Article publication

10 March 2025

Article review date

August 2025

Summary

This systematic review evaluated the evidence for an association between the ingestion of naturally occurring radionuclides in drinking water and cancer risk in populations. A total of 29 studies (20 ecological, 6 case-control and 3 case-cohort studies) published between 1966 and 2017 were included in the review. These studies mainly evaluated cancer risk of the bone, urinary tract, and gastrointestinal tract in relation to radium, uranium, and radon ingestion. Quality assessment of the included case-control and case-cohort studies was conducted according to the Newcastle-Ottawa Scale (NOS); ecological studies were considered as low quality. The review presented a narrative description of all the results from the included studies. Overall, the review indicated no elevated risk of cancer from the ingestion of drinking water containing naturally occurring radionuclides. However, some studies indicated an elevated risk of cancers in lung, kidney, breast and bone. However, due to a lack of high-quality studies the evidence from these studies was considered poor. The review concluded that the current evidence does not allow to confirm or rule out an increased risk of cancer due to the ingestion of radionuclides in water at concentrations that occur naturally.

Published in

Science of the Total Environment

Article link

Cancer risk due to ingestion of naturally occurring radionuclides through drinking water: A systematic review

ARPANSA commentary

This review provides an evaluation of whether naturally occurring concentrations of radionuclides in drinking water pose any increased risk of cancer in human populations. The findings largely indicate that there is no cancer risk due to this, however, the review also acknowledges that methodological limitations of most of the included studies challenge the certainty of risk evaluation. The limitations of the included studies were in exposure assessment and dosimetry, low statistical power, and inadequate control of confounders. Further, the included studies did not assess the association in relation to the ingestion of polonium, thorium and lead. The review did not undertake a quantitative synthesis of results such as a meta-analysis or a certainty in evidence assessment..

The Australian Drinking Water Guidelines (NHMRC, 2022) sets out  a radioactivity screening level at which consumption of drinking water will not exceed the Australian national reference level dose  of 1 mSv per year for exposure to ionising radiation. It has been estimated that  a very low proportion  (10%) of the total annual dose in Australian populations is from natural radionuclides in drinking water (NHMRC, 2022). In fact, such low radiation exposure occurring over a long period of time is unlikely to show any detectable increase in health risk (e.g., cancer) in populations (Guseva Canu et al., 2011). The Australian system for radiation protection from ionising radiation is closely aligned with international best practice as laid out in the recommendations of the International Commission on Radiological Protection. In the Australian context, exposure to ionising radiation from drinking water falls under the Guide for Radiation Protection in Existing Exposure Situations (2017).

Article publication date

July 2025

ARPANSA review date

July 2025

Summary

This study evaluated the global burden of skin cancer among adults 65 years or older from 1990 to 2021 and used this information to project the global burden out to 2050. The study used data collected from the cancer registries of 204 countries and territories, including Australia, that are detailed in the Global Burden of Disease (GBD) Study 2021 database. Cancer incidence was collected for melanoma, and keratinocyte cancers (KC) including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). The authors calculated the incidence rates per 100,000 people for these skin cancers. 

Melanoma incidence rates in 2021 were 20 (per 100,000) and projected to fall by 40% to 12 (per 100,000) by 2050. Both KC skin cancer types are expected to rise by 2050 with a 148% increase in BCC and a 53% increase in SCC. The incidence of skin cancers was higher for men than women both in 2021 and in 2050. The study concluded that the incidence and prevalence of keratinocyte cancers skin cancer in older people is likely to increase and there is a need to enact prevention and treatment strategies for these high-risk populations.

Published in

JAMA Dermatology 

Link to

Burden of Skin Cancer in Older Adults From 1990 to 2021 and Modelled Projection to 2050

ARPANSA commentary

This ecological study reported that, despite some decreases in melanoma incidence, overall skin cancer incidence is expected to rise globally between now and 2050 due to increases in SCC and BCC. There were limitations with the data as some countries do not provide data on SCC and BCC in their cancer registries. Australia also does not report on incidence of BCC and SCC as they are generally not life-threatening, often requiring only simple excision for treatment. This lack of reliable data could affect the accuracy of these forward projections, particularly for Australians.

The downward trend in melanoma incidence in Australia has been observed in a previous study (Pinto et al 2024) and is also confirmed by Cancer Council data. However, despite this positive outcome, melanoma incidence and mortality rates in Australia remain some of the highest in the world and two-thirds of Australians will receive a skin cancer diagnosis of some type in their lifetime. As such, skin cancers, including melanoma, continue to constitute a large public health burden. 

This study indicates that further work is needed to improve Australians’ sun protection behaviours and improve awareness to avoid the dire predictions this study has made for skin cancer incidence in the future. There needs to be continued focus on UV index awareness in Australia and the Slip, Slop, Slap, Seek and Slide messaging to prevent future skin cancers. Awareness of current UV index levels can be improved by utilising ARPANSA’s network of monitoring stations in Australia or through the freely available SunSmart Global UV app which also carries information for international cities. More information on UV protection can be found on the ARPANSA Sun Protection factsheet. 

Article publication date

13 May 2025

ARPANSA review date

25 July 2025

Summary

This systematic review examined the scientific body of evidence for the effect of extremely low frequency electric and magnetic fields (ELF-EMF) exposure on carcinogenesis and co-carcinogenesis in laboratory animals. The review included 13 studies on carcinogenesis and 41 studies on co-carcinogenesis. The review did not conduct a quantitative synthesis of evidence due to large differences in experimental design between studies. Instead, the review provided a narrative overview of the included literature. Included studies were also assessed for their risk of bias (RoB) according to OHAT.

The review found that there is broadly no evidence for a carcinogenic effect from ELF-EMF exposure alone. Results from co-carcinogenesis studies were varied with some reporting statistically significant effects and others reporting none, however, the authors assess that the total weight of evidence is inadequate to make definitive conclusions. It was noted that most studies reporting statistically significant effects utilised exposure magnitudes within the range of 100 to 999 µT. Forty of the included studies were evaluated to be at low RoB and it was noted that studies with higher RoB were more likely to report statistically significant effects. Clear indications of publication bias were also found in the review. 

Published in

Environmental Research

Link to study

Carcinogenicity of extremely low-frequency magnetic fields: A systematic review of animal studies 

ARPANSA commentary

This review considered cancer endpoints in laboratory animals resulting from ELF-EMF exposure. While the review did not pursue a meta-analysis and thus lacks quantitative results, it does collate a large amount of evidence and provide descriptive statistics which can be used to generate hypotheses. The major shortcoming of this approach is that the review has a notable focus on effect versus no-effect, which has no consideration for effect size or study precision. It is especially important to acknowledge this limitation given that the authors found clear evidence of publication bias among the included studies. This type of bias can have a large impact in binary evidence synthesis methods where statistical significance is the key differentiator between two groups as publication bias can result in an over-representation of statistically significant results in the literature (Thornton, A. & Lee, P., 2000).

The overall conclusion of the review is consistent with the World Health Organization’s assessment of in vivo studies (WHO, 2007) as well as prior reviews (McCann et al., 2000). 

ELF-EMF exposure in the general environment arises primarily from electrical supply infrastructure like powerlines, substations, home electrical appliances and wiring. However, it should be noted that the levels encountered in the environment are far below the levels used in most of the studies included by the review and far below the range specified in the review where included studies reported the highest proportion of co-carcinogenic effects. ARPANSA has measured ELF-EMF exposures present in Australian homes and in close proximity to powerlines and substations (Karipidis, K. 2015; Urban, D. et al., 2014). The exposures measured are all far below the international guideline values described by the International Commission on Non-Ionizing Radiation Protection. ARPANSA continues to monitor and review scientific literature related to ELF-EMF exposure and various health endpoints, including cancer. For more information see the ARPANSA factsheet Electricity and Health. 

10 July 2025

Article publication date

May 2025

ARPANSA review date

June 2025

Summary

This article provides experts’ critical perspectives on the scientific evidence on electromagnetic hypersensitivity (EHS) being caused by exposure to electromagnetic fields (EMF). Self-reported prevalence of EHS in populations varies between countries, for example, 1.5% (Hillert et al., 2002) - up to 3.2% (Hagström et al., 2012) during 1997-2007 in Sweden; 2.0%-3.5% during 1994-2008 in Austria (Schröttne et al., 2008); 13% (2007) and 4% (2012) in Taiwan (Meg Tseng et al., 2011). Further, EHS tends to be a relatively transient self-reported condition, and no specific symptom clusters related to EMF exposure sources have been identified. A recent World Health Organization commissioned  systematic review (Bosch-Capblanch  et al., 2024) concluded that people suffering from IEI-EMF cannot identify exposures better than by chance under blinded conditions nor were their reported symptoms different from control populations, or from the general population. Therefore, there is no robust scientific evidence to support EMF as the causal agent for EHS, although the condition may be experienced by some people. Randomized provocation trials are considered as the most appropriate research method to investigate a possible association between EMF exposure and EHS; however, these studies have notable limitations. They typically only capture short-term effects on self-perceived health, and their finding may be diluted or masked due the inclusion of participants who are either not genuinely affected by EHS or experience symptoms to a lesser degree. Additionally, many studies rely on a single exposure condition in terms of frequency and intensity, and no objective biomarkers have been identified to support a link between EMF exposure below regulatory limits and EHS. In view of this, the authors suggest that future studies should either consider single-case repeated design or observational studies relying on long-term EMF exposure focussing on the whole population rather than on self-perceived EHS population.

Published in

Frontiers in Public Health

Link to study

Electrohypersensitivity: what is belief and what is known?

ARPANSA commentary

The article provides a state-of-the art viewpoint on self-reported EHS associated to EMF exposure. The conclusions drawn in the article are consistent with the findings of the recent WHO systematic review and two Australian experimental studies (Verrender et al., 2018a; 2018b), which indicated no relationship between EMF exposure and EHS. Properly conducted scientific studies have consistently demonstrated that the belief of being exposed to EMF (rather than EMF exposure itself) contributes to triggering symptoms in healthy people. The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) provides evidence-based public health messages in relation to EMF exposure and health, including EHS. Based on current scientific evidence, EHS is not caused by EMF exposure at levels below the ARPANSA safety standard. Nevertheless, ARPANSA acknowledges that the health symptoms experienced by the affected individuals are real and can be a disabling problem and advise those affected to seek medical advice from a qualified medical specialist.

2 July 2025

Low dose chest CT scans have been added to Australia’s national diagnostic reference levels to support optimisation of patients’ radiation exposure.   

11 June 2025

Australian Radiation Protection and Nuclear Safety Act 1998
Australian Radiation Protection and Nuclear Safety Regulations 2018

As required by subsection 48(2) of the Australian Radiation Protection and Nuclear Safety Regulations 2018, the CEO of ARPANSA gives notice that she intends to make a decision under section 32 of the Australian Radiation Protection and Nuclear Safety Act 1998 regarding the following application for a facility licence:

Application No A01075 by the Australian Submarine Agency to construct a prescribed radiation facility, namely a low level waste management and maintenance facility to be known as the ‘Controlled Industrial Facility’ at the existing HMAS Stirling site at Garden Island, Rockingham in Western Australia.

An overview of this licence application is now available for public comment through our Consultation Hub. Submissions close at 11:59pm on 17 July 2025. For more information, or to provide a comment on the licence application, please refer to the ARPANSA consultation hub.

6 June 2025

Archaeological uses of radiation were among the topics discussed at the Commonwealth regulator’s annual licence holder forum held in Canberra on 30 May.  

The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) regulates Commonwealth entities that use or produce radiation.  

ARPANSA’s Chief Regulatory Officer, Jim Scott, says the forum is a unique opportunity for collaboration and dialogue between the regulator, current and future licence holders.  

‘It was wonderful to have the chance to hold the meeting at the National Museum of Australia and hear from them about some of the novel ways radiation is used in archaeology for example in imaging, dating and preservation of museum artefacts,’ Mr Scott said.  

‘Our CEO Dr Gillian Hirth welcomed attendees and spoke about ARPANSA’s role to be a steward for Australia’s nuclear future.’  

‘The keynote speaker, Professor Paul Salmon from the University of the Sunshine Coast, gave an interesting talk on the risks and opportunities of new technologies such as Artificial Intelligence.' 

‘We also heard from larger licence holders such as the Australian Nuclear Science and Technology Organisation who shared learnings from implementing new technologies during the recent shutdown of the Open-pool Australian lightwater reactor at Lucas Heights in New South Wales.’  

Mr Scott says Australia has a robust, best-practice regulatory framework designed to protect workers and the community from the harmful effects of radiation.  

These strong frameworks and a national commitment to radiation protection contribute to ARPANSA’s reputation as a leading authority.  

The annual licence holder forum provides an opportunity for ARPANSA to assist its licence holders to meet their obligations to keep the people and the environment safe from the harmful effects of radiation.  

Learn more about ARPANSA's regulatory services:  https://www.arpansa.gov.au/regulation-and-licensing/regulation/about-regulatory-services  

Article publication date

May 2025

ARPANSA review date

May 2025

Summary

This ecological study investigated trends in brain cancer incidence to evaluate the potential impact of increased mobile phone use in Spain since the early 2000s. It analysed brain cancer incidence data from 12 Spanish cancer registries, covering the period from 1985 to 2015. The analysis was stratified by age group, with separate evaluations for adults (aged 15 years and older) and children (aged 0 to 14 years). The dataset included 20,325 adult and 2,372 childhood brain cancer cases. Among adults, there was a slight annual increase in incidence of 1.7% until 1996, followed by a non-statistically significant decline of 0.1% per year up to 2015. In children, incidence rose by 7.6% annually until 1991, then declined by 1.0% per year through to 2015. The authors suggested that the increases observed in the 1980s and early 1990s could be attributed to improvements in diagnostic practices, particularly the adoption of advanced imaging techniques during that period. Overall, the study reported that the brain cancer incidence data in both adults and children does not support an association between mobile phone use and brain cancer. 

Published in

Clinical and Translational Oncology

Link to study

Trends in the incidence of brain cancer and the use of mobile phones: analysis of the Spanish Network of Cancer Registries (REDECAN) - PubMed

Commentary by ARPANSA

The study reported no increase in the incidence of brain cancer in Spain during the 2000s, a period marked by rapid growth in mobile phone use in the country. While ecological studies are limited in their ability to establish causal relationships between risk factors and disease, they are valuable for quickly testing hypotheses using existing datasets.

One major limitation of this study is that it does not provide specific data on mobile phone subscription rates in Spain. Moreover, the mobile phone data referenced from the Spanish Ministry of Economic Affairs and Digital Transformation only dates back to the 2000s, limiting the ability to assess long-term trends. Despite this limitation,the conclusions are also consistent with similar studies that investigated trends in brain tumour incidence rates over time (Elwood et al, 2022; Deltour et al, 2022), including an Australia study (Karipidis et al., 2018) that have consistently found no increase in the rates of brain tumours related to an increase in mobile phone use. The conclusions are also in alignment with epidemiological evidence from a recent systematic review showing no association between radiofrequency electromagnetic field (RF-EMF) exposure from mobile phones and brain cancer (Karipidis et al., 2024).

The conclusions are in line with ARPANSA’s assessment, that at exposure levels below those prescribed in the Australian radiofrequency standard RPS-S1,  there is no substantiated evidence of an association between RF-EMF and brain cancer or any other health effect. 

Article publication date

14 April 2025

ARPANSA review date

19 May 2025

Summary

This computational modelling study evaluated the relationship between current computed tomography (CT) scanning practices and future incidence of cancer in the USA. Data on CT use was extracted from a market outlook survey of hospitals and imaging facilities in the USA. CT scans were subdivided into categories and an average dose per category was determined using data from a US CT dose registry. Subsequently, absorbed doses were estimated for different organs through radiation transport simulations. Using information from the US National Research Council Biological Effects of Ionizing Radiation (BEIR) VII report, lifetime cancer risks corresponding to the calculated absorbed organ doses were computed. A sample of 121212 examinations was used to determine the proportion of scans for each CT scan category. By combining the lifetime cancer risk per CT scan type with the data on total CT scans, the total risk to the USA’s population was estimated.

The article computed that approximately 93 million CT scans were undertaken in the USA in 2023, with persons in the 60-69 age bracket undergoing the most examinations. Examinations performed in the last year of life were excluded for cancer estimates leaving 84 million CT scans which were modelled to result in 102700 cancers over the projected lifetime of the exposed patients. This is currently equivalent to approximately 5% of new cancers in the USA each year.

Published in

Journal of the American Medical Association Internal Medicine

Link to study

Projected Lifetime Cancer Risks From Current Computed Tomography Imaging | Radiology | JAMA Internal Medicine | JAMA Network

Commentary by ARPANSA

The use of ionising radiation, such as CT scans, in medicine involves a balance between benefit and risk. The article makes good use of some large databases, and models derived from epidemiological data, to assess long-term cancer risks from CT utilisation in the USA but does not attempt to address the benefit side of the equation. CT scans provide significant benefits to patients by enabling accurate and timely diagnosis, often avoiding the need for more invasive procedures, or identifying disease at an early stage when it can be effectively treated. Medical staff requesting CT scans must justify them by considering the balance of benefit and risk for each patient. Imaging staff must optimise scan settings to balance radiation exposure with the image quality needed for the diagnostic task. The risks identified in the paper underline the importance of continued and effective implementation of these principles of justification and optimisation.

The study uses cancer estimates from the BEIR VII risk model and as such inherits its limitations. The primary limitation is that the model is based on cancers observed in cohorts of survivors from the atomic weapons detonations in Hiroshima and Nagasaki and uncertainties remain in applying this information to other situations. The BEIR model estimates for the relationship between cancer risk and ionising radiation exposure are not new and have not changed for decades. In this sense the current paper does not present new information on the relationship between exposure and cancer risk but rather is using cancer risk as a tool to highlight potential issues with scan over-use. Additionally, the study's risk calculations factored in average life expectancies, which may overestimate future cancer risk for patients with shorter life expectancies due to underlying illness.

While our understanding of the relationship between exposure and cancer risks remains the same, advancements in CT scanning technology have significantly lowered patient doses and improved scan quality. ARPANSA’s National Diagnostic Reference Level (DRL) Service has tracked these optimisations, with data demonstrating that doses for common procedure types have been steadily decreasing over the last decade.

The study estimated 273 CT scans per 1000 population in the USA. In comparison, the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 2021 global survey reported 238 scans per 1000 population for the USA and 157 scans per 1000 population in Australia, both of which are comparable to the average for countries at the highest income level (159 scans per 1000 population). The lower prevalence of scans, in conjunction with the dose reductions mentioned above, indicate that similar modelling for Australia would give a substantially lower estimate on the projected number of cancers from CT scans. 

Most importantly, results from the study should be considered in the clinical context of CT scans. CT scans are performed for diagnostic purposes on unwell patients and the diagnostic benefits of the scan must be weighed against the potential harms. This principle of justification, along with the optimisation mentioned above, must be applied to all medical ionising radiation exposures in Australia as outlined in the Code for Radiation Protection in Medical Exposure RPS C-5. Simply, the conclusion presented by the paper does not account for the diseases treated and prevented by undergoing a scan and should not be cause for hesitancy in patients who have been prescribed a scan by their medical professional.  However, it does underline the importance of continued monitoring and vigilance in the usage of ionising radiation in medical procedures, including the use of referral guidelines and comparison of doses to diagnostic reference levels. These principles, advocated by the International Commission on Radiological Protection and highlighted in the Bonn Call for Action, a joint position statement by the International Atomic Energy Agency and the World Health Organization, continue to guide international best practice for the use of ionising radiation in medicine.