Scientific progress - wireless phones and brain cancer: current state of the science.

CONTEXT: The current science is not definitive about health risks from wireless phones; however, the legitimate questions about safety that have arisen from recent studies make claims of absolute safety no longer supportable. OBJECTIVE: The objective of this paper is to outline for primary care providers the results of the most current research on the possible impact of wireless phone use on human health. Presented are study results from Wireless Technology Research (WTR) program, the 7-year, $27 million effort funded by the wireless industry in the United States, that represents the world's most comprehensive research effort addressing this issue to date. Science-based recommendations for consumer interventions and future research are presented. DATA SOURCES: Original studies performed under the WTR program as well as other relevant research from around the world. STUDY SELECTION: This article presents a synopsis of the peer-reviewed in vitro and in vivo laboratory research, and the peer-reviewed epidemiology studies supported by the WTR, as well as a summary of other relevant work. DATA EXTRACTION: Only peer-reviewed scientific studies are presented, primarily WTR-sponsored research. In addition, results of the WTR literature surveillance program, which identified other relevant toxicology and epidemiology studies on an ongoing basis, are presented. These studies are presented in the context of their usefulness in providing intervention recommendations for consumers. DATA SYNTHESIS: Following a qualitative synthesis of specific relevant non-WTR research and a critical assessment of the WTR results, the following represents the current state of scientific understanding relevant to the public health impact of wireless phones: laboratory studies appear to have confirmed that radio frequency radiation from wireless phone antennas is insufficient to cause DNA breakage; however, this same radiation appears to cause genetic damage in human blood as measured through the formation of micronuclei. An increase in the rate of brain cancer mortality among hand-held cellular phone users as compared to car phone users, though not statistically significant, was observed in the WTR cohort study. A statistically significant increase in the risk of neuro-epithelial brain tumors was observed among cellular phone users in another case-control study. CONCLUSIONS: As new data emerge, our understanding of this complex problem will improve; however, at present there is a critical need for ongoing and open evaluation of the public health impact of new science, and communication of this science and derivative intervention options to those who are potentially affected.

Factors associated with breast implant rupture: pilot of a retrospective analysis.

This pilot study's goal was to test the feasibility of a data collection form which will be used in a scale-up study analyzing multiple surgeons' records. The goal of this expanded study will be to develop identifying factors for women who are at greater risk for having ruptured implants and, if necessary, target them for screening, surveillance, or intervention. In the pilot study, we compared factors associated with implant rupture in women with and without rupture. Similar studies have considered one or a few factors at a time and, generally, have given little attention to implant generation. We developed a data collection form after reviewing records of three surgeons. A total of 92 records was collected and analyzed. An important feature in the pilot was to compare the results of patients whose implants the surgeons had both implanted and explanted (n = 34) with those of patients whose implants the surgeons had only explanted (n = 55) (unknown = 3). This comparison could show if including all explantation patients in a surgeon's practice would bias the sample; however, based on this pilot data, concerns regarding this type of bias seem to be minimal. Similar amounts of data (e.g., implant information, history of capsular contracture, etc.) were collectable on patients whose surgeons both implanted and explanted them (87%) and who had different surgeons for implantation and explantation (84%). Though the data from this limited sample cannot offer firm conclusions on rupture associations, a few factors stood out: size of implants (38. 3% of ruptured versus 15.9% of intact implants were 100-200 cm3), history of mammography (46.8% of ruptured versus 24.4% of intact had mammograms, which is likely due to older women with older implants having more mammograms), and history of closed capsulotomy (85.1% of ruptured versus 68.9% of intact). Interestingly, additional procedures performed on the breast (e.g., scar revision, wound repair, etc.) did not affect rupture: both the ruptured and the intact groups had an average of 1.7 procedures performed. The data collection form tested very well in this pilot study. Also, including all patients in the study sample, instead of excluding those who received their implants elsewhere, did not change the results. Though there are not enough data to draw any firm conclusions regarding rupture factors, the collection instrument was rigorously tested and should perform well in an expanded study.

A review of the literature on the etiology of capsular contracture and a pilot study to determine the outcome of capsular contracture interventions.

The etiology of capsular contracture is unclear and probably multifactorial. This review covers the literature on several proposed contracture factors, including filler material, implant placement, surface texture, and bacterial infection. The pilot study's goal was to test the feasibility of a data collection form, which could be used in a scaled-up study analyzing multiple surgeon's records. The goal of the expanded version of this study will be to determine the efficacy of available interventions for capsular contracture, including surveillance. The Breast Implant Public Health Project, LLC (BIPHP), piloted a retrospective review of outcomes in women who had interventions to relieve capsular contracture or had chosen a wait-and-watch approach. An evaluation of the efficacy of various treatments can help women decide if they want to pursue treatment at all and, if so, which treatment might offer them the best solution. BIPHP researchers (E.E.A., M.E.) developed a data collection form after reviewing records of three surgeons (B.C., W.P., V.L.Y.). During the data collection using the same records, we tested a randomization process to identify women with capsular contracture who underwent various interventions, including a wait-and-watch strategy, and those who had no mention of any intervention or waiting approach. Data were gathered on a total of 90 breasts with capsular contracture (scored Baker I-IV or qualitatively), of which 45 underwent a total of 102 interventions for capsular contracture. Interventions were classified as "closed capsulotomy," "surgical," or "watchful waiting." Closed capsulotomy was performed most often (47%), followed by surgery (29%) and watchful waiting (21%). Presurgical Baker scores averaged higher in breasts that underwent surgery (3.1) than for watchful waiting (2.5) or closed capsulotomy (2.3). Though closed capsulotomies had 100% of outcomes scoring "improved" or "same," 58% of the breasts underwent the procedure more than once, suggesting that the favorable outcome was short-lived. The wait-and-watch approach resulted in scores of either "same" or "worse"; surgery (open capsulotomy, repositioning, or capsulectomy) resulted in 79% improved, 16% same, and 5% worse outcomes in breasts with outcomes listed. In all intervention procedure categories, outcomes were frequently unavailable; they were noted only 60% of the time (52/87). The missing 40% may have resulted from the doctor's failure to note it in the chart, satisfied patients not returning for additional treatment, or dissatisfied patients seeking treatment elsewhere. Generally, the data collection forms and procedures were workable; however, we uncovered issues to address in the scale-up of this pilot study: (1) the outcome report rate was 60%; (2) though Baker scores are commonly used to evaluate the degree of capsular contracture, it seems that grade I may have different meanings for different surgeons, which would need to be clarified; (3) participating surgeons will need to divulge standard-of-care items that they may not have included in medical records, but routinely performed (e.g., patient massage, use of prophylactic antibiotics); and (4) records were initially separated by "implant," then researchers realized that a more useful collection would be by "breast." The latter approach captures the history of the breast in one record, which may be more important to contracture than the differences in implants. With the modifications discussed, the study can be scaled up to encompass as many records as necessary to achieve robust statistical power. These data will add to the existing literature regarding factors associated with capsular contracture and identify factors that affect the successful outcome of capsular contracture interventions.

Reduced mortality among workers at a rubber plant.

We conducted a retrospective cohort study of mortality among current and former male employees of a modern tire manufacturing plant in Texas. Vital status was ascertained for more than 99% of the cohort of 2306 workers. Standardized mortality ratio analyses were completed based on 102 deaths. No significant excess for any disease-specific cause of death was identified, and significant deficits in all-cause mortality and deficits in cancer mortality were observed for both white and nonwhite men. The analyses were consistent in indicating that this work force has experienced no excessive disease-specific mortality.

The interplay of science, values, and experiences among scientists asked to evaluate the hazards of dioxin, radon, and environmental tobacco smoke.

To investigate the extent to which personal values and experiences among scientists might affect their assessment of risks from dioxin, radon, and environmental tobacco smoke (ETS), we conducted an experiment through a telephone survey of 1461 epidemiologists, toxicologists, physicians, and general scientists. Each participant was read a vignette designed to reflect the mainstream scientific thinking on one of the three substances. For half of the participants (group A) the substance was named. For the other half (group B), the substance was not named but was identified only as Substance X, Y, or Z. Knowing the name of the substance had little effect on the scientists' evaluation of dioxin, although those who knew the substance to be dioxin were more likely to rate the substance as a serious environmental health hazard (51% vs. 42%, p = 0.062). For radon, those who knew the substance by name were significantly more likely to consider it an environmental health hazard than were those who knew it as substance Z (91% vs. 78%, p less than 0.001). Participants who knew they were being asked about ETS rather than substance X were significantly more likely to consider the substance an environmental health hazard (88% vs. 66%, p less than 0.001), to consider the substance a serious environmental health hazard (70% vs. 33%, p less than 0.001), to believe that background exposure required public health intervention (85% vs. 41%, p less than 0.001), and to believe that above-background exposure required public health intervention (90% vs. 74%, p less than 0.001). These findings suggest that values and experiences may be influencing health risk assessments for these substances, and indicate the need for more study of this phenomenon.

Mortality of a municipal worker cohort: I. Males.

A retrospective cohort mortality study was conducted on 11,499 full-time municipal employees of the City of Buffalo, New York, who were employed at least one day between January 1, 1950 and October 1, 1979 and worked a minimum of five years. This paper outlines the method of the study and presents the all cause and cause-specific mortality for the male cohort of 10,128. Statistically significant deficits in mortality are seen for infectious diseases, diseases of the circulatory system, diseases of the respiratory system, and all external causes. Statistically significant increased mortality is seen for both malignant and benign neoplasms. All cause mortality was significantly lower than expected for professional, manager, and clerical workers. White-collar workers exhibit a decreased risk of mortality from all diseases of the circulatory system, all diseases of the respiratory system, and all external causes of death. No statistically significant increased or decreased risk of mortality from specific cancer sites is seen for white-collar workers. Blue-collar workers show statistically significant deficits in mortality from infectious diseases, all diseases of the circulatory system, all respiratory diseases, and all external causes. Blue-collar workers exhibit statistically significant increases for benign and malignant neoplasms and in particular, malignant neoplasms of the esophagus, large intestine, and rectum. The meaning of these findings will be clarified through analyses of specific worker groups.

A cross sectional study of employees with potential occupational exposure to ethylene oxide.

A cross sectional study was conducted on 84 employees potentially exposed to ethylene oxide (EO) to determine whether they had a higher prevalence of abnormalities of the haematopoietic, hepatic, or renal systems than a control group individually matched on age, hire date, race, smoking habits, alcohol history, and date of examination. Potential exposures were estimated to be generally below the current threshold limit value of 10 ppm, with most below 1 ppm. Results of the haematological and biochemical studies were similar in the two groups. A statistically significant (p = 0.035) increase in the prevalence of proteinuria was noted among the EO group which warrants further investigation.

Cancer incidence and trihalomethane concentrations in a public drinking water system.

Four thousand two hundred fifty-five cases of esophageal, stomach, colon, rectal, bladder, and pancreatic cancer reported from Erie County, NY between 1973 and 1976 were analyzed in terms of their relationship to type of water source, level of trihalomethane (THM) and various social and economic parameters. Among white males, a significant positive correlation existed between pancreatic cancer incidence rates and THM level. No other significant correlations were observed. This research lends little or no support to the hypothesis that THM levels which meet present standards are related to the incidence of human cancer.