<b>Bijsluiter</b>. De hyperlink naar het originele document werkt niet meer. Daarom laat Woogle de tekst zien die in dat document stond. Deze tekst kan vreemde foutieve woorden of zinnen bevatten en de opmaak kan verdwenen of veranderd zijn. Dit komt door het zwartlakken van vertrouwelijke informatie of doordat de tekst niet digitaal beschikbaar was en dus ingescand en vervolgens via OCR weer ingelezen is. Voor het originele document, neem contact op met de Woo-contactpersoon van het bestuursorgaan.<br><br>====================================================================== Pagina 1 ======================================================================

<pre>Mobile phones and cancer
   Part 3. Update and overall conclusions from epidemiological
   and animal studies
</pre>

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<pre></pre>

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<pre>Aan de staatssecretaris van Infrastructuur en Milieu
Onderwerp              : Aanbieding advies Mobile phones and cancer. Part 3. Update and overall
                          conclusions from epidemiological and animal studies
Ons kenmerk : U-973760/EvR/pm/673-E3
Bijlagen               :1
Datum                  : 1 juni 2016
Geachte staatssecretaris,
Hierbij bied ik u het advies Mobile phones and cancer. Part 3. Update and overall
conclusions from epidemiological and animal studies aan. Het advies is opgesteld door de
Commissie Elektromagnetische velden en getoetst door de Beraadsgroep Volksgezondheid.
De commissie heeft systematische literatuurstudies uitgevoerd naar de epidemiologische
en dierexperimentele gegevens over de relatie tussen blootstelling aan radiofrequente
elektromagnetische velden en kanker. In het eerste advies, dat in juni 2013 is uitgebracht,
zijn de epidemiologische gegevens besproken. Het tweede advies, gepubliceerd in septem-
ber 2014, bevat de analyse van de dierexperimentele studies. In het voorliggende advies
geeft de commissie een actualisering van de literatuur en integrale conclusies op grond van
alle gegevens tezamen.
De commissie concludeert dat er geen bewezen verband is tussen langdurig en frequent
gebruik van een mobiele telefoon en een verhoogd risico op tumoren in de hersenen of het
hoofd-hals gebied. Een verband kan echter ook niet worden uitgesloten. Wel acht zij het
onwaarschijnlijk dat blootstelling aan radiofrequente velden, die samenhangt met het
gebruik van een mobiele telefoon, kanker veroorzaakt.
Ik onderschrijf de conclusies van de commissie.
Met vriendelijke groet,
prof. dr. W.A. van Gool,
voorzitter
Bezoekadres                                                             Postadres
Parnassusplein 5                                                        Postbus 16052
2 5 11 V X       Den Haag                                               2500 BB Den Haag
E - m a i l : E . v a n . R o n g e n @ g r. n l                        w w w. g r. n l
Te l e f o o n ( 0 7 0 ) 3 4 0 5 7 3 0
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<pre></pre>

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<pre>To the State Secretary for Infrastructure and the Environment
Subject                   : Advisory report Mobile phones and cancer. Part 2. Update and overall
                            conclusions from epidemiological and animal studies
Our reference : U-973824/EvR/pm/673-F3
Enclosure(s) : 1
Date                      : June 1st, 2014
Dear State Secretary,
I have the pleasure of presenting you the advisory report Mobile phones and cancer. Part 3.
Update and overall conclusions from epidemiological and animal studies. It has been
drafted by the Electromagnetic Fields Committee of the Health Council and reviewed by its
Standing Committee on Public Health.
The Committee has performed systematic reviews of the epidemiological data and the
data from animal experiments on the relation between exposure to radiofrequency
electromagnetic fields and cancer. The first report, that was published in June 2013,
discussed the epidemiological data. The second report, published in September 2014,
contains the analysis of the studies on animal experiments. In the current report the
Committee provides an update of the literature and overall conclusions based on the
combined data.
The Committee concludes from this evidence that there is no established association
between long-term and frequent use of a mobile telephone and an increased risk for tumors
in the brain or head and neck. Such association can however also not be excluded. The
Committee considers it unlikely that exposure to radiofrequency electromagnetic fields
associated with the use of mobile phones, causes cancer.
I agree with the conclusions of the Committee.
Kind regards,
(signed)
Prof. dr. W.A. van Gool
President
P. O . B o x 1 6 0 5 2                                                   Visiting Address
NL-2500 BB The Hague                                                     Parnassusplein 5
The Netherlands                                                          N L - 2 5 11 V X      The Hague
Te l e p h o n e + 3 1 ( 7 0 ) 3 4 0 5 7 3 0                             The Netherlands
E - m a i l : E . v a n . R o n g e n @ g r. n l                         w w w. h e a l t h c o u n c i l . n l
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<pre>Mobile phones and cancer
Part 3. Update and overall conclusions from epidemiological
and animal studies
to:
the State Secretary for Infrastructure and the Environment
the Minister of Economic Affairs
the Minister of Health, Welfare and Sport
No. 2016/06, The Hague, June 1st, 2016
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<pre>The Health Council of the Netherlands, established in 1902, is an independent
scientific advisory body. Its remit is “to advise the government and Parliament on
the current level of knowledge with respect to public health issues and health
(services) research...” (Section 22, Health Act).
     The Health Council receives most requests for advice from the Ministers of
Health, Welfare & Sport, Infrastructure & the Environment, Social Affairs &
Employment, Economic Affairs, and Education, Culture & Science. The Council
can publish advisory reports on its own initiative. It usually does this in order to
ask attention for developments or trends that are thought to be relevant to
government policy.
     Most Health Council reports are prepared by multidisciplinary committees of
Dutch or, sometimes, foreign experts, appointed in a personal capacity. The
reports are available to the public.
                 The Health Council of the Netherlands is a member of the European
                 Science Advisory Network for Health (EuSANH), a network of science
                 advisory bodies in Europe.
This report can be downloaded from www.healthcouncil.nl.
Preferred citation:
Health Council of the Netherlands. Mobile phones and cancer: Part 3. Update
and overall conclusions from epidemiological and animal studies. The Hague:
Health Council of the Netherlands, 2016; publication no. 2016/06.
all rights reserved
ISBN: 978-94-6281-098-3
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<pre>   Contents
   Samenvatting 11
   Summary 15
   Introduction 19
.1 Background 19
.2 The research question 20
.3 Exposure 20
.4 Causation 21
.5 This report 22
   Recent epidemiological data 23
.1 Search and selection 23
.2 Quality analysis of cohort, case-control and case-case studies 24
.3 Results of the new cohort, case-control and case-case studies 31
.4 Ecological studies 34
.5 Tumour incidence in the Netherlands 36
   Recent experimental animal data 43
.1 Systematic search 43
.2 Results of the retrieved study 44
   Contents                                                          9
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<pre> .3 Evaluation of the retrieved study 44
 .4 Discussion and comparison with previous results 45
    Discussion and conclusions 49
 .1 The epidemiological evidence 49
 .2 The Bradford Hill considerations 50
 .3 The evidence from experimental animal studies 52
 .4 Overall conclusion on carcinogenicity 53
 .5 Ongoing and future studies 54
 .6 Reduction of exposure 54
    References 55
    Annexes 65
A   The Committee 67
B   Evaluation of the quality of the studies 71
C   Overview of ecological studies on brain tumours 79
D   Results from the selected publications 83
 0  Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre>Samenvatting
Waarom dit advies?
De blootstelling aan radiofrequente elektromagnetische velden is in de afgelopen
decennia aanzienlijk veranderd door de snelle groei van mobiele telecommunica-
tie, draadloos internet en andere bronnen. Dit heeft geleid tot groeiende bezorgd-
heid over mogelijke nadelige effecten van die blootstelling op de gezondheid. In
2012 heeft het International Agency for Research on Cancer (IARC) radiofre-
quente elektromagnetische velden geclassificeerd als ‘mogelijk kankerverwek-
kend bij mensen’. Die classificatie is voornamelijk gebaseerd op gegevens uit
epidemiologisch onderzoek, aangevuld met gegevens uit experimenten met
proefdieren.
     De commissie Elektromagnetische velden van de Gezondheidsraad heeft
zowel de epidemiologische als de dierexperimentele gegevens systematisch
geanalyseerd aan de hand van vooraf opgestelde protocollen en heeft daarbij ook
de kwaliteit van de onderzoeken in aanmerking genomen. In 2013 kwam de com-
missie met haar analyse van de epidemiologische gegevens, en in 2014 met die
van de dierexperimentele gegevens.1,2 Het nu voorliggende advies geeft naast
een actualisering van deze twee publicaties de in de eerdere adviezen aangekon-
digde eindconclusies van de commissie op grond van alle beschreven onder-
zoeksgegevens.
     De commissie heeft gezocht naar epidemiologische gegevens over een moge-
lijke associatie tussen blootstelling aan radiofrequente velden van mobiele tele-
Samenvatting                                                                       11
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<pre>  foons, en tumoren in de hersenen en andere weefsels in het hoofd en de nek
  (zoals hersenvliezen, gehoorzenuw en speekselklieren). Onderzoek naar andere
  bronnen van blootstelling aan radiofrequente velden en naar andere vormen van
  kanker wordt in dit advies niet behandeld. De onderzochte proefdierexperimen-
  ten hadden een bredere reikwijdte. Hierbij zijn alle mogelijke vormen van kanker
  onderzocht, evenals blootstelling aan alleen radiofrequente velden of in combi-
  natie met kankerverwekkende stoffen.
  Wat zijn de uitkomsten?
  Uit de epidemiologische gegevens komen enkele zwakke aanwijzingen naar
  voren voor een verband tussen langdurig en intensief gebruik van een mobiele
  telefoon en een toename van het aantal gliomen (hersentumoren) en brughoektu-
  moren (tumoren aan de gehoorzenuw). De bevindingen zijn biologisch soms niet
  plausibel. Zo zijn in enkele onderzoeken verhoogde risico’s gevonden na een
  kortdurend gebruik, wat niet spoort met de lange groeitijd van de betreffende
  tumoren. In andere gevallen vond men bij de hoogste blootstellingniveaus geen
  toename van het aantal tumoren en bij lagere niveaus wel. Ook dat staat haaks op
  wat men zou verwachten. Verder bieden gegevens over het vóórkomen van de
  betrokken tumoren in Nederland en andere landen geen ondersteuning voor een
  oorzakelijk verband. Voor meningiomen (tumoren van de hersenvliezen), tumo-
  ren van de hypofyse en speekselkliertumoren zijn geen aanwijzingen gevonden
  voor een samenhang met het gebruik van mobiele telefoons.
  De dierexperimentele gegevens leveren geen bewijzen dat blootstelling aan
  radiofrequente elektromagnetische velden tumoren kan opwekken. Mogelijk
  heeft een dergelijke blootstelling een effect op de verdere ontwikkeling van
  tumoren, maar de aanwijzingen daarvoor zijn zwak en in slechts één, heel speci-
  fiek, diermodel gevonden.
  Wat zijn de conclusies?
  De commissie heeft voor haar conclusies de epidemiologische en dierexperimen-
  tele bevindingen in samenhang beoordeeld. Naar haar oordeel kan niet worden
  gesteld dat er een bewezen verband is tussen langdurig en frequent gebruik van
  een mobiele telefoon en een verhoogd risico op tumoren in de hersenen of het
  hoofd-hals gebied. Op basis van de zeggingskracht van de beschikbare gegevens
  kan volgens de commissie slechts worden geconcludeerd dat zo’n verband niet
  valt uit te sluiten. De commissie acht het onwaarschijnlijk dat blootstelling aan
2 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre>radiofrequente velden, die samenhangt met het gebruik van een mobiele tele-
foon, kanker veroorzaakt. Gegevens uit dierexperimenten wijzen op de mogelijk-
heid dat blootstelling aan dergelijke velden de ontwikkeling van tumoren
stimuleert. Het is echter onduidelijk of hiermee de toegenomen kans op tumoren
in de hersenen en het hoofd-halsgebied, die in sommige epidemiologische onder-
zoeken is waargenomen, kan worden verklaard. De commissie vindt het waar-
schijnlijker dat een combinatie van verstoring, vertekening en toeval de
verklaring vormt voor de epidemiologische bevindingen.
Is er aanleiding om de blootstelling te verminderen?
Uit de zojuist geformuleerde conclusies vloeit voort dat onduidelijk is welke
waarde maatregelen hebben om de blootstelling aan radiofrequente elektromag-
netische velden te verminderen. Toch wil de commissie haar eerdere aanbeveling
herhalen: pas het ALARA-principe toe. Dat wil zeggen: houd de blootstelling zo
laag als redelijkerwijs mogelijk is (As Low As Reasonably Achievable). Het is
bijvoorbeeld onnodig dat apparatuur met een groter vermogen of gedurende een
langere tijdsperiode uitzendt dan noodzakelijk is om een goede verbinding te
hebben. De commissie stelt zich hiermee achter de aanbevelingen uit het advies
Voorzorg met rede van de Gezondheidsraad.3
Blijft er onderzoek nodig?
Er zijn nog steeds heel weinig gegevens over langetermijneffecten bij mensen.
Weliswaar zijn in sommige epidemiologische onderzoeken termijnen van dertien
jaar of langer onderzocht, maar over het algemeen werden slechts weinig perso-
nen zo langdurig gevolgd. De latentietijden voor de ontwikkeling van de rele-
vante tumoren zijn hoogstwaarschijnlijk langer. De commissie vindt het daarom
belangrijk dat de lopende cohortonderzoeken waarin de gezondheidseffecten van
het gebruik van mobiele telefoons worden onderzocht, door blijven gaan. Deze
onderzoeken zullen meer gegevens opleveren, waardoor met meer zekerheid
conclusies getrokken kunnen worden. De bepaling van de blootstelling is in alle
beschikbare onderzoeken erg zwak. Het is daarom van het grootste belang dat in
lopende en toekomstige onderzoeken de blootstelling aan radiofrequente velden
nauwkeuriger en objectiever wordt bepaald. Dit is des te meer van belang omdat
de blootstelling aan radiofrequente velden voortdurend verandert door verande-
ringen in het gebruik en de ontwikkeling van nieuwe mobiele telecommunicatie-
middelen.
Samenvatting                                                                    13
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<pre>Summary
Why this report?
Exposure to radiofrequency electromagnetic fields has considerably changed in
the past decades, due to the fast growth of mobile telecommunication, wireless
internet access and other sources. This has increased concern about possible
adverse health effects of such exposures. In 2012, the International Agency for
Research on Cancer (IARC) classified radiofrequency electromagnetic fields as
‘possibly carcinogenic to humans’. This classification was primarily based on
epidemiological data, with additional support from animal studies.
The Electromagnetic Fields Committee of the Health Council of the Netherlands
has performed systematic reviews of both the epidemiological and animal
experimental data using a priori defined protocols, taking into account the
scientific quality of the studies. The analysis of the epidemiological data has
been published in a report issued in 2013.1 The analysis of the data on
carcinogenesis in experimental animals was published in 2014.2 This report
provides an update of the two previous reports and the overall conclusions of the
Committee on the basis of all described data that was announced in the previous
reports.
Summary                                                                           15
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<pre>  Epidemiological evidence was sought for indications of an association between
  exposure to radiofrequency fields from mobile phones and tumours in the brain
  and various other tissues in the head and neck (e.g. meninges, acoustic nerve,
  parotid glands). Studies investigating other sources of exposure to
  radiofrequency fields and other cancers are not discussed in this report. The
  animal carcinogenesis studies had a broader scope and included all possible
  cancers, as well as exposure to radiofrequency fields alone and co-exposures to
  carcinogenic agents.
  What has been observed?
  Overall, the epidemiological data show some weak indications for an association
  between prolonged and intensive use of a mobile phone and an increased
  incidence of gliomas (brain tumours) and acoustic neuromas (tumours on the
  acoustic nerve). In some cases these findings lack biological plausibility. Some
  studies showed for instance increased risks after a short period of use, which is
  not compatible with the long period of development of the tumours in question.
  In other studies an increase in the number of tumours was not observed with the
  highest exposure level, but only with lower ones. This is also in contrast to
  expectations. Furthermore, data on the incidence of the relevant tumours from
  the Netherlands and other countries worldwide do not provide support for a
  causal relationship. For meningiomas, pituitary tumours and parotid gland
  tumours, no indications for an association with mobile phone use have been
  observed.
  The animal studies do not provide evidence for induction of tumours by exposure
  to radiofrequency electromagnetic fields. Such exposure may have a promoting
  effect on the development of tumours, but the indications for this are weak and
  have been observed in only one, very specific, animal model.
  What are the overall conclusions?
  The Committee jointly considered the epidemiological and experimental data to
  formulate its conclusions. The Committee feels that it is not possible to state that
  there is a proven association between long-term and frequent use of a mobile
  telephone and an increase in the risk of tumours in the brain and head and neck
  region in humans. Based on the strength of the evidence it can only be concluded
  that such an association cannot be excluded. The Committee considers it unlikely
  that exposure to radiofrequency fields, which is associated with the use of mobile
6 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre>telephones, causes cancer. The animal data indicate a possibility of a promoting
effect, but it is not clear whether this could explain the increased risk for tumours
in the brain, head and neck that has been observed in some epidemiological
studies. The Committee feels it more likely that a combination of bias,
confounding and chance might be an explanation for the epidemiological
observations.
Is there reason to limit exposure?
From the conclusions formulated above it follows that the value of any measures
to reduce exposure is unclear. Nevertheless, the Committee would like to repeat
its previous suggestion: apply the ALARA principle. This means that exposures
should be As Low As Reasonably Achievable. There is, for instance, no need for
any device to transmit with greater power or for a longer period of time than
needed for an adequate connection. This is fully in line with the suggestions from
the Health Council’s advisory report Prudent precaution.3
Is more research necessary?
There is still very limited information on really long-term effects in humans.
Some epidemiological studies have follow-up times of more than 13 years, but
with generally few subjects in the highest exposure categories. The latency times
for development of the relevant tumours are most likely longer. The Committee
therefore considers it important to continue the ongoing cohort studies evaluating
the health effects of mobile phone use, in order to provide more conclusive
human evidence. The exposure characterization in all currently available studies
is very poor. It is therefore very important that ongoing and future studies
incorporate more accurate and objective assessment of RF exposure. This is even
more important since personal exposure to RF continues to change due to
evolving patterns of use and new mobile telecommunication devices.
Summary                                                                               17
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<pre> hapter 1
        Introduction
1.1     Background
        The fast and extensive growth of mobile telephony and the resulting increase in
        exposure of people to radiofrequency electromagnetic fields (RF EMF) has
        increased concern for adverse effects resulting from such exposure. Especially
        dreaded are possible effects on the induction or promotion of the growth of
        cancer. Many studies have been published in the past decades, and on the basis of
        the available results the International Agency for Research on Cancer (IARC) of
        the World Health Organization (WHO) has classified RF EMF in 2010 as
        ‘possibly carcinogenic to humans’ (class 2B).4 This classification was primarily
        based on the results of epidemiological studies on the relation between mobile
        phone use and the risk of glioma (tumours of brain tissue) and acoustic neuroma
        (tumours of the acoustic nerve sheath), and on some data from experimental
        studies with animals which relate longterm exposure to tumour incidence.5
        The Electromagnetic Fields Committee of the Health Council of the Netherland
        (designated further in this report as ‘the Committee’) has performed its own,
        independent, systematic reviews of the literature on this subject. In a first report
        it has described the epidemiological data1, while a second report discussed the
        outcomes of experimental animal studies.2 In both reports, data collection,
        extraction and analysis have been done in a predetermined systematic way. The
        Introduction                                                                         19
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<pre>    composition of the Committee at the time of writing of the current report is given
    in Annex A.
1.2 The research question
    The basic question the Committee investigates in these reports is, whether there
    are indications for a causal relationship between exposure to RF EMF from
    mobile phones and tumours in the brain and various other tissues in the head (e.g.
    meninges, acoustic nerve, parotid glands). To this end, the Committee has
    performed systematic analyses of the relevant epidemiological and animal
    experimental literature.
    The Committee has focussed on exposure to RF EMF by the use of mobile
    phones, since this is the only type of exposure for which in some studies positive
    associations with an increase in incidence in tumours in the head and neck region
    have been observed. In other studies other types of exposure have been
    investigated (e.g. exposures from sources in the living or work environment,
    such as mobile telephone masts) in which also cancer in other parts of the body
    has been studied. These studies have not shown any association with factors
    indicative of exposure (such as distance to the source) and an increased risk of
    cancer, and are not discussed in this report.
1.3 Exposure
    In general, it is virtually impossible to assess with reasonable confidence what
    the exposure to RF EMF from mobile phones or other sources has been in the
    past. This is the case for exposures in the recent past, and even more for
    exposures several years ago. The same is true for assessment of the intensity and
    duration of use of a mobile phone, that has in most epidemiological studies been
    used as a proxy for exposure. So inherently the exposure assessment in
    retrospective studies such as case-control and case-case studies and retrospective
    cohort studies is poor. The only type of study that may have a better exposure
    assessment is a prospective cohort study, since that may include actual exposure
    assessment at different time periods during the follow-up.
    Assessment of the exposure to RF EMF resulting from the use of mobile phones
    is also hampered by the continuing technical developments that result in new,
    improved, types of phones that use different types of signals than their
    predecessors. These newer phones also often lead to the changes in their use. For
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<pre>    instance, the use of smartphones has changed the way of using a phone from
    primarily making calls to more text- and app-related use. This also leads to
    changes in exposure, since the phones are not held against the head so much
    anymore.
    In several epidemiological studies discussed in this and in the previous report,
    different phone types are distinguished. The oldest type is the analogue phone,
    that generally used simple modulation of a carrier frequency to transmit speech
    and text information. This was succeeded by the digital GSM phone, that used a
    pulse modulation of the carrier frequency for speech, text and data transmission.
    The next, 3rd, generation of mobile phones was UMTS, using yet another, more
    complex, type of signal to allow in particular more and faster data transfer. With
    increasing demand, the capabilities of UMTS would not suffice, therefore a 4th
    generation type of mobile phone system has been developed and the 5th
    generation is underway. Another type of wireless phone that is nowadays in use
    in most households is the cordless phone (mostly using the DECT protocol). This
    is a phone with a limited range that is connected through a small base station to
    the landline network and that replaces as such the old wired phones. In the report
    Mobile telephones the Committee has provided detailed technical information on
    the different generations of mobile phone and DECT systems.6
    Exposure from other sources, such as tablets, laptops and WiFi systems, is
    complex and different from that of mobile phones. In any case such sources do
    not result in appreciable exposure of the head.
1.4 Causation
    Associations observed in epidemiological studies may be indicative for a causal
    relationship, but in general it is difficult to establish a causal relationship from
    epidemiological evidence only, unless the association is consistently observed
    and the risk observed is high. Observing a dose-response relationship, i.e. an
    increase of the risk with increasing dose, is also an indication for a causal
    association. However, it is questionable whether the concept of ‘dose’, which is
    the product of the level and duration of exposure, can be applied to exposure to
    electromagnetic fields. In a short advisory report on power lines from 2008, the
    Committee indicated that there are no indications that ‘dose’ can be applied to
    low-frequency fields.7 The same can be concluded for radiofrequency fields. It is
    simply not known whether there is more damage inflicted by higher exposure
    levels and whether there is accumulation of damage with longer exposure. In
    Introduction                                                                         21
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<pre>    combination with the problems associated with assessing the exposure in
    epidemiological studies, this makes the concept of ‘dose’ impossible to use.
    Therefore, and for simplicity, the Committee uses in this report the term
    ‘exposure-response relationship’, which may refer to an exposure level-response
    relationship or an exposure duration-response relationship.
    When analyzing epidemiological data, it is important to take into account a
    number of considerations formulated by Bradford Hill, in order to conclude on
    the possibility of a causal relationship.8 These include strength, consistency,
    temporality, biological gradient (or exposure-response) and plausibility. The
    Committee wil discuss them in the final chapter of this report.
1.5 This report
    In the current report the results of the two previous reports are updated,
    summarized and integrated.
    The report starts in Chapter 2 with an update of the epidemiological data: results
    are presented of the systematic search and analysis of the epidemiological studies
    that have been published since the closing date of the first report of the
    Committee1 and an updated overview is provided of studies investigating the
    incidence of various types of tumours in the head and neck over time. Following
    an a priori defined protocol, all relevant studies, both case-control, cohort and
    other types of studies, were identified, extracted, selected for further analysis and
    evaluated for their quality. In addition, the Committee provides in this chapter an
    update of the data on the incidence of gliomas and parotid gland tumours in the
    Netherlands, using 10-year age classes and data up to 2012.
    Chapter 3 presents the results of a systematic search and analysis of the
    experimental animal studies that have been published since the closing date of
    the second report of the Committee.2
    In Chapter 4 the Committee discusses the evidence from the epidemiological and
    experimental data and gives its overall conclusions.
 2  Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre> hapter 2
        Recent epidemiological data
2.1     Search and selection
        Since the publication of the report of the Committee on the systematic analysis of
        the epidemiological data, several new studies and re-analyses of older studies
        have been published. On May 29, 2015, a additional systematic search in
        PubMed was performed, updating the last search done on August 14, 2011, with
        the following search protocol:
        ((cellular phone* OR mobile phone* OR cell phone* OR radio waves OR electromagnetic fields OR
        radio frequency) AND (tumour* OR cancer* OR neoplasm*) AND (epidemiology OR case-control
        OR cohort OR case-case OR dosimetry OR exposure assessment) AND (“2011/08/15”[Date -
        Entrez]: ‘3000’[Date - Entrez])) NOT (animal* OR rat OR rats OR mouse OR mice OR in vitro)
        This resulted in 451 hits. A first inspection on the basis of the titles resulted in
        89 papers that could potentially be used. Of the excluded 362 papers, 188 were
        not on tumours in the head, 80 were on treatment, 29 were on extremely low
        frequency fields, 10 were on animal or in vitro studies, 3 were on calculations of
        exposure, 3 were on radio-, tv- or GSM masts, and 49 were on other topics.
        The 89 selected papers were further inspected on the basis of the abstract or full
        text. This resulted in 10 papers that were to be fully analysed. Of the excluded
        79 papers, 21 were editorials or correspondence, 20 were reviews, 7 were not on
        Recent epidemiological data                                                                   23
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<pre>      mobile phones, 4 were not on tumours in the head, 5 were ecological studies,
      5 had already been described in the previous report, 1 was a pooled analysis of
      studies described in the previous report, 2 were on the association between
      mobile phones and the survival of cancer patients, 4 were on therapy, 1 was on
      technical issues, 4 were on theoretical issues, and 5 were in languages other than
      English, French, German or Dutch.
      The 10 remaining studies have been systematically evaluated in the same way as
      the studies in the first report of the Committee.1
2.2   Quality analysis of cohort, case-control and case-case studies
      In the previous report1, the Committee has developed a system to score the
      quality of epidemiological studies. In Annex B this is discussed in more detail. In
      the following tables, the overall score of the quality analysis is provided as a
      number between 0 and 10. To facilitate distinguishing higher from lower rated
      studies, they are colour coded, but without any particular meaning of the cut-off
      values. Ratings of 7.0 and higher are marked green, ratings of between 3.0 and
      7.0 are marked yellow, and ratings lower than 3.0 are marked red. In order to
      provide a complete overview of the quality of all identified epidemiological
      studies, the newly identified studies are added to the information from the studies
      presented in the previous report.1
2.2.1 Cohort studies
      One new cohort study has been published recently. The study population is a
      cohort of about 800,000 middle-aged women who are surveyed every 3-4 years
      on sociodemographic, medical and lifestyle factors. In the 1999-2005 survey, a
      general question about mobile phone use was included. The description of the
      study is given in Table 1, the results are given in Annex D.
 4    Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre> able 1 Cohort studies.
  eference                  Type of tumour               Exposure assessment           Country / time period / ages Overall score
                                                                                                                     (0-10)
 tudies from previous report
Dreyer et al. (1999)9       Brain cancer                 Length contract, type         Boston, Chicago, Dallas,      7.1
                                                         phone, duration calls         Washington DC, USA,
                                                                                       1994
                                                                                       ≥ 20 y at start
 rei et al. (2011)10        Brain tumours, including     Length of contract for those Denmark, 1982-2007             7.9
                            glioma, meningioma           with contract before 1996 ≥ 30 y at start
 chüz et al. (2011)11       Acoustic neuroma             Length of contract for those Denmark, 1982-2006             7.9
                                                         with contract before 1996 ≥ 30 y at start
New study
Benson et al. (2013)12      Brain tumours combined,      One-time question on          UK, 1996-2001, women          7.8
                            glioma, meningioma,          mobile phone use: never,      mean age 59.5 y
                            acoustic neuroma             less than once a day and
                                                         every day
Abbreviations: CI: confidence interval; IRR: incidence rate ratio; OR: odds ratio; SMR: standard mortality rate.
2.2.2          Case-control studies
               These include 4 new studies from the Hardell group and 5 new studies from other
               research groups. The studies from the Hardell group are presented separate from
               the other studies since they form a large cluster of often overlapping studies.
               Presenting them in a separate table provides a better overview. The description of
               the studies is given in Tables 2 and 3, the results are given in Annex D.
 able 2 Case-control studies of the Hardell group.
Reference             Type of tumour      Original, pooled / Population,           Response (%)        Time period /        Overall
                                          study no.            hospital based /                        place                score
                                                               ages                                                         (0-10)
 tudies from previous report
Hardell et al.        Brain tumour        Pooled, studies nrs Population          Cases: 90%           1997-2003            7.4
 2009)13              (incl. glioma,      2+3                  20-80 y            (malignant tum.);    Study 2: central
                      meningioma,                                                 88% (benign tum.,    region Sweden,
                      acoustic neuroma)                                           incl. meningioma,    study 3: 2 city
                                                                                  acoustic neuroma)    regions Sweden
                                                                                  Controls: 89%
Hardell et al.        Malignant brain     Pooled, studies nrs Population          Cases: 85%           1997-2003            7.4
 2011)14              tumour              2+3+4                20-80 y            Controls: 84%        Study 2: central
                                                                                                       region Sweden,
                                                                                                       study 3: 2 city
                                                                                                       regions Sweden;
                                                                                                       study 4: 4 city
                                                                                                       regions Sweden
               Recent epidemiological data                                                                                        25
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<pre>Hardell et al.       Parotid gland     Original            Population         Cases: 64%a          1994-2000          6.4
2004)15              tumour                                20-80 y            Controls: 90%a       6 city regions
                                                                                                   Sweden
 öderqvist et al.    Parotid gland     Original            Population         Cases: 75%a          2000-2003          7.2
 2012) 16            tumour                                22-80 y            Controls: 83%        3 city regions (9/
                                                                                                   21 counties)
                                                                                                   Sweden
New studies
Hardell et al.       Malignant brain   Original (study nr Population          Cases: 87%           2007-2009          7.4
 2013)17             tumours           5)                  18-75 y            Controls: 85%        6 Swedish cancer
                                                                                                   registries
Hardell & Carlberg Glioma              Pooled, studies nrs Population         Cases: 89%           1997-2003,         7.4
 2015)18                               2-5                 20-80, 18-75 y     Controls: 87%        2007-2009
                                                                                                   Study 2: central
                                                                                                   region Sweden,
                                                                                                   study 3: 2 city
                                                                                                   regions Sweden;
                                                                                                   study 4: 4 city
                                                                                                   regions Sweden,
                                                                                                   study 5: 6
                                                                                                   Swedish cancer
                                                                                                   registries
Hardell et al.       Acoustic neuroma Pooled, studies nrs Population          Cases: 93%           1997-2003,         7.9
 2013) 19                              2+5 (acoustic       20-80, 18-75 y     Controls: 87%        2007-2009
                                       neuroma data                                                Study 2: central
                                       from study nr 5                                             region Sweden,
                                       not published                                               study 5: 6
                                       separately)                                                 Swedish cancer
                                                                                                   registries
Carlberg et al.      Meningioma        Original            Population         Cases: 88%           2007-2009Cancer    7.4
 2013) 20                                                  18-75 y            Controls: 85%        registries, all of
                                                                                                   Sweden
    Recalculated by including excluded cases that were deceased or declared too ill by their physician. This was only done for
    the studies where these subpopulations had been included in the response calculations. See the previous report.1
 6             Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre> able 3 Case-control studies from research groups other than Hardell.
  eference            Type of tumour    Original, pooled Population,          Response (%)      Time period /      Overall
                                                          hospital based /                      place              score
                                                          ages                                                     (0-10)
  rain tumours, gliomas
 tudies from previous report
  akebayashi et al. Glioma,             Original          Hospital for cases  Cases: glioma     2000-2004          5.5
2008)21               meningioma,                         estimated to        59%, meningioma Greater Tokyo
                      pituitary adenoma                   represent 75% of    78%, pituitary    area, Japan
                                                          total # of cases in adenoma, 76%
                                                          area, population    Controls: 51%
                                                          controls
                                                          30-69 y
NTERPHONE             Glioma,           Pooled            Mixed               Cases: glioma     2000-2004          6.6
 tudy group           meningioma                          30-59 y             64% (36-92%),     13 countries
2010)22                                                                       meningioma 78%
                                                                              (56-92%)
                                                                              Controls: 53%
                                                                              (42-74%)
Muscat et al.         Primary brain     Original          Hospital            Cases: 82%        1994-1998          3.9
2000)23 a             cancer, incl.                       18-80 y             Controls: 90%     New York,
                      glioma                                                                    Providence,
                                                                                                Boston, USA
nskip et al.          Glioma,           Original          Hospital            Cases: 92%        1994-1998          5.0
2001)24               meningioma,                         ≥ 18 y              Controls: 86%     Phoenix, Boston,
                      acoustic neuroma                                                          Pittsburgh, USA
Auvinen et al.        Glioma,           Original          Population          Cases: 100%       1996               8.4
2002)25               meningioma,                         20-69 y             Controls: 100% as All of Finland
                      parotid gland                                           register-based
                      tumour
Gousias et al.        Glioma            Original          Population          Cases: 100%?      2005-2007          2.1
2009)26                                                   22-82 y             Controls: 100%?   6 districts of
                                                                                                Greece
  aldi et al.         Brain tumours     Original          Population          Cases: 70%        1999-2001          5.7
2011)27                                                   ≥ 15 y              Controls: 69%     Gironde, France
  ydin et al.         Brain tumours     Original          Population          Cases: 83%        2004-2008          7.5
2011)28               children                            7-19 y              Controls: 71%     All of Denmark,
                                                                                                Sweden, Norway,
                                                                                                Switzerland
  pinelli et al.      Glioma            Original          Hospital            Cases: 72%        2005               2.7
2010)29                                                   ≥ 18 y              Controls: 100%?   Marseille, Toulon,
                                                                                                France
  ew studies
  oureau et al.       Glioma,           Original          Population          Cases: 73%        2004-2006          5.8
2014) 30              meningioma                          ≥ 16 y              Controls: 45%     4 regions in
                                                                                                France
                 Recent epidemiological data                                                                               27
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<pre>  eltbower et al.   Brain tumours     Original           Hospital          Cases: 71 %      2007-2009           2.2
2014) 31                                                 0-24 y            Controls: 74 %   (Leeds); 2008-
                                                                                            2010
                                                                                            (Manchester)
                                                                                            2 hospitals in
                                                                                            Leeds and
                                                                                            Manchester (pilot
                                                                                            study)
Acoustic neuroma
 tudies from previous report
NTERPHONE           Acoustic neuroma Pooled              Mixed             Cases: 82%       2000-2004           7.1
 tudy group                                              30-59 y           (70-100%)        13 countries
2011)32                                                                    Controls: 53%
                                                                           (35-74%)
Muscat et al.       Acoustic neuroma Original            Hospital          Cases: 100%?     1997-1999           3.4
2002)33                                                  ≥ 18 y            Controls: 100%?  New York, USA
  ew studies
  orona et al.      Acoustic neuroma Original            Hospital          Cases: 88 %      2006-2010           3.8
2012)34                                                   ≥ 18 y           Controls: 83 %   2 municipalities
                                                                                            in northeast Brazil
Moon et al.         Acoustic neuroma Original            Hospital          Cases: 89%       1991-2010           3.9
2014)35                                                   ≥ 18 y           Controls: not    One hospital in
                                                                           provided         Seoul, South
                                                                                            Korea
  ettersson et al.  Acoustic neuroma Original            Population        Cases: 83%       2002-2007           7.2
2014) 36                                                 20-69 y           Controls: 65%    Swedish regional
                                                                                            cancer registers;
                                                                                            local acoustic
                                                                                            neuroma
                                                                                            registries at
                                                                                            otorhinolaryngolo
                                                                                            gy clinics in
                                                                                            Uppsala and
                                                                                            Linköping regions
  arotid gland tumour
 tudies from previous report
Duan et al.         Parotid gland     Original           Hospital          Cases: 78%       1993-2010           4.3
2011)37             tumour                               7-80 y            Controls: 62%    Beijing, China
  önn et al.        Parotid gland     Original           Population        Cases: 85%       2000-2002           6.5
2006)38 b           tumour                               20-69 y           overall (79%     All of Denmark,
                                                                           Denmark, 89%     3 cities Sweden
                                                                           Sweden)
                                                                           Controls:70%
                                                                           overall (60%
                                                                           Denmark, 72%
                                                                           Sweden)
  adetzki et al.    Parotid gland     Original           Population        Cases: 87%       2001-2003           6.4
2008)39             tumour                               ≥ 18 y            Controls: 66%    All of Israel
 8             Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre>Other tumours
 tudies from previous report
 tang et al.        Uveal melanoma Original            Population         Cases: 84%       1994-1997         4.6
2001)40                                                35-69 y +          Controls: 81%    Essen+ all of
                                                       Hospital                            Germany
                                                       35-74 y
 tang et al.        Uveal melanoma Original            Hospital           Cases: 94%       2002-2004         7.5
2009)41                                                20-74 y            Controls: 57%    Essen, Germany
                                                                          (hospital) & 52%
                                                                          (population)
Warren et al.       Intratemporal     Original         Hospital           Cases: 100%?     1995-2000         2.0
2003)42             facial nerve                       Cases: mean 47 y Controls: 100%?    Gainesville (Fl),
                    tumours                            Controls: mean                      USA
                                                       57.8, 52.6, 50.8 y
 choemaker et al.   Pituitary tumours Original         Population for     Cases: 61%       2001-2005         7.1
2009)43                                                cases, general     (calculated)     South-east UK
                                                       physicians for     Controls 43%:
                                                       controls
                                                       18-59 y
De Roos et al.      Neuroblastoma     Original         Hospital           Cases: 73%       1992-1994         0.8
2001)44                                                ≤ 19 y             Controls: 71%    139 hospitals,
                                                                                           USA & Canada
2.2.3         Case-case studies
              One new paper included both a case-control and a case-case study (Moon et al.,
              2014).35 The case-control study was described in the previous paragraph, the
              case-case study is described here. The results are given in Annex D.
 able 4 Case-case studies.
  eference          Type of tumour    Original, pooled Population,        Response (%)     Time period /     Overall
                                                       hospital based /                    place/ topic of   score
                                                       ages                                analysis          (0-10)
 tudies from previous report
Ali Kahn et al.     Glioma            Original         Hospital           100%             2000-2001         6.0
2003)45                                                20-81 y                             One hospital in
                                                                                           Dublin, Ireland
                                                                                           Handedness in
                                                                                           phone users vs.
                                                                                           tumour location
 alahaldin &        Acoustic neuroma Original          Hospital           100%?            2004-2005         5.2
  ener (2006)46                                        34-66 y                             Two hospitals in
                                                                                           Doha, Qatar
                                                                                           Possession of
                                                                                           phone (yes / no)
              Recent epidemiological data                                                                            29
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<pre> ato et al. (2010)47 Acoustic neuroma Original           Hospital          51%              2000-2006          8.3
                                                         ≥29 - ≤70 y                        22 hospitals in
                                                                                            Japan
                                                                                            Intensity of phone
                                                                                            use and laterality
                                                                                            vs. tumour
                                                                                            location and size
 ew study
Moon et al.          Acoustic neuroma Original           Hospital          Cases: 100%      1991-2010          7.5
2014)35                                                   ≥ 18 y                            One hospital in
                                                                                            Seoul, South
                                                                                            Korea
                                                                                            Association of
                                                                                            tumour volume
                                                                                            with mobile
                                                                                            phone use
2.2.4          Conclusions on the quality analysis
               Most of the new studies described here are of an adequate quality according to
               the grading system used. The pilot study of Feltbower et al.31 scored low on the
               methodological quality criteria “selection bias” and “misclassification of
               exposure” (see Table B5 in Annex B). The case-control studies of Corona et al.34
               and Moon et al.35 scored low on the criteria “selection bias” and “correction for
               confounding” (see Table B5 in Annex B).
               The grading system used is adequate for describing the general quality of the
               design and execution of the individual studies. In the previous report, however,
               the Committee already argued that, since it does not compare the studies, it does
               not capture any internal inconsistencies between studies from the same
               investigators.1 Such inconsistencies can be identified for the Hardell studies. In
               the previous report, the Committee mentioned that a striking feature of the
               Hardell case-control studies is their generally high response rate. In several of the
               studies from other groups discussed in the current report, similar high response
               rates have been obtained as in the more recent Hardell studies. Therefore the
               Committee does not consider the response rates in these recent Hardell studies as
               unrealistically high. However, the other critique to the Hardell studies is still
               valid. The authors have conducted a limited number of primary studies, but they
               combine their results in different ways in the various pooled analyses. They
               consider a large number of endpoints, which often vary between studies and
               pooled analyses, without clearly defined a priori hypotheses on endpoints or cut-
               off points for the exposure metrics (see tables D1-8 and D10-13 in Annex D).
               There are often inconsistencies between endpoints. Also, increased risks are
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<pre>      sometimes found already for very short follow-up times, such as >1-5 years. This
      is unlikely in view of the long latency times assumed for the types of tumours
      involved. Another issue is, that often an exposure-effect relationship is not
      present, although this in part may be the result of low numbers of subjects in the
      higher exposure categories. Because of these issues, the Committee has given the
      Hardell studies less weight in the overall analysis than would be the case on the
      basis of the results of the grading system as such.
2.3   Results of the new cohort, case-control and case-case studies
      The results of the newly identified studies are presented in tables D1-14 in
      Annex D and are briefly described here.
2.3.1 Cohort study
      In the million-women study by Benson et al. (2013)12 an increased risk was
      observed for acoustic neuroma associated with ≥ 10 years use of a mobile phone
      (relative risk = 2.46, 95% confidence interval 1.07, 5.64 (Table D5)). No
      increased risks were found for glioma (Table D1), meningioma (Table D10) and
      pituitary tumour (Table D14), nor with other exposure metrics (ever or daily use
      of a mobile phone) or for other tumours (results not presented).
2.3.2 Case-control and case-case studies
      Glioma
      Hardell et al. (2013)17 performed a new study into the relationship between
      mobile phone use and malignant brain tumours. The results were subsequently
      included in a new pooled analysis of these data that included the data from three
      previous studies.18 This pooled analysis showed increased risks for time since
      first use of generally more than 5 years for various types of mobile phones
      (analogue, GSM and UMTS) separately and combined, and for cordless phones
      for time since first use of more than 1 year (Table D1). For cumulative call time,
      increased risks were found for analogue phones for 123 or more hours, for GSM
      for more than 1 hour and for UMTS for 512-1,486 hours (Table D2). For all
      types of mobile phones combined, increased risks were found for cumulative call
      times of more than 1 hour. For cordless phones, increased risk was found for call
      times of more than 512 hours. When the data were analysed for laterality,
      Recent epidemiological data                                                        31
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<pre>  increased risks were found for ipsilateral use* for ever use of any type of phone
  except UMTS (Table D3) and for time since first use of more than 1 year. For all
  mobile phones combined, increased risk was also found for contralateral use of
  more the 20 years. When analysed as continuous variables, the risk was
  increased per 100 hours of use and per year of use for analogue and GSM
  phones, all mobile phones combined, and cordless phones, but not for UMTS
  phones (Table D4).
  Acoustic neuroma
  Hardell et al. (2013)19 published the pooled results for acoustic neuroma of a
  previous study and a new one (the data from the latter one were not published
  separately). For analogue phones they observed increased risks for all categories
  of time since first use of more than 1 year, and for GSM for more than 1 year, or
  more than 5 to 10 years (Table D5). For all mobile phones combined increased
  risks were observed for all times since first use of more than 1 year. For cordless
  phones risks were increased for time since first use of more than 1 year, and for
  more than 1 to 5 and more than 5 to 10 years.
  In a study by Corona et al. (2012)34 no increased risks were observed for times
  since first use of up to more than 6 years (Table D5). Moon et al. (2014)35 also
  did not observe increased risks for acoustic neuroma with average times since
  first use of around 10 years, while Petterson et al. (2014)36 found only an
  increased risk for digital or cordless phones used for 5-9 years, but not for longer
  or shorter periods; for analogue and digital phones combined they did not
  observe increased risks.
  For cumulative call time, Hardell et al. (2013)19 found increased risks for
  analogue phone use with all call times of more than 1 hour, and the same for
  GSM phones, except for call times of 123-155 hour (Table D6). A similar pattern
  was observed for all mobile phones combined. Cordless phone use showed an
  increased risk for call times more than 122 hour.
  Moon et al. (2014)35 found no difference between cases and controls with respect
  to cumulative call times. Pettersson et al. (2014)36 found an association between
  cumulative call time and risk for acoustic neuroma for cordless phones, but when
  considering only the histologically confirmed cases the results were less apparent
  Use of the phone predominantly on the same side of the head as where the tumour is located.
2 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre>      and they conclude that it is unlikely that there is a causal relation between the
      reported exposure and acoustic neuroma formation.
      When the data were analysed for laterality, Hardell et al. (2013)19 found increased
      risks for both ipsi- and contralateral use with ever use of an analogue phone, and
      with ipsilateral use of a GSM, but not of a UMTS phone, with all mobile phones
      combined, and with use of a cordless phone (Table D7). Corona et al. (2012)34
      and Pettersson et al. (2014)36 did not find any increased risk for either ipsi- or
      contralateral use with any endpoint considered. The latter authors also conclude
      that their data show that laterality analyses are prone to bias and that their results
      suggest that detection bias may be present in studies of a slow-growing tumour
      such as acoustic neuroma.
      When analysed as continuous variables by Hardell et al. (2013)19, the risk was
      increased per 100 hours of use and per year of use for analogue phones, all
      mobile, digital or wireless phones combined, but not for GSM, UMTS and
      cordless phones separately (Table D8). An increase in tumour volume was found
      for analogue phones only per 100 hours of use and per year of use. In a case-case
      study that was included in the publication by Moon et al. (2014)35 a larger tumour
      volume was observed for those with regular use of a mobile phone, and, in the
      group of regular users, for those who used their phone for more than 20 min per
      day and for those with a cumulative use of more than 2,000 hour (Table D9).
      Meningioma
      No increased risks were observed for meningioma by the Hardell group in a study
      by Carlberg et al. (2013)20 for time since first use (Table D10) and cumulative call
      time (Table D11). No effect of laterality was observed for ever use of any type of
      phone (Table D12). However, increased risks were found for all phone types
      except UMTS per 100 hour of use, but not per year of use (Table D13). Also no
      effects of these variables were found for changes in tumour volume.
2.3.3 Conclusions on the cohort, case-control and case-case studies
      Some epidemiological studies provide indications for an association between
      long-term or intensive use of a mobile telephone and an increased risk of tumours
      in the brain or head and neck region. However, the studies are not consistent and
      of varying quality. Increased risks have sometimes been observed with short time
      periods of use, which is unlikely in view of the slow growing nature of the
      Recent epidemiological data                                                            33
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<pre>    tumours involved. And in some cases increased risks have been observed only in
    an intermediate category of exposure, but not in higher ones. This is contrasting
    the expectation of an increased response with increasing exposure. The final
    conclusion is, that overall the evidence for an association is weak.
2.4 Ecological studies
    These studies investigate the occurrence of disease at population level in relation
    to the prevalence of (a proxy for) exposure in the population. They may analyze
    for instance the pattern of tumour occurrence over time (either by incidence or by
    mortality) in geographic entities such as countries, to identify any trends and to
    see whether these could be explained e.g. by trends in possession or use of
    mobile phones. Individual data on mobile phone use are not used in these studies.
    Such studies will inherently be limited by the poor level of insight into trends and
    patterns of mobile phone use, and hence of actual exposure, particularly for
    specific age, sex and other population group definitions.
    It should be noted that for many countries substantial and wide-spread mobile
    phone use is relatively recent (Figure 1).
    Figure 1 Number of mobile phone subscriptions per 100 inhabitants for some European countries
    and the USA. Data from ITU (http://www.itu.int/ITU-D/ict/statistics/explorer/index.html).
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<pre>      In most Western-European countries approximately half of the population had a
      mobile phone subscription in the year 2000. In the Nordic countries (Norway,
      Sweden, Finland and Denmark) the increase started earlier, but was caught up by
      the other countries around the century mark. By 2005 most people in the
      countries presented (except France and the USA) owned a mobile phone, but the
      extent of use is much less certain.
      The studies selected from the search mentioned in the previous paragraph
      included 5 ecological studies (studies on time trends of incidence of the
      respective tumours). However, a separate search was made using broader search
      terms into ecological studies investigating time trends of tumours in the head.
      This resulted in 23 studies, which are summarized in Table C1 in Annex C. These
      studies have not been evaluated in a similar systematic way as the case-control
      and cohort studies; instead, a description of the studies and their main findings are
      provided. A distinction is made between studies that include a time period up to
      2005 and later. The latter ones are considered more relevant for any relationship
      between tumour incidence and mobile phone use, since massive phone use did
      not start until the mid-1990’s and most tumours presumably have a long latency
      time of at least 10 years, as described in the previous report.1 (The Committee
      acknowledges, however, that this is an assumption with a considerable degree of
      uncertainty.) It is thus possible that any trends in tumour occurrence related to
      mobile phone use may not yet be visible in most countries, with an exception
      perhaps for the Nordic countries, since use started earlier there.
      In analyzing ecological studies, it has to be realized that trends in mortality can
      also be influenced by the introduction of more effective treatments and that
      trends in incidence can be affected by changes in diagnostic techniques.
2.4.1 Results of ecological studies
      Overall, the ecological studies do not provide indications of an increase in
      incidence of gliomas, meningiomas, acoustic neuromas and parotid gland
      tumours that might be associated with the increase in mobile telephone use that
      started in the mid-1990s. The effects observed, if any, are inconsistent: in some
      studies an increase in tumour incidence was observed in some age- or gender
      groups, while in others a decrease or no change at all was found. Undoubtedly
      there are differences in diagnostics and in the quality and completeness of the
      registries, especially in the earlier periods. The data from the later periods also do
      not show consistent changes.
      Recent epidemiological data                                                            35
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<pre>2.4.2 Conclusions on ecological studies
      The ecological studies do not provide any evidence for an association between an
      increase in mobile telephone use, or an increase of exposure to radiofrequency
      electromagnetic fields in general, and an increased risk for tumours in the brain
      and head and neck region.
2.5   Tumour incidence in the Netherlands
      The Committee has obtained an update of the data for glioma and parotid gland
      tumour incidence in the Netherlands that was published in the previous report.
      The most recent data are now from 2012 and a breakdown is made in 10-year age
      groups instead of the 20-year groups in the previous report.1 Data for other
      tumours are not provided, since for those the registration is not complete.
2.5.1 Glioma
      For gliomas, the age-corrected overall incidence shows an upward trend over the
      period 1989-2012 (Figure 2a). The age-stratified data indicate no increasing
      trend in the last 15-20 year in the age groups up to 60 years (Figs 2b-2c), but in
      the age groups over 60 years a consistent increase in glioma incidence is present
      (Figure 2d). According to the investigators of the Netherlands Cancer Registry,
      that provided these data, the increase is mainly the result of improvements in
      diagnostics and in the last decade especially by the identification of
      glioblastomas after introduction of the Stupp treatment plan, which stimulated
      physicians to better select patients for treatment. This conclusion is strengthened
      by an initial increase in the number of unspecified central nervous system
      tumours that would be the result of improved diagnostics followed by a relative
      decrease after introduction of the Stupp treatment plan. (Ho, personal
      communications 11-12-2015 and 14-03-2016, and Ho et al. (2014)48).
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<pre>Figure 2a Incidence of gliomas and unspecified central nervous system tumours in the Netherlands
from 1989-2012 for all age groups combined, age-corrected using the European Standard
Population*. Source: Netherlands Cancer Registry managed by CCCNL.
The incidence of cancer is the number of new cases registered in a certain period (often 1 year). In
order to follow the incidence over time or to compare it between regions, the incidence is often
presented as the crude rate, the absolute number of new cases per 100,000 persons per year. Since the
crude rate will often be higher when there are relative many older people in a region (the cancer
incidence is higher with older people) it is customary to standardize the incidence rate for the age
distribution. This is usually done using either the European or world standard population, resulting in
the ‘European standardized rate’(ESR) or the ‘world standardized rate’(WSR).
Recent epidemiological data                                                                             37
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<pre>  Figure 2b Glioma incidence in the Netherlands from 1989-2012 for the age groups 0-9,
  10-19 and 20-29 years. Source: Netherlands Cancer Registry managed by CCCNL.
  Figure 2c Glioma incidence in the Netherlands from 1989-2012 for the age groups 30-39,
  40-49 and 50-59 years. Source: Netherlands Cancer Registry managed by CCCNL.
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<pre>      Figure 2d Glioma incidence in the Netherlands from 1989-2012 for the age groups 60-69, 70-80
      and 80+ years. Source: Netherlands Cancer Registry managed by CCCNL.
2.5.2 Parotid gland tumours
      The incidence of parotid gland tumours in the Netherlands shows a slight upward
      trend over the entire period 1989-2012 overall (Figure 3a).
      Recent epidemiological data                                                                  39
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<pre>  Figure 3a Incidence of parotid gland tumours in the Netherlands from 1989-2012 for all age groups
  combined, per 100,000 person-years, age-corrected using the European standardized rate. Source:
  Netherlands Cancer Registry managed by CCCNL.
  Figure 3b Incidence of parotid gland tumours in the Netherlands from 1989-2012 for the age groups
  0-9, 10-19 and 20-29 years. Source: Netherlands Cancer Registry managed by CCCNL.
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<pre>Figure 3c Incidence of parotid gland tumours in the Netherlands from 1989-2012 for the age groups
30-39, 40-49 and 50-59 years. Source: Netherlands Cancer Registry managed by CCCNL.
Figure 3d Incidence of parotid gland tumours in the Netherlands from 1989-2012 for the age groups
60-69, 70-79 and 80+ years. Source: Netherlands Cancer Registry managed by CCCNL.
Recent epidemiological data                                                                       41
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<pre>2.5.3 Conclusions
      The overall age-standardized glioma incidence in the Netherlands shows an
      upward trend that started already before the 1990’s, when mobile phones were
      only available to very few people. This trend is mainly driven by the older age
      groups (60+). There are no indications that the massive use of mobile telephones
      that started in the mid 1990’s and increased to use in 100% of the population in
      the mid 2000’s (Figure 1) has led to an acceleration of the increase in glioma
      incidence. Assuming that the ‘early adopters’ of mobile phones were in the age
      categories of 20-30 and 30-40 years some 15 years ago, and there would be a
      latency time of about 5 years (which, according to current knowledge, is not very
      likely, it presumably is much longer), then an acceleration of the increase in
      tumour incidence might crudely be expected in the age categories of 30-40 and
      40-50 years. Increased incidences are not seen for these age groups, but only in
      the >60 years age groups. These might be explained by improved diagnostic
      procedures. In view of the presumed long latency times of gliomas, a longer
      follow-up might be necessary.
      For parotid gland tumours there seems to be a slight upward trend throughout the
      entire period of 1989-2012, but there is considerable scatter in the data, for a
      large part because of the very low incidence of this type of tumour. This is even
      more visible in the data for the different age groups. Also for parotid gland
      tumours, there are no indications that the massive use of mobile telephones has
      led to an increase in incidence in the Netherlands.
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<pre> hapter 3
        Recent experimental animal data
3.1     Systematic search
        On June 30, 2015, a systematic search was performed for studies published after
        the publication of the report of the Committee on the systematic analysis of the
        experimental animal data. This search was an update of the previous search done
        up to September 13, 2012. The following search protocol was used:
        (radiofrequency OR radio waves OR radio-waves OR cellphone* OR cell phone* OR cellular
        *phone* OR mobile phone* OR cellular phone[MeSH Terms] OR telephone, cellular[MeSH Terms])
        AND (animal OR rat OR mouse OR rats OR mice OR murine) AND (cancer OR carcinogen* OR
        tumour* OR tumor* OR neoplasm* OR benign OR malignant OR malignancy) NOT (“in
        vitro”[Publication Type] OR hyperthermia OR ablation OR imaging) AND (“2012/09/14”[Date -
        Entrez] : “3000”[Date - Entrez])
        This resulted in 53 hits. A first inspection on the basis of the titles resulted in 3
        papers that could potentially be used. Of the excluded 50 papers, 8 were in vitro
        studies, 7 were on treatment, 5 were reviews and 30 were on other topics.
        The three selected papers were further inspected on the basis of the abstract or
        full text. This resulted in one paper that was to be fully systematically evaluated
        in the same way as the studies in the second report of the Committee.2 Of the
        Recent experimental animal data                                                            43
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<pre>    papers not included, one was on structural damage to the brain and one was on
    treatment.
3.2 Results of the retrieved study
    The study that was found through the systematic search was a replication of a
    study described in the previous report.2 In that original study, Tillman et al.
    (2010)49 exposed pregnant mice to a UMTS signal starting at the 6th day of
    pregnancy, at a power density of 4.8 W/m2, corresponding to a whole-body SAR
    of 0.4 W/kg.50 On the 14th day of pregnancy they were injected with the
    carcinogen ethylnitrosourea (ENU). After birth, UMTS exposure of the offspring
    continued until the age of 69 weeks. The researchers observed increases in the
    incidence of liver and lung tumours, but suggested that at least the increased rate
    of liver tumours might have been influenced by an infection of Helicobacter
    hepaticus. They further considered the observations preliminary and suggested
    replication. The Committee commented in the report on animal carcinogenesis
    that it agreed with that suggestion, but also that it was difficult to interpret the
    findings because the proper control group, ENU treatment followed by sham
    exposure, was missing.
         Lerchl et al. (2015)50 performed a replication of the study of Tillman et al.
    (2010).49 They used larger groups and included all proper control groups.
    Moreover, care was taken to use only animals in which no infection with
    Helicobacter hepaticus was present. They also added two SAR levels in order to
    investigate a possible exposure-response relationship, and exposed the animals to
    0 (sham), 0.04, 0.4 (as in the Tillman et al. study) or 2 W/kg. They investigated
    the incidence of 23 tumour types and observed a significant enhancement in four
    of them (benign brochiolo-alveolar adenoma, malignant brochiolo-alveolar
    carcinoma, malignant hepatocellular carcinoma, malignant lymphoma).
    However, for none of these tumour types a consistent relation of incidence with
    exposure level was found. Surprisingly, the highest level showed the least
    effects. Nevertheless the study did confirm the results of Tillmann et al. (2010)49
    in that it showed an effect of RF exposure on ENU-induced tumours.
3.3 Evaluation of the retrieved study
    In the previous report2 the Committee developed a quality assessment system for
    animal studies that evaluates whether there are possible threats to the internal and
    external validity of the study. The results of the evaluation of the quality of the
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<pre>    Lerchl et al. (2015) study, following the same protocol as described in the
    previous report2, is shown in Table 7.
    Table 7 Overview of the scores for the internal and external validity of the relevant animal study.
    Authors                   Brief results                  Internal validity       External validity
                                                             Influence Comment Influence Comment
    Multiple tumours, non-transgenic animals
    Lerchl et al. (2015) 50   Increased number of lung
    Replication of            and liver tumours, no dose-
    Tillman et al. (2010)49   response; no effect other
                              tumours
    The blue colour indicates that threats to the internal and external validity of the
    study are considered low.
3.4 Discussion and comparison with previous results
    Lerchl et al. (2015)50 conclude that RF exposure has a promoting effect on ENU-
    induced carcinogenesis and suggest that perhaps changes in metabolism that are
    induced by tissue warming resulting from the absorption of RF energy may be an
    explanation for the observations. They suggest that for instance the uptake of
    ENU by the foetuses could have been higher due to an increased metabolism.
    However they do not provide any data to support this hypothesis and it is
    inconsistent with the absence of any exposure-response effect.
    In the previous report, the Committee described the results of its initial
    systematic review on animal carcinogenesis studies.2 The initial systematic
    literature search revealed a substantial body of 54 animal studies on the
    carcinogenesis of exposure to RF fields. In 23 studies the effect of exposure to
    RF EMF alone had been investigated. A variety of animal models and tumour
    types had been used, as well as a number of different types of RF signals,
    although the focus has been on the types of signals used in modern mobile
    telecommunication. Exposure duration was from several weeks up to two years,
    and the follow-up time generally lifelong. In addition, 24 studies investigated the
    modulating effects of RF exposure on carcinogenesis induced by various well-
    known carcinogenic compounds, and another seven studies the effect of RF
    exposure on the growth of implanted tumours. These data cover a wide range of
    experimental situations and may thus provide a reasonably well insight into the
    effects of RF exposure on carcinogenesis in rodents.
    Recent experimental animal data                                                                     45
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<pre>igure 4 Overview of the animal studies included in the systematic analysis, ordered by effect outcome and type of exposure,
nd colour coded for internal (upper) and external validity (lower). Red: threat to validity considered high; blue: threat
onsidered low; yellow: unknown.
            The analysis of the quality of the studies, as reflected in the possibility that the
            internal or external validity of the studies could be affected, showed that most of
            the studies are of adequate design. Figure 4, updated from the previous report to
            include the Lerchl et al. (2015)50 study, gives an overview of the studies included
            in the systematic analysis, ordered by effect outcome and type of exposure, and
            colour coded for internal (upper) and external validity (lower).
            In eight studies various issues resulted in a negative appraisal (indicated in red in
            the figure) and these studies were consequently excluded from the overall analysis
            (one paper contained two separate studies).51-57 Of the remaining 47 studies,
            six showed an increase in the incidence of several types of tumours.49, 50, 58, 59
            Four of these were closely linked and performed by the same research group of
            Szmigielski et al. and published in two papers.58, 59 These authors used rather high
            exposure levels and could not exclude thermal effects. The fifth study is the
            Tillman et al. study49 that found an increased incidence of chemically-induced
            lung tumours, but lacked a proper control group. The authors considered it to be a
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<pre>preliminary study that needed to be replicated, which has now been done.50 A
further three studies found a decreased rate of tumour growth in RF EMF exposed
animals. 60-62 There is no mechanistic explanation for this. In the majority of the
studies, however, 38 in total, describing experiments on a range of tumour types
and in different species, no effect on carcinogenesis has been observed.63-100
It may be that the observed responses in the Tillmann et al. (2010)49 and Lerchl
et al. (2015)50 studies are typical only for the specific type of mouse used, a cross
between two different mouse strains. No effect of life-long RF exposure on
ENU-induced carcinogenesis was observed in a number of studies using different
strains of rats61,62,80,85,86,89 as described in the previous report of the Committee.2
Animal models that use chemical or physical carcinogens are extremely difficult
to translate to the human situation, since the studies are designed in such a way
as to provide a sufficient rate of carcinogenesis to investigate modifications of
the exposure conditions, i.e. the dose of the carcinogen is relatively high and/or
the specific animal model used has an increased incidence of the particular
type(s) of cancer compared to other models. Nevertheless, taken together, the
Tillman et al. (2010)49 and Lerchl et al. (2015)50 studies do provide an indication
for a promoting effect of RF fields. The Committee therefore feels that its
conclusion from the previous report that “it is unlikely that long-term continuous
or repeated exposure to RF EMF may have initiating or promoting effects on the
development of cancer” should be changed to “it is unlikely that long-term
continuous or repeated exposure to RF EMF may have initiating effects on the
development of cancer, but a possible promoting effect warrants further
investigation”.
Recent experimental animal data                                                         47
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<pre> hapter 4
        Discussion and conclusions
4.1     The epidemiological evidence
        The Committee concludes that the results of the epidemiological studies
        published since the previous report do not provide more clarity on the question of
        whether frequent and/or long term use of a mobile phone is associated with
        induction or promotion of tumours in the head and neck region.
        The newer Hardell studies, which were in part pooled analyses of their previous
        studies, provide similar information as the previous ones: an increased risk of
        primarily gliomas and acoustic neuromas associated with mobile phone use.
        However, it has been pointed out in the previous report that the Hardell studies
        suffer from internal inconsistencies and this has not changed in the more recent
        studies. Therefore the Committee still gives the Hardell studies less weight in the
        overall evaluation of the epidemiological data. The recent studies from other
        research groups provide mixed results. A French case-control study provides
        weak indications for an association of mobile phone use and an increased risk of
        gliomas, but scores low with respect to quality. Three case-control studies found
        no indications for an increased risk of acoustic neuroma, but two of them score
        low for quality. In a study among women of an UK cohort with an adequate
        quality, indications for an increased risk of acoustic neuroma, but not for glioma,
        meningioma or pituitary tumours, were found. A new case-case study shows an
        Discussion and conclusions                                                          49
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<pre>    association between long-term mobile phone use and a increase in acoustic
    neuroma volume.
    The increased risk of tumours in the head and neck region that was found in
    some case-control and cohort studies is not reflected by increased incidences of
    these tumours in ecological studies.
    The data on the incidence of gliomas and parotid gland tumours in the
    Netherlands, which are now available up to 2012, show an increase in mainly the
    older population. Assuming that the ‘early adopters’ of mobile phones were in
    the age categories of 20-30 and 30-40 years some 15 years ago, and there would
    be an unlikely short latency time for these tumours of about 5 years, then an
    acceleration of the increase in tumour incidence might crudely be expected in the
    age categories of 30-40 and 40-50 years. An increased incidence is not seen in
    these age groups, but only in those of 60 years and older. This increase started
    already long before the massive use of mobile telephones and can be explained
    largely by improvements in diagnostic procedures. No acceleration of the
    increase has been observed after mobile phones have become in use by the
    majority of the population, but in view of the presumed long latency times of
    gliomas, a longer follow-up might be necessary.
4.2 The Bradford Hill considerations
    In observational studies such as the epidemiological studies described in this and
    in the previous report, the quality of exposure assessment is crucial, especially in
    deriving exposure-response relations.101 Moreover, the extent of selection bias
    and the adjustment for confounding factors are important in assessing the
    evidence for causality of associations. A standard tool in assessing evidence for
    causality are Bradford Hill’s considerations.8 Of these, in more recent
    epidemiological literature, strength, consistency, temporality, biological gradient
    (or exposure-response) and biological or physical plausibility are considered. It
    should be borne in mind that when these items are found to be present, this is
    considered to increase the likelihood of causality, but when they are not found,
    this does not prove that there is no causality.
    Strength
    A relative risk or odds ratio higher than 2 is usually considered to be a relatively
    strong association. Most relative risks observed in the studies discussed in this
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<pre>and the previous report are lower than 2. It is likely that in the studies described,
misclassification of exposure occurs. This will mostly lead to underestimation of
the odds ratio, thus decreasing the strength of the observed association.
Nevertheless, an odds ratio of less than 2 could also be indicative of causality if it
is consistently observed. This is not really the case in the studies described.
Consistency
Consistency of results from different studies strengthens the causality argument.
However, the consistency across and within the studies discussed in this and in
the previous report is not very high. In several studies some increased risks have
been observed in subgroups, while in others decreased risks were found. Mostly,
however, no increased or decreased risks were observed. However, where one
would expect the effect to occur if it exists, such as on the ipsilateral side of the
exposure after longer or heavier exposure, some consistency might be perceived.
Temporality
This refers to the fact that the occurrence of the disease should always follow the
exposure. In case-control studies exposure is always measured retrospectively, so
temporality can never truly be addressed. Prospective cohort studies could
provide more insight into this, but these are currently not available. So no
conclusions on temporality can be made.
Biological gradient or exposure-response
Exposure-response relationships can only be assessed if exposure can be
measured adequately and with sufficient precision.101 However, since the case-
control studies used questionnaires to retrospectively assess exposures which
often occurred long ago, recall bias will decrease the accuracy of exposure
assessment. Where in the INTERPHONE studies described in the previous
report1 an increased risk was observed, this was only in the highest out of 10
exposure categories for cumulative call time.22, 32 This does not constitute a clear
exposure-response relationship. No increased risks were found for cumulative
number of calls. Hardell observed several exposure-response relationships in the
analysis of time since first use and cumulative use for gliomas, also in the more
recent studies.
Discussion and conclusions                                                             51
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<pre>    Plausibility
    This refers to the understanding of the biological model underlying a true
    association between mobile phone use and brain tumours. Many reviews have
    concluded that there is no known biological model to explain a relationship
    between mobile phone use and an increased risk of cancer.102-105 Also the results
    of the animals studies described in this report do not support an effect. However,
    knowledge on a biological model is not a prerequisite for concluding on a causal
    relationship.
    In conclusion, application of the Bradford Hill considerations to the available
    epidemiological data described in this and in the previous report is not supportive
    of a causal relationship between the use of mobile phones and the occurrence of
    tumours in the head. This may be because there really is no causal relationship,
    but it may also reflect inadequacies of the methods used in the studies up to date
    or in the ability to measure exposure and outcome.
4.3 The evidence from experimental animal studies
    Concerning the experimental animal data, only one new study has been
    published since the previous report. It is a replication of an earlier report that
    suggested an increased incidence of liver tumours in a very specific mouse
    model of tumour development after prenatal exposure to the carcinogen
    ethylnitrosourea (ENU), but it was hampered by a missing control group and a
    bacterial infection. The replication did include all proper controls and confirmed
    the earlier results – an increase in the incidence of liver tumours – but also an
    increase in two specific types of lung tumour and in lymphomas. ENU is a
    carcinogen known to induce neurogenic tumours, so it is remarkable that out of
    the 23 types of tumours investigated, the four that showed an enhanced incidence
    were not of the expected type. Studies into the effect of RF + ENU on neurogenic
    tumours were discussed in the previous report and showed no effect of RF
    exposure. Also studies on the effects of long-term exposure to RF EMF alone or
    in combination with a number of carcinogens did not show any effect of RF EMF
    on the development of tumours.
    The Committee wishes to stress that the effects in rodents described here have
    been observed in a very specific mouse model with exposure to a carcinogen.
    Whether this has any predictive value of effects in humans is unknown.
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<pre>    The Committee concludes that with the result of the replication study, its
    previous conclusion that “it is highly unlikely that long-term continuous or
    repeated exposure to RF EMF may have initiating or promoting effects on the
    development of cancer” will have to be changed in “there is no evidence that
    long-term continuous or repeated exposure to RF EMF may have initiating
    effects on the development of cancer, but a possible promoting effect warrants
    further investigation”.
4.4 Overall conclusion on carcinogenicity
    Overall, the data from several epidemiological studies provide some indications
    for an association between long-term and/or intensive use of a mobile phone and
    an increased incidence of tumours in the brain and head and neck region, but the
    evidence is weak and inconsistent. The incidence data in the Netherlands and in
    other countries worldwide do not provide any support for such association. It is
    possible that the exposure to RF EMF resulting from the use of mobile phones
    plays a role in an association, should it exist, but the Committee considers it
    unlikely that such exposure actually induces tumours. Animal data do not
    provide evidence for induction of tumours, only a weak indication for a possible
    promotion effect.
    These conclusions are different from those of IARC.5 Concerning the
    epidemiological data, IARC concludes: “There is limited evidence in humans for
    the carcinogenicity of radiofrequency radiation. Positive associations have been
    observed between exposure to radiofrequency radiation from wireless phones
    and glioma, and acoustic neuroma.” 4 According to IARC’s definition of “limited
    evidence”, this means that “a positive association has been observed between
    exposure to the agent and cancer for which a causal interpretation is considered
    to be credible, but chance, bias or confounding could not be ruled out with
    reasonable confidence.” The conclusion of IARC with respect to the animal data
    is: “There is limited evidence in experimental animals for the carcinogenicity of
    radio frequency radiation.” Taking into account the epidemiological and
    experimental data, the Committee considers a causal interpretation unlikely and
    feels that the combination of bias, confounding and chance might be an
    explanation for the observations.
    Discussion and conclusions                                                        53
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<pre>4.5 Ongoing and future studies
    So far most studies have only been able to evaluate the effects of relatively short
    duration of exposure to RF EMF and were limited informative at best for insight
    in the development of relevant tumours with long latency times. Some
    epidemiological studies have follow-up times of more than 13 years, but with
    very few subjects in the highest exposure categories. The Committee therefore
    considers it very important that ongoing cohort studies evaluating the health
    effects of mobile phone use be continued in order to provide more conclusive
    human evidence. The exposure characterization in all currently available studies
    is very poor. It is therefore important that ongoing and future studies incorporate
    more accurate and objective assessment of RF exposure. This is even more
    important since personal exposure to RF EMF continues to change due to
    evolving ways of use and new mobile telecommunication devices.
4.6 Reduction of exposure
    The available data do not allow drawing conclusions on whether there is an
    association between an increased carcinogenic risk and any form of
    accumulation of exposure, for instance expressed in the total call time, or the
    total amount of energy deposited by the electromagnetic fields generated by the
    phone in the head or in any other body part. So it is not possible to state whether
    a higher or longer exposure is less safe than a lower or shorter exposure. The
    Committee therefore considers the value of any measures to reduce exposure
    unclear. However, it is possible that some individuals would like to reduce their
    exposure, despite the conclusion of the Committee that there is no consistent
    evidence for an increased risk for tumours in the brain and other regions in the
    head associated with mobile phone use. The Knowledge Platform
    Electromagnetic Fields provides a number of suggestions for exposure
    reduction.106
    Despite the fact that no exposure-response relationships have been observed, the
    Committee would like to repeat the suggestion from the previous report1 to apply
    the ALARA principle to exposure to RF EMF, meaning that exposures should be
    As Low As Reasonably Achievable. There is no need for any device to transmit
    with greater power or for a longer period of time than needed for an adequate
    connection. This is fully in line with the suggestions from the Health Council’s
    advisory report Prudent precaution.3
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<pre>  References
  Health Council of the Netherlands. Mobile phones and cancer. Part 1: Epidemiology of tumours in
  the head. The Hague, Health Council of the Netherlands; 2013: publication no. 2013/11.
  Health Council of the Netherlands. Mobile phones and cancer. Part 2: Animal studies on
  carcinogenesis. The Hague, Health Council of the Netherlands; 2014: publication no. 2014/22.
  Health Council of the Netherlands. Prudent precaution. The Hague, Health Council of the
  Netherlands; 2008: publication no. 2008/18E.
  Baan R, Grosse Y, Lauby-Secretan B, El Ghissassi F, Bouvard V, Benbrahim-Tallaa L, et al.
  Carcinogenicity of radiofrequency electromagnetic fields. Lancet Oncol 2011; 12(7): 624-6.
  IARC - International Agency for Research on Cancer. IARC Monographs on the Evaluation of
  Carcinogenic Risks to Humans. Non-ionizing radiation, Part 2: Radiofrequency electromagnetic
  fields. Volume 102. http://monographs.iarc.fr/ENG/Monographs/vol102/index.php, accessed 7
  March 2016.
  Health Council of the Netherlands. Mobile phones. Health Council of the Netherlands; 2002:
  publication no. 2002/01E.
  Health Council of the Netherlands. High voltage power lines. The Hague: Health Council of the
  Netherlands, 2008; publication no. 2008/04E.
  Bradford Hill A. The environment and disease: association or causation? Proc R Soc Med 1965;
  58: 295-300.
  Dreyer NA, Loughlin JE and Rothman KJ. Cause-specific mortality in cellular telephone users.
  JAMA 1999; 282(19): 1814-6.
0 Frei P, Poulsen AH, Johansen C, Olsen JH, Steding-Jessen M and Schüz J. Use of mobile phones and
  risk of brain tumours: update of Danish cohort study. BMJ 2011; 343: d6387.
  References                                                                                       55
</pre>

====================================================================== Einde pagina 55 =================================================================

<br><br>====================================================================== Pagina 56 ======================================================================

<pre>1 Schüz J, Steding-Jessen M, Hansen S, Stangerup SE, Caye-Thomasen P, Poulsen AH, et al. Long-
  term mobile phone use and the risk of vestibular schwannoma: a Danish nationwide cohort study. Am
  J Epidemiol 2011; 174(4): 416-22.
2 Benson VS, Pirie K, Schüz J, Reeves GK, Beral V and Green J. Mobile phone use and risk of brain
  neoplasms and other cancers: prospective study. Int J Epidemiol 2013; 42(3): 792-802.
3 Hardell L and Carlberg M. Mobile phones, cordless phones and the risk for brain tumours. Int J
  Oncol 2009; 35(1): 5-17.
4 Hardell L, Carlberg M and Hansson Mild K. Pooled analysis of case-control studies on malignant
  brain tumours and the use of mobile and cordless phones including living and deceased subjects. Int J
  Oncol 2011; 38(5): 1465-74.
5 Hardell L, Hallquist A, Hansson Mild K, Carlberg M, Gertzen H, Schildt EB, et al. No association
  between the use of cellular or cordless telephones and salivary gland tumours. Occup Environ Med
  2004; 61(8): 675-9.
6 Söderqvist F, Carlberg M and Hardell L. Use of wireless phones and the risk of salivary gland
  tumours: a case-control study. Eur J Cancer Prev 2012; 21(6): 576-9.
7 Hardell L, Carlberg M, Söderqvist F and Hansson Mild K. Case-control study of the association
  between malignant brain tumours diagnosed between 2007 and 2009 and mobile and cordless phone
  use. Int J Oncol 2013; 43(6): 1833-45.
8 Hardell L and Carlberg M. Mobile phone and cordless phone use and the risk for glioma - Analysis
  of pooled case-control studies in Sweden, 1997-2003 and 2007-2009. Pathophysiology 2015; 22(1):
  1-13.
9 Hardell L, Carlberg M, Söderqvist F and Hansson Mild K. Pooled analysis of case-control studies on
  acoustic neuroma diagnosed 1997-2003 and 2007-2009 and use of mobile and cordless phones. Int J
  Oncol 2013; 43(4): 1036-44.
0 Carlberg M, Söderqvist F, Hansson Mild K and Hardell L. Meningioma patients diagnosed 2007-
  2009 and the association with use of mobile and cordless phones: a case-control study. Environ
  Health 2013; 12(1): 60.
1 Takebayashi T, Varsier N, Kikuchi Y, Wake K, Taki M, Watanabe S, et al. Mobile phone use,
  exposure to radiofrequency electromagnetic field, and brain tumour: a case-control study. Br J Cancer
  2008; 98(3): 652-9.
2 INTERPHONE study group. Brain tumour risk in relation to mobile telephone use: results of the
  INTERPHONE international case-control study. Int J Epidemiol 2010; 39(3): 675-94.
3 Muscat JE, Malkin MG, Thompson S, Shore RE, Stellman SD, McRee D, et al. Handheld cellular
  telephone use and risk of brain cancer. JAMA 2000; 284(23): 3001-7.
4 Inskip PD, Tarone RE, Hatch EE, Wilcosky TC, Shapiro WR, Selker RG, et al. Cellular-telephone use
  and brain tumors. N Engl J Med 2001; 344(2): 79-86.
5 Auvinen A, Hietanen M, Luukkonen R and Koskela RS. Brain tumors and salivary gland cancers
  among cellular telephone users. Epidemiology 2002; 13(3): 356-9.
6 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
</pre>

====================================================================== Einde pagina 56 =================================================================

<br><br>====================================================================== Pagina 57 ======================================================================

<pre>6 Gousias K, Markou M, Voulgaris S, Goussia A, Voulgari P, Bai M, et al. Descriptive epidemiology of
  cerebral gliomas in Northwest Greece and study of potential predisposing factors, 2005-2007.
  Neuroepidemiology 2009; 33(2): 89-95.
7 Baldi I, Coureau G, Jaffre A, Gruber A, Ducamp S, Provost D, et al. Occupational and residential
  exposure to electromagnetic fields and risk of brain tumors in adults: a case-control study in Gironde,
  France. Int J Cancer 2011; 129(6): 1477-84.
8 Aydin D, Feychting M, Schüz J, Tynes T, Andersen TV, Schmidt LS, et al. Mobile phone use and
  brain tumors in children and adolescents: a multicenter case-control study. J Natl Cancer Inst 2011;
  103(16): 1264-76.
9 Spinelli V, Chinot O, Cabaniols C, Giorgi R, Alla P and Lehucher-Michel MP. Occupational and
  environmental risk factors for brain cancer: a pilot case-control study in France. Presse Med 2010;
  39(2): e35-e44.
0 Coureau G, Bouvier G, Lebailly P, Fabbro-Peray P, Gruber A, Leffondre K, et al. Mobile phone use
  and brain tumours in the CERENAT case-control study. Occup Environ Med 2014; 71(7): 514-22.
1 Feltbower RG, Fleming SJ, Picton SV, Alston RD, Morgan D, Achilles J, et al. UK case control study
  of brain tumours in children, teenagers and young adults: a pilot study. BMC Res Notes 2014; 7: 14.
2 INTERPHONE study group. Acoustic neuroma risk in relation to mobile telephone use: Results of
  the INTERPHONE international case-control study. Cancer Epidemiol 2011; 35(5): 454-63.
3 Muscat JE, Malkin MG, Shore RE, Thompson S, Neugut AI, Stellman SD, et al. Handheld cellular
  telephones and risk of acoustic neuroma. Neurology 2002; 58(8): 1304-6.
4 Corona AP, Ferrite S, Lopes MS and Rego MA. Risk factors associated with vestibular nerve
  schwannomas. Otol Neurotol 2012; 33(3): 459-65.
5 Moon IS, Kim BG, Kim J, Lee JD and Lee WS. Association between vestibular schwannomas and
  mobile phone use. Tumour Biol 2014; 35(1): 581-7.
6 Pettersson D, Mathiesen T, Prochazka M, Bergenheim T, Florentzson R, Harder H, et al. Long-term
  mobile phone use and acoustic neuroma risk. Epidemiology 2014; 25(2): 233-41.
7 Duan Y, Zhang HZ and Bu RF. Correlation between cellular phone use and epithelial parotid gland
  malignancies. Int J Oral Maxillofac Surg 2011; 40(9): 966-72.
8 Lönn S, Ahlbom A, Christensen HC, Johansen C, Schüz J, Edström S, et al. Mobile phone use and
  risk of parotid gland tumor. Am J Epidemiol 2006; 164(7): 637-43.
9 Sadetzki S, Chetrit A, Jarus-Hakak A, Cardis E, Deutch Y, Duvdevani S, et al. Cellular phone use and
  risk of benign and malignant parotid gland tumors--a nationwide case-control study. Am J Epidemiol
  2008; 167(4): 457-67.
0 Stang A, Anastassiou G, Ahrens W, Bromen K, Bornfeld N and Jöckel KH. The possible role of
  radofrequency radiation in the development of uveal melanoma. Epidemiology 2001; 12: 7-12.
1 Stang A, Schmidt-Pokrzywniak A, Lash TL, Lommatzsch PK, Taubert G, Bornfeld N, et al. Mobile
  phone use and risk of uveal melanoma: results of the risk factors for uveal melanoma case-control
  study. J Natl Cancer Inst 2009; 101(2): 120-3.
  References                                                                                              57
</pre>

====================================================================== Einde pagina 57 =================================================================

<br><br>====================================================================== Pagina 58 ======================================================================

<pre>2 Warren HG, Prevatt AA, Daly KA and Antonelli PJ. Cellular telephone use and risk of intratemporal
  facial nerve tumor. Laryngoscope 2003; 113(4): 663-7.
3 Schoemaker MJ and Swerdlow AJ. Risk of pituitary tumors in cellular phone users: a case-control
  study. Epidemiology 2009; 20(3): 348-54.
4 De Roos AJ, Teschke K, Savitz DA, Poole C, Grufferman S, Pollock BH, et al. Parental occupational
  exposures to electromagnetic fields and radiation and the incidence of neuroblastoma in offspring.
  Epidemiology 2001; 12(5): 508-17.
5 Ali Kahn A, O'Brien DF, Kelly P, Phillips JP, Rawluk D, Bolger C, et al. The anatomical distribution
  of cerebral gliomas in mobile phone users. Ir Med J 2003; 96(8): 240-2.
6 Salahaldin AH and Bener A. Long-term and frequent cellular phone use and risk of acoustic
  neuroma. Int Tinnitus J 2006; 12(2): 145-8.
7 Sato Y, Akiba S, Kubo O and Yamaguchi N. A case-case study of mobile phone use and acoustic
  neuroma risk in Japan. Bioelectromagnetics 2010; 32(2): 85-93.
8 Ho VK, Reijneveld JC, Enting RH, Bienfait HP, Robe P, Baumert BG, et al. Changing incidence and
  improved survival of gliomas. Eur J Cancer 2014; 50(13): 2309-18; 10.1016/j.ejca.2014.05.019.
9 Tillmann T, Ernst H, Streckert J, Zhou Y, Taugner F, Hansen V, et al. Indication of cocarcinogenic
  potential of chronic UMTS-modulated radiofrequency exposure in an ethylnitrosourea mouse model.
  Int J Radiat Biol 2010; 86(7): 529-41.
0 Lerchl A, Klose M, Grote K, Wilhelm AF, Spathmann O, Fiedler T, et al. Tumor promotion by
  exposure to radiofrequency electromagnetic fields below exposure limits for humans. Biochem
  Biophys Res Commun 2015; 459(4): 585-90; 10.1016/j.bbrc.2015.02.151.
1 Preskorn SH, Edwards WD and Justesen DR. Retarded tumor growth and greater longevity in mice
  after fetal irradiation by 2450-MHz microwaves. J Surg Oncol 1978; 10(6): 483-92.
2 Repacholi MH, Basten A, Gebski V, Noonan D, Finnie J and Harris AW. Lymphomas in
  Em-Pim1 transgenic mice exposed to pulsed 900 MHz electromagnetic fields. Radiat Res 1997;
  147(5): 631-40.
3 Paulraj R and Behari J. Effects of low level microwave radiation on carcinogenesis in Swiss Albino
  mice. Mol Cell Biochem 2011; 348(1-2): 191-7.
4 Ivanov VB, Subbotina TI, Khadartsev AA, Yashin MA and Yashin AA. Exposure to low-intensive
  superhigh frequency electromagnetic field as a factor of carcinogenesis in experimental animals. Bull
  Exp Biol Med 2005; 139(2): 241-4.
5 Anghileri LJ, Mayayo E and Domingo JL. Aluminum, calcium ion and radiofrequency synergism in
  acceleration of lymphomagenesis. Immunopharmacol Immunotoxicol 2009; 31(3): 358-62.
6 Anghileri LJ, Mayayo E, Domingo JL and Thouvenot P. Radiofrequency-induced carcinogenesis:
  cellular calcium homeostasis changes as a triggering factor. Int J Radiat Biol 2005; 81(3): 205-9.
7 Anghileri LJ, Mayayo E, Domingo JL and Thouvenot P. Evaluation of health risks caused by radio
  frequency accelerated carcinogenesis: the importance of processes driven by the calcium ion signal.
  Eur J Cancer Prev 2006; 15(3): 191-5.
8 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
</pre>

====================================================================== Einde pagina 58 =================================================================

<br><br>====================================================================== Pagina 59 ======================================================================

<pre>8 Szmigielski S, Szudzinski A, Pietraszek A, Bielec M and Wrembel JK. Accelerated development of
  spontaneous and benzopyrene-induced skin cancer in mice exposed to 2450 MHz microwave
  radiation. Bioelectromagnetics 1982; 3: 179-91.
9 Szudzinski A, Pietraszek A, Janiak M, Wrembel J, Kalczak M and Szmigielski S. Acceleration of the
  development of benzopyrene-induced skin cancer in mice by microwave radiation. Arch Dermatol
  Res 1982; 274(3-4): 303-12.
0 Tillmann T, Ernst H, Ebert S, Kuster N, Behnke W, Rittinghausen S, et al. Carcinogenicity study of
  GSM and DCS wireless communication signals in B6C3F1 mice. Bioelectromagnetics 2007; 28(3):
  173-87.
1 Shirai T, Kawabe M, Ichihara T, Fujiwara O, Taki M, Watanabe S, et al. Chronic exposure to a 1.439
  GHz electromagnetic field used for cellular phones does not promote N-ethylnitrosourea induced
  central nervous system tumors in F344 rats. Bioelectromagnetics 2005; 26(1): 59-68.
2 Adey WR, Byus CV, Cain CD, Higgins RJ, Jones RA, Kean CJ, et al. Spontaneous and nitrosourea-
  induced primary tumors of the central nervous system in Fischer 344 rats chronically exposed to 836
  MHz modulated microwaves. Radiat Res 1999; 152(3): 293-302.
3 Frei MR, Berger RE, Dusch SJ, Guel V, Jauchem JR, Merritt JH, et al. Chronic exposure of
  cancer-prone mice to low-level 2450 MHz radiofrequency radiation. Bioelectromagnetics 1998;
  19(1): 20-31.
4 Frei MR, Jauchem JR, Dusch SJ, Merritt JH, Berger RE and Stedham MA. Chronic, low-level
  (1.0 W/kg) exposure of mice prone to mammary cancer to 2450 MHz microwaves. Radiat Res 1998;
  150(5): 568-76.
5 Chou CK, Guy AW, Kunz LL, Johnson RB, Crowley JJ and Krupp JH. Long-term, low-level
  microwave irradiation of rats. Bioelectromagnetics 1992; 13(6): 469-96.
6 Toler JC, Shelton WW, Frei MR, Merritt JH and Stedham MA. Long-term, low-level exposure
  of mice prone to mammary tumors to 435 MHz radiofrequency radiation. Radiat Res 1997; 148(3):
  227-34.
7 Jauchem JR, Ryan KL, Frei MR, Dusch SJ, Lehnert HM and Kovatch RM. Repeated exposure of
  C3H/HeJ mice to ultra-wideband electromagnetic pulses: lack of effects on mammary tumors. Radiat
  Res 2001; 155(2): 369-77.
8 Utteridge TD, Gebski V, Finnie JW, Vernon-Roberts B and Kuchel TR. Long-term exposure of
  E-µ-Pim1 transgenic mice to 898.4 MHz microwaves does not increase lymphoma incidence. Radiat
  Res 2002; 158(3): 357-64.
9 La Regina M, Moros EG, Pickard WF, Straube WL, Baty J and Roti Roti JL. The effect of chronic
  exposure to 835.62 MHz FDMA or 847.74 MHz CDMA radiofrequency radiation on the incidence of
  spontaneous tumors in rats. Radiat Res 2003; 160(2): 143-51.
0 Sommer AM, Streckert J, Bitz AK, Hansen VW and Lerchl A. No effects of GSM-modulated 900
  MHz electromagnetic fields on survival rate and spontaneous development of lymphoma in female
  AKR/J mice. BMC Cancer 2004; 4: 77.
  References                                                                                          59
</pre>

====================================================================== Einde pagina 59 =================================================================

<br><br>====================================================================== Pagina 60 ======================================================================

<pre>1 Sommer AM, Bitz AK, Streckert J, Hansen VW and Lerchl A. Lymphoma development in mice
  chronically exposed to UMTS-modulated radiofrequency electromagnetic fields. Radiat Res 2007;
  168(1): 72-80.
2 Anderson LE, Sheen DM, Wilson BW, Grumbein SL, Creim JA and Sasser LB. Two-year chronic
  bioassay study of rats exposed to a 1.6 GHz radiofrequency signal. Radiat Res 2004; 162(2): 201-10.
3 Sanchez S, Masuda H, Billaudel B, Haro E, Anane R, Leveque P, et al. Effect of GSM-900 and
  -1800 signals on the skin of hairless rats. II: 12-week chronic exposures. Int J Radiat Biol 2006;
  82(9): 675-80.
4 Oberto G, Rolfo K, Yu P, Carbonatto M, Peano S, Kuster N, et al. Carcinogenicity study of 217 Hz
  pulsed 900 MHz electromagnetic fields in Pim1 transgenic mice. Radiat Res 2007; 168(3): 316-26.
5 Smith P, Kuster N, Ebert S and Chevalier HJ. GSM and DCS wireless communication signals:
  combined chronic toxicity/carcinogenicity study in the Wistar rat. Radiat Res 2007; 168(4): 480-92.
6 Saran A, Pazzaglia S, Mancuso M, Rebessi S, Di M, V, Tanori M, et al. Effects of exposure of
  newborn patched1 heterozygous mice to GSM, 900 MHz. Radiat Res 2007; 168(6): 733-40.
7 Jin YB, Lee HJ, Seon LJ, Pack JK, Kim N and Lee YS. One-year, simultaneous combined exposure
  of CDMA and WCDMA radiofrequency electromagnetic fields to rats. Int J Radiat Biol 2011; 87(4):
  416-23.
8 Lee HJ, Jin YB, Lee JS, Choi SY, Kim TH, Pack JK, et al. Lymphoma development of
  simultaneously combined exposure to two radiofrequency signals in AKR/J mice.
  Bioelectromagnetics 2011; 32(6): 485-92.
9 Hruby R, Neubauer G, Kuster N and Frauscher M. Study on potential effects of “902-MHz GSM-type
  Wireless Communication Signals” on DMBA-induced mammary tumours in Sprague-Dawley rats.
  Mutat Res 2008; 649(1-2): 34-44.
0 Shirai T, Ichihara T, Wake K, Watanabe S, Yamanaka Y, Kawabe M, et al. Lack of promoting effects
  of chronic exposure to 1.95-GHz W-CDMA signals for IMT-2000 cellular system on development of
  N-ethylnitrosourea-induced central nervous system tumors in F344 rats. Bioelectromagnetics 2007;
  28(7): 562-72.
1 Heikkinen P, Ernst H, Huuskonen H, Komulainen H, Kumlin T, Maki-Paakkanen J, et al. No effects
  of radiofrequency radiation on 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone-induced
  tumorigenesis in female Wistar rats. Radiat Res 2006; 166(2): 397-408.
2 Heikkinen P, Kosma VM, Alhonen L, Huuskonen H, Komulainen H, Kumlin T, et al. Effects of
  mobile phone radiation on UV-induced skin tumourigenesis in ornithine decarboxylase transgenic
  and non-transgenic mice. Int J Radiat Biol 2003; 79(4): 221-33.
3 Heikkinen P, Kosma VM, Hongisto T, Huuskonen H, Hyysalo P, Komulainen H, et al. Effects of
  mobile phone radiation on X-ray-induced tumorigenesis in mice. Radiat Res 2001; 156(6): 775-85.
4 Yu D, Shen Y, Kuster N, Fu Y and Chiang H. Effects of 900 MHz GSM wireless communication
  signals on DMBA-induced mammary tumors in rats. Radiat Res 2006; 165(2): 174-80.
5 Zook BC and Simmens SJ. The effects of 860 MHz radiofrequency radiation on the induction or
  promotion of brain tumors and other neoplasms in rats. Radiat Res 2001; 155(4): 572-83.
0 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
</pre>

====================================================================== Einde pagina 60 =================================================================

<br><br>====================================================================== Pagina 61 ======================================================================

<pre>6 Zook BC and Simmens SJ. The effects of pulsed 860 MHz radiofrequency radiation on the promotion
  of neurogenic tumors in rats. Radiat Res 2006; 165(5): 608-15.
7 Huang TQ, Lee JS, Kim TH, Pack JK, Jang JJ and Seo JS. Effect of radiofrequency radiation
  exposure on mouse skin tumorigenesis initiated by 7,12-dimethybenz[alpha]anthracene. Int J Radiat
  Biol 2005; 81(12): 861-7.
8 Anane R, Dulou PE, Taxile M, Geffard M, Crespeau FL and Veyret B. Effects of GSM-900
  microwaves on DMBA-induced mammary gland tumors in female Sprague-Dawley rats. Radiat Res
  2003; 160(4): 492-7.
9 Adey WR, Byus CV, Cain CD, Higgins RJ, Jones RA, Kean CJ, et al. Spontaneous and nitrosourea-
  induced primary tumors of the central nervous system in Fischer 344 rats exposed to frequency-
  modulated microwave fields. Cancer Res 2000; 60(7): 1857-63.
0 Bartsch H, Bartsch C, Seebald E, Deerberg F, Dietz K, Vollrath L, et al. Chronic exposure to a GSM-
  like signal (mobile phone) does not stimulate the development of DMBA-induced mammary tumors
  in rats: results of three consecutive studies. Radiat Res 2002; 157(2): 183-90.
1 Imaida K, Kuzutani K, Wang J, Fujiwara O, Ogiso T, Kato K, et al. Lack of promotion of 7,12-
  dimethylbenz[a]anthracene-initiated mouse skin carcinogenesis by 1.5 GHz electromagnetic near
  fields. Carcinogenesis 2001; 22(11): 1837-41.
2 Imaida K, Taki M, Watanabe S, Kamimura Y, Ito T, Yamaguchi T, et al. The 1.5 GHz electromagnetic
  near-field used for cellular phones does not promote rat liver carcinogenesis in a medium-term liver
  bioassay. Jpn J Cancer Res 1998; 89(10): 995-1002.
3 Imaida K, Taki M, Yamaguchi T, Ito T, Watanabe S, Wake K, et al. Lack of promoting effects of the
  electromagnetic near-field used for cellular phones (929.2 MHz) on rat liver carcinogenesis in a
  medium-term liver bioassay. Carcinogenesis 1998; 19(2): 311-4.
4 Mason PA, Walters TJ, DiGiovanni J, Beason CW, Jauchem JR, Dick EJ, Jr., et al. Lack of effect of
  94 GHz radio frequency radiation exposure in an animal model of skin carcinogenesis.
  Carcinogenesis 2001; 22(10): 1701-8.
5 Chagnaud JL, Moreau JM and Veyret B. No effect of short-term exposure to GSM-modulated
  low-power microwaves on benzo(a)pyrene-induced tumours in rat. Int J Radiat Biol 1999; 75(10):
  1251-6.
6 Wu RY, Chiang H, Shao BJ, Li NG and Fu YD. Effects of 2.45-GHz microwave radiation and
  phorbol ester 12-O-tetradecanoylphorbol-13-acetate on dimethylhydrazine-induced colon cancer in
  mice. Bioelectromagnetics 1994; 15(6): 531-8.
7 Higashikubo R, Culbreth VO, Spitz DR, LaRegina MC, Pickard WF, Straube WL, et al.
  Radiofrequency electromagnetic fields have no effect on the in vivo proliferation of the 9L
  brain tumor. Radiat Res 1999; 152: 665-71.
8 Salford LG, Brun A and Persson BR. Brain tumor development in rats exposed to electromagnetic
  fields used in wireless communication. Wireless-Netw 1997; 3: 463-9.
  References                                                                                           61
</pre>

====================================================================== Einde pagina 61 =================================================================

<br><br>====================================================================== Pagina 62 ======================================================================

<pre>9  Salford LG, Brun A, Persson BRR and Eberhardt J. Experimental studies of brain tumor development
   during exposure with continuous and pulsed 915 MHz radiofrequency radiation. Bioelectrochem
   Bioenerget 1993; 30(1-3): 313-8.
00 Santini R, Hosni M, Deschaux P and Pacheco H. B16 melanoma development in black mice exposed
   to low-level microwave radiation. Bioelectromagnetics 1988; 9(1): 105-7.
01 Vlaanderen J, Vermeulen R, Heederik D and Kromhout H. Guidelines to evaluate human
   observational studies for quantitative risk assessment. Environ Health Perspect 2008; 116(12):
   1700-5.
02 Kundi M. The controversy about a possible relationship between mobile phone use and cancer. Cien
   Saude Colet 2010; 15(5): 2415-30.
03 Repacholi MH, Lerchl A, Röösli M, Sienkiewicz Z, Auvinen A, Breckenkamp J, et al. Systematic
   review of wireless phone use and brain cancer and other head tumors. Bioelectromagnetics 2011.
04 AGNIR - Advisory Group on Non-ionising Radiation. Health effects from radiofrequency
   electromagnetic fields. Documents of the Health Protection Agency 2012.
05 SSM - Swedish Radiation Safety Authority - Independent Group of Experts. Recent research on EMF
   and health risk. Seventh annual report from SSM:s Independent Expert Group on Electromagnetic
   Fields, 2010. Stockholm, Swedish Radiation Safety Authority; 2011: SSM Report 2010:44.
06 Kennisplatform Elektromagnetische velden. Anders omgaan met mobiele telefoons. http://
   www.kennisplatform.nl/Onderwerpen/Mobieletelefoonsenzendmasten/omgaan-met-mobiele-
   telefoon.aspx, accessed 7 March 2016.
07 Rothman KJ, Greenland S and Lash TL. Modern epidemiology. 3rd ed. Philidelphia: Lippincott,
   Williams & Wilkins, 2008.
08 Sehmer EA, Hall GJ, Greenberg DC, O’Hara C, Wallingford SC, Wright KA, et al. Incidence of
   glioma in a northwestern region of England, 2006-2010. Neuro Oncol 2014; 16(7): 971-4.
09 Kim SJ, Ioannides SJ and Elwood JM. Trends in incidence of primary brain cancer in New Zealand,
   1995 to 2010. Aust N Z J Public Health 2015.
10 Aydin D, Feychting M, Schüz J and Röösli M. Childhood brain tumours and use of mobile phones:
   comparison of a case-control study with incidence data. Environ Health 2012; 11: 35.
11 Barchana M, Margaliot M and Liphshitz I. Changes in brain glioma incidence and laterality
   correlates with use of mobile phones--a nationwide population based study in Israel. Asian Pac
   J Cancer Prev 2012; 13(11): 5857-63.
12 Deltour I, Auvinen A, Feychting M, Johansen C, Klaeboe L, Sankila R, et al. Mobile phone use and
   incidence of glioma in the Nordic countries 1979-2008: Consistency check. Epidemiology 2012;
   23(2): 301-7.
13 Vocht F de, Burstyn I and Cherrie JW. Time trends (1998-2007) in brain cancer incidence rates in
   relation to mobile phone use in England. Bioelectromagnetics 2011; 32(5): 334-9.
14 Hardell L, Carlberg M, Söderqvist F and Hansson Mild K. Re: Time trends in brain tumor incidence
   rates in Denmark, Finland, Norway, and Sweden, 1974-2003. J Natl Cancer Inst 2010; 102(10): 740-1.
2  Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
</pre>

====================================================================== Einde pagina 62 =================================================================

<br><br>====================================================================== Pagina 63 ======================================================================

<pre>15 Ding LX and Wang YX. Increasing incidence of brain and nervous tumours in urban Shanghai,
   China, 1983-2007. Asian Pac J Cancer Prev 2011; 12(12): 3319-22.
16 Zada G, Bond AE, Wang YP, Giannotta SL and Deapen D. Incidence trends in the anatomic location
   of primary malignant brain tumors in the United States: 1992-2006. World Neurosurg 2012; 77(3-4):
   518-24.
17 Dore JF, Boniol M and Telle-Lamberton M. Re: Time trends in brain tumor incidence rates in
   Denmark, Finland, Norway, and Sweden, 1974-2003. J Natl Cancer Inst 2010; 102(10): 741-2.
18 Lönn S, Klaeboe L, Hall P, Mathiesen T, Auvinen A, Christensen HC, et al. Incidence trends of adult
   primary intracerebral tumors in four Nordic countries. Int J Cancer 2004; 108(3): 450-5.
19 Nomura E, Ioka A and Tsukuma H. Trends in the incidence of primary intracranial tumors in Osaka,
   Japan. Jpn J Clin Oncol 2011; 41(2): 291-4.
20 Deltour I, Johansen C, Auvinen A, Feychting M, Klaeboe L and Schüz J. Time trends in brain tumor
   incidence rates in Denmark, Finland, Norway, and Sweden, 1974-2003. J Natl Cancer Inst 2009;
   101(24): 1721-4.
21 Muscat JE, Hinsvark M and Malkin M. Mobile telephones and rates of brain cancer.
   Neuroepidemiology 2006; 27(1): 55-6.
22 Deorah S, Lynch CF, Sibenaller ZA and Ryken TC. Trends in brain cancer incidence and survival in
   the United States: Surveillance, Epidemiology, and End Results Program, 1973 to 2001. Neurosurg
   Focus 2006; 20(4): E1.
23 Crocetti E, Trama A, Stiller C, Caldarella A, Soffietti R, Jaal J, et al. Epidemiology of glial and non-
   glial brain tumours in Europe. Eur J Cancer 2012; 48(10): 1532-42.
24 Röösli M, Michel G, Kuehni CE and Spoerri A. Cellular telephone use and time trends in brain
   tumour mortality in Switzerland from 1969 to 2002. Eur J Cancer Prev 2007; 16(1): 77-82.
25 Cook A, Woodward A, Pearce N and Marshall C. Cellular telephone use and time trends for brain,
   head and neck tumours. N Z Med J 2003; 116(1175): U457.
26 Larjavaara S, Feychting M, Sankila R, Johansen C, Klaeboe L, Schüz J, et al. Incidence trends of
   vestibular schwannomas in Denmark, Finland, Norway and Sweden in 1987-2007. Br J Cancer 2011;
   105(7): 1069-75.
27 Nelson PD, Toledano MB, McConville J, Quinn MJ, Cooper N and Elliott P. Trends in acoustic
   neuroma and cellular phones: is there a link? Neurology 2006; 66(2): 284-5.
28 Shu X, Ahlbom A and Feychting M. Incidence trends of malignant parotid gland tumors in Swedish
   and nordic adults 1970 to 2009. Epidemiology 2012; 23(5): 766-7.
29 Ellington CL, Goodman M, Kono SA, Grist W, Wadsworth T, Chen AY, et al. Adenoid cystic
   carcinoma of the head and neck: Incidence and survival trends based on 1973-2007 Surveillance,
   Epidemiology, and End Results data. Cancer 2012; 118(18): 4444-51.
30 Derbi HA, Kruger E and Tennant M. Incidence of oral cancer in Western Australia (1982-2009):
   Trends and regional variations. Asia Pac J Clin Oncol 2014.
   References                                                                                               63
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<pre>4 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies</pre>

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<pre>A The Committee
B Evaluation of the quality of the studies
C Overview of ecological studies on brain tumours
D Results from the selected publications
  Annexes
                                                  65
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<pre>6 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies</pre>

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<pre>nnex A
     The Committee
     The membership of the Electromagnetic Fields Committee at the time of
     preparation of this advisory report was as follows:
     • Prof. G.C. van Rhoon, chair
         Professor of Physical Aspects of Electromagnetic Fields and Health, Erasmus
         University Medical Centre Rotterdam
     • Prof. A. Aleman
         Professor of Cognitive Neuropsychiatry, University of Groningen
     • Dr. S. Le Cessie
         Statistician, Department of Clinical Epidemiology and Department of
         Medical Statistics, Leiden University Medical Center (since 01-12-2015)
     • Prof. J.J.G. Geurts
         Professor of Translational Neuroscience Research, VU University Medical
         Centre, Amsterdam (since 01-01-2016)
     • Dr. A. Huss
         Institute for Risk Assessment Sciences, University of Utrecht
         (since 01-01-2016)
     • Prof. H. Kromhout
         Professor of Epidemiology of Health Effects from Exposure to
         Electromagnetic Fields, Institute for Risk Assessment Sciences, University
         of Utrecht
     • Prof. F.E. van Leeuwen
         Professor of Cancer Epidemiology, Free University of Amsterdam; Head,
     The Committee                                                                   67
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<pre>      Division of Psychosocial Research and Epidemiology, Netherlands Cancer
      Institute, Amsterdam (until 31-12-2015)
  •   Prof. H.F.J. Savelkoul
      Professor of Cell Biology and Immunology, Wageningen University
  •   Dr. R. van Strien
      Epidemiologist, Municipal Health Services, Amsterdam (since 01-01-2016)
  •   Prof. W.J. Wadman
      Professor of Neurobiology, University of Amsterdam
  •   D.H.J. van de Weerdt, physician
      Toxicologist and specialist in environmental medicine, Central Gelderland
      Municipal Health Services (GGD), Arnhem (until 31-12-2015)
  •   Prof. A.P.M. Zwamborn
      Professor of Electromagnetic Fields and Health, Eindhoven University of
      Technology; Physicist, TNO (Netherlands Organisation for Applied
      Scientific Research), The Hague (until 31-12-2015)
  •   Dr. G. Kelfkens, structurally consulted expert
      Physicist, National Institute for Public Health and the Environment,
      Bilthoven
  •   Prof. E. Lebret, observer
      Professor of Environmental Health Impact Assessment, Institute for Risk
      Assessment Sciences, Utrecht University; Knowledge Platform
      Electromagnetic Fields, Bilthoven (until 31-12-2015)
  •   Dr. M.J.M. Pruppers, observer
      Physicist, Knowledge Platform Electromagnetic Fields, Bilthoven
  •   J. Robijns, observer
      Ministry of Economic Affairs, The Hague
  •   R.P.R. Schutte, observer
      Ministry of Infrastructure and the Environment, The Hague
  •   Dr. H.F.G. van Dijk, scientific secretary
      Biologist, Health Council of the Netherlands, The Hague (since 01-09-2015)
  •   Dr. E. van Rongen, scientific secretary
      Radiobiologist, Health Council of the Netherlands, The Hague
  Prof. I.A. Kreis, epidemiologist, and Palles health research and consultancy
  assisted in the extraction and scoring of the data. The registration teams of the
  Comprehensive Cancer Centre Netherlands and Comprehensive Cancer Centre
  South collected the data for the Netherlands Cancer Registry and the scientific
  staff of the Comprehensive Cancer Centre Netherlands provided the analysis of
  the data.
8 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre>The Health Council and interests
Members of Health Council Committees are appointed in a personal capacity
because of their special expertise in the matters to be addressed. Nonetheless, it
is precisely because of this expertise that they may also have interests. This in
itself does not necessarily present an obstacle for membership of a Health
Council Committee. Transparency regarding possible conflicts of interest is
nonetheless important, both for the chairperson and members of a Committee
and for the President of the Health Council. On being invited to join a
Committee, persons are asked to submit a form detailing the functions they hold
and any other material and immaterial interests which could be relevant for the
Committee’s work. It is the responsibility of the Health Council to assess
whether or not someone can become a member. An expert who has no financial
but another clearly definable interest, can become a member under the restriction
that he will not be involved in the debate on the subject to which his interest
relates. If a person’s interest is not clearly definable, he can sometimes be
consulted as an expert. Experts working for a ministry or governmental
organisation can be structurally consulted. During the inaugural meeting the
declarations issued are discussed, so that all members of the Committee are
aware of each other’s possible interests.
The Committee                                                                      69
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<pre>0 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies</pre>

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<pre>nnex B
     Evaluation of the quality of the studies
     Table B1 shows the method used to evaluate cohort, case-control and case-case
     studies. Ecological studies were not evaluated.
     Questions 1-4 are contributing to the domain of selection, with a maximum score
     of 34; question 5 contributes to the domain of diagnosis, with a maximum score
     of 4; questions 6-14 contribute to the domain of exposure, with a maximum score
     of 69; questions 15 and 16 contribute to the domain of confounding, with a
     maximum score of 16; and question 17 contributes to the domain of conflict of
     interest, with a maximum score of 5.
     Evaluation of the quality of the studies                                        71
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<pre> able B1 Evaluation system used for cohort, case-control or case-case studies on mobile phone use and head and neck tumours.
No. Question                                  Evaluation                                   Score Remarks
     Selection
     Did cases & controls come from           a No or unknown                               0       Consider Berkson’s bias
     the same source population?              b Yes                                        12       if hospital based.
                                              c   Not applicable (cohort or case-case)     12
     Were the same inclusion/exclusion        a   No or unknown                             0
     criteria applied to cases and controls?  b   Yes                                       6
                                              c   Not applicable (cohort or case-case)      6
     What was the % response of the cases?    a   < 76% or unknown or unclassifiable        0       Include deceased cases
                                              b   76-90%                                    4       and refusals by physician
                                              c   > 90%                                     8       in (re)calculated
                                                                                                    response rates
                                              d   Not applicable (cohort or case-case)      8
     Was the absolute difference in           a   No or unknown                             0
     % response between cases and             b   Yes                                       4
     controls <20%?                           c   Not applicable (cohort or case-case)      8
     Diagnosis
     Was the cancer diagnosis valid?          a   No or unknown                             0       If they use cancer
                                              b   Yes, but imaging only                     1       registry they probably
                                              c   Yes, but imaging plus location only       2       have historogy and
                                                                                                    imaging but if they have
                                              d   Yes, including histology                  3
                                                                                                    glioma vs maningioma
                                              e   Yes, including histology and location     4       they certainly have
                                                                                                    histology
     Exposure
     Could the type of administration         a   Participant or proxy, interview           0
     of the (exposure) questionnaire lead         (in person or by phone) administered
     to observer bias?                        b   Participant or proxy, self administered   5
                                              c   Register-based                            5
     Were all cases and controls treated      a   No or not provided                        0       No is if there is clearly a
     equally?                                 b   Yes                                       5       different data collection
                                              c   Yes as is cohort study                    5       protocol or people
                                                                                                    involved between the
                                                                                                    groups
     Was there potential for non-differential a   Yes: register based data-collection       0
     misclassification?                       b   somewhat: self administered data          5
                                                  collection
                                              c   No: interview-based data collection       5
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<pre>  Completeness of type mobile telephone      a  Total of 2 points                            2 Accumulate points for
  history?                                   b  Total of 3 points                            3 phone type history
                                             c  Total of 4 points                            4 Mobile phone, non-
                                                                                               specified analogue or
                                             d  Total of 5 points                            5
                                                                                               digital: 3 points
                                             e  Total of 6 points                            6 Mobile phone, specified
                                             f  Total of 7 points                            7 analogue or digital: 4
                                                                                               points
                                             g  Total of 8 points                            8 Cordless or DECT
                                             h  Total of 9 points                            9 phone: 2 points
                                                                                               Change in phone type: 3
                                                                                               points
0 Did the measure of exposure include        a  No                                           0
  frequency and duration and start date?     b  Start date or call-duration or frequency     4
                                             c  Start date and call-duration or frequency 6
                                             d  All three, but no changes                    8
                                             e  All three, including changes in use for all 10
                                                types
1 Did the exposure assessment include        a  No                                           0
  lateralisation of phone use?               b  Indirectly via handedness                    5
                                             c  Yes, directly via questions and allowing 10
                                                for combinations
2 Were changes over time considered          a  No                                           0 If changes asked for and
  in the analysis?                           b  Yes                                          5 total hours called
                                                                                               calculated: assumed
                                                                                               changes incorporated
3 Was the exposure questionnaire             a  No or unknown                                0
  validated or was reliability tested?       b  Validated in another (related) study such    5
                                                as subsample
                                             c  Provider data verified                      10
4 Was the exposure assessed before           a  No (case-control)                            0
  the cancer diagnosis (thus avoiding        b  Yes (cohort or nested case-control)         10
  recall bias)?
  Confounding
5 Were confounders adjusted in a correct     A  No or unknown                                0 Potential confounders:
  way?                                       b  Yes                                          8 age, sex
6 Could residual confounding influence       A  Yes or unknown                               0 As little known about
  the results?                               b  Partly                                       4 potential confounders,
                                             c  No                                           8 this is likely to always be
                                                                                               partly true
  Conflict of interest
7 Was there evidence of potentail conflict   A Yes                                           0
  of interest?                               b Yes, but with firewall                        3
                                             c No                                            5
           Evaluation of the quality of the studies                                                                     73
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<pre>               The results of the scores per question are presented in Tables B2, B3 and B4.
               These are the combined scores for the two evaluators. These final scores were the
               result of independent scoring, comparison and mediation.
 able B2 Results of the quality scores for the cohort study.
                           Question
                           1     2     3      4     5     6     7    8  9    10    11   12  13    14    15   16    17
 enson et al. (2013)12     c     c     d      c     e     b     c    b  b    c     a    a   a     b     b    b     c
 able B3 Results of the quality scores for the case-control studies.
                           Question
                           1     2      3     4     5     6     7     8  9    10    11   12  13    14    15   16    17
Hardell et al. (2013)17    b     b      b     b     e     a     b     c  h    e     c    b   a     a     b    b     c
Hardell & Carlberg         b     b      b     b     e     a     b     c  h    e     c    b   a     a     b    b     c
2015)18
 arlberg et al. (2013)20   b     b      b     b     e     a     b     c  h    e     c    b   a     a     b    b     c
 oureau et al. (2014)30    b     b      a     a     d     a     a     c  f    e     c    b   a     a     b    b     c
 eltbower et al. (2014)31 a      a      a     b     d     a     b     c  b    b     a    a   a     a     a    a     c
Hardell et al. (2013)19    b     b      c     b     e     a     b     c  h    e     c    b   a     a     b    b     c
 orona et al. (2012)34     a     a      b     b     c     a     b     c  f    d     c    b   a     a     a    a     c
Moon et al. (2014)35       a     a      b     a     e     a     b     c  f    e     c    b   a     a     a    a     c
 ettersson et al. (2014)36 b     b      b     b     c     b     b     b  h    e     c    b   a     a     b    b     c
 able B4 Results of the quality scores for the case-case study.
                           Question
                           1     2     3     4     5      6     7    8  9    10    11   12  13    14    15   16    17
Moon et al. (2014)35       c     c     d     c     e     a      b    c  f    e     c    b   a     a     a    a     c
               These scores lead to the overall scores for the domains of selection, diagnosis,
               exposure and confounding which are presented in Table B5 as percentage of the
               maximum score for each domain.
               The Committee weighted the domains for the overall rating as 4 (Selection) :
               1 (Diagnosis) : 4 (Exposure) : 1 (Confounding) : 0 (Conflict of interest). The
               Committee considered Conflict of Interest to be important, but it could be poorly
               assessed due to missing information. The information that was used for scoring
               were the financial interests declared in the publications. In some cases, earlier
               publications about the same study revealed interests that were not declared later.
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<pre>               This may be correct, as at the time of the later publication the funding may have
               ceased, but some level of conflict of interest could still be suspected. The
               Committee felt that the impact of such financial ties can be widely different and
               there was insufficient information to take this into account. Also, non-financial
               interests and professional commitment to an opinion about an association
               between mobile phone use and brain cancer could also influence the presentation
               of the results. Again this could not be measured. Therefore the score for Conflict
               of Interest was not taken into account in the overall score but is only given for
               information.
               The final overall rating is given in the last column of Table B5 as a number
               between 0 and 10 (i.e. the total of the weighted percentage scores devided by
               100). To facilitate distinguishing higher from lower rated studies, they are colour
               coded, but without any particular meaning of the cut-off values. Ratings of 7.0
               and higher are marked green, ratings of between 3.0 and 7.0 are marked yellow,
               and ratings lower than 3.0 are marked red.
 able B5 Results for the evaluation of selected cohort, case-control and case-case studies.
                                Domains:           Selection Misclassifica Misclas-       Confounding Conflict of Overall
                                                   bias       tion of       sification of             interest    score
                                                              outcome       exposure                              (0-10)
Reference             Design Tumour                % of maximum obtainable score
 enson et al.         Cohort Brain tumours         100.0      100.0         50.0          75.0        100.0       7.8
2013)12                         combined, glioma,
                                meningioma
Hardell et al.        Ca-co     Malignant brain      76.5     100.0         64.7          75.0        100.0       7.4
2013)17                         tumours
Hardell & Carlberg Ca-co        Glioma               76.5     100.0         64.7          75.0        100.0       7.4
2015)18
 arlberg et al.       Ca-co     Meningioma           76.5     100.0         64.7          75.0        100.0       7.4
2013)20
 oureau et al.        Ca-co     Glioma,              52.9       75.0        54.4          75.0        100.0       5.8
2014)30                         meningioma
 eltbower et al.      Ca-co     Brain tumours        11.8       75.0        25.0            0.0       100.0       2.2
2014)31
Hardell et al.        Ca-co     Acoustic neuroma 88.2         100.0         64.7          75.0        100.0       7.9
2013)19
 orona et al.         Ca-co     Acoustic neuroma 23.5           50.0        58.8            0.0       100.0       3.8
2012)34
Moon et al. (2014)35 Ca-co      Acoustic neuroma 11.8         100.0         61.8            0.0       100.0       3.9
Moon et al. (2014)35 Ca-ca      Acoustic neuroma 100.0        100.0         61.8            0.0       100.0       7.5
 ettersson et al.     Ca-co     Acoustic neuroma 76.5           50.0        72.1          75.0        100.0       7.2
2014)36
 a-co: case-control, Ca-ca: case-case.
               Evaluation of the quality of the studies                                                                  75
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<pre>  Selection bias
  Selection biases are distortions that result from procedures used to select subjects
  and from factors that influence study participation. The common element of such
  biases is that the relation between exposure and disease is different for those who
  participate and for all those who should have been theoretically eligible for the
  study, including those who did not participate.107
  Maximum scores in the selection bias domain are inherently generated for the
  cohort and case-case studies.
  In the previous report, the Committee mentioned that a striking feature of the
  case-control studies in this domain is the generally high response rates of the
  Hardell studies. In several of the studies from other groups discussed in the
  current report, similar high response rates have been obtained. This means that
  the Committee does not consider the response rates in the Hardell studies
  reported here as unrealistically high.
  Misclassification of outcome
  As in the previous report, no problems were seen for any of the studies in the
  domain of misclassification of outcome.
  Misclassification of exposure
  In the domain of misclassification of exposure the items of interest are the bias
  resulting from the method of collecting the information on mobile phone use and
  the validity of the reported information.
  In the previous report it was described that in the Hardell studies exposure
  information was obtained by a written questionnaire followed in all cases by a
  follow-up interview by telephone. In some of the Hardell studies described in
  this report, it was stated that follow-up by telephone was done in less than 100%
  of cases. Telephone interviews may lead to observer bias and, hence, to
  differential misclassification with potential overestimation of the risks. Overall,
  as was also concluded in the previous report, the quality of the exposure
  assessment in the Hardell studies is difficult to judge.
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<pre>The quality of the exposure assessment in the other studies reported here is not
very high. This means that in all studies misclassification of exposure might have
occurred.
Confounding
A risk factor for brain tumours is a confounder when the exposure to that factor
is associated with the exposure of interest, in this case exposure resulting from
the use of mobile or cordless phones.
Evaluation of the quality of the studies                                           77
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<pre>8 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies</pre>

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<pre> nnex        C
             Overview of ecological studies on
             brain tumours
 able C1 Ecological studies.
 eference     Country     Data source   Tumour       Age         Time period Incidence or annual percentage of Comment
                                                                             change (95% CI); statistically
                                                                             significant in bold
Glioma’s and brain tumours - post 2005
 ehmer et al. England     National      Glioma       >15 year 2006-2010 6.93 / 100000 (6.82, 7.04); no
2014)108                  Cancer Data                                        trend
                          Repository
Kim et al.    New         New Zealand Brain cancers5-year-age 1995-2010 Glioma
2015)109      Zealand     Cancer                     subgroups;              Men, 10-69:       0.59% (-1.84, 0.68)
                          Registry                   0-9, 10-69,             Women, 10-69: 0.29% (-0.88, 1.48)
                                                     70+ year                Men, 10-29:       -5.46 (-8.09, -2.75)
                                                                             Women, 10-29: 2.69% (-6.21, 0.96)
                                                                             Men, 30-49:       0.16% (-2.13, 2.51)
                                                                             Women, 30-49: 3.12% (1.38, 4.89)
                                                                             Men, 50-69:       0.21% (-1.33, 1.78)
                                                                             Women, 50-69: 0.31% (-2.1, 1.52)
                                                                             Men, 70+:         2.98% (0.31, 5.72)
                                                                             Women, 70+: 1.76% (-0.04, 3.59)
 ydin et al. Denmark, NORDCAN Brain & CNS 5-19 year 1990-2009 No trend.
2012)110      Norway,                   tumours
              Finland,
              Iceland,
              Sweden
             Overview of ecological studies on brain tumours                                                         79
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<pre> archana et al. Israel     National      High-grade               1980-1984  Men:              2.58 / 100,000  World
2012)111                   Cancer        glioma                   1985-1989                    3.91 / 100,000  Standard
                           Registry                               1990-1994                    4.08 / 100,000  Population
                                                                  1995-1999                    5.56 / 100,000  standardize
                                                                  2000-2004                    6.21 / 100,000  d
                                                                  2004-2009                    5.64 / 100,000
                                                                  1980-1984  Women:            1.77 / 100,000
                                                                  1985-1989                    2.49 / 100,000
                                                                  1990-1994                    3.29 / 100,000
                                                                  1995-1999                    3.46 / 100,000
                                                                  2000-2004                    3.81 / 100,000
                                                                  2004-2009                    4.06 / 100,000
                                         Low-grade                1980-1984  Men:              2.57 / 100,000
                                         glioma                   1985-1989                    2.34 / 100,000
                                                                  1990-1994                    2.79 / 100,000
                                                                  1995-1999                    1.71 / 100,000
                                                                  2000-2004                    1.82 / 100,000
                                                                  2004-2009                    1.57 / 100,000
                                                                  1980-1985  Women:            1.93 / 100,000
                                                                  1985-1989                    1.72 / 100,000
                                                                  1990-1994                    1.78 / 100,000
                                                                  1995-1999                    1.38 / 100,000
                                                                  2000-2004                    1.17 / 100,000
                                                                  2004-2009                    1.04 / 100,000
Deltour et al. Denmark, National         Glioma       20-39,      1979-2008  Slight increase in 60-79 year
2012)112        Finland,   cancer                     40-59,                 group over entire period (men
                Norway and registries                 60-79 year             and women).
                Sweden
De Vocht et al. England    UK Office of  Brain cancer 10-year age 1998-2007 No change in any age group.
2011)113                   National                   groups
                           Statistics
Hardell et al. Denmark, NORDCAN          Nervous                  1960-2007 Men:               1.02% (0.90, 1.14)
2010)114        Norway,                  system                              Women:            1.66% (1.56, 1.76)
                Finland,                 tumours
                Iceland,
                Sweden
Ding and        Shanghai, Shanghai       Brain,                   1983-2007 Men:               1.2% (0.4, 1.9)
Wang            China      Municipal     nervous                             Women:            2.8% (2.1, 3.4)
2011)115                   Center for    tumours
                           Disease
                           Control and
                           Prevention,
                           Shanghai
                           Cancer
                           Institute,
                           Cancer
                           Incidence in
                           Five
                           Continents
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<pre> ada et al.     USA        Los Angeles Glioblastoma               1992-2006 Frontal lobe: 2.4-3.0%
2012)116                   County Cancer multiforme                         Temporal lobe: 1.3-2.3%
                           Surveillance                                     Overlapping -2.0% to -2.8%
                           Program                                          regions:
                           (LAC),                                           Parietal,        No change.
                           California                                       occipital lobes:
                           Cancer                                           Cerebellum: 11.9%
                           Registry                                         All glioma, all -0.5% to -0.8%
                           (CCR), SEER                                      sites:
Glioma’s and brain tumours - pre 2005
Doré et al.     France                    Central                 1980-2005 Men:             0.2%
2010)117                                  nervous                           Women:           1.1%
                                          system                  2000-2005 Men:             0.1%
                                          tumours                           Women:           0.6%
 önn et al.     Denmark, National         Glioma       20-79 year 1969-1998 Men:             0.7% (0.5, 0.9)
2004)118        Norway,    cancer                                           Women:           0.6% (0.4, 0.8)
                Finland,   registries
                Sweden
Nomura et al. Osaka,       Osaka Cancer Primary        0->74 year 1975-2004 0-19 year:       Decrease
2012)119        Japan      Registry       intracranial                      20-74 year:      Decrease
                                          tumours                           >74 year:        Increase
                                                                  1995-2004 All ages:        -1.8% (-2.6, -0.9)
                                          Glioblastoma            1995-2004 All ages:        -1.3% (-2.8, 0.2)
                                          Meningioma              1995-2004 All ages:        -2.9% (-5.1, -0.5)
Deltour et al. Denmark, National          Glioma                  1974-2003 Men:             0.5% (0.2, 0.8)
2009)120        Finland,   cancer                                           Women:           0.2% (0.1, 0.5)
                Norway and registries
                Sweden
Muscat et al. USA          SEER           Neuronal     ≥20 year   1973-1985 0.01 / 100,000 (0.00, 0.02)
2006)121                                  cancer                  1986-2002 0.01 / 100,000 (0.01, 0.01)
                                          (gangliomas
                                          and similar
                                          tumour
                                          types)
Deorah et al. USA          SEER           Brain cancer All ages   1973-1987 All ages:        1.68% (91.22, 2.130)
2006)122                                                          1988-2001                  -0.44% (-0.84, -0.030)
                                                                  1973-1989 < 20 year:       1.91% (0.72, 3.12)
                                                                  1990-2001                   0.22% (-1.25, 1.73)
                                                                  1973-1987 20-65 year:      0.62% (0.00, 1.24)
                                                                  1988-2001                  -0.98% (-1.57, -0.38)
                                                                  1973-1987 >65 year:        3.87% (2.58, 5.19)
                                                                  1988-2001                   0.08% (-0.50, 0.68)
                                          Glioblastoma            1973-1979 All ages:        -5.58% (-2.12, -8.91)
                                                                  1980-1991                   2.88% (1.47, 4.30)
                                                                  1992-2001                   0.321% (-1.0, 1.66)
 rocetti et al. Europe     RARECARE Glioma             All ages   1995-2002 All ages:        Stable
2012)123                                                                    0-19 year:       Stable
                                                                            20-39 year:      Stable
                                                                            40-59 year:      Stable
                                                                            60+ year:        Increase 1995-1997,
                                                                                             stable thereafter
               Overview of ecological studies on brain tumours                                                      81
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<pre>  öösli et al.    Switzerland Swiss Federal Brain cancer All ages    1969-2002 Men:             3.7-6.7 / 100,000
2007)124                      Statistical   mortality                          Women:           2.5-4.4 / 100,000
                              Office
Menigioma’s - pre 2005
Deltour et al. Denmark, National            Meningioma 20-79 year 1974-2003 Men:                0.8% (0.4, 1.3)
2009)120          Norway,     cancer                                           Women:           3.8% (3.2, 4.4)
                  Finland,    registries                                                        (after early 1990s)
                  Sweden
  ook et al.      New         New Zealand   Brain cancer, 20-69 year 1986-1998 No increase
2003)125          Zealand     Cancer        meningioma,
                              Registry      salivary
                                            gland
                                            tumours
  coustic neuroma’s - post 2005
  arjavaara et Denmark, National            Acoustic      All ages   1988-2006 3.0% (2.1, 3.9)                   Incidence
 l. (2011)126 Norway,         cancer        neuroma                            Roughly similar for age groups stable after
                  Finland,    registries                                       (0-44, 45-54, 55-64, >64 year) late 1990s,
                  Sweden                                                                                         some
                                                                                                                 decline
                                                                                                                 after 2000
  coustic neuroma’s - pre 2005
Nelson et al. England, National             Acoustic      All ages   1980-1983 Slight increase
2006)127          Wales       Cancer        neuroma and              1990-1997 Steep increase
                              Registry      other benign             1997-2000 Decrease
                                            cranial nerve
                                            tumours
Other tumours - post 2005
 hu et al.        Denmark,    Swedish       Parotid gland >20 years 1970       Sweden, men:     0.9 / 100,000
2012)128          Norway,     Cancer        tumours                  2009                       0.8 / 100,000
                  Finland,    Registry,
                  Iceland,    NORDCAN
                  Sweden
                                                                     1970      Sweden,          0.7 / 100,000
                                                                     2009      women:           0.7 / 100,000
                                                                     1970-2009 Nordic, men: 0.1% (-0.4, -0.2)
                                                                     1970-2009 Nordic, women: 0.2% (-0.5, -0.1)
  llington et al. USA         SEER          Adenoid       All ages   1973-2007 Continuous decrease
2012)129                                    cystic                             (men & women).
                                            carcinoma
Derbi et al.      Western     Western       Parotid gland All ages   1982      Men:             1.8 / 100,000
2014)130          Australia   Australia     cancer                   2009                       2.2 / 100,000
                              Cancer
                              Registry
                                                                     1982      Women:           3.1 / 100,000
                                                                     2009                       3.5 / 100,000
 2             Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre> nnex          D
               Results from the selected publications
               This Annex presents all the detailed results in tables, organized by tumour type.
               Statistically significant increased risks are in boldface type.
               Glioma
 able D1 Glioma and time since first use.
 eference                 Type of phone            Exposure
                                                   Time since 1st use (years)
Cohort study                                                                  Ca             RR   95%CI
Benson et al. (2013)12    All mobile phone         ≥10                        40 (571 total) 0.78 0.55-1.10
Case-control studies                                                          Ca / Co        OR   95%CI
Hardell et al. (2013)17   Analogue                 >1
                                                   >1-5                       0/0            --
                                                   >5-10                      2 / 10         0.6  0.1-3.1
                                                   >10-15                     25 / 51        1.4  0.7-3.0
                                                   >15-20                     39 / 86        1.4  0.7-2.7
                                                   >20-25                     48 / 80        2.1  1.1-4.0
                                                   > 25                       30 / 33        3.3  1.6-6.9
                          GSM                      >1                         546 / 1208     1.6  0.996-2.7
                                                   >1-5                       42 / 109       1.8  1.01-3.4
                                                   >5-10                      213 / 477      1.6  0.97-2.7
                                                   >10-15                     187 / 453      1.3  0.8-2.2
                                                   >15-20                     104 / 169      2.1  1.2-3.6
                                                   >20-25                     0/0            --
                                                   > 25                       0/0            --
               Results from the selected publications                                                       83
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<pre>            UMTS                      >1                      67 / 140        1.2            0.6-2.4
                                      >1-5                    55 / 126        1.2            0.6-2.4
                                      >5-10                   12 / 14         1.6            0.5-4.9
                                      >10-15                  0/0             --
                                      >15-20                  0/0             --
                                      >20-25                  0/0             --
                                      > 25                    0/0             --
            Mobile phone              >1                      548 / 1217      1.6            0.99-2.7
                                      >1-5                    41 / 108        1.8            1.002-3.4
                                      >5-10                   190 / 423       1.7            0.98-2.8
                                      >10-15                  163 / 399       1.3            0.8-2.2
                                      >15-20                  76 / 174        1.5            0.8-2.6
                                      >20-25                  48 / 80         1.9            1.1-3.5
                                      > 25                    30 / 33         2.9            1.4-5.8
            Cordless                  >1                      461 / 1015      1.7            1.1-2.9
                                      >1-5                    102 / 209       2.0            1.1-3.4
                                      >5-10                   188 / 436       1.6            0.95-2.7
                                      >10-15                  108 / 248       1.6            0.9-2.8
                                      >15-20                  57 / 109        2.1            1.2-3.8
                                      >20-25                  6 / 13          1.5            0.5-4.6
                                      > 25                    0/0             --
            Digital                   >1                      571 / 1261      1.7            1.04-2.8
                                      >1-5                    33 / 63         2.6            1.4-4.9
                                      >5-10                   177 / 421       1.6            0.9-2.7
                                      >10-15                  212 / 523       1.4            0.8-2.3
                                      >15-20                  143 / 241       2.2            1.3-3.6
                                      >20-25                  6 / 13          1.5            0.5-4.6
                                      > 25                    0/0             --
            All wireless              >1                      571 / 1261      1.7            1.04-2.8
                                      >1-5                    32 – 61         2.6            1.4-5.0
                                      >5-10                   163 / 378       1.6            0.98-2.8
                                      >10-15                  184 / 466       1.3            0.8-2.2
                                      >15-20                  110 / 231       1.7            1.02-3.0
                                      >20-25                  52 / 92         1.9            1.04-3.4
                                      > 25                    30 / 33         3.0            1.5-6.0
            Analogue only             >1                      0/0             --
                                      >1-5                    0/0             --
                                      >5-10                   0/0             --
                                      >10-15                  0/0             --
                                      >15-20                  0/0             --
                                      >20-25                  0/0             --
                                      > 25                    0/0             --
4 Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre>                       GSM only                 >1     78 / 176   1.6 0.9-2.9
                                                >1-5   9 / 13     3.4 1.2-9.5
                                                >5-10  33 / 79    1.6 0.8-3.2
                                                >10-15 28 / 68    1.3 0.6-2.6
                                                >15-20 8 / 16     1.8 0.6-4.9
                                                >20-25 0/0        --
                                                > 25   0/0        --
                       UMTS only                >1     1/0        --
                                                >1-5   1/0        --
                                                >5-10  0/0        --
                                                >10-15 0/0        --
                                                >15-20 0/0        --
                                                >20-25 0/0        --
                                                > 25   0/0        --
                       Cordless only            >1     23 / 44    3.5 1.6-7.8
                                                >1-5   10 / 14    5.8 2.0-17
                                                >5-10  9 / 19     3.7 1.3-11
                                                >10-15 3/8        2.0 0.4-9.4
                                                >15-20 1/2        2.9 0.2-39
                                                >20-25 0/0        --
                                                > 25   0/0        --
                       Digital only             >1     427 / 1001 1.7 1.01-22.7
                                                >1-5   32 / 61    2.7 1.4-5.3
                                                >5-10  162 / 370  1.7 1.03-3.0
                                                >10-15 163 / 418  1.3 0.88-2.2
                                                >15-20 68 / 140   1.9 1.1-3.4
                                                >20-25 2 / 12     0.6 0.1-2.7
                                                > 25   0/0        --
Hardell & Carlberg     Analogue                 >1     299 / 558  1.6 1.2-2.0
2015)18                                         >1-5   34 / 87    1.1 0.7-1.7
                                                >5-10  56 / 137   1.1 0.8-1.6
                                                >10-15 71 / 113   2.2 1.5-3.2
                                                >15-20 59 / 107   2.4 1.5-3.7
                                                >20-25 50 / 81    3.2 1.9-5.5
                                                > 25   29 / 33    4.8 2.5-9.1
                       GSM                      >1     884 / 2014 1.3 1.1-1.6
                                                >1-5   283 / 714  1.2 0.99-1.5
                                                >5-10  314 / 659  1.7 1.3-2.2
                                                >10-15 189 / 471  1.4 1.04-1.9
                                                >15-20 98 / 170   2.1 1.5-3.0
                                                >20-25 0/0        --
                                                > 25   0/0        --
            Results from the selected publications                              85
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<pre>                        UMTS                       >1                          58 / 141          2.0   0.95-4.4
                                                   >1-5                        46 / 127          1.9   0.9-4.1
                                                   >5-10                       12 / 14           4.1   1.3-2.1
                                                   >10-15                      0/0               --
                                                   >15-20                      0/0               --
                                                   >20-25                      0/0               --
                                                   > 25                        0/0               --
                        Mobile phone, total        >1                          945 / 2148        1.3   1.1-1.6
                                                   >1-5                        262 / 674         1.2   0.98-1.5
                                                   >5-10                       301 / 688         1.5   1.2-11.8
                                                   >10-15                      211 / 476         1.4   1.1-1.9
                                                   >15-20                      92 / 196          1.6   1.1-2.2
                                                   >20-25                      50 / 81           2.1   1.3-2.2
                                                   > 25                        29 / 33           3.0   1.7-5.2
                        Mobile phone, digital      >1                          885 / 2019        1.3   1.1-1.6
                        (GSM + UMTS)               >1-5                        284 / 719         1.2   0.99-1.5
                                                   >5-10                       314 / 659         1.7   1.3-2.2
                                                   >10-15                      189 / 471         1.4   1.04-1.9
                                                   >15-20                      98 / 170          2.1   1.5-3.0
                                                   >20-25                      0/0               --
                                                   > 25                        0/0               --
                        Cordless                   >1                          752 / 1724        1.4   1.1-1.7
                                                   >1-5                        271 / 653         1.3   1.1-1.6
                                                   >5-10                       294 / 655         1.4   1.1-1.8
                                                   >10-15                      131 / 294         1.4   1.1-1.9
                                                   >15-20                      50 / 109          1.7   1.1-2.5
                                                   >20-25                      6 / 13            1.4   0.5-3.8
                                                   > 25                        0/0               --
                        Digital (GSM + UMTS + >1                               1037 / 2393       1.3   1.1-1.6
                        cordless)                  >1-5                        295 / 796         1.2   0.9-1.4
                                                   >5-10                       363 / 758         1.6   1.3-2.0
                                                   >10-15                      242 / 584         1.4   1.1-1.9
                                                   >15-20                      131 / 242         2.0   1.5-2.8
                                                   >20-25                      6 / 13            1.6   0.6-4.4
                                                   > 25                        0/0               --
                        All wireless               >1                          1074 / 2472       1.3   1.1-1.6
                                                   >1-5                        271 / 748         1.1   0.9-1.4
                                                   >5-10                       351 / 767         1.5   1.2-1.9
                                                   >10-15                      248 / 578         1.4   1.1-1.8
                                                   >15-20                      121 / 253         1.7   1.2-2.3
                                                   >20-25                      54 / 93           1.9   1.3-2.9
                                                   > 25                        29 / 33           3.0   1.7-5.2
Abbreviations used:
Ca / Co: numbers of cases and controls; RR: relative risk; OR: odds ratio; CI: confidence interval.
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<pre> able D2 Glioma and cumulative call time.
 eference                 Type of phone       Exposure
 ohort study                                  Use                      Ca              RR   95%CI
 enson et al. (2013)12 All mobile phone Daily                          36 (571 total)  0.80 0.56-1.14
                                              Ever                     334 (571 total) 0.91 0.76-1.08
 ase-control studies                          Cumulative call time (h) Ca / Co         OR   95%CI
Hardell et al. (2013) 17 Analogue             >39-405                  90 / 184        1.7  0.9-3.0
                                              406-1091                 22 / 47         1.6  0.8-3.4
                                              1092-2376                18 / 23         2.6  1.2-6.0
                                              >2376                    14 / 6          7.7  2.5-24
                          GSM                 >39-405                  202 / 620       1.4  0.8-2.3
                                              406-1091                 138 / 260       1.9  1.1-3.3
                                              1092-2376                84 / 199        1.4  0.8-2.5
                                              >2376                    122 / 129       3.2  1.8-5.6
                          UMTS                >39-405                  35 / 87         1.1  0.5-2.4
                                              406-1091                 16 / 34         1.0  0.4-2.6
                                              1092-2376                11 / 17         1.7  0.6-4.8
                                              >2376                    5/2             5.1  0.8-32
                          All mobile phone >39-405                     190 / 587       1.4  0.8-2.3
                                              406-1091                 126 / 261       1.7  1.02-3.0
                                              1092-2376                95 / 210        1.5  0.9-2.7
                                              >2376                    137 / 159       2.8  1.6-4.8
                          Cordless            >39-405                  164 / 434       1.3  0.8-2.2
                                              406-1091                 120 / 278       1.7  1.01-3.0
                                              1092-2376                98 / 194        2.1  1.2-3.7
                                              >2376                    79 / 109        3.1  1.8-5.5
                          Digital (GSM +      >39-405                  113 / 327       1.5  0.9-2.5
                          UMTS + cordless) 406-1091                    113 / 320       1.4  0.8-2.4
                                              1092-2376                139 / 317       1.7  1.01-2.9
                                              >2376                    206 / 297       2.6  1.5-4.3
                          All wireless        >39-405                  108 / 317       1.5  0.9-2.5
                          (mobile + cordless) 406-1091                 110 / 314       1.4  0.8-2.4
                                              1092-2376                137 / 315       1.7  1.003-2.9
                                              >2376                    216 / 315       2.5  1.5-4.2
Hardell & Carlberg        Analogue            1-122                    119 / 304       1.2  0.9-1.6
2015)18                                       123-511                  88 / 146        1.8  1.3-2.5
                                              512-1486                 50 / 82         1.8  1.2-2.8
                                              >1486                    42 / 26         4.8  2.8-8.2
                          GSM                 1-122                    328 / 885       1.3  1.1-1.6
                                              123-511                  187 / 467       1.3  1.01-1.7
                                              512-1486                 174 / 388       1.5  1.1-1.9
                                              >1486                    195 / 274       2.3  1.7-3.1
               Results from the selected publications                                                 87
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<pre>                          UMTS                 1-122                  16 / 47          1.8              0.7-4.5
                                               123-511                17 / 54          1.5              0.6-3.8
                                               512-1486               20 / 31          3.0              1.2-7.5
                                               >1486                  5/9              2.7              0.7-10
                          All mobile phone 1-122                      340 / 920        1.3              1.05-1.5
                                               123-511                198 / 492        1.3              1.02-1.6
                                               512-1486               179 / 416        1.4              1.04-1.8
                                               >1486                  228 / 320        2.2              1.7-2.9
                          Cordless             1-122                  174 / 478        1.1              0.9-1.4
                                               123-511                203 / 534        1.2              0.97-1.6
                                               512-1486               210 / 451        1.6              1.3-2.1
                                               >1486                  165 / 261        2.3              1.8-3.1
                          Digital (GSM +       1-122                  214 / 618        1.2              0.9-1.4
                           UMTS + cordless) 123-511                   232 / 583        1.3              1.1-1.6
                                               512-1486               241 / 613        1.4              1.1-1.7
                                               >1486                  350 / 579        2.1              1.7-2.7
                          All wireless         1-122                  223 / 641        1.2              0.9-1.4
                          (mobile + cordless) 123-511                 235 / 596        1.3              1.04-1.6
                                               512-1486               249 / 617        1.4              1.1-1.7
                                               >1486                  367 / 618        2.0              1.6-2.6
 able D3 Glioma and laterality.
 eference               Exposure / type of phone   Ipsilateral                        Contralateral
                                                   Ca / Co      OR        95%CI       Ca / Co       OR         95%CI
Hardell et al. (2013)17 Ever use
                        Analogue                   84 / 118     2.3       1.2-4.5     46 / 84       1.4        0.7-2.9
                        GSM                        322 / 530    1.7       1.02-2.9    190 / 404     1.4        0.8-2.5
                        UMTS                       38 / 69      1.2       0.5-2.8     24 / 45       1.1        0.4-3.1
                        All mobile phone           324 / 534    1.7       1.01-2.9    190 / 407     1.4        0.8-2.5
                        Cordless                   272 / 454    1.9       1.1-3.2     156 / 327     1.6        0.9-2.8
Hardell & Carlberg Ever use
(2015)18                Analogue                   190 / 252    2.0       1.5-2.7     98 / 184      1.3        0.9-1.9
                        GSM                        550 / 865    1.8       1.4-2.2     298 / 684     1.1        0.8-1.4
                        UMTS                       35 / 70      2.3       0.99-5.4    21 / 45       1.9        0.7-4.8
                        All mobile phone           592 / 920    1.8       1.4-2.2     316 / 729     1.1        0.8-1.4
                        Cordless                   461 / 766    1.7       1.3-2.1     295 / 565     1.2        0.9-1.6
 8             Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre>                        Time since 1st use (years)
                        Mobile phone
                        >1                         592 / 920       1.8     1.4-2.2       316 / 729     1.1    0.8-1.4
                        >1-5                       167 / 271       1.6     1.3-2.1       80 / 234      0.9    0.7-1.2
                        >5-10                      187 / 289       1.9     1.4-2.5       106 / 238     1.3    0.9-1.8
                        >10-15                     131 / 225       1.7     1.2-2.3       74 / 152      1.3    0.9-2.0
                        >15-20                     59 / 84         2.2     1.5-3.4       29 / 76       1.0    0.6-1.7
                        >20-25                     29 / 38         2.3     1.3-4.1       17 / 20       2.2    1.1-4.6
                        >25                        19 / 13         4.6     2.1-10        10 / 9        3.2    1.2-8.6
                        Cordless phone
                        >1                         461 / 766       1.7     1.3-2.1       25 / 565      1.2    0.9-1.6
                        >1-5                       161 / 292       1.5     1.2-2.0       98 / 205      1.3    0.9-1.7
                        >5-10                      180 / 295       1.8     1.3-3.4       100 / 220     1..2   0.9-1.7
                        >10-15                     82 / 126        2.0     1.3-2.9       46 / 99       1.2    0.8-1.9
                        >15-20                     35 / 47         2.6     1.5-4.4       12 / 38       0.9    0.4-1.8
                        >20-25                     3/6             1.4     0.3-5.9       3/3           1.9    0.4-10
                        >25                        0/0             --                    0/0           --
 able D4 Glioma, analysis as continuous variables.
 eference                       Variable             Type of phone                                OR        95% CI
Hardell et al. (2013)17         Per 100 h of use     Analogue                                     1.04      1.01-1.06
                                                     GSM                                          1.01      1.01-1.02
                                                     UMTS                                         1.03      0.99-1.08
                                                     All mobile phone                             1.01      1.01-1.02
                                                     Cordless phone                               1.01      1.01-1.02
                                                     Digital (GSM + UMTS + cordless)              1.01      1.01-1.01
                                                     All wireless phone(mobile + cordless)        1.01      1.01-1.01
                                Per year of use      Analogue                                     1.04      1.02-1.07
                                                     GSM                                          1.01      0.99-1.04
                                                     UMTS                                         1.04      0.89-1.22
                                                     All mobile phone                             1.02      0.99-1.03
                                                     Cordless phone                               1.01      0.99-1.04
                                                     Digital (GSM + UMTS + cordless)              1.02      0.99-1.04
                                                     All wireless phone(mobile + cordless)        1.02      1.001-1.04
Hardell & Carlberg (2015)18 Per 100 h of use         Analogue                                     1.03      1.01-1.04
                                                     GSM                                          1.01      1.01-1.01
                                                     UMTS                                         0.98      0.94-1.02
                                                     Cordless                                     1.01      1.01-1.02
                                Per year of use      Analogue                                     1.06      1.04-1.08
                                                     GSM                                          1.03      1.01-1.05
                                                     UMTS                                         1.13      0.96-1.33
                                                     Cordless                                     1.03      1.02-1.05
               Results from the selected publications                                                                  89
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<pre>               Acoustic neuroma
 able D5 Acoustic neuroma and time since first use.
 eference               Type of phone                       Exposure
                                                            Time since 1st use (years)
 ohort study                                                                           Ca           RR       95%CI
 enson et al. (2013)12  All mobile phone                    ≥10                        8 (96 total) 2.46     1.07-5.64
 ase-control studies                                                                   Ca / Co      OR       95%CI
Hardell et al. (2013)19 Analogue                            >1                         86 / 558     2.9      2.0-4.3
                                                            >1-5                       16 / 87      2.2      1.2-4.0
                                                            >5-10                      33 / 137     3.2      2.0-5.2
                                                            >10-15                     16 / 113     3.0      1.6-5.7
                                                            >15-20                     9 / 107      3.5      1.5-8.5
                                                            >20                        12 / 114     7.7      2.8-21
                        GSM                                 >1                         173 / 2014   1.5      1.1-2.1
                                                            >1-5                       80 / 714     1.4      0.996-2.0
                                                            >5-10                      56 / 65      1.8      1.1-2.8
                                                            >10-15                     28 / 471     1.8      0.97-3.4
                                                            >15-20                     9 / 170      1.8      0.8-4.2
                                                            >20                        0/0          --
                        UMTS                                >1                         7 / 141      3.9      0.4-35
                                                            >1-5                       7 / 127      4.1      0.5-36
                                                            >5-10                      0 / 14       --
                                                            >10-15                     0/0          --
                                                            >15-20                     0/0          --
                                                            >20                        0/0          --
                        All mobile phone                    >1                         200 / 2148   1.6      1.2-2.2
                                                            >1-5                       65 / 674     1.3      0.9-1.8
                                                            >5-10                      77 / 688     2.3      1.6-3.3
                                                            >10-15                     34 / 476     2.1      1.3-3.5
                                                            >15-20                     12 / 196     2.1      1.02-4.2
                                                            >20                        12 / 114     4.5      2.1-9.5
                        Cordless                            >1                         156 / 1724   1.5      1.1-2.1
                                                            >1-5                       72 / 653     1.5      1.05-2.1
                                                            >5-10                      60 / 655     1.6      1.1-2.5
                                                            >10-15                     19 / 294     1.4      0.8-2.6
                                                            >15-20                     2 / 109      0.5      0.1-2.1
                                                            >20                        3 / 13       6.5      1.7-26
                        Digital (GSM + UMTS + cordless)     >1                         216 / 2393   1.5      1.1-2.0
                                                            >1-5                       93 / 796     1.4      1.01-1.9
                                                            >5-10                      73 / 758     1.6      1.1-2.3
                                                            >10-15                     38 / 584     1.6      0.97-2.8
                                                            >15-20                     9 / 242      1.1      0.5-2.5
                                                            >20                        3 / 13       8.1      2.0-32
 0             Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre>                          All wireless (mobile + cordless) >1             227 / 2472 1.5  1.1-2.0
                                                           >1-5           72 / 748   1.2  0.8-1.6
                                                           >5-10          84 / 767   1.9  1.3-2.7
                                                           >10-15         44 / 578   2.0  1.3-3.2
                                                           >15-20         13 / 253   1.7  0.9-3.3
                                                           >20            14 / 126   4.4  2.2-9.0
 orona et al. (2012)34    Analogue                         0              26 / 69    1.00
                                                           <6             15 / 32    1.24 0.58-2.66
                                                           ≥6             3/3        2.65 0.50-13.99
                          Digital                          0              11 / 31    1.00
                                                           <6             15 / 38    1.11 0.45-2.77
                                                           ≥6             18 / 35    1.45 0.59-3.54
                          All mobile phone                 0              9 / 29     1.00
                                                           <6             12 / 34    1.14 0.42-3.08
                                                           ≥6             23 / 41    1.81 0.73-4.47
Moon et al. (2014)35      Mobile phone                     Ca: 10.15±5.39 119 / 238  0.96 0.91-1.01
                                                           Co: 10.95±4.57
 etterson et al. (2014)36 Analogue                         <5             6/3        2.85 0.7-11.6
                                                           5-9            15 / 12    1.83 0.76-4.38
                                                           ≥10            36 / 44    1.17 0.66-2.08
                          Digital                          <5             51 / 77    1.14 0.73-1.78
                                                           5-9            89 / 101   1.53 1.02-2.32
                                                           ≥10            68 / 103   1.13 0.74-1.73
                          All mobile phone                 <5             80 / 130   1.04 0.72-1.52
                                                           5-9            119 / 150  1.40 0.98-2.00
                                                           ≥10            103 / 162  1.11 0.76-1.61
                                                           10-12          42 / 67    1.10 0.68-1.76
                                                           ≥13            61 / 95    1.12 0.72-1.73
                          Cordless                         <5             110 / 165  1.29 0.92-1.81
                                                           5-9            117 / 129  1.72 1.21-2.45
                                                           ≥10            66 / 109   1.22 0.82-1.80
              Results from the selected publications                                               91
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<pre> able D6 Acoustic neuroma and cumulative call time.
 eference                 Type of phone                    Exposure                 Ca / Co   OR           95%CI
                                                           Cumulative call time (h)
Hardell et al. (2013)19   Analogue                         1-122                    42 / 304  2.5          1.6-3.9
                                                           123-511                  23 / 146  3.1          1.8-5.5
                                                           512-1486                 14 / 82   4.2          2.1-8.4
                                                           >1486                    7 / 26    6.6          2.6-17
                          GSM                              1-122                    83 / 885  1.5          1.04-2.1
                                                           123-511                  30 / 467  1.2          0.7-2.0
                                                           512-1486                 38 / 388  2.2          1.3-3.6
                                                           >1486                    22 / 274  2.1          1.2-3.9
                          UMTS                             1-122                    5 / 47    9.1          0.9-89
                                                           123-511                  1 / 54    1.5          0.1-26
                                                           512-1486                 1 / 31    2.7          0.2-47
                                                           >1486                    0/9       --
                          All mobile phone                 1-122                    91 / 920  1.6          1.1-2.2
                                                           123-511                  37 / 492  1.5          0.9-2.3
                                                           512-1486                 42 / 146  2.4          1.5-3.8
                                                           >1486                    30 / 320  2.6          1.5-4.4
                          Cordless                         1-122                    36 / 478  1.2          0.8-1.8
                                                           123-511                  49 / 583  1.6          1.03-2.3
                                                           512-1486                 47 / 451  2.1          1.3-3.2
                                                           >1486                    24 / 261  1.9          1.1-3.2
                          Digital (GSM + UMTS +            1-122                    59 - 618  1.3          0.9-1.9
                          cordless)                        123-511                  49 / 583  1.3          0.9-2.0
                                                           512-1486                 58 / 613  1.9          1.3-2.8
                                                           >1486                    50 / 579  2.1          1.4-3.3
                          All wireless (mobile + cordless) 1-122                    57 / 641  1.2          0.8-1.7
                                                           123-511                  56 / 596  1.5          1.02-2.2
                                                           512-1486                 58 / 617  1.9          1.3-2.8
                                                           >1486                    56 / 618  2.2          1.5-3.4
Moon et al. (2014)35      All mobile phone                 Ca: 1779±2496            119 / 238 0.96         0.91-1.01
                                                           Co: 2236±2533
 etterson et al. (2014)36 All mobile phone                 <38                      70 / 109  1.09         0.73-1.62
                                                           38-189                   73 / 109  1.12         0.74-1.69
                                                           190-679                  66 / 107  1.13         0.75-1.70
                                                           >680                     89 / 110  1.46         0.98-2.17
                          Cordless                         <84                      64 / 96   1.22         0.82-1.82
                                                           84-285                   64 / 95   1.27         0.85-1.89
                                                           285-900                  70 / 97   1.42         0.96-2.09
                                                           >900                     84 / 97   1.67         1.13-2.49
 2             Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre> able D7 Acoustic neuroma and laterality.
 eference                   Exposure / type of phone Ipsilateral                Contralateral
                                                       Ca / Co   OR   95%CI     Ca / Co     OR   95%CI
Hardell et al. (2013)19     Ever use
                            Analogue                   54 / 252  2.9  1.9-4.6   29 / 184    2.5  1.4-4.2
                            GSM                        108 / 865 1.7  1.1-2.4   62 / 684    1.3  0.9-2.1
                            UMTS                       3 / 70    1.9  0.2-20    3 / 45      3.6  0.3-38
                            All mobile phone           123 / 920 1.8  1.3-22.6  73 / 729    1.5  0.9-2.2
                            Cordless                   101 / 766 1.8  12.-2.6   52 / 565    1.2  0.7-1.8
 orona et al. (2012)34      All mobile phone           14 / 26   1.40 0.65-3.04 7 / 26      0.57 0.23-1.43
 etterson et al. (2014)36 Analogue
                            Frequency of use
                            Never / rarely             84 / 108  1.00           76 / 96     1.00
                            Regular                    34 / 30   1.43 0.79-2.58 23 / 22     1.44 0.69-3.00
                            Digital
                            Frequency of use
                            Never / rarely             100 / 132 1.00           95 / 132    1.00
                            Regular                    85 / 99   1.15 0.76-1.74 95 / 107    1.35 0.86-2.12
                            All mobile phone
                            Frequency of use
                            Never / rarely             110 / 143 1.00           98 / 144    1.00
                            Regular                    117 / 156 0.98 0.68-1.43 131 / 154   1.33 0.89-1.99
                            Time since 1st use (years)
                            <5                         39 / 51   1.05 0.62-1.78 35 / 41     1.41 0.80-2.48
                            5-9                        38 / 53   0.95 0.57-1.58 57 / 57     1.51 0.92-2.49
                            ≥10                        40 / 51   1.01 0.61-1.68 39 / 56     1.09 0.63-1.88
                            Cumulative call time (h)
                            <38                        26 / 44   0.78 0.45-1.38 35 / 33     1.69 0.94-3.05
                            38-189                     28 / 32   1.18 0.63-2.20 30 / 41     1.05 0.56-1.95
                            190-679                    24 / 35   0.98 0.52-1.84 31 / 38     1.31 0.74-2.32
                            ≥680                       38 / 43   1.20 0.69-2.08 33 / 39     1.26 0.70-2.25
                            Cumulative no of calls
                            <1100                      27 / 41   0.88 0.50-1.55 36 / 39     1.42 0.82-2.47
                            1100-4400                  31 / 31   1.44 0.76-2.74 27 / 31     1.31 0.70-2.44
                            4400-13850                 28 / 42   0.86 0.48-1.51 35 / 43     1.26 0.73-2.18
                            ≥13850                     29 / 39   1.06 0.60-1.90 31 / 38     1.30 0.70-2.41
               Results from the selected publications                                                     93
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<pre> able D8 Acoustic neuroma, analysis as continuous variables.
 eference               Variable         Type of phone
Hardell et al. (2013)19 Incidence                                                    OR          95% CI
                        Per 100 h of use Analogue                                    1.05        1.02-1.08
                                         GSM                                         1.01        0.99-1.02
                                         UMTS                                        0.92        0.72-1.16
                                         All mobile phone                            1.01        1.001-1.02
                                         Cordless phone                              1.01        0.99-1.012
                                         Digital (GSM + UMTS + cordless)             1.01        1.0001-1.01
                                         All wireless phone(mobile + cordless)       1.01        1.002-1.01
                        Per year of use Analogue                                     1.10        1.06-1.14
                                         GSM                                         1.04        0.99-1.09
                                         UMTS                                        0.99        0.67-1.47
                                         All mobile phone                            1.06        1.03-1.09
                                         Cordless phone                              1.03        0.99-1.07
                                         Digital (GSM + UMTS + cordless)             1.04        1.0003-1.07
                                         All wireless phone(mobile + cordless)       1.06        1.03-1.09
                        % change in tumour volume                              n     % change    95% CI         p
                        Per 100 h of use Analogue                              61    +7.4        +1.0 to +14.2  0.02
                                         GSM                                   116   +2.1        -4.1 to +8.6   0.52
                                         UMTS                                  7     --          --             --
                                         All mobile phone                      137   +3.6        -1.1 to +8.6   0.13
                                         Cordless phone                        104   +4.2        -3.8 to +13.0  0.31
                                         All wireless phone (mobile +          153   +3.6        -1.1 to +8.6   0.13
                                         cordless)
                        Per year of use Analogue                               61    +10.3       +2.4 to 18.7   0.01
                                         GSM                                   116   +1.4        -0.6 to +3.5   0.18
                                         UMTS                                  7     --          --             --
                                         All mobile phone                      137   +1.7        -0.1 to +3.5   0.06
                                         Cordless phone                        104   +1.2        -1.1 to +3.6   0.31
                                         All wireless phone(mobile + cordless)153    +1.0        -0.1 to +2.2   0.08
 4             Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre> able D9 Acoustic neuroma: tumour volume in case-case study.
 eference                                                             Tumour volume (cm3)                  p
Moon et al. (2014)35                Use
                                    Non-regular                       2.71±3.78
                                    Regular                           8.10±10.71                           0.004
                                    Time since 1st use (year)
                                    ≤10                               5.57±8.15
                                    >10                               9.83±11.97                           0.130
                                    Time of use per day (min)
                                    ≤20                               4.88±5.60
                                    >20                               11.32±15.43                          0.026
                                    Cumulative use (h)
                                    ≤2000                             4.88±6.16
                                    >2000                             13.31±1.07                           0.007
              Meningioma
 able D10 Meningioma and time since first use.
Reference                 Type of phone                       Exposure
                                                              Time since 1st use (years)
 ohort study                                                                             Ca             RR       95%CI
 enson et al. (2013)12    All mobile phone                    ≥10                        20 (251 total) 1.10     0.66-1.84
 ase-control studies                                                                     Ca / Co        OR       95%CI
 arlberg et al. (2013)20  Analogue                            >1                         108 / 260      0.9      0.6-1.5
                                                              >1-5                       0/0            --
                                                              >5-10                      3 / 10         0.5      0.1-2.1
                                                              >10-15                     21 / 151       0.8      0.4-1.6
                                                              >15-20                     39 / 86        1.1      0.6-1.9
                                                              >20-25                     29 / 80        0.9      0.5-1.5
                                                              >25                        16 / 33        1.3      0.6-2.8
                          GSM                                 >1                         593 / 1208     1.0      0.7-1.4
                                                              >1-5                       70 / 109       1.1      0.7-1.7
                                                              >5-10                      236 / 477      0.9      0.7-1.4
                                                              >10-15                     212 / 453      1.0      0.7-1.5
                                                              >15-20                     75 / 169       1.0      0.6-1.5
                                                              >20-25                     0/0            --
                                                              >25                        0/0            --
                          UMTS                                >1                         47 / 140       0.7      0.4-1.2
                                                              >1-5                       40 / 126       0.6      0.3-1.2
                                                              >5-10                      7 / 14         1.1      0.4-3.5
                                                              >10-15                     0/0            --
                                                              >15-20                     0/0            --
                                                              >20-25                     0/0            --
                                                              >25                        0/0            --
              Results from the selected publications                                                                     95
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<pre>                           All mobile phone                     >1                          594 / 1217     1.0  0.7-1.4
                                                                >1-5                        69 / 108       1.1  0.7-1.7
                                                                >5-10                       217 / 423      1.0  0.7-1.4
                                                                >10-15                      185 / 399      1.0  0.7-1.4
                                                                >15-20                      78 / 174       1.0  0.6-1.5
                                                                >20-25                      29 / 80        0.8  0.5-1.4
                                                                >25                         16 / 33        1.2  0.6-2.3
                           Cordless                             >1                          522 / 10115    1.1  0.8-1.5
                                                                >1-5                        109 / 209      1.0  0.7-1.5
                                                                >5-10                       217 / 436      1.0  0.7-1.5
                                                                >10-15                      128 / 248      1.1  0.8-1.7
                                                                >15-20                      61 / 109       1.2  0.7-1.8
                                                                >20-25                      7 / 13         1.3  0.5-3.4
                                                                >25                         0/0            --
                           Digital (GSM + UMTS + cordless)      >1                          641 / 1261     1.0  0.7-1.5
                                                                >1-5                        43 / 64        1.2  0.7-1.9
                                                                >5-10                       222 / 420      1.0  0.7-1.4
                                                                >10-15                      248 / 523      1.0  0.7-1.54
                                                                >15-20                      121 / 241      1.1  0.7-1.6
                                                                >20-25                      7 / 13         1.2  0.5-3.3
                                                                >25                         0/0            --
                           All wireless (mobile + cordless)     >1                          641 / 1261     1.0  0.7-1.5
                                                                >1-5                        42 / 61        1.2  0.7-2.0
                                                                >5-10                       206 / 378      1.0  0.7-1.5
                                                                >10-15                      226 / 466      1.0  0.7-1.5
                                                                >15-20                      115 / 231      1.1  0.7-1.6
                                                                >20-25                      36 / 92        0.9  0.5-1.5
                                                                >25                         16 / 33        1.2  0.6-2.4
 able D11 Meningioma and cumulative call time.
Reference                Type of phone                      Exposure                 Ca / Co           OR      95%CI
                                                            Cumulative call time (h)
Carlberg et al. (2013)20 Analogue                           >39-405                  77 / 184          0.9     0.6-1.5
                                                            406-1091                 12 / 47           0.6     0.3-1.4
                                                            1092-2376                12 / 23           1.3     0.6-2.9
                                                            >2376                    7/6               3.0     0.9-9.7
                         GSM                                >39-405                  317 / 620         1.0     0.7-1.4
                                                            406-1091                 122 / 260         1.0     0.7-1.5
                                                            1092-2376                75 / 199          0.9     0.6-1.4
                                                            >2376                    79 / 129          1.5     0.9-2.3
                         UMTS                               >39-405                  30 / 87           0.7     0.3-1.3
                                                            406-1091                 6 / 34            0.4     0.1-1.2
                                                            1092-2376                6 / 17            0.6     0.2-1.8
                                                            >2376                    5/2               7.3     1.2-4.6
 6            Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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<pre>                         All mobile phone                    >39-405            306 / 587        1.0    0.7-1.4
                                                             406-1091           119 / 261        1.0    0.7-1.4
                                                             1092-2376          85 / 210         0.9    0.6-1.4
                                                             >2376              84 / 159         1.3    0.8-1.9
                         Cordless                            >39-405            194 / 434        1.0    0.7-1.4
                                                             406-1091           116 / 278        0.9    0.6-1.3
                                                             1092-2376          117 / 194        1.2    0.8-1.8
                                                             >2376              95 / 109         1.8    1.2-2.8
                         Digital (GSM + UMTS + cordless) >39-405                185 / 327        1.1    0.8-1.6
                                                             406-1091           134 / 320        0.9    0.6-1.3
                                                             1092-2376          135 / 317        0.9    0.6-1.3
                                                             >2376              187 / 297        1.4    0.96-2.0
                         All wireless (mobile + cordless)    >39-405            178 / 317        1.1    0.7-1.5
                                                             406-1091           134 / 314        0.9    0.6-1.3
                                                             1092-2376          138 / 315        0.9    0.6-1.4
                                                             >2376              191 / 315        1.4    0.9-2.0
 able D12 Meningioma and laterality.
 eference                     Exposure / type of      Ipsilateral                      Contralateral
                              phone
                                                      Ca / Co        OR  95%CI         Ca / Co      OR   95%CI
Carlberg et al. (2013)20      Ever use
                              Analogue                54 / 118       1.4 0.8-2.4       42 / 84      1.2  0.6-2.2
                              GSM                     283 / 530      1.1 0.7-1.6       214 / 404    1.1  0.7-1.6
                              UMTS                    26 / 69        0.8 0.4-1.8       17 / 45      0.8  0.3-2.1
                              All mobile phone        284 / 534      1.1 0.7-1.6       214 / 407    1.1  0.7-1.6
                              Cordless                244 / 454      1.1 0.7-1.6       188 / 327    1.2  0.8-1.8
              Results from the selected publications                                                             97
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<pre> able D13 Meningioma, analysis as continuous variables.
 eference                Variable           Type of phone
 arlberg et al. (2013)20 Incidence                                                         OR               95% CI
                         Per 100 h of use   Analogue                                       1.02             1.0004-1.04
                                            GSM                                            1.01             0.99-1.01
                                            UMTS                                           1.04             1.0002-1.07
                                            All mobile phone                               1.01             1.001-1.01
                                            Cordless phone                                 1.01             1.01-1.02
                                            Digital (GSM + UMTS + cordless)                1.01             1.003-1.01
                                            All wireless phone (mobile + cordless)         1.01             1.003-1.01
                         Per year of use    Analogue                                       1.00             0.98-1.03
                                            GSM                                            0.99             0.98-1.02
                                            UMTS                                           0.93             0.80-1.08
                                            All mobile phone                               0.99             0.98-1.01
                                            Cordless phone                                 1.01             0.99-1.03
                                            Digital (GSM + UMTS + cordless)                1.00             0.98-1.02
                                            All wireless phone (mobile + cordless)         1.00             0.98-1.02
                         % change in tumour volume
                                                                          n       % change          95% CI               p
                         Per 100 h of use   Analogue                      98      +1.6              -4.7 to +8.3         0.62
                                            GSM                           530     -0.9              -4.0 to +2.2         0.56
                                            UMTS                          41      +9.6              -21.1 to +52.4       0.57
                                            All mobile phone              531     -0.5              -2.8 to +1.9         0.68
                                            Cordless phone                465     -0.8              -3.6 to +2.0         0.57
                                            All wireless phone            570     -0.2              -2.5 to +2.1         0.86
                                            (mobile + cordless)
                         Per year of use    Analogue                      98      +0.1              -2.0 to +2.2         0.96
                                            GSM                           530     +0.1              -0.6 to +0.8         0.83
                                            UMTS                          41      +1.3              -2.0 to +4.7         0.42
                                            All mobile phone              531     +0.1              -0.5 to +0.1         0.84
                                            Cordless phone                465     -0.3              -0.7 to +0.1         0.13
                                            All wireless phone            570     -0.2              -0.5 to +0.1         0.19
                                            (mobile + cordless)
              Pituitary tumour
 able D14 Pituitary tumour and time since first use.
Reference                    Type of phone       Exposure
                                                 Time since 1st use (years)
Cohort study                                                                         Ca                RR           95% CI
Benson et al. (2013)12       All mobile phone ≥10                                    11 (110 total)    1.61         0.78-3.35
 8            Mobile phones and cancer / Part 3. Update and overall conclusions from epidemiological and animal studies
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