ID Number		891
Study Type		Epidemiology
Model		COSMOS - 900, 1800 MHz (NMT, GSM, W-CDMA) mobile phone use in Finland, Sweden, Denmark, Holland, and Great Britain and correlation with malignant tumors, heart disease, neuro-degenerative disease (Parkinson's disease, MS, ALS), eye and skin disease, and tinnitus
Details		A large cohort from Finland, Sweden, Denmark, Holland, and Great Britain (n = 200,000) will be followed to examine correlations between RF expsoures from mobile phones, as well as other occupational sources of RF and ELF, and the risk of malignant tumours, heart disease, neuro-degenerative disease (Parkinson's disease, MS, ALS), eye and skin disease tinnitus, and other health endpoints. Time on the phone will be evaluated mainly by questionairre, although billing records will also be used where possible to verify mobile phone time-of-use information. AUTHORS' ABSTRACT: Schüz et al. 2011 (IEEE #5492): BACKGROUND: There is continuing public and scientific interest in the possibility that exposure to radiofrequency (RF) electromagnetic fields (EMF) from mobile telephones or other wireless devices and applications might increase the risk of certain cancers or other diseases. The interest is amplified by the rapid world-wide penetration of such technologies. The evidence from epidemiological studies published to date have not been consistent and, in particular, further studies are required to identify whether longer term (well beyond 10 years) RF exposure might pose some health risk. METHODS: The "Cosmos" study described here is a large prospective cohort study of mobile telephone users (ongoing recruitment of 250,000 men and women aged 18+ years in five European countries - Denmark, Finland, Sweden, The Netherlands, UK) who will be followed up for 25+ years. Information on mobile telephone use is collected prospectively through questionnaires and objective traffic data from network operators. Associations with disease risks will be studied by linking cohort members to existing disease registries, while changes in symptoms such as headache and sleep quality and of general well-being are assessed by baseline and follow-up questionnaires. CONCLUSIONS: A prospective cohort study conducted with appropriate diligence and a sufficient sample size, overcomes many of the shortcomings of previous studies. Its major advantages are exposure assessment prior to the diagnosis of disease, the prospective collection of objective exposure information, long-term follow-up of multiple health outcomes, and the flexibility to investigate future changes in technologies or new research questions. AUTHORS' ABSTRACT: Toledano et al. 2015 (IEEE #6142): Large-scale prospective cohort studies are invaluable in epidemiology, but they are increasingly difficult and costly to establish and follow-up. More efficient methods for recruitment, data collection and follow-up are essential if such studies are to remain feasible with limited public and research funds. Here, we discuss how these challenges were addressed in the UK COSMOS cohort study where fixed budget and limited time frame necessitated new approaches to consent and recruitment between 2009-2012. Webbased e-consent and data collection should be considered in large scale observational studies, as they offer a streamlined experience which benefits both participants and researchers and save costs. Commercial providers of register and marketing data, smartphones, apps, email, social media, and the internet offer innovative possibilities for identifying, recruiting and following up cohorts. Using examples from UK COSMOS, this article sets out the dos and donts for today's cohort studies and provides a guide on how best to take advantage of new technologies and innovative methods to simplify logistics and minimize costs. Thus a more streamlined experience to the benefit of both research participants and researchers becomes achievable. AUTHORS' INTRODUCTION (in part): Toledano et al. 2015 (IEEE #6361(: The United Kingdom COhort Study of MObile phone uSe and health (UK COSMOS) is a prospective cohort study established to investigate the possible health effects associated with long-term use of mobile phones and other wireless technologies, to inform public health policy in the UK and beyond. UK COSMOS is part of the international COSMOS cohort study consortium (the UK, Sweden, The Netherlands, Finland, Denmark and France) on mobile phones and health, which has over 300 000 study participants across the six partner countries.1 Details of consortium partners are given at [www.ukcosmos. org]. A large prospective cohort study of mobile phone users with long-term follow-up has been recommended as a high priority by the World Health Organization.2,3 This reflects both scientific uncertainty and public concern regarding possible health effects of mobile phone use. Radiofrequency electromagnetic fields have recently been classified as possibly carcinogenic to humans (Group 2B) on the basis of limited evidence concerning risk of brain cancers.4 Results from the Interphone study, the largest case-control study on brain cancer to date, suggested possible increased risks of glioma at the highest levels of mobile phone use, but interpretation was unclear and the possible health effects of long-term heavy use of mobile phones remain uncertain.5 The COSMOS study was designed to investigate this question while addressing limitations of previous studies. Its cohort study design, with prospective exposure assessment, is less prone to potential selection and recall biases associated with case-control studies such as Interphone. Unlike the case-control approach, it addresses a wide range of disease outcomes of importance for public health in one investigation, including neurodegenerative disease, stroke and depression which have rarely been studied; previous studies have focused on few outcomes, mainly tumours of the brain and head. AUTHORS' ABSTRACT: Toledano et al. 2017 (IEEE #6837): This study investigates validity of self-reported mobile phone use in a subset of 75 993 adults from the COSMOS cohort study. Agreement between self-reported and operator-derived mobile call frequency and duration for a 3-month period was assessed using Cohens weighted Kappa (º). Sensitivity and specificity of both self-reported high (e10 calls/day or e4 h/week) and low (d6 calls/week or <30 min/week) mobile phone use were calculated, as compared to operator data. For users of one mobile phone, agreement was fair for call frequency (º = 0.35, 95% CI: 0.35, 0.36) and moderate for call duration (º = 0.50, 95% CI: 0.49, 0.50). Self-reported low call frequency and duration demonstrated high sensitivity (87% and 76% respectively), but for high call frequency and duration sensitivity was lower (38% and 56% respectively), reflecting a tendency for greater underestimation than overestimation. Validity of self-reported mobile phone use was lower in women, younger age groups and those reporting symptoms during/shortly after using a mobile phone. This study highlights the ongoing value of using self-report data to measure mobile phone use. Furthermore, compared to continuous scale estimates used by previous studies, categorical response options used in COSMOS appear to improve validity considerably, most likely by preventing unrealistically high estimates from being reported. AUTHORS' ABSTRACT: Auvinen et al. 2019 (IEEE #7297): Background: Mobile phone use and exposure to radiofrequency electromagnetic fields (RF-EMF) from it have been associated with symptoms in some studies, but the studies have shortcomings and their findings are inconsistent. We conducted a prospective cohort study to assess the association between amount of mobile phone use at baseline and frequency of headache, tinnitus or hearing loss at 4-year follow-up. Methods: The participants had mobile phone subscriptions with major mobile phone network operators in Sweden (n¼21 049) and Finland (n¼3120), gave consent for obtaining their mobile phone call data from operator records at baseline, and filled in both baseline and follow-up questionnaires on symptoms, potential confounders and further characteristics of their mobile phone use. Results: The participants with the highest decile of recorded call-time (average call-time >276 min per week) at baseline showed a weak, suggestive increased frequency of weekly headaches at 4-year follow-up (adjusted odds ratio 1.13, 95% confidence interval 0.951.34). There was no obvious gradient of weekly headache with increasing call-time (P trend 0.06). The association of headache with call-time was stronger for the Universal Mobile Telecommunications System (UMTS) network than older Global System for Mobile Telecommunications (GSM) technology, despite the latter involving higher exposure to RF-EMF. Tinnitus and hearing loss showed no association with call-time. Conclusions: People using mobile phones most extensively for making or receiving calls at baseline reported weekly headaches slightly more frequently at follow-up than other users, but this finding largely disappeared after adjustment for confounders and was not related to call-time in GSM with higher RF-EMF exposure. Tinnitus and hearing loss were not associated with amount of call-time.
Findings		Ongoing
Status		Ongoing
Start Date		Jan 1, 2006
End Date		Dec 1, 2031
Principal Investigator		Imperial College School of Med, UK - p.elliott @ imperial.ac.uk
Funding Agency		Nat'l Res Prog, Finland, Nat'l Res Prog, Denmark, MTHR (NRPB), UK
Country		UNITED KINGDOM
References		Schuz, J et al. Cancer Epidemiol., (2011) 35:37-43 Toledano, MB et al. PLoS ONE., (2015) 10(7)::doi:10.1371/journal.-pone.0131521 Toledano, MB et al. Int J Epidemiol., (2015) [Epub ahead of print]:1-13 Toledano, MB et al. International Journal of Hygiene and Environmental Health., (2018) 221:1-8 Auvinen, A et al. International Journal of Epidemiology., (2019) 48:1567-1579 Auvinen, A et al. . International Journal of Epidemiology., (2019) :- , , () :-
Comments		German arm of prospective mobile phone arm of the cohort study was canceled due to lack of exposure assessment and lack of volunteer participation. For occupational exposures, the German group initially looked at 30 different occupational groups that were regularly exposed to RF. However, only 3 groups met the exposure conditions (regularity, duration and determination) and other criteria (group size, selection, demographic data) required for inclusion in the study [plastic welding machines, engineers / technicians of middle / short-wave transmitters and radio hams. After evaluation of these 3 groups the authors concluded that a study protocol could not be defined & because of the small cohort size, inadequate control groups of non-exposed persons, a large number of non-controllable other risk factors, difficulties with the retrospective exposure assessment. Following these results, BfS funding agency also declined to fund the project. In the study arms that will go forward, questionairre asks for BOTH mobile phone exposure (time of use) and syptoms and is thus a likely source of bias. No published pilot or feasibility studies from the UK, Denmark, Sweden, or Finland. No peer or outside review of test protocol.