A History of the International Commission on Non-Ionizing Radiation Protection.

Concern about health risks from exposure to non-ionizing radiation (NIR) commenced in the 1950s after tracking radars were first introduced during the Second World War. Soon after, research on possible biological effects of microwave radiation in the former Soviet Union and the U.S. led to public and worker exposure limits being much lower in Eastern European than in Western countries, mainly because of different protection philosophies. As public concern increased, national authorities began introducing legislation to limit NIR exposures from domestic microwave ovens and workplace devices such as visual display units. The International Radiation Protection Association (IRPA) was formed in 1966 to represent national radiation protection societies. To address NIR protection issues, IRPA established a Working Group in 1974, then a Study Group in 1975, and finally the International NIR Committee (INIRC) in 1977. INIRC's publications quickly became accepted worldwide, and it was logical that it should become an independent commission. IRPA finally established the International Commission on Non-Ionizing Radiation Protection (ICNIRP), chartering its remit in 1992, and defining NIR as electromagnetic radiation (ultraviolet, visible, infrared), electromagnetic waves and fields, and infra- and ultrasound. ICNIRP's guidelines have been incorporated into legislation or adopted as standards in many countries. While ICNIRP has been subjected to criticism and close scrutiny by the public, media, and activists, it has continued to issue well-received, independent, science-based protection advice. This paper summarizes events leading to the formation of ICNIRP, its key activities up to 2017, ICNIRP's 25th anniversary year, and its future challenges.

WHO health risk assessment process for static fields.

The World Health Organization (WHO) has a commitment to helping Member States achieve safe, sustainable and health-enhancing human environments, protected from biological, chemical and physical agents. The latter includes advising on the health impact of electromagnetic fields (EMFs) and radiation. The results of the WHO/ICNIRP/NRPB workshop on static magnetic fields, published in this volume, provide a valuable and much needed contribution to the health risk assessment of exposure to static electric and magnetic fields, which is currently being coordinated by the WHO's International EMF Project. This WHO health risk assessment will be published as an environmental health criteria (EHC) monograph in early 2005. This paper briefly gives an overview of the process of developing the WHO static fields EHC monograph, the criteria applied to studies that could contribute to the EHC, along with the 'weight-of-evidence' approach to health risk assessment. In addition, there is an increasing awareness of the need to account for uncertainty in the science database. This is traditionally addressed by further research, and the EMF project addresses these needs through the development of a 'research agenda'. However, research programmes may take several years to complete, and the long latency associated with diseases such as cancer in people may also preclude a rapid outcome in some studies. The issue of current uncertainty is being addressed by the WHO EMF project through the development of a 'precautionary framework' in which precautionary measures will be applied to policy recommendations.

WHO's health risk assessment of ELF fields.

The World Health Organization (WHO), the International Commission on Non-Ionizing Radiation Protection (ICNIRP), WHO's scientific collaborating centres (including the UK's National Radiological Protection Board (NRPB)) and over 50 participating Member States are participants of WHO's International EMF Project. As part of WHO's health risk assessment process for extremely low frequency fields (ELF), this workshop was convened by NRPB to assist WHO in evaluating the potential health impacts of electrical currents and fields induced by ELF in molecules, cells, tissues and organs of the body. This paper describes the process by which WHO will conduct its health risk assessment. WHO is also trying to provide information on why exposure to ELF magnetic fields seems to be associated with an increased incidence of childhood leukaemia. Are there mechanisms that could lead to this health outcome or does the epidemiological evidence incorporate biases or other factors that need to be further explored?

Thermal stress and radiation protection principles.

Exposure to radiofrequency (RF) fields can occur in residential, occupational and medical settings. Since many technologies use RF fields, it is important to fully investigate their effects on the human body. Since the demonstrated effect of RF exposure is heating, it is important to critically evaluate studies of elevated temperature effects on the human body, from the cellular and tissue level to the whole body level, including potential effects on the susceptible groups such as the very young and the very old. WHO convened a Workshop in the Spring of 2002 on the subject of Adverse Temperature Levels in the Human. The goal of the workshop was to evaluate most recent data useful for the development of science-based RF exposure limits. This paper outlines radiation protection principles that underline such an evaluation. It discusses the quality of literature needed for sound scientific reviews, provides the hierarchy of scientific evidence used to establish effects, distinguish between biological effects and adverse health consequences and indicates how evidence is evaluated. In addition, criteria for determining the most sensitive effects, the value of an effect that has a dose-response and methods of extrapolation are also described. Finally, the need to account for scientific uncertainty in the formulation of guidance on exposure is discussed.

Carcinogenic effects of hyperthermia.

The purpose of this paper is to assess the evidence for and against the premise that hyperthermia is carcinogenic. The paper is one of several published in this issue of the International Journal of Hyperthermia on the subject of the health risks of hyperthermia. The motivation for this issue of the journal was the result of a World Health Organization workshop that dealt with this issue, as it relates to exposure of the population to RF fields. Since hyperthermia can be a natural consequence of such exposures, the health risks of hyperthermia are relevant in this context. Particularly in the case of carcinogenesis, it is necessary to provide a brief overview of the data that have been generated to examine the carcinogenic risks of RF exposure, so that these results can be compared with studies that have examined the carcinogenic risks of hyperthermia. For this reason, the paper is organized into three sections dealing with: (1) effects of heat on DNA damage/repair and mutations, (2) in vivo studies evaluating the carcinogenic potential of heat alone and combined with other carcinogens, and (3) in vivo studies involving RF exposures. The bulk of the data presented indicate that hyperthermia alone is not carcinogenic. If hyperthermia occurs in the presence of exposure to known carcinogens, such as radiation or chemical carcinogens there is the potential for modulation of carcinogenic effects of those agents. In some circumstances, hyperthermia can actually protect against tumour formation. In other instances, hyperthermia clearly increases incidence of tumour formation, but this occurs following thermal exposures (several degrees C temperature rise for up to 1 h or more) and radiation (therapeutic levels as for treatment of cancer) or chemical carcinogen doses higher than would be encountered by the general population. The extrapolation of these results to the general population, where radiation exposure levels would be at background and temperature rise from incidental RF exposure, such as cell phones (which are estimated to cause no more than 0.1 degrees C temperature rise) is not recommended. Current evidence indicates that the temperature elevations resulting from RF exposure are not carcinogenic. Caution should be used in situations where exposure to known carcinogens is combined with thermal exposures high enough to cause tissue damage. A summary of thermal thresholds for tissue damage from hyperthermia is presented in another paper in this special issue (Dewhirst et al.). No data exist that examine the carcinogenic risks of chronic thermal exposures below the threshold for detectable tissue damage, either alone or in combination with known carcinogens. This is an important goal for future research.

Summary, conclusions and recommendations: adverse temperature levels in the human body.

In the spring of 2002, The World Health Organization workshop 'Adverse Temperature Levels in the Human Body' brought together scientists with expertise in biological effects of hyperthermia to review the data and determine the evidence that could be used to evaluate potential adverse effects from human exposures to radiofrequency (RF) electromagnetic radiation in the range of 10-300 GHz. Standards for RF exposure in this frequency range are based currently on thermal effects. Information was reviewed on the ability of hyperthermia, either to the whole body or to part of the body to affect physiology, particularly the heart and circulatory system, to induce other thermoregulatory responses such as sweating, to affect the performance of simple and complex mental tasks, to induce various heat-related disorders such as heat stroke and to damage body tissue. Risks to a variety of organs were considered. In addition, thresholds for effects on developing embryos and foetuses and possible carcinogenic effects were also examined. These findings were discussed in the context of known cellular and biochemical responses of cells and tissues to hyperthermia. The experts judged the relevance of each study for informing decision-makers on the scientific basis for establishing safe exposure levels. The consensus was that standards should consider both temperature and time of exposure, whenever possible.

Health and safety implications of exposure to electromagnetic fields in the frequency range 300 Hz to 10 MHz.

An international seminar on health effects of exposure to electromagnetic fields (EMF) in the frequency range from 300 Hz to 10 MHz (referred to as the Intermediate Frequency (IF) range) was held in Maastricht, Netherlands, on 7-8 June 1999. The seminar, organized under the International EMF Project, was sponsored jointly by the World Health Organization (WHO), the International Commission on Non-Ionizing Radiation Protection (ICNIRP), and the Government of the Netherlands. This report does not attempt to summarize all of the material presented at the conference, but focuses on sources of exposure, biophysical and dosimetric considerations pertinent to extrapolating biological data from other frequency ranges to IF and identifies potential health concerns and needs for developing exposure guidelines. This paper is based on presentations at the conference and reports of working groups consisting of the speakers and other experts. It concludes with recommendations for further research aimed at improving health risk assessments in this frequency range.

Health risks from the use of mobile phones.

Widespread concerns have been raised about the possibility that exposure to the radiofrequency (RF) fields from mobile telephones or their base stations could affect people's health. Such has been the rapid growth of mobile telecommunications that there will be about one billion mobile phone users before 2005. Already there are more mobile than fixed-line users. Developing countries are establishing mobile telecommunications rather than the more expensive fixed-line systems. Thus, if there is any impact on health from mobile telephones, it will affect everyone in the world. The World Health Organization (WHO) established the International EMF Project in 1996 to evaluate the science, recommend research to fill any gaps in knowledge and to conduct formal health risk assessments of RF exposure once recommended research had been completed. In addition, the UK government established an independent expert group to review all the issues concerning health effects of mobile telephones and siting of base stations. Cancer has been suggested as an outcome of exposure to mobile telephones by some scientific reports. This paper reviews the status of the science and WHO's programme to address the key issues. In addition, the main conclusions and recommendations of the UK expert group will be summarised.

Interaction of static and extremely low frequency electric and magnetic fields with living systems: health effects and research needs.

An international seminar was held June 4-6, 1997, on the biological effects and related health hazards of ambient or environmental static and extremely low frequency (ELF) electric and magnetic fields (0-300 Hz). It was cosponsored by the World Health Organization (WHO), the International Commission on Non-Ionizing Radiation Protection (ICNIRP), the German, Japanese, and Swiss governments. Speakers provided overviews of the scientific literature that were discussed by participants of the meeting. Subsequently, expert working groups formulated this report, which evaluates possible health effects from exposure to static and ELF electric and magnetic fields and identifies gaps in knowledge requiring more research to improve health risk assessments. The working groups concluded that, although health hazards exist from exposure to ELF fields at high field strengths, the literature does not establish that health hazards are associated with exposure to low-level fields, including environmental levels. Similarly, exposure to static electric fields at levels currently found in the living and working environment or acute exposure to static magnetic fields at flux densities below 2 T, were not found to have demonstrated adverse health consequences. However, reports of biological effects from low-level ELF-field exposure and chronic exposure to static magnetic fields were identified that need replication and further study for WHO to assess any possible health consequences. Ambient static electric fields have not been reported to cause any direct adverse health effects, and so no further research in this area was deemed necessary.

A test of lymphoma induction by long-term exposure of E mu-Pim1 transgenic mice to 50 Hz magnetic fields.

E mu-Pim1 transgenic mice expressing a dysregulated Pim1 oncogene in their lymphoid cells were used to test whether exposure to 50 Hz magnetic fields can increase the frequency of malignant lymphoma in mice of a strain predisposed to develop such tumors spontaneously at low incidence. Specific-pathogen-free female mice were allocated randomly into groups of approximately 100 at 6-8 weeks of age and then exposed for 20 h/day for up to 18 months to sinusoidal magnetic fields of 0, 1, 100 or 1000 microT, or 1000 microT pulsed 15 min on and 15 min off. Additional E mu-Pim1 mice were injected with ethylnitrosourea (50 mg/kg body weight) as positive controls for enhanced lymphomagenesis; these yielded a cumulative incidence of lymphoma of 60% in 9 months. A lethal, transgene-dependent renal glomerular disease occurred at a frequency that varied from 9% to 19% among the groups, but the increase was statistically significant only at the 1000-microT exposure. Lymphoblastic and non-lymphoblastic (predominantly follicular) lymphomas were seen in 26 to 35% of the exposed mice, but at no significantly higher incidence than the 29% found in the sham-exposed mice. Hence we conclude that the lymphoma-prone mice did not reveal any tumorigenic effect of long-term exposure to 50 Hz magnetic fields.

Low-level exposure to radiofrequency electromagnetic fields: health effects and research needs.

The World Health Organization (WHO), the International Commission on Non-Ionizing Radiation Protection (ICNIRP), and the German and Austrian Governments jointly sponsored an international seminar in November of 1996 on the biological effects of low-level radiofrequency (RF) electromagnetic fields. For purposes of this seminar, RF fields having frequencies only in the range of about 10 MHz to 300 GHz were considered. This is one of a series of scientific review seminars held under the International Electromagnetic Field (EMF) Project to identify any health hazards from EMF exposure. The scientific literature was reviewed during the seminar and expert working groups formed to provide a status report on possible health effects from exposure to low-level RF fields and identify gaps in knowledge requiring more research to improve health risk assessments. It was concluded that, although hazards from exposure to high-level (thermal) RF fields were established, no known health hazards were associated with exposure to RF sources emitting fields too low to cause a significant temperature rise in tissue. Biological effects from low-level RF exposure were identified needing replication and further study. These included in vitro studies of cell kinetics and proliferation effects, effects on genes, signal transduction effects and alterations in membrane structure and function, and biophysical and biochemical mechanisms for RF field effects. In vivo studies should focus on the potential for cancer promotion, co-promotion and progression, as well as possible synergistic, genotoxic, immunological, and carcinogenic effects associated with chronic low-level RF exposure. Research is needed to determine whether low-level RF exposure causes DNA damage or influences central nervous system function, melatonin synthesis, permeability of the blood brain barrier (BBB), or reaction to neurotropic drugs. Reported RF-induced changes to eye structure and function should also be investigated. Epidemiological studies should investigate: the use of mobile telephones with hand-held antennae and incidence of various cancers; reports of headache, sleep disturbance, and other subjective effects that may arise from proximity to RF emitters, and laboratory studies should be conducted on people reporting these effects; cohorts with high occupational RF exposure for changes in cancer incidence; adverse pregnancy outcomes in various highly RF exposed occupational groups; and ocular pathologies in mobile telephone users and in highly RF exposed occupational groups. Studies of populations with residential exposure from point sources, such as broadcasting transmitters or mobile telephone base stations have caused widespread health concerns among the public, even though RF exposures are very low. Recent studies that may indicate an increased incidence of cancer in exposed populations should be investigated further.

Lymphomas in E mu-Pim1 transgenic mice exposed to pulsed 900 MHZ electromagnetic fields.

Whether radiofrequency (RF) fields are carcinogenic is controversial; epidemiological data have been inconclusive and animal tests limited. The aim of the present study was to determine whether long-term exposure to pulse-modulated RF fields similar to those used in digital mobile telecommunications would increase the incidence of lymphoma in E mu-Pim1 transgenic mice, which are moderately predisposed to develop lymphoma spontaneously. One hundred female E mu-Pim1 mice were sham-exposed and 101 were exposed for two 30-min periods per day for up to 18 months to plane-wave fields of 900 MHz with a pulse repetition frequency of 217 Hz and a pulse width of 0.6 ms. Incident power densities were 2.6-13 W/m2 and specific absorption rates were 0.008-4.2 W/kg, averaging 0.13-1.4 W/kg. Lymphoma risk was found to be significantly higher in the exposed mice than in the controls (OR = 2.4. P = 0.006, 95% CI = 1.3-4.5). Follicular lymphomas were the major contributor to the increased tumor incidence. Thus long-term intermittent exposure to RF fields can enhance the probability that mice carrying a lymphomagenic oncogene will develop lymphomas. We suggest that such genetically cancer-prone mice provide an experimental system for more detailed assessment of dose-response relationships for risk of cancer after RF-field exposure.

Radiofrequency field exposure and cancer: what do the laboratory studies suggest?

Significant concern has been raised about possible health effects from exposure to radiofrequency (RF) electromagnetic fields, especially after the rapid introduction of mobile telecommunications systems. Parents are especially concerned with the possibility that children might develop cancer after exposure to the RF emissions from mobile telephone base stations erected in or near schools. These questions have followed scientific reports suggesting that residence near high voltage power lines may to be associated with an increased childhood leukemia risk. Epidemiologic studies have been plagued by poor RF exposure assessment and differences in methodology. There are no high-quality epidemiologic studies that can be used to evaluate health risks from RF exposure. Laboratory studies in this area have been somewhat confusing. Some animal studies suggest that RF fields accelerate the development of sarcoma colonies in the lung, mammary tumors, skin tumors, hepatomas, and sarcomas. A substantial RF-induced increase in lymphoma incidence in transgenic mice exposed for up to 18 months has also been reported. In contrast, other studies have not found carcinogenic effects. These conflicting results indicate the need for more well-conducted studies on laboratory animals, supplemented with high-quality in vitro studies to identify effects that need further research in vivo, and to characterize any acting mechanisms, especially at low RF field levels. This paper provides a review of the laboratory studies and indicates what conclusions about RF-induced cancer can be drawn.

An evaluation of the copper-bromide laser for treating telangiectasia.

BACKGROUND: Copper bromide lasers, producing pulsed yellow and green light, have been developed for treating cutaneous lesions. OBJECTIVE: A clinical trial was conducted to evaluate the role of this laser, using its yellow wavelength, to treat benign vascular ectasia and establish some clinical guidelines for therapy. METHODS: Twenty-three informed consenting adults with facial telangiectasia, spider angiomas, or vascular nevi on the head, neck, or upper chest were treated with the laser. Assessment of results was performed by: blinded clinical evaluation, blinded comparison of "before" and "after" photographs, and patients' own reports of satisfaction levels. RESULTS: Good to excellent results were obtained in most patients, except for a few suffering minor skin atrophy where very large vessels were treated. CONCLUSIONS: The copper bromide laser was an effective tool in the treatment of certain cutaneous vascular lesions.