Radiation literature survey

Article publication date:

May 2022

Authored by:

Elysha Kolitz et al 

Summary

This systematic review examined the relationship between ultraviolet (UV) radiation exposure and keratinocyte carcinoma (also known as non-melanoma skin cancer) in people with a Fitzpatrick skin type of 4 to 6 and those who rarely experience sun burn and tan easily. UV index based on location, history of phototherapy, history of sunburn and occupational UV exposure were used as measures of exposure. The review screened 29,393 unique articles. Of those 454 articles were assessed by full text with 12 meeting the eligibility criteria and were included into the review. Of the included studies, 11 were conducted on East Asian populations with the remaining study conducted in Chile, and there was 1 ecological study, 2 case-control studies and 9 cohort studies. There were no associations reported between keratinocyte carcinoma and phototherapy exposure in 8 of the studies on East Asian populations. However, the other 4 studies reported an association between keratinocyte carcinoma and UV exposure based on location, occupation, and cumulative sun exposure. The authors also reported that the studies assessed in this review were of low to medium quality. 

Link to:

UV Exposure and the Risk of Keratinocyte Carcinoma in Skin of Color: A Systematic Review

Published in:

JAMA Dermatology

Commentary by ARPANSA:

The result from this study suggested that people of darker skin colour are at risk of skin cancers from outdoor jobs, living at lower latitudes, and greater cumulative sun exposure. This is in line with the advice of the Cancer Council and ARPANSA that recommends that all people in Australia should limit their UV exposure and use a combination of sun protection measures (e.g., clothing and sunglasses, shade and sunscreen). For more information see the ARPANSA factsheet, Sun exposure and health.

The study also reported that phototherapy is not a risk factor for keratinocyte carcinoma in darker skinned people. Other epidemiological studies have also shown no increased risk of skin cancer from phototherapy (Hearn et al 2008, Jeong Ju et al 2021). However, the narrow band UVB that is used in phototherapy has the energy levels to cause DNA damage and in turn cause skin cancer. It is likely that previous studies have not been large enough to identify the small increased risk of skin cancer that these treatments may cause (Hearn et al 2008). This is likely true for everyone regardless of their skin type. Phototherapy medical treatment for people with skin conditions if performed in consultation with a doctor is beneficial and would not inordinately increase a person’s risk of skin cancer. 
 

 

Article publication date:

October 2022

Authored by:

Elwood et al.

Summary:

There have been some case control studies that have found an increased risk of brain cancer associated with mobile phone use. If these results were true, due to the increasing prevalence in use of mobile phones, there would be an increased incidence of brain cancer over time. This study investigated whether the proliferation of mobile phone use had increased the incidence rate of brain cancer in the New Zealand population (aged 10 – 69 years) during 1995-2020. Data on incidence of brain cancers were collected from the New Zealand Cancer Registry, whereas mobile phone use data were estimated from information on mobile phone accounts and consumer surveys. Mobile phone use increased rapidly from 1990 to approximately 50% of the population by 2000 and almost all the population by 2006. There were 7,397 eligible brain cancer cases diagnosed in the study timeframe of which 6677 were glioma. The study found no increased incidence of glioma in the 10 – 69-year age bracket or in the parietal or temporal lobes of the brain which would receive the most radiofrequency electromagnetic energy from using a mobile phone. The authors conclude that the study found no increase in brain cancer related to mobile phone use.

Link to:

Trends in brain cancers (glioma) in New Zealand from 1995 to 2020, with reference to mobile phone use

Published In:

Cancer Epidemiology

Commentary by ARPANSA:

The results of this study are consistent with other major studies including the UK Million Women Study, the Mobi-kids study, the Nationwide Danish cohort study, as well as research conducted by APANSA (Karipidis et al.) and in the Nordic countries which found no association between mobile phone use and the risk of brain cancer. This study adds further evidence that there are no substantiated adverse health effects from exposure to radiofrequency electromagnetic energy from mobile phones and other wireless devices at levels below the limits set in the ARPANSA Safety Standard (RPS S-1). The ARPANSA Safety Standard provides protection to people of all ages and health statuses. It is the assessment of ARPANSA and other health authorities, including the World Health Organization and International Commission on Non-Ionizing Radiation Protection, that there is no substantiated scientific evidence that mobile phones cause any adverse health effect, including brain cancer. 

Article publication date:

September 2022

Authored by:

Zablotska et al.

Summary:

This study assessed the association between the exposures to radon and gamma (γ) radiation and the incidence of lung cancer in a cohort of uranium mine workers in Canada. The cohort of 16,752 workers (~ 92% male) employed during 1932-1980 received exposures to radon and γ-ray radiation and were followed for the development of new lung cancer from 1969 to 1999. The mean (+/-SD) cumulative total dose to the lung in the cohort was 931.65 (+/-1990.90) millisieverts. The cohort data was linked to the Canadian Cancer Data Base, which had more than 82% of the lung cancers confirmed by histology or cytology. Incidence of lung cancer analysis was restricted to male workers (n=15,351), who contributed to a total of 367,253 person-years. The study found that lung cancer incidence was significantly higher in the workers compared with the general Canadian male population. Risks of lung cancer (n=594, 34% squamous cell, 16% small cell, 17% adenocarcinoma) increased with increasing radon exposure. No significant difference in risks by different histologic lung cancer types was found.

Link to:

Association between exposures to radon and γ-ray radiation and histologic type of lung cancer in Eldorado uranium mining and milling workers from Canada

Published in:

Cancer

Commentary by ARPANSA:

The study provides an update on the risk of lung cancer following exposure to radon and γ-ray radiation in an occupational mining setting. The overall conclusion of increased risk of lung cancer among radon-exposed mining workers is consistent with other cohort studies (Lane et al., 2019). Though comparable data from Australia are limited, an Australian study (Peters et al., 2013) has shown an elevated risk of lung cancer among underground mining workers. In Australia, occupational exposure to radon in the uranium mining and milling industry is low and regulated to minimise cancer risk. The Code for Radiation Protection in Planned Exposure Situations sets out the requirements for the protection of occupationally exposed persons in uranium mines. Though an additional risk of lung cancer from radon exposure has been established, the risk is much smaller compared to that from tobacco smoking (ICRP, 2010). Avoiding tobacco smoking ultimately reduces the total lung cancer risk, including that from radon exposure.

Article publication date:

March 2022

Authored by:

Barbant et al.

Summary:

This systematic review and meta-analysis examined the association between extremely low frequency electric and magnetic fields (ELF EMF) and childhood leukemia. The literature search identified 863 studies of which 38 were included in the review. The main meta-analysis included 21 studies and reported a small association between ELF EMF and childhood leukemia when the study results were pooled together (Odds ratio (OR) 1.26; 95% confidence interval (CI) 1.06–1.49). However, when only the 10 studies published after 2000 were assessed the association was no longer present (OR 1.04, 95% CI 0.84-1.29). The authors reported the highest associations between ELF EMF and childhood leukemia in studies that assessed the use of electric blanket (OR 2.75; 95% CI 1.71-4.42) and ELF EMF exposure over 0.4 µT (OR 1.37; 95% CI 1.05–1.80). The authors concluded that prolonged exposure to ELF EMF over 0.4 µT is associated with a greater risk of childhood leukemia. 

Link to:

Exposure to magnetic fields and childhood leukemia: a systematic review and meta-analysis of case-control and cohort studies

Published In:

Reviews on Environmental Health

Commentary by ARPANSA:

The authors reported a decline in the risk of childhood leukemia in studies post 2000. This declining trend in more recent studies has previously been reported in pooled analyses by Kheifets et al (2010) and Swanson et al (2019). Another recent pooled analysis of over 40 studies by Amoon et al (2021) found no association between ELF EMF and childhood leukemia. The reducing risk that has been observed in recent papers could be due to improved methodology particularly in exposure assessment, however, this isn’t completely clear, and the reduced risk could be due to chance or other factors. 

The results from epidemiological studies on the association between childhood leukemia and exposure to ELF EMF have provided conflicting results with both positive and negative associations being reported. There are also problems with the methods in these studies that weaken the conclusion from their results. The factors that could be influencing the observed association include selection bias, misclassification, and other confounding factors (WHO, 2007). These factors are present in the studies used by this meta-analysis, and this prevents a causal association from being made between childhood leukemia and exposure to ELF EMF. 

Experimental studies have identified no substantiated biological mechanism that could explain a possible association between ELF MF and childhood leukaemia (SCENIHR, 2015). This, together with shortcomings of the epidemiological studies, limits any conclusions being made on reported associations between ELF MF and childhood leukaemia. 
 

Authored by:
Deltour et al.

Summary:
Mobile phone use in the Nordic countries has rapidly increased since the mid-1990s. This study investigated whether the increased use of mobile phones has also increased the incidence rate of brain tumours in men aged between 40 and 69 years. Males were chosen because, on average, they used mobile phones more in the study period. The study used data collected from national cancer registries on the incidence rate of glioma in Denmark, Norway, Finland and Sweden between 1979 and 2016. Mobile phone exposure data was collected from other major studies, published in this time period, that reported mobile phone use. There were 18,322 male glioma cases identified for analysis. The analysis found no changes to the underlying incidence trend indicating that there is no increased risk of glioma at a population-level related to increasing mobile phone use. The authors conclude that the study is further evidence that there are no changes in glioma incidence in Nordic countries that is attributable to mobile phone use.

Link to:
Time trends in mobile phone use and glioma incidence among males in the Nordic Countries, 1979–2016

Published In:
Environment International

Commentary by ARAPNSA:
The results of this study are consistent with other major studies including the UK Million Women Study and the Mobi-kids study, as well as research conducted by ARPANSA (Karipidis et al.) which found no association between mobile phone use and the risk of brain cancer. This study adds further evidence that there are no substantiated adverse health effects from exposure to radiofrequency electromagnetic energy from mobile phones and other wireless devices at levels below the limits set in the ARPANSA Safety Standard (RPS S-1). It is the assessment of ARPANSA and other health authorities, including the World Health Organization, that there is no substantiated scientific evidence that mobile phones cause any adverse health effect. For more information, please see the ARPANSA Mobile Phones and Health information page.

 

 

Authored By:

Bodewein et al.

Summary:

This systematic review evaluated the evidence on physiological and health-effects of radiofrequency electromagnetic field (RF-EMF) exposures related to wireless telecommunication devices (e.g. mobile phones, cordless phones, etc.) in children and adolescents. The study included 53 eligible studies: 42 epidemiological and 11 experimental.  The epidemiological studies evaluated health-effects, such as subjective symptoms, cognitive function, behaviour, infant development, and others; whereas the experimental studies assessed brain activity, cognitive function and other physiological parameters. The study showed that there is an inadequate or low evidence of an association between wireless telecommunication related RF-EMF exposures and health effects in children and adolescents.

Link to:

Systematic review of the physiological and health-related effects of radiofrequency electromagnetic field exposure from wireless communication devices on children and adolescents in experimental and epidemiological human studies

Published In:

PLOS ONE

Commentary by ARPANSA:

The review provides a robust evaluation of whether the use of mobile or cordless phone technologies has resulted in health or physiological effects among children and adolescents. The overall conclusion of the review is consistent to the findings of RF-EMF epidemiological studies performed in Australia. Two epidemiological studies conducted in Australian primary and secondary school children demonstrated no association between use of mobile and cordless phones and cognitive effects. Similarly, an experimental study conducted in Australia also did not show any effect on children’s brain activity and cognitive performance following mobile phone-like RF-EMF exposures.

The majority of epidemiological studies conducted so far on this topic share several similar limitations, particularly inaccuracies in ascertainment of personal and/or organ specific RF-EMF exposures and recall bias in RF-EMF exposure reporting (e.g., number and/or duration of calls made or received in the past). ARPANSA has identified that there is knowledge gap in this field and therefore, it is highlighted as one of the areas for further research on RF-EMF and health (

). Therefore, high-quality epidemiological research, using robust tools and methodology, should be continued in this area of research in future to enhance the understanding of potential health effects of RF-EMF exposures in children and adolescents. Based on the current scientific evidence, and consistent with the findings of this review, it is the assessment of ARPANSA that there is no substantiated evidence that RF-EMF exposures from mobile and cordless phones result in any long-term health or physiological effects in human populations, including children and adolescents.

Authored By:

Zhao et al

Summary:

 

This in vivo experimental study examined the impact of radiofrequency electromagnetic fields (RF EMF) exposure on the expression and immune cell production on rats. Rats were split up into 3 groups, two of the groups were exposed to RF EMF at frequencies of either 1.5 or 4.3 gigahertz (GHz) and with a power density of 100 W/m2 for 6 minutes. The third group were exposed to both frequencies for 6 minutes each. The authors reported statistically significant changes in expression and number of immune cells at 6 hours, 7 days and 14 days post exposure compared to rats not exposed to RF EMF. Similarly, a statistically significant increase in the expression of cytokines at 6 hours and 7 days was noted. The study concluded that RF EMF could cause immune suppression at the given exposure. 

 

Link to:

Immune Responses to Multi-Frequencies of 1.5 GHz and 4.3 GHz Microwave Exposure in Rats: Transcriptomic and Proteomic Analysis

Published In:

International Journal of Molecular Science

Commentary by ARPANSA:

The high level of RF EMF exposures used in the study would not be generally encountered by the public in the everyday environment. The exposure level used in the study is up to 13 times that of the maximum permissible whole body public exposure level (7.5 - 10 W/m2) (RPS S-1). Given the high exposure employed in the study the reported effects may have been due to heating. 

Previous studies have looked at the effects of RF EMF exposure on the immune system and conflicting results have been reported (Ohtani et al 2015, Yao et al 2020). The overall evidence of the impact of RF EMF on the immune system has been reviewed by Public Health England’s Independent Advisory Group on Non-ionising Radiation. This review concluded that there is no compelling evidence that exposure to low level RF EMF has an adverse effect on the immune system (HPA, 2012). Further, in reviewing the scientific literature overall it remains ARPANSA’s conclusion that there is no substantiated evidence that RF EMF exposure, below the limits set in RPS S-1, causes any health effects, including effects on the immune system. 
 

Authored By:

Clare et al.

Summary:

The Sun Safe app (iOS) was co-developed by the authors, teenagers, Australian sun health promotion experts, researchers, and digital health developers with the aim of improving sun health knowledge and promoting sun safe practices amongst adolescents. This pilot study aimed to test if the use of the Sun Safe app improved sun health knowledge and behaviour of teenagers (aged 12-13 years). A total of 51 participant completed the study conducted in Western Australia. The participants were split into 2 groups, the placebo group (n=25) which had access to the SunDial app (which notifies the user when sunrise and sunset events occur) and the Sun Safe group (n=26) which had access to the Sun Safe app. Participants completed questionnaires on sun health and knowledge and rated the quality of the app via survey. Improved sun health knowledge was observed in participants given the Sun Safe app, however, they also experienced significantly more sun burn events (relative risk 1.7, 95% confidence interval 1.1, 1.8). The Sun Safe app was rated well by users (average 4.2/5).

Link to:

The Effects of Using the Sun Safe App on Sun Health Knowledge and Behaviors of Young Teenagers: Results of Pilot Intervention Studies

Published In:

The Journal of Medical Internet Research - Dermatology

Commentary by ARPANSA:

The results of this pilot study found that the Sun Safe app participants were more likely to experience sun burn events but also had improved sun health knowledge. This may potentially be a confounding association as it is possible that following a sun burn event participants were more likely to seek information from the Sun Safe app which in turn improved their sun health knowledge. The study has several limitations including its small number of participants, the non-blinding of participants and potential confounding. Further research is required to assess the effects of the Sun Safe app on sun health knowledge and sun-protective behaviour. The Australian Cancer council also has its own app, the SunSmart App, that provides sun protection information and information on the UV levels across Australia. For more information on sun protection please view the ARPANSA sun protection webpage available here.

Authored By:

Chen et al

Summary:

This case series study examined the clinical features of laser pointer related injuries to the eye in children in the UK. A total of 9 children (aged 9-15 years, with injuries to 12 eyes), admitted for eye injuries induced by laser pointers were recruited into the study. All children were healthy prior to injury. Of the 9 children, 3 had deteriorating vision when examined while the remainder were asymptomatic but were referred to the clinic by optometrists who noted incidental macular changes. Exposure to a laser pointer was confirmed in 8 of the 9 cases. The patients were followed up for an average of 25.6 months following the initial referral. The structural macula changes persisted in all cases at follow up, and in one case there was progression in the macula lesion size. The authors conclude that although children may present as asymptomatic there can be permanent structural damage to the macula following a laser pointer exposure to the eye. This can progressively get worse and result in further complications.

Link to:

The Danger of Laser Pointer–Induced Retinal Damage in Children: A Large United Kingdom Case Series and Survey of Public Awareness

Published In:

Journal of Pediatric Ophthalmology and Strabismus

Commentary by ARPANSA:

All laser pointers that are available to the Australian public must have a power output of less than 1 milliwatt (1 mW). Lasers with an output below this are considered safe for accidental exposure due to the low risk of injury to the eye. Protection from laser pointers that comply with this limit occurs as a result of the human instinct called the ‘aversion response’. Laser pointers with power output above 1 mW are prohibited for importation into Australia under the Customs (Prohibited Imports) Regulations 1956. Unfortunately, Australian studies have shown that handheld laser pointers available to the public are not always labelled correctly and may emit energy at harmful levels above 1 mW. In one study, the majority of laser pointers imported into Australia when tested failed to meet the output restriction with outputs well above 1 mW (Wheatley, 2013). ARPANSA is providing advice on laser safety on its website to promote risk awareness and assist in responsible use of handheld laser products. ARPANSA is also working with online marketplaces to address the issue and in particular to facilitate sellers’ compliance with existing regulations. 

Authored By:

Walker et al

Summary:

In Australia, 95% of melanomas and 99% of non-melanoma skin cancers are attributed to overexposure to ultraviolet radiation. This review examined the last 40 years of sun protection policies and achievements in Australia and suggested the need for further action. The cancer prevention program started in 1981 with mass-media campaigns featuring the Slip, Slop, Slap message and an evidence based SunSmart program. Australian sun protection policy has evolved over the years and initiatives like taking the GST tax off sunblock and early childhood sun protection programs have been introduced. However, in Australia skin cancer remains the most common type of cancer and the incidence of non-melanoma skin cancer is greater than all other cancer types combined. The authors state that sun protection policy makers have become complacent and more work needs to be done.  They suggest that future sun protection policies should focus on a comprehensive media campaign, robust data collection and implementing regulatory measures to safeguard children. The review concluded that these measures offer the best opportunity to consolidate the current sun protection programs and protect future generations from preventable skin cancer. 

Link to:

Forty years of Slip! Slop! Slap! A call to action on skin cancer prevention for Australia

Published In:

Public Health Research and Practice

Commentary by ARPANSA:

Australia has one of the highest rates of skin cancer in the world. At least two in three Australians will be diagnosed with skin cancer by the age of 70. The major cause of skin cancer is exposure to ultraviolet (UV) radiation from the sun. However, UV induced skin cancer is almost entirely preventable. It is important that all Australians are aware of the damages of UV exposure from the sun and high-profile awareness campaigns have been the backbone of how Australians have been informed of this danger for the last 40 years. 

One of the best sources of information on sun protection and skin cancer is the Cancer Council website. The Cancer Council provides information of skin cancer causes, prevention, diagnosis, screening, and early detection. The major sun protection messaging that both ARPANSA and Cancer Council still promote is the Slip, Slop, Slap Seek and Slide as it can provide a high level of UV protection. However, it is still good to be out of the sun in the middle of the day when the UV is at its peak. 

ARPANSA operates UV monitors that provide real time data on UV levels for cities across Australia. These monitors make up the ARPANSA UV Network and this information can been found on the ARPANSA Ultraviolet Radiation Index webpage. This UV data is also collected and displayed by news organisations and can be found on the Cancer Council website. More information on UV protection can be found on the ARPANSA Sun Protection factsheet.