Mobile phone use and acoustic neuroma risk in Korea

Jae-wook Choi1) Songyi Yoon1) Dong-Soo Yoo2)Hae-Joon Kim1) Joon-young Lee3) Soo-Ho Shim1) Mun-seob Ahn1) Kyong-Hee Kim) Jeung-Hun Kim4) Chul-Ki Park5) Sung-

Suk Lee6) Hae-Rim Park7) Yong-Ku Jeong8) Yong-Sik Kim9) Kyung-Mi Park10)

Department of Preventive Medicine, College of Medicine, Korea University1) Graduate School Korea University2) Department of Biostatistics, Korea university3) Seoul Asan Hospital4) Seoul National Hospital5) Korea Canter Center Hosptial6) Hanrim Unversity Hospital7) Korea University Anam Hospital8) Korea University Ansan Hospit

al9)Sanggye Paik Hospital10)*Corresponding author: Jae-wook Choi(shine@korea.ac.kr)

2

Background

• The question about the effect of an electromagnetic wave produced by a cellul

ar phone to the human being prevails internationally due to dramatic incease

of the number of cellular phone user

• the studies are about the epidemiology study about the correlation with a brai

n tumor, the study about the effect to a human being with the short time expo

sure, the experimental study about tumor, gene expression and the effect of D

NA with animals, and mainly the study in vitro about the effect to the cell ---->

Among these, some of the results of the studies have been released and expo

sed to the users of a cellular phone so that the insecurity of the health statue

of them rises

3

Background

• The active epidemiology study about the effect of an electromagnetic waves

produced by a cellular phone to human being has been proceeded as a form

of collaborated epidemiology study in the WHO IARC interphone study team

since 2000, which 13 nations leaded by Europe have participated in

• Among them, the first study has been completed in 2003; and the results of 9

studies have been released recently. Six studies of them has been proved to

be not correlated. Also three is not directly correlated but they still have the

potential of a damage to heath, which is still required to be further studied.

4

StudyYears

Study TypeAge

No.of

Cases

Odds ratio

95% CIComments

Inskip et al 2

001 USA

1994-1998

Case-Control>-18years 5

1.9

(0.6-5.9)>-5 years of cell phone use

Muscat et al

2002 USA

1997-1999

Case-Control>-18years 11

1.7

(0.5-5.1)

3-6 years of cell phone use

Lonn et al

2004 swede

n

(Interphone)

1999-2002

Case-Control20-69

years14

1.8

(0.8-4.3)

>-10 years since first ‘regular’mobile phone

use, result for either side of head

Christensen et al 2004 Denmark

(Interphone)

2000-2002

Case-Control20-69

years45

0.9

(0.5-1.6)Regular use

Summary of eight studies on acoustic neuroma and mobile phones

5

StudyYears

Study TypeAge

No.of

Case

s

Odds ratio

95% CIComments

Schoemaker et al 2005 D

enmark,Finland,

Sweden, Norway, Scotlan

d, England

(Interphone)

1999-2004

Case-Control

18-

69years

(variable)

3600.9

(0.7-1.1)Regular use

Hardell et al

2006 Sweden

1997-2003

Case-Control

20-

28years130

1.7

(1.2-2.3)

>/1 year latency of mobile

phone use

Schuz et al

2006 Denmark

1982-2002

Cohort 18 years 32SIR0.7

(0.5-1.03)

No data on latency or laterality

of tumour and use of mobile ph

one

Takebayashi et al 2006 Tokyo

2000-2004

Case-Control30-

69years51

0.7

(0.4-1.2)Regular use

Summary of eight studies on acoustic neuroma and mobile phones

6

Background

39,565

32,745

43,410

35,387

44,037

32,831

46,908

35,412

48,005

35,841

55,398

43,627

0

20,000

40,000

60,000

80,000

100,000

No.

of

case

s

1996 1997 1998 1999 2000 2002

Years

Cancer Registry by sex

Male Female

7

Background

Cancer incidence by region, Age-standardized incidence rate (ASR) Unit: cases, per 100,000 Male (Left), Female (Right)

8

Background

0 5000 10000 15000 20000 25000

Unit: per 100,000

Cancer Incidence in Korea(1999- 2002)

Brain T umor Pancreas Colon and Rector Liver Lung Stomach

AllCancer

9

Background

671

36

593

38

500550600650700750

No.

of

case

s

남자 여자

S E X

Acoustic Neuroma Incidence in Korea(1999- 2002)

뇌종양 청신경초종

Male (Left) Female (Right)Brain Tumor (Blue) Acoustic Neuroma (Red)

10

Background

• It should be noticed since it was reported that some studies about an acoust

ic neuroma or immunologic studies in a cellular level reported the relationsh

ip with the exposure

• 95 % of an acoustic neuroma occurs ipsilaterally and non-genetically. Aroun

d 5 % is a form of a neurofibroma, which is a genetic disease; the type 1 is d

ue to a genetic damage on chromosome 17, while the type 2 is due to a gene

tic damage on chromosome 22

11

Background

• Considering other studies about the relationship between the acoustic n

euroma and the exposure of the electromagnetic wave produced by a cel

lular phone, the epidemiologic characteristics of the tumor, and the anat

omical position which corresponds to the actual exposure spot, the stud

y about the risk of the acoustic neuroma is definitely needed to be acco

mplished.

12

Subjects of study

Method of study

• A disease of a subject group was Acoustic neuroma; C72.

• A Subject group was a group with 51 patients out of 64 patient diagnosed patho

logically or radiologically that was reported to the clinical laboratory and the ot

orihinoaryngology of 9 hospitals with the age of 15 to 69, excluded 13 patients

of dead people, people who refused to do, and not eligible people

• A control group was preceded in the same way. It was 102 matched to Acoustic

neuroma; C72 with the ratio of 1:2, which was age (±5), sex, address

• The ratio of control and subject according to a disease was based on he protoc

ol about the control-subject study of Feasibility study in 1999 presented by WH

O IARC Interphone study team

• The study was on process from February 1st, 2002 to December 31st, 2006.

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Method Of Study

Method of study

• The epidemiology study about the effect of the electromagnetic waves produced by a cellular phone and a process system through its

questionnaire was the same with Figure 1.

• The participating hospitals reported the subjects to the study team within one week of the diagnosis and the nurse who was trained about the epidemiology study accomplished the questionnaire within one month with cooperation of the doctor in charge.

• IRB of each hospital during the questionnaire examined the moral part of this study, and the examination was completed in 2005.

• The theme and purpose of this study were fully explained and the questionnaire was accomplished with agreement of a patient, and informed consent was obtained.

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Method Of Study

Method of study

• Categories included in the questionnaire were 148 in total

• Basic categories were about individual’s social economic state, medial

insurance, smoking and drinking habit, sleeping and exercise habit, eating

habit, subjective symptoms before hospitalization, job history, electronics

and method of transportation.

• The categories related to a mobile phone were calling time, total calling

time, monthly average calling fee, the type of phone, text message, calling

spot ( on body), symptoms related to a mobile phone use.

15

Target Disease Selection

Establishment of target disease reporting system Exposure Assessment

Pathology, Neurosurgery and ENT department ofNine University hospital in Seoul and Kyungi province

Validity verification of Exposure Assessment model

Case-Control selection (Sex-age-matching) A part of mobile phone user

Total call timeCase-control research accomplishment

Exposure Assessment model(Analog/Digital, Total call time,Average daily minutes of use) Comparison

Yes NoElectromagnetic wavesExposure Assessment

Derivation Development Odds Ratio

Figure 1. Case-control study designFigure 1. Case-control study design

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Method of study

• The calculated credibility was used to demonstrate that the Korean questio

nnaire was suitable for the study.

• The analysis of the data was the evaluation standard about the credibility

(consistency) of the two questionnaires obtained by Test-retest; it calculat

ed kappa value ( or Kapa value with weight) and 95% credibility range of K

apa value.

• For the matter of Kapa value of each category about the subjective sympto

ms due to a mobile use was 0.477-1.000; and it was consistent in the credi

bility and the appropriateness.

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Data Analysis

Method of study

• Data analysis is about the frequency of the basic characteristics of both

the control and the subject groups, the distribution of a mobile phone

related categories, and the distribution of subjective symptoms after a

mobile phone use.

• To demonstrate the consistency with the characteristics of the variables

such as the type of a mobile phone, the variables, SPSS-PC 10.0 program

was used.

RESULTRESULT(Case 51, Control 102(Case 51, Control 102)

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Table 1. General characteristics of case and control groupTable 1. General characteristics of case and control group

†χ2-test. *Student t-test.

Cases (n=51) Controls (n=102) p-value

Gender†Male 21 (41.2) 42 (41.2)

1.000Female 30 (58.8) 60 (58.8)

Age§ 46.47±13.5 (19.0-68.0) 43.65±14.2 (19.0-73.0) 0.527

Education§ 12.02±3.0 (6.0-18.0) 12.43±4.1 (0-19.0) 0.604

Smoking†Yes 6 (11.8) 15 (14.7)

0.618No 45 (88.2) 87 (85.3)

Drinking†Yes 21 (41.2) 56 (55.4)

0.097No 30 (58.8) 45 (44.6)

Region†Urban 37 (74.0) 83 (87.4)

0.043Rural 13 (26.0) 12 (12.6)

Sleeping hours§ 6.92±1.5 (4.0-10.0) 6.6±1.1 (4.0-9.0) 0.053

Hair dye use†Yes 30 (58.8) 68 (66.7)

0.341No 21 (41.2) 34 (33.3)

Family cancer decease history†

Yes 11 (21.6) 30 (29.4)0.302

No 40 (78.4) 72 (70.6)

Stress§ 82.15±57.7 (16.0-276.0) 75.54±78.0 (11.0-420.0) 0.170

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Table 2. CharacteristicsCharacteristics of mobile phone usage

†χ²-test. §student t-test: * p<0.05, **p<0.001.

Cases (n=51) Controls (n=102)

Wireless phone useYes 44 (86.3) 79(77.5)

No 7 (13.7) 23(22.5)

Months of use 66.46±28.7 (12-120) 65.99±34.9 (10-145)

Average daily minutes of use 17.21±16.1 (2-60) 32.29±38.6 (1-240)

Antenna use

Yes 5 (13.5) 9(12.3)

No 32 (86.5) 64(87.7)

Monthly expenses for Wireless phone (won)

43951±35401(13000-200000) 42014±26287(14000-180000)

N(%), Mean±SD(min-max

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Table 3. Subjective symptoms against mobile phone Table 3. Subjective symptoms against mobile phone useuse

Symtoms   Cases

(n=51)

Controls

(n=102)Symtoms

Cases

(n=51)

Controls

(n=102)

Headache Yes 1(2.3) 4(5.1) Heating on Ear Yes 11(25.6) 31(39.2)

No 42(97.7) 75(94.9) No 32(74.4) 48(60.8)

Dizziness Yes 1(2.3) 3(3.8) Heating on face Yes 3(7.0) 10(12.7)

No 42(97.7) 76(96.2) No 40(93.0) 69(87.3)

Concentration Disturbance

Yes 1(2.3) 3(3.8) Skin drying Yes 1(2.3) 4(5.1)

No 42(97.7) 76(96.2) No 42(97.7) 75(94.9)

Displeasure Yes 3(7.0) 4(5.1) Facial pain Yes 0(0.0) 2(2.5)

No 40(93.0) 75(94.9) No 43(100.0) 77(97.5)

Physical fatigue

Yes 1(2.3) 4(5.1) Eye pain

Yes 2(4.7) 2(2.5)

No 42(97.7) 75(94.9) No 41(95.3) 77(97.5)

Memory Disturbance

Yes 0(0.0) 5(6.3)

No 43(100.0) 74(93.7)†χ2-test.

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Table 4. Odds ratio of Acoustic neuroma between mobile phone typesTable 4. Odds ratio of Acoustic neuroma between mobile phone types

Cases (n=51) Controls (n=102) OR (95% CI)

Non useAnalogDigital+AnalogDigital

7(13.7)5(9.8)

22(43.1)17(33.3)

23(22.5)10(9.8)

44(43.1)25(24.5)

1.00.45(0.16-1.28)0.74(0.21-2.54)0.74(0.33-1.64)

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Table 5. Odds ratio of Acoustic Neuroma between mobile phone usages

†The odds ratio (OR) and 95% confidence interval (CI) were calculated by unconditional multiple logistic regression analysis with fifteen categorize variables [ gender(1:male, 0:female); age(1:>20years, 2:20-29years, 3:30-39years, 4:40-49years, 5:50-59years, 6:≤60) years; residential district(1:rural area, 0:urban area); smoking habits(1:yes, 0:no); drinking habits(1:yes, 0:no); sleeping hours(1:<7hours, 0:≥7hours); hair dyeing(1:yes, 0: no); cancer in family members in a direct line(1:yes, 0:no); stress(1:yes, 0:no); Mobile phone use(1:yes, 0:no); Cumulative length of use(1:Non use, 2: <48months, 3:48-83months, 4:≥84months); Cumulative call time(1:Non use, 2:<300hours, 3: 300—899hours, 4:≥900hours); monthly fee (1:Non use, 2:<30,000won, 3:30,000-49,999won, 4:50,000-79,999won, 5:≥80,000won); Regular side of mobile phone use(1:right, 2:left, 3:both, 4:don’t know); Laterality(1:Non use, 2:Ipsi-use, 3:Contra-use, 4:both).

Mobile phone usages Cases (n=51) Controls (n=102) OR (95% CI)

Mobile phone use NoYes

7(13.7)44(86.3)

23(22.5)79(77.5)

1.01.83(0.73-4.61)

CumulativeLength of use (month)

Non use<4848-83≥84

7(13.7)11(21.6)19(37.3)14(27.5)

23(22.5)19(18.6)38(37.3)22(21.6)

1.01.90(0.62-5.86)1.64(0.60-4.51)2.09(0.71-6.15)

Cumulative call time(hour)

Non use<300300--899≥900

7(14.3)17(34.7)15(30.6)10(20.4)

23(22.5)25(24.5)18(17.6)36(35.3)

1.02.23(0.79-6.36)2.74(0.92-8.13)0.91(0.30-2.74)

Monthly fee(won)

Non use<30,00030,000-49,99950,000-79,999≥80,000

7(14.0)12(24.0)23(46.0)

4(8.0)4(8.0)

23(23.0)26(26.0)27(27.0)19(19.0)

5(5.0)

1.01.52(0.51-4.50)2.80(1.02-7.70)0.69(0.18-2.72)

2.63(0.55-12.55)

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Table 6. The locations of Acoustic neuroma and mobile phone usage

p<0.05

Tumor Site

Phone usage

Right (%) Left (%) Both (%) Total (%)

Right 3(42.9) 10(83.3) 1(50.0) 14(66.7)

Left 4(57.1) 1(8.3) 0(0.0) 5(23.8)

Both 0(0.0) 1(8.3) 1(50.0) 2(9.5)

Total 7(100.0) 12(100.0) 2(100.0) 21(100.0)

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Discussion

• A mobile phone has been generalized in Korea so that the mobile phone

user explosively has increased since 1995.

• The distribution rate exceeded 70 % with the 33,592,000 members of a

mobile phone now on December in 2004;also it increased to 79% with the

38,342,000 in 2006

• The effect of the electromagnetic waves by a mobile phone to human was

in the middle of interest so that there are many epidemiology studies about

it. According to the results, there is not significant relevancy between the

use of a mobile phone and the rate of cancer

26

Discussion

• The matter about the use of cellular phone and health has not been fully

studied, and the latency period to become a cancer after the exposure is more

than at least 10 years since the initial exposure.

• When considering some results of the epidemiology study in the residential

area, the study was to prove the relationship between a user of a analogue

and a digital mobile phone who lived in countryside and a user in the city in

central Sweden. In this study, it was reported that the urban people was likely

to have a brain tumor than the people in countryside , which was indicated in

some results of some users of an analogue and digital mobile phone for 10

years The result of this study, it was also consistent with the different

locations of residence.

27

Discussion

• In this study, the subjective symptoms after a mobile phone use in each br

ain tumor group was examined in details: a headache, dizziness, deteriorat

ion of concentration, physical fatigue, memory impairment, ear burning, fa

cial flush and burning, skin dryness, facial itchiness and stinginess and ey

e hurt and tear.

• The control group had more frequency of headache, dizziness and deterior

ation of concentration than the subject group.

• The symptoms of pain or dizziness of the subject group were mainly depen

dent on their own memory; it should be considered that the recall bias due

to the headache produced by an acoustic neuroma could have affected the

results of the study.

28

Discussion

• In the study about the relevancy of an acoustic neuroma with the calling sp

ot, the incidence was 42.9 % for the right ear, while the incidence was 57.

1 % for the left when the mobile phone was used on each ear; but it was no

t statically significant.

• The analysis method used in this study was a case only design, which was

the practical application of the method suggested by Inksip (2001)

29

Donclusion

• To prove the interaction, the sample and the exposure evaluation for

analysis are made as well as the epidemiology studies about the possible

brain tumor by the electromagnetic waves and its related factors.

• And this study will present the basic data for the studies about a mobile

phone use and its related brain tumor in the future.

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Thank you !!