Risks to health and well-being from radio-frequency

radiation emitted by cell phones and other wireless

devices
Anthony B. Miller1*, Margaret Sears2, Lennart Hardell3, Mark Oremus4, Colin L. Soskolne5

1
University of Toronto, Canada, 2Ottawa Hospital Research Institute, Canada, 3Örebro
University, Sweden, 4University of Waterloo, Canada, 5University of Alberta, Canada
Submitted to Journal:
Frontiers in Public Health

Specialty Section:
Radiation and Health

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ISSN:

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2296-2565

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Article type:
Review Article

Received on:

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18 Mar 2019

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Accepted on:

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25 Jul 2019

P Provisional PDF published on:

25 Jul 2019

Frontiers website link:

www.frontiersin.org

Citation:
Miller AB, Sears M, Hardell L, Oremus M and Soskolne CL(2019) Risks to health and well-being from
radio-frequency radiation emitted by cell phones and other wireless devices. Front. Public Health
7:223. doi:10.3389/fpubh.2019.00223

Copyright statement:
© 2019 Miller, Sears, Hardell, Oremus and Soskolne. This is an open-access article distributed under
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Frontiers in Public Health | www.frontiersin.org

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 1 Risks to health and well-being from radio-frequency radiation emitted
2 by cell phones and other wireless devices
3 Anthony B. Miller1*, Margaret E. Sears2, L. Lloyd Morgan3, Devra L. Davis3, Lennart Hardell4,
4 Mark Oremus5, Colin L. Soskolne6,7

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1
6 Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
2
7 Ottawa Hospital Research Institute, and Prevent Cancer Now, Ottawa, Ontario, Canada

8 3 Environmental Health Trust, P.O. Box 58, Teton Village, WY 83025

4 The
9 Environment and Cancer Research Foundation, Örebro, Sweden
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10 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada

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6

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University of Alberta, Edmonton, Alberta, Canada.

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University of Canberra, Canberra, Australian Capital Territory (ACT), Australia.

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Anthony Miller

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* Correspondence:

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16 ab.miller@utoronto.ca

17 Keywords: brain cancer, electric hypersensitivity, glioma, meningioma, non-cancer outcomes,

18 policy recommendations, radiofrequency fields.

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 Risks from Radiofrequency Radiation

20 Abstract

21 Radiation exposure has long been a concern for the public, policy makers and health researchers.
22 Beginning with radar during World War II, human exposure to radio-frequency radiation1 (RFR)
23 technologies has grown substantially over time. In 2011, the International Agency for Research on
24 Cancer (IARC) reviewed the published literature and categorized RFR as a ‘possible’ (Group 2B)
25 human carcinogen. A broad range of adverse human health effects associated with RFR have been
26 reported since the IARC review. In addition, three large-scale carcinogenicity studies in rodents
27 exposed to levels of RFR that mimic lifetime human exposures have shown significantly increased
28 rates of Schwannomas and malignant gliomas, as well as chromosomal DNA damage. Of particular
29 concern are the effects of RFR exposure on the developing brain in children. Compared with an adult
30 male, a cell phone held against the head of a child exposes deeper brain structures to greater radiation
31 doses per unit volume, and the young, thin skull’s bone marrow absorbs a roughly 10-fold higher
32 local dose. Experimental and observational studies also suggest that men who keep cell phones in
33 their trouser pockets have significantly lower sperm counts and significantly impaired sperm motility
34 and morphology, including mitochondrial DNA damage. Based on the accumulated evidence, we
35 recommend that IARC re-evaluate its 2011 classification of the human carcinogenicity of RFR, and
36 that WHO complete a systematic review of multiple other health effects such as sperm damage. In
37 the interim, current knowledge provides justification for governments, public health authorities, and
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39 body is harmful, and to support measures to reduce all exposures to RFR.

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physicians/allied health professionals to warn the population that having a cell phone next to the

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1 Per IEEE C95.1-1991, the radio-frequency radiation frequency range is from 3 kHz to 300 GHz and is non-ionizing.

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 Risks from Radiofrequency Radiation Running Title

41 Introduction

42 We live in a generation that relies heavily on technology. Whether for personal use or work, wireless
43 devices, such as cell phones, are commonly used around the world, and exposure to radio-frequency
44 radiation (RFR) is widespread, including in public spaces (Carlberg et al, 2019, Hardell et al, 2018).
45 In this review, we address the current scientific evidence on health risks from exposure to RFR,
46 which is in the non-ionizing frequency range. We focus here on human health effects, but also note
47 evidence that RFR can cause physiological and/or morphological effects on bees, plants and trees
48 (Halgamuge, 2016; Odemer and Odemer, 2019; Waldmann-Selsam et al, 2016).
49 We recognize a diversity of opinions on the potential adverse effects of RFR exposure from cell or
50 mobile phones and other wireless transmitting devices (WTDs) including cordless phones and Wi-Fi.
51 The paradigmatic approach in cancer epidemiology, which considers the body of epidemiological,
52 toxicological and mechanistic/cellular evidence when assessing causality, is applied.

53 Carcinogenicity

54 Since 1998, the International Commission on Non-Ionizing Radiation Protection (ICNIRP) has

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55 maintained that no evidence of adverse biological effects of RFR exist, other than tissue heating at

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56 exposures above prescribed thresholds (ICNIRP, 1998).
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In contrast, in 2011, an expert working group of the International Agency for Research on Cancer

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(IARC) categorized RFR emitted by cell phones and other WTDs as a Group 2B (‘possible’) human

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carcinogen (IARC, 2013).
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Since the IARC categorization, analyses of the large international Interphone study, a series of
studies by the Hardell group in Sweden, and the French CERENAT case-control studies, signal

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increased risks of brain tumors, particularly with ipsilateral use (Miller et al, 2018). The largest case-
control studies on cell phone exposure and glioma and acoustic neuroma demonstrated significantly
elevated risks that tended to increase with increasing latency, increasing cumulative duration of use,
ipsilateral phone use, and earlier age at first exposure (Miller et al, 2018).
66 Pooled analyses by the Hardell group that examined risk of glioma and acoustic neuroma stratified
67 by age at first exposure to cell phones found the highest odds ratios among those first exposed before
68 age 20 years (Hardell and Carlberg, 2015; Hardell et al, 2013a,b). For glioma, first use of cell phones
69 before age 20 years resulted in an odds ratio (OR) of 1.8 (95% confidence interval [CI] 1.2-2.8). For
70 ipsilateral use, the OR was 2.3 (CI 1.3-4.2); contralateral use was 1.9 (CI 0.9-3.7). Use of cordless
71 phone before age 20 yielded OR 2.3 (CI 1.4–3.9), ipsilateral OR 3.1 (CI 1.6–6.3) and contralateral
72 use OR 1.5 (CI 0.6–3.8) (Hardell and Carlberg, 2015).
73 Although Karipidis et al (2018) and Nilsson et al (2019) found no evidence of an increased incidence
74 of gliomas in recent years in Australia and Sweden, respectively, Karipidis et al (2018) only reported
75 on brain tumour data for ages 20-59 and Nilsson et al (2019) failed to include data for high grade
76 glioma. In contrast, others have reported evidence that increases in specific types of brain tumors
77 seen in laboratory studies are occurring in Britain and the US:
78 • The incidence of neuro-epithelial brain cancers has significantly increased in all children,
79 adolescent, and young adult age groupings from birth to 24 years in the United States (Gittleman et
80 al, 2015; Ostrom et al, 2016).
81 • A sustained and statistically significant rise in glioblastoma multiforme across all ages has
82 been described in the UK (Phillips et al, 2018).

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83 The incidence of several brain tumors are increasing at statistically significant rates, according to the
84 2010-2017 Central Brain Tumor Registry of the U.S. (CBTRUS) dataset (CBTRUS Annual Reports
85 2010-2017):
86 • There was a significant increase in incidence of radiographically diagnosed tumors of the
87 pituitary from 2006–2012 (APC = 7.3% [95% CI: 4.1%, 10.5%]), with no significant change in
88 incidence from 2012–2015 (Ostrom et al, 2018).
89 • Meningioma rates have increased in all age groups from 15 through 85+ years.
90 • Nerve sheath tumor (Schwannoma) rates have increased in all age groups from age 20 through 84
91 years.
92 • Vestibular Schwannoma rates, as a percentage of nerve sheath tumors, have also increased from
93 58% in 2004 to 95% in 2010-2014.
94 Epidemiological evidence was subsequently reviewed and incorporated in a meta-analysis by Röösli
95 et al (2019). They concluded that overall, epidemiological evidence does not suggest increased brain
96 or salivary gland tumor risk with mobile phone (MP) use, although the authors admitted that some
97 uncertainty remains regarding long latency periods (>15 years), rare brain tumor subtypes, and MP
98 usage during childhood. Of concern is that these analyses included cohort studies with poor exposure
99 classification (Söderqvist et al, 2012).

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100 In epidemiological studies, recall bias can play a substantial role in the attenuation of odds ratios

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101 towards the null hypothesis. An analysis of data from one large multicenter case-control study of
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RFR exposure, did not find that recall bias was an issue ( Vrijheid et al, 2006). In another multi-

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country study it was found that young people can recall phone use moderately well, with recall

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depending on the amount of phone use and participants' characteristics (Goedhart et al, 2018). With

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105 less rigorous querying of exposure, prospective cohort studies are unfortunately vulnerable to

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106 exposure misclassification and imprecision in identifying risk from rare events, to the point that
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negative results from such studies are misleading (Brzozek et al 2018; Miller et al, 2018).

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Another example of disparate results from studies of different design focuses on prognosis for
patients with gliomas, depending upon cell phone use. A Swedish study on glioma found lower
survival in patients with glioblastoma associated with long term use of wireless phones (Carlberg and
Hardell, 2014). Ollson et al (2019), however, reported no indication of reduced survival among
glioblastoma patients in Denmark, Finland and Sweden with a history of mobile phone use (ever
regular use, time since start of regular use, cumulative call time overall or in the last 12 months)
114 relative to no or non-regular use. Notably, Olsson et al (2019) differed from Carlberg and Hardell
115 (2014) in that the study did not include use of cordless phones, used shorter latency time and
116 excluded patients older than 69 years. Furthermore, a major shortcoming was that patients with the
117 worst prognosis were excluded, as in Finland inoperable cases were excluded, all of which would
118 bias the risk estimate towards unity.
119 In the interim, three large-scale toxicological (animal carcinogenicity) studies support the human
120 evidence, as do modelling, cellular and DNA studies identifying vulnerable sub-groups of the
121 population.
122 The U.S. National Toxicology Program (NTP) (National Toxicology Program (2018a; 2018b) has
123 reported significantly increased incidence of glioma and malignant Schwannoma (mostly on the
124 nerves on the heart, but also additional organs) in large animal carcinogenicity studies with exposure
125 to levels of RFR that did not significantly heat tissue. Multiple organs (e.g., brain, heart) also had
126 evidence of DNA damage. Although these findings have been dismissed by the ICNIRP (2018), one
127 of the key originators of the NTP study has refuted the criticisms (Melnick, 2019).

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128 A study by Italy’s Ramazzini Institute has evaluated lifespan environmental exposure of rodents to
129 RFR, as generated by 1.8 GHz GSM antennae of cell phone radio base stations. Although the
130 exposures were 60 to 6,000 times lower than those in the NTP study, statistically significant
131 increases in Schwannomas of the heart in male rodents exposed to the highest dose, and Schwann-
132 cell hyperplasia in the heart in male and female rodents were observed ( Falcioni et al, 2018). A non-
133 statistically significant increase in malignant glial tumors in female rodents also was detected. These
134 findings with far field exposure to RFR are consistent with and reinforce the results of the NTP study
135 on near field exposure. Both reported an increase in the incidence of tumors of the brain and heart in
136 RFR-exposed Sprague-Dawley rats, which are tumors of the same histological type as those observed
137 in some epidemiological studies on cell phone users.
138 Further, in a 2015 animal carcinogenicity study, tumor promotion by exposure of mice to RFR at
139 levels below exposure limits for humans was demonstrated (Lerchl et al, 2015). Co-carcinogenicity
140 of RFR was also demonstrated by Soffritti and Giuliani (2019) who examined both power-line
141 frequency magnetic fields as well as 1.8GHz modulated RFR. They found that exposure to
142 Sinusoidal-50 Hz Magnetic Field (S-50 Hz MF) combined with acute exposure to gamma radiation
143 or to chronic administration of formaldehyde in drinking water induced a significantly increased
144 incidence of malignant tumours in male and female Sprague Dawley rats. In the same report,

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145 preliminary results indicate higher incidence of malignant Schwannoma of the heart after exposure to

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146 RFR in male rats. Given the ubiquity of many of these co-carcinogens, this provides further evidence
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achievable.

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to support the recommendation to reduce the public’s exposure to RFR to as low as is reasonably

Finally, a case series highlights potential cancer risk from cell phones carried close to the body. West

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150 et al (2013) reported four “extraordinary” multifocal breast cancers that arose directly under the
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antennae of the cell phones habitually carried within the bra, on the sternal side of the breast (the
opposite of the norm). We note that case reports can point to major unrecognized hazards and
avenues for further investigation, although they do not usually provide direct causal evidence.
In a study of four groups of men, of which one group did not use mobile phones, it was found that
DNA damage indicators in hair follicle cells in the ear canal were higher in the RFR exposure groups
than in the control subjects. In addition, DNA damage increased with the daily duration of exposure
(Akdag et al, 2018).
158 Many profess that RFR cannot be carcinogenic as it has insufficient energy to cause direct DNA
159 damage. In a review, Vijayalaxmi and Prihoda (2019) found some studies suggested significantly
160 increased damage in cells exposed to RF energy compared to unexposed and/or sham-exposed
161 control cells, others did not. Unfortunately, however, in grading the evidence, these authors
162 failed to consider baseline DNA status or the fact that genotoxicity has been poorly predicted
163 using tissue culture studies (Corvi and Madia 2017). As well funding, a strong source of bias in
164 this field of enquiry, was not considered (Huss et al, 2007).

165 Children and Reproduction

166 As a result of rapid growth rates and the greater vulnerability of developing nervous systems, the
167 long-term risks to children from RFR exposure from cell phones and other WTDs are expected to be
168 greater than those to adults (Redmayne et al, 2013). By analogy with other carcinogens, longer
169 opportunities for exposure due to earlier use of cell phones and other WTDs could be associated with
170 greater cancer risks in later life.

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171 Modelling of energy absorption can be an indicator of potential exposure to RFR. A study modelling
172 the exposure of children 3-14 years of age to RFR has indicated that a cell phone held against the
173 head of a child exposes deeper brain structures to roughly double the radiation doses (including
174 fluctuating electrical and magnetic fields) per unit volume than in adults, and also that the marrow in
175 the young, thin skull absorbs a roughly 10-fold higher local dose than in the skull of an adult male
176 (Fernández et al, 2018). Thus, pediatric populations are among the most vulnerable to RFR exposure.
177 The increasing use of cell phones in children, which can be regarded as a form of addictive behavior
178 (De-Sola Gutiérrez et al, 2016), has been shown to be associated with emotional and behavioral
179 disorders. Divan, et al (2008) studied 13,000 mothers and children and found that prenatal exposure
180 to cell phones was associated with behavioral problems and hyperactivity in children. A subsequent
181 Danish study of 24,499 children found a 23% increased odds of emotional and behavioral difficulties
182 at age 11 years among children whose mothers reported any cell phone use at age 7 years, compared
183 to children whose mothers reported no use at age 7 years (Sudan et al, 2016). A cross-sectional study
184 of 4,524 US children aged 8–11 years from 20 study sites indicated that shorter screen time and
185 longer sleep periods independently improved child cognition, with maximum benefits achieved with
186 low screen time and age-appropriate sleep times (Walsh et al, 2018). Similarly, a cohort study of
187 Swiss adolescents suggested a potential adverse effect of RFR on cognitive functions that involve
188 brain regions mostly exposed during mobile phone use (Foerster et al, 2018). Sage et al (2017) posit

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189 that epigenetic drivers and DNA damage underlie adverse effects of wireless devices on childhood

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190 development.
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RFR exposure occurs in the context of other exposures, both beneficial (e.g., nutrition) and adverse

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(e.g., toxicants or stress). Two studies identified that RFR potentiated adverse effects of lead on

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neurodevelopment, with higher maternal use of mobile phones during pregnancy (1198 mother-child

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194 pairs, Choi et al, 2017) and Attention Deficit Hyper-activity Disorder (ADHD) with higher cell

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195 phone use and higher blood lead levels, in 2,422 elementary school children (Byun et al., 2013).
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A study of Mobile Phone Base Station Tower settings adjacent to school buildings has found that
high exposure of male students to RFR from these towers was associated with delayed fine and gross
motor skills, spatial working memory, and attention in adolescent students, compared with students
who were exposed to low RFR (Meo et al, 2018). A recent prospective cohort study showed a
potential adverse effect of RFR brain dose on adolescents’ cognitive functions including spatial
memory that involve brain regions exposed during cell phone use (Foerster et al, 2018).
202 In a review, Pall (2016) concluded that various non-thermal microwave EMF exposures produce
203 diverse neuropsychiatric effects. Both animal research (Deniz et al, 2017; Eghlidospour et al, 2017;
204 Aldad et al, 2012) and human studies of brain imaging research (Huber et al, 2002; Huber et al, 2005;
205 Volkow et al, 2011; Kostoff and Lau, 2013) indicate potential roles of RFR in these outcomes.
206 Male fertility has been addressed in cross-sectional studies in men. Associations between keeping
207 cell phones in trouser pockets and lower sperm quantity and quality have been reported (Adams et al,
208 2014). Both in vivo and in vitro studies with human sperm confirm adverse effects of RFR on the
209 testicular proteome and other indicators of male reproductive health (Adams et al, 2014; Houston et
210 al, 2016), including infertility (Kesari et al, 2018). Rago et al (2013) found significantly altered
211 sperm DNA fragmentation in subjects who use mobile phones for more than 4 h/day and in particular
212 those who use the device in the trousers pocket. In a cohort study, Zhang et al (2016) found that cell
213 phone use may negatively affect sperm quality in men by decreasing the semen volume, sperm
214 concentration, or sperm count, thus impairing male fertility. Gautam et al (2019) studied the effect of
215 3G (1.8 - 2.5 GHz) mobile phone radiations on the reproductive system of male Wistar rats. They

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 Risks from Radiofrequency Radiation Running Title

216 found that exposure to mobile phone radiations induces oxidative stress in the rats which may lead to
217 alteration in sperm parameters affecting their fertility.
218 Related observations, implications and strengths of current evidence
219 An extensive review of numerous published studies confirms non-thermally induced biological
220 effects or damage (e.g., oxidative stress, damaged DNA, gene and protein expression, breakdown of
221 the blood-brain barrier) from exposure to RFR ( BioInitiative Working Group, 2012), as well as
222 adverse (chronic) health effects from long-term exposure (Belyaev, 2010). Biological effects of
223 typical population exposures to RFR are largely attributed to fluctuating electrical and magnetic
224 fields (Barnes and Greenebaum, 2016; Panagopoulos et al, 2013; Ying et al, 2014).
225 Indeed, an increasing number of people have developed constellations of symptoms attributed to
226 exposure to RFR (e.g., headaches, fatigue, appetite loss, insomnia), a syndrome termed Microwave
227 Sickness or Electro-Hyper-Sensitivity (EHS) (Belyaev et al, 2016, Heuser and Heuser, 2017, Belpomme
228 et al, 2018).
229 Causal inference is supported by consistency between epidemiological studies of the effects of RFR
230 on induction of human cancer, especially glioma and vestibular Schwannomas, and evidence from
231 animal studies (Miller et al, 2018). The combined weight of the evidence linking RFR to public
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health risks includes a broad array of findings: experimental biological evidence of non-thermal

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effects of RFR; concordance of evidence regarding carcinogenicity of RFR; human evidence of male

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reproductive damage; human and animal evidence of developmental harms; and limited human and

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235 animal evidence of potentiation of effects of chemical toxicants. Thus diverse, independent evidence

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236 of a potentially troubling and escalating problem warrants policy intervention.
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Challenges to research, from rapid technological advances

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Advances in RFR-related technologies have been and continue to be rapid. Changes in carrier
frequencies and the growing complexity of modulation technologies can quickly render ‘yesterday’s
technologies obsolete. This rapid obsolescence restricts the amount of data on human RFR exposure
to particular frequencies and modulations and related health outcomes that can be collected during
243 the lifespan of the technology in question.
244 Epidemiological studies with adequate statistical power must be based upon large numbers of
245 participants with sufficient latency and intensity of exposure to specific technologies. Therefore, a
246 lack of epidemiological evidence does not necessarily indicate an absence of effect, but rather an
247 inability to study an exposure for the length of time necessary, with an adequate sample size and
248 unexposed comparators, to draw clear conclusions. For example, no case-control study has been
249 published on fourth generation (4G; 2 - 8 GHz) Long-term Evolution (LTE) modulation, even though
250 the modulation was introduced in 2010 and achieved a 39% market share worldwide by 2018
251 (Anonymous, 2018).
252 With this absence of human evidence, governments must require large-scale animal studies (or other
253 appropriate studies of indicators of carcinogenicity and other adverse health effects) to determine
254 whether the newest modulation technologies incur risks, prior to release into the marketplace.
255 Governments should also investigate short-term impacts such as insomnia, memory, reaction time,
256 hearing and vision, especially those that can occur in children and adolescents, whose use of wireless
257 devices has grown exponentially within the past few years.

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258 The Telecom industry’s fifth generation (5G) wireless service will require the placement of many
259 times more small antennae/cell towers close to all recipients of the service, because solid structures,
260 rain and foliage block the associated millimeter wave RFR (Rappaport et al., 2013). Frequency
261 bands for 5G are separated into two different frequency ranges. Frequency Range 1 (FR1) includes
262 sub-6GHz frequency bands, some of which are bands traditionally used by previous standards, but
263 has been extended to cover potential new spectrum offerings from 410 MHz to 7125 MHz.
264 Frequency Range 2 (FR2) includes higher frequency bands from 24.25 GHz to 52.6 GHz. Bands in
265 FR2 are largely of millimeter wave length, these have a shorter range but a higher available
266 bandwidth than bands in the FR1. 5G technology is being developed as it is also being deployed,
267 with large arrays of directional, steerable, beam-forming antennae, operating at higher power than
268 previous technologies. 5G is not stand-alone – it will operate and interface with other (including 3G
269 and 4G) frequencies and modulations to enable diverse devices under continual development for the
270 “internet of things,” driverless vehicles and more (Rappaport et al, 2013).
271 Novel 5G technology is being rolled out in several densely populated cities, although potential
272 chronic health or environmental impacts have not been evaluated and are not being followed. Higher
273 frequency (shorter wavelength) radiation associated with 5G does not penetrate the body as deeply as
274 frequencies from older technologies although its effects may be systemic (Beltzalel et al, 2018;
275 Russell, 2018). The range and magnitude of potential impacts of 5G technologies are under-

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276 researched, although important biological outcomes have been reported with millimeter wavelength

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277 exposure. These include oxidative stress and altered gene expression, effects on skin and systemic

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278 effects such as on immune function (Russell, 2018). In vivo studies reporting resonance with human
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sweat ducts (Beltzalel et al, 2018), acceleration of bacterial and viral replication, and other endpoints
indicate the potential for novel as well as more commonly recognized biological impacts of this range

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of frequencies, and highlight the need for research before population-wide continuous exposures.

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Gaps in applying current evidence
Current exposure limits are based on an assumption that the only adverse health effect from RFR is
heating from short-term (acute), time-averaged exposures (Federal Communication Commission,
2013). Unfortunately, in some countries, notably the US, scientific evidence of the potential hazards
of RFR has been largely dismissed (Alster, 2015). Findings of carcinogenicity, infertility and cell
damage occurring at daily exposure levels - within current limits - indicate that existing exposure
289 standards are not sufficiently protective of public health. Evidence of carcinogenicity alone, such as
290 that from the NTP study, should be sufficient to recognize that current exposure limits are
291 inadequate.
292 Public health authorities in many jurisdictions have not yet incorporated the latest science from the
293 U.S. NTP or other groups. Many cite 28-year old guidelines by the Institute of Electrical and
294 Electronic Engineers which claimed that “Research on the effects of chronic exposure and
295 speculations on the biological significance of non-thermal interactions have not yet resulted in any
296 meaningful basis for alteration of the standard.” (Institute of Electrical and Electronic Engineers,
297 1991)2
298 Conversely, some authorities have taken specific actions to reduce exposure to their citizens
299 (Environmental Health Trust, 2018), including testing and recalling phones that exceed current
300 exposure limits.

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2 The FCC adopted the IEEE C95.1 1991 standard in 1996.

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301 While we do not know how risks to individuals from using cell phones may be offset by the benefits
302 to public health of being able to summon timely health, fire and police emergency services, the
303 findings reported above underscore the importance of evaluating potential adverse health effects from
304 RFR exposure, and taking pragmatic, practical actions to minimize exposure.
305 We propose the following considerations to address gaps in the current body of evidence:
306 • As many claim that we should by now be seeing an increase in the incidence of brain tumors
307 if RFR causes them, ignoring the increases in brain tumors summarized above, a detailed evaluation
308 of age-specific, location-specific trends in the incidence of gliomas in many countries is warranted.
309
310 • Studies should be designed to yield the strongest evidence, most efficiently:
311 ➢ Population-based case-control designs can be more statistically powerful to determine
312 relationships with rare outcomes such as glioma, than cohort studies. Such studies should
313 explore the relationship between energy absorption (SAR3), duration of exposure, and adverse
314 outcomes, especially brain cancer, cardiomyopathies and abnormal cardiac rythms,
315 hematologic malignancies, thyroid cancer.
316 ➢ Cohort studies are inefficient in the study of rare outcomes with long latencies, such as
317 glioma, because of cost-considerations relating to the follow-up required of very large cohorts
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needed for the study of rare outcomes. In addition, without continual resource-consuming

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follow-up at frequent intervals, it is not possible to ascertain ongoing information about

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changing technologies, uses (e.g. phoning versus texting or accessing the Internet) and/or

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321 exposures.

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322 ➢ Cross-sectional studies comparing high-, medium-, and low-exposure persons may yield
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hypothesis-generating information about a range of outcomes relating to memory, vision,

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hearing, reaction-time, pain, fertility, and sleep patterns.

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Exposure assessment is poor in this field, with very little fine-grained detail as to frequencies
and modulations, and doses and dose rates, and peak exposures, particularly over the long-term.
Solutions such as wearable meters and phone apps have not yet been incorporated in large-scale
research.
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331 • Systematic reviews on the topic could use existing databases of research reports, such as the
332 one created by Oceania Radiofrequency Science Advisory Association (Leach et al, 2018) or EMF
333 Portal (2018), to facilitate literature searches.
334
335 • Studies should be conducted to determine appropriate locations for installation of antennae
336 and other broadcasting systems; these studies should include examination of biomarkers of
337 inflammation, genotoxicity and other health indicators in persons who live at different radiuses
338 around these installations. This is difficult to study in the general population because many people’s
339 greatest exposure arises from their personal devices.
340
341 • Further work should be undertaken to determine the distance that wireless technology
342 antennae should be kept away from humans to ensure acceptable levels of safety, distinguishing

3 When necessary, SAR values should be adjusted for age of child in W/kg.

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343 among a broad range of sources (e.g., from commercial transmitters to Bluetooth devices),
344 recognizing that exposures fall with the inverse of the square of the distance (The inverse-square law
345 specifies that intensity is inversely proportional to the square of the distance from the source of
346 radiation). The effective radiated power from cell towers needs to be regularly measured and
347 monitored.
348
349 Policy recommendations based on the evidence to date
350 At the time of writing, a total of 32 countries or governmental bodies within these countries 4 have
351 issued policies and health recommendations concerning exposure to RFR ( Environmental Health
352 Trust, 2018). Three U.S. states have issued advisories to limit exposure to RFR (CDPH, 2017;
353 Connecticut Department of Public Health, 2017; Massachusetts, 2017) and the Worcester Massachusetts
354 Public Schools (2017) voted to post precautionary guidelines on Wi-Fi radiation on its website. In
355 France, Wi-Fi has been removed from pre-schools and ordered to be shut off in elementary schools
356 when not in use, and children aged 16 years or under are banned from bringing cell phones to school
357 (Samuel, 2018). Because the national test agency found 9 out of 10 phones exceeded permissible
358 radiation limits, France is also recalling several million phones.
359
360
361
We therefore recommend the following:
1.

n al
Governmental and institutional support of data collection and analysis to monitor potential

o
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362 links between RFR associated with wireless technology, and cancers, sperm, the heart, the nervous

i
363 system, sleep, vision and hearing, and effects on children.

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364

o
365 2. Further dissemination of information regarding potential health risk information that is in
366
367
368
369
370
371
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wireless devices and manuals is necessary to respect users’ Right To Know. Cautionary statements
and protective measures should be posted on packaging and at points of sale. Governments should
follow the practice of France, Israel and Belgium and mandate labeling, as for tobacco and alcohol.

3. Regulations should require that any WTD that could be used or carried directly against the
skin (e.g., a cell phone) or in close proximity (e.g., a device being used on the lap of a small child) be
372 tested appropriately as used, and that this information be prominently displayed at point of sale, on
373 packaging, and both on the exterior and within the device.
374
375 4. IARC should convene a new working group to update the categorization of RFR, including
376 current scientific findings that highlight, in particular, risks to youngsters of subsequent cancers. We
377 note that an IARC Advisory Group has recently recommended that RFR should be re-evaluated by
378 the IARC Monographs program with high priority.
379
380 5. The World Health Organization (WHO) should complete its long-standing RFR systematic
381 review project, using strong modern scientific methods. National and regional public health
382 authorities similarly need to update their understanding and to provide adequate precautionary
383 guidance for the public to minimize potential health risks.

10
4Argentina, Australia, Austria, Belgium, Canada, Chile, Cyprus, Denmark, European Environmental Agency, European Parliament, Finland,
France, French Polynesia, Germany, Greece, Italy, India, Ireland, Israel, Namibia, New Zealand, Poland, Romania, Russia, Singapore, Spain,
Switzerland, Taiwan, Tanzania, Turkey, United Kingdom, United States.

This is a provisional file, not the final typeset article

 Risks from Radiofrequency Radiation Running Title

384
385 6. Emerging human evidence is confirming animal evidence of developmental problems with
386 RFR exposure during pregnancy. RFR sources should be avoided and distanced from expectant
387 mothers, as recommended by physicians and scientists (babysafeproject.org)
388
389 7. Other countries should follow France, limiting RFR exposure in children under 16 years of
390 age.
391
392 8. Cell towers should be distanced from homes, daycare centers, schools and places frequented
393 by pregnant women, men who wish to father healthy children, and the young.
394
395
396 Specific examples of how the health policy recommendations above, invoking the Precautionary
397 Principle, might be practically applied to protect public health, are provided in the Annex.
398
399
400 Acknowledgements

l
401 The authors acknowledge the contributions of Mr. Ali Siddiqui in drafting the Policy

a
402 Recommendations, and those from members of the Board of the International Network for
403
404
405

si n
Epidemiology in Policy (INEP) into previous iterations of this manuscript. We are grateful to external

o
reviewers for their thoughtful critiques that have served to improve both accuracy and presentation.

i
v
406 This manuscript was initially developed by the authors as a draft of a Position Statement of INEP.

o
407 The opportunity was then provided to INEP’s 23 member organizations to endorse what the INEP
408
409
410
411
412
413
414
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Board had recommended, but 12 of those member organizations elected not to vote. Of the 11 that
did vote, three endorsed the statement, two voted against it, and six abstained. Ultimately, the Board
voted to abandon its involvement with what it determined to be a divisive topic. The authors then
decided that, in the public interest, the document should be published independent of INEP.

Conflict of Interest Statement

The authors declare that this manuscript was drafted in the absence of any commercial or financial
415 relationships that could be construed as a potential conflict of interest, although subsequent to its
416 preparation, DLD became a consultant to legal counsel representing persons with glioma attributed to
417 radiation from cell phones.

418 Funding

419 No funding was required for the preparation of this manuscript.

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epidemiologic studies of mobile phone use and cancer risk. Journal of Exposure Science and
Environmental Epidemiology 1–14. doi:10.1038/sj.jes.7500509.

Waldmann-Selsam, C., Balmori-de la Plante, A., Breunig, H., Balmori, A. (2016).

Radiofrequency radiation injures trees around mobile phone base stations.
Sci Total Environ. Dec 1;572:554-569. doi: 10.1016/j.scitotenv.2016.08.045.

674 Walsh, J.J., Barnes, J.D., Cameron, J.D. et al. (2018). Associations between 24 Hour Movement
675 Behaviours and Global Cognition in US Children: A Cross-Sectional Observational Study. The
676 Lancet Child & Adolescent Health, September 27, 2018. https://doi.org/10.1016/S2352-
677 4642(18)30278-5 (accessed September 29 2018).

678 West, J.G., Kapoor, N.S., Liao, S-Y. et al (2013). Multifocal Breast Cancer in Young Women with
679 Prolonged Contact between Their Breasts and Their Cellular Phones. Case Rep Med., no. 354682.

680 Worcester School Committee Precautionary Option on Radiofrequency Exposure (2017).

681 http://wpsweb.com/sites/default/files/www/school_safety/radio_frequency.pdf (accessed 25 August
682 2018).

683 Ying, L. and Héroux, P. (2014). Extra-Low-Frequency Magnetic Fields Alter Cancer Cells Through
684 Metabolic Restriction. Electromagnetic Biology and Medicine 33, no. 4: 264–75.
685 https://doi.org/10.3109/15368378.2013.817334 (accessed 12 September 2018).

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686 Zhang, G., Yan, H., Chen, Q. et al. (2016). Effects of cell phone use on semen parameters: Results
687 from the MARHCS cohort study in Chongqing, China. Environ Int; 91:116-21. doi:
688 10.1016/j.envint.2016.02.028.

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689 ANNEX: EXAMPLES OF ACTIONS FOR REDUCING RFR EXPOSURE

690 1. Focus actions for reducing exposure to RFR on pregnant women, infants, children and
691 adolescents, as well as males who might wish to become fathers.
692 2. Reduce, as much as possible, the extent to which infants and young children are exposed to
693 RFR from Wi-Fi-enabled devices such as baby monitors, wearable devices, cell phones, tablets, etc.
694 3. Avoid placing cell towers and small cell antennae close to schools and homes pending further
695 research and revision of the existing exposure limits. In schools, homes and the workplace, cable or
696 optical fiber connections to the Internet are preferred. Wi-Fi routers in schools and
697 daycares/kindergartens should be strongly discouraged and programs instituted to provide Internet
698 access via cable or fiber.
699 4. Ensure that WTDs minimize radiation by transmitting only when necessary, and as
700 infrequently as is feasible. Examples include transmitting only in response to a signal (e.g., accessing
701 a router or querying a device, a cordless phone handset being turned on, or voice or motion
702 activation). Prominent, visible power switches are needed to ensure that WTDs can be easily turned
703 on only when needed, and off when not required (e.g., Wi-Fi when sleeping).
704 5. Lower permitted power densities in close proximity to fixed-site antennae, from
705 “occupational” limits to exposure limits for the general public.
706 6. Update current exposure limits to be protective against the non-thermal effects of RFR. Such
707 action should be taken by all heath ministries and public health agencies, as well as industry
708
709
710
biological effects (Hardell et al., 2018).
7.

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regulatory bodies. Exposure limits should be based on measurements of RFR levels related to

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Ensure that advisories relating to cell phone use are placed in such a way that purchasers can

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711 find them easily, similar to the Berkeley Cell Phone "Right to Know" Ordinance (Moskowitz, (2014).

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712 8. Advise the public that texting and speaker mode are preferable to holding cell phones to the

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713 ear. Alternatively, use hands-free accessories for cell phones, including air tube headsets that
714
715
716
717
718
719
720
9.

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interrupt the transmission of RFR.

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When possible, keep cell phones away from the body (e.g., on a nearby desk, in a purse or
bag, or on a mounted hands-free accessory in motor vehicles).
Delay the widespread implementation of 5G (and any other new technology) until studies can
be conducted to assess safety. This includes a wide range of household and community-wide
infrastructure WTDs and self-driving vehicles, as well as the building of 5G minicells.
11. Fiber-optic connections for the Internet should be made available to every home, office,
721 school, warehouse and factory, when and where possible.

722
723 ANNEX REFERENCES
724 1. Hardell, L., Carlberg, M. and Hedendahl, L.K. (2018). Radiofrequency radiation from nearby base
725 stations gives high levels in an apartment in Stockholm, Sweden – a case report. Oncol Lett;15:7871-
726 7883.
727 2. Moskowitz, J.M. (2014). Berkeley Cell Phone "Right to Know" Ordinance.
728 (https://ehtrust.org/policy/the-berkeley-cell-phone-right-to-know-ordinance and
729 https://www.saferemr.com/2014/11/berkeley-cell-phone-right-to-know.html (accessed 29 September
730 2018).

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731 Glossary:
732 ALARA As Low a level As Reasonably Achievable
733 CBTRUS Central Brain Tumor Registry of the United States
734 CI Confidence Interval
735 EMR Electro Magnetic Radiation
736 IARC International Agency for Research on Cancer
737 ICNIRP International Commission on Non-Ionizing Radiation Protection
738 INEP International Network for Epidemiology in Policy
739 LTE Long-Term Evolution modulation
740 NTP U.S. National Toxicology Program
741 OR Odds Ratio
742 RFR Radio-Frequency Radiation

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743 SAR Specific Absorption Rate
744 WTD Wireless Transmitting Device

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