OBJECTIVES:This study investigated occupational exposure to radiofrequency electromagnetic fields (RF EMF) using two job-exposure matrices (JEMs) and risk of glioma. DESIGN:Population-based family case-control study. SETTING:Cases were recruited from participating hospitals in the Australian states of New South Wales, Queensland, Tasmania, Western Australia and Victoria between January 2013 and November 2017. PARTICIPANTS:The study population consisted of 467 cases of glioma and 367 family controls recruited for the Australian Genomics and Clinical Outcomes of Glioma case-control study between 2013 and 2017. Participants completed questionnaires on demographic and other information, including a detailed occupational history. EXPOSURES:Exposure to RF EMF was estimated using both the multicountry case-control study INTEROCC JEM and the Canadian JEM (CANJEM). PRIMARY OUTCOME MEASURES:ORs and 95% CIs were calculated from logistic regression models adjusted for relatedness between cases and controls, sex, age, ethnicity, education level, smoking status and alcohol consumption. RESULTS:There was no statistically significant positive association overall for risk of glioma when applying either JEM. For the highest compared with the lowest quartile of lifetime exposure, results using the INTEROCC JEM showed an OR of 0.74 (95% CI 0.47 to 1.15) for electric fields and 0.92 (95% CI 0.58 to 1.45) for magnetic fields, while the CANJEM showed an OR of 0.85 (95% CI 0.54 to 1.32). We also did not observe associations when applying different assumptions regarding latency or time windows or with glioma grade. CONCLUSION:Overall, this study found no evidence of an association between occupational RF EMF exposure and glioma. Future research should focus on refining occupational RF EMF exposure assessment.

Importance:Substantial improvements in childhood cancer survival have created a critical need to address serious long-term health complications, such as valvular heart disease (VHD). Objective:To identify treatment-related risk factors for VHD in a large European cohort of long-term childhood cancer survivors. Design, Setting, and Participants:This nested case-control study used data from the PanCareSurFup (PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies) and ProCardio cohorts, including detailed radiation dose reconstruction and chemotherapy exposure, for childhood cancer survivors from 7 European countries, diagnosed between 1940 and 2009, who survived at least 5 years after cancer diagnosis. Case patients, defined as having symptomatic VHD, were matched with controls 1:2 by subcohort, sex, age at cancer diagnosis, and calendar year of initial diagnosis. Data were analyzed from October 2023 to June 2025. Exposures:Doses were calculated by performing a whole-body dosimetric reconstruction using a voxel-based anthropomorphic phantom with more than 200 delineated anatomic structures or substructures. Cumulative dose to cytotoxic agents was also assessed. Main Outcome and Measure:Development of symptomatic VHD (grade ≥3 per the Common Terminology and Criteria for Adverse Events, version 4.03). Results:Of the 225 cases, 136 participants (60.4%) were male, and 195 (86.7%) were diagnosed with VHD beyond 20 years from childhood cancer. Survivors receiving a mean heart radiation therapy (RT) dose of 5 to less than 15 Gy had an increased risk of VHD (odds ratio [OR], 4.7; 95% CI, 2.1-10.7) compared to those without heart RT, with higher risk when more than half of the heart was exposed. The heart RT dose response appeared exponential, with the OR being 104.1 (95% CI, 27.8-389.6) for mean heart dose of 30 Gy or more, increasing considerably with follow-up from 6.0 (95% CI, 1.4-26.5) after 5 to 19 years to 71.4 (95% CI, 20.4-250.0) after 30 or more years. Cumulative anthracycline doses of 400 mg/m2 or higher were also associated with increased VHD risk (OR, 3.8; 95% CI, 1.4-10.3), showing an exponential dose-response pattern. Cumulative exposure to platinum agents was associated with VHD risk in a linear manner. No statistically significant associations were found for other chemotherapy agents or radiation to the spleen. Conclusion and Relevance:In this case-control study, heart RT, anthracyclines, and platinum agents were associated with increased VHD risk in childhood cancer survivors. Risks from both RT and anthracyclines were amplified with age and follow-up, underscoring the need for long-term cardiac surveillance.

OBJECTIVE:To estimate the association between occupational exposures to extremely low-frequency magnetic fields (ELF-MF) and postmenopausal breast cancer. METHODS:Lifetime job histories from a population-based case-control study (2008 to 2011) of histologically confirmed breast cancer in Montréal, Canada, were linked to a job-exposure matrix to assign geometric mean ELF-MF exposure/workday. Logistic regression estimated odds ratios and 95% confidence intervals for cumulative, average, maximum, and duration of maximum exposure to ELF-MFs (per interquartile range increase), adjusting for individual-level and ecological covariables. RESULTS:Data from 663 cases and 592 controls revealed no association between occupational ELF-MF exposure and postmenopausal breast cancer, though restricting exposures to 0 to 10 years before interview and to those during breast development, some positive associations was observed, particularly for ER+/PR+ tumors. CONCLUSIONS:Our findings suggest no association between occupational ELF-MF exposure and postmenopausal breast cancer risk.

INTRODUCTION:Over the past two decades, the amount of transmitted mobile data has increased rapidly. It is unknown whether the implementation of the new technologies enabling this has resulted in changes of outdoor radio-frequency electromagnetic fields (RF-EMF) exposure. Therefore, microenvironmental measurements were used to investigate temporal trends in RF-EMF exposure between 2016 and 2023, in the Netherlands, Switzerland, Belgium and Spain, following a similar protocol across campaigns. Microenvironmental measurements refer to exposure measurements performed at predefined small areas that have been differentiated with a specific function in that particular area. This allowed us to compare exposure trends between countries and years. METHODS:The data was collected as part of the ACCEDERA (2016-2018), ETAIN (2023), and GOLIAT (2023) projects, walking repeatedly the same routes with RF-EMF exposimeters. Identical microenvironments were identified in each country and measurements of the exposure from mobile base stations, mobile phones and the total exposure were compared across years. RESULTS:Comparing measurements between 6 and 14 unique microenvironments in each country, our data did not suggest significant changes in the exposure from the mobile base station origin (total downlink exposure) between baseline measurements in 2016 to follow up and 2023 for the four countries. Across all countries and years the median values of the mobile base station exposure ranged from 0.11 mW/m2 (Switzerland, 2023) to 0.62 mW/m2 (Netherlands, 2018). There was no consistent trend in the individual microenvironments across the countries. CONCLUSIONS:Our measurements of RF-EMF outdoor exposure levels across included microenvironment groups do not indicate change in exposure levels between 2016 and 2023 despite an increase in mobile data traffic by a factor of 8 in Western Europe1.

Supplementary Table from Cancer Effects of Low to Moderate Doses of Ionizing Radiation in Young People with Cancer-Predisposing Conditions: A Systematic Review

Objectives: Assessing occupational exposure to radiofrequency electromagnetic fields (RF-EMF) presents significant challenges due to the considerable variability in exposure levels within and between occupations. This spatial and temporal variability complicates the reliable evaluation of potential health risks associated with RF-EMF exposure in the workplace. Accurate assessment methods are crucial to understand the extent of exposure and to evaluate potential health risks, especially given the potential for higher exposures in occupational settings compared to the general population. This study compares the historical RF-EMF exposure estimates in the INTEROCC RF-EMF job-exposure matrix (RF-JEM) with recent personal measurement data collected in 2 countries as part of the OccRF-Health study, to assess the broader applicability of the RF-JEM. Methods: Weighted kappa (k (w)) coefficients and Spearman rank correlation tests were performed to assess the alignment between RF-JEM estimates and measurements for 8 h time-weighted average exposure intensity and prevalence estimates across various occupations. The comparisons were mainly based on 22 jobs having >= 5 measured workers in the OccRF-Health study. Results: Poor agreement was found for both exposure prevalence and intensity between both methods (k (w) < 0.1). RF-JEM values likely overestimated exposure levels for both electric (E) and magnetic (H) fields (mean percentage difference >194%) compared to current personal measurements. Conclusions: Findings suggest that the INTEROCC-JEM likely overestimates current exposure intensity levels in the measured jobs. Adopting a semiquantitative JEM could also mitigate misclassification errors due to exposure variability, improving accuracy in exposure assessment. These findings indicate the need for more targeted personal measurements, including among highly exposed workers, and for potentially considering new exposure metrics to more accurately assess occupational RF-EMF exposures in occupational epidemiological research.

Potential differential and non-differential recall error in mobile phone use (MPU) in the multinational MOBI-Kids case-control study were evaluated. We compared self-reported MPU with network operator billing record data up to 3 months, 1 year, and 2 years before the interview date from 702 subjects aged between 10 and 24 years in eight countries. Spearman rank correlations, Kappa coefficients and geometric mean ratios (GMRs) were used. No material differences in MPU recall estimates between cases and controls were observed. The Spearman rank correlation coefficients between self-reported and recorded MPU in the most recent 3 months were 0.57 and 0.59 for call number and for call duration, respectively. The number of calls was on average underestimated by the participants (GMR = 0.69), while the duration of calls was overestimated (GMR = 1.59). Country, years since start of using a mobile phone, age at time of interview, and sex did not appear to influence recall accuracy for either call number or call duration. A trend in recall error was seen with level of self-reported MPU, with underestimation of use at lower levels and overestimation of use at higher levels for both number and duration of calls. Although both systematic and random errors in self-reported MPU among participants were observed, there was no evidence of differential recall error between cases and controls. Nonetheless, these sources of exposure measurement error warrant consideration in interpretation of the MOBI-Kids case-control study results on the association between children's use of mobile phones and potential brain cancer risk.

Abstract Risk of depression increased in the general population after the COVID-19 pandemic outbreak. By examining the interplay between genetics and individual environmental exposures during the COVID-19 lockdown, we have been able to gain an insight as to why some individuals are more vulnerable to depression, while others are more resilient. This study, conducted on a Spanish cohort of 9218 individuals (COVICAT), includes a comprehensive non-genetic risk analysis, the exposome, complemented by a genomics analysis in a subset of 2442 participants. Depression levels were evaluated using the Hospital Anxiety and Depression Scale. Together with Polygenic Risk Scores (PRS), we introduced a novel score; Poly-Environmental Risk Scores (PERS) for non-genetic risks to estimate the effect of each cumulative score and gene-environment interaction. We found significant positive associations for PERSSoc (Social and Household), PERSLife (Lifestyle and Behaviour), and PERSEnv (Wider Environment and Health) scores across all levels of depression severity, and for PRSB (Broad depression) only for moderate depression (OR 1.2, 95% CI 1.03–1.40). On average OR increased 1.2-fold for PERSEnv and 1.6-fold for PERLife and PERSoc from mild to severe depression level. The complete adjusted model explained 16.9% of the variance. We further observed an interaction between PERSEnv and PRSB showing a potential mitigating effect. In summary, stressors within the social and behavioral domains emerged as the primary drivers of depression risk in this population, unveiling a mitigating interaction effect that should be interpreted with caution.

Les expositions professionnelles, susceptibles d’accroître les risques pour la santé, sont souvent étudiées de manière indépendante les unes des autres, sans intégrer la problématique des expositions multiples, qui représente pourtant la réalité des situations professionnelles. L’absence de prise en compte de ces multi-expositions pourrait expliquer certains résultats contradictoires observés dans la littérature entre expositions professionnelles et développement intra utérin. À ce jour, aucune étude épidémiologique n’a réellement pris en compte l’impact des multi-expositions professionnelles maternelles sur la croissance intra-utérine. Les objectifs de notre étude sont d’identifier des profils de multi-expositions professionnelles maternelles durant la grossesse et d’étudier leur association avec la croissance intra-utérine au sein de la cohorte nationale mère-enfant ELFE. Les expositions professionnelles à 50 facteurs (chimiques, physiques, biologiques, biomécaniques, organisationnels, psychosociaux) ont été identifiées à partir de matrices emplois expositions. Les mères ont été classées comme exposées, probablement exposées, non exposées, en fonction de la probabilité d’exposition liée à leur activité professionnelle. Les événements étudiés sont le poids de naissance, le petit poids pour l’âge gestationnel (SGA) et le périmètre crânien. Les profils de multi-expositions ont été déterminés par classification hiérarchique basée sur les facteurs issus d’une analyse des correspondances multiples. Des modèles de régression linéaire et logistique ont ensuite permis d’étudier le lien entre ces profils et les issues de grossesse en ajustant sur les facteurs de confusion potentiels. Les 12 851 mères incluses dans l’étude étaient exposées à 8 facteurs, en moyenne, dont au moins un biomécanique. Cinq profils de multi-expositions ont été identifiés, caractérisés par : (1) travail peu exposé, stress au travail, (2) contraintes posturales, forte latitude décisionnelle, (3) contraintes posturales, travail intense, (4) contraintes posturales, risques chimiques et biologiques, (5) accumulation de tous les types de contraintes. Les études d’associations montrent une augmentation du risque de SGA dans le profil 5, par rapport au profil 1. Il n’y a pas d’associations significatives avec les autres profils, ni avec les autres indicateurs de croissance intra-utérine. Cette étude a permis d’identifier différents profils d’exposition à des facteurs de risque professionnels de femmes pendant la grossesse et leurs associations avec la croissance fœtale. Le cumul de contraintes liées à la profession d’aide-soignante semble particulièrement associé à une augmentation du risque de petit poids pour l’âge gestationnel.

Radiofrequency electromagnetic fields (RF-EMF, 100 kHz to 300 GHz) are classified by IARC as possibly carcinogenic to humans (Group 2B). This study evaluates the potential association between occupational RF-EMF exposure and brain tumor risk, utilizing for the first time, a RF-EMF job-exposure matrix (RF-JEM) developed in the multi-country INTEROCC case-control study. Cumulative and time-weighted average (TWA) occupational RF-EMF exposures were estimated for study participants based on lifetime job histories linked to the RF-JEM using three different methods: (1) by considering RF-EMF intensity among all exposed jobs, (2) by considering RF-EMF intensity among jobs with an exposure prevalence ≥ the median exposure prevalence of all exposed jobs, and (3) by considering RF-EMF intensity of jobs of participants who reported RF-EMF source use. Stratified conditional logistic regression models were used, considering various lag periods and exposure time windows defined a priori. Generally, no clear associations were found for glioma or meningioma risk. However, some statistically significant positive associations were observed including in the highest exposure categories for glioma for cumulative and TWA exposure in the 1- to 4-year time window for electric fields (E) in the first JEM application method (odds ratios [ORs] = 1.36, 95% confidence interval [95% CI] 1.08, 1.72 and 1.27, 95% CI 1.01, 1.59, respectively), as well as for meningioma for cumulative exposure in the 5- to 9-year time window for electric fields (E) in the third JEM application method (OR = 2.30, 95% CI 1.11, 4.78). We did not identify convincing associations between occupational RF-EMF exposure and risk of glioma or meningioma.

Few studies have explored the effects of n utero radiation exposure on human health and cognition and none have taken into account thyroid hormone levels (T3), which have shown to affect cognitive performance. We investigated mechanisms of possible radiation effects on IQ in two cohorts of 250 persons each: exposed n utero after the Chernobyl accident: a 'higher exposure group (HEG)', whose mothers resided in more heavily contaminated territories at the time of the Chernobyl accident, and a 'lesser exposure group (LEG)' whose mothers resided in less contaminated areas. The dataset included information on estimated prenatal thyroid radiation dose, gestation week at the time of the accident (ATA); thyroid hormones: T3 (triiodothyronine) and T4 (thyroxine) levels measured at age 11-12 years and general IQ measured at three time points: t1: 6-7 years old; t2: 11-12 years old and t3: 15-16 years old. Descriptive and inference analyses were used to explore the dynamic of changes through time and the associations between key variables at the three time points. Estimated radiation doses to the thyroid gland were substantially higher in the HEG than in the LEG (mean 391 vs 25 mGy respectively). Significant differences in thyroid hormones levels were observed between the two groups, with lower values in T3 (higher in T4) in the LEG. At t1, the general IQ, as well as verbal and non-verbal IQ scores, were lower in the HEG than in the LEG. In the HEG, analyses adjusting simultaneously for radiation dose, gestational week ATA and T3 levels suggest that all three variables are associated with IQ, with the latter being highest among those exposed later during gestation and decreasing with increasing level of dose and of T3. No significant association was observed between IQ and T4 levels. No effect of exposure on IQ was seen in the LEG. Further investigation of this hypothesis will be important to understand the relation between n utero exposure radiation dose to thyroid, thyroid hormone levels and IQ, taking into account effects of potential confounding factors (physiological stress, maternal anxiety related evacuation).

PURPOSE:Childhood cancer survivors, in particular those treated with radiation therapy, are at high risk of long-term iatrogenic events. The prediction of risk of such events is mainly based on the knowledge of the radiation dose received to healthy organs and tissues during treatment of childhood cancer diagnosed decades ago. We aimed to set up a standardized organ dose table to help former patients and clinicians in charge of long-term follow-up clinics. METHODS AND MATERIALS:We performed whole body dosimetric reconstruction for 2646 patients from 12 European countries treated between 1941 and 2006 (median, 1976). Most plannings were 2- or 3-dimensional. A total of 46% of patients were treated using Cobalt 60, and 41%, using a linear accelerator. The median prescribed dose was 27.2 Gy (IQ1-IQ3, 17.6-40.0 Gy). A patient-specific voxel-based anthropomorphic phantom with more than 200 anatomic structures or substructures delineated as a surrogate of each subject's anatomy was used. The radiation therapy was simulated with a treatment planning system based on available treatment information. The radiation dose received by any organ of the body was estimated by extending the treatment planning system dose calculation to the whole body, by type and localization of childhood cancer. RESULTS:The integral dose and normal tissue doses to most of the 23 considered organs increased between the 1950s and 1970s and decreased or plateaued thereafter. Whatever the organ considered, the type of childhood cancer explained most of the variability in organ dose. The country of treatment explained only a small part of the variability. CONCLUSIONS:The detailed dose estimates provide very useful information for former patients or clinicians who have only limited knowledge about radiation therapy protocols or techniques, but who know the type and site of childhood cancer, sex, age, and year of treatment. This will allow better prediction of the long-term risk of iatrogenic events and better referral to long-term follow-up clinics.

Supplementary Figure 1 - Search strategy for identification of studies on salivary biomarkers of exposure, susceptibility and effect relevant for ionizing radiation research.

•First longitudinal study to estimate daily RF-EMF dose of 6152 U.K. adolescents at ages 12 and 14.•At baseline (age 12), mean daily whole body RF-EMF dose was 170 mJ/kg/day.•Two years later, whole body dose was similar, but brain dose increased (+32% for temporal lobe).•The main contributor to the head and brain was own device use, in particular 2G mobile calls.•Dose at baseline and follow-up were correlated between 0.25 and 0.36 for various tissues.

Background The European EPI-CT study aims to quantify cancer risks from CT examinations of children and young adults. Here, we assess the risk of brain cancer.Methods We pooled data from nine European countries for this cohort study. Eligible participants had at least one CT examination before age 22 years documented between 1977 and 2014, had no previous diagnosis of cancer or benign brain tumour, and were alive and cancer-free at least 5 years after the first CT. Participants were identified through the Radiology Information System in 276 hospitals. Participants were linked with national or regional registries of cancer and vital status, and eligible cases were patients with brain cancers according to WHO International Classification of Diseases for Oncology. Gliomas were analysed separately to all brain cancers. Organ doses were reconstructed using historical machine settings and a large sample of CT images. Excess relative risks (ERRs) of brain cancer per 100 mGy of cumulative brain dose were calculated with linear dose-response modelling. The outcome was the first reported diagnosis of brain cancer after an exclusion period of 5 years after the first electronically recorded CT examination.Findings We identified 948 174 individuals, of whom 658 752 (69%) were eligible for our study. 368 721 (56%) of 658 752 participants were male and 290 031 (44%) were female. During a median follow-up of 5middot6 years (IQR 2middot4-10middot1), 165 brain cancers occurred, including 121 (73%) gliomas. Mean cumulative brain dose, lagged by 5 years, was 47middot4 mGy (SD 60middot9) among all individuals and 76middot0 mGy (100middot1) among people with brain cancer. A significant linear dose-response relationship was observed for all brain cancers (ERR per 100 mGy 1middot27 [95% CI 0middot51-2middot69]) and for gliomas separately (ERR per 100 mGy 1middot11 [0middot36-2middot59]). Results were robust when the start of follow-up was delayed beyond 5 years and when participants with possibly previously unreported cancers were excluded.Interpretation The observed significant dose-response relationship between CT-related radiation exposure and brain cancer in this large, multicentre study with individual dose evaluation emphasises careful justification of paediatric CTs and use of doses as low as reasonably possible.Funding EU FP7; Belgian Cancer Registry; La Ligue contre le Cancer, L'Institut National du Cancer, France; Ministry of Health, Labour and Welfare of Japan; German Federal Ministry of Education and Research; Worldwide Cancer Research; Dutch Cancer Society; Research Council of Norway; Consejo de Seguridad Nuclear, Generalitat de Catalunya, Spain; US National Cancer Institute; UK National Institute for Health Research; Public Health England. Copyright (c) 2022 World Health Organization. Published by Elsevier Ltd. All rights reserved.

Background: This study aimed to examine the association between risk of brain tumors and radiofrequency (RF) exposure from mobile phones among young people in Korea and Japan. Methods: This case-control study of brain tumors in young people was conducted in Korea and Japan under the framework of the international MOBI-Kids study. We included 118 patients diagnosed with brain tumors between 2011 and 2015 and 236 matched appendicitis controls aged 10–24 years. Information on mobile phone use was collected through face-to-face interviews. A detailed RF exposure algorithm, based on the MOBI-Kids algorithm and modified to account for the specificities of Japanese and Korean phones and networks, was used to calculate the odds ratios (ORs) for total cumulative specific energy using conditional logistic regression. Results: The adjusted ORs in the highest tertile of cumulative call time at 1 year before the reference date were 1.61 (95% confidence interval [CI], 0.72–3.60) for all brain tumors and 0.70 (95% CI, 0.16–3.03) for gliomas, with no indication of a trend with exposure. The ORs for glioma specifically, were below 1 in the lowest exposure category. Conclusion: This study provided no evidence of a causal association between mobile phone use and risk of brain tumors as a whole or of glioma specifically. Further research will be required to evaluate the impact of newer technologies of communication in the future.

BACKGROUND:INTEROCC is a seven-country cohort study of occupational exposures and brain cancer risk, including occupational exposure to electromagnetic fields (EMF). In the absence of data on individual exposures, a Job Exposure Matrix (JEM) may be used to construct likely exposure scenarios in occupational settings. This tool was constructed using statistical summaries of exposure to EMF for various occupational categories for a comparable group of workers.METHODS:In this study, we use the Canadian data from INTEROCC to determine the best EMF exposure surrogate/estimate from three appropriately chosen surrogates from the JEM, along with a fourth surrogate based on Berkson error adjustments obtained via numerical approximation of the likelihood function. In this article, we examine the case in which exposures are gamma-distributed for each occupation in the JEM, as an alternative to the log-normal exposure distribution considered in a previous study conducted by our research team. We also study using those surrogates and the Berkson error adjustment in Poisson regression and conditional logistic regression.RESULTS:Simulations show that the introduced methods of Berkson error adjustment for non-stratified analyses provide accurate estimates of the risk of developing tumors in case of gamma exposure model. Alternatively, and under some technical assumptions, the arithmetic mean is the best surrogate when a gamma-distribution is used as an exposure model. Simulations also show that none of the present methods could provide an accurate estimate of the risk in case of stratified analyses.CONCLUSION:While our previous study found the geometric mean to be the best exposure surrogate, the present study suggests that the best surrogate is dependent on the exposure model; the arithmetic means in case of gamma-exposure model and the geometric means in case of log-normal exposure model. However, we could present a better method of Berkson error adjustment for each of the two exposure models. Our results provide useful guidance on the application of JEMs for occupational exposure assessments, with adjustment for Berkson error.

BACKGROUND:The SHAMISEN (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) European project was conducted in 2015-2017 to review the lessons learned from the experience of past nuclear accidents and develop recommendations for preparedness and health surveillance of populations affected by a nuclear accident. Using a toolkit approach, Tsuda et al. recently published a critical review of the article by Cléro et al. derived from the SHAMISEN project on thyroid cancer screening after nuclear accident. MAIN BODY:We address the main points of criticism of our publication on the SHAMISEN European project. CONCLUSION:We disagree with some of the arguments and criticisms mentioned by Tsuda et al. We continue to support the conclusions and recommendations of the SHAMISEN consortium, including the recommendation not to launch a mass thyroid cancer screening after a nuclear accident, but rather to make it available (with appropriate information counselling) to those who request it.