Electromagnetic fields and female breast cancer

Maria Feychting
Institute of Environmental Medicine, Karolinska Institutet

Breast cancer incidence

No./100 000
200 180 160 140 120 100 80 60 40 20 0 1970 1975 1980 1985 1990 1995 2000 2005

Women

Men
Year
Source: Socialstyrelsens statistikdatabaser, Cancer Registry

Background

Hypotheses
Magnetic field exposure suppresses melatonin production (Stevens RG, 1987) Melatonin protects against breast cancer development (Cohen M, 1978) Therefore:

Stevens RG, 1987

Magnetic field exposure increases breast cancer risk

Magnetic fields - melatonin

Contradictory evidence
Most human experimental studies found no effect Several observational studies have found lower melatonin levels in exposed groups
Often limited to subgroups

Melatonin breast cancer, experimental

In vivo and in vitro experimental research support protective effect of melatonin

Effects of melatonin treatment have been shown on MCF-7 breast cancer cells (estrogen receptor positive) Reduced incidence of chemically induced breast tumors after melatonin treatment Increased incidence of breast tumors after pinealectomy and chemical induction of breast tumors

Melatonin breast cancer, humans

One prospective epidemiological study found no association

Travis et al. JNCI 2004

Another prospective epidemiological study found a lower breast cancer incidence in women with high melatonin levels
Schernhammer et al. JNCI 2005

Evaluations of EMF-breast cancer

The literature has been reviewed by several national and international bodies
IARC UK AGNIR and others

Conclusions: the available evidence is inadequate for an assessment WHO Environmental Health Criteria
Most recent:

IARC evaluation starting point

Performed in 2001 The epidemiologic evidence indicated little or no overall effect Some studies suggested an effect for premenopausal breast cancer
Especially estrogen receptor positive, ER+

Fit the hypothesized biological mechanism

Exposure sources

Occupational exposure Residential exposure Electric bed heating devices, e.g. electric blankets

Occupational exposure assessment

Early studies categorized job-titles into electrical occupations Later studies have made personal measurements in occupations mostly on men and created Job-Exposure-Matrices (JEM)

Occupational exposure assessment

Measurements on men may not adequately estimate magnetic field exposure for women
differences between men and women holding the same occupation, no information about the exposure in typically female occupations - large proportion of women with unknown exposure levels

A Swedish study measured magnetic fields in occupations common among women

Forssn et al. 2004

Residential exposure assessment

Wire codes

crude categorization based on proximity of residence to power lines of different voltages no consideration of line voltage Detailed information about power line configuration and historical load

Distance to power line alone Historical calculations

Residential exposure assessment

Magnetic field measurements

Spot measurements Long term stationary measurements (24 or 48 h, even up to 7 days) Personal measurements

Electric bed heating devices

Electric blankets, matress pads, water beds

Varying degree of information about habits of use, duration of use, circumstances of use Most sophisticated estimates in recent studies

New studies, occupational exposure

Study
Labreche et al. 2003

Exp. assessment Results

Interviews. Assessment by occupational hygienist No risk increase overall Increased risk for PR+ breast cancer when exp <35 years of age

Comment
No doseresponse analyses

Canada

US

Van Wijngaarden et al. 2001

Interviews. Measurements on convenience sample, six broad occupational groups

No risk increase Crude overall exposure Increased risk for assessment ER+ breast cancer after 10 yr exposure

New studies, occupational exposure

Study
Kliukiene et al. 2004
Norway

Exp. assessment Results

Census data every No risk increase 10th year overall Assessment by Occupational hygienist Norwegian radio and telegraph operators, no. years * type of ship Indication of increased breast cancer risk

Comment
Crude exposure assessment Time >0.1 T Mix of ELF and RF fields No control of shiftwork

Norway

Kliukiene et al. 2003

New studies, occupational exposure

Study Exp. assessment Results
No risk increase

Comment
Categorized into high, medium, low, background exposure Crude exposure assessment

McElroy et al. Longest held full2007 time employment. US Assessment by occupational hygienist Peplonska et al. 2007 Occupational history. Exposure assessment based on industry.

Poland

Increased risk in electronic and electric equipment manufacturers

Swedish occupational study

Case-control study
20,000 cases, 116,000 controls

Occupation from censuses every 5th year Exposure assessment:

JEM developed for women based on personal measurements TWA, maximum exposure, rate of change

Control of confounding from age, parity, socioeconomic status

Forssn et al. Am J Epidemiol, 2005

The female JEM

Measurements on females Aim: to cover about 85% of female workers Several different metrics were constructed:
Arithmetic mean Geometric mean Median Max Rate of change

Female JEM vs male JEM

Forssn, 2004

Exposure contrasts

Large variation of exposure within many occupations Identified occupations where a large proportion of total measurements were high
Cashiers, working proprietors in retail trade, air stewardesses, dental nurses, cooks, post office clerks, kitchen maids

And occupations where a large proportion were low

e.g. farmers, primary-school teachers, in-office buyers and sellers, general public administrative workers, national insurance office workers

Swedish occupational study

Results >0.3 T
All ages: <50 yr: >50 yr: ER+ tumors: 1.01 (0.93-1.10) 1.07 (0.89-1.28) 1.00 (0.90-1.11) 0.98 (0.87-1.11)

All risk estimates are close to 1.0 regardless of age, ER-status, duration of exposure, age at start of exposure etc.

Occupations with exposure contrast

Overall results: OR=1.03 (0.94-1.13) <50 years at diagnosis: OR=0.98 (0.82-1.18) >50 years at diagnosis: OR=1.06 (0.95-1.18) ER+ tumors: OR=0.95 (0.84-1.08)

Residential exposure
Study
Davis et al. 2002

Exp. assessment Results

48 h bedroom measurements Wire codes No indication of risk increase, regardless of age, ER-status or exposure metric No indication of risk increase, regardless of age, ER-status or exposure metric

Comment
Low exposure cutpoint, 0.073 T Highest quartile 0.17 T, analyzed also 90th percentile

US, Seattle

US, Long Island

Schoenfeld et al. 2003

24 h bedroom measurements Wire codes

Residential exposure
Study
London et al. 2003

Exp. assessment Results

7 day nighttime bedroom measurements Wire codes Historical calculations of magnetic fields generated by power lines No indication of risk increase, regardless of age, ER-status or exposure metric

Comment
Highest exposure cutpoint: 0.4 T

US, LA

Kliukiene et al. 2004

Norway

Increased risk Lack of related to ever being doseexposed to magnetic response fields >0.05 T

Electric bed heating devices

Study
Davis et al. 2002

Exp. assessment Results

Interview Ever use and no. of hours/year not counting only to warm the bed Interview Very detailed information about use of electric blanket No indication of risk increase

Comment
Investigated also other appliances no association Includes many aspects of use that could influence level of exp.

US, Seattle

US, Long Island

Kabat et al. 2003

No indication of risk increase, regardless of age or ERstatus

Electric bed heating devices

Study
Zhu et al. 2003

Exp. assessment
Telephone interview Any electric bedding device Ever use and no. of years Analyse separately only to warm the bed

Results
Increased risk, increasing with numbers of years of use

Comment
Small number of controls in highest exp. category Speculates that AfricanAmerican women are more sensitive

US, Tennessee

Summary and conclusions

More than a dozen additional studies after IARC evaluation Occupational studies: overall findings negative, but indications of increased risks in subgroups in some studies No consistency regarding the subgroup in which increased risks were found

Summary and conclusions

A large Swedish occupational case-control study with enough power for statistically stable analyses of the various subgroups found no effects of the exposure. Chance is a likely explanation for findings of increased risks in different subgroup analyses

Summary and conclusions

Three well-designed residential studies with comprehensive exposure assessment found no indications of increased risk One Norwegian residential study found an increased risk at very low exposure levels; No obvious reason why this would not be seen also in the US studies should the finding be true

Summary and conclusions

Majority of studies of electric bed heating devices found no increased risk inluding two well designed studies One study of African-American women found an increased risk speculates that this is a sensitive subgroup However, African-American women were also inluded in one residential study and no effects were found

Conclusions

The weight of the evidence available today suggests that power frequency magnetic field exposure is not a risk factor for female breast cancer development Cannot exclude possibility of minor risk increase