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Article ID: WMC003946 ISSN 2046-1690

Health effects of Mobile Phone

Corresponding Author:
Dr. Hala Awadalla,
professor, Institute of Environmental Studies and Research, Abbassia, 11566 - Egypt

Submitting Author:
Dr. Hala Awadalla,
professor, Institute of Environmental Studies and Research, Abbassia, 11566 - Egypt

Article ID: WMC003946

Article Type: Review articles
Submitted on:11-Jan-2013, 12:23:36 AM GMT Published on: 11-Jan-2013, 06:14:09 PM GMT
Article URL: http://www.webmedcentral.com/article_view/3946
Subject Categories:PUBLIC HEALTH
Keywords:Mobile cancer sleep epidemiology
How to cite the article:Awadalla H. Health effects of Mobile Phone . WebmedCentral PUBLIC HEALTH
2013;4(1):WMC003946
Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution
License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the
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WebmedCentral > Review articles Page 1 of 24

WMC003946 Downloaded from http://www.webmedcentral.com on 11-Jan-2013, 06:14:10 PM
Health effects of Mobile Phone
Author(s): Awadalla H
Abstract
The increased use of mobile phone by the public is
accompanied by a wave of contradictory reports about
the possible health effects, which result from exposure
to electromagnetic fields (EMF) by the phone’s user
and neighbors of stations. Given the immense
numbers of users of mobile phones, even small
adverse effects on health could have major public
health implications. This article reviews the present
knowledge concerning the biological and medical
effects of exposure to cellular phone. However, this
knowledge still contains certain gaps which should be
filled. Health conditions which have reported to the use
of mobile phones mainly include some types of cancer,
changes of brain activity and effect on hearing. The
numerous epidemiological studies relative to the
occurrence of cancer by exposure to electromagnetic
fields are conflicting. The absence of associations
reported thus far is less conclusive because the
current observation period is still too short. Currently
data are completely lacking on the potential
carcinogenic effect of exposures in childhood and
adolescence. This review summarizes the current
state of evidence concerning whether the
radiofrequency fields (RF) energy used for wireless
communication might be hazardous. Relevant studies
were identified by searching Medline.
Introduction
The public focus on cancer as a health concern of RF
exposure may be a spillover from anxiety about the
carcinogenic effects of ionizing radiation, rather than
being due to any direct biological theories or findings
relating to RF exposure.( Rothman, 2000)
The nocebo hypothesis states that expectations of
sickness cause sickness in the expectant individual.
Maintaining anxiety by fostering doubts in gullible
populations about the quality of the environment they
live in may cause serious mental illness. Anxiety
caused by health scares is an increasing public health
problem, which should be addressed in its own right.
(Bonneux, 2007)
Change is the only constant in the world, or better said,
advancement and evolution is imperative to any field
of science and technology. Computing and
WebmedCentral > Review articles
communication science has seen drastic change in the
past decade or two. (Chauhan, 2002) These systems
then end up in landfills and are not regular municipal
waste. They contain many hazardous substances like
heavy metals, non-biodegradable materials and
persistent, bioaccumulative toxins. Various end-of-life
options need to consider for such substances. The
inherent property of pervasiveness is mobility and use
of unwired devices. The communication among such
devices has to be through the air instead of wire. The
only media presently used for this wireless
communication is the part of electromagnetic spectrum
(the radio frequency). Constant exposure to this
frequency is a cause of concern among some
researchers. Though there is no study, which has
consistently shown the health hazard from RFR (radio
frequency range), but this does not prove the
non-existence of the hazard. This paper is an attempt
to make the reader aware of threat to human life and
environment, caused by mobile devices and wireless
communication and suggest some solutions to the
same.(Chauhan, 2002)
Mobile phones also called cellular phones are an
integral part of modern telecommunications. In many
countries, over half the population already uses mobile
phones and market is still growing rapidly (WHO,
2000). Since their introduction in a few countries in the
1980s, mobile phones have gone from being
expensive items that were mainly used by the
business elite, to being communication tools used by
the general population. (Samkange-Zeeb and Blettner,
2009)
When considering just the sheer numbers of published
studies, the number of the no-effect studies is larger
than the number of the studies that show an effect.
This is commonly referred as the “weight of the
evidence” that is pointing out to the no effect- result,
as the prevailing one. This argument is often used as
evidence indicating that there are no health effects
below the present safety standard limits. We need to
determine what kind of important health-related
studies have not yet been done and, therefore, what
important health-related evidence we are missing.
Only when considering both, the available and the
missing evidence, we can more reliably judge the
reliability of the current safety standards. (Leszczynski
& Xu, 2010)
In view of the current limited state of knowledge
concerning the possible adverse health effects of RF
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exposure, and of the increasingly widespread use of
portable telephones in many countries, research – in
particular epidemiological studies – must be carried
out to determine whether radiotelephones could cause
adverse health effects. (Cardis and Kilkenny, 2001)
Our main aim in this paper is to give a broad outline of
the environmental and health concerns that have
arisen from mobile phone use, and to summarize what
is known about these adverse effects. We will focus
not only on effects that have been investigated
extensively, such as brain cancer, but also on some
outcomes that are currently discussed as being of
potential concern (e.g., hearing and behavioral
problems), which have not yet been studied in
population-based studies.
Uses of mobile phone:
Cell phone usage include: help people feel safe,
financial benefits, manage time efficiently, and keep in
touch with friends and family members. People have
various feeling and attitudes towards cell phone usage
(Aoki & Downes 2003). Self reported mobile phone
use may not fully represent pattern of actual use and
this has implication for calculating exposures from
questionnaire data (Parslow, et al., 2003). For many
parents, they offer an important means of keeping in
touch with their children as they travel to and from
school, sporting activities or meeting with friends.
(Samkange-Zeeb and Blettner, 2009)
Through the global wireless network, participants
scattered across a city or the world can easily
coordinate activities and upload data to servers that
can process it and integrate it with other data, such as
GIS map layers and weather reports, that a variety of
organizations publish on the web. Most modern
phones, and certainly phones of the future, can record
images, motion, and other signals, automatically
associating them with location and time. New
data-modeling techniques can infer a lot about
individuals and the places they inhabit. (Goldman et
al., 2009)
Telehealth technology could encourage better
doctor-patient interaction regarding patient symptoms
and quality of life monitoring, a study carried out
aiming to develop a new system for transmitting
patients self-reported outcomes using mobile phones
or the internet and to test whether patients can and will
use the system via a mobile phone, the results show
that more than half of patients used mobile phone
(Bielli et al., 2004).
A study was conducted to develop a health education
program to reduce body weight via mobile phones
message, a tendency for reduced body weight was
WebmedCentral > Review articles
found in 46% of participants (Kubota et al., 2004). A
program targeting college students that integrates web
and cell phone technologies to deliver a
smoking-cessation intervention, the results provide
support for using wireless text messages to deliver
potentially effective smoking-cessation behavioral
interventions to college students (Obermayer et al.,
2004).
In the year 2000, there were an estimated 500 million
mobile phone users worldwide. Today, there are about
3.3 billion users. (Samkange-Zeeb and Blettner, 2009)
According to the International Telecommunications
Union, the number of cell-phone subscriptions has
reached 5 billion (mid 2010), with more than half of all
users believed to be children and young adults.( Levis
et al., 2011)
Egyptian mobile phone use will exceed 100% by the
end of 2012, claims a new report from Business
Monitor International, as subscriptions climb to
outnumber the country’s actual population. The high
growth in mobile use will be driven by the appearance
of new operators in the market which will serve rural
areas, says the report. It also forecasts 15 % of mobile
subscribers will be using 3G by the year 2015. (Ahram
on line, 2011)
The latest report by the Ministry of Communications
and Information Technology has revealed that the
number of cell phone users inEgyptis 92 million, with a
prevalence rate of 113%, and an annual increase of
27.8%. The same report, published on the ministry's
website, detected a drop in the number of fixed-line
telephone users, now 8.5 million, with a prevalence
rate of 11%, and an annual drop of 12%.
(EgyptIndependent, 2012)
Problems, challenges and limitation of
epidemiological studies:
When evaluating the possible health effects of mobile
phone radiation, as with any other environmental
factor, no matter naturally occurring or man-made, are
needed several types of scientific evidence such as (i)
the possible mechanism how the effect is induced in
living organism, (ii) in vitro laboratory studies that
confirm the existence of a biophysical and biochemical
mechanism of the effect, (iii) animal studies, (iv)
human volunteer studies, and (v) epidemiological
evidence of the effect on human population. Each type
of the evidence is of different significance and value
for the estimation and proof of human health effect.
The most important is epidemiological evidence,
followed by the human volunteer studies and animal
experiments. (Leszczynski & Xu, 2010)
For diseases other than cancer, few studies are
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available and the evidence is inconclusive. In the light
of an absence of any credible biological hypotheses
and convincing experimental results on how low level
RF could cause disease, epidemiologic research is
particularly important. It is also the most relevant
branch of science for risk identification and
assessment because it directly investigates the
putative exposure-disease relationship in humans
under real-life circumstances. (Schüz et al., 2011) In
vitro evidence does not directly inform about the
possible health impact but it provides information
about the possible mechanism of the effect on cellular
level. (Leszczynski & Xu, 2010)
The epidemiological evidence on the association
between a risk factor and cancer is then summarized
according to discrete categories (sufficient, limited,
inadequate, no evidence). The distinctions among
categories are chiefly based on (a) reproducibility of
the evidence; (b) validity (absence of bias and
confounding); (c) role of chance. (WHO, 2000)
Methodological considerations revealed that three
important conditions for epidemiologic studies to
detect an increased risk are not met: a) no
evidence-based exposure metric is available; b) the
observed duration of mobile phone use is generally
still too low; c) no evidence-based selection of end
points among the grossly different types of neoplasias
is possible because of lack of etiologic hypotheses.
Concerning risk estimates, selection bias,
misclassification bias, and effects of the disease on
mobile phone use could have reduced estimates, and
recall bias may have led to spuriously increased risks.
The overall evidence speaks in favor of an increased
risk, but its magnitude cannot be assessed at present
because of insufficient information on long-term use.
(Kundi , 2009)
Epidemiologic studies are based on diagnosed tumors,
whose identification depends not just on the induction
period (period between exposure and initiation of
disease) but also on their latency (ie, how long they
are present before being detected). Latency is likely to
be short for fast-growing maligancies, but could be
decades for less aggressive tumors such as acoustic
neuromas and benign meningiomas. (Ahlbom et al.,
2009) There seems to be a major discrepancy not only
in the results of the executed case-control
epidemiological studies but also in deciding which of
the studies are methodologically of better, more
reliable, quality. We have performed sufficiently many
epidemiological case-control studies but their results
are of insufficient quality to reliably draw any
health-risk-related estimates. (Leszczynski & Xu, 2010)
There is a call for changing methodological approach
WebmedCentral > Review articles
applies also to other areas of EMF research because
when looking at the EMF publications one gets
impression that this research is “stuck” on replication
and re-replication of the studies using the same, often
outdated, methods that in the end do not give
resolution to the problem. (Leszczynski & Xu, 2010).
Analytical epidemiology intends to estimate the risk as
a function of exposure to an agent by application of
one of three classical study types: cross-sectional,
case–control, and cohort study designs. (Kundi , 2009)
In epidemiological studies, exposure assessment is a
challenge and random exposure misclassification is
likely to have occurred in these studies. The
corresponding bias probably diluted any
exposure–response association, if one existed. (Röösli,
2010) In several studies, there were indications that
nonparticipation was related to exposure status, with
mobile phone users more willing to participate than
nonusers. Selection bias introduced by
nonparticipation was estimated to cause a downward
bias of around 10% in odds ratios for regular mobile
phone use. Exposure definitions and methods of
categorization (ever/never use of mobile phones;
definition of regular, heavy, and long-term use; and the
exposure cut points) were inconsistent across studies,
making direct comparison difficult. (Ahlbom et al.,
2009) The Interphone protocol defined regular use as
at least one outgoing or incoming call per week for at
least 6 months, with ever-regular use starting 1 year
before the reference date. Hardell and colleagues
defined the unexposed subjects as those who have
not used a mobile or cordless phone for ≥ 1 year
before diagnosis (or reference date in controls).
(Kundi , 2009) It was concluded that the actual use of
mobile phones was underestimated in light users and
overestimated in heavy users. (Hardell et al., 2008)
For all study designs, it has to be assumed that
exposure to the agent can be assessed with a certain
sensitivity and specificity. In the case of mobile phone
use, the appropriate exposure metric is unknown.
Absorption of electromagnetic energy in the body of
the user depends on technical features of the phone
and the network, as well as on anatomical features
and habits of use. It is obvious that given a certain
indicator of mobile phone use, such as years of
regular use, cumulative number of calls, cumulative
hours of use, or cumulative absorption of
electromagnetic energy in a certain area of the body.
(Kundi , 2009)
Cross-sectional studies are by design limited in their
ability to elucidate causal relationships. For
self-reported outcomes, information bias could create
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spurious exposure–outcome associations if study
participants are aware of their exposure status, which
is to be expected if exposure is assessed on the basis
of distance to a visible transmitter. Selection bias is
also of concern, since people who believe that they
can feel exposure may be more likely to participate in
a study. Cross-sectional studies may reveal effects of
prolonged mobile phone base station exposure if the
applied measures do in fact represent the exposure
level over a longer time period. (Röösli, 2010)
Data collection or selection of study participants was
obviously related to exposure and outcome and
therefore biased. (Röösli, 2010) Method of data
acquisition could be important in several respects: a)
interviews not blinded to case status may introduce a
bias from the expectations of the interviewer; b) the
interaction between interviewee and interviewer as
such can lead to bias (Rosenthal effects); c)
answering a questionnaire at home is less demanding
(especially considering the conditions after surgery)
than personal interviews; d) at home it is possible to
check telephone bills or to inspect contracts with
network providers to verify data. Exposure
assessment in patients could be particularly biased if
conducted by interviews compared with the
questionnaire method (Kundi, 2009), the interviewer
was aware whether they were a case (patient) or a
control, thereby potentially introducing observational
bias. (Hardell et al., 2008) Bias often represents
underreporting of mobile phone use, because it is
more likely that a patient forgot using a mobile phone
once years ago. For these reasons, the questionnaire
method seems to be superior to the interview
technique. However, there are also advantages of the
computer-assisted personal interview (CAPI) method:
data can be immediately checked for errors and
discrepancies, and the interviewer can explain points
that are not clear and may help in recalling inquired
items (Kundi, 2009).
An interview creates a stressful situation for a patient
with a recent brain tumor diagnosis and operation.
These patients, especially under pressure, often have
difficulties remembering past exposures and inevitably
have problems with concentration and may have
problems with other cognitive shortcomings. According
to Hardell experience a better option would have been
to start with a mailed questionnaire that could be
answered by the patient during the period of
well-being. If necessary this can be complemented by
a telephone interview. This procedure has the
additional advantage that it can be accomplished
without disclosure during the data collection, whether
a person is a case or a control. (Hardell et al., 2008)
WebmedCentral > Review articles
Method:
To identify studies on environmental and health effects
of mobile phone use in PubMed/Medline, we searched
the database using various combinations of the terms
mobile phones, electromagnetic fields (EMFs), RF,
microwave, health effects, environmental effects,
subjective symptoms, epidemiology, cancer, hearing
impairment and childhood exposure. Original reports
of research surveys, experimental studies and review
articles were selected. We also used the search
engine ‘Google’ to look for data on the global
prevalence, trends and uses of mobile phones, citing
some newspaper articles and reports identified during
the search. Non-English language articles with
abstracts written in English were also considered.
Impacts of mobile phone:
We became so engrossed in making this technology
unobtrusive that we ignored the long-term negative
effects that this technology is causing on our society.
The threat posed by introduction of such devices can
be classified as:
i) Environmental impacts:
a) Physical waste
b) Energy consumption
ii) Health impacts.
Environmental impacts of mobile phone:
WEEE (waste from electrical and electronic
equipments) is the popular informal name for electrical
and electronic equipment at the end of their useful life.
E-Waste is dangerous as certain components therein
contain hazardous materials that pose a threat to
public health and the environment. Among WEEE are
Information technology and telecommunications
equipment and consumer equipment such as
televisions, stereo equipment, electric tooth brushes,
transistor radios, lighting equipment (fluorescent
lamps). Others are electrical and electronic tools
(handheld drills, saws, screwdrivers), toys (Play
station, Game boy, etc.), large household appliances
(refrigerators/freezers, washing machines,
dishwashers), small household appliances (toasters,
coffee makers, irons, hairdryers), medical equipment
systems (with the exception of all implanted and
infected products), monitoring and control instruments
and automatic dispensers. (Shivoga, 2010)
It poses threat to humans and other flora and fauna in
two ways – direct (environmental) and indirect (health)
hazards. Disposal of these devices, which are soon
becoming obsolete due to introduction of new
generation, are a sever threat to environment due the
dangerous trash that they produce: plastics that do not
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biodegrade, heavy metals that are carcinogenic,
gasses from production and incineration that are toxic,
and landfills that threaten generations to come. This is
the physical waste that cannot be classified under the
regular municipal waste and needs different end-of-life
disposition options. Apart from this physical waste,
another significant environmental concern is the
Energy Consumption. One of the basic requirements
of a mobile device is that it should be energy efficient.
These days, these devices are becoming more and
more energy efficient, but the overall energy
consumption due to such devices continues to
increase as their total number increase rapidly and
their environmental impact is greater than current
devices because of the use of batteries. (Jain et al.,
2002)
Lots of toxic metals and chemicals can be found in
e-waste. If they are not treated properly or not
recycled in a proper way even disposed off in landfills
they can cause adverse effects on human health and
environment as they can leach into the surrounding
soil, water and the atmosphere. Waste contains
poisonous substances like Pb, Sn, and Hg etc. which
give rise to sever diseases like cancer, birth defects,
neurological and respiratory disorders. (Reena1, 2011)
During the life cycle of a mobile phone and its charger
energy consumption is the key environmental impact,
especially in the mobile phone manufacture and use
phases. In addition the use of various materials can
pose a potential risk to the environment and the focus
on recycling in the end of life phase is also key to
reducing the environmental impact of mobile phones.
Extending the lifetime of the product will naturally
reduce resource consumption and disposal burdens.
Health concerns also focus highly in life cycle and
associated studies, for example emitted radiation.
Therefore the core criteria focus on energy use in the
mobile phone and charger system, and materials. The
comprehensive criteria include further aspects of
materials, ecodesign and extending product lifetimes.
(Harwell, 2010)
The 1992 Basel Convention is an international treaty
signed by 169 countries to regulate the international
trade of hazardous waste. The Convention's central
goal is "environmentally sound management" (ESM),
which involves controlling hazardous waste from its
production to its storage, transport, reuse, recycling,
and final disposal. In addition, the Basel Ban
Amendment was adopted in 1995 to outlaw the
transfer of hazardous waste from developed to
developing countries. The Amendment has not yet
entered into force, but several countries have already
implemented the ban, including the European Union
WebmedCentral > Review articles
andChina. However, illegal trading is pervasive and
those who benefit from the waste trade continue to
strongly oppose a global ban with European Union`s
(EU) directives such as WEEE and restriction of
Hazardous substances (ROHS) coming into effect
from 2006 in Europe. E-waste recycling is increasingly
receiving a major trust. (Reena1, 2011)
It is sincerely hoped, however, that the future
generation of mobile phones will not be considered
hazardous waste. This will be a reality not because we
have turned away fromBasel’s text, obligations and
definitions, but because the mobile phones of the
future will cease to contain harmful substances such
as beryllium, arsenic, lead, brominated flame
retardants, and will cease to threaten the environment
and health of future generations. However, such
“greening of design” is not as likely to occur promptly if
we continue to allow the real costs of pollution to be
transferred to weaker economies and populations
desperate for even toxic jobs. (Baselaction network,
2004)
There have been a large number of occupational
studies over several decades, particularly on cancer,
cardiovascular disease, adverse reproductive outcome
and cataract, in relation to RF exposure. Results of
studies on mobile telephone users, particularly on
brain tumors and less often on other cancers and on
symptoms to date give no consistent evidence of
causal relation between RF exposure and any adverse
health effect. (Ahlbom et al., 2004) Occupational RF
exposures are more varied in dose, type of signal, and
anatomical localization than exposures from cellular
telephones. (Rothman, 2000)
Epidemiologic, cellular and animal studies have been
carried out, but none of them have reached definitive
conclusions. Although some biological effects on cell
culture have been observed, their link with human
cancer development is far from established. Most of
the animal studies show negative results. (Colonna ,
2005).
Adaptive power control (a technology to adapt the
transmission power to what is required given actual
conditions, such as distance between the phone and
base station) may reduce the emitted power by as
much as a 1000-fold. With adaptive power control,
exposure is generally higher at greater distance from
the base station (eg, in rural areas) (Lonn, et al.,
2004), when the user is moving (eg, in a car), and in
places where there is intensive use with frequent
handovers. To compensate for the shielding effect of
building materials, power levels of phones are, on
average, higher when a phone is used indoors than
outdoors. The importance of the various usage
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circumstances may vary with geographic location and
over time. In addition to system characteristics, the
radiofrequency exposure also depends on the
characteristics of the phone itself, including the type
and location of the antenna (eg, pull-out rod or built-in)
and the tilt of the phone relative to the head. (Ahlbom
et al., 2009)
The specific energy absorption rate (SAR) is a
measure commonly used to calculate the RF energy
absorbed by the body during mobile phone use.
Mobile phones typically operate at frequencies of
450–900MHz (analogue systems), 1800–1900 MHz
(digital systems) and 1900– 2200MHz Universal
Mobile Telecommunications System (UMTS). The
highest brain SAR values measured in a laboratory
using real mobile phones were reported to be in the
range of 0.9–1.76 W/kg for analogue phones, and 0.44
W/kg for digital Global System for Mobile
Communications (GSM) phones-values that fall below
the International Commission for Non-Ionising
Radiation Protection (ICNIRP) recommendation of 2.0
W/kg. (Samkange-Zeeb and Blettner, 2009) Mobile
phone technology has changed considerably since its
inception, with the earlier analogue phones being
replaced gradually by digital ones. The former
technology operates at a higher power than the latter,
emitting more electromagnetic radiation. (ICNIRP,
2004) A considerable number of long-term mobile
phone users (duration of use X10 years) have used
both analogue and digital phones, and have thus been
exposed to the power settings of both technologies.
(Samkange-Zeeb and Blettner, 2009)
Base stations:
Base stations are low-powered radio antennae that
communicate with user handsets. Given the immense
number of users of mobile phones, even small
adverse effects on health could have major public
health implications. Several important considerations
must be kept in mind when evaluating possible health
effects of radio frequency (RF) fields. One is frequency
of operations, current mobile phone systems operate
at frequencies between 800-1800 mega-hertz (MHz)
such RF field should not be confused with ionizing
radiation such as X-ray or gamma rays. Unlike ionizing
radiation, RF fields cannot cause ionization or
radioactivity in the body. RF exposure to a user of
mobile phone is far higher than to person living near a
cellular base station. However, apart from infrequent
signals used to maintain links with nearby base
stations, the handset transmits RF energy only while a
call is being made, whereas base stations are
continuously transmitting signals (WHO, 2000).
To safeguard human health and the environment, the
WebmedCentral > Review articles
following solutions and recommendations were made:
Sharing of infrastructure such as Base Transmission
Stations (BTS) and fibreoptic cable network so as to
reduce duplication in the physical infrastructure by
service providers, phone number portability and
discouragement of locking of clients to networks
(modems, laptops and handsets on offer) noting that
‘technology’ to go round some of these controls is
already in use, albeit illegally, proper consumer
education and responsibility, capacity building through
curricula in schools, the media and stakeholders
workshops and enforcement of policies, laws and
regulations. (Nyansikera, 2010)
To date, little is known about the levels of
radiofrequency exposure in the general population
from sources such as mobile phones being used by
oneself or other people, mobile phone base stations,
and radio and television transmitters. Measurements
that have been performed have usually been made as
a result of public concern about base station
exposures or other specific sources, and have
therefore been made at locations that could be
assumed to have higher fields than would be the case
if measurement locations were selected randomly.
Furthermore, all measurements have been stationary,
and there is today no knowledge about the level of
exposure that an individual will have throughout the
day. Some countries have set up networks monitoring
the radiofrequency exposure at certain locations, but
again, the locations chosen have been driven by the
existence of base stations or other RF exposure
sources, and do not reflect the RF exposure in the
general population. (Ahlbom et al., 2004)
In a study carried out to examine whether or not
neighbors of cell towers are particularly concerned
about adverse health effects of mobile phones bas
stations (MPBSs), the outcome of this study indicates
that the risk rating is comparable with other perceived
common hazards of civilized world. It is hypothesized
that offering information and participation to the
concerned population will be efficient in reducing
exaggerated fears (Hutteret al., 2004). The performed
study showed the relationship between incidence of
individual symptoms, the level of exposure and the
distance between a residential area and base station.
This association was observed in both groups of
persons, those who linked their complaints with
presence of base station and those who did not notice
such a relation. Further studies, clinical and those
based on questionnaires are needed to explain the
background of the reported complaints (Bortkiewiezet
al., 2004).
The electromagnetic field levels near wireless
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transmitting stations for mobile phones are certainly
modest when we consider that they never exceeded
the limits established by the aforesaid Ministerial
decree. On the contrary radio and television
equipment creates a much greater source of exposure
(L,Abbate et al., 2004)
In conclusion, a review does not indicate an
association between any health outcome and
radiofrequency electromagnetic field exposure from
MPBSs at levels typically encountered in people’s
everyday environment. The evidence of no
relationship exists between MPBS exposure and acute
symptom development. (Röösli, 2010) Comparison of
complaints frequencies for 16 non specific health
symptoms was done. The results showed significant
increase in relation with age of subjects (elder subjects
are more sensitive) and also that the facing location is
the worst position for some symptoms studied
especially for distance till 100 m from base stations.
No significant difference is observed in the frequency
of symptoms related to the duration of exposure (from
1 year to > 5 years) expected for irritability significantly
increased after > 5 years. Other electromagnetic
factors (electrical transformers, radio-television
transmitters) have effects on the frequency of some
symptoms reported by the subjects (Santini et al.,
2003). In this study the complaints include headache,
sleep disturbance, discomfort, irritability, depression,
loss of memory, and dizziness. Women significantly
more often than men complained of headache, nausea,
loss of appetite, sleep disturbance, depression, and
discomfort (Santini et al., 2002).
In a case study, there was a neurological abnormality
in a patient after accidental exposure of the left side of
the face to mobile phone radiation [Code Division
Multiple Access (CDMA)] from a down-powered
mobile phone base station antenna (Hocking &
Westeman, 2001). To entangle the area of mobile
phone availability one needs to find a base antenna
network. This means that the base antennas are
closer and closer to people. Each antenna is the
source of electromagnetic fields and thus it has to be
designed carefully with respect to public health
(Dackiewiez & Krawezyk, 2003). Since antennae
direct their power outward, and do not radiate
significant amounts of energy from their back surfaces
or towards the top or bottom of antenna, the levels of
RF energy inside or to the sides of the building are
normally very low (WHO, 2000).
Health impacts of mobile phone:
The known biological effects associated with these
fields vary with the frequency and intensity of
exposure. Frequency is the number of cycles per
WebmedCentral > Review articles
second that energy wave oscillates. Intensity varies
both with the amount of power emitted (measured by
watts) by the energy source and the distance of the
individual from the source. Different regions of
electromagnetic spectrum may affect biological
systems differently. However, for much of the non-
ionizing radiation spectrum, including RF, we currently
have insufficient scientific information to evaluate the
full range of potential health risk of human exposure
(NIOSH, 1993).
The effect of RF on living organisms may be
didactically divided into the following:
Thermal effects and non thermal effects
1) Thermal effects: these are the best known effects.
They result from water molecule polarization as
electromagnetic waves course through tissues and
produce heat (temperature variation over 1oC).
(Repacholi, 2001) This is the principle behind
microwave ovens and medical diathermy devices.
(Surdulescu & Steward, 2005)
Although from the perspective of the thermal effects
paradigm, the rate of energy deposition in tissues of
the mobile phone user is below levels considered
harmful, there has been debate since the 1930s that
tissue heating may not be the only relevant effect
elicited by exposure to high-frequency EMFs; thus,
there may be a relevant risk that has not been estab-
lished yet because of the scarcity of exposure
conditions that are comparable across a significant
proportion of the population. (Kundi , 2009)
Current evidence indicates that the temperature
elevation resulting from RF exposure is not
carcinogenic. If hyperthermia occurs in the presence
of exposure to known carcinogens, such as radiation
or chemical carcinogens there is the potential for
modulation of carcinogenic effects of those agents. In
some circumstances, hyperthermia can actually
protect against tumor formation. In other instances,
hyperthermia clearly increases incidence of tumor
formation (Dewhirst et al., 2003).
2) Non-thermal effects: these take place with no
temperature change in biological tissues. These
effects have not yet been fully clarified, and are the
reason for many debates among scientists. These
effects include electrical force induction and possibly
an increase in heat shock protein synthesis in cells.
The most significant expression of these proteins
occurs in the physiological cell defense response
against oxidative stress and in osmotic pressure
variations, among other factors. Continuous heat
shock protein synthesis, however, may be involved in
oncogenesis, by inhibiting cell apoptosis. This
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mechanism might explain how chronic exposure to
high RF loads could cause cancer in susceptible
subjects (French et al., 2000) a mechanism that is still
under debate in the scientific community. However
Focke et al., (2010) reported that ELF-EMF might
interfere with the DNA repair process what might
cause accumulation of damaged DNA in cell. If so,
such process could be considered as at least potential
trigger for the development of cancer.
Lim, et al., (2005) carried out a study to determine
whether exposure to mobile phone radiation causes a
non thermal stress response in human leukocytes.
They reported that heat caused an increase in the
number of cells expressing stress proteins heat shock
protein (HSP70, HSP27) and this increase dependent
on time. However no statistically significant difference
was detected in the number of cell expressing stress
proteins after RF field exposure
Genotoxic effect:
Rats were exposed to a far field 1.6 GHz iradium
wireless communication signal for two years. Bone
marrow smears were examined for the extent of
genotoxicity, there was no evidence for excess
genotoxicity in rats that were chronically exposed to
1.6 GHz compared to sham-exposed and cage
controls (Vijayaxmi et al., 2003).
No study thus far has demonstrated that exposure to
RF without thermal effects produces genetic mutations
or chromosomal aberrations in mammal cells, which
suggests that RF cannot initiate tumors (Moulder et
al., 2005). This is in contrary to the results of another
study which indicate that the genotoxic effect of
electromagnetic radiation is elicited via a non-thermal
pathway (Mashevich et al., 2003).
It is known that although humans and animals possess
many of the same genes, the functions of the same
genes might differ and some of the same cancer types
are regulated by different genes in animals and in
humans. This causes that some of the cancers that
will appear in animal will not appear in humans and
vice-versa. (Leszczynski & Xu, 2010)
Effects on fertility:
Data suggest that EMR emitted by cellular phone
influences human sperm motility. In addition to these
acute adverse effects of EMR on sperm motility,
long-term EMR exposure may lead to behavioral or
structural changes of the male germ cell. These
effects may be observed later in life, and they are to
be investigated more seriously. (Erogul et al., 2006) In
the analysis of the effect of GSM equipment on the
semen it was noted that an increase in the percentage
of sperm cells of abnormal morphology is associated
WebmedCentral > Review articles
with the duration of exposure to the waves emitted by
the GSM phone. It was also confirmed that a decrease
in the percentage of sperm cells in vital progressing
motility in the semen is Correlated with the frequency
of using mobile phones.( Wdowiak et al., 2007)
Cancer:
As the head is the part of the body that receives the
most exposure to microwave radiation, several
epidemiological studies have been conducted in
different countries to determine a causal association
between mobile phones and cancer. Most of these
studies focus on brain tumor, while others focus on
salivary gland cancer, intraocular melanoma and
cancer of the hemopoietic and lymphatic tissue. Some
of these studies found a direct correlation between
mobile phone use and increase cancer risk, this risk
increases with increasing latency and duration of
mobile phone use (Kundi et al., 2004).
In an 18-month carcinogenicity study, transgenic mice
were exposed to pulsed 900 MHz (RF) radiation at a
whole-body specific absorption rate (SAR) of 0.5, 1.4
or 4.0 W/kg ,the results showed no effect of RF
radiation under the conditions used on the incidence of
any neoplastic or non-neoplastic lesion, and thus the
study does not provide evidence that RF radiation
possesses carcinogenic potential. (Oberto et al., 2007)
To study the hypothesis that exposure to RF from
mobile phones increases the incidence of gliomas,
meningiomas and acoustic neuromas in adults. The
incident cases were of patients aged 19-69 years who
were diagnosed during 2001-2002 in Southern Norway.
Population controls were selected and
frequency-matched for age, sex, and residential area.
Detailed information about mobile phone use was
collected from glioma patients, meningioma patients
and acoustic neuroma patients and from controls, no
increasing trend was observed for gliomas or acoustic
neuromas by increasing duration of regular use, the
time since first regular use or cumulative use of mobile
phones. The results from this study indicate that use of
mobile phones is not associated with an increased risk
of gliomas, meningiomas or acoustic neuromas.(
Klaeboeet al.,2007)
The overall pattern of results does not support the
presence of an association between mobile telephone
use and glioma. There is no consistent evidence of an
increased risk of meningioma among mobile phone
users. (Ahlbom et al., 2009)
Christensen, et al., (2004) reported that the use of cell
phone for 10 years or more did not increase the risk of
acoustic neuroma over that of short-term users.
Furthermore, tumors did not occur more frequently on
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the side of the head on which the telephone was
typically used and the size of the tumor did not
correlate with the pattern of cell phone use.
Acoustic neuroma can cause unilateral deafness,
which could lead to cessation of phone use (and
hence spuriously reduced risks). Alternatively, the
deafness could lead to the diagnosis of an otherwise
unrecognized tumor and hence lead to spuriously
increased risks. (Ahlbom et al., 2009) Our study group
was the first to report a consistent pattern of an
association between wireless phones and glioma and
acoustic neuroma, whereas this was not found for
meningioma. Meta-analysis of all published studies in
this area using a reasonable latency period of at least
10 years confirmed this finding for use of mobile
phones and ipsilateral glioma and acoustic neuroma,
but no significant association was found for
meningioma. (Hardell et al., 2008)
A retrospective cohort study of cancer incidence was
conducted inDenmark, all users of cellular telephones
during the period from 1982-through 1995. The results
of this investigation, the first nationwide cancer
incidence study of cellular phones users, do not
support the hypothesis of an association between use
of these telephones and tumors of the brain or salivary
gland, leukemia or other cancer (Johansen et al., 2001)
There was also no association with the type of phone
used, using a phone for a long time (more than 5 or 10
years) or excessive use (more than 2000 hours);
although the last two results were based on small
numbers of cases and controls. The authors conclude
that the results add to the evidence that using wireless
phones is not associated with an increased risk for
salivary gland tumours. However, the authors note that
further studies are needed with more information on
long-term and heavy use of wireless phones.
(Soderqvist et al., 2012)
Incidence rates for malignancies which are developed
in the head and neck including those sites that
hypothetically receive the highest levels of radio
frequency radiation during cellular telephone use,
have not changed materially since the introduction of
cellular telephones to New-Zealand (Cook et al.,
2003). In a Swedish study, the data suggests that the
use of hand-held cellular telephone does not increase
risk of brain cancer (Muscat et al., 2000).
In a study carried out on rabbits, the results revealed
that the standard cellular telephone can alter brain
function as a consequence of absorption of energy by
brain (Marino et al., 2003). Three groups of rats were
exposed to mobile phone electromagnetic field of
different strength; there was highly significant
evidence of neural damage in the cortex,
WebmedCentral > Review articles
hippocampus and basal ganglia in the brain of
exposed rats (Salfore et al., 2003). In another study
aiming to explore the possible influence of RF on
human brain function, the result showed that RF
emitted by cellular phones has no abnormal effect on
human EEG activity (Hietanenet al., 2000). It was
reported that ten minutes exposure to the EMF emitted
from mobile telephone had no effect on hearing at
least at outer ear, middle ear and cochlear level
(Ozturan et al., 2002). Mobile phones do not affect
propagation of electrical stimuli along the auditory
nerve to auditory brainstem centers (Bak et al., 2003).
After very high exposures, nerves may be grossly
injured. After lower exposures, which may result in
dysaethesia, ordinary nerve conduction studies find no
abnormality but current perception threshold studies
have found abnormalities (Hocking & Westeman,
2003).
Children:
Regarding children, there are currently little data on
cell phone use and health effects, including the risk of
cancer. (Mussa, 2011) In a study carried out inUK, It
was concluded that major changes in head
development occur after second year of life that might
point at a difference in electromagnetic susceptibility
between children and adults. The health council
therefore finds no reason to recommend limiting the
use of mobile phones by children (Van Rongen et al.,
2004). Studies on the health-related effect of
electromagnetic fields are available in particular for the
low-frequency range, based on an appropriate
estimation of exposure, a number of these studies
reveal an association between exposure to this type of
fields and the occurrence of infantile leukemia in the
highest exposure category (Nowak & Radon, 2004).
In a study that carried out inEgypt, ninety women with
uncomplicated pregnancies aged 18-33 years, and 30
full term healthy newborn infants were included. The
pregnant mothers were exposed to EMF emitted by
mobile telephones while on telephone-dialing mode for
10 minutes during pregnancy and after birth. The main
out come were measurements of fetal and neonatal
HR and COP. A statistical significant increase in fetal
and neonatal HR, and statistical significant decrease
in stroke volume and COP before and after use of
mobile phone were noted. All these changes are
attenuated with increase in gestational age. (Rezk et
al., 2008)
Accidents:
Based on the epidemiological evidence available, the
main public-health concern is clearly motor vehicle
collisions, a behavioural effect rather than an effect of
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radiofrequency exposure as such. .(Rothman, 2000)
Health risks may include increased incidence rate of
traffic accidents caused by using telephone during
driving (Karger , 2005) These indirect health effects
presumably outweigh the direct biological
perturbations and should be investigated in more
detail in the future (Hossman & Hermann, 2003). Data
fromPewResearchCenter’s Internet and American Life
Project show that as of 2009 about 48 percent of teens
had been in a car when the driver was texting. These
statistics are likely to be low, since texting by teens
has increased since 2009. (Wargo et al., 2012)
Electromagnetic hypersensitivity
The term ”electromagnetic hypersensitivity” (EHS) if
often used to denote a phenomenon where individuals
experience adverse health effects while using or being
in the vicinity of electric, magnetic, or electromagnetic
field sources and devices, and when the individuals
themselves attribute their symptoms to these sources
and devices. There are no diagnostic criteria available,
and symptoms experienced vary substantially between
different individuals, but are generally non-specific with
no objective signs present. The severity of the
condition varies; the majority of cases present mild
symptoms, but some cases experience severe
problems with major consequences for work and every
day life. (Ahlbom et al., 2004) The scientific literature
on this area has been reviewed previously by
Bergqvist et al. for the European Commission
(Bergqvist, et al. 1997), updated in 2000 [Bergqvist, et
al. 2000], and by Levallois (Levallois 2002). This report
briefly summarizes the findings of the previous reviews,
and evaluates additional studies available in the
scientific literature.
It is difficult or even impossible to correctly estimate
the prevalence of EHS, simply because there are no
established diagnostic criteria, and the definition of the
disease is largely based on each individual’s own
beliefs and attribution of various symptoms to different
sources of electromagnetic field exposure. Therefore,
assessments of the prevalence will entirely depend on
the methods used to identify cases, and the types of
questions asked in each specific survey. The hitherto
reported prevalence of EHS varies considerably
throughout the world and between reports; at the time
of the review for the European Commission [Bergqvist,
et al. 1997] For reasons discussed above the validity
of the reported prevalence in different studies can be
questioned, and the prevalence in different countries
cannot easily be compared. Finding out such sensitive
subpopulation and defining it might be only possible by
examining molecular level responses to this radiation.
(Leszczynski & Xu, 2010) Reported prevalence rates
WebmedCentral > Review articles
of electromagnetic hypersensitivity (EHS), which refers
to the attribution of symptoms to exposure of RF EMFs,
ranged from 1.5 to 10% in various population-based
studies, with the majority of participants complaining of
sleeping disorders and headaches. (Samkange-Zeeb
and Blettner, 2009)
The authors conclude that although the symptoms of
EHS sufferers are certainly real and can be very
debilitating, the current scientific evidence does not
show a connection with EMF. (Oftedal et al., 2012)
There was no significant association between
short-term RF exposure from GSM mobile phones
and subjective symptoms (e.g. headaches, nausea
etc), well-being and physiological parameters (e.g.
heart rate, blood pressure etc) in humans. (Augner et
al., 2012)
The human volunteer studies have focused on mobile
phone radiation effects on e.g. cognition, blood
pressure, headaches, skin allergy-like symptoms,
sleep disorders or direct recognition, by the exposed
subject, whether mobile phone emits radiation or is
switched off . These studies have one major set-back
– experimental environment and used exposure and
measurement hardware can psychologically affect
behavior of the volunteers during the experiments and
the obtained information might become subjective and
unreliable. (Leszczynski & Xu, 2010) Studies
conducted inSaudi Arabia,Egypt, andPolandreported
associations between mobile phone use and
headache, fatigue, dizziness, tension, difficulties with
concentration and sleep disturbances. Regular mobile
phone users reported health complaints, such as
tiredness, stress, headache, anxiety, concentration
difficulties and sleep disturbances more often than
less frequent users. (Samkange-Zeeb and Blettner,
2009)
Interphone study:
The Interphone collaboration consisted of a series of
16 coordinated case– control study coordinated by the
International Agency for Research on Cancer in Lyon,
was initiated in 1999 and conducted in 13 countries.
TheUSstudies and some of the Swedish studies were
based on case ascertainment that started as early as
1994, while the Interphone studies ascertained cases
from 2000 through 2004. (Ahlbom et al., 2009) Overall,
no increase in risk of glioma or meningioma was
observed with use of mobile phones. There were
suggestions of an increased risk of glioma at the
highest exposure levels, but biases and error prevent
a causal interpretation. There was no increase in risk
of acoustic neuroma with ever regular use of a mobile
phone or for users who began regular use 10 years or
more before the reference date. (Wild, 2011)
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COSMOS Study:
The international cohort study on mobile phone use
and health (COSMOS) is a long term project to
investigate possible health effects associated with long
term mobile phone use. The UK study is part of an
international consortium of five European countries
(UK, Denmark, Sweden, Finland, and the Netherlands)
which together will characterise the mobile phone use
(through operator traffic records and a self-reported
questionnaire) and follow the health of at least
200,000 mobile phone users (18+ years of age) for 20
to 30 years. Health outcomes to be studied include
risk of cancers, benign tumors, neurological and
cerebro-vascular diseases, as well as change in
occurrence of specific symptoms over time, such as
headache and sleep disorders. (Schüz et al., 2011)
A large, prospective cohort study of mobile phone
users with long-term follow-up has been given top
priority in many EMF research agendas, because
exposure information is captured prior to occurrence of
disease, removing a major weakness of the previous
case–control studies which are subject to possible
recall bias. (Schüz et al., 2011)
Its major advantages are exposure assessment prior
to the diagnosis of disease, the prospective collection
of objective exposure information, long term follow-up
of multiple health outcomes, and the flexibility to
investigate future changes in technologies or new
research questions (Schüz et al., 2011)
Discussion
All studies have some methodological deficiencies: (1)
too short duration of mobile phone use to be helpful in
risk assessment (2) exposure was not rigorously
determined, and (3) there is a possibility of recall and
response error in some studies (Kundi et al., 2004).
The major limitation of epidemiological studies
addressing the health effects of mobile phone use is
related to exposure assessment. These limitations are
inherent in case-control studies. Quality of evidence
can be improved by conducting prospective cohort
studies. (Auvinen et al., 2006). Some studies collected
data from the 1990s, when most of the handsets were
analog. These have been replaced by digital
technology, where microwave emissions have a lower
output power at higher frequencies.(Moulder et al.,
2005)
If we admit that RF and microwaves may take
decades to initiate tumors, monitoring people exposed
to radiation will have to continue before we conclude
that there is no risk for developing neoplasms.
(International Commission for Non-Ionizing Radiation
Protection, 2004). There is no evidence supporting the
WebmedCentral > Review articles
influence of mobile phone use on the occurrence of
benign or malignant CNS tumors, results of studies on
mobile phone handset radiation and the risk of
developing acoustic neuroma have been contradictory
(Balbani & Montovani, 2008)
Various papers have suggested that exposure to
mobile phone microwaves has no influence on the
activity of cochlear outer hair cells or of cochlear nerve
electrical conduction, both in vivo and in vitro. Another
point is that all of the studies on humans were carried
out on normal-hearing volunteers. It is not know
whether the cochlea of patients with inner ear
conditions would be more sensitive to electromagnetic
radiation. (Balbani & Montovani, 2008)
To date all of the existing epidemiological studies on
RF exposure and symptoms are cross sectional, which
makes them of limited value in an evaluation of
whether low level RF exposure can cause various
symptoms. In a cross-sectional study the exposure
and the outcome are assessed simultaneously,
without consideration of the time sequence of the
events. In addition, all of the available studies on RF
exposure ask the subjects themselves to assess both
their exposure (e.g. distance to nearest base station or
amount of mobile phone use) and the outcome
(various symptoms), which lead to a considerable risk
that the exposure assessment is influenced by the
disease, or that only symptoms that an individual
attribute to the RF exposure are reported. Another
limitation is that the participation rates in most of the
studies are low or not possible to assess, and there is
a large potential for selection bias; people who
experience symptoms that they attribute to mobile
phones or base stations may be more prone to
participate in a study investigating this particular
question, than people with no such beliefs. Also the
Stewart report [IEGMP 2000] acknowledged the
limitations inherited in studies using a cross-sectional
design.
In two studies on base station exposure and
symptoms published; one from France [Santini, et al.
2002a] and one fromSpain[Navarro, et al. 2003]. None
of the studies have reported how subjects were
selected for participation in the studies, and
participation rates cannot be estimated. Participants
have answered questions about various symptoms
such as headaches, concentration difficulties, memory
loss, fatigue, sleeping problems etc. They were also
asked to estimate the distance to the nearest base
station, with no independent validation. Not only is self
reported distance to base stations a questionable
exposure assessment method; it has also been shown
that distance is a poor surrogate for RF exposure from
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base stations [Schuz and Mann 2000]. The Spanish
study also made measurements of the exposure in the
homes, but did neither report how subjects were
selected for measurements nor the proportion of
subjects agreeing to have measurements taken in
their homes. For unknown reasons they have also
excluded all participants living between 150 and 250
meters from a base station, which makes correlation
coefficients between distance and exposure of little
value. Both the French and the Spanish study report
an increased prevalence of symptoms close to base
stations, but the design limitations make it impossible
to assess whether these findings are a results of bias
or real effects.
The first 10-years after the start of use of mobile
phone, do not show any link between brain cancer and
mobile phone radiation. However, even if such causal
link would exist, it might be not detectable in such
short-term studies because the numbers of phone
users 10-20 years ago were small. (Leszczynski & Xu,
2010). Because of the lack of studies that would
provide unbiased information whether the human body
responds to mobile phone radiation, it is problematic to
consider that the presently available safety standards
protect all users of mobile phones. (Leszczynski & Xu,
2010)
Due to ethical considerations, there are no published
studies where the effects of mobile phone radiation on
development or health of children would have been
examined. The scientific evidence comes only from
the studies examining young animals and its
applicability to human children might be of limited
value. (Leszczynski & Xu, 2010)
Some case– control studies have asked about the
habitual side of mobile phone use when the phone is
hand-held, and have sought to investigate the
association with ipsilateral and contralateral brain
tumors. However, there is no evidence of consistency
over time in a person’s preferred side of use.
Retrospective self-report of preferred side of use may
be subject to bias. If cases believe that mobile phone
use may have caused their tumor, they might
over-report mobile phone use on the same side as the
tumor. In addition, analysis of data regarding laterality
of phone use presents analytic problems. First, a
method is needed for handling cases and controls who
say they have no preferred side of use. Second, the
analysis of control data regarding laterality of mobile
phone is problematic because controls have no tumor
to determine a reference side. (Ahlbom et al., 2009)
Recommendation
WebmedCentral > Review articles
The current safety standards might be the best what
can be done using the presently available scientific
evidence and they should not be altered arbitrarily,
without scientific justification. However, these
standards are not yet sufficiently supported by the
science and can not be considered as scientifically
reliable.
This is why we should continue research in this area.
The reason for continuation of research is not just
science for the science’s sake. The reason is that our
scientific evidence is insufficient to support the notions
that there will be no health effects and that the safety
standards are sufficient to protect all users. The
present situation of scientific uncertainty calls for both
precautionary measures and for further research, we
will look at the health issues associated with mobile
phone use that might be of interest for future research.
According to the weight each research activity carries
in human health risk assessment: epidemiology,
laboratory studies in humans, animals, cellular
systems, and mechanisms. It should be recognized
that, whilst epidemiological and human laboratory
studies directly address endpoints related to human
health, cellular and animal studies are of value in
assessing causality and biological plausibility.
Dosimetry is considered separately, but is important
for all research. .(WHO, 2006)
Animal studies are used when it is unethical or
impractical to perform studies on humans and have
the advantage that experimental conditions can be
rigorously controlled, even for chronic
exposures.(WHO, 2006). Use novel experimental
techniques and methodological approaches, to get a
better insight into possible biological effects of power
lines and mobile phones on DNA damage.
(Leszczynski & Xu, 2010). The need for in vitro
laboratory studies for discovering the biochemical
mechanism of the effect and they provide support for
human and animal studies, but they can not be directly
used to determine the probability of health risk or in
providing information for setting of human health
safety standard. (Leszczynski & Xu, 2010)
Human volunteer studies, using methods of
proteomics, transcriptomics and other reliable
biochemical analyses, are urgently needed to
demonstrate whether human body (tissues, organs)
responds, or not, to mobile phone radiation on
molecular level. This research will provide information
which molecules, proteins and genes react to mobile
phone radiation. With this information in hand it will be
possible to formulate new, knowledge-based,
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hypotheses for further health risk related studies in
humans (Leszczynski & Xu, 2010)
Recent studies suggest that RF exposure has no or
very little effect on the expression of cancer-related
genes (e.g., proto-oncogenes and tumor suppressor
genes). However, the results of studies of the effects
of RF exposure on stress protein expression,
particularly hsps, have so far been inconsistent,
although mostly negative outcomes have been
reported in vitro. Heating remains a potential
confounder, and probably accounts for some of the
positive effects reported. Nevertheless, further studies
should be conducted to evaluate the influence of RF
exposure on major stress signaling pathways.
(Vecchia et al., 2009)
Further experimental and epidemiologic studies are
needed to seek explanations for the controversies in
studies on mobile phones so far. These studies should
apply sound methodology for exposure assessment of
mobile phone radiation and should focus on the effects
of long-term use (more than 10 years). Cohort studies,
in particular, should be established to investigate the
long-term effects of mobile phone use on brain cancer
as well as to address a broad range of health
outcomes, not only brain tumours. (Mussa, 2011) In a
cohort study, new endpoints brought up by other
research activities can be included even during the
conduct of the study, and the effects of evolving
technologies (e.g. digital, 3G, and new modulation
patterns) can be naturally integrated and have the
advantages of avoiding the recall and selection biases
common to case-control studies.
A call has been made for future studies to adopt an
interdisciplinary approach involving psychology,
laboratory study and epidemiological disciplines
together with improved personal dosimetry to explore
the subjective symptoms due to mobile use.
(Samkange-Zeeb and Blettner, 2009)
Mobile phones are not only used for telephoning, but
also for sending text messages, listening to music,
playing games and watching videos, thereby exposing
different body parts to electromagnetic waves.
Although there is currently no evidence of significant
exposures from these other forms of usage, an
assessment of patterns of exposure, which takes into
account the various ways in which mobile phones can
be used, is needed. (Samkange-Zeeb and Blettner,
2009). Researchers have recommended further study
of effects on the eye lens and lens epithelial cells
Little is known about possible adverse effects of
mobile phone use on children, especially effects that
might appear later in life. Ideally, prospective cohort
WebmedCentral > Review articles
studies covering different age groups as well as
pregnant women and capable of incorporating the
rapidly changing technology and exposures should be
conducted. (Samkange-Zeeb and Blettner, 2009)
Studies of pre and postnatal exposure to
low-frequency EMFs on immune function and on the
induction of minor skeletal variations. Effects of
prolonged intermittent exposure from the early
postnatal period on subsequent cognitive function in
animals.
Further studies should focus on exposure gradients
rather than exposed versus non-exposed groups.
Future studies should also be planned in less
industrialized countries, where hardly any investigation
has been carried out to date. Further research should
focus on long-term effects of mobile phones bas
stations and should include children and adolescents.
Additional cross-sectional studies would be of limited
value, so future studies should apply a longitudinal
design.
WHO developed a Research Agenda in order to
facilitate and coordinate research worldwide on the
possible adverse health effects of EMF. Studies to fill
important gaps in knowledge focused on health risk
assessment that are needed to significantly reduce
the uncertainty in the current scientific information.
● A large prospective longitudinal cohort study of
mobile telephone users that includes
● Incidence as well as mortality data.
● Large-scale studies of subjects with high
occupational RF exposure, including cohort studies
as well as the use of the RF occupational exposure
data within large scale existing case-control
studies.as workers exposed to RF fields in some
occupations receive high exposure levels and
sometimes exceeding ICNIRP guidelines.
● Prospective cohort study of children and adolescent
mobile phone users and all health outcomes other
than brain cancer such as cognitive effects and
effects on sleep quality. These endpoints are critical
for children because of the importance of cognitive
abilities and learning in early development
● Studies of RF effects on cell differentiation, e.g.,
during haemopoiesis in bone marrow, and on nerve
cell growth using brain slices/cultured neurons. The
possibility that haemopoietic and/or neuronal tissue
might show an abnormal growth response to RF
exposure would be important because of lack of
investigation in this area.
● Micro-dosimetry research (i.e., at the cellular or
subcellular levels) that may yield new insights
concerning biologically relevant targets of RF
exposure.
● Risk perception of individuals, including studies on
the formation of beliefs and perceptions about the
relationship between RF exposure and health. To
adequately communicate research results, and to
contribute to an informed public debate about RF
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exposure and health, more knowledge about the 7. Augner C, et al Acute effects of electromagnetic
prevalence of perception patterns, and the concerns fields emitted by GSM mobile phones on subjective
shaping these patterns and their diffusion, is needed
well-being and physiological reactions: A
meta-analysis Sci Total Environ 2012: in pres
Conclusion 8. Auvinen A, Toivo T, Tokola K. (2006)
“Epidemiological risk assessment of mobile phones
and cancer: where can we improve?” Eur J Cancer
Currently, much remain unknown about the health
Prev.Dec;15(6):516-23.
effects of mobile phones, no biological data exist to
9. Bak M., Sliwinska-Kowalska M., Zmyslony M.,
give a reason for concern about the health effects of
Dudarewiez A. (2003). No effects of acute exposure to
magnetic field pulses from mobile phones. Only a
the electromagnetic fields emitted by mobile phone on
small number of studies done on the effects of these
brainstem auditory potentials in young volunteers.
frequencies of radiation have investigated cancer as
International Occupational Medicine & Environmental
an end point. At present, evidence for a causal
health, 16(3), 201-8.
relationship between mobile phone use and cancer
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relies predominantly on epidemiology, in particular on
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the large studies. Nevertheless, an increased risk of
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mobile phone use and brain tumor, restricted to heavy
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relationship between mobilephone use and cancer.
rare subtypes of brain tumors may be compatible with
Environ Health Perspect. 2009 Mar;117(3):316-24.
stable incidence trends at this time and thus further
Review.
monitoring of brain tumor, especially during childhood,
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incidence rate time trends is warranted. Weak
health risk controversy: the reliability and sufficiency of
evidence in favor of a causal relationship is provided
science behind the safety standards. Health Res
by some animal and in vitro studies, but overall,
Policy Syst. 2010 Jan 27;8(1):2
genotoxicity assays, both in vivo and in vitro, are
13. Baselaction network, Wireless Waste: Basel
inconclusive up to date.
Convention’s Next Hazardous Waste Challenge, April
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Illustrations
Illustration 1

Table 1. Select Cell Phone Radiation Studies Demonstrating Potential Effects on Fertility

Author
Year Effect Noted

DeIuliis et al. 2009 “RF-EMR in both the power density and frequency range of mobile phones
enhances mitochondrial reactive oxygen species generation by human
spermatozoa, decreasing the motility and vitality of these cells while
stimulating DNA base adduct formation and, ultimately, DNA fragmentation.
These findings have clear implications for the safety of extensive mobile
phone use by males of reproductive age, potentially affecting both their
fertility andthe health andw ell-being of their offspring.”

Salama N et 2009 “Low intensity pulsedrad iofrequency emittedby a conventional mobile phone
al. kept in the standby position could affect the testicular function and structure
in the adult rabbit.”

Agarwal A et 2009 “Radiofrequency electromagnetic waves emitted from cell phones may lead
al. to oxidative stress in human semen. We speculate that keeping the cell
phone in a trouser pocket in talk mode may negatively affect spermatozoa
and impair male fertility.”

Agarwal A et 2008 “Use of cell phones decrease[s] the semen quality in men by decreasing the
al. sperm count, motility, viability, and normal morphology. The decrease in
sperm parameters was dependent on the duration of daily exposure to cell
phones and independent of the initial semen quality.”

Yan JG et al. 2007 “Rats exposed to 6 hours of daily cellular phone emissions for 18 weeks
exhibited a significantly higher incidence of sperm cell death than control
group rats through chisquared analysis…. [A]bnormal clumping of sperm
cells was present in rats exposed to cellular phone emissions andw as not
present in control group rats. These results suggest that carrying cell phones
near reproductive organs could negatively affect male fertility.”

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Illustration 2

Table 2. IARC Cancer Groups:

IRC's Number Examples

Group 1:Carcinogenic to 107 Asbestos, arsenic, benzene, radon, solar

humans radiation, vinyl chloride, tobacco smoke

Group 2A:Probably 59 Nitrate or nitrite, UV radiation, trichloroethylene

carcinogenic to humans

Group 2B:Possibly 266 Carbon tetrachloride, gasoline, diesel fuel

carcinogenic to humans (marine), lead, naphthalene, styrene, RF- EMFs

Group 3:Unclassifiable as 508 Fluorescent lighting, Hepatitis D virus, personal

to carcinogenicity in use of hair coloring products, malathion,
humans melamine

Group 4:Probably not 1 Caprolactam (used in making plastics and nylon)

carcinogenic to humans

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Illustration 3

Table 3. RF Radiation from Cell Phones and Cancer:Conclusions of Peer-Reviewed Review Studies

Author
FINDINGS

Ahlbom A et al. “…the studies published to date do not demonstrate an increased risk within
(2009) approximately years of use for any tumor of the brain or any other head tumor.… For
slow growing tumors…the absence of association reported thus far is less conclusive
because the observation period has been too short.”

Khurana VG et “..there is adequate epidemiologic evidence to suggest a link between prolonged cell
al. (2009) phone usage and the development of an ipsilateral brain tumor.”

Han YY et al. “Some studies of longer term cell phone use have found an increased risk of ipsilateral
(2009) AN [acoustic neuroma].”

Kohli et al. “The evaluation of current evidence provided by various studies to suggest the possible
(2009) carcinogenic potential of radiofrequency radiation is inconclusive.”

Myung et al. “…there is possible evidence linking mobile phone use to an increased risk of tumors
from a meta-analysis of low biased case-control studies.”

Croft et al (2009) “There are reports of small associations between MP-use ipsilateral to the tumour for
greater than years, for both acoustic neuroma and glioma, but the present paper
argues that these are especially prone to confounding by recall bias.“

Abdus-Salam et “…published research works over several decades including some with over ten years of
al. (2008) follow up have not demonstrated any significant increase in cancer among mobile phone
users. However, the need for caution is emphasized as it may take up to four decades
for arcinogenesis to become fully apparent.”

Kundi (2008) “The overall evidence speaks in favor of an increased risk, but its magnitude cannot be
assessed at present because of insufficient information on long-term use.”

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Illustration 4

Table 4. Epidemiological Studies on Children and Potential Health Effects from Mobile Phone Use:

Date Health Effect Finding Location

Study

Hardell 2008 Brain tumors Those who used cell phones before age Sweden
et al. 20 had >5-fold increase in glioma risk.

CEFALO 2004 Brain tumors “Regular users of mobile phones were Denmark, Norway,
Study -2008 not statistically significantly more likely Sweden, and
to have been diagnosed with brain Switzerland
tumors compared with non users.”

Danish 1998 Behavioral Behavior problems Denmark

National -2008
Birth
ohort/UC
LA

MOCHE 2006 Environmental Pending Korea

-2010 Exposures
during
pregnancy
And childhood

MOBI-KI Began Brain tumor Pending Australia, Canada,

DS Study 2010 Germany,Greece,Israel
,Italy,

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Illustration 5

Table 5. Comparison of the Hardell and Interphone Studies:

AUTHOR
FINDING CONCERNS FUNDING

Lennart Hardell Increased risk for Recall bias; no Independently funded

et al. glioma and acoustic doseresponse
neuroma after 10 years relationship
of mobilephoneuse

IARC’s Suggestions of an Biases and error Funded in part by

Interphone increased risk of glioma prevent a causal industry with
at the highest exposure interpretation. agreement to
levels. guarantee scientific
independence

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