Exposure assessment and other challenges in non-ionizing radiation studies of childhood leukaemia

Effects of ELF-PEMF exposure on spontaneous alternation, anxiety, motor co-ordination and locomotor activity of adult wistar rats and viability of C6 (Glial) cells in culture

The effects of ELF-PEMF exposure on spontaneous alternation, anxiety, motor coordination, and locomotor activity have been discussed in various pre-clinical and clinical settings. Several epidemiological and experimental studies have demonstrated the potential effects of ELF-PEMF when exposed > ∼1 h/day; however, very few studies have focused on understanding the influence of ELF-PEMF exposure of 1-3 mT with an exposure duration of < 1 h/day on spontaneous alternation, anxiety, motor coordination, and locomotor activity. Hence, we attempted to study the effects of ELF-PEMF exposure of 1-3 mT, 50 Hz with an exposure duration of 20 min each with a 4 h gap (2 times) on the cellular proliferation and morphologies of C6 (Glial) cells and spontaneous alternation, anxiety, motor coordination and locomotor activity of Wistar rats under in vitro and in vivo conditions, respectively. The results showed that ELF-PEMF exposure did not induce any significant levels of cellular fragmentation and changes in the morphology of glial cells. Also, the outcomes revealed no noticeable effects on spontaneous alternation, anxiety, motor coordination, and locomotor activity in PEMF-exposed groups compared with the control. No undesirable side effects were observed at the highest dose (B=3 mT). We also performed histological analysis of the selected brain sections (hippocampus and cortex) following ELF-PEMF exposure. Incidentally, no significant changes were observed in cortical cell counts, tissue structure, and morphology.

Children's exposure assessment of radiofrequency fields: Comparison between spot and personal measurements

INTRODUCTION

Radiofrequency (RF) fields are widely used and, while it is still unknown whether children are more vulnerable to this type of exposure, it is essential to explore their level of exposure in order to conduct adequate epidemiological studies. Personal measurements provide individualized information, but they are costly in terms of time and resources, especially in large epidemiological studies. Other approaches, such as estimation of time-weighted averages (TWAs) based on spot measurements could simplify the work.

OBJECTIVES

The aims of this study were to assess RF exposure in the Spanish INMA birth cohort by spot measurements and by personal measurements in the settings where children tend to spend most of their time, i.e., homes, schools and parks; to identify the settings and sources that contribute most to that exposure; and to explore if exposure assessment based on spot measurements is a valid proxy for personal exposure.

METHODS

When children were 8 years old, spot measurements were conducted in the principal settings of 104 participants: homes (104), schools and their playgrounds (26) and parks (79). At the same time, personal measurements were taken for a subsample of 50 children during 3 days. Exposure assessment based on personal and on spot measurements were compared both in terms of mean exposures and in exposure-dependent categories by means of Bland-Altman plots, Cohen's kappa and McNemar test.

RESULTS

Median exposure levels ranged from 29.73 (in children's bedrooms) to 200.10 μW/m² (in school playgrounds) for spot measurements and were higher outdoors than indoors. Median personal exposure was 52.13 μW/m² and median levels of assessments based on spot measurements ranged from 25.46 to 123.21 μW/m². Based on spot measurements, the sources that contributed most to the exposure were FM radio, mobile phone downlink and Digital Video Broadcasting-Terrestrial, while indoor and personal sources contributed very little (altogether <20%). Similar distribution was observed with personal measurements. There was a bias proportional to power density between personal measurements and estimates based on spot measurements, with the latter providing higher exposure estimates. Nevertheless, there were no systematic differences between those methodologies when classifying subjects into exposure categories. Personal measurements of total RF exposure showed low to moderate agreement with home and bedroom spot measurements and agreed better, though moderately, with TWA based on spot measurements in the main settings where children spend time (homes, schools and parks; Kappa = 0.46).

CONCLUSIONS

Exposure assessment based on spot measurements could be a feasible proxy to rank personal RF exposure in children population, providing that all relevant locations are being measured.

Exposure to 50 Hz Magnetic Fields in Homes and Areas Surrounding Urban Transformer Stations in Silla (Spain): Environmental Impact Assessment

Exposure to extremely low frequency electromagnetic fields (ELFs) is almost inevitable almost anywhere in the world. An ELF magnetic field (ELF-MF) of around 1 mG = 0.1 μT is typically measured in any home of the world with a certain degree of development and well-being. There is fear and concern about exposure to electromagnetic fields from high- and medium-voltage wiring and transformer stations, especially internal transformer stations (TSs), which in Spain are commonly located inside residential buildings on the ground floor. It is common for neighbors living near these stations to ask for stations to be moved away from their homes, and to ask for information about exposure levels and their effects. Municipality is the closest administration to the citizens that must solve this situation, mediating between the citizens, the utility companies and the national administration. In this case, the municipality of Silla (València, Spain) wanted to know the levels of exposure in the dwellings annexed to the TSs, to compare them with Spanish legislation and the recommendations coming from epidemiological studies. This article presents the first systematic campaign of ELF-MF measurements from TSs carried out in a Spanish city. Many measurements were carried out in the rooms of the apartments doing spatial averages of spatial grid measurements. Measurements are made in the bed and bedrooms and a weighted average and an environmental impact indicator were obtained for each location. We found that old TSs usually provide the highest peak exposure levels. A notable result of this work is that approximately one quarter of the population living above or next to a TS would be exposed to a weighted MF level greater than 0.3 μT, and that about a 10% of this population would not be able to relocate their bedroom or living room to minimize the level of exposure.

Electromagnetic fields in neonatal incubators: the reasons for an alert

BACKGROUND

Neonatal incubators are important tools for sick newborns in the first few days of life. Nevertheless, their electric engine, often very close to the newborn's body, emits electromagnetic fields (EMF) to which newborns are exposed. Aim of this paper is to review the available literature on EMF exposure in incubators, and the effects of such exposures on newborns that have been investigated.

METHODS

We carried out a systematic review of studies about EMF emissions produced by incubators, using Medline and Embase databases from 1993 to 2017.

RESULTS

We retrieved 15 papers that described the EMF exposure in incubators and their biological effects on babies. EMF levels in incubators appear to be between 2 and 100 mG, depending on the distance of the mattress from the electric engine. In some cases, they exceed this range. These values interfere with melatonin production or with vagal tone. Even caregivers are exposed to high EMF, above 200 mG, when working at close contact with the incubators.

CONCLUSION

EMF have been described as potentially hazardous for human health, and values reported in this review are an alert to prevent babies' and caregivers' exposure when close to the incubators. A precautionary approach should be adopted in future incubator design, to prevent high exposures of newborns in incubators and of caregivers as well.

Exposure to extremely low and intermediate-frequency magnetic and electric fields among children from the INMA-Gipuzkoa cohort

Detailed assessment of exposure to extremely low frequency (ELF) and intermediate frequency (IF) fields is essential in order to conduct informative epidemiological studies of the health effects from exposure to these fields. There is limited information available regarding ELF electric fields and on both magnetic and electric field exposures of children in the IF range. The aim of this study was to characterize ELF and IF exposure of children in the Spanish INMA cohort. A combination of spot and fixed measurements was carried out in 104 homes, 26 schools and their playgrounds and 105 parks. Low levels of ELF magnetic fields (ELF-MF) were observed (with the highest 24-h time-weighted average (TWA) exposure being 0.15μT in one home). The interquartile range (IQR) of ELF electric fields (ELF-EF) ranged from 1 to 15V/m indoors and from 0.3 to 1.1V/m outdoors and a maximum value observed was 55.5V/m in one school playground. IQR ranges for IF magnetic and electric fields were between 0.02 and 0.23μT and 0.2 and 0.5V/m respectively and maximum values were 0.03μT and 1.51V/m in homes. Correlations between magnetic and electric fields were weak for ELF (Spearman 0.04-0.36 in different settings) and moderate for IF (between 0.28 and 0.75). Children of INMA-Gipuzkoa cohort were exposed to very low levels of ELF-MF in all settings and to similar levels of ELF-EF compared to the range of previously reported levels, although somewhat higher exposures occurred at home. Children enrolled to our study were similarly exposed to IF in all settings.

Re-examining the association between residential exposure to magnetic fields from power lines and childhood asthma in the Danish National Birth Cohort

Background

A study reported an increased risk of asthma in children whose mothers were exposed to magnetic field (MF) levels above 0.2 μT during pregnancy. We re-examined this association using data from mothers and children in the Danish National Birth Cohort (DNBC).

Methods

This study included 92,676 singleton-born children and their mothers from the DNBC. MF exposure from power lines was estimated for all residences where the mothers lived during pregnancy and for all children from birth until the end of follow up. Exposure was categorized into 0 μT, 0.1 μT, and ≥ 0.2 μT for analysis. Definitive and possible asthma cases were identified using data from three independent data sources: 1) mothers’ reports, 2) a national hospitalization register, 3) a national prescription drug register. We calculated hazard ratios (HR) and 95% confidence intervals (CI) for the association between the highest level of exposure during pregnancy and asthma in children, adjusting for several potential confounding factors. We also examined the sensitivity of the risk estimates to changes in exposure and outcome definitions.

Results

No differences or trends in the risk of asthma development were detected between children with different levels of MF exposure regardless of the asthma case definition or outcome data source. For definitive cases, the HR (95% CI) for those with any exposure was 0.72 (0.27–1.92), and it was 0.41 (0.06–2.92) for those exposed to ≥ 0.2 μT. Adjustments for confounding and variations in the exposure definition did not appreciably alter the results.

Conclusion

We did not find evidence that residential exposure to MF during pregnancy or early childhood increased the risk of childhood asthma. This interpretation is in line with the lack of an established biological mechanism directly linking MF exposure to asthma, but high exposure was very rare in this cohort.

Patient exposure to extremely low-frequency magnetic fields during laparoscopic and robotic surgeries

BACKGROUND

Laparoscopic and robotic surgeries require many electronic devices, and the hazard of extremely low-frequency magnetic fields (ELF-MFs) from these devices to humans remains uncertain. This study aimed to measure and compare patients' exposure levels to ELF-MFs in laparoscopic and robotic surgeries.

METHODS

The intensity of ELF-MF exposure to patients was measured every 10 s during 30 laparoscopic surgeries and 30 robotic surgeries using portable ELF-MF measuring devices with logging capabilities.

RESULTS

The mean ELF-MF exposures were 0.11 ± 0.07 μT for laparoscopic surgeries and 0.12 ± 0.10 μT for robotic surgeries. There were no significant differences between the laparoscopic and robotic surgeries.

CONCLUSIONS

Patients' mean ELF-MF exposure levels in laparoscopic and robotic surgeries were lower than 0.2 μT, which is considered safe according to previous studies. However, because many medical devices have been implemented for multiple purposes in hospitals, the MF environment in hospitals regarding patient health should not be overlooked. Copyright © 2015 John Wiley & Sons, Ltd.

Safety of Exposure From Extremely Low Frequency Magnetic Fields During Prenatal Ultrasound Examinations in Clinicians and Pregnant Women

Investigations into the safety of ultrasonography in pregnancy have focused on the potential harm of ultrasound itself. However, no data have been published regarding the electromagnetic fields that ultrasound devices might produce. This study is the first to measure extremely low-frequency magnetic field (ELF-MF) exposure of clinicians and pregnant women during prenatal ultrasound examinations in the examination room from 2 different ultrasound devices and compare them with ELF-MFs during patient consultation in the consulting room.The ELF-MF intensities that clinicians and pregnant women were exposed to were measured every 10 seconds for 40 prenatal ultrasound examinations using Philips iU22 or Accuvix V20 Prestige machines and 20 patient consultations in a consulting room using portable ELF-MF measurement devices. The mean ELF-MF exposure of both clinicians and pregnant women was 0.18 ± 0.06 mG during prenatal ultrasound examination. During patient consultation, the mean ELF-MF exposures of clinicians and pregnant women were 0.10 ± 0.01 and 0.11 ± 0.01 mG, respectively. Mean ELF-MF exposures during prenatal ultrasound examination were significantly higher than those during patient consultations (P < 0.001 by Mann-Whitney U test).Our results provide basic reference data on the ELF-MF exposure of both clinicians and pregnant women during prenatal ultrasound monitoring from 2 different ultrasound devices and patient consultation, all of which were below 2 mG, the most stringent level considered safe in many studies, thus relieving any anxiety of clinicians and pregnant women regarding potential risks of ELF-MFs.

Pilot study of extremely low frequency magnetic fields emitted by transformers in dwellings. Social aspects

A large number of epidemiologic studies examining the potential effect of residential exposure to extremely-low frequency (ELF) magnetic fields and childhood leukemia have been published. Two pooled analyses [Ahlbom A, Day N, Feychting M, Roman E, Skinner J, Dockerty J, Linet M, et al. (2000). A pooled analysis of magnetic fields and childhood leukaemia. Br J Cancer. 83(5):692-698; Greenland S, Sheppard AR, Kaune WT, Poole C, Kelsh AM (2000). A pooled analysis of magnetic fields, wire codes, and childhood leukemia. Epidemiology. 11(6):624-634], which included the major epidemiologic studies on ELF magnetic fields and childhood leukemia showed twofold increase in childhood leukemia risk in association with residential ELF exposure above 0.3-0.4 μT. Based on "limited" epidemiologic evidence linking ELF exposure to childhood leukemia and "inadequate evidence" for carcinogenicity of ELF in rodent bioassays, the International Agency for Research on Cancer (IARC) classified ELF magnetic fields as a possible human carcinogen (2B classification) [International Agency for Research on Cancer (IARC) (2002). Non-ionizing radiation, Part 1: Static and extremely low-frequency (ELF) electric and magnetic fields. IARC monographs on the evaluation of carcinogenic risks to humans. Vol. 80. IARC Press: Lyon], confirmed by WHO on the basis of studies published after 2000 [World Health Organization. Extremely low frequency fields. In: 238 Environmental health criteria, Geneva: WHO; 2007]. The analysis of more recent studies of ELF magnetic fields and childhood leukemia had small findings and propose methodological improvements concerning the uncertainties in epidemiological approaches and exposure assessment, bias in selection of controls [Kheifets L, Oksuzyan S (2008). Exposure assessment and other challenges in non-ionizing radiation studies of childhood leukaemia. Radiat Prot Dosimetry. 132(2):139-147]. By the end of 2010, 37 countries had been identified for possible participation in the International study TRANSEXPO. The pilot work has been completed in five countries (Finland, Hungary, Israel, Switzerland and Bulgaria). In 2008, Bulgaria through the National Centre of Public Health Protection joined with pilot study in TRANSEXPO Project. At this first stage of the project our investigation was directed to performing measurements in dwellings with built-in transformer stations, collecting data of population and cancer registry and choosing the epidemiology design feasible for continuing the project. Taking into account the available sources of information in Bulgaria (different registers of the population) needed for epidemiological approach, it was found that the most appropriate epidemiology design would be the nested case-control study. Control group could be collected in accordance with the international requirements for such epidemiological studies. This approach could be modified in the course of the further study in order to ensure achievement of the purposes of the main international requirements of the study.

Does apartment's distance to an in-built transformer room predict magnetic field exposure levels?

It has been shown that magnetic field exposure in apartments located directly on top or adjacent to transformer rooms is higher compared with exposure in apartments located further away from the transformer rooms. It is unclear whether this also translates into exposure contrast among individuals living in these apartments. We performed spot measurements of magnetic fields in 35 apartments in 14 apartment buildings with an in-built transformer and additionally performed 24-h personal measurements in a subsample of 24 individuals. Apartments placed directly on top of or adjacent to a transformer room had on average exposures of 0.42 μT, apartments on the second floor on top of a transformer room, or sharing a corner or edge with the transformer room had 0.11 μT, and apartments located further away from the transformer room had levels of 0.06 μT. Personal exposure levels were approximately a factor 2 lower compared with apartment averages, but still showed exposure contrasts, but only for those individuals who live in the apartments directly on top or adjacent to a transformer room compared with those living further away, with 0.23 versus 0.06 μT for personal exposure when indoors, respectively. A classification of individuals into 'high' and 'low' exposed based on the location of their apartment within a building with an in-built transformer is possible and could be applied in future epidemiological studies.

Childhood leukaemia close to high-voltage power lines--the Geocap study, 2002-2007

Background:

High-voltage overhead power lines (HVOLs) are a source of extremely low-frequency magnetic fields (ELF-MFs), which are classified as possible risk factors for childhood acute leukaemia (AL). The study was carried out to test the hypothesis of an increased AL incidence in children living close to HVOL of 225–400 kV (VHV-HVOL) and 63–150 kV (HV-HVOL).

Methods:

The nationwide Geocap study included all the 2779 cases of childhood AL diagnosed in France over 2002–2007 and 30 000 contemporaneous population controls. The addresses at the time of inclusion were geocoded and precisely located around the whole HVOL network.

Results:

Increased odds ratios (ORs) were observed for AL occurrence and living within 50 m of a VHV-HVOL (OR=1.7 (0.9–3.6)). In contrast, there was no association with living beyond that distance from a VHV-HVOL or within 50 m of a HV-HVOL.

Conclusion:

The present study, free from any participation bias, supports the previous international findings of an increase in AL incidence close to VHV-HVOL. In order to investigate for a potential role of ELF-MF in the results, ELF-MF at the residences close to HVOL are to be estimated, using models based on the annual current loads and local characteristics of the lines.

Measurement procedure to assess exposure to extremely low-frequency fields: a primary school case study

How to correctly measure the exposure of general public to extremely low-frequency (ELF) radiation is a key issue for ELF epidemiological studies. This paper proposes a measurement procedure to accurately assess the exposure of people to electric and magnetic field in the frequency band from 5 Hz to 100 kHz in buildings and their premises. As ELF radiation could be particularly harmful to children, the measurement procedure is focused on exposure to ELF in schools. Thus, the students' exposure to ELF fields can be assessed by correlating the ELF measurements to the hours of school activity. In this paper, the measurement protocol was applied to study the ELF exposure on students from García Quintana primary school in Valladolid, Spain. The campaign of measurements for ELF exposure assessment in this primary school was of great interest for the Regional Council of Public Health because of the social alarm generated by the presence of a significant number cancer cases in children.

Environmental radon exposure and childhood leukemia

Despite the fact that animal and human epidemiological studies confirmed a link between radon exposure in homes and increased risk of lung cancer in general population, other types of cancers induced by radon, such as leukemia, have not been consistently demonstrated. The aim of this review was to summarize data published thus far from ecological and case-control studies in exposed populations, taking into account radon dose estimation and evidence of radon-induced genotoxicity, in an effort to clarify the correlation between home radon exposure and incidence of childhood leukemia. Among 12 ecological studies, 11 reported a positive association between radon levels and elevated frequency of childhood leukemia, with 8 being significant. In conjunction with ecological studies, several case-control studies on indoor radon exposure and childhood leukemia were examined, and most investigations indicated a weak association with only a few showing significance. A major source of uncertainty in radon risk assessment is radon dose estimate. Methods for radon exposure measurement in homes of children are one of the factors that affect the risk estimates in a case-control study. The effects of radon-induced genetic damage were studied both in vitro and in vivo using genetic endpoints including chromosomal aberration (CA), micronuclei (MN) formation, gene mutation, and deletions and insertions. By applying a meta-analysis, an increased risk of childhood leukemia induced by indoor radon exposure was noted for overall leukemia and for acute lymphoblastic leukemia (ALL). Data thus indicated an association between environmental radon exposure and elevated leukemia incidence, but more evidence is required in both human investigations and animal mechanistic research before this assumption may be confirmed with certainty.

Adult mortality from leukemia, brain cancer, amyotrophic lateral sclerosis and magnetic fields from power lines: a case-control study in Brazil

Recent publications renewed interest in assessing potential health risks for subjects living close to transmission lines. This study aimed at evaluating the association of both distance of home address to the nearest overhead transmission line and of the calculated magnetic fields from the power lines and mortality from leukemia, brain cancer, and amyotrophic lateral sclerosis. We carried out a death certificate based case-control study accessing adult mortality in the Metropolitan Region of São Paulo, in Brazil. Analysis included 1,857 cases of leukemia, 2,357 of brain cancer, 367 of amyotrophic lateral sclerosis, and 4,706 as controls. An increased risk for mortality from leukemia among adults living at closer distances to transmission lines compared to those living further then 400 m was found. Risk was higher for subjects that lived within 50 m from power lines (OR=1.47; 95% CI=0.99-2.18). Similarly, a small increase in leukemia mortality was observed among adults living in houses with higher calculated magnetic fields (OR=1.61; 95% CI=0.91-2.86 for those exposed to magnetic fields >0.3 µT). No increase was seen for brain tumours or amyotrophic lateral sclerosis. Our findings are suggestive of a higher risk for leukemia among subjects living closer to transmission lines, and for those living at homes with higher calculated magnetic fields, although the risk was limited to lower voltage lines.

Indoor environment and children's health: recent developments in chemical, biological, physical and social aspects

Much research is being carried out into indoor exposure to harmful agents. This review focused on the impact on children's health, taking a broad approach to the indoor environment and including chemical, microbial, physical and social aspects. Papers published from 2006 onwards were reviewed, with regards to scientific context. Most of publications dealt with chemical exposure. Apart from the ongoing issue of combustion by-products, most of these papers concerned semi volatile organic compounds (such as phthalates). These may be associated with neurotoxic, reprotoxic or respiratory effects and may, therefore, be of particular interest so far as children are concerned. In a lesser extent, volatile organic compounds (such as aldehydes) that have mainly respiratory effects are still studied. Assessing exposure to metals is still of concern, with increasing interest in bioaccessibility. Most of the papers on microbial exposure focused on respiratory tract infections, especially asthma linked to allergens and bio-aerosols. Physical exposure includes noise and electromagnetic fields, and articles dealt with the auditory and non auditory effects of noise. Articles on radiofrequency electromagnetic fields mainly concerned questions about non-thermal effects and papers on extremely low-frequency magnetic fields focused on the characterization of exposure. The impact of the indoor environment on children's health cannot be assessed merely by considering the effect of these different types of exposure: this review highlights new findings and also discusses the interactions between agents in indoor environments and also with social aspects.

Extremely low frequency magnetic field measurements in buildings with transformer stations in Switzerland

The aim of this study was to evaluate an exposure assessment method that classifies apartments in three exposure categories of extremely low frequency magnetic fields (ELF-MF) based on the location of the apartment relative to the transformer room. We completed measurements in 39 apartments in 18 buildings. In each room of the apartments ELF-MF was concurrently measured with 5 to 6 EMDEX II meters for 10 min. Measured arithmetic mean ELF-MF was 0.59 μT in 8 apartments that were fully adjacent to a transformer room, either directly above the transformer or touching the transformer room wall-to-wall. In apartments that only partly touched the transformer room at corners or edges, average ELF-MF level was 0.14 μT. Average exposure in the remaining apartments was 0.10 μT. Kappa coefficient for exposure classification was 0.64 (95%-CI: 0.45-0.82) if only fully adjacent apartments were considered as highly exposed (>0.4 μT). We found a distinct ELF-MF exposure gradient in buildings with transformer. Exposure classification based on the location of the apartment relative to the transformer room appears feasible. Such an approach considerably reduces effort for exposure assessment and may be used to eliminate selection bias in future epidemiologic studies.

Predictors of mobile telephone use and exposure analysis in Australian adolescents

AIM

Australian adolescents are increasingly using mobile telephones (MP) while the debate on MP safety persists. This group is not generally engaged in full-time employment, suggesting that their MP use is not work related. We investigated possible predictors of MP use in young people.

METHODS

We assessed exposure to radiofrequency energy from MP by means of a self-administered questionnaire adapted from INTERPHONE--an international case-control study of adult brain, head and neck tumours. We investigated possible determinants of MP use in adolescent Australians using self-reported number of incoming and outgoing voice calls as exposure metric.

RESULTS

There is a high prevalence of MP use amongst Australian adolescents (94%). Males were significantly younger than females at age of first uptake of MP (P= 0.02). Participants without siblings were significantly younger at age of first uptake. Personality traits were associated with regular MP usage: higher psychoticism scores were associated with regular use (IRR = 1.06, P= 0.03); there was a tendency for students with higher extraversion scores to report more MP use. Parental socio-economic status was associated with MP use, but parents who expressed moderate/high level concerns about possible health risks of use were more likely to have children who used MP (OR = 4.06, P= 0.05).

CONCLUSIONS

Almost all adolescent Australians use MP, but regular exposure was associated with personality traits. Parental socio-economic status and perceived health risks of MP use were also associated with use of phones. Longitudinal studies are needed to assess the predictors of mobile phone use in the long term.

Aetiology of childhood leukaemia

The acute leukaemias account for about 30% of all malignancy seen in childhood across the Western world. A peak incidence of precursor B cell ALL has emerged as socio-economic conditions have improved in countries worldwide. From twin studies and the use of neonatal blood spots it has been possible to back track the first initiating genetic events within critical haemopoietic cells to foetal development in utero for most precursor B cell ALL and some cases of AML. These events may occur as part of normal foetal development. Whether other factors (environmental or constitutional) are involved to increase the chance of these first genetic changes happening is unclear. For some leukaemias (e.g. infant MLL positive ALL) the first event appears adequate to create a malignant clone but for the majority of ALL and AML further 'genetic' changes are required, probably postnatal. Many environmental factors have been proposed as causative for leukaemia but only ionising irradiation and certain chemicals, e.g. benzene and cytotoxics (alkylators and topoisomerase II inhibitors) have been confirmed and then principally for acute myeloid leukaemia. It appears increasingly likely that delayed, dysregulated responses to 'common' infectious agents play a major part in the conversion of pre-leukaemic clones into overt precursor B cell ALL, the most common form of childhood leukaemia. Constitutional polymorphic alleleic variants in immune response genes (especially the HLA Class II proteins) and cytokines may play a role in determining the type of immune response. High penetrance germ-line mutations are involved in only about 5% of childhood leukaemias (more in AML than ALL). There is little evidence to support any role of viral transformation in causation, unlike in animals. Other environmental factors for which some evidence exists include non-ionising electromagnetic radiation and electric fields, although their mode of action in leukaemogenesis remains unclear. There is no single cause for childhood leukaemia and for most individuals a combination of factors appears to be necessary; all involving gene-environment interactions. To date few clear preventative measures have emerged, except the complete avoidance of first trimester X-rays in pregnancy; a healthy diet with adequate oral folic acid intake both preconception and early in pregnancy; and the early exposure of children to other children outside the home to facilitate stimulation and maturation of the natural immune system. Here then are clear echoes of the "hygiene hypothesis" regarding the initiation of allergies, autoimmune disease and type I diabetes mellitus in children and young people.

Extremely low frequency electric fields and cancer: assessing the evidence

Much of the research and reviews on extremely low frequency (ELF) electric and magnetic fields (EMFs) have focused on magnetic rather than electric fields. Some have considered such focus to be inappropriate and have argued that electric fields should be part of both epidemiologic and laboratory work. This paper fills the gap by systematically and critically reviewing electric-fields literature and by comparing overall strength of evidence for electric versus magnetic fields. The review of possible mechanisms does not provide any specific basis for focusing on electric fields. While laboratory studies of electric fields are few, they do not indicate that electric fields should be the exposure of interest. The existing epidemiology on residential electric-field exposures and appliance use does not support the conclusion of adverse health effects from electric-field exposure. Workers in close proximity to high-voltage transmission lines or substation equipment can be exposed to high electric fields. While there are sporadic reports of increase in cancer in some occupational studies, these are inconsistent and fraught with methodologic problems. Overall, there seems little basis to suppose there might be a risk for electric fields, and, in contrast to magnetic fields, and with a possible exception of occupational epidemiology, there seems little basis for continued research into electric fields.