Magnetic f iel d s o f h igh v o l tage po werl ines and ris k o f cancerin

F innis h ad u l ts : natio nwid e co h o rt s tu d y

P ia KV erk as al o , E ero P u k k al a, J aak k o Kaprio , Kau k o V H eik k il a, Mark k u Ko s k env u o
A b s tract
O b j ectiv e- T o inv es tigate th e ris k o f cancer in
as s o ciatio n with m agnetic f iel d s in F innis h ad u l ts
l iv ing cl o s e to h igh v o l tage po werl ines .
D es ign- N atio nwid e co h o rt s tu d y .
S u b j ects - 3 8 3 7 0 0 peo pl e wh o l iv ed d u ring
1 9 7 0 - 8 9 with in 5 0 0 m etres o f o v erh ead po werl ines
o f 1 1 0 - 4 0 0 k V in a m agnetic f iel d cal cu l ated to b e
0 . 0 1 F T . S tu d y s u b j ects were id entif ied b y reco rd
l ink ages o f natio nwid e regis ters .
Main o u tco m e m eas u res - N u m b ers o f o b -
s erv ed and ex pected cas es o f cancer, s tand ard is ed
incid ence ratio s , and incid ence rate ratio s
ad j u s ted f o r s ex , age, cal end ar y ear, and s o cial
cl as s - f o r ex am pl e, b y co ntinu o u s cu m u l ativ e ex -
po s u re per 1 tT y ear- with 9 5 % co nf id ence inter-
v al s f ro m m u l tipl icativ e m o d el s f o r al l cancers
co m b ined and 2 1 s el ected ty pes .
R es u l ts - A l to geth er 8 4 1 5 cas es o f cancer were
o b s erv ed ( s tand ard is ed incid ence ratio 0 . 9 8 ; 9 5 %
co nf id ence interv al 0 . 9 6 to 1 . 0 0 ) in ad u l ts . A l l inci-
d ence rate ratio s f o r b o th s ex es co m b ined were
no n- s ignif icant and b etween 0 . 9 1 and 1 . 1 1 .
S ignif icant ex ces s es were o b s erv ed in m u l tipl e
m y el o m a in m en ( incid ence rate ratio 1 . 2 2 ) and in
co l o n cancer in wo m en ( 1 . 1 6 ) .
C o ncl u s io ns - T y pical res id ential m agnetic
f iel d s generated b y h igh v o l tage po werl ines d o no t
s eem to b e rel ated to th e ris k o f o v eral l cancer in
ad u l ts . T h e prev io u s l y s u gges ted as s o ciatio ns
b etween ex trem el y l o w f req u ency m agnetic f iel d s
and tu m o u rs o f th e nerv o u s s y s tem , l y m ph o m a,
and l eu k aem ia in ad u l ts and b reas t cancer in
wo m en were no t co nf irm ed .
D epartm ent o f P u b l ic
H eal th , P O Bo x 4 1 ,
F I N - 0 0 0 1 4 U niv ers ity o f
H el s ink i, F inl and
P ia KV erk as al o , res earch er
J aak k o Kaprio , s enio r res earch
f el l o w
Kau k o V H eik k il d , s y s tem s
anal y s t
F innis h C ancer R egis try ,
I ns titu te f o r S tatis tical
and E pid em io l o gical
C ancer R es earch ,
L iis ank atu 2 1 B,
F I N - 0 0 1 7 0 H el s ink i
E ero P u k k al a, res earch er
D epartm ent o f P u b l ic
H eal th , U niv ers ity o f
T u rk u , L em m ink f iis enk atu
1 , F I N - 2 0 5 2 0 T u rk u ,
F inl and
Mark k u Ko s k env u o , pro f es s o r
C o rres po nd ence to :
D rV erk as al o .
BMJ 1 9 9 6 ; 3 1 3 : 1 0 4 7 - 5 1
I ntro d u ctio n
T h e epid em io l o gical ev id ence f o r a carcino genic
ef f ect o f m agnetic f iel d s co m es f ro m th ree paral l el l ines
o f res earch : f irs tl y , s tu d ies o n ch il d h o o d cancer in th e
v icinity o f po wer l ines ' - 6 ; s eco nd l y , s tu d ies o n ad u l t can-
cer in rel atio n to el ectrical o ccu patio ns o r m eas u red
m agnetic f iel d s f ro m o ccu patio nal s o u rces ' 7 1 4 ; and ,
th ird l y , s tu d ies o n ad u l t cancer in rel atio n to m agnetic
f iel d s f ro m no n- o ccu patio nal s o u rces incl u d ing po wer
l ines . " 2 6
E l ev en epid em io l o gical s tu d ies h av e s o f ar b een pu b -
l is h ed o n ad u l t cancer in rel atio n to res id ential m agnetic
f iel d s . O f th em , s ev en s tu d ies with co nf l icting res u l ts
and at m o s t m o d es t increas es in ris k h av e as s es s ed
ex po s u res to po wer l ines " 2 2 and f o u r to el ectric
b l ank ets . 2 3 2 6 T h ree s tu d ies h av e incl u d ed al l ty pes o f
cancer' 5 - 1 7
2 1
wh ereas f o u r were res tricted to h aem ato -
l o gical m al ignancies o r l eu k aem ia, " 8 1 2 0 2 3 o ne incl u d ed
b o th l eu k aem ia and b rain tu m o u rs , 2 2 two were o n b reas t
cancer in wo m en, 2 5
2 6 and o ne was l im ited to tes ticu l ar
cancer. 2 4
We inv es tigated th e ef f ect o f 5 0 H z m agnetic f iel d s o n
th e o ccu rrence o f s ev eral ty pes o f cancer. H igh v o l tage
po werl ines were ch o s en as th e s o u rce o f m agnetic f iel d s
m erel y b ecau s e th ere were ex is ting d o cu m ents f ro m
po wer co m panies th at al l o wed th e retro s pectiv e es tim a-
tio n o f ex po s u re to m agnetic f iel d s . A natio nwid e ex po -
s u re regis ter was created o n pers o nal ex po s u res to 5 0
H z m agnetic f iel d s f ro m h igh v o l tage po wer l ines o v er a
perio d o f 2 0 y ears ( 1 9 7 0 - 8 9 ) in F inl and , wh ich m ad e it
po s s ib l e to inv es tigate s ev eral ty pes o f cancer in o ne
po pu l atio n b as ed co h o rt s tu d y . We pres ent th e res u l ts
o n th e rel atio n b etween m agnetic f iel d s o f h igh v o l tage
po wer l ines and ris k o f cancer in ad u l ts .
S u b j ects and m eth o d s
A S S E S S ME N T O F E XP O S U R E
T h e ex po s u re as s es s m ent o f th is s tu d y was b as ed o n
cal cu l atio ns o f th e av erage annu al m agnetic f iel d s ( m ag-
netic f iel d d ens ities ) s eparatel y f o r each o f th e y ears
1 9 7 0 - 8 9 at al l b u il d ings l o cated cl o s er th an 5 0 0 m etres
f ro m 1 1 0 k V , 2 2 0 k V , and 4 0 0 k V o v erh ead po wer l ines
in F inl and . T h e b as el ine ex po s u re d ata incl u d ed th e
l o catio ns o f b u il d ings ( ex act co o rd inates incl u d ed in th e
C entral P o pu l atio n R egis ter) and po wer l ines ( in b as ic
m aps , s cal e 1 : 2 0 0 0 0 ) , as wel l as th e v o l tage, apparent
po wer, and to wer ty pes o f th e 1 1 0 - 4 0 0 k V po wer l ines
( f ro m po werco m pany reco rd s ) . T h es e d ata co v er ab o u t
1 8 0 0 0 k m - th at is , 9 0 % o f th e to tal l ength o f
res pectiv e po wer l ines in F inl and .
I n th e cal cu l atio n o f m agnetic f iel d s , v ariab l es s u ch as
cu rrent, ty pical s patial l o catio ns o f ph as e co nd u cto rs in
po wer l ines , and th e s h o rtes t d is tance to th e central
po int o f th e b u il d ing were tak en into acco u nt. C u rrents
were cal cu l ated f ro m o peratio nal / no m inal v o l tages and
apparent po wers o f al l po wer l ines . T h e ex po s u re
as s es s m ent is m o re th o ro u gh l y d es crib ed in earl ier
pu b l icatio ns . 4 2 7
R E C O R D L I N KA GE S
F u rth er d ata co l l ectio n was b as ed ex cl u s iv el y o n th e
l ink ages o f natio nwid e regis ters ( th at is , pers o n and
b u il d ing d ata f il es o f th e C entral P o pu l atio n R egis ter,
P o pu l atio n C ens u s 1 9 7 0 , and F innis h C ancer R egis -
try ) . T h e s tu d y co h o rt co ns is ted o f al l peo pl e wh o h ad
l iv ed in a b u il d ing with a cal cu l ated m agnetic f iel d o f
0 . 0 1 m icro tes l a
( gT )
f o r any perio d b etween th e y ears
1 9 7 0 - 8 9 . T h is m eans th at th e s tu d y po pu l atio n
co m pris ed b o th peo pl e with cl earl y increas ed ex po s u res
to res id ential m agnetic f iel d s o f po wer l ines and th o s e
wh o h ad b een ex po s ed o nl y to ty pical res id ential b ack -
gro u nd l ev el s . T h e gro u p with l eas t cu m u l ativ e
ex po s u re ( < 0 . 2 , u T y ears ) s erv ed as th e internal
ref erence gro u p in s o m e o f th e cancer anal y s es . A s th e
res u l t o f s ev eral s u cces s iv e reco rd l ink ages , th e
s u m m ary d ata f il es o f th e s tu d y end ed u p incl u d ing th e
f o l l o wing inf o rm atio n: d ates o f b irth and d eath , s ex ,
res id ential h is to ry with d ates o f m o v ing in and o u t o f
th e b u il d ing, h is to ry o f ex po s u re with cal cu l ated av erage
annu al m agnetic f iel d s f o r each o f th e cal end ar y ears
b etween 1 9 7 0 - 8 9 , s o cial cl as s , and cancer d ata
incl u d ing prim ary s ites , h is to l o gical co d es , and d ates o f
d iagno s is f o r al l incid ent prim ary tu m o u rs .
T h e f o l l o wing prim ary s ites o f cancerwere s el ected to
b e s tu d ied : o v eral l cancer, s to m ach ( co d e 1 5 1 in th e
I nternatio nal C l as s if icatio n o f D is eas es , s ev enth rev is io n) ,
co l o n ( 1 5 3 ) , rectu m and recto s igm o id ( 1 5 4 ) , pancreas
( 1 5 7 ) , l ary nx and epigl o ttis ( 1 6 1 ) , l u ng and trach ea
( 1 6 2 . 0 - 1 ) , b reas t in wo m en ( 1 7 0 ) , u terine co rpu s ( 1 7 2 ) ,
o v ary ( 1 7 5 ) , pro s tate ( 1 7 7 ) , tes tis ( 1 7 8 ) , k id ney ( 1 8 0 ) ,
b l ad d er, u reter, and u reth ra ( 1 8 1 ) , m el ano m a o f th e
s k in ( 1 9 0 ) , no n- m el ano m a o f th e s k in ( 1 9 1 ; ex cl u d es
b as al cel l carcino m as ) , nerv o u s s y s tem ( 1 9 3 ) , th y ro id
BMJ V O L U ME 3 1 3 2 6 O C T O BE R 1 9 9 6 1 0 4 7
gl and ( 1 9 4 ) , no n- H o d gk in' s l y m ph o m a ( 2 0 0 , 2 0 2 ) ,
H o d gk in' s d is eas e ( 2 0 1 ) , m u l tipl e m y el o m a ( 2 0 3 ) , and
l eu k aem ia ( 2 0 4 - 2 0 8 ) . Gl io m as ( co d e 4 7 , A m erican
C ancer S o ciety Manu al o f T u m o r N o m encl atu re C o d ing)
and m eningio m as ( co d e 4 6 ) were anal y s ed s eparatel y
f ro m o th er tu m o u rs o f th e nerv o u s s y s tem . Breas t can-
cer in m en was no t incl u d ed b ecau s e o nl y f o u r cas es
were ex pected to o ccu r in th e wh o l e co h o rt.
S T A T I S T I C A L A N A L YS E S
T h e pers o nal h is to ries ( b etween 1 J anu ary 1 9 7 0 and
3 1 D ecem b er 1 9 8 9 ) o f ex po s u re to res id ential m agnetic
f iel d s were s u m m aris ed in th e m eas u re o f cu m u l ativ e
ex po s u re, wh ich in th is s tu d y ref ers to th e s u m o f th e
pro d u cts o f res id ential m agnetic f iel d ( in , u T ) and l ength
o f s u ch ex po s u re ( in y ears ) . C u m u l ativ e ex po s u re was
catego ris ed b y u s ing th e ex po s u re cu t o f f po ints o f 0 . 2 ,
0 . 4 , 1 . 0 , and 2 . 0 th at were s el ected a prio ri o n th e b as is
o f th e d is trib u tio n o f cu m u l ativ e ex po s u re in th e s tu d y
po pu l atio n to s et apart s tu d y s u b j ects with d if f erent
ex po s u res . T h e d ates o f entering each ex po s u re
catego ry were d ef ined f o r each s tu d y s u b j ect and o nl y
th e ex po s u res b ef o re th e d ate o f d iagno s is were co ns id -
ered in th e cancer anal y s es .
F o r d eterm inatio n o f incid ence rates , th e cal cu l atio n
o f pers o n y ears b egan o n 1 J anu ary 1 9 7 4 at th e earl ies t
o r, if l ater, at b irth o r wh en th e s u b j ect m o v ed into a
b u il d ing with a cal cu l ated m agnetic f iel d o f > 0 . 0 1 pT .
P ers o n y ears f ro m th o s e aged l es s th an 2 0 y ears were
ex cl u d ed f ro m th e anal y s es . C al cu l atio n o f pers o n y ears
end ed at d eath o r o n 3 1 D ecem b er 1 9 8 9 . T h e o b s erv ed
nu m b ers o f cas es and pers o n y ears at ris k were
cal cu l ated b y age ( f iv e y ear age gro u ps ) , s ex , cal end ar
perio d ( 1 9 7 4 - 8 1 ; 1 9 8 2 - 9 0 ) , ex po s u re catego ry ( < 0 . 2 0 ;
0 . 2 0 - 0 . 3 9 ; 0 . 4 0 - 0 . 9 9 ; 1 . 0 0 - 1 . 9 9 ; 2 2 . 0 0 gT y ears ) , and
s o cial cl as s ( I ( h igh es t) ; I I ; I I I ; I V ; u nk no wn) . E ach
ex po s u re catego ry was d eterm ined b y cu m u l ativ e ex po -
s u re u p to th e d ate o f d iagno s is , d eath , o r 3 1 D ecem b er
1 9 8 9 . T h e s o cial cl as s v ariab l e was u s ed o nl y in th e
incid ence rate ratio anal y s es . T h e ex pected nu m b ers o f
cas es were cal cu l ated b y m u l tipl y ing th e s pecif ic
nu m b er o f pers o n y ears f o r th e catego ry b y th e
co rres po nd ing incid ence o f cancer in F inl and . T h e
s tand ard is ed incid ence ratio s were cal cu l ated b y
d iv id ing th e o b s erv ed nu m b er o f cas es b y th e nu m b er
ex pected . T h e 9 5 % co nf id ence interv al s were d ef ined
u nd er th e as s u m ptio n th at th e o b s erv ed nu m b er o f
cas es f o l l o wed th e P o is s o n d is trib u tio n.
T h e pu rpo s e o f co nd u cting th e incid ence rate ratio
anal y s es in ad d itio n to th e s tand ard is ed incid ence ratio
anal y s es was , f irs tl y , to u s e th e l eas t ex po s ed gro u p as
th e ref erence ( ins tead o f th e general F innis h po pu l a-
tio n) and , s eco nd l y , to ad j u s t f o r po tential co nf o u nd ing
b y s o cial cl as s . Mu l tipl icativ e P o is s o n regres s io n with
s pecif ic nu m b ers o f o b s erv ed cas es and pers o n y ears at
ris k f o r each catego ry was u s ed to tak e ex po s u re and
co nf o u nd ing v ariab l es into acco u nt s im u l taneo u s l y ; th e
incid ence rate ratio s were es tim ated f ro m th es e m o d el s .
T h e s ignif icance o f a v ariab l e was as s es s ed b y a
l ik el ih o o d ratio tes t; th e criterio n o f s ignif icance was s et
at th e 5 % l ev el . A m o d el with s ex , age, cal end ar perio d ,
ex po s u re, and s o cial cl as s was f itted ( s ee prev io u s para-
graph f o r catego ries ) . E x po s u re and age were treated as
b o th nu m erical and catego rical v ariab l es ; ex po s u re was
ad d itio nal l y treated as a d ich o to m o u s v ariab l e ( in th e
res u l ts s ectio n, h o wev er, th e incid ence rate ratio s f o r
catego rical and d ich o to m o u s ex po s u re are pres ented in
o nl y a f ew cas es o f s pecial interes t) . T h e cal cu l ated
m eans o f cu m u l ativ e ex po s u re with in each ex po s u re
catego ry ( 0 . 0 5 , 0 . 2 8 , 0 . 6 2 , 1 . 3 8 , and 5 . 0 4 tT y ears )
were u s ed as nu m erical es tim ates o f ex po s u re. T h e
h igh es t cu t o f f po int was s et at 1 . 0 , u T y ears in th e
anal y s is o f H o d gk in' s d is eas e and 0 . 4 , u T y ears in th e
anal y s is o f tes ticu l ar cancer, h o wev er, b ecau s e th e
nu m b er o f ex pected cancer cas es in th e h igh es t
ex po s u re catego ry wo u l d o th erwis e h av e b een l es s th an
two . A d d itio n o f th e age s q u are term was al s o attem pted
wh en we u s ed a nu m erical age v ariab l e. T h e po s s ib il ity
o f ef f ect m o d if icatio n b y s ex , age, and s o cial cl as s was
inv es tigated b y f itting th e co rres po nd ing interactio n
term . Wh en appro priate, th e s pecif ic incid ence rate
ratio s f o r each catego ry o f co nf o u nd er were al s o
es tim ated f ro m m o d el s .
R es u l ts
T h e s tu d y co h o rt co ns is ted o f 3 8 3 7 0 0 peo pl e
( 1 8 9 3 0 0 m en) wh o co ntrib u ted a to tal o f 2 . 5 m il l io n
pers o n y ears af ter th e age 2 0 . A l to geth er 2 7 5 0 0 0 ( 1 1 %)
pers o n y ears were as s o ciated with a cu m u l ativ e
ex po s u re o f 0 . 4 0 J T y ears ( tab l e 1 ) . T h ere were 8 4 1 5
o b s erv ed cas es o f cancer ( 4 0 8 2 in m en) . T ab l e 2 s h o ws
th e nu m b ers b y prim ary s ite.
R is k o f cancerin wh o l e co h o rt- T h ere was a d ecreas e o f
2 % in th e ris k o f o v eral l cancer in th e wh o l e s tu d y
co h o rt co m pared with th e general F innis h po pu l atio n;
th e d ecreas e was o f s im il ar m agnitu d e in m en and
wo m en. A l l s tand ard is ed incid ence ratio s s pecif ic f o r a
prim ary s ite were b etween 0 . 9 0 and 1 . 1 0 with th e
ex ceptio n o f l ary ngeal cancer ( s tand ard is ed incid ence
ratio 0 . 8 5 ; 9 5 % co nf id ence interv al 0 . 6 6 to 1 . 0 8 ) . T h e
o nl y s ignif icant s tand ard is ed incid ence ratio was
o b s erv ed f o r l u ng cancer wh ich was d ecreas ed b y 7 %
co m pared with th e general F innis h po pu l atio n ( 0 . 9 3 ;
0 . 8 7 to 0 . 9 8 ) .
R E S U L T S F O R S P E C I F I C C A N C E R S
T h e f o l l o wing paragraph s s u m m aris e th e res u l ts ; th e
o b s erv ed ris k s o f cancer with catego rical and co ntinu -
o u s cu m u l ativ e ex po s u re. ( th at is , ch ange in ris k giv en
per 1 , T y ear increas e in ex po s u re) are pres ented in
m o re d etail in tab l es 2 and 3 .
H aem ato l o gical m al ignancies - O v eral l , th e ris k s o f
no n- H o d gk in' s l y m ph o m a, H o d gk in' s d is eas e, m u l tipl e
m y el o m a, and l eu k aem ia d id no t v ary b y l ev el o f
m agnetic f iel d . T h e incid ence rate ratio f o r no n-
H o d gk in' s l y m ph o m a was 1 . 0 3 ( tab l e 3 ) . F o r m u l tipl e
m y el o m a, a s ignif icant ex ces s ris k ( 1 . 2 2 ) was o b s erv ed
in m en b u t a no n- s ignif icant d ecreas e in ris k ( 0 . 8 7 ) was
o b s erv ed in wo m en ( tab l e 3 ) .
T u m o u rs o f th e nerv o u s s y s tem - N o as s o ciatio n was
o b s erv ed b etween th e ris k o f tu m o u rs o f th e nerv o u s
T ab l e 1 - D is trib u tio ns o f pers o n y ears b y ex po s u re and
co v ariates
S tu d y v ariab l e P ers o n y ears ( %)
C u m u l ativ e ex po s u re ( pT y ears ) * :
< 0 . 2 0 2 0 4 0 7 0 0 ( 8 0 . 2 )
0 . 2 0 - 0 . 3 9 2 2 2 8 0 0 ( 8 . 8 )
0 . 4 0 - 0 . 9 9 1 7 0 2 0 0 ( 6 . 7 )
1 . 0 0 - 1 . 9 9 6 1 7 0 0 ( 2 . 4 )
2 . 0 0 4 7 8 0 0 ( 1 . 9 )
S ex :
Men 1 2 2 2 8 0 0 ( 4 8 . 1 )
Wo m en 1 3 2 0 3 0 0 ( 5 1 . 9 )
A ge ( y ears ) :
2 0 - 3 5 9 7 7 5 0 0 ( 3 8 . 4 )
3 5 - 4 9 8 1 1 7 0 0 ( 3 1 . 9 )
5 0 - 6 4 4 6 6 7 0 0 ( 1 8 . 4 )
6 5 2 8 7 2 0 0 ( 1 1 . 2 )
C al end ar pero d :
1 9 7 4 - 8 1 6 4 3 5 0 0 ( 2 5 . 3 )
1 9 8 2 - 9 0 1 8 9 9 6 0 0 ( 7 4 . 7 )
S o cial cl as s :
1 7 7 5 0 0 ( 7 . 0 )
1 1 6 3 9 6 0 0 ( 2 5 . 2 )
I I I 1 2 8 3 6 0 0 ( 5 0 . 5 )
I V 3 2 2 6 0 0 ( 1 2 . 7 )
U nk no wn 1 1 9 8 0 0 ( 4 . 7 )
T o tal 2 5 4 3 1 0 0
* T o tal is 2 5 4 3 2 0 0 b ecau s e o f ef f ect o f ro u nd ing.
BMJ V O L U ME 3 1 3 2 6 O C T O BE R 1 9 9 6 1 0 4 8
T ab l e 2 - N u m b ers o f cas es o f cancer b y prim ary s ite acco rd ing to cu m u l ativ e ex po s u re to m agnetic f iel d s o f h igh v o l tage po wer l ines in ad u l ts .
F igu res are nu m b ers o f o b s erv ed cas es ; s tand ard is ed incid ence ratio s ( 9 5 % co nf id ence interv al s )
E x po s u re ( pT )
P rim ary s ite < 0 . 2 0 0 . 2 0 - 0 . 3 9 0 . 4 0 - 0 . 9 9 1 . 0 0 - 1 . 9 9 > 2 . 0 0
A l l s ites ( n = 8 4 1 5 ) 6 3 9 3 ; 0 . 9 8 ( 0 . 9 6 to 1 . 0 1 ) 8 7 7 ; 0 . 9 8 ( 0 . 9 1 to 1 . 0 4 ) 6 9 5 ; 0 . 9 7 ( 0 . 9 0 to 1 . 0 4 ) 2 3 0 ; 0 . 8 9 ( 0 . 7 8 to 1 . 0 1 ) 2 2 0 ; 0 . 9 2 ( 0 . 8 1 to 1 . 0 5 )
S to m ach ( n = 6 3 3 ) 4 7 0 ; 0 . 9 9 ( 0 . 9 0 to 1 . 0 8 ) 7 3 ; 1 . 1 1 ( 0 . 8 7 to 1 . 3 9 ) 6 0 ; 1 . 1 3 ( 0 . 8 6 to 1 . 4 5 ) 1 1 ; 0 . 5 8 ( 0 . 2 9 to 1 . 0 3 ) 1 9 ; 1 . 0 6 ( 0 . 6 4 to 1 . 6 6 )
C o l o n ( n = 4 4 4 ) 3 2 4 ; 0 . 9 7 ( 0 . 8 6 to 1 . 0 8 ) 4 5 ; 0 . 9 6 ( 0 . 7 0 to 1 . 2 8 ) 4 5 ; 1 . 1 7 ( 0 . 8 6 to 1 . 5 7 ) 1 2 ; 0 . 8 7 ( 0 . 4 5 to 1 . 5 1 ) 1 8 ; 1 . 4 0 ( 0 . 8 3 to 2 . 2 2 )
R ectu m ( n = 3 1 3 ) 2 3 9 ; 0 . 9 9 ( 0 . 8 7 to 1 . 1 2 ) 3 7 ; 1 . 0 8 ( 0 . 7 6 to 1 . 1 8 ) 2 5 ; 0 . 9 0 ( 0 . 5 8 to 1 . 3 3 ) 3 ; 0 . 3 0 ( 0 . 0 6 to 0 . 8 8 ) 9 ; 0 . 9 6 ( 0 . 4 4 to 1 . 8 2 )
P ancreas ( n = 3 4 1 ) 2 5 4 ; 1 . 0 4 ( 0 . 9 2 to 1 . 1 8 ) 3 9 ; 1 . 1 2 ( 0 . 8 0 to 1 . 5 3 ) 2 7 ; 0 . 9 5 ( 0 . 6 3 to 1 . 3 9 ) 1 3 ; 1 . 2 7 ( 0 . 6 8 to 2 . 1 8 ) 8 ; 0 . 8 3 ( 0 . 3 6 to 1 . 6 4 )
L ary nx ( n = 6 6 ) 4 7 ; 0 . 8 0 ( 0 . 5 9 to 1 . 0 7 ) 1 0 ; 1 . 2 3 ( 0 . 5 9 to 2 . 7 7 ) 3 ; 0 . 4 7 ( 0 . 1 0 to 1 . 3 7 ) 3 ; 1 . 3 0 ( 0 . 2 7 to 3 . 8 1 ) 3 ; 1 . 3 9 ( 0 . 2 9 to 4 . 0 6 )
L u ng ( n = 1 1 2 2 ) 8 5 3 ; 0 . 9 4 ( 0 . 8 8 to 1 . 0 0 ) 1 1 9 ; 0 . 9 3 ( 0 . 7 7 to 1 . 1 1 ) 9 0 ; 0 . 8 8 ( 0 . 7 1 to 1 . 0 8 ) 2 8 ; 0 . 7 7 ( 0 . 5 1 to 1 . 1 1 ) 3 2 ; 0 . 9 1 ( 0 . 6 2 to 1 . 2 9 ) -
Breas t ( n = 1 2 2 9 ) 9 4 5 ; 1 . 0 5 ( 0 . 9 8 to 1 . 1 2 ) 1 3 0 ; 1 . 0 6 ( 0 . 8 8 to 1 . 2 5 ) 8 7 ; 0 . 8 9 ( 0 . 7 1 to 1 . 1 0 ) 4 4 ; 1 . 2 2 ( 0 . 8 9 to 1 . 6 4 ) 2 3 ; 0 . 7 5 ( 0 . 4 8 to 1 . 1 3 )
C o rpu s u teri ( n = 2 5 1 ) 1 8 2 ; 0 . 9 4 ( 0 . 8 1 to 1 . 0 8 ) 2 4 ; 0 . 8 7 ( 0 . 5 6 to 1 . 3 0 ) 3 4 ; 1 . 5 4 ( 1 . 0 7 to 2 . 1 5 ) 4 ; 0 . 5 0 ( 0 . 1 4 to 1 . 2 7 ) 7 ; 0 . 9 9 ( 0 . 4 0 to 2 . 0 3 )
O v ary ( n = 2 6 3 ) 2 0 7 ; 1 . 0 3 ( 0 . 9 0 to 1 . 1 8 ) 1 9 ; 0 . 7 1 ( 0 . 4 3 to 1 . 1 1 ) 2 2 ; 1 . 0 4 ( 0 . 6 5 to 1 . 5 7 ) 7 ; 0 . 9 1 ( 0 . 3 6 to 1 . 8 7 ) 8 ; 1 . 2 1 ( 0 . 5 2 to 2 . 3 9 )
P ro s tate ( n = 5 5 7 ) 4 0 0 ; 0 . 9 7 ( 0 . 8 8 to 1 . 0 8 ) 6 6 ; 1 . 0 9 ( 0 . 8 4 to 1 . 3 9 ) 5 9 ; 1 . 2 2 ( 0 . 9 3 to 1 . 5 7 ) 1 0 ; 0 . 5 9 ( 0 . 7 8 to 1 . 0 9 ) 2 2 ; 1 . 2 2 ( 0 . 7 7 to 1 . 8 5 )
T es tis ( n = 3 8 ) 3 2 ; 1 . 0 0 ( 0 . 6 8 to 1 . 1 4 ) 1 ; . 0 3 1 ( 0 . 0 1 to 1 . 7 0 ) 4 ; 1 . 6 0 ( 0 . 4 4 to 4 . 1 0 ) 1 ; 1 . 1 2 ( 0 . 0 3 to 6 . 2 6 ) - ; 0 ( 0 . 0 0 to 5 . 5 1 )
Kid ney ( n = 2 5 8 ) 1 9 1 ; 0 . 9 1 ( 0 . 7 8 to 1 . 0 4 ) 2 9 ; 0 . 9 7 ( 0 . 6 5 to 1 . 4 0 ) 2 7 ; 1 . 1 2 ( 0 . 7 4 to 1 . 6 3 ) 5 ; 0 . 5 8 ( 0 . 1 9 to 1 . 3 4 ) 6 ; 0 . 7 5 ( 0 . 2 8 to 1 . 6 3 )
Bl ad d er ( n = 3 0 0 ) 2 3 7 ; 1 . 0 8 ( 0 . 9 5 to 1 . 2 3 ) 2 9 ; 0 . 9 2 ( 0 . 6 2 to 1 . 3 3 ) 1 7 ; 0 . 6 7 ( 0 . 3 9 to 1 . 0 8 ) 1 1 ; 1 . 2 2 ( 0 . 6 1 to 2 . 1 9 ) 6 ; 0 . 6 8 ( 0 . 2 5 to 1 . 4 9 )
S k in, m el ano m a ( n = 2 4 5 ) 1 7 9 ; 0 . 9 4 ( 0 . 8 1 to 1 . 0 9 ) 2 1 ; 0 . 8 7 ( 0 . 5 4 to 1 . 3 3 ) 2 8 ; 1 . 4 7 ( 0 . 9 8 to 2 . 1 2 ) 1 0 ; 1 . 4 5 ( 0 . 6 9 to 2 . 6 6 ) 7 ; 1 . 1 9 ( 0 . 4 8 to 2 . 4 6 )
S k in, no n- m el ano m a ( n = 2 3 4 ) 1 7 7 ; 1 . 0 1 ( 0 . 8 7 to 1 . 1 7 ) 2 0 ; 0 . 9 2 ( 0 . 5 6 to 1 . 4 2 ) 2 6 ; 1 . 4 4 ( 0 . 9 4 to 2 . 1 2 ) 6 ; 0 . 9 3 ( 0 . 3 4 to 2 . 0 2 ) 5 ; 0 . 8 0 ( 0 . 2 6 to 1 . 8 8 )
N erv o u s s y s tem ( n = 3 0 1 ) 2 3 8 ; 0 . 9 4 ( 0 . 8 2 to 1 . 0 6 ) 3 5 ; 1 . 1 0 ( 0 . 7 7 to 1 . 5 3 ) 1 6 ; 0 . 6 4 ( 0 . 3 7 to 1 . 0 4 ) 5 ; 0 . 5 5 ( 0 . 1 8 to 1 . 2 8 ) 7 ; 0 . 9 2 ( 0 . 3 7 to 1 . 8 9 )
T h y ro id ( n = 1 5 1 ) 1 2 2 ; 1 . 0 1 ( 0 . 8 4 to 1 . 2 1 ) 8 ; 0 . 5 5 ( 0 . 2 4 to 1 . 0 9 ) 1 0 ; 0 . 8 9 ( 0 . 4 3 to 1 . 6 4 ) 7 ; 1 . 7 1 ( 0 . 6 9 to 3 . 5 2 ) 4 ; 1 . 2 0 ( 0 . 3 3 to 3 . 0 8 )
N o n- H o d gk in' s l y m ph o m a ( n = 2 7 3 ) 2 0 8 ; 1 . 0 2 ( 0 . 8 9 to 1 . 1 7 ) 3 4 ; 1 . 3 3 ( 0 . 9 2 to 1 . 8 6 ) 1 2 ; 0 . 5 4 ( 0 . 2 8 to 0 . 9 5 ) 1 0 ; 1 . 2 5 ( 0 . 6 0 to 2 . 2 9 ) 9 ; 1 . 2 5 ( 0 . 5 7 to 2 . 3 7 )
H o d gk in' s d is eas e ( n = 7 3 ) 6 1 ; 1 . 0 1 ( 0 . 7 7 to 1 . 3 0 ) 5 ; 0 . 7 5 ( 0 . 2 4 to 1 . 7 5 ) 4 ; 0 . 7 8 ( 0 . 2 1 to 2 . 0 0 ) 3 ; 1 . 6 4 ( 0 . 3 4 to 4 . 7 6 ) - ; 0 ( 0 . 0 0 to 2 . 5 1 )
Mu l tipl e m y el o m a ( n = 1 1 2 ) 8 2 ; 0 . 9 4 ( 0 . 7 5 to 1 . 1 7 ) 1 2 ; 0 . 9 6 ( 0 . 5 0 to 1 . 6 8 ) 1 0 ; 0 . 9 8 ( 0 . 4 7 to 1 . 8 1 ) 3 ; 0 . 8 2 ( 0 . 1 7 to 2 . 4 0 ) 5 ; 1 . 4 6 ( 0 . 4 7 to 3 . 4 0 )
L eu k aem ia ( n = 2 0 3 ) 1 5 6 ; 0 . 9 6 ( 0 . 8 2 to 1 . 1 3 ) 2 3 ; 1 . 0 6 ( 0 . 6 8 to 1 . 6 0 ) 1 5 ; 0 . 8 7 ( 0 . 4 9 to 1 . 4 3 ) 5 ; 0 . 8 1 ( 0 . 2 6 to 1 . 8 8 ) 4 ; 0 . 7 1 ( 0 . 1 9 to 1 . 8 1 )
T ab l e 3 - I ncid ence rate ratio s ( 9 5 % co nf id ence interv al s ) per 1 P T y ear increas e in
ex po s u re b y prim ary s ite and s ex
P rim ary s ite Men Wo m en T o tal
A l l ty pes 0 . 9 6 ( 0 . 9 2 to 1 . 0 0 ) 1 . 0 0 ( 0 . 9 7 to 1 . 0 4 ) 0 . 9 8 ( 0 . 9 6 to 1 . 0 1 )
S to m ach 0 . 9 3 ( 0 . 8 1 to 1 . 0 8 ) 1 . 0 5 ( 0 . 9 3 to 1 . 1 9 ) 1 . 0 0 ( 0 . 9 1 to 1 . 0 9 )
C o l o n 0 . 9 5 ( 0 . 7 9 to 1 . 1 3 ) 1 . 1 6 ( 1 . 0 3 to 1 . 2 9 ) 1 . 0 7 ( 0 . 9 8 to 1 . 1 8 )
R ectu m 0 . 8 4 ( 0 . 6 5 to 1 . 0 8 ) 1 . 0 5 ( 0 . 8 8 to 1 . 2 4 ) 0 . 9 6 ( 0 . 8 3 to 1 . 1 0 )
L ary nx 1 . 1 2 ( 0 . 8 9 to 1 . 4 1 ) 1 . 1 1 ( 0 . 8 8 to 1 . 3 9 )
P ancreas 0 . 6 6 ( 0 . 4 5 to 0 . 9 7 ) 1 . 1 2 ( 0 . 9 7 to 1 . 2 8 ) 0 . 9 6 ( 0 . 8 4 to 1 . 1 0 )
L u ng 0 . 9 9 ( 0 . 9 2 to 1 . 0 7 ) 0 . 9 4 ( 0 . 7 7 to 1 . 1 6 ) 0 . 9 8 ( 0 . 9 2 to 1 . 0 6 )
Breas t - 0 . 9 5 ( 0 . 8 8 to 1 . 0 2 )
-
C o rpu s u teri - 1 . 0 1 ( 0 . 8 8 to 1 . 1 7 )
O v ary - 1 . 0 3 ( 0 . 8 9 to 1 . 1 9 ) -
P ro s tate 1 . 0 3 ( 0 . 9 5 to 1 . 1 3 )
-
T es tis 1 . 0 6 ( 0 . 5 5 to 2 . 0 5 ) - -
Kid ney 0 . 9 7 ( 0 . 7 9 to 1 . 1 8 ) 0 . 9 4 ( 0 . 7 3 to 1 . 2 1 ) 0 . 9 6 ( 0 . 8 2 to 1 . 1 2 )
Bl ad d er 0 . 8 6 ( 0 . 7 0 to 1 . 0 5 ) 1 . 0 5 ( 0 . 8 2 to 1 . 3 6 ) 0 . 9 1 ( 0 . 7 8 to 1 . 0 7 )
Mel ano m a 1 . 0 5 ( 0 . 8 6 to 1 . 2 8 ) 1 . 1 0 ( 0 . 9 2 to 1 . 3 3 ) 1 . 0 8 ( 0 . 9 4 to 1 . 2 3 )
S k in, no n- m el ano m a 0 . 9 0 ( 0 . 6 8 to 1 . 1 8 ) 0 . 9 8 ( 0 . 8 0 to 1 . 2 1 ) 0 . 9 5 ( 0 . 8 0 to 1 . 1 2 )
N erv o u s s y s tem 0 . 9 4 ( 0 . 7 2 to 1 . 2 2 ) 0 . 9 8 ( 0 . 8 1 to 1 . 2 0 ) 0 . 9 7 ( 0 . 8 3 to 1 . 1 3 )
T h y ro id 1 . 0 2 ( 0 . 8 1 to 1 . 2 8 ) 1 . 0 5 ( 0 . 8 7 to 1 . 2 7 )
N o n- H o d gk in' s l y m ph o m a 0 . 9 2 ( 0 . 7 2 to 1 . 1 7 ) 1 . 1 2 ( 0 . 9 5 to 1 . 3 1 ) 1 . 0 3 ( 0 . 9 0 to 1 . 1 8 )
H o d gk in' s d is eas e 0 . 1 8 ( 0 . 0 0 9 9 to 3 . 2 4 ) 0 . 9 3 ( 0 . 6 2 to 1 . 4 0 )
Mu l tipl e m y el o m a 1 . 2 2 ( 1 . 0 0 to 1 . 4 9 ) 0 . 8 7 ( 0 . 5 7 to 1 . 3 2 ) 1 . 0 9 ( 0 . 9 1 to 1 . 3 1 )
L eu k aem ia 0 . 8 3 ( 0 . 5 9 to 1 . 6 7 ) 1 . 0 2 ( 0 . 8 1 to 1 . 2 8 ) 0 . 9 3 ( 0 . 7 7 to 1 . 1 3 )
* T h e ad j u s ted m o d el d o es no t co nv erge.
s y s tem and m agnetic f iel d s o f po wer l ines . T h is res u l t
was co ns is tent f o r gl io m as and m eningio m as in m en as
wel l as wo m en.
Mel ano m a o f th e s k in- Mel ano m a o f th e s k in was
th e o nl y ty pe o f cancer f o r wh ich th e ris k was s o m e-
wh at increas ed th ro u gh o u t th e th ree h igh es t catego ries
o f ex po s u re and in b o th s ex es . T h e incid ence rate
ratio was 1 . 0 5 f o r m en and 1 . 1 0 f o r wo m en ( tab l e 3 ) .
T h e incid ence rate ratio s ( no t s h o wn in tab l es ) f o r th e
f o u r co ns ecu tiv e l ev el s o f ex po s u re were 0 . 9 1 ( 0 . 5 8 to
1 . 4 3 ) , 1 . 5 4 ( 1 . 0 3 to 2 . 2 9 ) , 1 . 5 2 ( 0 . 8 0 to 2 . 8 7 ) , and
1 . 2 5 ( 0 . 5 9 to 2 . 6 6 ) in rel atio n to th e l o wes t ex po s u re
l ev el .
O es tro gen d epend ent cancers - T h e o v eral l ris k o f b reas t
cancer in wo m en d ecreas ed no n- s ignif icantl y with l ev el
o f m agnetic f iel d ( 0 . 9 5 ; tab l e 3 ) . R is k s o f cancers o f th e
u terine co rpu s and o v ary d id no t d if f er b y ex po s u re.
C o l o n cancer- T h e ris k o f co l o n cancer increas ed with
ex po s u re in wo m en ( 1 . 1 6 ; 1 . 0 3 to 1 . 2 9 ) b u t no t in m en
( 0 . 9 5 ; 0 . 7 9 to 1 . 1 3 ) ( tab l e 3 ) . I n wo m en th e ris k was
h igh es t in th e h igh es t ex po s u re catego ry with 2 . 0 , u T
y ears ( 2 . 0 3 ; 1 . 1 5 to 3 . 5 8 ) .
O th er ty pes o f cancer- We f o u nd no as s o ciatio n
b etween l ev el o f m agnetic f iel d and cancers o f th e s to m -
ach , rectu m , tes tis , pro s tate, k id ney , b l ad d er, and
th y ro id gl and and no n- m el ano m a o f th e s k in. T h e co n-
s ecu tiv e incid ence rate ratio s s pecif ic f o r catego ry o f
ex po s u re f o r l ary ngeal cancerwere 1 . 0 , 1 . 5 1 , 0 . 5 7 , 1 . 5 9 ,
and 1 . 6 8 ( al l no n- s ignif icant) and th e incid ence rate
ratio was 1 . 1 1 per 1 , u T y ear increas e in ex po s u re ( tab l e
3 ) . I n pancreatic cancer th ere was a s ignif icant d ecreas e
in m en ( 0 . 6 6 ) b u t no t in wo m en ( 1 . 1 2 ) .
D is cu s s io n
ME T H O D O L O GI C A L I S S U E S
T h e pres ent s tu d y is th e f irs t natio nwid e s tu d y o n th e
rel atio n o f res id ential m agnetic f iel d s and cancer in
ad u l ts , and its nu m b er o f ex po s ed cas es ex ceed s th e
nu m b ers o f th e prev io u s res id ential co h o rt s tu d ies 1 7 2 1
b y f iv ef o l d to 2 5 - f o l d . T h e as s es s m ent o f ex po s u re to o k
into acco u nt h is to rical ex po s u res o v er a perio d o f 2 0
y ears . Mo re th an 2 0 ty pes o f cancer were s creened f o r
an as s o ciatio n with m agnetic f iel d s . T h e interpretatio n
o f th e res u l ts is a ch al l enging tas k , partl y b ecau s e o ne
ris k es tim ate o u t o f 2 0 is ex pected to d if f er f ro m nu l l ( at
9 5 % s ignif icance) b ecau s e o f ch ance al o ne. T h e m agni-
tu d e o f th e o b s erv ed ris k s and pres ence o f a d o s e
res po ns e, s ignif icance, co ns is tency , and b io l o gical pl au -
s ib il ity h av e al l to b e co ns id ered in th e ev al u atio n o f th e
res u l ts .
I n th e anal y s es with co ntinu o u s cu m u l ativ e ex po s u re,
th e incid ence rate ratio s were pres ented f o r a u nit
ch ange o f o nl y 1 , u T y ear, wh ich , h o wev er, repres ents
th e actu al ex po s u re d if f erences with in th e s tu d y co h o rt.
T h e as s es s m ent o f ex po s u re in o u r s tu d y h as b een
d is cu s s ed in greater d etail in s o m e prev io u s
pu b l icatio ns . 4 2 7 2 8
T h e d ata co l l ectio n was entirel y o n th e b as is o f
natio nwid e regis ters , wh ich s et l im its to th e inf o rm atio n
av ail ab l e o n po tential co nf o u nd ers . U nl ik e th e earl ier
res id ential co h o rt s tu d ies , o u r s tu d y ad j u s ted th e ris k
es tim ates f o r s o cial cl as s in ad d itio n to age, s ex , and cal -
end ar perio d . T h is d id no t m aterial l y ch ange th e ris k
es tim ates o f cancer. S o cial cl as s in F inl and h as b een
s h o wn to b e a go o d pro x y o f a v ariety o f l if es ty l e f acto rs
as s o ciated with cau s es o f cancer, 2 9 b u t o b v io u s l y th ere is
s o m e res id u al co nf o u nd ing in th e pres ent anal y s es . T h e
accu racy o f th e po pu l atio n regis tratio n s y s tem in
F inl and is h igh , th e co v erage o f cancer regis tratio n is
v irtu al l y co m pl ete, 3 0 and th e reco rd l ink age pro ced u res
BMJ V O L U ME 3 1 3 2 6 O C T O BE R 1 9 9 6 1 0 4 9
rel iab l e. 3 ' T h eref o re, tech nical reas o ns are no t l ik el y to
b ias th e res u l ts . T h e co h o rt is al s o a part o f th e ref erence
po pu l atio n. T h o s e ex po s ed
>
0 . 2 j T y ears , h o wev er,
m ak e u p o nl y s o m e 2 % o f th e to tal po pu l atio n- th at is ,
th e d il u ting ef f ect in th e s tand ard is ed incid ence ratio s is
negl igib l e.
F I N D I N GS
O v eral l , we f o u nd no m aj o r increas es - o r no
increas es at al l - in th e ris k s o f cancer as s o ciated with
m agnetic f iel d s o f h igh v o l tage po wer l ines f o r th e 2 1
prim ary s ites inv es tigated . T h is o b s erv atio n is q u ite
co ns is tent with th e f ind ings o f th e prev io u s epid em io -
l o gical s tu d ies wh ere th e o b s erv ed rel ativ e ris k s h av e
m o s t o f ten b een cl o s e to u nity .
Magnetic f iel d s h av e prev io u s l y b een as s o ciated with
s ev eral ty pes o f cancer s u ch as l eu k aem ia, l y m ph o m a,
tu m o u rs o f th e nerv o u s s y s tem , b reas t cancer,
m el ano m a, and pro s tate cancer, b u t th e o u tco m e ev ent,
if any , h as rem ained m o re o r l es s o b s cu re. I n ad d itio n to
th e v ario u s epid em io l o gical o b s erv atio ns , s o m e th eo -
retical papers h av e attem pted to b rid ge th e gaps
b etween l ab o rato ry o b s erv atio ns and epid em io l o gical
cancer s tu d ies with regard to s u s ceptib l e ty pes o f
cancer. F o r ins tance, th e m el ato nin h y po th es is s u gges ts
a l ink b etween el ectro m agnetic f iel d s and h o rm o ne
rel ated cancers o n th e b as is o f th e o b s erv atio ns o f el ec-
tro m agnetic f iel d s red u cing m el ato nin. ' 2 We o b s erv ed
no increas e in th e ris k s f o r cancers o f f em al e b reas t,
o v ary , u terine co rpu s , pro s tate, and tes tis as s o ciated
with m agnetic f iel d s o f po wer l ines .
T h e ris k s o f h aem ato l o gical m al ignancies and
tu m o u rs o f th e nerv o u s s y s tem were al s o eq u al to u nity .
T h e prev io u s l y o b s erv ed o r s u gges ted increas es in th es e
ty pes 7 were th u s no t co nf irm ed . T h e ris k s o f th e cancers
o f th e s to m ach , pancreas , l u ng, k id ney , b l ad d er, and
th y ro id gl and and o f no n- m el ano m a o f th e s k in d id no t
d if f er b y m agnetic f iel d ex po s u re.
T h e ris k o f m el ano m a was th e o nl y cancer f o r wh ich
we o b s erv ed s o m e ind icatio n o f an increas e in ris k ,
wh ich h as in s o m e s tu d ies b een rel ated to m agnetic
f iel d s . 8 3 3 3 7 T h e m agnitu d e o f increas e was , h o wev er,
rath er l o w ( rel ativ e ris k increas e l es s th an 1 0 % per 1 , u T
y ear) , and th e h igh es t rel ativ e ris k o ccu rred in interm e-
d iate ex po s u re catego ries . T h e po s s ib l e co nf o u nd ing b y
s o l ar and no n- s o l ar ris k d eterm inants ' 8 3 9 co u l d no t b e
co ns id ered in th e s tatis tical anal y s es b ecau s e o f th e l ack
o f inf o rm atio n o n rel ev ant co nf o u nd ers . I f th e o b s erv ed
8 % increas e in th e ris k o f m el ano m a was d u e to
ex trem el y l o w f req u ency m agnetic f iel d s , th is wo u l d
co rres po nd to l es s th an o ne ex tra cas e o u t o f s ev eral
h u nd red cas es annu al l y in th e F innis h po pu l atio n o f f iv e
m il l io n.
T h e o b s erv atio n o f a s ignif icant increas e in th e ris k o f
cancer o f th e co l o n in wo m en was no t an anticipated
f ind ing and m ay wel l b e d u e to ch ance. T h ere is o nl y
o ne prev io u s epid em io l o gical o b s erv atio n o f an increas e
th e ris k o f co l o n cancer am o ng peo pl e ex po s ed to m ag-
netic f iel d s , 8 wh ereas th ree o th er s tu d ies pu b l is h ed s o
f ar h av e f o u nd no ex ces s ris k s o f co l o n cancer. ' 2 2 1 4 0
A s
to th e po s s ib l e carcino genic m ech anis m in co l o n cancer
it h as b een s u gges ted th at th e earl ier o b s erv atio n o f h igh
s to res o f iro n in th e b o d y increas ing th e ris k m igh t b e
ex pl ained b y iro n h av ing a ro l e in catal y s ing o x y gen
rad ical s . 4 ' O n th e o th er h and , 6 0 H z m agnetic f iel d s
h av e b een repo rted to pro d u ce ex pres s io n o f trans f errin
recepto rs o n h u m an co l o n cancer cel l s in v it: ro 4 2 - th at
is , b o d y iro n co u l d act as a co carcino gen with ex trem el y
l o w f req u ency m agnetic f iel d s .
C O N C L U S I O N S
I n co ncl u s io n, th e ex trem el y l o w f req u ency m agnetic
f iel d s o f h igh v o l tage po wer l ines at ty pical res id ential
l ev el s d o no t s eem to b e as s o ciated with an increas e in
Key m es s ages
* A l th o u gh s m al l increas es in th e ris k o f cancer in
ch il d ren wh o l iv e near po wer l ines and in ad u l ts
ex po s ed to m agnetic f iel d s f ro m o ccu patio nal
s o u rces h av e b een o b s erv ed , s tu d ies o n res id ential
ex po s u res and cancer in ad u l ts h av e b een f ew and
inco ncl u s iv e
* T h e pres ent po pu l atio n b as ed co h o rt s tu d y
am o ng F innis h ad u l ts with 8 5 0 0 o b s erv ed cancer
cas es f o u nd no increas e in th e ris k o f o v eral l cancer
in ad u l ts ex po s ed to m agnetic f iel d s o f h igh v o l tage
po wer l ines
* T h e prev io u s l y s u gges ted as s o ciatio ns b etween
m agnetic f iel d s and tu m o u rs o f th e nerv o u s
s y s tem , l y m ph o m a, l eu k aem ia, and b reas t cancer
in wo m en were no t co nf irm ed
* T h e res u l ts o f th e pres ent s tu d y s u gges t s tro ngl y
th at ty pical res id ential m agnetic f iel d s generated b y
h igh v o l tage po werl ines are no t rel ated to cancer in
ad u l ts
* T h e po s s ib il ity o f an increas e in ris k at h igh er
m agnetic f iel d l ev el s , o r in m o re s pecif ic cancer
s u b ty pes , canno t b e ex cl u d ed o n th e b as is o f th is
s tu d y
cancer am o ng ad u l ts ; th is h o l d s f o r th e h aem ato l o gical
m al ignancies and f o r tu m o u rs o f th e nerv o u s s y s tem as
wel l as f o r th e gro u p o f h o rm o ne rel ated cancers in m al e
and f em al e genital s . A s to s pecif ic cancer ty pes , th e ro l e
o f ex trem el y l o w f req u ency m agnetic f iel d s in th e
path o genes is o f m y el o m a, m el ano m a, and co l o n cancer
rem ains u ncertain.
We gratef u l l y ack no wl ed ge D rJ o rm a V al j u s ( I V O Gro u p) f o r
h is patient wo rk in getting th is s tu d y s tarted and Mr Mik k o
H o ngis to ( I V O Gro u p) f o r h is co m preh ens iv e wo rk in th e co m -
pu tatio n o f m agnetic f iel d s . We al s o th ank Mr P ek k a J arv inen
( I V O Gro u p) , MrH annu L am m i ( Karttak es k u s O y ) , and Mr
Martti Ko rpiranta ( T T - V al tio npal v el u t Q y ) .
F u nd ing: I V O Gro u p ( a po wer co m pany ) f u nd ed th e d ata
co l l ectio n and as s es s m ent o f ex po s u re. T h e A cad em y o f
F inl and , I V O Gro u p, and I nd u s trial P o werT rans m is s io n C o m -
pany ( ano th er po wer co m pany ) f u nd ed th e cancer anal y s es and
repo rting.
C o nf l ict o f interes t: N o ne.
1 Werth eim er N , L eeper E . E l ectrical wiring co nf igu ratio ns and ch il d h o o d
cancer. A m J E pid em io l 1 9 7 9 ; 1 0 9 : 2 7 3 - 8 4 .
2 F ey ch ting M, A h l b o m A . Magnetic f iel d s and cancer in ch il d ren l iv ing cl o s e
to S wed is h h igh v o l tage po wer l ines . A m J 7 E pid em io l 1 9 9 3 ; 1 3 8 : 4 6 7 - 8 1 .
3 O l s en J H , N iel s en A , S ch u l gen G. R es id ence near h igh v o l tage f acil ities and
th e ris k o f cancer in ch il d ren. BMJ 1 9 9 3 ; 3 0 7 : 8 9 1 - 5 .
4 V erk as al o P K, P u k k al a E , H o ngis to MY, V al j u s J , J arv inen P , H eik k il a K,
et al . R is k o f cancer in F innis h ch il d ren l iv ing cl o s e to po wer l ines .
BM_
1 9 9 3 ; 3 0 7 : 8 9 5 - 9 .
5 P res to n- Martin S , N av id i W, T h o m as D , L ee P ey - J , Bo wm an J , P o go d a J .
L o s A ngel es s tu d y o f res id ential m agnetic f iel d s and ch il d h o o d b rain
tu m o u rs . A m J E pid em io l 1 9 9 6 ; 1 4 3 : 1 0 5 - 1 9 .
6 Gu rney J G, Mu el l er BA , D av is S , S ch wartz S M, S tev ens R G, Ko peck y KJ .
C h il d h o o d b rain tu m o r o ccu rrence in rel atio n to res id ential po wer l ine
co nf igu ratio ns , el ectric h eating s o u rces , and el ectric appl iance u s e. A m J
E pid em io l 1 9 9 6 ; 1 4 3 : 1 2 0 - 8 .
7 S av itz D A , A h l b o m A . E pid em io l o gic ev id ence o n cancer in rel atio n to res i-
d ential and o ccu patio nal ex po s u res . I n: C arpenterD O , A y rapety an S , ed s .
Bio l o gical ef f ects o f el ectric and m agnetic f iel d s . Benef icial and h arm f id ef f ects .
V o l 2 . S an D iego : A cad em ic P res s , 1 9 9 4 : 2 3 3 - 6 1 .
8 T y nes T , A nd ers en A , L angm ark F . I ncid ence o f cancer in N o rwegian
wo rk ers po tential l y ex po s ed to el ectro m agnetic f iel d s . A m J
E pid em io l
1 9 9 2 ; 1 3 6 : 8 1 - 8 .
9 Gu enel P , R as k m ark P , A nd ers en J B, L y nge E . I ncid ence o f cancer in per-
s o ns with o ccu patio nal ex po s u re to el ectro m agnetic f iel d s in D enm ark . Br
J I nd Med 1 9 9 3 ; 4 0 : 7 5 8 - 6 4 .
1 0 F l o d eru s B, P eras o n T , S tenl u nd C , Wennb erg A , O at A , Knav e B. O ccu pa-
tio nal ex po s u re tO el ectro m agnetic f iel d s in rel atio n to l eu k aem ia and
b rain tu m o ra: a cas e- co ntro l s tu d y in S wed en. C ancer C au s es C entral
1 9 9 3 ; 4 : 4 6 5 - 7 6 .
1 1 S ah l J D , Kel s h MA , Greenl and S . C o h o rt and nes ted cas e- co ntro l s tu d ies
o f h em ato po ietic cancera and b rain cancer am o ng el ectric u til ity wo rk era.
E pid em io l o gy 1 9 9 3 ; 4 : 1 0 4 - 1 4 .
1 2 T h eriau l t G, Go l d b erg M, Mil l er A B, A rm s tro ng B, Gu enel P , D ead m an J ,
et al . C ancer ris k s as s o ciated with o ccu patio nal ex po s u re to m agnetic
f iel d s am o ng el ectric u til ity wo rk ers in O ntario and Q u eb ec, C anad a, and
F rance: 1 9 7 0 - 1 9 8 9 . A m J aE pid em io l 1 9 9 4 ; 1 3 9 : 5 5 0 - 7 2 .
1 0 5 0 BMJ V O L U ME 3 1 3 2 6 O C T O BE R 1 9 9 6
1 3 S av itz D A , L o o m is D P . Magnetic f iel d ex po s u re in rel atio n to l eu k em ia and
b rain cancer m o rtal ity am o ng el ectric u til ity wo rk ers . A m I E pid em io l
1 9 9 5 ; 1 4 1 : 1 2 3 - 3 4 .
1 4 L o o m is D P , S av itz D A , A nanth C V . Breas t cancer m o rtal ity am o ng f em al e
el ectrical wo rk ers in th e U nited S tates . J N atl C ancer I ns t 1 9 9 4 ; 8 6 : 9 2 1 - 5 .
1 5 Werth eim er N , L eeper E . A d u l t cancer rel ated to el ectrical wires near th e
h o m e. I ntJ E pid em io l 1 9 8 2 ; 1 1 : 3 4 5 - 5 5 .
1 6 Werth eim er N , L eeper E . Magnetic f iel d ex po s u re rel ated to cancer
s u b ty pes . A nn N YA cad S ci 1 9 8 7 ; 5 0 2 : 4 3 - 5 4 .
1 7 McD o wal l ME . Mo rtal ity o f pers o ns res id ent in th e v icinity o f el ectricity
trans m is s io n f acil ities .
Bry
C ancer 1 9 8 6 ; 5 3 : 2 7 1 - 9 .
1 8 S ev ers o n R K, S tev ens R G, Kau ne WT , T h o m as D B, H eu s er L , D av is S ,
et al . A cu te no nl y m ph o cy tic l eu k em ia and res id ential ex po s u re to po wer
f req u ency m agnetic f iel d s . A m j E pid em io l 1 9 8 8 ; 1 2 8 : 1 0 - 2 0 .
1 9 C o l em an MP , Bel l C M, T ay l o r H L , P rim ic- Z ak el j M. L eu k aem ia and res i-
d ence near el ectricity trans m is s io n eq u ipm ent: a cas e- co ntro l s tu d y . BrJ
C ancer 1 9 8 9 ; 6 0 : 7 9 3 - 8 .
2 0 Yo u ngs o n J H A M, C l ay d en A D , My ers A , C artwrigh t R A . A cas e/ co ntro l
s tu d y o f ad u l t h aem ato l o gical m al ignancies in rel atio n to o v erh ead po wer-
l ines . BrJ C ancer 1 9 9 1 ; 6 3 : 9 7 7 - 8 5 .
2 1 S ch reib er GH , S waen GM, Meij ers J M, S l angen J J , S tu rm ans F . C ancer
m o rtal ity and res id ence near el ectricity trans m is s io n eq u ipm ent: a retro -
s pectiv e co h o rt s tu d y . I ntJ E pid em io l 1 9 9 3 ; 2 2 : 9 - 1 5 .
2 2 F ey ch ting M, A h l b o m A . Magnetic f iel d s , l eu k em ia, and central nerv o u s
s y s tem tu m o rs in S wed is h ad u l ts res id ing near h igh - v o l tage po wer l ines .
E pid em io l o gy 1 9 9 4 ; 5 : 5 0 1 - 9 .
2 3 P res to n- Martin S , P eters J M, Yu MC , Garab rant D H , Bo wm an J D .
My el o geno u s l eu k em ia and el ectric b l ank et u s e. Bio el ecrro m agnetics
1 9 8 8 ; 9 : 2 0 7 - 1 3 .
2 4 V erreau l t R , Weis s N S , H o l l enb ach KA , S trad er C H , D al ing J R . U s e o f
el ectric b l ank ets and ris k o f tes ticu l ar cancer. A m J E pid em io l
1 9 9 0 ; 1 3 1 : 7 5 9 - 6 2 .
2 5 V ena J E , Grah am S , H el l m ann R , S wans o n M, Bras u re J . U s e o f el ectric
b l ank ets and ris k o f po s tm eno pau s al b reas t cancer. A m J E pid em io l
1 9 9 1 ; 1 3 4 : 1 8 0 - 5 .
2 6 V ena J E , F reu d enh eim J L , Mars h al l J R , L au gh l in R , S wans o n M, S ax o n G.
R is k o f prem eno pau s al b reas t cancer and u s e o f el ectric b l ank ets . A m J
E pid em io l 1 9 9 4 ; 1 4 0 : 9 7 4 - 9 .
2 7 V al j u s J , H o ngis to M, V erk as al o P , J arv inen P , H eik k il a K, Ko s k env u o M.
R es id ential ex po s u re to m agnetic f iel d s generated b y 1 1 0 - 4 0 0 k V po wer
l ines in F inl and . Bio el ectro m agnetics 1 9 9 5 ; 1 6 : 3 6 5 - 7 6 .
2 8 V erk as al o P , P u k k al a E , H o ngis to M, V al j u s J , J arv inen P , H eik k il a K, et al .
P o wer- f req u ency m agnetic f iel d s and po s s ib l e ad v ers e h eal th ef f ects ( l et-
ter) . BMJ 1 9 9 4 ; 3 0 8 : 1 1 6 2 - 3 .
2 9 P u k k al a E . C ancer ris k b y s o cial cl as s and o ccu patio n. A s u rv ey o f 1 0 9 , 0 0 0
cancer cas es am o ng F inns o f wo rk ing age. I n: Wah rend o rf J , ed . C o ntrib u -
tio ns to epid em io l o gy and b io s tatis tics . V o l 7 . Bas el : Karger, 1 9 9 5 .
3 0 T eppo L , P u k k al a E , L eh to nen M. D ata q u al ity and q u al ity co ntro l o f a
po pu l atio n- b as ed cancer regis try . A cta O nco l 1 9 9 4 ; 3 3 : 3 6 5 - 9 .
3 1 P u k k al a E . U s e o f reco rd l ink age in s m al l - area s tu d ies . I n: E l l io t P , Gu zick
J , E ngl is h D , S tern R , ed s . Geo graph ical and env iro nm ental epid em io l o gy .
O x f o rd : O x f o rd U niv ers ity P res s , 1 9 9 2 : 1 2 5 - 3 1 .
3 2 S tev ens R G. E l ectric po wer u s e and b reas t cancer: a h y po th es is . A m J f E pi-
d em io l 1 9 8 7 ; 1 2 5 : 5 5 6 - 6 1 .
3 3 V A gero D , O l in R . I ncid ence o f cancer in th e el ectro nics ind u s try : u s ing th e
new S wed is h C ancer E nv iro nm ent R egis try as a s creening ins tru m ent. Br
J I nd Med 1 9 8 3 ; 4 0 : 1 8 8 - 9 2 .
3 4 V agero D , A h l b o m A , S ah l s ten S . C ancer m o rb id ity am o ng wo rk ers in th e
tel eco m m u nicatio ns ind u s try . BrJ I nd Med 1 9 8 5 ; 4 2 : 1 9 1 - 5 .
3 5 O l in R , V A gero D , A h l b o m A . Mo rtal ity ex perience o f el ectrical engineers .
BrJ I nd Med 1 9 8 5 ; 4 2 : 2 1 1 - 2 .
3 6 S o rah an T , Waterh o u s e J A H , McKiernan MJ , A s to n R H . C ancer incid ence
and cancer m o rtal ity in a co h o rt o f s em ico nd u cto r wo rk ers . BrJ I nd Med
1 9 8 5 ; 4 2 : 5 4 6 - 5 0 .
3 7 D e Gu ire L , T h ' I riau l t G, I tu rra H , P ro v ench er S , C y r D , C as e BW
I ncreas ed incid ence o f m al ignant m el ano m a o f th e s k in in a tel eco m m u -
nicatio ns ind u s try . Br I nd Med 1 9 8 8 ; 4 5 : 8 2 4 .
3 8 Wh item an D , Green A . Mel ano m a and s u nb u rn. C ancer C au s es C o ntro l
1 9 9 4 ; S : 5 6 4 - 7 2 .
3 9 R o ck l ey P F , T rief f N , Wagner R F J , T y ring S K. N o ns u nl igh t ris k f acto rs f o r
m al ignant m el ano m a. I . C h em ical agents , ph y s ical co nd itio ns , and o ccu -
patio n. I nty
D erm ato l 1 9 9 4 ; 3 3 : 3 9 8 - 4 0 6 .
4 0 T y nes T , R eitan J B, A nd ers en A . I ncid ence o f cancer am o ng wo rk ers in
N o rwegian h y d ro el ectric po wer co m panies . S cand Wo rk E nv iro n H eal th
1 9 9 4 ; 2 0 : 3 3 9 - 4 4 .
4 1 S tev ens R G. Bio l o gical l y b as ed epid em io l o gical s tu d ies o f el ectric po wer
and cancer. E nv iro n H eal th P ers p S u ppl 1 9 9 3 ; 1 0 1 ( s u ppl 4 ) : 9 3 - 1 0 0 .
4 2 P h il l ips J L , R u tl ed ge L , Winters WD . T rans f errin b ind ing to two h u m an
co l o n carcino m a cel l l ines : ch aracterizatio n and ef f ect o f 6 0 - H z
el ectro m agnetic f iel d s . C ancer R es earch 1 9 8 6 ; 4 6 : 2 3 9 - 4 4 .
( A ccepted 6 S eptem b er 1 9 9 6 )
A ccid ent and T rau m a
R es earch C enter, U KK
I ns titu te f o r H eal th
P ro m o tio n R es earch , P O
Bo x 3 0 , F I N - 3 3 5 0 1
T am pere, F inl and
P ek k a Kannu s , ch ief ph y s ician
Mik a P al v anen, res earch f el l o w
S eppo N iem i, res earch
as s is tant
J ari P ark k ari, res earch f el l o w
I l k k a V u o ri, pro f es s o r
D epartm ent o f S u rgery ,
T am pere U niv ers ity
H o s pital , T am pere,
F inl and
Mark k u J arv inen, pro f es s o r
C o rres po nd ence to :
D rKannu s .
BM7 1 9 9 6 ; 3 1 3 : 1 0 5 1 - 2
I ncreas ing nu m b erand
incid ence o f o s teo po ro tic
f ractu res o f th e pro x im al
h u m eru s in el d erl y peo pl e
P ek k a Kannu s , Mik a P al v anen, S eppo N iem i,
J ari P ark k ari, Mark k u J arv inen, I l k k a V u o ri
T h e m o s t co m m o n f o rm s o f o s teo po ro tic f ractu res
o ccu r at th e d is tal f o rearm , s pine, and h ip. T reating l es s
co m m o n f ractu res ( s u ch as th o s e o f th e pro x im al
h u m eru s , pel v is , k nee, and ank l e' ) is al s o d em and ing
and ex pens iv e. Yet epid em io l o gical inf o rm atio n o n
th es e is s carce; no natio nwid e s tu d y o f th e incid ence o f
th e o s teo po ro tic f ractu res o f th e pro x im al h u m eru s h as
b een repo rted .
S u b j ects , m eth o d s , and res u l ts
We d ef ined an o s teo po ro tic f ractu re o f th e pro x im al
h u m eru s as a f ractu re o ccu rring in peo pl e aged 2 6 0
th at res u l ted f ro m m inim al trau m a o nl y - th at is , a f al l
f ro m s tand ing h eigh t o r l es s . We s el ected al l s u ch
patients ad m itted to F innis h h o s pital s in 1 9 7 0 - 2 ,
1 9 7 4 - 5 , 1 9 7 8 - 8 0 , 1 9 8 3 - 5 , 1 9 8 8 - 9 , and 1 9 9 1 - 3 f o r
prim ary treatm ent o f f irs t f ractu re o f th e pro x im al
h u m eru s f ro m th e N atio nal H o s pital D is ch arge
R egis ter. P rev io u s s tu d ies h av e f o u nd th e accu racy o f
th e regis ter to b e 9 6 _ 9 7 %. 2 3 4 T h e s tu d y co v ered th e
entire F innis h po pu l atio n. We ad j u s ted f o r th e s u b j ects '
age b y u s ing th e m ean po pu l atio n b etween 1 9 7 0 and
1 9 9 3 as th e s tand ard po pu l atio n and ex pres s ed f ractu re
incid ences as th e nu m b er o f cas es / l 0 0 0 0 0 pers o ns / y ear
b y s ex and b y age.
T h e to tal nu m b er o f o s teo po ro tic f ractu res o f th e
pro x im al h u m eru s increas ed s tead il y d u ring th e s tu d y
perio d , f ro m 2 1 2 in 1 9 7 0 to 8 4 4 in 1 9 9 3 ( an av erage
increas e o f 1 3 % a y ear) . T h e m ean age o f patients al s o
increas ed , f ro m 7 2 . 1 y ears ( 1 9 7 0 ) to 7 6 . 2 y ears ( 1 9 9 3 ) .
T h e age ad j u s ted incid ence ( per 1 0 0 0 0 0 peo pl e aged
1 2 0
-
Wo m en
1 0 0 -
8 0 -
0
z 6 0
Men
4 0 -
< 2 0 -
O
9 7 0 1 9 7 5 1 9 8 0 1 9 8 5 1 9 9 0
Year
F ig 1 A ge ad j u s ted incid ence o f o s teo po ro tic f ractu res o f
th e pro x im al h u m eru s in inh ab itants o f F inl and aged
>
6 0
d u ring 1 9 7 0 - 9 3
, 6 0 ) o f f ractu res increas ed d u ring 1 9 7 0 - 9 3 f ro m 5 0 to
1 0 6 in wo m en and f ro m 1 4 to 4 1 in m en ( f ig 1 ) .
C o m m ent
We f o u nd a s tead y increas e in th e age s pecif ic
incid ences f o r f ractu res o f th e pro x im al h u m eru s in
b o th s ex es and in al l ages o v er th e co u rs e o f th e s tu d y . I n
F inl and no t o nl y is th e incid ence o f f ractu res increas ing
b u t al s o th e po pu l atio n at ris k is increas ing- a d ev el o p-
m ent l ik el y to accel erate in th e nearf u tu re. T h e increas -
ing m ean age o f patients is l ik el y to m ean m o re
pro b l em s in treating th es e f ractu res , incl u d ing l o nger
tim es f o r h eal ing and reh ab il itatio n and m o re co m pl ica-
tio ns o f f ractu res s u ch as no n- u nio ns . A d d itio nal l y , a
h igh erm ean age o f patients is l ik el y to increas e m o rb id -
ity and m o rtal ity .
BMJ V O L U ME 3 1 3 2 6 O C T O BE R 1 9 9 6 1 0 5 1