Radiation literature survey

Literature review date

September 2024

Article publication date

July 2024

Summary

This systematic review and meta-analysis examined the effect of radiofrequency electromagnetic energy (RF EME) on cognitive performance in human experimental studies. The review included 50 studies in the meta-analysis (2,433 participants) from 15 countries that were conducted between 2001 and 2021. It assessed cognitive performance of five (of the 7) cognitive domains (Orientation and attention, Perception, Memory, Construction and motor performance, and Concept formation and reasoning), including 19 (of 35) cognitive domain subclasses as defined by Lezak et al (2004). Each subclass was assessed based on the speed and accuracy of the participant performing tasks associated with that particular subclass (attentional capacity, concentration, etc). Most of the included studies used 2G-era mobile phone RF EME as the exposure source. Certainty of evidence and risk of bias were also evaluated according to OHAT-GRADE approach. 

The authors reported no statistically significant results, indicating that RF-EME exposure has not impact on cognitive performance on human in experimental studies for all of the 19 subclasses tested. However, the certainty in these results ranged from high to low. Three of the 19 subclasses were not able to be tested for both speed and accuracy. Of 35 meta-analyses performed on the subclasses, a majority (20) of them provided high certainty of evidence that RF EME exposure results in little to no difference in cognitive outcome. The evidence on the effect of RF EME on the remaining 16 subclasses of the cognitive domains was uncertain. This uncertainty was due to limitations in the study quality, inconsistency in the results or imprecision of the combined effect size estimate. Overall, the review reported no evidence that RF EME exposure impacts cognitive performance. 

Link to

The effect of exposure to radiofrequency electromagnetic fields on cognitive performance in human experimental studies: Systematic review and meta-analyses

Published in

Environment International 

ARPANSA commentary

The overall conclusion of the review was that RF EME exposure does not impact cognitive performance in human experimental studies. This systematic review is the most comprehensive that has been published on this topic as it considered all cognitive domains and people of all ages. Other recent reviews and meta-analyses have had similar outcomes (Valentini et al, 2010; Barth et al ,2011; Zubko et al, 2017) reporting no impact of mobile phone frequencies on short term cognitive performance. However, these studies only examined a few cognitive domains including, attention, processing speed and working memory. Further, these reviews did not assess the quality or risk of bias of their included studies in the same manner as this systematic review. For example, Barth et al (2011) performed no quality assessment; Valentini et al (2010) used a simple assessment that assessed the blinding, participant selection, exposure assessment and statistics used. Zubko et al (2017) did use the risk of bias tool developed by OHAT, however, it did not assess the certainty of the evidence according to the GRADE approach. 

This review is part of the World Health Organization’s (WHO) ongoing project assessing the health effects of RF-EMF. ARPANSA is supporting this WHO review process. One of the WHO systematic reviews has examined the long-term impacts on cognition of RF EME exposure (Benke et al 2024). This review was conducted in Australia and was co-led by ARPANSA scientists. This systematic review also reported that RF EME had no consistent impact on cognition.

Overall, the results from this systematic review are consistent with previous research and ARPANSA’s scientific understanding that exposure to RF EME below the limits in the ARPANSA RF safety standard do not cause health impacts, including cognitive outcomes.

Article review date

August 2024

Article publication date

July 2024

Summary

This meta-analysis of cohort studiesevaluated the current evidence on the association between occupational exposure to ionising radiation and risk of thyroid cancer. A total of six studies published between 2006 and 2021, which had a total of 420,543 participants, 6,322 cases and a mean follow-up period of 23 years, were included in the analysis. Data on radiation exposure levels (in Gray (Gy) or mSv) were available for almost all studies; whereas the information on thyroid cancer was largely based on clinical (i.e., histopathological) diagnosis except two studies which had self-reported diagnosis. The associations between ionising radiation exposure (i.e., personal or estimated thyroid doses)  and thyroid cancer were examined in terms of risk ratio (RR) with 95% confidence interval (CI). Quality assessment of the included studies was also conducted according to the Newcastle-Ottawa Scale (NOS). The results showed that the five included studies had reported the occupational radiation exposure doses (individual doses or estimated thyroid doses), which ranged from 10.4 to 500 mGy or <0.20 to 7.2 mSv. Occupational radiation exposure was associated with the risk of thyroid cancer (RR=1.61, 95% CI: 1.27‑2.04). Sex-wise sensitivity analysis further showed that males with the history of occupational radiation exposure (compared to females) tend to be at a slightly higher risk of developing thyroid cancer (RR=1.74, 95% CI: 1.61‑1.87 vs. RR=1.30, 95% CI: 1.15‑1.48). Overall, the evidence from the meta-analysis indicates that occupational exposure to ionising radiation was associated with the risk of thyroid cancer. 

Published in

Oncology Letters

Link to study

Occupational radiation exposure and risk of thyroid cancer: A meta‑analysis of cohort studies 

Commentary by ARPANSA

The meta-analysis provides the latest risk estimate of thyroid cancer risk among occupationally exposed human populations to ionising radiation. These findings are consistent with those of a previous pooled analysis of seven studies (Ron et al, 1995); however, contrary to those reported in a previous case-control study (Fincham et al, 2000). Similarly, the findings that males tend to have higher risk of developing thyroid cancer is contrary to the findings of a latest study (Khoramian et al., 2024) reporting higher thyroid cancer risk among females (compared to males) undergoing head CT imaging. No similar data are available to compare these findings in the Australian context. A key limitation of the current meta-analysis is that the available data in the included studies did not allow a detailed subgroup analysis of the occupation type, dose‑effect and time‑effect relationship. Further, the meta-analysis doesn't provide any information on the exposure contrast, so it is difficult to determine whether the exposure metrics that were used in the meta-analysis from the different studies were appropriate. Though quality of a majority of the included studies in the meta-analysis was high, they had a considerable heterogeneity (I²=84%) resulting in between-study variance.

In Australia, The Code for Radiation Protection in Planned Exposure Situations  sets out the requirements for the protection of occupationally exposed persons in all planned exposure situations. All Australian jurisdictions have uniform annual limits (20 mSv) for occupational exposure to ionising radiation. In addition to the dose limits, optimisation of radiation protection and safety involves practising ‘as low as reasonably achievable (ALARA) considering economic and societal factors.

Article review date

August 2024

Article publication date

July 2024

ARPANSA summary

This study aimed to investigate the efficacy of public health messaging in relation to sun protection when using appearance-based or health-based messages. The study recruited 95 participants (aged 17-24 years) who first completed a questionnaire on their sun protection behaviour and knowledge. The participants were then shown one of six possible text messages and their sun protection intentions were evaluated. Each of the six text messages tried a different strategy to appeal to the study participants. The messages either contained information on melanoma health risk, methods of sun protection, the cosmetic consequences of surgical melanoma removal or a combination thereof. The results showed that none of the messages affected the sun protection intentions of the participants compared to a control message indicating no significant difference between any of the interventions. Outside of the intervention evaluations, the survey found a gender-gap in sunbathing behaviour where 26% of male participants sunbathed compared to 60% of female participants. 

Link to study

Sun safety in young Queensland adults: behaviours, knowledge, and responses to health-based and appearance-based text messages

Published in

Australian Psychologist

ARPANSA commentary

Ongoing sun protection campaigns in Australia like SunSmart continue to seek to improve the efficacy of their messaging, ultimately with the goal of reducing adverse health outcomes related to sun overexposure. Recent studies (Persson, S. et al., 2018; Mahler, H. 2015; Cheng, J. et al. 2018) have indicated that appealing to concerns about appearance may be more effective than appealing to concerns about health risk and this direction has been partially adopted by some newer sun protection campaigns. 

The present study did not add significantly to this discussion as neither the health-based nor appearance-based messages had an effect compared to the control. The use of a single intra-survey text message to deliver the intervention and the absence of follow-up behaviour evaluations were highlighted as major limitations that contributed to the ineffectiveness shown. The authors also identified several other limitations with their study including low statistical power for the number of conditions that were tested and a gender imbalance among the study participants. It should also be noted that the appearance-based messaging in the study focused on surgical scarring from melanoma excisions, whereas other studies have focused primarily on skin photo-aging. This difference, although subtle, is significant as photo-aging is a much more deterministic outcome compared to melanoma and related treatments.

Whenever the UV-index is over three, ARPANSA recommends protecting yourself from the sun by following the five sun protection principles. More information about the risks of sun exposure and methods of sun protection can be found from: The World Health Organization, The Cancer Council of Australia and SunSmart websites. 

Article review date

August 2024

Article publication date

August 2024

ARPANSA summary

This prospective cohort study examined the association between exposure to radiofrequency electromagnetic energy (RF-EME) from the use of Wi-Fi, cordless and mobile phones, and behavioural problems among children. The study included 2,465 children (aged 8-17 years) from the Hokkaido Study on Environment and Children's Health. Data on the use of Wi-Fi, cordless and mobile phones was collected from parent-child dyads at baseline (October 2020-January 2021). Data on the children’s behavioural problems were collected at baseline and follow-up (September 2021-March 2022) via a Strength and Difficulties Questionnaire (SDQ). The children were categorized into four groups of composite measure of behaviour stability: normal (i.e., no difficulty at baseline and follow-up), persistent (borderline/clinical at baseline and follow-up), improved (borderline/clinical at baseline and normal follow-up), and concurrent (normal at baseline and borderline/clinical at follow-up). The association between RF-EME and different behavioural problems in children were estimated in terms of odds ratio (OR) with 95% confidence interval (CI).

No overall statistically significant association was found between RF-EMF exposure from Wi-Fi, cordless or mobile phone calls via mobile networks, and behavioural problems.  Conducting phone calls via the internet for over 40 minutes weekly had an increased risk (OR 2.01; 95% CI:1.14–3.57) for concurrent total difficulty scores. Mobile phone audio-streaming between 60 to 120 minutes weekly had a reduced risk (OR 0.53; 95% CI:0.30–0.93) for persistent total difficulty score. Cordless phone use was associated with higher odds (OR 1.88; 95% CI:1.24–2.85) of improved total difficulty scores. 

Link to study

Link between Wi-Fi, cordless devices, mobile phone usage patterns, and behavioral problems among Japanese children: A prospective cohort study

Published in

Environmental Research

ARPANSA commentary

The study largely showed that no association was found between Wi-Fi, mobile phone calls via mobile networks, and behavioural problems. However, there were a few sporadic findings showing both positive and negative effects. It is likely that these may have been affected by confounding or chance findings. A major limitation of the study is that the data on the uses of Wi-Fi and mobile and cordless phones were self-reported or reported by a parent on behalf of their child, which results in recall bias and an inaccurate estimation of the effect. Another major limitation is that any effects arising from RF-EME exposure could not be distinguished from effects that result from the activities themselves (e.g., texting, gaming/streaming and social media use). 

Overall the results of the study are consistent with the findings of the latest World Health Organization review and two Australian studies  (Bhatt et al., 2017; Thomas et al., 2011). The effect exposure to RF-EME sources on cognition has been reviewed by the International Commission on Non-Ionising Radiation Protection (ICNIRP) in their 2020 guidelines and they concluded that there is no substantiated experimental or epidemiological evidence that exposure to RF-EME affects cognition.  Overall, there remains no consistent scientific evidence that exposure to RF-EME below the limits set in ARPANSA safety standard, which is aligned with the ICNIRP guidelines, is a hazard to human health. 

Article review data

August 2024

Article publication date

February 2024

ARPANSA summary

This cohort study examined the association between ultraviolet radiation (UVR) and childhood acute lymphocytic leukaemia (ALL) and childhood non-Hodgkin lymphoma (NHL). The study included 30,349 cases of ALL and 8062 cases (aged <20 years old) of NHL collected from population-based cancer registries (SEER 2022) for the years 2000-2020. The study adjusted for sex, median rent, calendar year, age and racial/ethnic group. UVR exposure data were collected from the measurements of 239 UVR measurement stations, which provided exposure measures of average solar UVR (mW/cm²) and cumulative solar UVR exposure (MJ/cm²). The authors reported an association between ALL incidence and UVR (relative risk (RR) 1.2/mW/cm² (95% confidence interval (CI) 1.06-1.36)), but significant decreasing trends for NHL (RR 0.6/mW/cm2 (95% CI 0.51-0.82)). There was no increasing trend for cumulative UVR exposure for ALL (RR = 1.44/MJ/cm2 95% CI 0.95-2.2) but again there was a decreasing trend for NHL (RR = 0.28/MJ/cm2 95% CI 0.166-0.49). The study concluded that high UVR exposure could be associated with ALL, however, the evidence was not strong enough to make firm conclusions. 

Link to study

Solar ultraviolet radiation exposure, and incidence of childhood acute lymphocytic leukaemia and non-Hodgkin lymphoma in a US population-based dataset - PMC (nih.gov)

Published in

British Journal of Cancer

ARPANSA commentary

The authors reported an association between ALL incidence and UVR exposure. There is disagreement in the literature surrounding the association between ALL and UVR exposure. A French study reported that for children aged less than 5 years old there was an increasing trend of ALL for each 25 J/cm² of UVR exposure (standardized incidence ratio 1.18; 95% CI 1.10-1.27) (Coste et al 2015). However, a Californian study reported a reduction in the risk of ALL with UVR exposure of ≥5,111 W/h/m² (odds ratio 0.89, 95% CI: 0.81-0.99) for children under 5 years old (Lombardi et al 2013). Overall, it remains unclear if UVR exposure increases the risk of ALL. The study also reported a protective effect of solar UVR exposure on childhood NHL. This has been reported in previous studies and has been assessed in systematic reviews. The systematic reviews have reported contradictory results that UVR exposure reduced the risk of NHL in children and adults  (Kim and Kim 2021) and increased the risk of NHL in people aged 17 and above (Lu et al 2017). Overall, the evidence for an effect of UVR exposure on NHL is unclear. 

A major limitation of this study and those by Lombardi et al (2013) and Coste et al (2015) is that they do not examine UVR exposure at the individual level. The actual UVR a person is exposed to could deviate significantly from the average solar UVR depending on how much time they spend outside each day and their occupation. None of these factors were considered by the authors. This could result in misclassification bias where the people in the low exposure group could have high exposure and those in the high exposure group could have low exposure.

Given high UVR exposure in Australia compared to many parts of the world, ARPANSA recommends adoption of  the 5 sun protection principles (i.e. Slip, Slop, Slap, Seek, Slide) when the UV Index is 3 or more. ARPANSA administers and maintains UVR monitoring stations across Australia that can be used to measure the UV Index in real-time and provide sun protection recommendation to the general public on a daily basis. 

Article review data

August 2024

Article publication date

June 2024

ARPANSA summary

This cohort study, conducted in the USA, examined the impact of ambient ultraviolet radiation (UVR)  on the incidence of ocular melanoma. The study included 18,089 cases of ocular melanoma collected from 21 of the Surveillance, Epidemiology, and End Results (SEER) population-based cancer registries from 2000-2019. Cases were stratified by county of residence, sex, age at diagnosis and year of diagnosis (2000–2003, 2004–2007, 2008–2011, 2012–2015, 2016–2019). The UVR exposure used in the study was based on cloud adjusted UVR measurements from 2000 different locations that are meant to represent high population areas.

The authors reported no association for the highest quartile of UVR exposure and total ocular melanoma (UVR Q4 versus Q1 incidence rate ratio (IRR) = 0.98; 95% confidence interval (CI):0.94-1.03). However, there was an association for the highest quartile of UVR exposure and ocular melanoma in ciliary body/iris cases specifically (IRR = 1.63; 95%CI:1.43-1.87). The authors concluded there was association between solar UVR and ocular melanoma in the ciliary body/iris, but not for all anatomical sites when using the highest exposed category of solar UVR. 

Link to study

Ambient ultraviolet radiation and ocular melanoma incidence in the United States, 2000−2019

Published in

Eye

ARPANSA commentary

This study indicated an association between high solar UVR exposure and ocular melanoma in the ciliary body/iris. For the highest exposed category there was no association for total ocular melanoma cases. The observed lack of an association is contrary to the well-established link between UVR and skin melanoma (Olsen et al 2015). The lack of an association in total ocular melanoma could be due to a number of confounders relating to the lack of individualised exposure assessment in this study.  The actual ocular UVR a person is exposed to could deviate significantly from the UVR depending on how much time they spend outside each day, usage of eye protection (sunglasses) and their occupation. None of these factors were considered by the authors. This could result in misclassification bias where the people in the low exposure group could have high exposure and those in the high exposure group could have low exposure. While the study does provide interesting results for how solar UVR might impact ocular melanoma no firm conclusions can be drawn from their findings. An Australian study that looked at ocular  melanoma reported a higher age-standardized incidence rate in people 55 and older between 2008-2013 (ASR) in Queensland (ASR 3.9, 95% CI 3.3–4.5) that has a higher average UV index compared to Victoria (ASR 2.8, 95% CI 2.4–3.1) (Chalada et al 2021). However, this study also suffers from misclassification bias as it also does not present individual exposure data or account for sun protective behaviours.

Review date

July 2024

Article publication date

June 2024

Summary

This systematic review and meta-analysis evaluated the current evidence on the association between radiofrequency electromagnetic field (RF-EMF) exposure and female pregnancy outcomes in human epidemiological studies. A total of 18 studies (eight on general public exposure and 10 on occupational exposure) were identified for this evaluation. The studies had RF-EMF exposure measures in terms of self-reported mobile phone use, measured distance to mobile base station (for general public exposures); and measurements and/or expert assessment or exposure modelled based on job-exposure matrices (for occupational exposures). The pregnancy outcomes considered included pre-term birth, small for gestational age (SGA), miscarriage, stillbirth. The associations between RF-EMF exposure and the outcomes were examined in terms of pooled relative risk (RR) or odds ratio (OR) with 95% confidence interval (CI). The synthesis of evidence was conducted according to the OHAT guidelines. For general public studies, maternal mobile phone exposure was not associated with pre-term birth risk (RR 1.14, 95 % CI: 0.97–1.34), or low birth weight (RR 1.14, 95 % CI 0.96–1.36), there was an association with SGA (RR 1.13, 95 % CI 1.02–1.24). For occupational studies, no association between maternal RF-EMF exposure and miscarriage (RR 1.06, 95 % CI 0.96–1.18), congenital anomalies (OR 1.06, 95 % CI 0.85–2.32), pre-term birth (RR 1.19, 95 % CI 0.32–4.37) or low birth weight (RR 2.90, 95 % CI 0.69–12.23) were found. Both the general public and occupational findings were low to very low certainty evidence. Overall evidence from review and meta-analysis indicates no or little association between maternal RF-EMF exposure and pregnancy outcomes in general public and occupational populations. 

Link to

The effects of radiofrequency exposure on adverse female reproductive outcomes: A systematic review of human observational studies with dose–response meta-analysis

Published in

Environment International

Commentary by ARPANSA:

The review provides state-of-the art methods on investigating whether maternal RF-EMF exposure is related to adverse pregnancy outcomes in the general and working populations. The included studies in the review have numerous limitations, including use of exposure surrogates (e.g., self-reported time spent on mobile phones or mobile phone use). The analysis of evidence on the association resulted in low-or very low-certainty mainly due to risk of bias, inconsistencies, indirectness, and imprecisionin the included studies. This report indicates that there is no substantiated evidence that maternal RF-EMF exposure (below the public and occupational limits described in the ICNIRP guidelines) causes adverse reproductive outcomes in female populations. This is in line with the public health message of the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) on RF-EMF exposure and health. The RF-EMF exposures in Australia are generally far below the limits given in the Australian Safety Standard (e.g., RPS-S1) and the ICNIRP guidelines. The Australian Safety Standard, developed by ARPANSA, is consistent with the ICNIRP guidelines and is based on validated international scientific evidence. Further, the findings reinforce the assessment of ARPANSA that there is no substantiated evidence that RF-EMF exposures at levels below the limits set in the Australian standard cause any adverse health effects. The review forms a part of the World Health Organization’s ongoing project to assess potential health effects of RF-EMF in the general and working population and ARPANSA is supporting this process.  

Review date

July 2024

Article publication date

July 2024

Summary

This randomised controlled trial in the USA studied the effect of three digital intervention programs on skin cancer risk protection practices. The authors recruited 1369 participants aged 18-25 and provided them with information on skin cancer risk factors in the form of either a basic pamphlet, an interactive program from a previous study or a new, enhanced interactive program. The efficacy of the three programs was then assessed over a 52-week period by evaluating the self-reported sun protection and skin cancer awareness behaviours of the participants. 1144 people completed all 52 weeks of the sun protection program.

The results showed a statistically significant difference  between both interactive programs on sun protection and habitual skin protection behaviour compared to the basic pamphlet. Other behaviours like skin self-examinations, sunscreen use and indoor tanning were also examined and while some weeks showed a significant difference between the interactive programs and the basic pamphlet, there was no consistent difference. Overall, the authors concluded that while the interactive programs were more effective than the basic pamphlet, there was no difference in efficacy between their original interactive program and the newly enhanced program.

Link to

Digital Interventions to Modify Skin Cancer Risk Behaviors in a National Sample of Young Adults: Randomized Controlled Trial

Published in

Journal of Medical Internet Research

Commentary by ARPANSA

Despite the vast amount of conclusive scientific information available on the effects of sun exposure and ultraviolet radiation (UVR) on health, particularly on skin cancer and melanoma risk, it remains an ongoing challenge to translate this information into meaningful behavioural change. This is particularly important in Australia where, although the average UV-index is very high, the climate is moderate year-round and outdoor activities are a large part of the prevailing culture. Although recent studies (De Pinto et al., 2024) detail some positive trends for melanoma incidence in Australia, the incidence rates remain some of the highest in the world. As such, skin cancers, including melanoma, continue to constitute a large public health burden. Sun health promotion campaigns have been shown to have a beneficial impact on public awareness (Tabbakh et al., 2019) and are also cost-effective (Shih et al., 2009). This study, and others like it, help to develop methodologies for improving the prevalence of preventative behaviour, ultimately to reduce the incidence and mortality rates of skin cancers.

More information about the risks of sun exposure and methods of sun protection can be found from: The World Health Organization, The Cancer Council of Australia and SunSmart websites. ARPANSA recommends following the five sun protection principles when the UV-index is over three. ARPANSA administers and maintains UVR monitoring stations across Australia that can be used to see the UV-index in real time across Australia and make informed decisions about sun protection. 

Review date

July 2024

Article publication date

June 2024

Summary

This systematic review and meta-analysis examined the effect of radiofrequency electromagnetic fields (RF-EMF) on male fertility as reported in human observational studies. The reviewers screened over twenty thousand articles that were identified in their literature search and ultimately included nine studies in the final review. Of the nine studies, seven related to mobile phone use and two studies related to occupational RF-EMF exposure (from radar or communications transmitters). The analysis of male fertility indicators for these two groups was performed separately. The fertility indicators that were considered were sperm concentration (amount), morphology (size, shape) and motility (movement) as well as total sperm count and time to pregnancy. Analysis on mobile phone use was further segmented by ‘duration of phone use’ and phone position (e.g., amount of time phone is kept in front pocket). The review also conducted certainty of evidence and risk of bias evaluations according to OHAT-GRADE.

Only four meta-analyses were possible on RF-EMF exposure from mobile phone use and each showed little to no effect on fertility outcomes. Each of these analyses were rated as very low certainty evidence. These ratings were mainly due to inconsistency and indirectness of the included studies resulting from poor exposure characterisation and outcome assessments. For outcomes where a meta-analysis was not possible, including those relating to the effect of phone position, all but one of the included studies reported no statistically significant effects. The study describing an effect presented a negative relation between mobile phone usage and sperm total motility. However, this result is weakened by very poorly classified exposure (measured by the total years participants had been using mobile phones and then grouped for comparison) and further weakened by probable selective reporting bias.

No meta-analysis was possible for occupational exposure due to large differences in the types of RF-EMF exposures between the two included studies. These studies reported a statistically significant difference in sperm concentration, motility and morphology for workers that were exposed compared to those who were not exposed. The authors cautioned against drawing overarching conclusions on occupational exposures from these findings due to the high risk of bias ratings for these studies and low amount of total data available on occupational exposures. 

Link to

The effects of radiofrequency exposure on male fertility: A systematic review of human observational studies with dose–response meta-analysis

Published in

Environment International

Commentary by ARPANSA

The review concluded that the currently available evidence on the effect of RF-EMF exposure on male fertility indicates little evidence of an association. However, the review also noted very low certainty of evidence and high risk of bias associated with the available evidence. Notably, the characterisation of exposure (e.g., phone call duration or self-reported usage) was highlighted as a major limitation of the currently available studies, introducing bias and uncertainty in the evidence. These crude surrogate exposure measures have also been highlighted as major limitations in other recent studies (Benke et al., 2024; Feychting et al., 2024; Röösli et al., 2024).

The International Commission on Non-Ionising Radiation Protection (ICNIRP) has also reviewed the effect of RF-EMF on fertility, concluding that there was no adverse effect of RF-EMF on human fertility, reproduction, or development. Overall, there remains no substantiated scientific evidence that exposure to RF-EMF below the limits set in ARPANSA safety standard  or the ICNIRP guidelines are a hazard to human fertility.

This review is part of the World Health Organization’s ongoing project assessing the health effects of RF-EMF (SR3 – Adverse reproductive outcomes (human observational studies)). ARPANSA is supporting this WHO review process. Another of these WHO reviews covered studies on male fertility in vitro and in non-human mammals which ARPANSA has reviewed in a previous literature survey. A systematic review of female fertility and reproductive outcomes has been published as a separate review by the same authors.

Review date

June 2024

Article publication date

June 2024

Summary 

This systematic review evaluated the evidence on exposure to radiofrequency electromagnetic energy (RF EME) and the long-term impacts on cognition in epidemiological studies. The review screened 3945 research papers and of these 5 prospective cohort studies were included in the final analysis. These studies were conducted between 2006 and 2017 and included 4639 participants consisting of 2808 adults and 1831 children across three countries (Australia, Singapore and Switzerland). The main source of RF EME was mobile phone use which was measured by the self-reported number of calls per week or minutes per day. Of the included studies only two, that investigated the effects of RF EME on cognition in children, were similar enough to be included in a meta-analysis (Bhatt et al. 2017 and Thomas et al. 2017). 

The meta-analysis found little to no effect of RF EME on learning and memory, executive function and complex attention in children with low or very low certainty of evidence. The review also assessed the effects of RF EME in elderly people and also found no evidence of an effect in any of the examined cognitive domains with very low certainty of evidence. An exposure–response relationship was not identified for any of the cognitive outcomes. The authors concluded that further studies are needed to address all types of populations, exposures and cognitive outcomes. 

Link to

The effects of radiofrequency exposure on cognition: A systematic review and meta-analysis of human observational studies

Published in

Environment International

Commentary by ARPANSA

The review found no consistent evidence of an effect of RF EME on cognition. However, there were limitations in the available evidence. One issue with the available literature is that the majority of the previous studies are cross-sectional studies, and these were not included in the systematic review. This is because they are unable to assess the long-term impact of exposure as they assess exposure and effect simultaneously by design. While the number of included studies was reduced, inclusion of cross-sectional studies would not have increased the certainty of the evidence. Previous narrative reviews that included cross-sectional studies reported inconsistent associations, with some finding improved cognition (Ishihara et al, 2020; ARPANSA, 2014).

There were several other limitations in the evidence including the fact that the effects of RF EME on cognition could not be separated from the effects of mobile phone use on cognition. This includes the impact that behaviours such as texting, gaming and social media use have on cognition. Another limitation in the evidence is exposure assessment being based on self-reported mobile phone use which can result in recall bias. 

Another major issue is that all of the studies used different tests to examine cognition. One of the main recommendations of this systematic review is that in future studies a consistent set of cognitive function tests for evaluation of each cognitive domain should be used. 

Overall, while there is no consistent evidence of an effect of RF-EMF exposure on cognition more long-term observational studies are needed to address important knowledge gaps.

The effect of RF EME on cognition has been reviewed by the International Commission on Non-Ionising Radiation Protection (ICNIRP) in their 2020 guidelines and they concluded there is no substantiated experimental or epidemiological evidence that exposure to RF EME affects cognition.  Overall, there remains no consistent scientific evidence that exposure to RF EME below the limits set in ARPANSA safety standard which is aligned with the ICNIRP guidelines is a hazard to human cognition or any other health effects. 

This review is part of the World Health Organisation’s (WHO) ongoing project assessing the health effects of RF-EMF. ARPANSA is supporting this WHO review process. One of the ongoing WHO systematic reviews will be examining cognitive impairment in human experimental studies (Pophof et al, 2021). This review will include an examination of the acute effects that RF EME has on cognition.