Susanna Lagorio, Maria Blettner, Dan Baaken, Maria Feychting, Ken Karipidis, Tom Loney, Nicola Orsini, Martin Röösli, Marilia Silva Paulo, Mark Elwood


Environment International


December 2021


  • Department of Oncology and Molecular Medicine, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
  • Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany
  • Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  • Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), Yallambie, VIC, Australia
  • College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
  • Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
  • Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
  • Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
  • University of Auckland, New Zealand


The World Health Organization (WHO) has an ongoing project to assess potential health effects of exposure to radiofrequency electromagnetic fields (RF-EMF) in the general and working population. Here we present the protocol for a systematic review of the scientific literature on cancer hazards from exposure to RF-EMF in humans, commissioned by the WHO as part of that project.


To assess the quality and strength of the evidence provided by human observational studies for a causal association between exposure to RF-EMF and risk of neoplastic diseases.

Eligibility criteria

We will include cohort and case-control studies investigating neoplasia risks in relation to three types of exposure to RF-EMF: near-field, head-localized, exposure from wireless phone use (SR-A); far-field, whole body, environmental exposure from fixed-site transmitters (SR-B); near/far-field occupational exposures from use of handheld transceivers or RF-emitting equipment in the workplace (SR-C). While no restriction on tumour type will be applied, we will focus on selected neoplasms of the central nervous system (brain, meninges, pituitary gland, acoustic nerve) and salivary gland tumours (SR-A); brain tumours and leukaemias (SR-B, SR-C).

Information sources

Eligible studies will be identified through Medline, Embase, and EMF-Portal.

Risk-of-bias assessment

We will use a tailored version of the OHAT's tool to evaluate the study's internal validity.

Data synthesis

We will consider separately studies on different tumours, neoplasm-specific risks from different exposure sources, and a given exposure-outcome pair in adults and children. When a quantitative synthesis of findings can be envisaged, the main aims of the meta-analysis will be to assess the strength of association and the shape of the exposure–response relationship; to quantify the degree of heterogeneity across studies; and explore the sources of inconsistency (if any). When a meta-analysis is judged inappropriate, we will perform a narrative synthesis, complemented by a structured tabulation of results and appropriate visual displays.

Evidence assessment

Confidence in evidence will be assessed in line with the GRADE approach.


This project is supported by the World Health Organization. Co-financing was provided by the New Zealand Ministry of Health; the Istituto Superiore di Sanità in its capacity as a WHO Collaborating Centre for Radiation and Health; ARPANSA as a WHO Collaborating Centre for Radiation Protection.

Link to study

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