Editor's Choice - Incidence of Lower Limb Amputations in Sweden from 2008 to 2017.

OBJECTIVE: This study examined the recent national and regional incidence of lower limb amputations (LLAs) in Sweden and their annual changes. METHODS: This was an observational study using Swedish national register data. All initial amputations were identified in Sweden from 2008 to 2017 in individuals 18 years or older using the national inpatient register. The amputations were categorised into three levels: high proximal (through or above the knee joint), low proximal (through the tibia to through the ankle joint), and partial foot amputations. To examine the national and regional incidence and annual changes, the age, sex, and region specific population count each year was used as the denominator and Poisson regression or negative binomial regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) adjusted for age and sex. RESULTS: The national annual incidence of LLAs was 22.1 per 100 000 inhabitants, with a higher incidence in men (24.2) than in women (20.0). The incidence of LLAs (all levels combined) declined during the study period, with an IRR of 0.984 per year (95% CI 0.973 - 0.994). This was mainly due to a decrease in high proximal amputations (0.985, 95% CI 0.974 - 0.995) and low proximal amputations (0.973, 95% CI 0.962 - 0.984). No change in the incidence of partial foot amputations was observed (0.994, 95% CI 0.974 - 1.014). Such declines in LLA incidence (all levels combined) were observed in nine of the 21 regions. Compared with the national average and with adjustment for age, sex, diabetes, and artery disease, the regional IRR varied from 0.85 to 1.36 for all LLAs, from 0.67 to 1.61 for high proximal amputations, from 0.50 to 1.51 for low proximal amputations, and from 0.13 to 3.68 for partial foot amputations. CONCLUSION: The incidence of LLAs has decreased in Sweden. However, regional variations in incidence, time trends, and amputation levels warrant further research.

Very high radiofrequency radiation at Skeppsbron in Stockholm, Sweden from mobile phone base station antennas positioned close to pedestrians' heads.

In urban environment there is a constant increase of public exposure to radiofrequency electromagnetic fields from mobile phone base stations. With the placement of mobile phone base station antennas radiofrequency hotspots emerge. This study investigates an area at Skeppsbron street in Stockholm, Sweden with an aggregation of base station antennas placed at low level close to pedestrians' heads. Detailed spatial distribution measurements were performed with 1) a radiofrequency broadband analyzer and 2) a portable exposimeter. The results display a greatly uneven distribution of the radiofrequency field with hotspots. The highest spatial average across all quadrat cells was 12.1 V m⁻1 (388 mW m⁻2), whereas the maximum recorded reading from the entire area was 31.6 V m⁻1 (2648 mW m⁻2). Exposimeter measurements show that the majority of exposure is due to mobile phone downlink bands. Most dominant are 2600 and 2100 MHz bands used by 4G and 3G mobile phone services, respectively. The average radiofrequency radiation values from the earlier studies show that the level of ambient RF radiation exposure in Stockholm is increasing. This study concluded that mobile phone base station antennas at Skeppsbron, Stockholm are examples of poor radiofrequency infrastructure design which brings upon highly elevated exposure levels to popular seaside promenade and a busy traffic street.

Case-control study on occupational exposure to extremely low-frequency electromagnetic fields and the association with acoustic neuroma.

Exposure to extremely low-frequency electromagnetic fields (ELF-EMF) was in 2002 classified as a possible human carcinogen, Group 2B, by the International Agency for Research on Cancer at WHO based on an increased risk for childhood leukemia. In case-control studies on brain and head tumours during 1997-2003 and 2007-2009 we assessed life-time occupations in addition to exposure to different agents. The INTEROCC ELF-EMF Job-Exposure Matrix was used for associating occupations with ELF-EMF exposure (µT) with acoustic neuroma. Cumulative exposure (µT-years), average exposure (µT) and maximum exposed job (µT) were calculated. No increased risk for acoustic neuroma was found in any category. For cumulative exposure in the highest exposure category 8.52+ µT years odds ratio (OR) = 1.2, 95% confidence interval (CI) = 0.8-2.0, p linear trend = 0.37 was calculated. No statistically significant risks were found in the time windows 1-14 years, and 15+ years, respectively. In conclusion occupational ELF-EMF was not associated with an increased risk for acoustic neuroma.

Case-control study on occupational exposure to extremely low-frequency electromagnetic fields and glioma risk.

BACKGROUND: Exposure to extremely low-frequency electromagnetic fields (ELF-EMF) was in 2002 classified as a possible human carcinogen, Group 2B, by the International Agency for Research on Cancer at WHO. METHODS: Life time occupations were assessed in case-control studies during 1997-2003 and 2007-2009. An ELF-EMF Job-Exposure Matrix was used for associating occupations with ELF exposure (µT). Cumulative exposure (µT-years), average exposure (µT), and maximum exposed job (µT) were calculated. RESULTS: Cumulative exposure gave for astrocytoma grade IV (glioblastoma multiforme) in the time window 1-14 years odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.4-2.6, p linear trend <0.001, and in the time window 15+ years OR = 0.9, 95%CI = 0.6-1.3, p linear trend = 0.44 in the highest exposure categories 2.75+ and 6.59+ µT years, respectively. CONCLUSION: An increased risk in late stage (promotion/progression) of astrocytoma grade IV for occupational ELF-EMF exposure was found.

Increasing incidence of thyroid cancer in the Nordic countries with main focus on Swedish data.

BACKGROUND: Radiofrequency radiation in the frequency range 30 kHz-300 GHz was evaluated to be Group 2B, i.e. 'possibly' carcinogenic to humans, by the International Agency for Research on Cancer (IARC) at WHO in May 2011. Among the evaluated devices were mobile and cordless phones, since they emit radiofrequency electromagnetic fields (RF-EMF). In addition to the brain, another organ, the thyroid gland, also receives high exposure. The incidence of thyroid cancer is increasing in many countries, especially the papillary type that is the most radiosensitive type. METHODS: We used the Swedish Cancer Register to study the incidence of thyroid cancer during 1970-2013 using joinpoint regression analysis. RESULTS: In women, the incidence increased statistically significantly during the whole study period; average annual percentage change (AAPC) +1.19 % (95 % confidence interval (CI) +0.56, +1.83 %). Two joinpoints were detected, 1979 and 2001, with a high increase of the incidence during the last period 2001-2013 with an annual percentage change (APC) of +5.34 % (95 % CI +3.93, +6.77 %). AAPC for all men during 1970-2013 was +0.77 % (95 % CI -0.03, +1.58 %). One joinpoint was detected in 2005 with a statistically significant increase in incidence during 2005-2013; APC +7.56 % (95 % CI +3.34, +11.96 %). Based on NORDCAN data, there was a statistically significant increase in the incidence of thyroid cancer in the Nordic countries during the same time period. In both women and men a joinpoint was detected in 2006. The incidence increased during 2006-2013 in women; APC +6.16 % (95 % CI +3.94, +8.42 %) and in men; APC +6.84 % (95 % CI +3.69, +10.08 %), thus showing similar results as the Swedish Cancer Register. Analyses based on data from the Cancer Register showed that the increasing trend in Sweden was mainly caused by thyroid cancer of the papillary type. CONCLUSIONS: We postulate that the whole increase cannot be attributed to better diagnostic procedures. Increasing exposure to ionizing radiation, e.g. medical computed tomography (CT) scans, and to RF-EMF (non-ionizing radiation) should be further studied. The design of our study does not permit conclusions regarding causality.

Mobile phone and cordless phone use and the risk for glioma - Analysis of pooled case-control studies in Sweden, 1997-2003 and 2007-2009.

We made a pooled analysis of two case-control studies on malignant brain tumours with patients diagnosed during 1997-2003 and 2007-2009. They were aged 20-80 years and 18-75 years, respectively, at the time of diagnosis. Only cases with histopathological verification of the tumour were included. Population-based controls, matched on age and gender, were used. Exposures were assessed by questionnaire. The whole reference group was used in the unconditional regression analysis adjusted for gender, age, year of diagnosis, and socio-economic index. In total, 1498 (89%) cases and 3530 (87%) controls participated. Mobile phone use increased the risk of glioma, OR=1.3, 95% CI=1.1-1.6 overall, increasing to OR=3.0, 95% CI=1.7-5.2 in the >25 year latency group. Use of cordless phones increased the risk to OR=1.4, 95% CI=1.1-1.7, with highest risk in the >15-20 years latency group yielding OR=1.7, 95% CI=1.1-2.5. The OR increased statistically significant both per 100h of cumulative use, and per year of latency for mobile and cordless phone use. Highest ORs overall were found for ipsilateral mobile or cordless phone use, OR=1.8, 95% CI=1.4-2.2 and OR=1.7, 95% CI=1.3-2.1, respectively. The highest risk was found for glioma in the temporal lobe. First use of mobile or cordless phone before the age of 20 gave higher OR for glioma than in later age groups.

Use of mobile and cordless phones and survival of patients with glioma.

BACKGROUND: We analysed the survival of patients after glioma diagnosis in relation to the use of wireless phones. METHODS: All cases diagnosed between 1997 and 2003 with a malignant brain tumour (n = 1,251) in our case-control studies were included and followed from the date of diagnosis to the date of death or until May 30, 2012. RESULTS: For glioma, the use of wireless phones (mobile and cordless phones) gave a hazard ratio (HR) = 1.1 (95% confidence interval, CI = 0.9-1.2), with > 10-year latency HR = 1.2 (95% CI = 1.002-1.5, p trend = 0.02). For astrocytoma grade I-II (low-grade), the results were, HR = 0.5 (95% CI = 0.3-0.9) and for astrocytoma grade IV (glioblastoma), HR = 1.1 (95% CI = 0.95-1.4), with > 10 year latency HR = 1.3 (95% CI = 1.03-1.7). In the highest tertile (> 426 h) of cumulative use, HR = 1.2 (95% CI = 0.95-1.5) was found for glioblastoma. The results were similar for mobile and cordless phones. CONCLUSIONS: Decreased survival of glioma cases with long-term and high cumulative use of wireless phones was found. A survival disadvantage for astrocytoma grade IV, but a survival benefit for astrocytoma grade I-II was observed which could be due to exposure-related tumour symptoms leading to earlier diagnosis and surgery in that patient group.

Meningioma patients diagnosed 2007-2009 and the association with use of mobile and cordless phones: a case-control study.

BACKGROUND: To study the association between use of wireless phones and meningioma. METHODS: We performed a case-control study on brain tumour cases of both genders aged 18-75 years and diagnosed during 2007-2009. One population-based control matched on gender and age was used to each case. Here we report on meningioma cases including all available controls. Exposures were assessed by a questionnaire. Unconditional logistic regression analysis was performed. RESULTS: In total 709 meningioma cases and 1,368 control subjects answered the questionnaire. Mobile phone use in total produced odds ratio (OR) = 1.0, 95% confidence interval (CI) = 0.7-1.4 and cordless phone use gave OR = 1.1, 95% CI = 0.8-1.5. The risk increased statistically significant per 100 h of cumulative use and highest OR was found in the fourth quartile (>2,376 hours) of cumulative use for all studied phone types. There was no statistically significant increased risk for ipsilateral mobile or cordless phone use, for meningioma in the temporal lobe or per year of latency. Tumour volume was not related to latency or cumulative use in hours of wireless phones. CONCLUSIONS: No conclusive evidence of an association between use of mobile and cordless phones and meningioma was found. An indication of increased risk was seen in the group with highest cumulative use but was not supported by statistically significant increasing risk with latency. Results for even longer latency periods of wireless phone use than in this study are desirable.

Using the Hill viewpoints from 1965 for evaluating strengths of evidence of the risk for brain tumors associated with use of mobile and cordless phones.

BACKGROUND: Wireless phones, i.e., mobile phones and cordless phones, emit radiofrequency electromagnetic fields (RF-EMF) when used. An increased risk of brain tumors is a major concern. The International Agency for Research on Cancer (IARC) at the World Health Organization (WHO) evaluated the carcinogenic effect to humans from RF-EMF in May 2011. It was concluded that RF-EMF is a group 2B, i.e., a "possible", human carcinogen. Bradford Hill gave a presidential address at the British Royal Society of Medicine in 1965 on the association or causation that provides a helpful framework for evaluation of the brain tumor risk from RF-EMF. METHODS: All nine issues on causation according to Hill were evaluated. Regarding wireless phones, only studies with long-term use were included. In addition, laboratory studies and data on the incidence of brain tumors were considered. RESULTS: The criteria on strength, consistency, specificity, temporality, and biologic gradient for evidence of increased risk for glioma and acoustic neuroma were fulfilled. Additional evidence came from plausibility and analogy based on laboratory studies. Regarding coherence, several studies show increasing incidence of brain tumors, especially in the most exposed area. Support for the experiment came from antioxidants that can alleviate the generation of reactive oxygen species involved in biologic effects, although a direct mechanism for brain tumor carcinogenesis has not been shown. In addition, the finding of no increased risk for brain tumors in subjects using the mobile phone only in a car with an external antenna is supportive evidence. Hill did not consider all the needed nine viewpoints to be essential requirements. CONCLUSION: Based on the Hill criteria, glioma and acoustic neuroma should be considered to be caused by RF-EMF emissions from wireless phones and regarded as carcinogenic to humans, classifying it as group 1 according to the IARC classification. Current guidelines for exposure need to be urgently revised.

Use of mobile phones and cordless phones is associated with increased risk for glioma and acoustic neuroma.

The International Agency for Research on Cancer (IARC) at WHO evaluation of the carcinogenic effect of RF-EMF on humans took place during a 24-31 May 2011 meeting at Lyon in France. The Working Group consisted of 30 scientists and categorised the radiofrequency electromagnetic fields from mobile phones, and from other devices that emit similar non-ionising electromagnetic fields (RF-EMF), as Group 2B, i.e., a 'possible', human carcinogen. The decision on mobile phones was based mainly on the Hardell group of studies from Sweden and the IARC Interphone study. We give an overview of current epidemiological evidence for an increased risk for brain tumours including a meta-analysis of the Hardell group and Interphone results for mobile phone use. Results for cordless phones are lacking in Interphone. The meta-analysis gave for glioma in the most exposed part of the brain, the temporal lobe, odds ratio (OR)=1.71, 95% confidence interval (CI)=1.04-2.81 in the ≥10 years (>10 years in the Hardell group) latency group. Ipsilateral mobile phone use ≥1640h in total gave OR=2.29, 95% CI=1.56-3.37. The results for meningioma were OR=1.25, 95% CI=0.31-4.98 and OR=1.35, 95% CI=0.81-2.23, respectively. Regarding acoustic neuroma ipsilateral mobile phone use in the latency group ≥10 years gave OR=1.81, 95% CI=0.73-4.45. For ipsilateral cumulative use ≥1640h OR=2.55, 95% CI=1.50-4.40 was obtained. Also use of cordless phones increased the risk for glioma and acoustic neuroma in the Hardell group studies. Survival of patients with glioma was analysed in the Hardell group studies yielding in the >10 years latency period hazard ratio (HR)=1.2, 95% CI=1.002-1.5 for use of wireless phones. This increased HR was based on results for astrocytoma WHO grade IV (glioblastoma multiforme). Decreased HR was found for low-grade astrocytoma, WHO grades I-II, which might be caused by RF-EMF exposure leading to tumour-associated symptoms and earlier detection and surgery with better prognosis. Some studies show increasing incidence of brain tumours whereas other studies do not. It is concluded that one should be careful using incidence data to dismiss results in analytical epidemiology. The IARC carcinogenic classification does not seem to have had any significant impact on governments' perceptions of their responsibilities to protect public health from this widespread source of radiation.

Exposure to phenoxyacetic acids and glyphosate as risk factors for non-Hodgkin lymphoma- pooled analysis of three Swedish case-control studies including the sub-type hairy cell leukemia.

The association between pesticide exposure and non-Hodgkin lymphoma (NHL) including hairy cell leukemia (HCL) was analyzed in a pooled study of three case-control studies. Results on exposure to pesticides were based on 1,425 cases and 2,157 controls participating in the studies. Exposures were assessed by self-administered questionnaires completed as needed by phone. In the pooled univariate analyses adjusted by age, gender and year of diagnosis, exposure to herbicides of the phenoxyacetic acid type yielded statistically significant increased risk with odds ratio (OR) = 1.9, 95% confidence interval CI) = 1.4-2.5. The herbicide glyphosate gave OR = 2.2, 95% CI = 1.3-3.8. Impregnating agents increased the risk. No clear dose-response effect was seen. OR was highest in the >10-20 years latency group for herbicides and impregnating agents. In the multivariate analysis including main pesticide groups, statistically significant increased risk was found for herbicides, OR = 1.6, 95% CI = 1.2-2.1 and impregnating agents with OR = 1.4, 95% CI = 1.1-1.8. This analysis confirmed an association between NHL including HCL and exposure to certain herbicides.

Review of four publications on the Danish cohort study on mobile phone subscribers and risk of brain tumors.

BACKGROUND: Since the International Agency for Research on Cancer recently classified radiofrequency electromagnetic fields, such as those emanating from mobile and cordless phones, as possibly carcinogenic to humans (group 2B), two additional reports relevant to the topic have been published. Both articles were new updates of a Danish cohort on mobile phone subscribers and concern the possible association between assumed use of mobile phones and risk of brain tumors. The aim of the present review is to reexamine all four publications on this cohort. METHODS: In brief, publications were scrutinized, and in particular, if the authors made explicit claims to have either proved or disproved their hypothesis, such claims were reviewed in light of applied methods and study design, and in principle, the stronger the claims, the more careful our review. RESULTS: The nationwide Danish cohort study on mobile phone subscribers and risk of brain tumors, including at best 420,095 persons (58% of the initial cohort), is the only one of its kind. In comparison with previous investigations, i.e., case-control studies, its strength lies in the possibility to eliminate non-response, selection, and recall bias. Although at least non-response and recall bias can be excluded, the study has serious limitations related to exposure assessment. In fact, these limitations cloud the findings of the four reports to such an extent that render them uninformative at best. At worst, they may be used in a seemingly solid argument against an increased risk--as reassuring results from a large nationwide cohort study, which rules out not only non-response and recall bias but also an increased risk as indicated by tight confidence intervals. CONCLUSION: Although two of the most comprehensive case-control studies on the matter both have methodological limitations that need to be carefully considered, type I errors are not the only threats to the validity of studies on this topic--the Danish cohort study is a textbook example of that.

Use of wireless phones and serum ß-trace protein in randomly recruited persons aged 18-65 years: a cross-sectional study.

BACKGROUND: There are studies suggesting effects on sleep from pulse-modulated radiofrequency fields used in mobile and cordless phones. So far, reports of adverse effects in observational studies are of limited value for risk assessment while effects from experimental studies seem to be more consistent but unclear as to their importance for health. The aim of this study was to investigate whether use of wireless phones is associated with lower concentrations of ß-trace protein (lipocalin-type prostaglandin D synthase), a key enzyme in the synthesis of prostaglandin D(2), an endogenous sleep-promoting neurohormone. METHODS: Three hundred and fourteen people, aged 18-65 years and living in the municipality of Örebro, Sweden, were recruited randomly using the population registry. Total and age-specific linear regression analyses adjusted for known covariates were used to calculate associations between levels of ß-trace protein and short- and long-term use of wireless phones. RESULTS: Overall, no statistically significant association between use of wireless phones and the serum concentration of ß-trace protein was found, neither with respect to short-term nor long-term use. Age-specific analyses, however, yielded negative associations for long-term use (cumulative hours of use) and ß-trace protein in the youngest age group (18-30 years). CONCLUSION: This study provided no overall evidence of an association between wireless phone use and serum concentrations of ß-trace protein. While the findings in the 18-30 year age group indicating lower concentrations with more cumulative hours of use should be further investigated, no causal inferences can be made from the results of the present study.

Childhood brain tumour risk and its association with wireless phones: a commentary.

Case-control studies on adults point to an increased risk of brain tumours (glioma and acoustic neuroma) associated with the long-term use of mobile phones. Recently, the first study on mobile phone use and the risk of brain tumours in children and adolescents, CEFALO, was published. It has been claimed that this relatively small study yielded reassuring results of no increased risk. We do not agree. We consider that the data contain several indications of increased risk, despite low exposure, short latency period, and limitations in the study design, analyses and interpretation. The information certainly cannot be used as reassuring evidence against an association, for reasons that we discuss in this commentary.

Lost opportunities for cancer prevention: historical evidence on early warnings with emphasis on radiofrequency radiation.

Some historical aspects on late lessons from early warnings on cancer risks with lost time for prevention are discussed. One current example is the cancer-causing effect from radiofrequency (RF) radiation. Studies since decades have shown increased human cancer risk. The fifth generation, 5G, for wireless communication is about to be implemented world-wide despite no comprehensive investigations of potential risks to human health and the environment. This has created debate on this technology among concerned people in many countries. In an appeal to EU in September 2017, currently endorsed by more than 400 scientists and medical doctors, a moratorium on the 5G deployment was required until proper scientific evaluation of negative consequences has been made (www.5Gappeal.eu). That request has not been taken seriously by EU. Lack of proper unbiased risk evaluation of the 5G technology makes adverse effects impossible to be foreseen. This disregard is exemplified by the recent report from the International Commission on non-ionizing radiation protection (ICNIRP) whereby only thermal (heating) effects from RF radiation are acknowledged despite a large number of reported non-thermal effects. Thus, no health effects are acknowledged by ICNIRP for non-thermal RF electromagnetic fields in the range of 100 kHz-300 GHz. Based on results in three case-control studies on use of wireless phones we present preventable fraction for brain tumors. Numbers of brain tumors of not defined type were found to increase in Sweden, especially in the age group 20-39 years in both genders, based on the Swedish Inpatient Register. This may be caused by the high prevalence of wireless phone use among children and in adolescence taking a reasonable latency period and the higher vulnerability to RF radiation among young persons.

Mobile phone use and the risk for malignant brain tumors: a case-control study on deceased cases and controls.

We investigated the use of mobile or cordless phones and the risk for malignant brain tumors in a group of deceased cases. Most previous studies have either left out deceased cases of brain tumors or matched them to living controls and therefore a study matching deceased cases to deceased controls is warranted. Recall error is one issue since it has been claimed that increased risks reported in some studies could be due to cases blaming mobile phones as a cause of the disease. This should be of less importance for deceased cases and if cancer controls are used. In this study brain tumor cases aged 20-80 years diagnosed during 1997-2003 that had died before inclusion in our previous studies on the same topic were included. Two control groups were used: one with controls that had died from another type of cancer than brain tumor and one with controls that had died from other diseases. Exposure was assessed by a questionnaire sent to the next-of-kin for both cases and controls. Replies were obtained for 346 (75%) cases, 343 (74%) cancer controls and 276 (60%) controls with other diseases. Use of mobile phones gave an increased risk, highest in the >10 years' latency group yielding odds ratio (OR) = 2.4, and 95% confidence interval (CI) = 1.4-4.1. The risk increased with cumulative number of lifetime hours for use, and was highest in the >2,000 h group (OR = 3.4, 95% CI = 1.6-7.1). No clear association was found for use of cordless phones, although OR = 1.7, 95% CI = 0.8-3.4 was found in the group with >2,000 h of cumulative use. This investigation confirmed our previous results of an association between mobile phone use and malignant brain tumors.

Epidemiological evidence for a health risk from mobile phone base stations.

Human populations are increasingly exposed to microwave/radiofrequency (RF) emissions from wireless communication technology, including mobile phones and their base stations. By searching PubMed, we identified a total of 10 epidemiological studies that assessed for putative health effects of mobile phone base stations. Seven of these studies explored the association between base station proximity and neurobehavioral effects and three investigated cancer. We found that eight of the 10 studies reported increased prevalence of adverse neurobehavioral symptoms or cancer in populations living at distances < 500 meters from base stations. None of the studies reported exposure above accepted international guidelines, suggesting that current guidelines may be inadequate in protecting the health of human populations. We believe that comprehensive epidemiological studies of long-term mobile phone base station exposure are urgently required to more definitively understand its health impact.

Health risks from radiofrequency radiation, including 5G, should be assessed by experts with no conflicts of interest.

The fifth generation, 5G, of radiofrequency (RF) radiation is about to be implemented globally without investigating the risks to human health and the environment. This has created debate among concerned individuals in numerous countries. In an appeal to the European Union (EU) in September 2017, currently endorsed by >390 scientists and medical doctors, a moratorium on 5G deployment was requested until proper scientific evaluation of potential negative consequences has been conducted. This request has not been acknowledged by the EU. The evaluation of RF radiation health risks from 5G technology is ignored in a report by a government expert group in Switzerland and a recent publication from The International Commission on Non-Ionizing Radiation Protection. Conflicts of interest and ties to the industry seem to have contributed to the biased reports. The lack of proper unbiased risk evaluation of the 5G technology places populations at risk. Furthermore, there seems to be a cartel of individuals monopolizing evaluation committees, thus reinforcing the no-risk paradigm. We believe that this activity should qualify as scientific misconduct.

Is the Increasing Incidence of Thyroid Cancer in the Nordic Countries Caused by Use of Mobile Phones?

The International Agency for Research on Cancer (IARC) at the World Health Organization (WHO) categorized in 2011 radiofrequency (RF) as a possible human carcinogen, Group 2B. During use of the handheld wireless phone, especially the smartphone, the thyroid gland is a target organ. During the 21st century, the incidence of thyroid cancer is increasing in many countries. We used the Swedish Cancer Register to study trends from 1970 to 2017. During that time period, the incidence increased statistically significantly in women with average annual percentage change (AAPC) +2.13%, 95% confidence interval (CI) +1.43, +2.83%. The increase was especially pronounced during 2010-2017 with annual percentage change (APC) +9.65%, 95% CI +6.68, +12.71%. In men, AAPC increased during 1970-2017 with +1.49%, 95% CI +0.71, +2.28%. Highest increase was found for the time period 2001-2017 with APC +5.26%, 95% CI +4.05, +6.49%. Similar results were found for all Nordic countries based on NORDCAN 1970-2016 with APC +5.83%, 95% CI +4.56, +7.12 in women from 2006 to 2016 and APC + 5.48%, 95% CI +3.92, +7.06% in men from 2005 to 2016. According to the Swedish Cancer Register, the increasing incidence was similar for tumors ≤4 cm as for tumors >4 cm, indicating that the increase cannot be explained by overdiagnosis. These results are in agreement with recent results on increased thyroid cancer risk associated with the use of mobile phones. We postulate that RF radiation is a causative factor for the increasing thyroid cancer incidence.