Epidemiological studies : Reviews

POWER LINES AND HEALTH PART I: CHILDHOOD CANCER
Gezondheidsraad Nederland, April 18th 2018
Gezondheidsraad Nr. 2018/08.
Available at: www.gezondheidsraad.nl

The Electromagnetic Fields Committee of the Health Council re-analyzed the data on a possible relationship between exposure to magnetic fields generated by overhead and underground power lines and the incidence of childhood cancer. It did so in greater detail and including the most recent studies. Most studies do not measure the exact exposure of children, because that is too complex and time-consuming. Instead, some studies consider the distance between a child’s residence and the power line. Because the strength of the magnetic field generated by the line decreases with increasing distance, the distance provides an indication for the magnetic field strength in the residence. In other studies, the residential magnetic field strength has been assessed by measurements or calculations, or combinations of the two.
Overall, the results indicate an increasing risk of childhood leukaemia with decreasing distance and increasing magnetic field strength. The risk estimate is higher when the magnetic field strength is assessed more accurately. The most representative exposure estimate is the assessment of the magnetic field strength in all residences of a child between birth and diagnosis. Based on these data, the estimated leukaemia risk seems to be more than two and a half times higher in children that have been long-term exposed to an average magnetic field strength of 0.3 to 0.4 microtesla or higher compared to children that are exposed at background level. There is considerable uncertainty in this risk estimate, but the Committee considers it highly unlikely that in reality there is no increased risk. These new analyses confirm the earlier conclusions of the Health Council.
For other types of cancer in children only data are available on brain tumours and lymphomas. Only for brain tumours sufficient data are available to carry out analyses. In studies using distance as a measure of exposure, no indications for a association with brain cancer in children have been found. In studies using the magnetic field strength as an exposure metric, the risk of brain cancer seems almost 1.5 times higher in children that have been long-term exposed in their homes to magnetic field strengths averaging 0.4 microtesla or more. There is considerable uncertainty in this risk estimate and the Committee considers it more likely that the increase is a chance finding than in the case of leukaemia.
Conclusions: The analyses of the Committee provide indications of an association between exposure to magnetic fields around overhead power lines and the incidence of childhood leukaemia and possibly brain tumours. When the results are summarized in terms of the framework for assessing causality of the US Environmental Protection Agency, the Committee concludes that they are ‘suggestive of a causal relationship’ between magnetic field exposure and both leukaemia and brain tumours. However, the indications are weaker for brain tumours than for leukaemia. For both cancer types there is insufficient evidence for the qualification of a ‘likely’ or ‘proven causal relationship’, also because there is no supporting evidence from animal studies. Regarding the risk of childhood lymphomas, there is insufficient data to infer on causality. An influence of other factors that are associated with the presence of overhead power lines cannot be excluded. However, this has not been shown in research to date. It can also not be excluded that the observations, in particular those concerning brain tumours, are chance findings.

RECENT RESEARCH ON EMF AND HEALTH RISK. TWELFTH REPORT FROM SSM’S SCIENTIFIC COUNCIL ON ELECTROMAGNETIC FIELDS, 2017.
Swedish Radiation Safety Authority’s (SSM) Scientific Council, April 2018.
Report number: 2018:09 ISSN: 2000-0456
Available at  www.stralsakerhetsmyndigheten.se

Of recent studies on residential exposure to ELF magnetic fields and childhood leukaemia, two found decreasing risk estimates over time, but this finding is not consistent across epidemiological studies. Altogether, while it remains an open question as to what caused the decrease of observed relative risks: these studies do not alter the current interpretation of an observed association of residential exposure to ELF magnetic fields and childhood leukaemia yet absence of a causal explanation.
Research on other outcomes is scarce and does not indicate new insights for health risk assessment.
Only one human experimental study was found, exhibiting severe limitations and thus does not contribute to the knowledge about acute effects of ELF magnetic field exposure on cognitive performance.

RECENT RESEARCH ON EMF AND HEALTH RISK
Eleventh report from SSM’s Scientific Council on Electromagnetic Fields, 2016
Research Report number: 2016:15 – ISSN: 2000-0456
Available at www.stralsakerhetsmyndigheten.se

Conclusions on ELF epidemiological studies

New studies on ELF-MF exposure and childhood leukaemia were small and thus do not alter the current interpretation on this subject. In adult cancer studies, no indication for a risk increase was seen in a large cohort study investigating use of electric blankets in relation to thyroid cancer and also not in a large study on occupational ELF-MF exposure and acute myeloid leukaemia. For ALS, a large population-based Swedish study suggested that electric shocks, but not ELF-MF exposure, may be a risk factor for the working population less than 65 years. This is in contrast to studies that appeared last year that suggested it may be the other way around. This question therefore remains as yet unresolved. For non-vascular dementia, a Dutch study provided some indications for an association with ELF-MF exposure. Only few observational studies addressing ELF-MF exposure and symptoms have been published during the last decade and correspondingly, study results are scarce. A large cross-sectional survey found some associations with self-reported exposure to electrical devices. The limitation for the interpretation of this finding is that both outcome and exposure are reported by the same person.

RISK ANALYSIS OF HUMAN EXPOSURE TO ELECTROMAGNETIC FIELDS
European Health Risk Assessment Network on Electromagnetic Fields Exposure
https://webgate.ec.europa.eu/chafea_pdb/assets/files/pdb/20081106/20081106_d1-d9_en_ps.pdf

Information in EMF-Portal

ENVIRONMENTAL EXPOSURE TO ELECTROMAGNETIC FIELDS AND HEALTH. POSITION PAPER OF THE FRENCH HEALTH WATCH INSTITUTE.
Institut de Veille Sanitaire, 20/11/20104
http://www.invs.sante.fr/fr/Publications-et-outils/Avis-et-note-de-position/Expositions-environnementales-aux-champs-electromagnetiques-et-sante

Several epidemiological observations are consistent with an increased risk of childhood leukemia; they involve relatively high environmental exposures to ELF-EMF, above 0.4 µT on average over 24 hours, such as those of the immediate neighbors of high or very high voltage power lines (THT).

In France, such exposure would cover 1.8% of the general population and is associated with EHV lines in 10 to 20% of cases. The results of the national Geocap case-control study were published in 2013. This study by Inserm aimed to study the risk of acute childhood leukemia in connection with exposure to ELF-EMF. The risk for leukemia was evaluated based on the distance to power lines in mainland France. It includes 2779 cases of acute childhood leukemia recorded exhaustively at the national level during the period 2002-2007 and 30,000 controls. The study concludes with an increased risk of acute leukemia when the residence is located within 50 m of a line THT (225 and 400 kV), with an odds ratio (OR) of 1.7 (confidence interval 95% [0.9, 3.6]) for all age groups. For children under 5, the OR is significant, equal to 2.6 ([1.0, 7.0]), with a significant trend in the increase in function of the inverse of the distance. In contrast, there is no increase in risk beyond 50 m from EHV line or a power line (from 63 to 150 kV) and no other significant trend in terms of distance. The results of this study carried out for the first time across the entire continental France confirm those already published in the international literature, with risk increases of the same order, found in some specific way in children less than 5 years, at a distance of less than 50 meters from VHT lines or exposed to a magnetic field strength greater than 0.3 / 0.4 µT. The Geocap study provides no new information on the danger of ELF-EMF, but confirms previous knowledge and shows that the French situation is comparable to other countries where the risk has been studied.
All the available epidemiological studies, however, did not provide sufficient evidence to establish a link of causality between the occurrence of leukemia and exposure to ELF-EMF and the results have not been confirmed by those of experimental work carried out on the animal. So it is only on the basis of statistical associations observed in epidemiology that the International Agency for Research on Cancer (IARC) in 2002 ranked the ELF-EMF in category 2B: possible carcinogen for humans.

Health effects as diverse as sleep disorders, headaches, reproductive abnormalities, cardiovascular disease and neurodegenerative diseases have been studied at the international level during the last 30 years. At levels of exposure encountered in the general population, in the frequency of the power grid, no health effects are currently considered causally determined. WHO concluded in 2007 concerning non-cancer pathology, that “the scientific evidence for a link to ELF-EMF was much more tenuous than for childhood leukemia and in some cases (e.g. for cardiovascular disease) the evidence was sufficient to whether one is ensured that ELF-EMF does not cause these diseases.” The SCENHIR, in light of the most recent data, confirmed by 2009 most of the findings issued in 2007.

However, epidemiological studies have found a statistical link between exposure to ELF-EMF in the workplace and the onset of Alzheimer’s disease. They have been the subject of a meta-analysis in 2008 that could not conclude the existence of a causal relationship. However, the heterogeneity of the studies selected in this meta-analysis make it necessary to consider the results with caution.

SCIENTIFIC COMMITTEE ON EMERGING AND NEWLY IDENTIFIED HEALTH RISKS (SCENIHR): POTENTIAL HEALTH EFFECTS OF EXPOSURE TO ELECTROMAGNETIC FIELDS.
SCENIHR, 27 January 2015.
http://ec.europa.eu/health/scientific_committees/emerging/docs/scenihr_o_041.pdf

The purpose of this Opinion is to update the SCENIHR Opinions of 19 January 2009 ‘Health effects of exposure to EMF’ and 6 July 2009 ‘Research needs and methodology to address the remaining knowledge gaps on the potential health effects of EMF’ in the light of newly available information since then, and to give special consideration to areas where important knowledge gaps were identified in the previous Opinion.

Health effects from Extremely Low Frequency (ELF) EF and MF.

The new epidemiological studies are consistent with earlier findings of an increased risk of childhood leukaemia with estimated daily average exposures above 0.3 to 0.4 μT. As stated in the previous Opinions, no mechanisms have been identified and no support is existing from experimental studies that could explain these findings, which, together with shortcomings of the epidemiological studies prevent a causal interpretation.

Epidemiological studies do not provide convincing evidence of an increased risk of neurodegenerative diseases, including dementia, related to power frequency MF exposure. Furthermore, they show no evidence for adverse pregnancy outcomes in relation to ELF MF. The studies concerning childhood health outcomes in relation to maternal residential ELF MF exposure during pregnancy involve some methodological issues that need to be addressed. They suggest implausible effects and need to be replicated independently before they can be used for risk assessment. Recent results do not show an effect of the ELF fields on the reproductive function in humans.

Studies investigating possible effects of ELF exposure on the power spectra of the waking EEG are too heterogeneous with regard to applied fields, duration of exposure, and number of considered leads, and statistical methods to draw a sound conclusion. The same is true for behavioral outcomes and cortical excitability.

Overall, existing studies do not provide convincing evidence for a causal relationship between ELF MF exposure and self-reported symptoms.

SCIENTIFIC COMMITTEE ON EMERGING AND NEWLY IDENTIFIED HEALTH RISKS SCENIHR: HEALTH EFFECTS OF EXPOSURE TO EMF.
EU Directorate – General for Health & Consumer Protection, 19 January 2009

Extremely low frequency fields (ELF fields)
The few new epidemiological and animal studies that have addressed ELF exposure and cancer do not change the previous assessment that ELF magnetic fields are a possible carcinogen and might contribute to an increase in childhood leukaemia. At present, in vitro studies did not provide a mechanistic explanation of this epidemiological finding.
No new studies support a causal relationship between ELF fields and self-reported
symptoms.

New epidemiological studies indicate a possible increase in Alzheimer’s disease arising from exposure to ELF. Further epidemiological and laboratory investigations of this observation are needed.
Recent animal studies provided an indication for effects on the nervous system at flux densities from 0.10-1.0 mT. However, there are still inconsistencies in the data, and no definite conclusions can be drawn concerning human health effects.

Very few recent in vitro studies have investigated effects from ELF fields on diseases other than cancer and those available have very little relevance. There is a need for hypothesis-based in vitro studies to examine specific diseases.
It is notable that in vivo and in vitro studies show effects at exposure levels (from 0.10 mT and above) to ELF fields that are considerably higher than the levels encountered in the epidemiological studies (µT-levels) which showed an association between exposure and diseases such as childhood leukaemia and Alzheimer’s disease. This warrants further investigation.

ENVIRONMENTAL HEALTH CRITERIA – MONOGRAPH N° 238 : EXTREMELY LOW FREQUENCY FIELDS.
http://www.who.int/peh-emf/publications/elf_ehc/en/index.html
Fact Sheet No 322: ELECTROMAGNETIC FIELDS AND PUBLIC HEALTH. EXPOSURE TO EXTREMELY LOW FREQUENCY FIELDS.
http://www.who.int/mediacentre/factsheets/fs322/en/index.html
World Health Organisation, Geneva, Switzerland. 2007.

Much of the scientific research examining long-term risks from ELF magnetic field exposure has focused on childhood leukaemia. In 2002, IARC published a monograph classifying ELF magnetic fields as “possibly carcinogenic to humans”. This classification is used to denote an agent for which there is limited evidence of carcinogenicity in humans and less than sufficient evidence for carcinogenicity in experimental animals (other examples include coffee and welding fumes). This classification was based on pooled analyses of epidemiological studies demonstrating a consistent pattern of a two-fold increase in childhood leukaemia associated with average exposure to residential power-frequency magnetic field above 0.3 to 0.4 μT. The Task Group concluded that additional studies since then do not alter the status of this classification.

However, the epidemiological evidence is weakened by methodological problems, such as potential selection bias. In addition, there are no accepted biophysical mechanisms that would suggest that low-level exposures are involved in cancer development. Thus, if there were any effects from exposures to these low-level fields, it would have to be through a biological mechanism that is as yet unknown. Additionally, animal studies have been largely negative. Thus, on balance, the evidence related to childhood leukaemia is not strong enough to be considered causal.

Childhood leukaemia is a comparatively rare disease with a total annual number of new cases estimated to be 49,000 worldwide in 2000. Average magnetic field exposures above 0.3 μT in homes are rare: it is estimated that only between 1% and 4% of children live in such conditions. If the association between magnetic fields and childhood leukaemia is causal, the number of cases worldwide that might be attributable to magnetic field exposure is estimated to range from 100 to 2400 cases per year, based on values for the year 2000, representing 0.2 to 4.95% of the total incidence for that year. Thus, if ELF magnetic fields actually do increase the risk of the disease, when considered in a global context, the impact on public health of ELF EMF exposure would be limited.

A number of other adverse health effects have been studied for possible association with ELF magnetic field exposure. These include other childhood cancers, cancers in adults, depression, suicide, cardiovascular disorders, reproductive dysfunction, developmental disorders, immunological modifications, neurobehavioral effects and neurodegenerative disease. The WHO Task Group concluded that scientific evidence supporting an association between ELF magnetic field exposure and all of these health effects is much weaker than for childhood leukaemia. In some instances (i.e. for cardiovascular disease or breast cancer) the evidence suggests that these fields do not cause them.

HEALTH EFFECTS OF ELECTROMAGNETIC FIELDS.
Expert Group on Health Effects of Electromagnetic Fields, Ireland
Department of Communications, Marine and Natural Resources, Ireland. 2007.

Extremely low frequency (ELF) fields induce electric fields and currents in tissues that can result in involuntary nerve and muscle stimulation, but only at very high field strengths. These acute effects form the basis of international guidelines that
limit exposure. However, fields found in our environment are so low that no acute effects result from them, except for small electric shocks that can occur from touching large conductive objects charged by these fields. No adverse health effects have been established below the limits suggested by international guidelines.

There is limited scientific evidence of an association between ELF magnetic fields and childhood leukaemia. This does not mean that ELF magnetic fields cause cancer, but the possibility cannot be excluded. However considerable research carried out in laboratories has not supported this possibility, and overall the evidence is considered weak, suggesting it is unlikely that ELF magnetic fields cause leukaemia in children. Nevertheless the evidence should not be discounted and so no or low cost precautionary measures to lower people’s exposure to these fields have been suggested. As a precautionary measure future power lines and power installations should be sited away from heavily populated areas to keep exposures to people low. The evidence for 50 Hz magnetic fields causing childhood leukaemia is too weak to require re-routing of existing lines, and so these measures should only apply to new lines.

Conclusion: The conclusions of the Expert Group are consistent with those of similar reviews conducted by authoritative national and international agencies.

POWER FREQUENCY ELECTROMAGNETIC FIELDS, MELATONIN AND THE RISK OF BREAST CANCER.
Documents of the Health Protection Agency- Series B: Radiation, Chemical and Environmental
Hazards, RCE-1, February 2006.

Exposure to power frequency electromagnetic fields (EMFs) is ubiquitous in modern life. The hypothesis that chronic exposure to EMFs may increase the risk of breast cancer, via a reduction in secretion of the hormone melatonin from the pineal gland, was first made almost 20 years ago, and has led to a great deal of research. To review this hypothesis, this report addresses evidence on three issues, namely, whether:

(a) EMFs affect the production or action of melatonin,
(b) melatonin affects the risk of breast cancer,
(c) EMFs affect the risk of breast cancer.

Investigations using cells, animals and humans have not given consistent or convincing evidence that EMF exposure affects melatonin production or action. However, there are deficiencies in the existing research, which leave open the possibility of an effect.

There is stronger evidence that melatonin can inhibit the growth of cancer cells in laboratory culture and in animals. Data on the possible relation of melatonin levels to risk of subsequent breast cancer in humans are limited and inconclusive. Studies investigating the effect of light exposure (which affects melatonin) on breast cancer risk in humans have given some evidence for an association, but left it unclear whether, if there is an association, it is causal in nature. There is no consistent evidence, from research using cells, animals and humans, that EMF exposure is a cause of breast cancer, nor has any mechanism for such an association been demonstrated.

The report concludes with recommendations for further research.

Conclusion: Overall, the evidence that melatonin, and the timing and extent of light exposure, may affect breast cancer risk is intriguing but inconclusive. In aggregate, the evidence to date does not support the hypothesis that exposure to power frequency EMFs affects melatonin levels or the risk of breast cancer.

PROXIMITY TO OVERHEAD POWER LINES AND CHILDHOOD LEUKAEMIA: AN INTERNATIONAL POOLED ANALYSIS.
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RESIDENTIAL MOBILITY AND CHILDHOOD LEUKEMIA.
Amoon AT, Oksuzyan S, Crespi CM, Arah OA, Cockburn M, Vergara X, Kheifets L.
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EFFECTS OF EXTREMELY LOW-FREQUENCY MAGNETIC FIELD EXPOSURE ON COGNITIVE FUNCTIONS: RESULTS OF A META-ANALYSIS.
Barth A, Ponocny I, Ponocny-Seliger E, Vana N, Winker R.
Bioelectromagnetics. 2010; 31: 173-179.

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EXPOSURE TO ELECTROMAGNETIC FIELDS (NON-IONIZING RADIATION) AND ITS RELATIONSHIP WITH CHILDHOOD LEUKEMIA: A SYSTEMATIC REVIEW.
Calvente I, Fernandez MF, Villalba J, Olea N, Nuñez MI.
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CASE-CONTROL STUDY ON OCCUPATIONAL EXPOSURE TO EXTREMELY LOW-FREQUENCY ELECTROMAGNETIC FIELDS AND THE ASSOCIATION WITH MENINGIOMA.

Carlberg M, Koppel T, Ahonen M, Hardell L.
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THE EFFECTS OF LOW-FREQUENCY ENVIRONMENTAL-STRENGTH ELECTROMAGNETIC FIELDS ON BRAIN ELECTRICAL ACTIVITY: A CRITICAL REVIEW OF THE LITERATURE.
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ELECTROMAGNETIC FIELDS, OXIDATIVE STRESS, AND NEURODEGENERATION.
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A META-ANALYSIS ON THE RELATIONSHIP BETWEEN EXPOSURE TO ELF-EMFS AND THE RISK OF FEMALE BREAST CANCER.
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EXTREMELY LOW-FREQUENCY ELECTROMAGNETIC FIELDS EXPOSURE AND FEMALE BREAST CANCER RISK: A META-ANALYSIS BASED ON 24,338 CASES AND 60,628 CONTROLS.
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ASSUMPTIONS IN QUANTITATIVE ANALYSES OF HEALTH RISKS OF OVERHEAD POWER LINES.
de Jong A, Wardekker J.A., van der Sluijs J.P.
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“DIRTY ELECTRICITY”: WHAT, WHERE, AND SHOULD WE CARE?
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SYSTEMATIC REVIEW OF THE EXPOSURE ASSESSMENT AND EPIDEMIOLOGY OF HIGH-FREQUENCY VOLTAGE TRANSIENTS.
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A CONSENSUS PANEL REVIEW OF CENTRAL NERVOUS SYSTEM EFFECTS OF THE EXPOSURE TO LOW-INTENSITY EXTREMELY LOW-FREQUENCY MAGNETIC FIELDS.

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EFFECTS OF ELECTROMAGNETIC FIELD EXPOSURE ON THE HEART: A SYSTEMATIC REVIEW.
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CHILDHOOD LEUKEMIA AND RESIDENTIAL MAGNETIC FIELDS: ARE POOLED ANALYSES MORE VALID THAN THE ORIGINAL STUDIES?
Elwood J.M.
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NON-CANCER EMF EFFECTS RELATED TO CHILDREN.
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ELECTROMAGNETIC FIELDS AND FEMALE BREAST CANCER.
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EXPOSURE TO ELECTROMAGNETIC FIELDS AND HUMAN REPRODUCTION: THE EPIDEMIOLOGIE EVIDENCE.
Figa-Talamanca I, Nardone P, Giliberti C
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DESIGNS AND ANALYSES FOR EXPLORING THE RELATIONSHIP OF MAGNETIC FIELDS TO CHILDHOOD LEUKAEMIA: A PILOT PROJECT FOR THE DANISH NATIONAL BIRTH COHORT.
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LEUKEMIA ATTRIBUTABLE TO RESIDENTIAL MAGNETIC FIELDS: RESULTS FROM ANALYSES ALLOWING FOR STUDY BIASES.
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POTENTIAL HEALTH IMPACTS OF RESIDENTIAL EXPOSURES TO EXTREMELY LOW FREQUENCY MAGNETIC FIELDS IN EUROPE.
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EXTREMELY LOW FREQUENCY ELECTROMAGNETIC FIELDS STIMULATION MODULATES AUTOIMMUNITY AND IMMUNE RESPONSES: A POSSIBLE IMMUNO-MODULATORY THERAPEUTIC EFFECT IN NEURODEGENERATIVE DISEASES.
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AMYOTROPHIC LATERAL SCLEROSIS AND OCCUPATIONAL EXPOSURES: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSES.
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 OCCUPATIONAL EXPOSURES AND NEURODEGENERATIVE DISEASES – A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSES.
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DO MAGNETIC FIELDS CAUSE INCREASED RISK OF CHILDHOOD LEUKEMIA VIA MELATONIN DISRUPTION?
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CAN DISTURBANCES IN THE ATMOSPHERIC ELECTRIC FIELD CREATED BY POWERLINE CORONA IONS DISRUPT MELATONIN PRODUCTION IN THE PINEAL GLAND?
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EXTREMELY LOW FREQUENCY MAGNETIC FIELD EXPOSURE AND PARKINSON’S DISEASE-A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE DATA.
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OCCUPATIONAL EXPOSURE TO EXTREMELY LOW-FREQUENCY MAGNETIC FIELDS AND THE RISK OF ALS: A SYSTEMATIC REVIEW AND META-ANALYSIS.
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OCCUPATIONAL EXPOSURE TO EXTREMELY LOW FREQUENCY MAGNETIC FIELD AND RISK OF ALZHEIMER DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS.
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DO ELECTROMAGNETIC FIELDS ENHANCE THE EFFECTS OF ENVIRONMENTAL CARCINOGENS?
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DO EXTREMELY LOW FREQUENCY MAGNETIC FIELDS ENHANCE THE EFFECTS OF ENVIRONMENTAL CARCINOGENS? A META-ANALYSIS OF EXPERIMENTAL STUDIES.
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RECENT ADVANCES IN RESEARCH RELEVANT TO ELECTRIC AND MAGNETIC FIELD EXPOSURE GUIDELINES.
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EXPLORING EXPOSURE–RESPONSE FOR MAGNETIC FIELDS AND CHILDHOOD LEUKEMIA.
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PUBLIC HEALTH IMPACT OF EXTREMELY LOW-FREQUENCY ELECTROMAGNETIC FIELDS.
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POOLED ANALYSIS OF RECENT STUDIES ON MAGNETIC FIELDS AND CHILDHOOD LEUKAEMIA.
Kheifets L, Ahlbom A, Crespi CM, Draper G, Hagihara J, Lowenthal RM, Mezei G, Oksuzyan S, Schüz J, Swanson J, Tittarelli A, Vinceti M, Wunsch Filho V.
Br J Cancer. 2010; 103(7): 931-932.

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A POOLED ANALYSIS OF EXTREMELY LOW-FREQUENCY MAGNETIC FIELDS AND CHILDHOOD BRAIN TUMORS.
Kheifets L, Ahlbom A, Crespi CM, Feychting M, Johansen C, Monroe J, Murphy MF, Oksuzyan S, Preston-Martin S, Roman E, Saito T, Savitz D, Schüz J, Simpson J, Swanson J, Tynes T, Verkasalo P, Mezei G.
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EXTREMELY LOW-FREQUENCY MAGNETIC FIELDS AND HEART DISEASE.
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FUTURE NEEDS OF OCCUPATIONAL EPIDEMIOLOGY OF EXTREMELY LOW FREQUENCY ELECTRIC AND MAGNETIC FIELDS: REVIEW AND RECOMMENDATIONS.
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EXTREMELY LOW FREQUENCY ELECTRIC FIELDS AND CANCER: ASSESSING THE EVIDENCE.
Kheifets L, Renew D, Sias G, Swanson J.
Bioelectromagnetics. 2010; 31: 89-101.

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DEVELOPING POLICY IN THE FACE OF SCIENTIFIC UNCERTAINTY: INTERPRETING 0.3 MICROTESLA OR 0.4 MICROTESLA CUTPOINTS FROM EMF EPIDEMIOLOGIC STUDIES.
Kheifets L., Sahl J.D., Shimkhada R., Repacholi M.H.
Risk Anal. 2005 ;25 : 927-935.

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COMPARATIVE ANALYSES OF STUDIES OF CHILDHOOD LEUKEMIA AND MAGNETIC FIELDS, RADON AND GAMMA RADIATION.
Kheifets L, Swanson J, Yuan Y, Kusters C, Vergara X.
J Radiol Prot. 2017; 37(2):459-491.

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EXTREMELY LOW FREQUENCY ELECTRIC AND MAGNETIC FIELDS/ IS IT TIME TO BE REASONABLE?
Lambrozo J, Plante M.
Environ Risque Santé 2014; 13,6:440-444.

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CHILDHOOD LEUKEMIA NOT LINKED WITH ELF MAGNETIC FIELDS.
Leitgeb N.
Journal of Electromagnetic Analysis and Applications 2014; 6(7):174-183.

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EXPOSURE TO POWER-FREQUENCY MAGNETIC FIELDS AND THE RISK OF INFERTILITY AND ADVERSE PREGNANCY OUTCOMES: UPDATE ON THE HUMAN EVIDENCE AND RECOMMENDATIONS FOR FUTURE STUDY DESIGNS.
Lewis RC, Hauser R, Maynard AD, Neitzel RL, Wang L, Kavet R, Meeker JD.
J Toxicol Environ Health B Crit Rev. 2016;19(1):29-45.

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GENETIC DAMAGE IN HUMANS EXPOSED TO EXTREMELY LOW-FREQUENCY ELECTROMAGNETIC FIELDS.
Maes A, Verschaeve L.
Arch Toxicol. 2016;90(10):2337-2348.

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A LITERATURE REVIEW: THE CARDIOVASCULAR EFFECTS OF EXPOSURE TO EXTREMELY LOW FREQUENCY ELECTROMAGNETIC FIELDS.
McNamee DA , Legros AG , Krewski R , Wisenberg G , Prato FS , Thomas AW .
Int Arch Occup Environ Health. 2009; 82(8):919-933.

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IS THERE A RELATION BETWEEN EXTREMELY LOW FREQUENCY MAGNETIC FIELD EXPOSURE, INFLAMMATION AND NEURODEGENERATIVE DISEASES? A REVIEW OF IN VIVO AND IN VITRO EXPERIMENTAL EVIDENCE.
Mattsson MO, Simkó M.
Toxicology. 2012; 301:1-12.

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SELECTION BIAS AND ITS IMPLICATIONS FOR CASE-CONTROL STUDIES: A CASE STUDY OF MAGNETIC FIELD EXPOSURE AND CHILDHOOD LEUKAEMIA.
Mezei G., Kheifets L.
Int J Epidemiol. 2006; 35 : 397-406.

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ARE PATIENTS WITH CARDIAC IMPLANTS PROTECTED AGAINST ELECTROMAGNETIC INTERFERENCE IN DAILY LIFE AND OCCUPATIONAL ENVIRONMENT?
Napp A, Stunder D, Maytin M, Kraus T, Marx N, Driessen S.
Eur Heart J. 2015;36(28):1798-1804.

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A META-ANALYSIS ON RESIDENTIAL EXPOSURE TO MAGNETIC FIELDS AND THE RISK OF AMYOTROPHIC LATERAL SCLEROSIS.
Röösli M, Jalilian H.
Rev Environ Health. 2018 Jun 6.

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IDIOPATHIC ENVIRONMENTAL INTOLERANCE ATTRIBUTED TO ELECTROMAGNETIC FIELDS (FORMERLY ‘ELECTROMAGNETIC HYPERSENSITIVITY’): AN UPDATED SYSTEMATIC REVIEW OF PROVOCATION STUDIES.
Rubin GJ, Nieto-Hernandez R, Wessely S.
Bioelectromagnetics. 2010; 31: 1-11.

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EXPOSURE TO EXTREMELY LOW-FREQUENCY MAGNETIC FIELDS AND THE RISK OF CHILDHOOD CANCER: UPDATE OF THE EPIDEMIOLOGICAL EVIDENCE.
Schüz J.
Prog Biophys Mol Biol. 2011; 107: 339-342..

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IMPLICATIONS FROM EPIDEMIOLOGIC STUDIES ON MAGNETIC FIELDS AND THE RISK OF CHILDHOOD LEUKEMIA ON PROTECTION GUIDELINES.
Schüz J.
Health Phys. 2007; 92 : 642-648.

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EXPOSURE TO ELECTROMAGNETIC FIELDS AND THE RISK OF CHILDHOOD LEUKAEMIA: A REVIEW.
Schüz J , Ahlbom A.
Radiat Prot Dosimetry. 2008;132: 202-211.

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EXTREMELY LOW-FREQUENCY MAGNETIC FIELDS AND RISK OF CHILDHOOD LEUKEMIA: A RISK ASSESSMENT BY THE ARIMMORA CONSORTIUM.
Schüz J, Dasenbrock C, Ravazzani P, Röösli M, Schär P, Bounds PL, Erdmann F, Borkhardt A, Cobaleda C, Fedrowitz M, Hamnerius Y, Sanchez-Garcia I, Seger R, Schmiegelow K, Ziegelberger G, Capstick M, Manser M, Müller M, Schmid CD, Schürmann D, Struchen B, Kuster N.
Bioelectromagnetics. 2016 Mar 15.

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ELECTROMAGNETIC FIELDS AND EPIDEMIOLOGY: AN OVERVIEW INSPIRED BY THE FOURTH COURSE AT THE INTERNATIONAL SCHOOL OF BIOELECTROMAGNETICS.
Schüz J, Lagorio S, Bersani F.
Bioelectromagnetics. 2009; 30(7): 5115-24.

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Association between parental occupational exposure to extremely low frequency magnetic fields and childhood nervous system tumors risk: A meta-analysis.
Su L, Zhao C, Jin Y, Lei Y, Lu L, Chen G.
Sci Total Environ. 2018 Nov 15;642:1406-1414.

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ELECTROMAGNETIC FIELD EXPOSURE AND MALE BREAST CANCER RISK: A META-ANALYSIS OF 18 STUDIES.
Sun JW, Li XR, Gao HY, Yin JY, Qin Q, Nie SF, Wei S.
Asian Pac J Cancer Prev. 2013; 14(1): 523-528.

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COULD THE GEOMAGNETIC FIELD BE AN EFFECT MODIFIER FOR STUDIES OF POWER-FREQUENCY MAGNETIC FIELDS AND CHILDHOOD LEUKAEMIA?
Swanson J, Kheifets L.
J Radiol Prot. 2012; 32:413-418.

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BIOPHYSICAL MECHANISMS: A COMPONENT IN THE WEIGHT OF EVIDENCE FOR HEALTH EFFECTS OF POWER-FREQUENCY ELECTRIC AND MAGNETIC FIELDS.
Swanson J., Kheifets L.
Radiat Res. 2006 ; 165 : 470-478.

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 CHANGES OVER TIME IN THE REPORTED RISK FOR CHILDHOOD LEUKEMIA AND MAGNETIC FIELDS.
Swanson J, Kheifets L, Vergara X.
J Radiol Prot. 2019 Feb 8;39(2):470-488

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POWER-FREQUENCY ELECTRIC AND MAGNETIC FIELDS IN THE LIGHT OF DRAPER ET AL. 2005.
Swanson J, Vincent T, Kroll M, Draper G.
Ann N Y Acad Sci. 2006;1076 : 318-330.

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IS MELATONIN THE HORMONAL MISSING LINK BETWEEN MAGNETIC FIELD EFFECTS AND HUMAN DISEASES?
Touitou Y., Bogdan A., Lambrozo J., Selmaoui B.
Cancer Causes Control. 2006 ; 17 : 547-552.

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OCCUPATIONAL EXPOSURE TO EXTREMELY LOW-FREQUENCY MAGNETIC FIELDS AND NEURODEGENERATIVE DISEASE: A META-ANALYSIS.
Vergara X, Kheifets L, Greenland S, Oksuzyan S, Cho YS, Mezei G.
J Occup Environ Med. 2013; 55(2): 135-146.

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EXTREMELY LOW FREQUENCY (ELF) ELECTRIC AND MAGNETIC FIELD EXPOSURE LIMITS: RATIONALE FOR BASIC RESTRICTIONS USED IN THE DEVELOPMENT OF AN AUSTRALIAN STANDARD.
Wood AW .
Bioelectromagnetics. 2008; 29: 414-428.

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MAGNETIC FIELDS EXPOSURE AND CHILDHOOD LEUKEMIA RISK: A META-ANALYSIS BASED ON 11,699 CASES AND 13,194 CONTROLS.
Zhao L, Liu X, Wang C, Yan K, Lin X, Li S, Bao H, Liu X.
Leuk Res. 2014; 38(3):269-274.

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ASSOCIATION BETWEEN EXTREMELY LOW-FREQUENCY ELECTROMAGNETIC FIELDS OCCUPATIONS AND AMYOTROPHIC LATERAL SCLEROSIS: A META-ANALYSIS.
Zhou H, Chen G, Chen C, Yu Y, Xu Z.
PLoS One. 2012;7(11):e48354.

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