Radiation literature survey

Review date

17 April 2024

Article publication date

March 2024

Summary

This systematic review evaluated the evidence on exposure to radiofrequency electromagnetic energy (RF-EME) and male fertility both in-vivo and in-vitro. The review included studies on rats, mice, guineapigs, hamsters, rabbits (n=117 animal studies) and human sperm (n=10 studies). The studies employed a wide range of RF-EMF frequencies (800-2400 megahertz, MHz, the in-vitro studies;  100 MHz – 10 gigahertz, GHz,  for most of the animal studies). The specific absorption rate (SAR) exposure levels ranged from 0.00003 to 27.5 W/kg (for human studies); and 0.000012-184 W/kg (for animal studies). The review examined the included studies based on the GRADE approach which assesses the certainty of evidence. For human studies, a small detrimental effect of RF-EME exposure on sperm vitality (standardized mean differences (SMD) −1.37 (95 % confidence interval (CI) −2.46 to −0.28)), and no-effect on DNA/chromatin alterations (SMD −0.17 (95 % CI −0.48 to 0.13)) were reported. However, these results showed very low certainty of evidence. For the animal studies, a reduction in pregnancy rate (odds ratio (OR) 2.39 (95 % CI 1.52 to 3.74) and no-effect on litter size (SMD 0.04 (95 % CI −0.15 to 0.23)) were observed. These animal endpoints showed moderate certainty of evidence; whilst the other animal endpoints showed very low or low certainty of evidence. 

Link to

Effects of radiofrequency electromagnetic field (RF-EMF) exposure on male fertility: A systematic review of experimental studies on non-human mammals and human sperm in vitro

Published In

Environmental International 

ARPANSA commentary

The review concluded that no conclusions could be made on the effect of RF-EME on male human fertility based on the evidence. However, it is important to note that the RF EME exposure levels reported by the systematic review for a reduction in pregnancy rate, which is the only negative effects outcome with a moderate level of certainty in the evidence, had an average exposure across the studies of 23.87 W/kg. This average exposure  which is over 28,000 times the public limit for whole body average exposure set in the ARPANSA safety standard (RPS S-1) and theICNIRP RF guidelines. Further, the authors reported that 75-80% investigating human fertility exposed human sperm RF EME levels above the safety limits. There are a number of other limitations identified in the review including issues with blinding, experimental procedures not following the recommended guidelines, use of inappropriate exposure levels and sources of bias not being considered. 

The effect of RF-EME on fertility has been reviewed by ICNIRP in their 2020 guidelines and they concluded that RF-EME has no adverse effects on human fertility, reproduction, or development. Overall, there remains no consistent scientific evidence that exposure to RF EME below the limits set in ARPANSA safety standard or the ICNIRP RF guidelines are a hazard to human fertility.

Review date

March 2024

Article publication date

March 2024

Summary

This prospective cohort study on Mobile Phones and Health (COSMOS), examined association between long-term mobile phone use and risk of brain tumours. The study recruited 264,574 adult participants in Denmark, Finland, the Netherlands, Sweden and the UK during 2007–2012. Data on brain tumour (glioma, meningioma or acoustic neuroma) occurrence in the participants was obtained through cohort linkage to respective national cancer registries. Data on the participants’ mobile phone use (number of years since start of regular mobile phone use or cumulative hours of mobile phone call-time) were collected from the participants at baseline (i.e., at the beginning of the study). A total of 149 participants were diagnosed with glioma, 89 with meningioma, and 29 with acoustic neuroma during follow-up (median follow-up of 7.1 years). The risk estimate per 100 cumulative hours of mobile phone call-time was 1.00 (95% CI: 0.98–1.02) for glioma, 1.01 (95% CI: 0.96–1.06) for meningioma, and 1.02 (95% CI: 0.99–1.06) for acoustic neuroma. Over 15 years of mobile phone use was not associated with an increased tumour risk. These results showed that the cumulative amount of mobile phone use is not associated with the risk of developing glioma, meningioma, or acoustic neuroma.

Published in

Environmental International

Link to

Mobile phone use and brain tumour risk – COSMOS, a prospective cohort study

ARPANSA commentary

The conclusion of the study demonstrate that long-term mobile phone use is not associated with the risk of developing glioma, meningioma, or acoustic neuroma. The overall conclusion of this study is consistent with the findings of previous prospective cohort studies (Schuz et al., 2022; Schuz et al., 2011; Frei et al., 2011), the Interphone case-control study  (Interphone Study Group, 2010), a recent review by the US Food and Drug Administration on RF-EMF and Cancer, and studies investigating trends in brain tumour incidence rates over time (Elwood et al., 2022; Deltour et al., 2022), including an Australia study (Karipidis et al., 2018). 

The current study has a major strength over previous studies that it is the largest multinational prospective cohort study. The study adopted a robust approach for collecting detailed data on the participants’ mobile phone usage to overcome the limitation of recall bias, exposure measurement error and exposure misclassification to a large extent, which otherwise would have biased the risk estimates. Notable limitations of the study include the collection of mobile phone use data only at baseline, and inclusion of relatively small numbers of meningioma and acoustic neuroma cases, which limits the statistical power of the study.

Based on the current scientific evidence, and consistent with the findings of this study, it is the assessment of ARPANSA that there is no substantiated evidence that mobile phone use (resulting in RF-EMF exposures at levels below the limits set in the ARPANSA Safety Standard) cause any adverse health effects, including brain tumours in humans populations. The World Health Organization is currently assessing available evidence on potential human health effects (including brain tumours) of radiofrequency electromagnetic field (RF EMF) exposure, including that associated with mobile phone use. The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is supporting this process.

Review date

March 2024

Article publication date

February 2024

Summary

The study analysed historic incidence and mortality data related to cutaneous malignant melanoma between 1980 and 2020. Data analysis was performed for each eligible country and was further divided by gender and age group, one age group between 20-44 years and another age group between 45-64 years. 

Globally, from the 2005-2009 period to the 2015-2019 period it was found that mortality has generally declined in both age groups except for a few countries that displayed an increase in mortality rates. Global incidence was either static or trending upwards. The authors primarily attribute recent notable declines in mortality to advances made in melanoma treatments since approximately 2010. 

Incidence in Australia was found to be declining in the 20-44 age bracket and stable in the 45-64 age bracket. The comparatively promising incidence trends in Australia were attributed to prevention programs, effective control of UV exposure and an increased use in high-quality sunscreens. It was further shown that the mortality rate in Australia has declined by 41.7% among men and 47.9% among women in the 20-44 age bracket and in the 45-64 age bracket the mortality rate has also declined by 22.9% among men and 25.5% among women.

The study also identifies a gender difference, with women globally recording higher incidence rates but lower mortality rates than their male counterparts. The authors suggested greater health care awareness in female patients as a potential reason. The unreliable distinction between melanoma and non-melanoma skin cancer on death certificates in most countries was highlighted as a source of bias for older populations.

Published in

Melanoma Research

Link to

Global trends in cutaneous malignant melanoma incidence and mortality

ARPANSA commentary

This study collated data on melanoma incidence and mortality rates in a variety of countries and highlighted a recent downward trend in melanoma mortality rates in many countries including Australia. This downward mortality trend is also seen in data provided by the Cancer Council. While the study details favourable trends for Australia, including a falling incidence rate where many other countries are reporting a rising incidence rate, it should be noted that the actual values of melanoma incidence and mortality rates in Australia remain some of the highest in the world, exceeding the rates found in some other countries by multiple times. 

Skin cancers, including melanoma, are one of the largest public health concerns in Australia with two-thirds of Australians receiving a skin cancer diagnosis of some type in their lifetime. For melanoma specifically, it is estimated that 1 in 21 Australian women and 1 in 14 Australian men will be diagnosed with melanoma by the time they reach the age of 85 (Australian Institute of Health and Welfare 2023). The largest risk factor for melanoma is overexposure to ultraviolet radiation (UVR) from the sun, with as many as 95% of all melanomas being attributed to UVR overexposure (Whiteman et al. 2015,  Armstrong & Kricker 1993).

ARPANSA recommends following the five sun protection principles when the UV-index is over three. ARPANSA administers and maintains UVR monitoring stations across Australia that can be used to see the UVR index in real time across Australia and make informed decisions about sun protection. More information about the risks of sun exposure and methods of sun protection can be found from: The World Health Organization, The Cancer Council of Australia and SunSmart websites.

Review date

March 2024

Article publication date

11 January 2024

Summary

This prospective cohort study examined the association between primary central nervous system (CNS) tumours and chronic external occupational exposure to gamma radiation. The study included 22,377 workers from Mayak Production Association that had been hired to work at a facility with reactors, radiochemical production or plutonium production plants between 1948 and 1982. Radiation exposure was estimated based on ‘Mayak Worker Dosimetry System—2013’ (MWDS 2013). A total of 43 workers who were acutely exposed to radiation and developed acute radiation syndrome as well as 717 workers with missing medical records were excluded from the analysis. The authors examined the excess relative risk of all CNS, glioma and meningioma per Gray (Gy) of external gamma dose. They reported ERR per 1 Gy of external gamma brain dose was 0.05 (95% confidence interval (CI) −0.30 to 0.70) for all CNS tumours, −0.18 (95% CI 0 to 0.44) for gliomas, and 0.38 (95% CI −0.32 to 2.08) for meningiomas. The study concluded no statistically significant association between ionising radiation (IR) exposure and incidence of any CNS cancer type among the workers.  

Published in

Radiation and Environmental Biophysics 

Link to

Risk of central nervous system tumour incidence in a cohort of workers chronically exposed to ionising radiation

ARPANSA commentary

The study found no association between low chronic external exposure to gamma radiation and CNS cancers. This is similar to a study by Kitahara et al (2017), which showed absence of association  between low to moderate cumulative occupational radiation exposure and CNS cancers in radiation technologists (ERR per 100 mGy: 0.1; 95% CI: −0.30 to 1.50). Another study (Boice et al 2022) of medical radiation workers in the United States also found no significant association between cumulative absorbed doses of radiation ( 18.9 mGy - 1.08 Gy) and brain cancers (ERR at 100 mGy = 0.20; 95% CI: − 0.30 to 0.71). The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) states that at low levels (less than 0.1 Gray) IR exposure, the possible increased risk of cancer is uncertain. However, it remains important to track doses of occupational radiation in workplaces as the doses of 100-1000 millisieverts can increase the risk of cancer. 

ARPANSA publishes a series of evidence-based documents to guide Australian radiation protection principles and practices for radiation workers and the general public. For example,The Code for Radiation Protection in Planned Exposure Situations (2020)established a framework in Australia for the protection of occupationally exposed persons, the public and the environment in planned IR exposure situations. A planned exposure situation, is an exposure arising from the planned operation of a radiation source or facility that causes exposure to a radiation source is called a ‘planned exposure’ and in these planned exposure situations, some level of exposure can be expected to occur. The guideline applies the three main principles of radiation protection for planned exposure situations: i) justification (that any activity involving IR exposure should do more good than harm), ii) optimisation (that actual IR exposure, likelihood of exposures and number of exposed persons should be as low as reasonably achievable taking into account economic and societal factors), and iii) dose limits (levels of radiation dose that must not, under normal circumstances, be exceeded). ARPANSA will continue to update the latest science on human radiation protection, including cancer risk associated with IR exposure, in order to protect Australian general public and occupational populations.

Review date

March 2024

Article publication date

December 2023

Summary

This case-control study examined the association between extremely low frequency electric and magnetic fields (ELF EMF) and  all types of childhood leukeamia and or childhood acute lymphoblastic leukeamia. The study included 182 cases of childhood leukeamia and 726 population controls matched on sex, year of birth and residential area. Exposure to ELF EMF was assessed based on proximity to transformer station and participants were assigned to the exposed category if they lived within 15 or 25 meters of a transformer station. Distance to a substation was determined based on residential address. Potential confounders were mitigated by adjusting the results for traffic-related air quality, distance from high voltage powerlines, annual fuel supply of petrol stations within 1000 meters and urban area density or agricultural crop density within 100 meters. The authors reported no association between proximity of less than 15 meters to transformer stations and childhood leukeamia (<15 m, odd ratios (OR) 1.0; confidence interval (CI) 0.2 – 4.9) or childhood acute lymphoblastic leukeamia (<15 m: OR 1.0; CI 0.2 – 4.9). They also reported no association between proximity of less than 25 meters to transformer stations and childhood leukeamia (<25 m: OR 1.2; CI 0.4 – 3.4) or childhood acute lymphoblastic leukeamia (<25 m: OR 0.7; CI 0.2 – 2.6). The authors also found no association between proximity of less than 15 or 25 meters to transformer stations and any childhood leukeamia type when age was split by the <5 and ≥ 5 years of age. 

Published in

Environmental Research 

Link to

Residential exposure to magnetic fields from transformer stations and risk of childhood leukemia

ARPANSA commentary

The authors make statements throughout their discussion that their results provide evidence for association between residential proximity to transformer stations and childhood leukeamia. This is false for several reasons. Firstly, they do not report any statistically significant association between distance to transformer stations and any childhood leukeamia. Secondly, they make these claims based on evidence that only includes at most 5 exposed cases. Thirdly, the study assigned exposure to participants who live less than 15 or 25 meters from transformer stations, however, measurements have shown that when you are between 3-7 meters away from a transformer the associated ELF EMF will on average be <0.4 µT. When more than 10 meters away ELF EMF will usually be <0.2 µT (Kandel et al 2013). The average magnetic field in the home can range from <0.1 to 1 µT. This indicates that the proximity of participants to transformer stations may have had no effect on their ELF EMF exposure level or their likelihood to develop childhood leukeamia, unless their home was extremely close to a transformer station. Overall, the claims made by the authors are baseless and due to the methodical shortcomings of the study it provides no evidence of an association with childhood leukaemia.

Some epidemiological studies observing outcomes from exposure to ELF MF greater than 0.3 or 0.4 µT have shown an association with childhood leukaemia (SCENIHR 2015). However, this association has not been established by consistent scientific evidence. The epidemiological evidence for this association is weakened by various methodological problems such as potential selection bias, misclassification and confounding. Furthermore, it is not supported by laboratory or animal studies and no credible theoretical mechanism has been proposed on how ELF MF could cause cancer. Overall, the scientific evidence does not establish that exposure to ELF EMF in the everyday environment is a hazard to human health. 

Review date

23 February 2024

Article publication date

January 2024

Summary

This systematic review and meta-analysis evaluated the current evidence on the association between longer-term or repeated radiofrequency electromagnetic field (RF-EMF) exposure and tinnitus, migraine and non-specific symptoms among the general and working populations. A total of 13 papers (including 486, 558 participants), which reported local (e.g., brain) or whole-body RF-EMF exposure for at least 1 week were included in the review.  The associations between RF-EMF exposure to the whole-body or brain and the health outcomes were examined in terms of pooled relative risk (RR) or standardized mean difference (SMD). The synthesis of evidence was conducted according to the OHAT guidelines.

For tinnitus, the pooled RR was 1.43 (95% Confidence Interval, CI: 0.94 to 2.18) per 100 minutes of wireless phone call time per week. For migraine, the RR was 1.2 (95% CI: 1.1 to 1.3) for mobile phone subscribers compared to non-subscribers. For headache, the pooled change in SMD was 0.64 (95%CI: -2.38 to 1.10) per 100 minutes of wireless phone call time per week. For sleep disturbances, the pooled change in SMD was 1.51 (95% CI: - 2.00 to 5.03) per 1 V/m of exposure. For non-specific symptoms, the pooled change in SMD was 1.13 (95% CI: - 0.94 to 3.20) per 1 V/m of exposure. Overall, the findings of the review showed that there is no association between RF-EMF exposure and the investigated health outcomes. However, the absence of associations reported is based on very low certainty evidence. The results also indicated that RF-EMF exposure below the values defined in the International Commission on Non-Ionising Radiation Protection (ICNIRP) guidelines  does not cause tinnitus, migraine or any non-specific symptoms.

Link to

The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A systematic review and meta-analysis on human observational studies

ARPANSA commentary

The review provides state-of-the art evidence on whether a long-term RF-EMF exposure to whole-body or brain is related to adverse health outcomes in the general and working populations. The included studies in the review have numerous limitations, including indirectness of the exposure surrogate (e.g., self-reported number/duration of phone calls or mobile phone subscriptions resulting in near field exposure), self-reported health outcomes and the relatively short follow-up periods in longitudinal studies. Very low certainty evidence on the associations reported in the review was attributed to a limited number of studies, possible risk of bias in some studies, inconsistencies, indirectness, and imprecision. The review indicates that exposure to RF-EMF below the limits described in the ICNIRP guidelines does not cause the health effects investigated in the study. This is in line with the public health message of the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) on RF-EMF exposure and health. The general public RF-EMF exposures in Australia generally are far below the human  safety  limits given in the Australian safety Standard (e.g., RPS-S1) and the ICNIRP limits. The Australian Safety Standard, developed by ARPANSA, is consistent with the ICNIRP guidelines and is based on validated international scientific evidence. Further, the findings reinforce the assessment of ARPANSA that there is no substantiated evidence that RF-EMF exposures at levels below the limits set in the Australian standard cause any adverse health effects, including those assessed in this review. The review forms a part of the World Health Organization’s ongoing project to assess potential health effects of RF-EMF in the general and working population and ARPANSA is supporting this process.

Review date

29 February 2024

Article publication date

09 February 2024

Summary

This systematic review examined if adverse health effects are evident in children born to parents who were exposed to ionising radiation prior to conception. The review evaluated 127 publications between 1988 and 2018, a companion study covers publications between 2018 and 2021. Studies were grouped by health outcomes (e.g., pregnancy outcomes, genomic anomalies, cancer, mortality rates and non-cancer diseases) and analysis was further segmented by exposure scenario (e.g., occupational, atomic bomb survivors or environmental). Pregnancy outcomes were further divided into congenital abnormalities, perinatal mortality, birth weight and other.

For almost every category, it was reported that there was inadequate evidence to conclude whether there is or isn’t an effect associated with any exposure scenario, the authors identifying inconsistencies in the conclusions and methodologies of studies within the same category. The exception to this assessment was for congenital abnormalities in occupationally exposed populations, where the evidence suggested ‘high confidence for an effect’. However, the study warned against assigning significance to this conclusion as it was based on only eight studies, including two with small populations. When these two studies were excluded, the conclusion was inadequate evidence, which was congruent with the other assessments of congenital abnormalities.  The authors note difficulties in identifying populations where there was certainty that ionising radiation exposure occurred prior to conception and that there was no exposure after conception. Further, the review suggests a need for studies to improve homogeneity in their methods and reporting of results, provide accurate dosimetry and share data to improve the statistical power of the available evidence.

Link to

A systematic review of human evidence for the intergenerational effects of exposure to ionizing radiation 

ARPANSA commentary

This review presents a synthesis of studies on the effects of preconceptual exposure to ionising radiation on health outcomes for subsequent progeny.

There are some flaws in how the reviewers have applied the systematic review protocol. Among other issues, the authors assert that they are following Cochrane’s guidelines for their statistical analysis. These guidelines state that there are limited circumstances where a complete meta-analysis and its accompanying statistical measures can be eschewed in favour of other methods. Despite many studies in this review meeting eligibility for a meta-analysis, the authors did not conduct meta-analyses of the results and instead relied on vote-counting to determine a direction of the effect. Vote-counting does not consider the statistical significance or size of the effect reported in an individual study or account for the relative scales of each study.

With these shortcomings in mind, the overall findings of the review showed inadequate evidence for health outcomes on the progeny of parents that were exposed to ionising radiation prior to conception. A finding of ‘inadequate evidence’ indicates that the evidence does not support an affirmative or negative conclusion for the existence of an effect. However, the authors rightfully infer that if there is a health effect, it is small and difficult to measure. Therefore, the study calls for increased homogeneity in both testing protocol and reporting of results, echoing other studies (Rooney et al., 2014; Walker et al., 2018).

It is worth noting that many of the population groups in the studies included in this review are the offspring of occupationally exposed persons or survivors of historic nuclear events and disasters where exposure to ionising radiation was uncontrolled.

The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) periodically reviews and publishes the latest evidence on sources, effects and risks of ionising radiation exposure (e.g., UNSCEAR 2020/2021 Report Volume I). These reports are regarded as principal sources of authoritative information on this topic. Similarly, the International Commission on Radiological Protection (ICRP) provides guidelines to protect people and the environment from the harmful effects of ionising radiation. This study contributes to a broader effort by an ICRP task group designed to review the scientific literature on the effect of ionising radiation on the offspring of exposed individuals. Reviews like this one will help to inform decisions about whether radiological protection systems require revision.

Consistent to ICRP guidelines, the Australian Radiation Protection and Nuclear Safety Agency has a set of regulations for controlling exposure to ionising radiation. These regulations ensure that the benefits of personal exposure, where exposure cannot be eliminated (e.g. X-ray radiography), are balanced against potential harm and that this harm is minimised.

Review date

17 January 2024

Article publication date

8 January 2024

Summary

This review compares the guidelines and restrictions set by various international, national and regional bodies for exposure to radiofrequency electromagnetic fields (RF-EMF). A total of 10 RF-EMF guideline documents are reviewed. The comparison shows very similar guidance provided by each of the peak international bodies: the International Commission on Non-Ionizing Radiation (ICNIRP) and the Institute of Electrical and Electronics Engineers (IEEE). Minor differences are found between these guidelines and those set by the Federal Communications Commission (FCC) at particular frequencies due to differences in the assessment of RF-EMF absorption within the human body.

Further examination of guideline documents showed that ICNIRP’s limits have been adopted by a majority of countries. The authors address the more conservative limits (1-2 orders of magnitude lower than ICNIRP) adopted by a subset of countries as well as some proposed extreme limits (6 orders of magnitude lower than ICNIRP). As a part of their evaluation, the authors assert that these lower limits, particularly the extreme limits, do not have a scientific basis. Conversely, USA and Japan are identified as the only two countries with less restrictive limits than elsewhere in the world as they take their guidance from the FCC.

The authors also contextualise the limits by comparing them to measurements of RF-EMF exposure in the environment that members of the public may be exposed to from sources such as mobile telephony and Wi-Fi. This comparison demonstrates that the average RF-EMF exposure in the environment is far below the limits set by ICNIRP and is also below the more conservative limits set by other countries and bodies.

Link to

Personal exposure to radiofrequency electromagnetic fields: A comparative analysis of international, national, and regional guidelines

Published in

Environmental Research 

ARPANSA commentary

This review clearly presents the similarities and differences between RF-EMF exposure limits set by different countries and how they compare to guidance from international bodies, similar to a 2018 report that ARPANSA has previously summarised. The report highlights that the exposure to RF-EMF experienced by the public, including by people in Australia, remains well below the limits set by safety standards. The review’s criticisms of the more conservative limits set by some countries echoes criticisms presented in similar reviews in the past (Madjar, 2016).  

In Australia, exposure to RF-EMF is limited by the ARPANSA Safety Standard which details exposure limits for the general public and for occupationally exposed people. The ARPANSA Safety Standard is congruent with the limits set by ICNIRP and with those adopted by most countries worldwide. The standard is designed to protect people of all ages and health statuses against all known adverse health effects from exposure to RF-EMF. The standard is based on current scientific research that shows the levels at which harmful effects occur and it sets limits well below these harmful levels.

Review date

December 2023

Article publication date

October 2023

Summary

This systematic review and meta-analysis examined the association between electromagnetic fields (EMF) and miscarriage or spontaneous abortion. This report included six epidemiological studies (3 case-control, 1 nested case-control and 2 cohort studies) to synthesise the evidence on the topic. The quality of the included studies was assessed using the Newcastle-Ottawa Scale and the authors reported that all included studies were of high quality. The included studies assessed both radiofrequency (RF) EMF and extremely low frequency (ELF) EMF exposure sources as a result of mobile phone use, home ELF-EMF levels, home RF-EMF levels and electricity power lines. The study reported that both EMF  exposure was significantly associated with miscarriage with a risk ratio of 1.70 (95% confidence interval: 1.12 - 2.36).

Link to:

Electromagnetic Field Exposure and Abortion in Pregnant Women: A Systematic Review and Meta-Analysis

Published in

Malays J Med Sci

ARPANSA commentary

Although the results from this study indicated a potential risk of miscarriage associated with EMF exposure, they are difficult to interpret and rely on due to methodological issues in the review and the limited epidemiological evidence available. First, the authors amalgamated all different types of exposure sources (i.e., ELF EMF and RF EMF). A meta-analysis is meant to be uniform in how it examines exposure and this deviation from standard scientific practice reduces the evidence value of the study overall and prevents any real conclusions from being drawn (Wong and Raabe 1996). The authors also reported a high heterogeneity of 84.55% which indicates that the included studies were all quite different. A heterogeneity this high means the overall outcome of the study could be due to random chance (Imrey, 2020).

There is also an issue with how the author assessed the quality of a study. The authors seem to have assessed the studies overall and not by assessed outcome. This could have affected the results of the review and contributed to an incorrect assessment of the level of bias. An example of this is the included study by Lee et al (2002) that reported the highest risk ratio. The study had a 50% loss to follow-up for the outcome used by this review, however, the authors still rated this part as being unlikely to introduce bias. This is incorrect and a 50% loss rate would result in selection bias. This is even stated in the study by Lee et al (2002).

The authors only assessed one outcome from each of the included studies and made no justification on how individual outcomes were selected. This could indicate that they cherry picked the results of the included studies to get the result they wanted.  

Overall, there remains limited evidence on the potential effect of miscarriage due to EMF exposure. The Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) in 2015 assessed potential health effect of EMF exposures to humans and concluded that the available evidence does not show any effect of EMF on the reproductive function in humans. A recent systematic review on animals conducted by the World Health Organization (WHO) also found that RF EMF exposure does not have a detrimental effect on fecundity of animals (Cordelli et al 2023).

Review date

November 2023

Article publication date

October 2023

Summary

This study presents the World Health Organization/International Labour Organization joint estimates of occupational exposures to ultraviolet radiation (UVR) globally and attributable non-melanoma skin cancer (NMSC) deaths and overall disease burden (i.e., disability-adjusted life year or DALYs) for the years 2000, 2010 and 2019. Occupational exposure to UVR was estimated using occupation as a proxy for outdoor work, involving 763 cross-sectional surveys from 96 countries/areas. Attributable NMSC burden was estimated by applying the population attributable fraction (PAFs) to WHO’s estimates of the total NMSC burden. The study reported that 1.6 billion workers (28.4 % of the working-age population) were occupationally exposed to UVR across the world in 2019. Globally, the PAFs were 29.0 % [95% uncertainty range  24.7–35.0)] for NMSC deaths, and 30.4 % (UR 29.0–31.7) for DALYs. Attributable NMSC burdens were 18,960 deaths (UR 18,180–19,740) and 0.5 million DALYs (UR 0.4–0.5). During 2000–2019, attributable deaths and DALYs almost doubled; and men and old age populations carried larger burden. The study also reports that Australia has one of the highest rates of NMSC burden and rate of death associated with occupational UVR exposure. The study concluded that UVR exposure is responsible for a considerable and growing attributable burden of NMSC; therefore, occupational outdoor UVR exposure is a significant hazard.

Link to

Global, regional and national burdens of non-melanoma skin cancer attributable to occupational exposure to solar ultraviolet radiation for 183 countries, 2000–2019: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

Published in

Environment International - Volume 181

ARPANSA commentary

The (International Agency for Research on Cancer, IARC) classifies solar UVR as a Group 1 carcinogen (IARC, 1992). The global burden of occupational UVR exposure estimated by this study shows that occupational UVR exposure is the third largest attributable burden of cancer globally. Therefore, the estimations of NMSC deaths and DALYs associated with occupational UVR exposure are significant. A key limitation of this study is that UVR exposure estimations were done based on exposure assigned via occupation as a proxy that experts judged as always working outdoors rather than data gathered employing personal exposure measurements. This might have introduced some exposure misclassification bias, which results in under- or overestimation of the exposure and subsequent estimation of the burden/risk of disease. Notably, a recent WHO systematic review and meta-analysis (WHO, 2021) reported limited evidence for an association between occupational UVR exposure and skin cancer.

In Australia, skin cancer accounts for the largest number of cancers diagnosed each year (Australian Institute of Health and Welfare, 2016). A study reports that 22% of workers are occupationally exposed to UVR (Carey et al., 2014) along with other known carcinogens. Therefore, the findings of this study highlight the need of adequate sun protection for outdoor workers internationally, including Australia. This is supported by both IARC and Australian national (e.g., Cancer Council Australia Sun safety | Cancer Council) recommendations for current sun protection. ARPANSA recommends that all people including workers should limit their UVR exposures, and a combination of sun protection measures (e.g., clothing and sunglasses, shade and sunscreen) should be used, wherever applicable. For more information see the ARPANSA factsheet, Sun exposure and health.