Environmental Health Criteria 238

EXTREMELY LOW FREQUENCY FIELDS

Published under the joint sponsorship of International Labour Organization, the International Commission on Non-Ionizing Radiation Protection, and the World Health Organization.

This report contains the collective views of aninternational group of experts and does notnecessarily represent the decisions or the statedpolicy of the International Commission of Non-Ionizing Radiation Protection, the InternationalLabour Organization, or the World HealthOrganization.

WHO Library Cataloguing-in-Publication Data

Extremely low frequency fields.

(Environmental health criteria ; 238)

1.Electromagnetic fields. 2.Radiation effects. 3.Risk assessment. 4.Envi-ronmental exposure. I.World Health Organization. II.Inter-OrganizationProgramme for the Sound Management of Chemicals. III.Series.

ISBN 978 92 4 157238 5 (NLM classification: QT 34)ISSN 0250-863X

World Health Organization 2007

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Environmental Health CriteriaCONTENTS

PREAMBLE .................................................................................................xiThe WHO Environmental Health Criteria Programme .....................xiElectromagnetic Fields ......................................................................xiScope.................................................................................................xiiProcedures........................................................................................xiiiExtremely Low Frequency Environmental Health Criteria.............xivParticipants in the WHO Expert Working Groups ...........................xvAcknowledgements...........................................................................xxAbbreviations...................................................................................xxi

1 SUMMARY AND RECOMMENDATIONS FOR FURTHER STUDY...............................................................................................1

1.1 Summary .......................................................................................11.1.1 Sources, measurements and exposures....................................11.1.2 Electric and magnetic fields inside the body...........................21.1.3 Biophysical mechanisms .........................................................31.1.4 Neurobehaviour .......................................................................51.1.5 Neuroendocrine system ...........................................................61.1.6 Neurodegenerative disorders ...................................................71.1.7 Cardiovascular disorders .........................................................81.1.8 Immunology and haematology................................................81.1.9 Reproduction and development...............................................81.1.10 Cancer......................................................................................91.1.11 Health risk assessment...........................................................111.1.12 Protective measures ...............................................................12

1.2 Recommendations for research...................................................141.2.1 Sources, measurements and exposures..................................141.2.2 Dosimetry ..............................................................................151.2.3 Biophysical mechanisms .......................................................151.2.4 Neurobehaviour .....................................................................161.2.5 Neuroendocrine system .........................................................171.2.6 Neurodegenerative disorders .................................................171.2.7 Cardiovascular disorders .......................................................171.2.8 Immunology and haematology..............................................171.2.9 Reproduction and development.............................................171.2.10 Cancer....................................................................................171.2.11 Protective measures ...............................................................18

2 SOURCES, MEASUREMENTS AND EXPOSURES.................212.1 Electric and magnetic fields ........................................................21

2.1.1 The field concept ...................................................................212.1.2 Quantities and units ...............................................................222.1.3 Polarization............................................................................222.1.4 Time variation, harmonics and transients..............................232.1.5 Perturbations to fields, shielding ...........................................24

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2.2 Sources of alternating fields ....................................................... 252.2.1 Electric fields ........................................................................ 252.2.1.1 Naturally occurring fields................................................ 252.2.1.2 Artificial fields ................................................................ 262.2.2 Magnetic fields...................................................................... 282.2.2.1 Naturally occurring fields................................................ 282.2.2.2 Artificial fields ................................................................ 30

2.3 Assessment of exposure.............................................................. 542.3.1 General considerations .......................................................... 542.3.2 Assessing residential exposure to magnetic fields:

methods not involving measurement .................................... 562.3.2.1 Distance ........................................................................... 562.3.2.2 Wire code ........................................................................ 562.3.2.3 Calculated historical fields .............................................. 582.3.3 Assessing residential exposure to magnetic

fields using measurements .................................................... 592.3.3.1 Spot measurements in the home...................................... 592.3.3.2 Longer-term measurements in homes ............................. 602.3.3.3 Personal exposure monitoring ......................................... 632.3.4 Assessing exposure to magnetic fields from appliances ....... 652.3.5 Assessing exposure at schools .............................................. 662.3.6 Assessing non-occupational exposure to magnetic fields:

discussion .............................................................................. 672.3.7 Assessing occupational exposure to magnetic fields ............ 682.3.8 Assessing exposure to electric fields..................................... 712.3.9 Exposure assessment: conclusions........................................ 72

3 ELECTRIC AND MAGNETIC FIELDS INSIDE THE BODY 733.1 Introduction................................................................................. 733.2 Models of human and animal bodies .......................................... 743.3 Electric field dosimetry............................................................... 76

3.3.1 Basic interaction mechanisms ............................................... 763.3.2 Measurements ....................................................................... 773.3.3 Computations ........................................................................ 773.3.4 Comparison of computations with measurements ................ 83

3.4 Magnetic field dosimetry ............................................................ 853.4.1 Basic interaction mechanisms ............................................... 853.4.2 Computations uniform field ............................................... 853.4.3 Computations non-uniform fields ...................................... 893.4.4 Computations

inter-laboratory comparison and model effects..................... 903.5 Contact current............................................................................ 913.6 Comparison of various exposures............................................... 923.7 Microscopic dosimetry ............................................................... 933.8 Conclusions................................................................................. 95

4 BIOPHYSICAL MECHANISMS ................................................. 974.1 Introduction................................................................................. 974.2 The concept of plausibility ......................................................... 97

v4.3 Stochastic effects, thresholds and dose-response relationships ..984.4 Induced currents and fields .......................................................100

4.4.1 Currents induced by fields...................................................1004.4.2 Comparison with noise........................................................1004.4.3 Myelinated nerve fibre stimulation thresholds....................1014.4.4 Neural networks and signal detection .................................1024.4.5 Transients ............................................................................1034.4.6 Heating effects of induced currents.....................................1034.4.7 Summary on induced currents .............................................103

4.5 Other direct effects of fields......................................................1044.5.1 Ionization and breaking of bonds ........................................1044.5.2 Forces on charged particles .................................................1054.5.3 Forces on magnetic particles ...............................................1054.5.4 Free radicals ........................................................................1074.5.5 Effects with narrow bandwidths..........................................1094.5.5.1 Cyclotron resonance ......................................................1094.5.5.2 Larmor precession .........................................................1094.5.5.3 Quantum mechanical resonance phenomena.................1094.5.6 Stochastic resonance............................................................110

4.6 Indirect effects of fields ............................................................1104.6.1 Surface charge and microshocks .........................................1104.6.2 Contact currents...................................................................1104.6.3 Deflection of cosmic rays....................................................1114.6.4 Effects on airborne pollutants..............................................1124.6.4.1 Production of corona ions..............................................1124.6.4.2 Inhalation of pollutant particles .....................................1134.6.4.3 Deposition under power lines ........................................1144.6.4.4 Implications for health...................................................115

4.7 Conclusions...............................................................................1155 NEUROBEHAVIOUR .................................................................118

5.1 Electrophysiological considerations .........................................1185.2 Volunteer studies.......................................................................121

5.2.1 Surface electric charge ........................................................1215.2.2 Nerve stimulation ................................................................1235.2.3 Retinal function ...................................................................1245.2.4 Brain electrical activity .......................................................1255.2.5 Sleep ....................................................................................1315.2.6 Cognitive effects..................................................................1325.2.7 Hypersensitivity...................................................................1365.2.8 Mood and alertness..............................................................137

5.3 Epidemiological studies ............................................................1435.3.1 Depression ...........................................................................1435.3.2 Suicide .................................................................................143

5.4 Animal studies...........................................................................1455.4.1 Perception and field detection .............................................1455.4.2 Arousal and aversion ...........................................................1475.4.3 Brain electrical activity .......................................................151

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5.4.4 Neurotransmitter function ................................................... 1525.4.5 Cognitive function............................................................... 153

5.5 Conclusions............................................................................... 1606 NEUROENDOCRINE SYSTEM................................................ 162

6.1 Volunteer studies ...................................................................... 1626.1.1 The pineal hormone: melatonin .......................................... 1626.1.1.1 Laboratory studies ......................................................... 1626.1.1.2 Residential and occupational studies............................. 1636.1.2 Pituitary and other hormones .............................................. 165

6.2 Animal studies .......................................................................... 1716.2.1 Melatonin ............................................................................ 1716.2.1.1 Laboratory rodents ........................................................ 1716.2.1.2 Seasonal breeders .......................................................... 1726.2.1.3 Non human primates ..................................................... 1776.2.2 The pituitary and other hormones ....................................... 1786.2.2.1 Pituitary-adrenal effects................................................. 1786.2.2.2 Other endocrine studies ................................................. 179

6.3 In vitro studies .......................................................................... 1796.3.1 Effects on melatonin production in vitro ............................ 1816.3.2 Effects on the action of melatonin in vitro.......................... 182

6.4 Conclusions............................................................................... 1857 NEURODEGENERATIVE DISORDERS ................................. 187

7.1 Alzheimer's disease................................................................... 1887.1.1 Pathology ............................................................................ 1887.1.2 Epidemiology ...................................................................... 189

7.2 Amyotrophic lateral sclerosis ................................................... 1967.2.1 Pathology ............................................................................ 1967.2.2 Epidemiology ...................................................................... 196

7.3 Parkinsons disease, Multiple Sclerosis.................................... 2027.3.1 Pathology ............................................................................ 2027.3.2 Epidemiology ...................................................................... 203

7.4 Discussion................................................................................. 2037.5 Conclusions............................................................................... 206

8 CARDIOVASCULAR DISORDERS.......................................... 2078.1 Acute effects ............................................................................. 207

8.1.1 Electrocardiogram changes, heart rate, and heart rate variability...................................................... 207

8.1.2 Blood pressure..................................................................... 2108.2 Long-term effects...................................................................... 2118.3 Discussion................................................................................. 218

8.3.1 Heart rate variability hypothesis ......................................... 2188.3.2 Epidemiologic evidence ...................................................... 219

8.4 Conclusions............................................................................... 2209 IMMUNE SYSTEM AND HAEMATOLOGY.......................... 221

9.1 Immune system......................................................................... 2219.1.1 Human studies..................................................................... 222

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9.1.2 Animal studies.....................................................................2249.1.3 Cellular studies ....................................................................226

9.2 Haematological system .............................................................2339.2.1 Human studies .....................................................................2339.2.2 Animal studies.....................................................................2339.2.3 Cellular studies ....................................................................236

9.3 Conclusions...............................................................................23710 REPRODUCTION AND DEVELOPMENT .............................239

10.1 Epidemiology ............................................................................23910.1.1 Maternal exposure ...............................................................23910.1.1.1 Video display terminals .................................................23910.1.1.2 Electrically heated beds .................................................23910.1.1.3 Other residential and occupational exposure.................24210.1.2 Paternal exposure ................................................................246

10.2 Effects on laboratory mammals ...............................................24710.2.1 Electric fields.......................................................................24710.2.2 Magnetic fields ....................................................................24710.2.2.1 Effects on prenatal development ...................................24710.2.2.3 Multi-generation studies ................................................25010.2.2.4 Effects on mammalian embryos in vitro........................25010.2.2.5 Effects of paternal exposure ..........................................251

10.3Effects on non-mammalian species ...............................................25210.3.1 Bird embryos .......................................................................25210.3.1.1 Development..................................................................25210.3.1.2 Interaction with known teratogens.................................25310.3.2 Other non-mammalian species ............................................253

10.4 Conclusion ................................................................................25411 CANCER .......................................................................................255

11.1 IARC 2002 evaluation: summary .............................................25611.2 Epidemiological studies ............................................................263

11.2.1 Childhood leukaemia...........................................................26311.2.1.1 Epidemiology.................................................................26311.2.1.2 Trends and ecologic correlations ...................................26611.2.1.3 New data ........................................................................26811.2.1.4 Evaluating epidemiological evidence:

possible explanations .....................................................27011.2.2 Adult cancer ........................................................................27611.2.2.1 Breast cancer..................................................................27711.2.2.2 Leukaemia and brain cancer ..........................................29111.2.2.3 Other cancers .................................................................30511.2.3 Epidemiology: conclusions .................................................307

11.3 Carcinogenesis in laboratory animals .......................................30811.3.1 Rodent bioassays .................................................................30811.3.1.1 Large scale, life-time studies .........................................30811.3.1.2 Leukaemia/lymphoma ...................................................30911.3.1.3 Brain tumours ................................................................31011.3.2 EMF exposure combined with carcinogens ........................312

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11.3.2.1 Liver pre-neoplastic lesions........................................... 31211.3.2.2 Leukaemia/lymphoma ................................................... 31211.3.2.3 Mammary tumours ........................................................ 31311.3.2.4 Skin tumours.................................................................. 31411.3.2.5 Brain tumours ................................................................ 31511.3.3 Transplanted tumours.......................................................... 31611.3.4 Genotoxicity in animals ...................................................... 31611.3.5 Non-genotoxic studies......................................................... 32111.3.6 Animal studies: conclusions................................................ 321

11.4 In vitro carcinogenesis studies.................................................. 32211.4.1 Genotoxic effects ................................................................ 32311.4.1.1 Genotoxic effects of ELF magnetic fields alone ........... 32311.4.1.2 Combined genotoxic effects .......................................... 32411.4.2 Expression of oncogenes and cancer-related genes ............ 32711.4.3 Differentiation, proliferation and apoptosis ........................ 33511.4.4 Gap junction intercellular communications ........................ 33911.4.5 Free radicals ........................................................................ 34611.4.6 In vitro conclusions ............................................................ 347

11.5 Overall conclusions................................................................... 34712 HEALTH RISK ASSESSMENT................................................. 349

12.1 Introduction............................................................................... 34912.2 Hazard identification................................................................. 350

12.2.1 Biological versus adverse health effects ............................. 35012.2.2 Acute effects........................................................................ 35012.2.3 Chronic effects .................................................................... 350

12.3 Exposure assessment................................................................. 35112.3.1 Residential exposures.......................................................... 35112.3.2 Occupational exposures ...................................................... 351

12.4 Exposure-response assessment ................................................. 35212.4.1 Threshold levels .................................................................. 35212.4.2 Epidemiological methods.................................................... 352

12.5 Risk characterization................................................................. 35312.5.1 Acute effects........................................................................ 35312.5.2 Chronic effects .................................................................... 35312.5.3 Uncertainties in the risk characterization............................ 35412.5.3.1 Biophysical mechanisms ............................................... 35412.5.3.2 Exposure metric............................................................. 35512.5.3.3 Epidemiology ................................................................ 355

12.6 Conclusions............................................................................... 35513 PROTECTIVE MEASURES ...................................................... 357

13.1 Introduction............................................................................... 35713.2 General issues in health policy ................................................. 357

13.2.1 Dealing with environmental health risks............................. 35713.2.2 Factors affecting health policy ............................................ 359

13.3 Scientific input.......................................................................... 36113.3.1 Emission and exposure standards........................................ 36113.3.2 Risk in perspective .............................................................. 362

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13.4 Precautionary-based policy approaches ....................................36213.4.1 Existing precautionary ELF policies ...................................36213.4.2 Cost and feasibility..............................................................366

13.5 Discussion and recommendations.............................................36713.5.1 Recommendations ...............................................................372

APPENDIX: Quantitative risk assessment for childhood leukaemia ........374A.1 Exposure distribution ................................................................374A.2 Exposure-response analysis using attributable

fraction estimates for EMF and childhood leukaemia ..............375A.3 Risk characterization.................................................................377

14 REFERENCES ...............................................................................38515 GLOSSARY ...................................................................................43116 RESUME ET RECOMMANDATIONS RELATIVES AUX

ETUDES A MENER ......................................................................44616.1 Rsum......................................................................................446

16.1.1 Sources, mesurage et expositions........................................44616.1.2 Champs lectriques et magntiques dans lorganisme ........44716.1.3 Mcanismes biophysiques...................................................44916.1.4 Neurocomportement............................................................45016.1.5 Systme neuroendocrinien ..................................................45216.1.6 Troubles neurodgnratifs .................................................45316.1.7 Troubles cardio-vasculaires.................................................45416.1.8 Immunologie et hmatologie...............................................45416.1.9 Reproduction et dveloppement ..........................................45516.1.10Cancer .................................................................................45516.1.11Evaluation du risque pour la sant......................................45716.1.12Mesures de protection.........................................................459

16.2 Recommandations en matire de recherche..............................46116.2.1 Sources, mesurage et expositions........................................46116.2.2 Dosimtrie ...........................................................................46216.2.3 Mcanismes biophysiques...................................................46316.2.4 Neuro-comportement...........................................................46316.2.5 Systme neuroendocrinien ..................................................46416.2.6 Troubles neurodgnratifs .................................................46416.2.7 Troubles cardio-vasculaires.................................................46516.2.8 Immunologie et hmatologie...............................................46516.2.9 Reproduction et dveloppement ..........................................46516.2.10Cancer .................................................................................46516.2.11Mesures de protection.........................................................466

17 .47017.1 ..............................................................................47017.1.1 ,

............................................................................47017.1.2 .......47217.1.3 .........................................47317.1.4 .............................................................475

x17.1.5 ......................................... 47717.1.6 ........................ 47917.1.7 - ........................ 47917.1.8 ....................................... 47917.1.9 ....................................... 48017.1.10 ................................... 48117.1.11 ...................................... 48317.1.12 ............................................... 485

17.2 .................. 48717.2.1 , 48817.2.2 ...................................................................... 48917.2.3 ......................................... 48917.2.4 ............................................................. 49017.2.5 ......................................... 49117.2.6 ........................ 49117.2.7 - ............................ 49117.2.1 ........................................ 49117.2.9 ........................ 49217.2.10 ..................................... 49217.2.11 ............................................... 493

18 Resumen y recomendaciones para estudios posteriores ..................... 49718.1 Resumen ................................................................................... 497

18.1.1 Fuentes, mediciones y exposiciones ................................... 49718.1.2 Campos elctricos y magnticos dentro del cuerpo ............ 49818.1.3 Mecanismos biofsicos ........................................................ 50018.1.4 Neurocomportamiento......................................................... 50118.1.5 Sistema neuroendocrino ...................................................... 50318.1.6 Trastomnos neurodegenerativos......................................... 50418.1.7 Trastornos cardiovasculares ................................................ 50518.1.8 Inmunologa y hematologa................................................. 50518.1.9 Reproduccin y desarrollo ................................................. 50618.1.10Cncer................................................................................ 50618.1.11Evaluacin de los riesgos de salud .................................... 50818.1.12Medidas de proteccin....................................................... 510

18.2 Recomendaciones para la investigacin .................................. 51218.2.1 Fuentes, mediciones y exposiciones .................................. 51218.2.2 Dosimetra .......................................................................... 51318.2.3 Mecanismos biofsicos ....................................................... 51418.2.4 Neurocomportamiento........................................................ 51418.2.5 Sistema neuroendocrino ..................................................... 51518.2.6 Trastornos neurodegenerativos .......................................... 51518.2.7 Trastornos cardiovasculares ............................................... 51518.2.8 Inmunologa y hematologa ............................................... 51618.2.9 Reproduccin y desarrollo ................................................. 51618.2.10Cncer ............................................................................... 51618.2.11Medidas de proteccin....................................................... 517

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PREAMBLE

The WHO Environmental Health Criteria Programme

In 1973 the World Health Organization (WHO) EnvironmentalHealth Criteria Programme was initiated with the following objectives:(i) to assess information on the relationship between exposure to

environmental pollutants and human health, and to provideguidelines for setting exposure limits;

(ii) to identify new or potential pollutants;(iii) to identify gaps in knowledge concerning the health effects of

pollutants;(iv) to promote the harmonization of toxicological and epidemiological

methods in order to have internationally comparable results.It should be noted in this context that WHO defines health as the

state of complete physical, mental and social well being and not merely theabsence of disease or infirmity (WHO, 1946).

The first Environmental Health Criteria (EHC) monograph, on mer-cury, was published in 1976 and since that time an ever-increasing number ofassessments of chemical and of physical agents have been produced. In addi-tion, many EHC monographs have been devoted to evaluating toxicologicalmethodology, e.g. for genetic, neurotoxic, teratogenic and nephrotoxicagents. Other publications have been concerned with epidemiological guide-lines, evaluation of short-term tests for carcinogens, biomarkers, effects onthe elderly and so forth.

The original impetus for the Programme came from World HealthAssembly resolutions and the recommendations of the 1972 UN Conferenceon the Human Environment. Subsequently the work became an integral partof the International Programme on Chemical Safety (IPCS), a cooperativeprogramme of the United Nations Environment Programme (UNEP), theInternational Labour Office (ILO) and WHO. With the strong support of thenew partners, the importance of occupational health and environmentaleffects was fully recognized. The EHC monographs have become widelyestablished, used and recognized throughout the world.

Electromagnetic Fields

Three monographs on electromagnetic fields (EMF) address possi-ble health effects from exposure to extremely low frequency (ELF) fields,static and ELF magnetic fields, and radiofrequency (RF) fields (WHO, 1984;WHO, 1987; WHO, 1993). They were produced in collaboration with UNEP,ILO and the International Non-Ionizing Radiation Committee (INIRC) of theInternational Radiation Protection Association (IRPA) and from 1992 theInternational Commission on Non-Ionizing Radiation Protection (ICNIRP).

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EHC monographs are usually revised if new data are available thatwould substantially change the evaluation, if there is public concern forhealth or environmental effects of the agent because of greater exposure, or ifan appreciable time period has elapsed since the last evaluation. The EHCson EMF are being revised and will be published as a set of three monographsspanning the relevant EMF frequency range (0300 GHz); static fields (0Hz), ELF fields (up to 100 kHz, this volume) and RF fields (100 kHz 300GHz).

WHO's assessment of any health risks produced by non-ionizingradiation emitting technologies (in the frequency range 0300 GHz) fallswithin the responsibilities of the International EMF Project. This Project wasestablished by WHO in 1996 in response to public concern over healtheffects of EMF exposure, and is managed by the Radiation and Environmen-tal Health Unit (RAD) which is coordinating the preparation of the EHCMonographs on EMF.

The WHO health risk assessment exercise includes the develop-ment of an extensive database that comprises relevant scientific publications.Interpretation of these studies can be controversial, as there exists a spectrumof opinion within the scientific community and elsewhere. In order toachieve as wide a degree of consensus as possible, the health risk assessmentalso draws on, and in some cases includes sections of, reviews already com-pleted by other national and international expert review bodies, with particu-lar reference to: the International Agency for Research on Cancer (IARC)

Monograph on static and extremely low frequency (ELF) fieldsIARC, 2002. In June 2001 IARC formally evaluated the evidencefor carcinogenesis from exposure to static and ELF fields. Thereview concluded that ELF magnetic fields are possiblycarcinogenic to humans.

Reviews on physics/engineering, biology and epidemiologycommissioned by WHO to the International Commission on Non-Ionizing Radiation Protection (ICNIRP), a non-governmentalorganization in formal relations with WHO (ICNIRP, 2003).

Reviews by the Advisory Group on Non-Ionising Radiation(AGNIR) of the Health Protection Agency (HPA), United Kingdom(AGNIR, 2001a; 2001b; 2004; 2006).

Scope

The EHC monographs are intended to provide critical reviews onthe effect on human health and the environment of chemicals, physical andbiological agents. As such, they include and review studies that are of directrelevance for the evaluation. However, they do not describe every study car-ried out. Worldwide data are used and are quoted from original studies, notfrom abstracts or reviews. Both published and unpublished reports are con-sidered but preference is always given to published data. Unpublished data

xiii

are only used when relevant published data are absent or when they are piv-otal to the risk assessment. A detailed policy statement is available thatdescribes the procedures used for unpublished proprietary data so that thisinformation can be used in the evaluation without compromising its confi-dential nature (WHO, 1990).

In the evaluation of human health risks, sound human data, when-ever available, are generally more informative than animal data. Animal andin vitro studies provide support and are used mainly to supply evidence miss-ing from human studies. It is mandatory that research on human subjects isconducted in full accord with ethical principles, including the provisions ofthe Helsinki Declaration (WMA, 2004).

All studies, with either positive or negative effects, need to be eval-uated and judged on their own merit, and then all together in a weight of evi-dence approach. It is important to determine how much a set of evidencechanges the probability that exposure causes an outcome. Generally, studiesmust be replicated or be in agreement with similar studies. The evidence foran effect is further strengthened if the results from different types of studies(epidemiology and laboratory) point to the same conclusion.

The EHC monographs are intended to assist national and interna-tional authorities in making risk assessments and subsequent risk manage-ment decisions. They represent an evaluation of risks as far as the data willallow and are not, in any sense, recommendations for regulation or standardsetting. These latter are the exclusive purview of national and regional gov-ernments. However, the EMF EHCs do provide bodies such as ICNIRP withthe scientific basis for reviewing their international exposure guidelines.

Procedures

The general procedures that result in the publication of this EHCmonograph are discussed below.

A first draft, prepared by consultants or staff from a RAD Collabo-rating Centre, is based initially on data provided from reference databasessuch as Medline and PubMed and on IARC and ICNIRP reviews. The draftdocument, when received by RAD, may require an initial review by a smallpanel of experts to determine its scientific quality and objectivity. Once thedocument is acceptable as a first draft, it is distributed, in its unedited form,to well over 150 EHC contact points throughout the world who are asked tocomment on its completeness and accuracy and, where necessary, provideadditional material. The contact points, usually designated by governments,may be Collaborating Centres, or individual scientists known for their partic-ular expertise. Generally some months are allowed before the comments areconsidered by the author(s). A second draft incorporating comments receivedand approved by the Coordinator (RAD), is then distributed to Task Groupmembers, who carry out the peer review, at least six weeks before their meet-ing.

xiv

The Task Group members serve as individual scientists, not as rep-resentatives of their organization. Their function is to evaluate the accuracy,significance and relevance of the information in the document and to assessthe health and environmental risks from exposure to the part of the electro-magnetic spectrum being addressed. A summary and recommendations forfurther research and improved safety aspects are also required. The composi-tion of the Task Group is dictated by the range of expertise required for thesubject of the meeting (epidemiology, biological and physical sciences, med-icine and public health) and by the need for a balance in the range of opin-ions on the science, gender and geographical distribution.

The membership of the WHO Task Groups is approved by theAssistant Director General of the Cluster on Sustainable Development andHealth Environments. These Task Groups are the highest level committeeswithin WHO for conducting health risk assessments.

Task Groups conduct a critical and thorough review of an advanceddraft of the ELF EHC monograph and assess any risks to health from expo-sure to both electric and magnetic fields, reach agreements by consensus, andmake final conclusions and recommendations that cannot be altered after theTask Group meeting.

The World Health Organization recognizes the important roleplayed by non-governmental organizations (NGOs). Representatives fromrelevant national and international associations may be invited to join theTask Group as observers. While observers may provide a valuable contribu-tion to the process, they can only speak at the invitation of the Chairperson.Observers do not participate in the final evaluation; this is the sole responsi-bility of the Task Group members. When the Task Group considers it to beappropriate, it may meet in camera.

All individuals who as authors, consultants or advisers participatein the preparation of the EHC monograph must, in addition to serving in theirpersonal capacity as scientists, inform WHO if at any time a conflict of inter-est, whether actual or potential, could be perceived in their work. They arerequired to sign a conflict of interest statement. Such a procedure ensures thetransparency and probity of the process.

When the Task Group has completed its review and the Coordinator(RAD) is satisfied as to the scientific consistency and completeness of thedocument, it then goes for language editing, reference checking, and prepara-tion of camera-ready copy. After approval by the Director, Department ofProtection of the Human Environment (PHE), the monograph is submitted tothe WHO Office of Publications for printing. At this time a copy of the finaldraft is sent to the Chairperson and Rapporteur of the Task Group to checkthe proofs.

Extremely Low Frequency Environmental Health Criteria

This EHC addresses the possible health effects of exposure toextremely low frequency (>0 Hz 100 kHz) electric and magnetic fields. By

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far the majority of studies concern the health effects resulting from exposureto power frequency (5060 Hz) magnetic fields; a few studies address theeffects of exposure to power frequency electric fields. In addition, a numberof studies have addressed the effects of exposure to the very low frequency(VLF, 330 kHz) switched gradient magnetic fields used in Magnetic Reso-nance Imaging, and, more commonly, the weaker VLF fields emitted byvisual display units (VDUs) and televisions.

The ELF EHC is organized by disease category; separate expertworking groups met in order to develop drafts addressing neurodegenerativedisorders (Chapter 7), cardiovascular disorders (Chapter 8), childhood leu-kaemia (section 11.2.1) and protective measures (Chapter 13). The member-ship of these expert working groups is given below. Drafts of the otherchapters were prepared by consultants, staff from WHO collaborating cen-tres and by RAD Unit staff. These included Prof. Paul Elliot, Imperial Col-lege of Science, Technology and Medicine, UK, Prof. Maria Stuchly,University of Victoria, Canada, and Dr Bernard Veyret, ENSCPB, France, inaddition to individuals who were also members of one of the expert workinggroups and/or the Task Group (see below). The draft chapters were individu-ally reviewed by external referees prior to their collation as a draft document.

The draft EHC was subsequently distributed for external review.Editorial changes and minor scientific points were addressed by a WHO Edi-torial Group and the final draft was distributed to Task Group members priorto the Task Group meeting.

The Task Group met from October 37, 2005 at WHO headquartersin Geneva. The text of the EHC was subsequently edited for clarity and con-sistency by an Editorial Group consisting of Prof. Emilie van Deventer andProf. Chiyoji Ohkubo, both from WHO, Geneva, Switzerland, Dr Rick Saun-ders, Health Protection Agency, Chilton, UK, Dr Eric van Rongen, HealthCouncil of the Netherlands, Prof. Leeka Kheifets, UCLA School of PublicHealth, Los Angeles, CA, USA and Dr Chris Portier, NIEHS, Research Tri-angle Park, NC, USA. Following a final review by the Task Group and scien-tific and text editing, the EHC was published on the International EMFProjects website on 18 June 2007.

Participants in the WHO Expert Working Groups

WHO Neurodegenerative Disorders Workshop, WHO HQ,Geneva. 1213 December, 2002

Prof. Anders Ahlbom, Institute of Environmental Medicine, KarolinskaInstitute, Stockholm, SwedenProf. Laurel Beckett, School of Medicine UC Davis, Davis, CA, UnitedStates of America

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Prof. Colin Blakemore, University of Oxford, Oxford, United KingdomDr Zoreh Davanipour, Roswell Park Cancer Institute, Buffalo, NY, UnitedStates of AmericaDr Michel Geffard, National Graduate School of Chemistry and Physics ofBordeaux (ENSCPB), Pessac, FranceDr Larry Goldstein, World Health Organization, Geneva, SwitzerlandDr Christoffer Johansen, Institute of Cancer Epidemiology, Copenhagen,DenmarkDr Leeka Kheifets, World Health Organization, Geneva, SwitzerlandProf. Robert Olsen, Washington State University, Pullman, WA, UnitedStates of AmericaDr Michael Repacholi, World Health Organization, Geneva, SwitzerlandProf. Eugene Sobel, Roswell Park Cancer Institute, Buffalo, NY, UnitedStates of America

WHO Cardiovascular Disorders Workshop, Stockholm, Sweden,2728 May 2003

Prof. Anders Ahlbom, Institute of Environmental Medicine, KarolinskaInstitute, Stockholm, SwedenDr Christoffer Johansen, Institute of Cancer Epidemiology, Copenhagen,DenmarkDr Leeka Kheifets, World Health Organization, Geneva, SwitzerlandDr Maria Feychting, Institute of Environmental Medicine, Karolinska Insti-tute, Stockholm, SwedenDr Jack Sahl, Southern California Edison Co, Upland, CA, United States ofAmerica

WHO Childhood Leukaemia Workshop, NIES, Japan, 1618September 2003

Prof. Abdelmonem Afifi, UCLA School of Public Health, Los Angeles, CA,United States of AmericaProf. Anders Ahlbom, Institute of Environmental Medicine, KarolinskaInstitute, Stockholm, SwedenProf. Emilie van Deventer, World Health Organization, Geneva, SwitzerlandDr Michinori Kabuto, National Institute for Environmental Studies, Tsukuba,Ibariki, Japan

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Dr Bill Kaune, EMF Consultant, United States of America.Prof. Leeka Kheifets, UCLA School of Public Health, Los Angeles, CA,United States of America.Dr Gabor Mezei, Electric Power Research Institute, Palo Alto, CA, UnitedStates of AmericaDr Chris Portier, National Institute of Environmental Health Sciences,Research Triangle Park, NC, United States of AmericaDr Tomohiro Saito, National Centre for Child Health and Development,JapanDr John Swanson, National Grid Transco, London, United KingdomDr Naoto Yamaguchi, Graduate School of Medicine, Tokyo Women's Medi-cal University, Japan

WHO Protective Measures for ELF EMFs Workshop, NIEHS, USA,911 February, 2005

Dr Robert Bradley, Consumer and Clinical Radiation Protection Bureau,Ottawa, CanadaMr Abiy Desta, Center for Devices and Radiological Health, Rockville, MD,United States of AmericaMrs Shaiela Kandel, Soreq Nuclear Research Center, Yavne, IsraelProf. Leeka Kheifets, UCLA School of Public Health, Los Angeles, CA,United States of America.Dr Raymond Neutra, Division of Environmental and Occupational DiseaseControl, Californai Department of Health Services, Oakland, CA, UnitedStates of AmericaDr Chris Portier, National Institute of Environmental Health Sciences,Research Triangle Park, NC, United States of AmericaDr Michael Repacholi, World Health Organization, Geneva, SwitzerlandDr Jack Sahl, Southern California Edison Company, Upland, CA, UnitedStates of AmericaDr John Swanson, National Grid Transco, London, United KingdomDr Mary Wolfe, National Institute of Environmental Health Sciences,Research Triangle Park, NC, United States of America

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Task Group on ELF electric and magnetic fields, Geneva, 37October, 2005

Members

Prof. Anders Ahlbom, Institute of Environmental Medicine, KarolinskaInstitute, Stockholm, SwedenDr Larry Anderson, Battelle Pacific Northwest National Laboratory, Rich-land, WA, United States of AmericaDr Christoffer Johansen, Institute of Cancer Epidemiology, Copenhagen,DenmarkDr Jukka Juutilainen, University of Kuopio, Kuopio, FinlandDr Michinori Kabuto, National Institute for Environmental Studies, Tsukuba,Ibariki, JapanMrs Shaiela Kandel, Soreq Nuclear Research Center, Yavne, IsraelProf. Leeka Kheifets, UCLA School of Public Health, Los Angeles, CA,United States of AmericaDr Isabelle Lagroye, National Graduate School of Chemistry and Physics ofBordeaux (ENSCPB), Pessac, FranceDipl-Ing Rdiger Matthes, Federal Office for Radiation Protection, Ober-schleissheim, GermanyProf. Jim Metcalfe, University of Cambridge, Cambridge, United KingdomProf. Meike Mevissen, Institut fr Tiergenetik, Bern, SwitzerlandProf. Junji Miyakoshi, Hirosaki University, Hirosaki, JapanDr Alastair McKinlay, Health Protection Agency, Chilton, United KingdomDr Shengli Niu, International Labour Organization, Geneva, SwitzerlandDr Chris Portier, National Institute of Environmental Health Sciences,Research Triangle Park, NC, United States of AmericaDr Eric van Rongen, Health Council of the Netherlands, The Hague, TheNetherlandsDr Nina Rubtsova, RAMS Institute of Occupational Health, Moscow, Rus-sian FederationDr Paolo Vecchia, National Institute of Health, Rome, ItalyProf. Barney de Villiers, University of Stellenbosch, Cape Town, SouthAfrica Prof. Andrew Wood, Swinburne University of Technology, Melbourne, Aus-tralia

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Prof. Zhengping Xu, Zhejiang University School of Medicine, Hangzhou,China

Observers

Mr Kazuhiko Chikamoto, Japan NUS Co., Minato-Ku, Tokyo, JapanDr Robert Kavet, Electric Power Research Institute, Palo Alto, CA, UnitedStates of AmericaProf. Hamilton Moss de Souza, CEPEL - Electrical Energy Research Center,Adrianpolis, BrazilDr Michel Plante, Hydro-Qubec, Montreal, CanadaDr Martine Souques, EDF Gaz de France, Paris, FranceDr John Swanson, National Grid Transco, London, United Kingdom

WHO Secretariat

Dr Houssain Abouzaid, World Health Organization Regional Office for theEastern Mediterranean (EMRO), Nasr City, Cairo, EgyptProf. Emilie van Deventer, World Health Organization, Geneva, SwitzerlandProf. Chiyoji Ohkubo, World Health Organization, Geneva , SwitzerlandDr Michael Repacholi, World Health Organization, Geneva, SwitzerlandDr Rick Saunders, c/o World Health Organization, Health ProtectionAgency, Chilton, United Kingdom

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ACKNOWLEDGEMENTS

This monograph represents the most thorough health risk assessment cur-rently available on extremely low frequency electric and magnetic fields.WHO acknowledges and thanks all contributors to this important publica-tion.In particular, thanks go to the experts that drafted the initial version of thevarious chapters, including Prof. Paul Elliot, Prof. Maria Stuchly, and Prof.Bernard Veyret, the members of the Working Groups and the members of theTask Group.Special thanks go to Dr Eric van Rongen, from the Health Council of theNetherlands, and Dr Rick Saunders, from the Health Protection Agency,United Kingdom, for their continuing work throughout the development ofthis monograph, and to Prof. Leeka Kheifets, who continued her involvementin the development of the document long after she left WHO. WHO also acknowledges the generous support of the Health Council of theNetherlands for providing the scientific and language editing, and for per-forming the final layout of the document.

Dr. Emilie van DeventerActing Coordinator, Radiation and Environmental HealthWorld Health Organization1 June 2007

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ABBREVIATIONS

AC alternating currentACTH adrenocorticotropic hormoneAD Alzheimers diseaseAF attributable fractionAGNIR Advisory Group on Non-Ionising RadiationALL acute lymphocytic leukaemiaALS amyotrophic lateral sclerosisAMI acute myocardial infarctionAML acute myeloid leukaemiaaMT6s 6-sulphatoxymelatoninAN attributable numberBP benzo(a)pyreneCA chromosomal aberrationsCAM cell adhesion moleculeCBPI cytokinesis-blocked proliferation indexCI confidence intervalCNS central nervous systemCon-A concanavalin-ACx connexinDC direct currentDENA diethylnitrosamineDMBA 7,12-dimethylbenz(a)anthraceneDNA desoxyribonucleic acidEAS electronic access and security systemEBCLIS electric blanket cancer Long Island studyECG electrocardiogramEEG electroencephalogramsEHC Environmental Health CriteriaELF extremely low frequencyEM electromagneticEMF electromagnetic fieldsENU N-ethyl-N-nitrosoureaER estrogen receptorERP evoked or event-related potentialsES embryonic stem cellsFDTD finite-difference time-domainFFT fast Fourier transformationFSH follicle stimulating hormoneGABA gamma-aminobutyric acidGCS ceramide glucosyltransferaseGH growth hormoneGJIC gap junction intercellular communicationH2O2 hydrogenperoxydeHIOMT hydroxyindole-O-methyltransferaseHRV heart rate variability

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HSF heat shock factorhsp heat shock proteinIARC International Agency for Research on CancerICNIRP International Commission on Non-Ionizing Radiation ProtectionIEEE Institute of Electrical and Electronic EngineersIEI idiopathic environmental intoleranceIFN interferonIg immunoglobulinIL interleukinJEM job-exposure matrixLAK lymphokine activated killerLH luteinising hormoneLIBCSP Long Island breast cancer study projectLPS lipopolysaccharideLTP long-term potentiationMBM mouse bone marrowMN micronucleusMRI magnetic resonance imagingmRNA messenger ribonucleic acidMS multiple sclerosisNA noradrenalineNADH nicotinamide adenine dinucleotide NADPH nicotinamide adenine dinucleotide phosphateNAT N-acetyl-transferase enzymeNDI nuclear division indexNGF nerve growth factorNHL non-Hodgkin lymphomaNIEHS National Institute for Environmental Health SciencesNIOHS National Institute for Occupational Safety and HealthNK natural killerNMDA N-methyl-D-aspartateNMU N-methylnitrosureaNO nitric oxideNRPB National Radiological Protection BoardODC ornithine decarboxylaseOHCC ordinary high current configuration8-OhdG 8-hydroxydeoxyguanineOLCC ordinary low current configurationOR odds ratioPAGE poly-acrylamide gel electrophoresisPARP poly-ADP ribose polymerasePBMC peripheral blood mononuclear cellsPHA phytohemagglutinin PKC protein kinase CRAD Radiation and Environmental Health UnitRF radiofrequencyRFID radiofrequency identificationRNS reactive nitrogen species

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ROS reactive oxygen speciesRR relative riskSCE sister chromatid exchangeSD standard deviationSES socioeconomic statusSMR standardized mortality ratioSIR standardized incidence ratioSPFD scalar potential finite differenceSRR standardized relative mortality risk ratioTGFR transforming growth factor- receptorTMS transcranial magnetic stimulationTNF tumour necrosis factorTNFR tumour necrosis factor receptorTPA 12-0-tetradecanoylphorbol-13-acetateTSH thyroid-stimulating hormoneTWA time-weighted averageUG undergroundUKCCSI United Kingdom childhood cancer study investigatorsULF ultra low frequencyUV ultravioletVDU visual display unitVHCC very high current configurationVLCC very low current configurationVLF very low frequencyWBC white blood cellWHO World Health Organization

Units

A ampere kA kiloampere, 103 ampereeV electronvoltF farad F microfarad, 10-6 faradHz hertz kHz kilohertz, 103 hertz MHz megahertz, 109 hertzJ joule kJ kilojoule, 103 jouleM molar nM nanomolar,10-9 molarN newton pN piconewton,10-12 newtonV volt kV kilovolt, 103 volt mV millivolt, 10-3 volt V microvolt, 10-6 volt

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T tesla kT kilotesla, 103 tesla mT millitesla, 10-3 tesla T microtesla, 10-6 tesla nT nanotesla, 10-9 teslaW watt kW kilowatt, 103 watt ohm k kiloohm, 103 ohm

11 SUMMARY AND RECOMMENDATIONS FOR FURTHERSTUDYThis Environmental Health Criteria (EHC) monograph addresses

the possible health effects of exposure to extremely low frequency (ELF)electric and magnetic fields. It reviews the physical characteristics of ELFfields as well as the sources of exposure and measurement. However, itsmain objectives are to review the scientific literature on the biological effectsof exposure to ELF fields in order to assess any health risks from exposure tothese fields and to use this health risk assessment to make recommendationsto national authorities on health protection programs.

The frequencies under consideration range from above 0 Hz to 100kHz. By far the majority of studies have been conducted on power-frequency(50 or 60 Hz) magnetic fields, with a few studies using power-frequencyelectric fields. In addition, there have been a number of studies concerningvery low frequency (VLF, 330 kHz) fields, switched gradient magneticfields used in magnetic resonance imaging, and the weaker VLF fields emit-ted by visual display units and televisions.

This chapter summarizes the main conclusions and recommenda-tions from each section as well as the overall conclusions of the health riskassessment process. The terms used in this monograph to describe thestrength of evidence for a given health outcome are as follows. Evidence istermed limited when it is restricted to a single study or when there areunresolved questions concerning the design, conduct or interpretation of anumber of studies. Inadequate evidence is used when the studies cannot beinterpreted as showing either the presence or absence of an effect because ofmajor qualitative or quantitative limitations, or when no data are available.

Key gaps in knowledge were also identified and the researchneeded to fill these gaps has been summarized in the section entitled Rec-ommendations for research.

1.1 Summary

1.1.1 Sources, measurements and exposuresElectric and magnetic fields exist wherever electricity is generated,

transmitted or distributed in power lines or cables, or used in electrical appli-ances. Since the use of electricity is an integral part of our modern lifestyle,these fields are ubiquitous in our environment.

The unit of electric field strength is volts per metre (V m-1) or kilo-volts per metre (kV m-1) and for magnetic fields the flux density is measuredin tesla (T), or more commonly in millitesla (mT) or microtesla (T) is used.

Residential exposure to power-frequency magnetic fields does notvary dramatically across the world. The geometric-mean magnetic field inhomes ranges between 0.025 and 0.07 T in Europe and 0.055 and 0.11 Tin the USA. The mean values of the electric field in the home are in the rangeof several tens of volts per metre. In the vicinity of certain appliances, the

2instantaneous magnetic-field values can be as much as a few hundredmicrotesla. Near power lines, magnetic fields reach approximately 20 T andelectric fields up to several thousand volts per metre.

Few children have time-averaged exposures to residential 50 or 60Hz magnetic fields in excess of the levels associated with an increased inci-dence of childhood leukaemia (see section 1.1.10). Approximately 1% to 4%have mean exposures above 0.3 T and only 1% to 2% have median expo-sures in excess of 0.4 T.

Occupational exposure, although predominantly to power-fre-quency fields, may also include contributions from other frequencies. Theaverage magnetic field exposures in the workplace have been found to behigher in electrical occupations than in other occupations such as officework, ranging from 0.40.6 T for electricians and electrical engineers toapproximately 1.0 T for power line workers, with the highest exposures forwelders, railway engine drivers and sewing machine operators (above 3 T).The maximum magnetic field exposures in the workplace can reach approxi-mately 10 mT and this is invariably associated with the presence of conduc-tors carrying high currents. In the electrical supply industry, workers may beexposed to electric fields up to 30 kV m-1.

1.1.2 Electric and magnetic fields inside the bodyExposure to external electric and magnetic fields at extremely low

frequencies induces electric fields and currents inside the body. Dosimetrydescribes the relationship between the external fields and the induced electricfield and current density in the body, or other parameters associated withexposure to these fields. The locally induced electric field and current den-sity are of particular interest because they relate to the stimulation of excit-able tissue such as nerve and muscle.

The bodies of humans and animals significantly perturb the spatialdistribution of an ELF electric field. At low frequencies the body is a goodconductor and the perturbed field lines outside the body are nearly perpen-dicular to the body surface. Oscillating charges are induced on the surface ofthe exposed body and these induce currents inside the body. The key featuresof dosimetry for the exposure of humans to ELF electric fields are as fol-lows: The electric field inside the body is normally five to six orders of

magnitude smaller than the external electric field. When exposure is mostly to the vertical field, the predominant

direction of the induced fields is also vertical. For a given external electric field, the strongest induced fields are

for the human body in perfect contact through the feet with ground(electrically grounded) and the weakest induced fields are for thebody insulated from the ground (in free space).

3 The total current flowing in a body in perfect contact with ground isdetermined by the body size and shape (including posture), ratherthan tissue conductivity.

The distribution of induced currents across the various organs andtissues is determined by the conductivity of those tissues

The distribution of an induced electric field is also affected by theconductivities, but less so than the induced current.

There is also a separate phenomenon in which the current in thebody is produced by means of contact with a conductive objectlocated in an electric field.For magnetic fields, the permeability of tissue is the same as that of

air, so the field in tissue is the same as the external field. The bodies ofhumans and animals do not significantly perturb the field. The main interac-tion of magnetic fields is the Faraday induction of electric fields and associ-ated current densities in the conductive tissues. The key features ofdosimetry for the exposure of humans to ELF magnetic fields are as follows: The induced electric field and current depend on the orientation of

the external field. Induced fields in the body as a whole are greatestwhen the field is aligned from the front to the back of the body, butfor some individual organs the highest values are for the fieldaligned from side to side.

The weakest electric fields are induced by a magnetic field orientedalong the vertical body axis.

For a given magnetic field strength and orientation, higher electricfields are induced in larger bodies.

The distribution of the induced electric field is affected by theconductivity of the various organs and tissues. These have a limitedeffect on the distribution of induced current density.

1.1.3 Biophysical mechanismsVarious proposed direct and indirect interaction mechanisms for

ELF electric and magnetic fields are examined for plausibility, in particularwhether a signal generated in a biological process by exposure to a fieldcan be discriminated from inherent random noise and whether themechanism challenges scientific principles and current scientific knowledge.Many mechanisms become plausible only at fields above a certain strength.Nevertheless, the lack of identified plausible mechanisms does not rule outthe possibility of health effects even at very low field levels, provided basicscientific principles are adhered to.

Of the numerous proposed mechanisms for the direct interaction offields with the human body, three stand out as potentially operating at lowerfield levels than the others: induced electric fields in neural networks, radicalpairs and magnetite.

4Electric fields induced in tissue by exposure to ELF electric ormagnetic fields will directly stimulate single myelinated nerve fibres in abiophysically plausible manner when the internal field strength exceeds afew volts per metre. Much weaker fields can affect synaptic transmission inneural networks as opposed to single cells. Such signal processing bynervous systems is commonly used by multicellular organisms to detectweak environmental signals. A lower bound on neural networkdiscrimination of 1 mV m-1 has been suggested, but based on currentevidence, threshold values around 10100 mV m-1 seem to be more likely.

The radical pair mechanism is an accepted way in which magneticfields can affect specific types of chemical reactions, generally increasingconcentrations of reactive free radicals in low fields and decreasing them inhigh fields. These increases have been seen in magnetic fields of less than 1mT. There is some evidence linking this mechanism to navigation duringbird migration. Both on theoretical grounds and because the changesproduced by ELF and static magnetic fields are similar, it is suggested thatpower-frequency fields of much less than the geomagnetic field of around 50T are unlikely to be of much biological significance.

Magnetite crystals, small ferromagnetic crystals of various forms ofiron oxide, are found in animal and human tissues, although in traceamounts. Like free radicals, they have been linked to orientation andnavigation in migratory animals, although the presence of trace quantities ofmagnetite in the human brain does not confer an ability to detect the weakgeomagnetic field. Calculations based on extreme assumptions suggest alower bound for the effects on magnetite crystals of ELF fields of 5 T.

Other direct biophysical interactions of fields, such as the breakingof chemical bonds, the forces on charged particles and the various narrowbandwidth resonance mechanisms, are not considered to provide plausibleexplanations for the interactions at field levels encountered in public andoccupational environments.

With regard to indirect effects, the surface electric charge inducedby electric fields can be perceived, and it can result in painful microshockswhen touching a conductive object. Contact currents can occur when youngchildren touch, for example, a tap in the bathtub in some homes. Thisproduces small electric fields, possibly above background noise levels, inbone marrow. However, whether these present a risk to health is unknown.

High-voltage power lines produce clouds of electrically chargedions as a consequence of corona discharge. It is suggested that they couldincrease the deposition of airborne pollutants on the skin and on airwaysinside the body, possibly adversely affecting health. However, it seemsunlikely that corona ions will have more than a small effect, if any, on long-term health risks, even in the individuals who are most exposed.

None of the three direct mechanisms considered above seem plausi-ble causes of increased disease incidence at the exposure levels generallyencountered by people. In fact they only become plausible at levels orders of

5magnitude higher and indirect mechanisms have not yet been sufficientlyinvestigated. This absence of an identified plausible mechanism does not ruleout the possibility of adverse health effects, but it does create a need forstronger evidence from biology and epidemiology.

1.1.4 Neurobehaviour Exposure to power-frequency electric fields causes well-defined

biological responses, ranging from perception to annoyance, through surfaceelectric charge effects. These responses depend on the field strength, theambient environmental conditions and individual sensitivity. The thresholdsfor direct perception by 10% of volunteers varied between 2 and 20 kV m-1,while 5% found 1520 kV m-1 annoying. The spark discharge from a personto ground is found to be painful by 7% of volunteers in a field of 5 kV m-1.Thresholds for the discharge from a charged object through a grounded per-son depend on the size of the object and therefore require specific assess-ment.

High field strength, rapidly pulsed magnetic fields can stimulateperipheral or central nerve tissue; such effects can arise during magnetic res-onance imaging (MRI) procedures, and are used in transcranial magneticstimulation. Threshold induced electric field strengths for direct nerve stimu-lation could be as low as a few volts per metre. The threshold is likely to beconstant over a frequency range between a few hertz and a few kilohertz.People suffering from or predisposed to epilepsy are likely to be more sus-ceptible to induced ELF electric fields in the central nervous system (CNS).Furthermore, sensitivity to electrical stimulation of the CNS seems likely tobe associated with a family history of seizure and the use of tricyclic antide-pressants, neuroleptic agents and other drugs that lower the seizure threshold.

The function of the retina, which is a part of the CNS, can beaffected by exposure to much weaker ELF magnetic fields than those thatcause direct nerve stimulation. A flickering light sensation, called magneticphosphenes or magnetophosphenes, results from the interaction of theinduced electric field with electrically excitable cells in the retina. Thresholdinduced electric field strengths in the extracellular fluid of the retina havebeen estimated to lie between about 10 and 100 mV m-1 at 20 Hz. There is,however, considerable uncertainty attached to these values.

The evidence for other neurobehavioural effects in volunteer stud-ies, such as the effects on brain electrical activity, cognition, sleep, hypersen-sitivity and mood, is less clear. Generally, such studies have been carried outat exposure levels below those required to induce the effects describedabove, and have produced evidence only of subtle and transitory effects atbest. The conditions necessary to elicit such responses are not well-defined atpresent. There is some evidence suggesting the existence of field-dependenteffects on reaction time and on reduced accuracy in the performance of somecognitive tasks, which is supported by the results of studies on the gross elec-trical activity of the brain. Studies investigating whether magnetic fieldsaffect sleep quality have reported inconsistent results. It is possible that these

6inconsistencies may be attributable in part to differences in the design of thestudies.

Some people claim to be hypersensitive to EMFs in general. How-ever, the evidence from double-blind provocation studies suggests that thereported symptoms are unrelated to EMF exposure.

There is only inconsistent and inconclusive evidence that exposureto ELF electric and magnetic fields causes depressive symptoms or suicide.Thus, the evidence is considered inadequate.

In animals, the possibility that exposure to ELF fields may affectneurobehavioural functions has been explored from a number of perspectivesusing a range of exposure conditions. Few robust effects have been estab-lished. There is convincing evidence that power-frequency electric fields canbe detected by animals, most likely as a result of surface charge effects, andmay elicit transient arousal or mild stress. In rats, the detection range isbetween 3 and 13 kV m-1. Rodents have been shown to be aversive to fieldstrengths greater than 50 kV m-1. Other possible field-dependent changes areless well-defined; laboratory studies have only produced evidence of subtleand transitory effects. There is some evidence that exposure to magneticfields may modulate the functions of the opioid and cholinergic neurotrans-mitter systems in the brain, and this is supported by the results of studiesinvestigating the effects on analgesia and on the acquisition and performanceof spatial memory tasks.

1.1.5 Neuroendocrine systemThe results of volunteer studies as well as residential and occupa-

tional epidemiological studies suggest that the neuroendocrine system is notadversely affected by exposure to power-frequency electric or magneticfields. This applies particularly to the circulating levels of specific hormonesof the neuroendocrine system, including melatonin, released by the pinealgland, and to a number of hormones involved in the control of body metabo-lism and physiology, released by the pituitary gland. Subtle differences weresometimes observed in the timing of melatonin release associated with cer-tain characteristics of exposure, but these results were not consistent. It isvery difficult to eliminate possible confounding by a variety of environmen-tal and lifestyle factors that might also affect hormone levels. Most labora-tory studies of the effects of ELF exposure on night-time melatonin levels involunteers found no effect when care was taken to control possible con-founding.

From the large number of animal studies investigating the effects ofpower-frequency electric and magnetic fields on rat pineal and serum mela-tonin levels, some reported that exposure resulted in night-time suppressionof melatonin. The changes in melatonin levels first observed in early studiesof electric field exposures up to 100 kV m-1 could not be replicated. Thefindings from a series of more recent studies, which showed that circularly-polarised magnetic fields suppressed night-time melatonin levels, wereweakened by inappropriate comparisons between exposed animals and his-

7torical controls. The data from other experiments in rodents, covering inten-sity levels from a few microtesla to 5 mT, were equivocal, with some resultsshowing depression of melatonin, but others showing no changes. In season-ally breeding animals, the evidence for an effect of exposure to power-fre-quency fields on melatonin levels and melatonin-dependent reproductivestatus is predominantly negative. No convincing effect on melatonin levelshas been seen in a study of non-human primates chronically exposed topower-frequency fields, although a preliminary study using two animalsreported melatonin suppression in response to an irregular and intermittentexposure.

The effects of exposure to ELF fields on melatonin production orrelease in isolated pineal glands were variable, although relatively few invitro studies have been undertaken. The evidence that ELF exposure inter-feres with the action of melatonin on breast cancer cells in vitro is intriguing.However this system suffers from the disadvantage that the cell lines fre-quently show genotypic and phenotypic drift in culture that can hinder trans-ferability between laboratories.

No consistent effects have been seen in the stress-related hormonesof the pituitary-adrenal axis in a variety of mammalian species, with the pos-sible exception of short-lived stress following the onset of ELF electric fieldexposure at levels high enough to be perceived. Similarly, while few studieshave been carried out, mostly negative or inconsistent effects have beenobserved in the levels of growth hormone and of hormones involved in con-trolling metabolic activity or associated with the control of reproduction andsexual development.

Overall, these data do not indicate that ELF electric and/or mag-netic fields affect the neuroendocrine system in a way that would have anadverse impact on human health and the evidence is thus considered inade-quate.

1.1.6 Neurodegenerative disordersIt has been hypothesized that exposure to ELF fields is associated

with several neurodegenerative diseases. For Parkinsons disease and multi-ple sclerosis the number of studies has been small and there is no evidencefor an association with these diseases. For Alzheimers disease and amyo-trophic lateral sclerosis (ALS) more studies have been published. Some ofthese reports suggest that people employed in electrical occupations mighthave an increased risk of ALS. So far, no biological mechanism has beenestablished which can explain this association, although it could have arisenbecause of confounders related to electrical occupations, such as electricshocks. Overall, the evidence for the association between ELF exposure andALS is considered to be inadequate.

The few studies investigating the association between ELF expo-sure and Alzheimers disease are inconsistent. However, the higher qualitystudies that focused on Alzheimer morbidity rather than mortality do not

8indicate an association. Altogether, the evidence for an association betweenELF exposure and Alzheimers disease is inadequate.

1.1.7 Cardiovascular disordersExperimental studies of both short-term and long-term exposure

indicate that while electric shock is an obvious health hazard, other hazard-ous cardiovascular effects associated with ELF fields are unlikely to occur atexposure levels commonly encountered environmentally or occupationally.Although various cardiovascular changes have been reported in the litera-ture, the majority of effects are small and the results have not been consistentwithin and between studies. With one exception, none of the studies of car-diovascular disease morbidity and mortality has shown an association withexposure. Whether a specific association exists between exposure and alteredautonomic control of the heart remains speculative. Overall, the evidencedoes not support an association between ELF exposure and cardiovasculardisease.

1.1.8 Immunology and haematologyEvidence for the effects of ELF electric or magnetic fields on com-

ponents of the immune system is generally inconsistent. Many of the cellpopulations and functional markers were unaffected by exposure. However,in some human studies with fields from 10 T to 2 mT, changes wereobserved in natural killer cells, which showed both increased and decreasedcell numbers, and in total white blood cell counts, which showed no changeor decreased numbers. In animal studies, reduced natural killer cell activitywas seen in female mice, but not in male mice or in rats of either sex. Whiteblood cell counts also showed inconsistency, with decreases or no changereported in different studies. The animal exposures had an even broaderrange of 2 T to 30 mT. The difficulty in interpreting the potential healthimpact of these data is due to the large variations in exposure and environ-mental conditions, the relatively small numbers of subjects tested and thebroad range of endpoints.

There have been few studies carried out on the effects of ELF mag-netic fields on the haematological system. In experiments evaluating differ-ential white blood cell counts, exposures ranged from 2 T to 2 mT. Noconsistent effects of acute exposure to ELF magnetic fields or to combinedELF electric and magnetic fields have been found in either human or animalstudies.

Overall therefore, the evidence for effects of ELF electric or mag-netic fields on the immune and haematological system is considered inade-quate.

1.1.9 Reproduction and developmentOn the whole, epidemiological studies have not shown an associa-

tion between adverse human reproductive outcomes and maternal or paternalexposure to ELF fields. There is some evidence for an increased risk of mis-

9carriage associated with maternal magnetic field exposure, but this evidenceis inadequate.

Exposures to ELF electric fields of up to 150 kV m-1 have beenevaluated in several mammalian species, including studies with large groupsizes and exposure over several generations. The results consistently showno adverse developmental effects.

The exposure of mammals to ELF magnetic fields of up to 20 mTdoes not result in gross external, visceral or skeletal malformations. Somestudies show an increase in minor skeletal anomalies, in both rats and mice.Skeletal variations are relatively common findings in teratological studiesand are often considered biologically insignificant. However, subtle effectsof magnetic fields on skeletal development cannot be ruled out. Very fewstudies have been published which address reproductive effects and no con-clusions can be drawn from them.

Several studies on non-mammalian experimental models (chickembryos, fish, sea urchins and insects) have reported findings indicating thatELF magnetic fields at microtesla levels may disturb early development.However, the findings of non-mammalian experimental models carry lessweight in the overall evaluation of developmental toxicity than those of cor-responding mammalian studies.

Overall, the evidence for developmental and reproductive effects isinadequate.

1.1.10 CancerThe IARC classification of ELF magnetic fields as possibly carci-

nogenic to humans (IARC, 2002) is based upon all of the available dataprior to and including 2001. The review of literature in this EHC monographfocuses mainly on studies published after the IARC review.

Epidemiology

The IARC classification was heavily influenced by the associationsobserved in epidemiological studies on childhood leukaemia. The classifica-tion of this evidence as limited does not change with the addition of twochildhood leukaemia studies published after 2002. Since the publication ofthe IARC monograph the evidence for other childhood cancers remains inad-equate.

Subsequent to the IARC monograph a number of reports have beenpublished concerning the risk of female breast cancer in adults associatedwith ELF magnetic field exposure. These studies are larger than the previousones and less susceptible to bias, and overall are negative. With these studies,the evidence for an association between ELF magnetic field exposure and therisk of female breast cancer is weakened considerably and does not supportan association of this kind.

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In the case of adult brain cancer and leukaemia, the new studiespublished after the IARC monograph do not change the conclusion that theoverall evidence for an association between ELF magnetic fields and the riskof these diseases remains inadequate.

For other diseases and all other cancers, the evidence remains inad-equate.

Laboratory animal studies

There is currently no adequate animal model of the most commonform of childhood leukaemia, acute lymphoblastic leukaemia. Three inde-pendent large-scale studies of rats provided no evidence of an effect of ELFmagnetic fields on the incidence of spontaneous mammary tumours. Moststudies report no effect of ELF magnetic fields on leukaemia or lymphoma inrodent models. Several large-scale long-term studies in rodents have notshown any consistent increase in any type of cancer, including haematopoie-tic, mammary, brain and skin tumours.

A substantial number of studies have examined the effects of ELFmagnetic fields on chemically-induced mammary tumours in rats. Inconsis-tent results were obtained that may be due in whole or in part to differencesin experimental protocols, such as the use of specific sub-strains. Most stud-ies on the effects of ELF magnetic field exposure on chemically-induced orradiation-induced leukaemia/lymphoma models were negative. Studies ofpre-neoplastic liver lesions, chemically-induced skin tumours and braintumours reported predominantly negative results. One study reported anacceleration of UV-induced skin tumourigenesis upon exposure to ELF mag-netic fields.

Two groups have reported increased levels of DNA strand breaks inbrain tissue following in vivo exposure to ELF magnetic fields. However,other groups, using a variety of different rodent genotoxicity models, foundno evidence of genotoxic effects. The results of studies investigating non-genotoxic effects relevant to cancer are inconclusive.

Overall there is no evidence that exposure to ELF magnetic fieldsalone causes tumours. The evidence that ELF magnetic field exposure canenhance tumour development in combination with carcinogens is inadequate.

In vitro studies

Generally, studies of the effects of ELF field exposure of cells haveshown no induction of genotoxicity at fields below 50 mT. The notableexception is evidence from recent studies reporting DNA damage at fieldstrengths as low as 35 T; however, these studies are still being evaluatedand our understanding of these findings is incomplete. There is also increas-ing evidence that ELF magnetic fields may interact with DNA-damagingagents.

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There is no clear evidence of the activation by ELF magnetic fieldsof genes associated with the control of the cell cycle. However, systematicstudies analysing the response of the whole genome have yet to be per-formed.

Many other cellular studies, for example on cell proliferation, apop-tosis, calcium signalling and malignant transformation, have produced incon-sistent or inconclusive results.

Overall conclusion

New human, animal and in vitro studies, published since the 2002IARC monograph, do not change the overall classification of ELF magneticfields as a possible human carcinogen.

1.1.11 Health risk assessmentAccording to the WHO Constitution, health is a state of complete

physical, mental and social well-being and not merely the absence of diseaseor infirmity. A risk assessment is a conceptual framework for a structuredreview of information relevant to estimating health or environmental out-comes. The health risk assessment can be used as an input to risk manage-ment that encompasses all the activities needed to reach decisions on whetheran exposure requires any specific action(s) and the undertaking of theseactions.

In the evaluation of human health risks, sound human data, when-ever available, are generally more informative than animal data. Animal andin vitro studies can support evidence from human studie