downgraded. They argue that heterogeneity in the included papers does not impact the certainty of results. This is counter to standard systematic review methodology, such as  outlined in the GRADE assessment, which typically considers methodological heterogeneity as a source of inconsistency that reduces confidence in the overall body of evidence. By dismissing these variations as inconsequential, the authors risk overlooking important sources of bias or effect modification that could influence the interpretation of results. Melnick et al., suggests that the conclusions for SR4 should be changed because of some negative results, particularly those reported for laboratory animals and human sperm in vitro. However, the only negative outcome with a high level of certainty in the evidence, had an average exposure across the studies of 23.87 W/kg. This average is over 28,000 times the public limit for whole body average exposure set in the ARPANSA safety standard (RPS S-1)

Effects on cognition in human observational studies (SR5)
Melnick et al. had various criticisms of SR5, one of the mains ones being that a study by Grigoriev et al. (2018) should not have been excluded. However, this study was excluded due to significant methodological flaws, particularly, the lack of a description of exposure assessment, follow-up protocol and participant details.  For instance, the study fails to account for mobile phone use changing between the age of 7 to 17 years, which is critical given that previous research (Thomas et al., 2010; Bhatt et al., 2017) consistently shows increased mobile phone use as children age. Therefore, its exclusion from SR5 is well-founded. Regarding the exclusion of other studies, namely, cross-sectional studies were excluded as they are unable to establish causality, and this reason is clearly described in SR5 and its protocol.

Effects on cognitive performance in human experimental studies (SR6)
Melnick et al.’s main criticism of SR6 is the use of the neuropsychological assessment classification system for cognitive domains (Lezak et al., 2012) and suggest that the incorrectly cited Cattell-Horn-Carrol (CHC) taxonomy should have been used. However, the cognitive domains used for grouping the systematic review outcomes are in fact based on CHC taxonomy and Lezak et al. (2012) only describes ways these different domains can be tested for. This comment by the authors is therefore invalid. Melnick et al., further criticise the heterogeneity of the included studies stating this would reduce the ability of the meta-analyses to detect a small effect. Statistical power is an issue that was discussed in the systematic review and remains an issue in the literature, particularly in singular one off studies. However, the pooling data for use in a meta-analysis, as done in this systematic review, is how the lack of statistical power in the literature can be alleviated.  

Symptoms (human observational studies) (SR-7)
Melnick et al. purport that the health outcomes (tinnitus, migraines, and sleep disturbances) included in SR7 should not have been evaluated. This is contrasting to literature which clearly shows individuals report both of these as short-term and long-term effects (Medic et al., 2017; Lipton et sl., 2001; Zeleznik et al., 2024). The authors also criticised one of the key included studies, the COSMOS study (Auvinen et al., 2019), allegedly citing its inappropriate study methodology, such as exclusions and follow-up time. The COSMOS study excluded the subjects with a history of tinnitus or weekly headaches at baseline to avoid potential reverse causation. This is a common practice in epidemiological studies when the goal is to test the relationships between environmental exposures and health outcomes (Rezende et al., 2022). This approach helps isolate the effect of preexisting conditions and those that align with outcomes after exposure (Poorolajal, 2025). The four-year follow-up period in the COSMOS longitudinal cohort study is a strong design choice for evaluating health symptoms (Kamal et al., 2025). The methodological approaches adopted in the COSMOS study, represent the most robust design and are well supported by evidence.

Human experimental non-specific symptoms (SR-8)
With respect to the systematic review on non-specific symptoms in human experimental studies (SR-8) Melnick et al. assert that, because studies on people without idiopathic environmental intolerance attributed to EMF (IEI-EMF, also known as electromagnetic hypersensitivity or EHS) were included in the review, it cannot effectively review studies on people with IEI-EMF. However, in SR8, the analyses were subdivided by IEI-EMF and non IEI-EMF populations. The commentary also questions why human provocation studies using EMF frequencies outside of the RF section of electromagnetic spectrum are excluded from the review and suggests that their exclusion prevents consideration of the results of studies using RF-EMF exposure. SR-8’s protocol, and the entire set of systematic reviews more broadly, clearly define the exposure that is to be studied and so a large departure of the review from this paradigm would be inappropriate. The inclusion criteria of SR-8 adequately cover the topic under investigation (RF-EMF).

Oxidative Stress (SR-9)
The primary criticism Melnick et al. ascribe to the systematic review on the effect of RF-EMF on biomarkers of oxidative stress (SR-9) is the inclusion criteria. Melnick et al. take issue with the fact that numerous studies were excluded from SR-9 for using an unreliable method of outcome assessment and that studies were excluded for not adequately characterising their exposure system. However, both reasons are valid causes for exclusion regardless of the number of studies that fall under that category. The secondary criticism Melnick et al. have of SR-9 is the subdivision of the meta-analyses into biomarker and biological system pairs which they assert may dilute an overall effect. However, combining outcomes across different organs and markers would create a lack of specificity thus reducing the usability of the results for directing further research and drawing conclusions relevant to human health outcomes. Combining biomarkers and biological systems into a net category only enables vague discussions of miscellaneous oxidative stress. 

ARPANSA has written brief evaluations of each systematic review and published them as part of our radiation literature survey program. They are available here: SR1A & 1B, SR2, SR3A & B, SR4, SR5, SR6, SR7, SR8, SR9.

Date of publication

24 September 2025

Article review date

09 October 2025

Summary

This research article investigated media reports of injuries from cosmetic non-ionising radiation (NIR) use like laser and intense pulsed light (IPL) treatments in Australia. Australian news media between 2008 and 2023 was searched for reports of adverse outcomes from cosmetic NIR treatments and 95 unique instances of injury were found. Laser treatments accounted for 60 of these cases and IPL treatment accounted for 29. More injuries arose in non-clinical settings (60 reports) as opposed to clinical settings (18 reports) and women comprised the overwhelming majority of reported adverse effects. Approximately twenty percent of reports involved permanent injury. In cases that described a causative factor, 93 percent indicated that operator related factors contributed to the injury. 

Commentary on the regulatory environment for cosmetic NIR treatments was also provided which noted the lack of national uniformity in regulation across Australian jurisdictions. Also of note were anecdotal reports relating to the apparent absence of judicial recourse for victims and slow regulatory responses in jurisdictions where regulations exist. 

Published in

Journal of Bioethical Inquiry

Link to article

Burned in Pursuit of Beauty: Injuries From Cosmetic Use of Non-Ionizing Radiation and Associated Regulatory Gaps

ARPANSA commentary

Cosmetic treatments utilising NIR exposures necessarily require people undergoing treatments to experience an over-exposure for the purported effects to eventuate. As such, careful and considered use is required to manage the relatively small margin between the intended effect and an adverse outcome. ARPANSA has published advice for both consumers and treatment providers involved in laser, IPL and LED phototherapy treatments to help avoid the occurrence of adverse effects. Additional information can be found in a 2020 statement by the International Commission on Non-ionizing Radiation Protection which provides detail on the different types of exposures and similarly concludes that there is potential for harm from cosmetic NIR devices.

A limitation of the methodology adopted by the article is the reliance on media reporting for identification of adverse events. This is unlikely to result in a complete and representative sample as only the most severe injuries gain media attention. However, absent any mandated reporting structure implemented by regulation or similar, this limitation is somewhat unavoidable. Further reporting complications are presented by the increased availability of small consumer grade ‘at-home’ cosmetic devices whose misuse is unlikely to be reported.  

Currently, the existence and extent of regulation for cosmetic NIR devices in Australia varies greatly across the state jurisdictions (Karipidis, K. et al., 2019). In 2015, ARPANSA sought consultation on a regulatory impact statement detailing the potential implementation of a national regulatory framework for cosmetic NIR treatments. While support existed for the implementation of stronger regulation, ultimately there was insufficient evidence for the extent of harm within Australia to justify the impact of regulation. Further information and analysis can be found in ARPANSA technical report 177. The current article contributes evidence that may be used in future to support stronger regulatory practice.

Article publication date

May 2025

ARPANSA review date

October 2025

Summary

This Australian human experimental study examined if radiofrequency electromagnetic fields (RF EMF) misinformation could impact the release of the stress hormone cortisol and electromagnetic hypersensitivity (EHS) symptoms. The study included 144 participants who were randomly assigned to watch either an alarmist video about the harm of RF EMF or an unrelated control video before being either exposed or not exposed to RF EMF in an open label trial. The study tested for participants’ reported non-specific symptoms of exposure, salivary cortisol levels and their belief that RF EMF exposure could cause harm before and after watching the alarmist video. The study found that watching an alarmist video did not increase the rate that participants experience symptoms or increase cortisol levels. The authors concluded that awareness and belief of exposure play a more important role in symptom perception than a physiological release of a stress hormone. 

Published in

Health and wellbeing 

Link to study

What is the effect of alarmist media and radiofrequency electromagnetic field (RF‐EMF) exposure on salivary cortisol and non‐specific symptoms? - PMC

Commentary by ARPANSA

The results are consistent with previous studies reporting that knowledge or awareness of being exposed to RF‐EMF increases symptoms (Eltiti et al 2007, Verrender et al, 2018).. Furthermore, studies have shown that people who report to have EHS cannot detect the presence of RF EMF better than those who don’t report to have EHS (Van Moorselar et al. 2016; Verrender et al. 2018). 

One limitation of the study is that the anticipation of the RF EMF exposure, or an increased stress level from being in a new environment, may have already increased the participants cortisol levels (Barthel et al 2025). A habituation period and retesting of the cortisol levels are not mentioned within the study protocol. If cortisol levels remained high throughout the testing period, this may have prevented the testing from being able to show an impact of the alarmist video on cortisol (Nejtek 2002, Barthel et al 2025). 

A recent World Health Organization commissioned systematic review (Bosch-Capblanch  et al., 2024) concluded that EHS symptoms self-attributed to everyday RF-EMF are more likely to be a result of the nocebo effect. The systematic review also aligns with the advice by ARPANSA and the World Health Organization (WHO) that exposure to the low levels of RF EMF experienced by the public is not the cause of non-specific symptoms experienced by some individuals. 

Article publication date

August 2025

ARPANSA review date

September 2025

Summary

This experimental cell (in vitro) study evaluated the effect of exposure to 5G radiofrequency electromagnetic fields (RF-EMF) on oxidative stress and DNA repair in human skin cells. Cells were either given no exposure (i.e., sham exposed) or exposed at 3.5 GHz frequency to specific absorption rate levels of 0.08 W/kg and 4 W/kg; a constant temperature of 37 °C at tissue sample level was maintained throughout the exposure. Oxidate stress on the cells was evaluated by assessing production of reactive oxygen species (ROS) following 24 hours exposure; adaptive response and DNA damage repair efficiency of the exposed cells were evaluated after the cells were exposed for 20 hours and up to 48 hours, respectively. The findings of the study showed no significant effect of 5G RF-EMF exposure, either alone or in combination with a ‘positive control’ (e.g., arsenic trioxide ROS inducer). Further, the RF-EMF exposure neither induced an adaptive response to oxidative stress or impaired DNA repair efficiency of the exposed cells. The study concluded that 5G RF-EMF exposure at a constant temperature (37 °C) does not affect oxidative stress levels, trigger an adaptive response, or interfere with DNA repair processes in human skin cells.

Published in

Scientific Reports 

Link to study

Impact of in vitro exposure to 5G-modulated 3.5 GHz fields on oxidative stress and DNA repair in skin cells | Scientific Reports

Commentary by ARPANSA 

The study findings indicate that 5G RF-EMF exposure well above prescribed whole body general public limits (e.g., in the ARPANSA safety standard) of 0.08 or 4 W/kg does not result in oxidative stress, trigger adaptive response, or impair DNA repair efficiency in human skin cells. These findings are consistent to the recent conclusions of the Swedish Radiation Safety Authority and WHO commissioned review  (systematic review). They reported  statistically non-significant results for most of the outcomes; though some showed significant effects. Nevertheless, for all outcomes irrespective of whether or not they reported an effect, the studies were rated as very low certainty of evidence.  The review also highlighted the need for future quality studies to support evidence-based emerging RF-EMF health risk assessments. Overall, ARPANSA views that there is no substantiated scientific evidence that RF-EMF exposure (including from 5G at 3.5 GHz) below the limits set in the ARPANSA safety standard, which is aligned with the international best practice ICNIRP guidelines, poses a  health risk to human populations. 

Article publication date

March 2025

ARPANSA review date

September 2025

Summary

This study examined the Ultraviolet radiation (UVR) protection of shade cloths and natural shade present in 10 playgrounds on Australia’s Sunshine Coast. The study used UV light meters to assess the UVR levels, expressed as a UV index, in open space, underneath trees, shade cloth and shelter sheds. A 3D model of the parks was also generated to evaluate the amount of shade in the parks. The study found that the amount of shade in each park varied by a large margin from 25.9% to 77.2% and so did the ultraviolet protection factor (UPF) of the shade cloths which ranged from 5.1 (low protection) to 14.9 (moderate protection). In open spaces, the UV index was reported as between 21.5 and 26. Under the shade cloths, despite the low protection ratings, the UV index was substantially lower, ranging from 1.7 to 5. The authors concluded that the shade cloth in many of the parks needs to be updated as many of the UPF ratings were below 15, whereas ARPANSA recommends UPF ratings of 15 or above (ARPANSA, 2025). They also suggested that shade in general should be increased in parks to ensure users are provided with more protection. 

Published in

Carvolth & Tavares
Journal of Urban Design

Link to study

Full article: Ultraviolet radiation (UVR) exposure in playgrounds: an Australian case study

Commentary by ARPANSA

This study unfortunately has a glaring problem with their UV measurements that detract from what is otherwise an interesting study. The issue is that the UV index levels they are reporting are all wildly above the levels that exist in the natural environment. The reported UV index values for the open sky of between 21.5 and 26 are far above the midsummer maximums measured in ARPANSA’s UV monitoring network for Brisbane and more extreme UV environments like Darwin. This is despite the measurements in the study being conducted in midwinter (July) where typical maximum values for Brisbane are around 4. There is therefore a clear issue with their measurement apparatus in setup or interpretation and the reported measurements are not UV index levels or erythemally weighted irradiance as the authors believe. They also used their reported UV index levels to calculate the protection factor for playground shade cloth. This means that all the UV related information they report is incorrect and cannot be used to evaluate sun safety in parks. 

The study still reports on shade coverage and the methods they used for this are sound and provide usable data. The results for each park were reported individually and the authors could have done more with the data they collected which would allow for a better snapshot of shade in the parks. An interesting picture unfolds when examining the data by quartiles. We found that in the 3^rd quartile there was a 53% shade coverage meaning that 75% of parks had less than 53% shade coverage. The recommendations for shade coverage of playground by the NSW Cancer Institute is 70% (Cancer Institute NSW, 2025). The requirements for Queensland are that all play equipment be fully covered (Queensland Department of Health). 

Overall, despite the errors in this study, ARPANSA agrees with the sentiment of the authors that sun protection needs to be a focus when designing or upgrading parks. Australia has some of the highest rates of melanoma and overall skin cancer in the world and two-thirds of Australians will receive a skin cancer diagnosis of some type in their lifetime. One of the best ways for Australians to protect themselves from the sun is by following the Slip, Slop, Slap, Seek and Slide messaging. More information on UV protection can be found on the ARPANSA Sun Protection factsheet. 

Article review date

10 September 2025

Article published date

25 July 2025

Summary

This article discussed the current state of knowledge on skin cancer prevention in relation to sunscreen use. The article first provides an overview of the established causative link between ultraviolet (UV) radiation exposure and skin cancer as well as the associated burden of disease. It also describes the efficacy of sunscreen use in preventing skin cancer noting significantly reduced risk for skin cancer among sunscreen users. The larger portion of the article discusses finer details of sunscreen use and clinical recommendations for health practitioners in addition to highlighting challenges.

The study highlights that outdoor workers, children under two years old, people with deeply pigmented skin or, conversely, oculocutaneous albinism and the immunocompromised require tailored sun protection advice. A lack of high-quality research investigating sunscreen use in people with diverse skin tones, particularly those with deeply pigmented skin, poses challenges when making clinical recommendations for these populations especially with respect to balancing the harms and benefits of sun exposure. The article also notes that general sun protection behaviours remain driven by warm conditions rather than objective measures like the UV index, leaving people vulnerable to UV overexposure that can easily occur on cold, overcast and cloudy days.

Published in

British Medical Journal

Link to article

Skin cancer prevention and sunscreens

ARPANSA commentary

Skin cancer is a major public health problem in Australia with two-thirds of Australians receiving a skin cancer diagnosis in their lifetime where 95% of all melanomas are attributed to UV overexposure (Whiteman et al. 2015,  Armstrong & Kricker 1993). Although advances in treatment for melanoma have aided in reducing mortality, the incidence rates in Australia remain some of the highest in the world (De Pinto et al., 2024; Australian Institute of Health and Welfare, 2024). 

The conclusions of the article relating to the high efficacy of sunscreens agrees with other reviews (Sander  et al., 2020), including those published by ARPANSA (Henderson et al., 2022). However, it is important to remember that, as noted in the article, sunscreen is just one of the five sun protection principles and should not be relied on exclusively for sun protection. ARPANSA recommends following all five sun protection principles whenever the UV index is over three.

The article correctly identifies limited research into all factors of sunscreen use among people with deeply pigmented skin. Although this causes associated challenges in providing sun protection advice, the Australian Skin and Skin Cancer Research Centre has recently published a position statement on balancing the harms and benefits of sun exposure which contains sun exposure recommendations that vary depending on a person’s skin type, location in Australia and the time of year. The position statement can be used in conjunction with knowledge of the UV index or the SunSmart Global UV application to make well-informed decisions on sun exposure. 

Article publication

10 March 2025

Article review date

August 2025

Summary

This systematic review evaluated the evidence for an association between the ingestion of naturally occurring radionuclides in drinking water and cancer risk in populations. A total of 29 studies (20 ecological, 6 case-control and 3 case-cohort studies) published between 1966 and 2017 were included in the review. These studies mainly evaluated cancer risk of the bone, urinary tract, and gastrointestinal tract in relation to radium, uranium, and radon ingestion. Quality assessment of the included case-control and case-cohort studies was conducted according to the Newcastle-Ottawa Scale (NOS); ecological studies were considered as low quality. The review presented a narrative description of all the results from the included studies. Overall, the review indicated no elevated risk of cancer from the ingestion of drinking water containing naturally occurring radionuclides. However, some studies indicated an elevated risk of cancers in lung, kidney, breast and bone. However, due to a lack of high-quality studies the evidence from these studies was considered poor. The review concluded that the current evidence does not allow to confirm or rule out an increased risk of cancer due to the ingestion of radionuclides in water at concentrations that occur naturally.

Published in

Science of the Total Environment

Article link

Cancer risk due to ingestion of naturally occurring radionuclides through drinking water: A systematic review

ARPANSA commentary

This review provides an evaluation of whether naturally occurring concentrations of radionuclides in drinking water pose any increased risk of cancer in human populations. The findings largely indicate that there is no cancer risk due to this, however, the review also acknowledges that methodological limitations of most of the included studies challenge the certainty of risk evaluation. The limitations of the included studies were in exposure assessment and dosimetry, low statistical power, and inadequate control of confounders. Further, the included studies did not assess the association in relation to the ingestion of polonium, thorium and lead. The review did not undertake a quantitative synthesis of results such as a meta-analysis or a certainty in evidence assessment..

The Australian Drinking Water Guidelines (NHMRC, 2022) sets out  a radioactivity screening level at which consumption of drinking water will not exceed the Australian national reference level dose  of 1 mSv per year for exposure to ionising radiation. It has been estimated that  a very low proportion  (10%) of the total annual dose in Australian populations is from natural radionuclides in drinking water (NHMRC, 2022). In fact, such low radiation exposure occurring over a long period of time is unlikely to show any detectable increase in health risk (e.g., cancer) in populations (Guseva Canu et al., 2011). The Australian system for radiation protection from ionising radiation is closely aligned with international best practice as laid out in the recommendations of the International Commission on Radiological Protection. In the Australian context, exposure to ionising radiation from drinking water falls under the Guide for Radiation Protection in Existing Exposure Situations (2017).

Article publication date

July 2025

ARPANSA review date

July 2025

Summary

This study evaluated the global burden of skin cancer among adults 65 years or older from 1990 to 2021 and used this information to project the global burden out to 2050. The study used data collected from the cancer registries of 204 countries and territories, including Australia, that are detailed in the Global Burden of Disease (GBD) Study 2021 database. Cancer incidence was collected for melanoma, and keratinocyte cancers (KC) including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). The authors calculated the incidence rates per 100,000 people for these skin cancers. 

Melanoma incidence rates in 2021 were 20 (per 100,000) and projected to fall by 40% to 12 (per 100,000) by 2050. Both KC skin cancer types are expected to rise by 2050 with a 148% increase in BCC and a 53% increase in SCC. The incidence of skin cancers was higher for men than women both in 2021 and in 2050. The study concluded that the incidence and prevalence of keratinocyte cancers skin cancer in older people is likely to increase and there is a need to enact prevention and treatment strategies for these high-risk populations.

Published in

JAMA Dermatology 

Link to

Burden of Skin Cancer in Older Adults From 1990 to 2021 and Modelled Projection to 2050

ARPANSA commentary

This ecological study reported that, despite some decreases in melanoma incidence, overall skin cancer incidence is expected to rise globally between now and 2050 due to increases in SCC and BCC. There were limitations with the data as some countries do not provide data on SCC and BCC in their cancer registries. Australia also does not report on incidence of BCC and SCC as they are generally not life-threatening, often requiring only simple excision for treatment. This lack of reliable data could affect the accuracy of these forward projections, particularly for Australians.

The downward trend in melanoma incidence in Australia has been observed in a previous study (Pinto et al 2024) and is also confirmed by Cancer Council data. However, despite this positive outcome, melanoma incidence and mortality rates in Australia remain some of the highest in the world and two-thirds of Australians will receive a skin cancer diagnosis of some type in their lifetime. As such, skin cancers, including melanoma, continue to constitute a large public health burden. 

This study indicates that further work is needed to improve Australians’ sun protection behaviours and improve awareness to avoid the dire predictions this study has made for skin cancer incidence in the future. There needs to be continued focus on UV index awareness in Australia and the Slip, Slop, Slap, Seek and Slide messaging to prevent future skin cancers. Awareness of current UV index levels can be improved by utilising ARPANSA’s network of monitoring stations in Australia or through the freely available SunSmart Global UV app which also carries information for international cities. More information on UV protection can be found on the ARPANSA Sun Protection factsheet. 

Article publication date

13 May 2025

ARPANSA review date

25 July 2025

Summary

This systematic review examined the scientific body of evidence for the effect of extremely low frequency electric and magnetic fields (ELF-EMF) exposure on carcinogenesis and co-carcinogenesis in laboratory animals. The review included 13 studies on carcinogenesis and 41 studies on co-carcinogenesis. The review did not conduct a quantitative synthesis of evidence due to large differences in experimental design between studies. Instead, the review provided a narrative overview of the included literature. Included studies were also assessed for their risk of bias (RoB) according to OHAT.

The review found that there is broadly no evidence for a carcinogenic effect from ELF-EMF exposure alone. Results from co-carcinogenesis studies were varied with some reporting statistically significant effects and others reporting none, however, the authors assess that the total weight of evidence is inadequate to make definitive conclusions. It was noted that most studies reporting statistically significant effects utilised exposure magnitudes within the range of 100 to 999 µT. Forty of the included studies were evaluated to be at low RoB and it was noted that studies with higher RoB were more likely to report statistically significant effects. Clear indications of publication bias were also found in the review. 

Published in

Environmental Research

Link to study

Carcinogenicity of extremely low-frequency magnetic fields: A systematic review of animal studies 

ARPANSA commentary

This review considered cancer endpoints in laboratory animals resulting from ELF-EMF exposure. While the review did not pursue a meta-analysis and thus lacks quantitative results, it does collate a large amount of evidence and provide descriptive statistics which can be used to generate hypotheses. The major shortcoming of this approach is that the review has a notable focus on effect versus no-effect, which has no consideration for effect size or study precision. It is especially important to acknowledge this limitation given that the authors found clear evidence of publication bias among the included studies. This type of bias can have a large impact in binary evidence synthesis methods where statistical significance is the key differentiator between two groups as publication bias can result in an over-representation of statistically significant results in the literature (Thornton, A. & Lee, P., 2000).

The overall conclusion of the review is consistent with the World Health Organization’s assessment of in vivo studies (WHO, 2007) as well as prior reviews (McCann et al., 2000). 

ELF-EMF exposure in the general environment arises primarily from electrical supply infrastructure like powerlines, substations, home electrical appliances and wiring. However, it should be noted that the levels encountered in the environment are far below the levels used in most of the studies included by the review and far below the range specified in the review where included studies reported the highest proportion of co-carcinogenic effects. ARPANSA has measured ELF-EMF exposures present in Australian homes and in close proximity to powerlines and substations (Karipidis, K. 2015; Urban, D. et al., 2014). The exposures measured are all far below the international guideline values described by the International Commission on Non-Ionizing Radiation Protection. ARPANSA continues to monitor and review scientific literature related to ELF-EMF exposure and various health endpoints, including cancer. For more information see the ARPANSA factsheet Electricity and Health.