EMF Issues and Epidemiology - The Source s/EEI... · 7/8/2010 · EMF Issues and Epidemiology...

EMF Issues and Epidemiology

Gabor Mezei, MD, Ph.D.Environment

Edison Electric InstituteOccupational Safety and Health Committee ConferenceOctober 7, 2008

2© 2008 Electric Power Research Institute, Inc. All rights reserved.

Electric Power Research Institute

EnvironmentAir Quality

Global Climate Change

Electric and Magnetic Fields (EMF)Occupational

Health & SafetyLand & GroundwaterWater & Ecosystems

Power Delivery & Markets

TransmissionSubstations

Grid ReliabilityPower Markets

Distribution Power Quality

Energy Utilization

Nuclear PowerComponent

Reliability & SafetyNuclear Operations & Asset Management

Nondestructive Evaluation

Plant Technology

GenerationEnvironmental Control Fossil Steam Plants

Combustion Turbines Market Analysis

Renewables Hydroelectric

Distributed Resources


USA Today Nov 10, 2006

Why be concerned with EMF?

Possible Human Carcinogen (Group 2B)




Topics

Health Risk Assessments and Reviews• IARC Monograph• WHO Environmental Health Criteria• California Dept of Health Services• BioInititativeMain Research Areas• Childhood Leukemia• Miscarriage• Occupational Exposure


Scientific Consensus

IARC 2002

“Extremely low-frequency magnetic fields are possibly carcinogenic to humans (Group 2B).”

– “…limited evidence in humans… in relation to childhood leukemia.”

– “…inadequate evidence in experimental animals for … carcinogenecity…”


Scientific Consensus

WHO EHC 2007

• Accepts IARC Group 2B based on childhood leukemia epidemiology

– Epidemiology evidence is inadequate for other cancers and other diseases

– Evidence does not support an association for breast cancer and cardiovascular disease


“California” View

California Dept of Health Services 2002

• “…inclined to believe that EMFs can cause … childhood leukemia, adult brain cancer, Lou Gehrig’s Disease, and miscarriage.”


BioInitiative Working Group

BioInitiative Report 2007• “…existing public safety standards… look to

be thousands of times too lenient.”–“…a reasonable approach would be 1 mG

(0.1 µT) …to all new or upgraded power lines …”

• “… little doubt that … ELF causes childhood leukemia.”

• “strong evidence” for other diseases (e.g., breast cancer and Alzheimer’s)

• Essentially no discrimination between ELF and RF (cell phone and brain cancer)


EMF Childhood Leukemia Pooled Analyses

Ahlbom et al., British J. Cancer 2000

• 9 studies• 3,247 cases; 10,400 controls• Geometric mean

Greenland et al., Epidemiology 2000

• 12 studies• 2,656 cases; 7,084 controls• Time-weighted average

0.5

1.0

1.5

2.0

2.5

3.0

3.5

<1 1-2 2-4 >4Magnetic Field (mG)

Odd

s R

atio

(±95

% C

I)

0.5

1.0

1.5

2.0

2.5

3.0

<1 >1 - 2 >2 - 3 >3Magnetic Field (mG)

Odd

s R

atio

(±95

% C

I)


Why The Association?

• Control Selection Bias

• Some Other Exposure?

IContact

RS

RP

V2

V1

SPContact

RRVVI

+−

=21

IContact

RS

RP

V2

V1

SPContact

RRVVI

+−

=21


TransExpo

International Study of Childhood Leukemia and Residences above Transformer Rooms

• No subject participation required to assess exposure

– Limit/exclude selection bias

• Focus on highly exposed population

• Funded by EPRI

Great Potential Scientific Impact!

15

NetherlandsPortugalChinaBulgariaIsraelBelgiumSpainKoreaItalyHungaryBrazilPolandFranceSwitzerlandFinland

ArmeniaNorwaySwedenCroatiaRomaniaCanada

Too SmallNo Responseyet

Pilot Under Consideration

TurkeyJapan UKUSDenmark AustriaMexico

AustraliaUkraineGermanyRussia

Not FeasibleTo be Explored

ContactedInterested/Being

Explored

Pilot Ongoing

TransExpoStatus of Participation by Country


The Northern California Childhood Leukemia Study (NCCLS)

• NIH-funded large case-control study of childhood leukemia– Environmental and genetic risk factors

Cases0-14 years oldIncident leukemiaNo previous cancerResident of 35-county study area English or Spanish-speaking

Controls randomly selected from CA birth registry, matched to cases on child’s age, sex, Hispanic status, and maternal race


NCCLS – EPRI Component

• Investigate link between risk of childhood leukemia and – Residential contact voltage– Residential magnetic fields– Wire configuration codes

ContactVoltage Magnetic

FieldW-L Wire

Code


UK Study (Draper et al, 2005):

• Is childhood cancer associatedwith distance from transmission lines?

• Result

– Leukemia risk versus distance from lines

• At <200 m, a 69% increase

• At 200-600 m, a 23% increase

• However, negligible magnetic field beyond ~150m

• EPRI conducting replication in California


Replication of Draper Study in California

Record Linkage• California Cancer Registry• California Birth Registry• GIS information of California

utilities and addresses of cases and controls


Childhood Leukemia Survival Study


Foliart et al. 2006 – Overall Survival

0.1

1

10

<1 1 - <2 2 - <3 >=3 Magnetic Field (mG)

Rel

ativ

e R

isk

(w/9

5% C

I)

16/235

7%

7/87

8% 1/19

5%

4/18

22%

13.8



German Childhood Leukemia Survival Study

Results Conclusions• “…broadly consistent…”• “…poorer survival…”• “…small numbers…”• “…biological

mechanism… is not known.”


Childhood Leukemia Survival Pooled Analysis

571875223529GRAND TOTAL381293352548TOTAL33421Sweden

02792Norway

12225Finland

222598Denmark

03872New Zealand

123888239Canada

31347906UK

1766177595US Case-control

1958187981TOTAL71852595Germany

1240135386US Survival study

>0.4 µT>0.2 µT>0.1 µTN ALL

Next Step

• Follow up of cases from previous studies

• Combined analysis

• EPRI funding

• Project to start in 2008

Estimated number of cases


Miscarriage

Pre-2002• Inadequate evidence to link EMF to pregnancy outcomes

(NIEHS 1998)

Li et al. 2002; Lee et al. 2002• Consistently increased risk of miscarriage with peak

exposure > 16 mG– Higher risk among “susceptible”

• No association with mean MF


Miscarriage

Savitz 2002• Mobility hypothesis

Mezei et al. 2005Savitz et al. 2006• Evidence for an association between mobility and peak

MF

Kaiser replication• In progress• Funded by NIH


Miscarriage

Main Issues• Most miscarriages occur in early pregnancies

– Some undetected• Information on mobility and miscarriage• If effect is real then great public health impact

Study of Women with Assisted Reproductive Technologies (ART)

• Intrauterine insemination (IUI)• In vitro fertilization (IVF)• Intracytoplasmic sperm injection (ICSI)


Miscarriage

EPRI to Join Ongoing Study• EPRI to add simultaneous measurements

– MF exposure (EMDEX)– Activity monitor (e.g., accelerometer)

Main Advantages• Known date of conception• Highly motivated women• “Susceptible” population• Involvement of couples


Occupational EMF and Leukemia and Brain Cancer: An Update to Two Meta-Analyses

Background• Two meta-analyses in 1995 and 1997 showed a small

increase in risk of adult leukemia and brain cancer with occupational EMF exposure

• Number of new studies have since been published• WHO evaluation of ELF-EMF recommended update• Systematic literature search identified 20 new publication

on brain cancer and 21 on leukemia

• Kheifets et al. JOEM 2008


Results

Past and New Studies Cumulative Plot


Results

Past and New Studies Cumulative Plot


Results

Past and New Studies Meta-Analysis


Conclusions

• No clear exposure pattern• Results do not depend on methods or individual studies• Pooled risk estimates were lower than in past meta-

analyses– Leukemia subtypes showed no consistent pattern

when past and present meta-analyses were compared.

• The lack of a clear pattern of EMF exposure and outcome risk does not support a hypothesis that these exposures are responsible for the observed excess risk


Implanted Medical Devices

• Fast advancing technology– Standards and testing bodies cannot cope

• Types of failures are not readily anticipated• Aging workforce requiring such devices• Clinical/Regulatory/Compliance testing is costly, time

consuming– Not necessarily protect against litigation


Implanted Medical Devices

• Potential interference from occupational 60 Hz or RF sources• Practical research to characterize exposure and improve

safety– Evaluate interference potential: signal confounding,

device damage, undesired or lethal operations, inhibition• May develop small 60 Hz personal monitor to alarm at preset

threshold– Facilitate work by users; avoid complex measurements


Radio-Frequency (RF) Safety

New Issue for Electric Utilities• Wireless Antennas

– Leased space on T&D structures– New exposure for workers (RF)

• FCC RF exposure limitsEPRI RF Work• Characterize RF Exposures• Provide Information, Education,

Training• Demonstration of Compliance with

Government Regulations


EMF Success Story

Researchand

Communication

Filter

ChildhoodLeukemia(miscarriage)

(ALS)

NowThen (~1988-93)Birth Defects

MiscarriageChildhood Cancer

Adult CancerALS

Alzheimer’s DiseaseDepression

Others


Thank You!

Contact Information

Gabor Mezei, MD, Ph.D.EPRI Environment3420 Hillview AvenuePalo Alto, CA 94304www.epri.com

Phone: (650) [email protected]

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EMF Issues and Epidemiology - The Source s/EEI... · 7/8/2010 · EMF Issues and Epidemiology...

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