Monday, July 26, 2021

In 1989, Susan Reynard, a 31-year-old woman in Madeira Beach, Florida, was diagnosed with a malignant astrocytoma in the left parieto-occipital area of her brain. She underwent surgery and despite that, given the unfortunate nature of this tumor, expired in 1993 at the age of 34. There was nothing unusual or unique about her disease or its outcome.

What was very unusual and unique, however, was what followed. Her husband, David Reynard, filed a lawsuit in Florida’s courts claiming that NEC, the maker of Susan’s cell phone, was responsible for her tumor and her subsequent death. I don’t know much about public relations, but somehow Reynard managed to get onto the Larry King Live Show, where his accusations regarding cell phones acquired a nationwide audience. This created widespread concern regarding the risks and safety of cell phone use that has not subsided to this day.

Cell phones generate electromagnetic radiation. Ionizing radiation, the type of radiation in X-rays, radioactive elements and nuclear explosions, can cause brain tumors. These two types of radiation share nothing in common except for the word “radiation.” When the case did get to court in 1995, the expert witness in support of the plaintiffs argued that the tumor was on the left, that Susan was left-handed and used the phone at her left ear. He also argued that cell phones generate electromagnetic radiation. There was no scientific evidence showing a link on any level—cellular, animal data, human epidemiologic data—between exposure to cell phones and the incidence of brain tumors. The case was quickly dismissed.

Between 1990 and 2002, use of cell phones skyrocketed from 4 million to over 130 million; there were 280 million in use in 2010 in the U.S. Given this enormous population-level rise in the prevalence of cell phones, as well as its constant presence at people’s skulls, one might hypothesize that if the radiation emanating from these devices were indeed carcinogenic, then there should have been a concomitant rise in the incidence of brain tumors. But the reality is that there has been very little change in brain tumor incidence over this time period. The annual male incidence rate was 3.12/100,000 for 1987-1991 and 3.23/100,000 for 2002-2006, while for females it went from 2.60/100,000 to 3.25/100,000, hardly a major change. Likewise, one might have expected a trend towards the right side for brain tumors over the time frame, since 85% of the population is right-dominant, during which cell phone use expanded. But this also has not occurred.

Despite winning the Reynard case, the cell phone companies recognized that more litigation was inevitable. Consequently, they undertook to actually investigate the potential association between electromagnetic radiation and brain tumors. Studies were conducted both in the lab and in epidemiologic settings. I cannot speak as an expert to the lab studies except to say that I believe this type of radiation is nowhere near as harmful as ionizing radiation and shows very little indication of carcinogenic potential to cells.

As for the epidemiologic studies, the vast majority (and there have been many) showed no association between cell phone use and brain tumor risk. For transparency, let me comment that I was co-author on one such study published in 2000 that found no association. Some studies focused on acoustic neuromas, the type of tumor that occurs in the vicinity of the ear, figuring that this would be the likeliest anatomic site that the radiation would be likely to affect. The overall evidence does not seem different for these tumors than for gliomas or brain tumors as a whole.

Caution is appropriate, however. The International Agency for Research on Cancer, the most widely respected organization for assessing carcinogenic risk, when it evaluated radiofrequency radiation (RFR) exposure in 2011, gave it a ranking of 2B (possible carcinogenicity). In effect, this evaluation leaves the door open, in IARC’s opinion, to future evidence.

What kept it from being more negative? There was the work of Lennart Hardell, a Swedish epidemiologist. He is a respected scientist, and somehow, most of his studies on the subject have found associations in one way or another between cell phone use and risk, in contrast to most of the rest of the published literature. These studies are controversial and have potential flaws, but they are part of the mosaic.

To keep the issue hot, subsequent to the publication of the IARC monograph on the subject, the National Toxicology Program, which conducts animal studies to assess the potential for chemicals or other exposures to cause cancer, published its findings with regard to RFR (electromagnetic radiation). They found that it caused the occurrence of Schwannomas and gliomas in three rodent studies. Others have criticized these studies—the doses were much more than a human would ever get in a lifetime, the control group was not well designed, etc. But the results remain.

And I suppose with them will remain this topic as an issue going forward.

Alfred I. Neugut, MD, PhD, is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York.

This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.

By Alfred I. Neugut


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