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1.	Hardell, Elin, et al. (author) Case-control study on perfluorinated alkyl acids (PFAAs) and the risk of prostate cancer 2014 In: Environment International. - : Elsevier. - 0160-4120 .- 1873-6750. ; 63, s. 35-39 Journal article (peer-reviewed)abstract Perfluorinated alkyl acids (PFAAs) are emerging environmental contaminants. Possible health effects for humans include increased risk for cancer but the knowledge is limited. In this study serum concentrations of certain perfluorinated sulfonates (PFHxS and PFOS) and carboxylates (PFOA, PFNA, PFDA, PFUnDA) were analyzed among 201 cases with prostate cancer and 186 population based control subjects. All blood samples were collected during 2007-2011 and no case had been treated with radio- or chemotherapy before enrolment in the study. The blood concentrations did not differ statistically significant between cases and controls except for PFDA with higher concentration among the cases (p = 0.03). Analyses based on Gleason score and prostate specific antigen (PSA) level did not change the results. Heredity was a risk factor for prostate cancer yielding odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.01-3.1. The analyzed PFAAs yielded statistically significant higher ORs in cases with a first degree relative reporting prostate cancer, e.g., PFOA gave OR = 2.6, 95% CI = 1.2-6.0 and PFOS gave OR = 2.7,95% CI = 1.04-6.8. The results showed a higher risk for prostate cancer in cases with heredity as a risk factor. In further studies interaction between gene and environment should be considered. (C) 2013 Elsevier Ltd. All rights reserved.
2.	Hardell, Karin, 1975-, et al. (author) Concentrations of organohalogen compounds and titres of antibodies to Epstein-Barr virus antigens and the risk for non-Hodgkin lymphoma 2009 In: Oncology Reports. - Athens, Greece : Spandidos Publications. - 1791-2431 .- 1021-335X. ; 21:6, s. 1567-1576 Journal article (peer-reviewed)abstract Exposure to some pesticides and persistent organic pollutants (POPs) has been indicated to be a risk factor for non-Hodgkin's lymphoma (NHL). Epstein-Barr virus (EBV) has been associated with some subgroups of NHL. In a previous study we found an interaction between high concentrations of some POPs and titres of antibodies to EBV early antigen (EA IgG) in relation to NHL. In the present study we measured lipid adjusted plasma concentrations of 35 congeners of polychlorinated biphenyls (PCB). p,p'-dichlorodiphenyldichloroethyelene (p,p'-DDE), hexachlorobenzene (HCB), seven subgroups of chlordanes (cis-heptachlorepoxide, cis-chlordane, trans-chlordane, oxychlordane, MC6, trans-nonachlordane, cis-nonachlordane) and one polybrominated diphenylether (PBDE) congener (no. 47) in 99 cases with NHL and 99 population based controls. Odds ratios (OR) for NHL were estimated. Sum of PCBs > median in the controls gave odds ratio (OR) 2.0, 95% confidence interval (CI) 0.99-3.9. High sum of chlordanes yielded OR 2.3, 95% CI 1.2-4.5. An interaction with EBV EA IgG was found. High sum of PCB gave OR 5.2, 95% CI 1.9-14 in the group with EA IgG > 40. Similarly HCB yielded OR 5.3, 95% CI 1.9-15, pp'-DDE gave OR 3.3, 95% CI 1.4-7.7 and sum of chlordanes yielded OR 6.8, 95% CI 2.3-20, whereas no association was found with PBDE. In summary this study confirmed an association between certain POPs and NHL with all interaction with titre of IgG antibody to EBV EA.
3.	Hardell, Lennart, et al. (author) Adipose Tissue Concentrations of Dioxins and Dibenzofurans, Titers of Antibodies to Epstein–Barr Virus Early Antigen and the Risk for Non-Hodgkin Lymphoma 2001 In: Environmental Research. - : Elsevier BV. - 0013-9351. ; 87:2, s. 99-107 Journal article (peer-reviewed)abstract A rapid increase in the incidence of non-Hodgkin lymphoma (NHL) has been reported in many countries. Exposure to certain pesticides or organochlorines has been shown to be a risk factor. Epstein–Barr virus (EBV) is a human herpesvirus that has been associated with some subgroups of NHL, such as Burkitt lymphoma and lymphomas related to severe immunosuppression. In this study we measured concentrations of dioxins and dibenzofurans in 33 NHL cases and 39 surgical controls. For 23 of the cases and 32 of the controls EBV titers were also available. Median titer of antibodies to EBV early antigen (EA) IgG was higher in patients than in controls. Concentrations of dioxins and dibenzofurans were divided into two groups according to the median concentration for the controls. Unconditional logistic regression analysis was performed adjusting for sex, age, and body mass index. For several higher chlorinated congeners increased risk was found for patients in the high-concentration and high-titer group. For toxic equivalency factor >27.79 and EA>80 an odds ratio of 2.8 with 95% confidence interval 0.52–18 was calculated. These results indicated that current exposure to certain organochlorines in combination with EBV might increase the risk for NHL.
4.	Hardell, Lennart, 1944-, et al. (author) Decreased survival in pancreatic cancer patients with high concentrations of organochlorines in adipose tissue 2007 In: Biomedicine and Pharmacotherapy. - : Elsevier BV. - 0753-3322 .- 1950-6007. ; 61:10, s. 659-664 Journal article (peer-reviewed)abstract We analysed adipose tissue concentrations of persistent organic pollutants (POPs) in 21 cases with exocrine pancreatic cancer. The comparison group consisted of 59 subjects. Significantly increased concentrations of polychlorinated biphenyls (PCBs), hexachlorobenzene (HCB), sum of chlordanes and polybrominated diphenylethers (PBDEs) were found in the cases. For 1,1,-dichloro-2,2-bis(p-chlorophenyl)-ethylene (p,p'-DDE) no significant difference was seen. For PCBs no odds ratio (OR) could be calculated since all cases had concentration>median in controls used as a cut-off. HCB yielded OR=53.0, 95% confidence interval (CI)=4.64-605 and sum of chlordanes OR=18.4, 95% CI=2.71-124 whereas OR was not significantly increased for p,p'-DDE or PBDEs. Body mass index (BMI) at the time of tissue sampling was significantly lower for the cases. This might have influenced the results. Using BMI one year previously or decreasing the concentrations of POPs with the same percentage as weight loss among the cases did not change the results. Survival of the cases was shorter in the group with the concentration of POPs>median among cases, significantly so for the sum of PCBs (147 vs. 294 days), p,p'-DDE (134 vs. 302 days), and sum of chlordanes (142 vs. 294 days) in the high and low group, respectively. The results were based on a low number of cases and should be interpreted with caution.
5.	Hardell, Lennart, et al. (author) Increased concentrations of certain persistent organic pollutants in subjects with self-reported electromagnetic hypersensitivity : a pilot study 2008 In: Electromagnetic Biology and Medicine. - : Informa UK Limited. - 1536-8378 .- 1536-8386. ; 27:2, s. 197-203 Journal article (peer-reviewed)abstract Electromagnetic hypersensitivity (EHS) is used for a variety of subjective symptoms related to exposure to electromagnetic fields (EMF). The aim of this pilot study was to analyze the concentrations of certain persistent organic pollutants (POPs) in subjects with self-reported EHS. In total, 13 EHS subjects and 21 controls were included, all female. The concentration of several POPs was higher in EHS subjects than in controls. Lower concentrations were found for hexachlorobenzene and two types of chlordanes. The only significantly increased odds ratios (ORs) were found for polybrominated diphenyl ether (PBDE) #47 yielding OR=11.7, 95% confidence interval (CI)=1.45-94.7 and the chlordane metabolite MC6 with OR=11.2, 95% CI=1.18-106. The results were based on low numbers and must be interpreted with caution. This hypothesis generating study indicates the necessity of a larger investigation on this issue.
6.	Nordström, Marie, et al. (author) Concentrations of Organochlorines Related to Titers to Epstein-Barr Virus Early Antigen IgG as Risk Factors for Hairy Cell Leukemia 2000 In: Environmental Health Perspectives. ; 108:5, s. 441-5 Journal article (peer-reviewed)abstract Hairy cell leukemia (HCL) is a rare chronic B-cell malignancy that, according to modern classifications, is a subgroup of non-Hodgkin lymphomas (NHLs) . A rapid increase in incidence of NHL has been reported in many countries. The reasons for this increase are largely unknown, but exposure to organochlorines has been suggested as a risk factor. Epstein-Barr virus is a human herpesvirus that has been associated with certain subgroups of NHL. In this study, we measured lipid adjusted blood concentrations (in nanogram per gram) of 36 congeners of polychlorinated biphenyls (PCBs) , p,p´-dichlorodiphenyldichloroethylene (p,p´-DDE) , hexachlorobenzene (HCB) , and four subgroups of chlordanes (trans-nonachlor, cis-nonachlor, MC6, and oxychlordane) in incident cases of HCL and controls from the general population. We obtained results on organochlorines and antibodies for 54 cases and 54 controls. Titers of antibodies to the Epstein-Barr early antigen and Epstein-Barr nuclear antigen, measured as P107, were correlated to concentrations of organochlorines to evaluate the possibility of an interaction between these factors in the pathogenesis of HCL. We found no significant difference in lipid-adjusted blood concentrations of total PCBs, p,p´-DDE, HCB, or the sum of the chlordanes between cases and controls. Titers of antibodies to Epstein-Barr early antigen IgG 40 were correlated to an increased risk for HCL. This risk was further increased in those with a level above the median value of p,p´-DDE, HCB, or the sum of the chlordanes, suggesting an interaction between Epstein-Barr virus and a higher concentration of these chemicals. We also found increased risk for the sum of immunotoxic PCB group.
7.	Nygren, Martin, et al. (author) Identification of 2,3,7,8-substituted polychlorinated dioxins and dibenzofurans in environmental and human samples 1986. - 1 In: Chlorinated dioxins and dibenzofurans in perspective. - Boca Raton : CRC Press. - 9781315891545 - 9781351070645 ; , s. 17-34 Book chapter (other academic/artistic)abstract Polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) are two series of tricyclic, almost planar aromatic compounds that exhibit very similar physical, chemical, and biological properties. The human exposure to PCDDs and PCDFs by milk consumption is not negligible. Detection levels in ecological and human samples should be orders of magnitude below the usual detection levels obtained in pesticide analyses. One objective of the study is to identify background levels of PCDDs and PCDFs in these samples, especially those of human origin. The spectrum of toxic effects is species dependent but for humans they include chloracne and porphyria cutane tarda and for other animals edema, thymic atrophy, teratogenicity, liver lesions and a slow wasting syndrome followed by death. It is evident that it is of particular importance to identify the ultimate source or sources of the toxic 2,3,7,8-substituted PCDDs and PCDFs found as background constituents in the environmental and human samples, especially the samples of mother's milk, which are of toxicological interest.
8.	Ahrens, Wolfgang, et al. (author) Occupational exposure to endocrine-disrupting compounds and biliary tract cancer among men 2007 In: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 33:5, s. 387-396 Journal article (peer-reviewed)abstract Objectives This study investigated the association between cancer of the extrahepatic biliary tract and exposure to endocrine-disrupting compounds. Methods Altogether 183 men with histologically confirmed carcinoma of the extrahepatic biliary tract and 1938 matched controls were interviewed between 1995 and 1997 in the frame of an international multicenter case-control study in six European countries (Denmark, France, Germany, Italy, Spain, and Sweden). Selfreported job descriptions were converted to semiquantitative variables (intensity, probability, and duration of exposure) for 14 endocrine-disrupting compounds. The cases were compared with 1421 population controls and 517 colon adenocarcinoma patients. Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained with unconditional logistic regression and adjusted for age, country, and gallstones. Results Occupational exposure to endocrine-disrupting compounds resulted in an OR of 1.4 (95% CI 1.0-2. 1) with no dose-effect relationship for cumulative exposure (low: OR 1.3, 95% CI 0.6-3.0; medium: OR 1.5, 95% CI0.8-2.7; high: OR 1.4, 95% CI 0.9-2.4) (only index participants). The elevated risk was restricted to extrahepatic bile ducts and ampulla Vateri (OR 1.7, 95% CI 1.0-2.6). The adjusted OR for cancer of the extrahepatic biliary tract after exposure to polychlorinated biphenyls was 2.8 (95% CI 1.3-5.9, only index participants). Conclusions The data show some associations between exposure to endocrine-disrupting compounds in the workplace and the risk for cancer of the extrahepatic biliary tract among men, particularly for the extrahepatic bile duct and ampulla of Vater. Polychlorinated biphenyls could possibly be a strong risk factor.
9.	Ahrens, Wolfgang, et al. (author) Risk factors for extrahepatic biliary tract carcinoma in men: medical conditions and lifestyle: results from a European multicentre case-control study 2007 In: European Journal of Gastroenterology and Hepathology. - 1473-5687. ; 19:8, s. 623-630 Journal article (peer-reviewed)abstract OBJECTIVES: To identify risk factors of carcinoma of the extrahepatic biliary tract in men. METHODS: Newly diagnosed and histologically confirmed patients, 35-70 years old, were interviewed between 1995 and 1997 in Denmark, Sweden, France, Germany and Italy. Population controls were frequency-matched by age and region. Adjusted odds ratios and 95%-confidence intervals were estimated by logistic regression. RESULTS: The analysis included 153 patients and 1421 controls. The participation proportion was 71% for patients and 61% for controls. Gallstone disease was corroborated as a risk factor for extrahepatic biliary tract carcinoma in men (odds ratio 2.49; 95% confidence interval 1.32-4.70), particularly for gall bladder tumors (odds ratio 4.68; 95% confidence interval 1.85-11.84). For a body mass index [height (m) divided by squared weight (kg2)] >30 at age 35 years, an excess risk was observed (odds ratio 2.58; 95% confidence interval 1.07-6.23, reference: body mass index 18.5-25) that was even stronger if the body mass index was >30 for the lowest weight in adulthood (odds ratio 4.68; 95% confidence interval 1.13-19.40). Infection of the gall bladder, chronic inflammatory bowel disease, hepatitis or smoking showed no clear association, whereas some increase in risk was suggested for consumption of 40-80 g alcohol per day and more. CONCLUSIONS: Our study corroborates gallstones as a risk indicator in extrahepatic biliary tract carcinoma. Permanent overweight and obesity in adult life was identified as a strong risk factor for extrahepatic biliary tract carcinoma, whereas we did not find any strong lifestyle-associated risk factors. Inconsistent results across studies concerning the association of extrahepatic biliary tract carcinoma with overweight and obesity may be explained by the different approaches to assess this variable.
10.	Behrens, Thomas, et al. (author) Hormonal exposures and the risk of uveal melanoma 2010 In: Cancer Causes and Control. - : Springer Science and Business Media LLC. - 1573-7225 .- 0957-5243. ; 21:10, s. 1625-1634 Journal article (peer-reviewed)abstract Several studies suggest that hormonal mechanisms may be associated with the development of uveal melanoma. Therefore, the association between the risk of uveal melanoma and exposure to hormonal exposures was investigated in a case-control study from nine European countries. Incident cases of uveal melanoma were frequency-matched to population and hospital controls by country, age, and sex. Female subjects were asked about their reproductive history, use of menopausal hormone replacement therapy and oral contraceptives. Among men, occupational handling of oils while working with transformers or capacitors which contain polychlorinated biphenyls (PCB) was solicited. Unconditional logistic regression analyses were calculated, adjusting for several potential confounders. Analyses were stratified by sex. Two hundred and ninety-three cases (165 men, 128 women) and 3,198 control subjects (2,121 men, 1,077 women) were interviewed. Among women, no associations were observed with hormonal status variables, intake of hormonal therapy or intake of oral contraceptives. Men showed an increased risk with occupational exposure to transformer/capacitor oils (OR = 2.74; Bonferroni-corrected 99.3% CI 1.07-7.02). However, these results were based on few exposed subjects only. The results of this study do not support the hypothesis of a hormonal influence in the carcinogenesis of uveal melanoma. Our finding of a potentially increased risk with PCB-containing oils requires further research.
11.	Behrens, Thomas, et al. (author) Occupational exposure to electromagnetic fields and sex-differential risk of uveal melanoma 2010 In: Occupational and Environmental Medicine. - : BMJ. - 1470-7926 .- 1351-0711. ; 67:11, s. 751-759 Journal article (peer-reviewed)abstract Objectives The association between occupational exposure to electromagnetic fields (EMF) and the risk of uveal melanoma was investigated in a case-control study in nine European countries. Methods Incident cases of uveal melanoma and population as well as hospital controls were included and frequency matched by country, 5-year birth cohort and sex. Subjects were asked whether they had worked close to high-voltage electrical transmission installations, computer screens and various electrical machines, or in complex electrical environments. Measurements of two Scandinavian job-exposure matrices were applied to estimate lifelong cumulative EMF exposure. Unconditional logistic regression analyses, stratified by sex and eye colour were calculated, adjusting for several potential confounders. Results 293 patients with uveal melanoma and 3198 control subjects were interviewed. Women exposed to electrical transmission installations showed elevated risks (OR 5.81, 95% CI 1.72 to 19.66). Positive associations with exposure to control rooms were seen among men and women, but most risk increases were restricted to subjects with dark iris colour. Application of published EMF measurements revealed stronger risk increases among women compared to men. Again, elevated risks were restricted to subjects with dark eye colour. Conclusion Although based on a low prevalence of exposure to potential occupational sources of EMF, our data indicate that exposed dark-eyed women may be at particular risk for uveal melanoma.
12.	Behrens, Thomas, et al. (author) Occupational exposure to endocrine-disrupting chemicals and the risk of uveal melanoma 2012 In: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 38:5, s. 476-483 Journal article (peer-reviewed)abstract Objectives We investigated the association between occupational exposure to endocrine-disrupting chemicals (EDC) and the risk of uveal melanoma using international data of a case control study from nine European countries. Methods After exclusion of proxy interviews, 280 cases and 3084 control subjects were included in the final analysis. Information on possible exposure to EDC was derived from 27 job-specific questionnaires (JSQ), which solicited detailed questions on occupational tasks. Relative risk estimates were based on the JSQ and potential exposure to a group of endocrine-disrupting agents. We constructed several exposure scores, taking into account intensity of exposure, use of personal protective equipment, and exposure duration. We calculated unconditional logistic regression analyses, adjusting for country, age, sex, eye color and a history of ocular damage due to intense ultraviolet (UV) exposure. Results The overall exposure prevalence to EDC was low reaching a maximum of 11% for heavy metals with endocrine-disrupting properties. Although working in some industries was associated with increased melanoma risk [such as dry cleaning: odds ratio (OR) 6.15, 95% confidence interval (95% CI) 2.0-18.96 and working in the glass manufacturing industry: OR 3.49, 95% CI 1.10-11.10], agent-specific risks were not elevated. The strongest possible risk increase was observed for organic solvents with endocrine-disrupting properties (OR 1.31, 95% CI 0.78-2.21). Calculation of exposure scores did not indicate consistently elevated results with higher score values. Sensitivity analyses did not alter these results. Conclusion Occupational exposure to EDC was not associated with an increased risk for uveal melanoma.
13.	Behrens, Thomas, et al. (author) Pesticide exposure in farming and forestry and the risk of uveal melanoma 2012 In: Cancer Causes and Control. - : Springer. - 0957-5243 .- 1573-7225. ; 23:1, s. 141-151 Journal article (peer-reviewed)abstract Since pesticides are disputed risk factors for uveal melanoma, we studied the association between occupational pesticide exposure and uveal melanoma risk in a case-control study from nine European countries.Incident cases of uveal melanoma and population as well as hospital controls were included and frequency-matched by country, 5-year age groups and sex. Self-reported exposure was quantified with respect to duration of exposure and pesticide application method. We calculated the exposure intensity level based on application method and use of personal protective equipment. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by unconditional logistic regression analyses and adjusted for several potential confounders.293 case and 3,198 control subjects were interviewed. We did not identify positive associations with activities in farming or forestry, pesticide application or pesticide mixing. No consistent positive associations were seen with exposure intensity level scores either. The only statistically significantly raised association in this study was for exposure to chemical fertilizers in forestry (OR = 8.93; 95% CI 1.73-42.13), but this observation was based on only six exposed subjects. Results did not change when we restricted analyses to morphologically verified cases and excluded proxy interviews as well as cancer controls. We did not observe effect modification by sex or eye color.Risk estimates for pesticide exposures and occupational activities in agriculture and forestry were not increased and did not indicate a hormonal mechanism due to these exposures.
14.	Belpomme, D., et al. (author) The growing incidence of cancer : Role of lifestyle and screening detection (Review) 2007 In: International Journal of Oncology. - : Spandidos Publications. - 1019-6439 .- 1791-2423. ; 30:5, s. 1037-1049 Research review (peer-reviewed)abstract The increasing incidence of a variety of cancers after the Second World War confronts scientists with the question of their origin. In Western countries, expansion and ageing of the population, as well as progress in cancer detection using new diagnostic and screening tests cannot fully account for the observed growing incidence of cancer. Our hypothesis is that environmental factors play a more important role in cancer genesis than it is usually agreed: i) over the last 2-3 decades, alcohol consumption and tobacco smoking in men have significantly decreased; ii) obesity is increasing in many countries, but the growing incidence of cancer also concerns cancers not related to obesity nor to other lifestyle-related factors; iii) there is evidence that the environment has changed over the same time scale as the recent rise in cancer incidence, and that this change included the accumulation of many new carcinogenic factors in the environment; iv) genetic susceptibility to cancer due to genetic polymorphism cannot have changed over one generation and actually favours the role of exogenous factors through gene-environment interactions; v) age is not the unique factor to be considered since the rising incidence of cancers is seen across all age categories, including children; vi) the fetus is specifically vulnerable to exogenous factors. A fetal exposure during a critical window period may explain why current epidemiological studies may be negative in adults. We therefore propose that the involuntary exposure to many carcinogens in the environment contributes to the rising trend in cancer incidence.
15.	Belpomme, D., et al. (author) The multitude and diversity of environmental carcinogens 2007 In: Environmental Research. - : Elsevier BV. - 0013-9351 .- 1096-0953. ; 105:3, s. 414-429 Journal article (peer-reviewed)abstract We have recently proposed that lifestyle-related factors, screening and aging cannot fully account for the present overall growing incidence of cancer. In order to propose the concept that in addition to lifestyle related factors, exogenous environmental factors may play a more important role in carcinogenesis than it is expected, and may therefore account for the growing incidence of cancer, we overview herein environmental factors, rated as certainly or potentially carcinogenic by the International Agency for Research on Cancer (IARC). We thus analyze the carcinogenic effect of microorganisms (including viruses), radiations (including radioactivity, UV and pulsed electromagnetic fields) and xenochemicals. Chemicals related to environmental pollution appear to be of critical importance, since they can induce occupational cancers as well as other cancers. Of major concerns are: outdoor air pollution by carbon particles associated with polycyclic aromatic hydrocarbons; indoor air pollution by environmental tobacco smoke, formaldehyde and volatile organic compounds such as benzene and 1,3 butadiene, which may particularly affect children, and food pollution by food additives and by carcinogenic contaminants such as nitrates, pesticides, dioxins and other organochlorines. In addition, carcinogenic metals and metalloids, pharmaceutical medicines and cosmetics may be involved. Although the risk fraction attributable to environmental factors is still unknown, this long list of carcinogenic and especially mutagenic factors supports our working hypothesis according to which numerous cancers may in fact be caused by the recent modification of our environment. (C) 2007 Elsevier Inc. All rights reserved.
16.	Carlberg, Michael, et al. (author) Case-control study on occupational exposure to extremely low-frequency electromagnetic fields and glioma risk 2017 In: American Journal of Industrial Medicine. - : John Wiley & Sons. - 0271-3586 .- 1097-0274. ; 60:5, s. 494-503 Journal article (peer-reviewed)abstract BACKGROUND: Exposure to extremely low-frequency electromagnetic fields (ELF-EMF) was in 2002 classified as a possible human carcinogen, Group 2B, by the International Agency for Research on Cancer at WHO.METHODS: Life time occupations were assessed in case-control studies during 1997-2003 and 2007-2009. An ELF-EMF Job-Exposure Matrix was used for associating occupations with ELF exposure (μT). Cumulative exposure (μT-years), average exposure (μT), and maximum exposed job (μT) were calculated.RESULTS: Cumulative exposure gave for astrocytoma grade IV (glioblastoma multiforme) in the time window 1-14 years odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.4-2.6, p linear trend <0.001, and in the time window 15+ years OR = 0.9, 95%CI = 0.6-1.3, p linear trend = 0.44 in the highest exposure categories 2.75+ and 6.59+ μT years, respectively.CONCLUSION: An increased risk in late stage (promotion/progression) of astrocytoma grade IV for occupational ELF-EMF exposure was found.
17.	Carlberg, Michael, et al. (author) Case-Control Study on Occupational Exposure to Extremely Low-Frequency Electromagnetic Fields and the Association with Meningioma 2018 In: BioMed Research International. - : Hindawi Limited. - 2314-6133 .- 2314-6141. Journal article (peer-reviewed)abstract Objective. Exposure to extremely low-frequency electromagnetic fields (ELF-EMF) was in 2002 classified as a possible human carcinogen, Group 2B, by the International Agency for Research on Cancer at WHO based on an increased risk for childhood leukemia. In case-control studies on brain tumors during 1997-2003 and 2007-2009 we assessed lifetime occupations in addition to exposure to different agents. The INTEROCC ELF-EMF Job-ExposureMatrix was used for associating occupations with ELF-EMF exposure (mu T) with meningioma. Cumulative exposure (mu T-years), average exposure (mu T), and maximum exposed job (mu T) were calculated. Results. No increased risk for meningioma was found in any category. For cumulative exposure in the highest exposure category 8.52+ mu T years odds ratio (OR) = 0.9, 95% confidence interval (CI) = 0.7-1.2, and.. linear trend = 0.45 were calculated. No statistically significant risks were found in different time windows. Conclusion. In conclusion occupational ELF-EMF was not associated with an increased risk for meningioma.
18.	Carlberg, Michael, et al. (author) Decreased Survival of Glioma Patients with Astrocytoma Grade IV (Glioblastoma Multiforme) Associated with Long-Term Use of Mobile and Cordless Phones 2014 In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 11:10, s. 10790-10805 Journal article (peer-reviewed)abstract On 31 May 2011 the WHO International Agency for Research on Cancer (IARC) categorised radiofrequency electromagnetic fields (RF-EMFs) from mobile phones, and from other devices that emit similar non-ionising electromagnetic fields, as a Group 2B, i.e., a "possible", human carcinogen. A causal association would be strengthened if it could be shown that the use of wireless phones has an impact on the survival of glioma patients. We analysed survival of 1678 glioma patients in our 1997-2003 and 2007-2009 case-control studies. Use of wireless phones in the >20 years latency group (time since first use) yielded an increased hazard ratio (HR) = 1.7, 95% confidence interval (CI) = 1.2-2.3 for glioma. For astrocytoma grade IV (glioblastoma multiforme; n = 926) mobile phone use yielded HR = 2.0, 95% CI = 1.4-2.9 and cordless phone use HR = 3.4, 95% CI = 1.04-11 in the same latency category. The hazard ratio for astrocytoma grade IV increased statistically significant per year of latency for wireless phones, HR = 1.020, 95% CI = 1.007-1.033, but not per 100 h cumulative use, HR = 1.002, 95% CI = 0.999-1.005. HR was not statistically significant increased for other types of glioma. Due to the relationship with survival the classification of IARC is strengthened and RF-EMF should be regarded as human carcinogen requiring urgent revision of current exposure guidelines.
19.	Carlberg, Michael, et al. (author) Evaluation of Mobile Phone and Cordless Phone Use and Glioma Risk Using the Bradford Hill Viewpoints from 1965 on Association or Causation 2017 In: BioMed Research International. - : Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141. ; 2017 Research review (peer-reviewed)abstract Objective: Bradford Hill's viewpoints from 1965 on association or causation were used on glioma risk and use of mobile or cordless phones.Methods: All nine viewpoints were evaluated based on epidemiology and laboratory studies.Results: Strength: meta-analysis of case-control studies gave odds ratio (OR) = 1.90, 95% confidence interval (CI) = 1.31-2.76 with highest cumulative exposure. Consistency: the risk increased with latency, meta-analysis gave in the 10+ years' latency group OR = 1.62, 95% CI = 1.20-2.19. Specificity: increased risk for glioma was in the temporal lobe. Using meningioma cases as comparison group still increased the risk. Temporality: highest risk was in the 20+ years' latency group, OR = 2.01, 95% CI =1.41-2.88, for wireless phones. Biological gradient: cumulative use of wireless phones increased the risk. Plausibility: animal studies showed an increased incidence of glioma and malignant schwannoma in rats exposed to radiofrequency (RF) radiation. There is increased production of reactive oxygen species (ROS) from RF radiation. Coherence: there is a change in the natural history of glioma and increasing incidence. Experiment: antioxidants reduced ROS production from RF radiation. Analogy: there is an increased risk in subjects exposed to extremely low-frequency electromagnetic fields.Conclusion: RF radiation should be regarded as a human carcinogen causing glioma.
20.	Carlberg, Michael, et al. (author) Increasing incidence of thyroid cancer in the Nordic countries with main focus on Swedish data 2016 In: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 16 Journal article (peer-reviewed)abstract BACKGROUND: Radiofrequency radiation in the frequency range 30 kHz-300 GHz was evaluated to be Group 2B, i.e. 'possibly' carcinogenic to humans, by the International Agency for Research on Cancer (IARC) at WHO in May 2011. Among the evaluated devices were mobile and cordless phones, since they emit radiofrequency electromagnetic fields (RF-EMF). In addition to the brain, another organ, the thyroid gland, also receives high exposure. The incidence of thyroid cancer is increasing in many countries, especially the papillary type that is the most radiosensitive type.METHODS: We used the Swedish Cancer Register to study the incidence of thyroid cancer during 1970-2013 using joinpoint regression analysis.RESULTS: In women, the incidence increased statistically significantly during the whole study period; average annual percentage change (AAPC) +1.19 % (95 % confidence interval (CI) +0.56, +1.83 %). Two joinpoints were detected, 1979 and 2001, with a high increase of the incidence during the last period 2001-2013 with an annual percentage change (APC) of +5.34 % (95 % CI +3.93, +6.77 %). AAPC for all men during 1970-2013 was +0.77 % (95 % CI -0.03, +1.58 %). One joinpoint was detected in 2005 with a statistically significant increase in incidence during 2005-2013; APC +7.56 % (95 % CI +3.34, +11.96 %). Based on NORDCAN data, there was a statistically significant increase in the incidence of thyroid cancer in the Nordic countries during the same time period. In both women and men a joinpoint was detected in 2006. The incidence increased during 2006-2013 in women; APC +6.16 % (95 % CI +3.94, +8.42 %) and in men; APC +6.84 % (95 % CI +3.69, +10.08 %), thus showing similar results as the Swedish Cancer Register. Analyses based on data from the Cancer Register showed that the increasing trend in Sweden was mainly caused by thyroid cancer of the papillary type.CONCLUSIONS: We postulate that the whole increase cannot be attributed to better diagnostic procedures. Increasing exposure to ionizing radiation, e.g. medical computed tomography (CT) scans, and to RF-EMF (non-ionizing radiation) should be further studied. The design of our study does not permit conclusions regarding causality.
21.	Carlberg, Michael, et al. (author) Meningioma patients diagnosed 2007-2009 and the association with use of mobile and cordless phones : a case-control study 2013 In: Environmental Health. - : BioMed Central (BMC). - 1476-069X. ; 12:60 Journal article (peer-reviewed)abstract Background: To study the association between use of wireless phones and meningioma. Methods: We performed a case-control study on brain tumour cases of both genders aged 18-75 years and diagnosed during 2007-2009. One population-based control matched on gender and age was used to each case. Here we report on meningioma cases including all available controls. Exposures were assessed by a questionnaire. Unconditional logistic regression analysis was performed. Results: In total 709 meningioma cases and 1,368 control subjects answered the questionnaire. Mobile phone use in total produced odds ratio (OR) = 1.0, 95% confidence interval (CI) = 0.7-1.4 and cordless phone use gave OR = 1.1, 95% CI = 0.8-1.5. The risk increased statistically significant per 100 h of cumulative use and highest OR was found in the fourth quartile (>2,376 hours) of cumulative use for all studied phone types. There was no statistically significant increased risk for ipsilateral mobile or cordless phone use, for meningioma in the temporal lobe or per year of latency. Tumour volume was not related to latency or cumulative use in hours of wireless phones. Conclusions: No conclusive evidence of an association between use of mobile and cordless phones and meningioma was found. An indication of increased risk was seen in the group with highest cumulative use but was not supported by statistically significant increasing risk with latency. Results for even longer latency periods of wireless phone use than in this study are desirable.
22.	Carlberg, Michael, et al. (author) On the association between glioma, wireless phones, heredity and ionising radiation 2012 In: Pathophysiology. - : Elsevier. - 0928-4680 .- 1873-149X. ; 19:4, s. 243-252 Journal article (peer-reviewed)abstract We performed two case–control studies on brain tumours diagnosed during 1 January 1997 to 30 June 2000 and 1 July 2000 to 31 December 2003, respectively. Living cases and controls aged 20–80 years were included. An additional study was performed on deceased cases with a malignant brain tumour using deceased controls. Pooled results for glioma yielded for ipsilateral use of mobile phone odds ratio (OR)=2.9, 95% confidence interval (CI)=1.8–4.7 in the >10 years latency group. The corresponding result for cordless phone was OR=3.8, 95% CI=1.8–8.1. OR increased statistically significant for cumulative use of wireless phones per 100h and per year of latency. For high-grade glioma ipsilateral use of mobile phone gave OR=3.9, 95% CI=2.3–6.6 and cordless phone OR=5.5, 95% CI=2.3–13 in the >10 years latency group. Heredity for brain tumour gave OR=3.4, 95% CI=2.1–5.5 for glioma. There was no interaction with use of wireless phones. X-ray investigation of the head gave overall OR=1.3, 95% CI=1.1–1.7 for glioma without interaction with use of wireless phones or heredity. In conclusion use of mobile and cordless phone increased the risk for glioma with highest OR for ipsilateral use, latency >10 years and third tertile of cumulative use in hours. In total, the risk was highest in the age group <20 years for first use of a wireless phone.
23.	Carlberg, Michael, et al. (author) Pooled analysis of Swedish case-control studies during 1997-2003 and 2007-2009 on meningioma risk associated with the use of mobile and cordless phones 2015 In: Oncology Reports. - : Spandidos. - 1021-335X .- 1791-2431. ; 33:6, s. 3093-3098 Journal article (peer-reviewed)abstract A pooled analysis of two case-control studies on meningioma with patients diagnosed during 1997-2003 and 2007-2009 was conducted. Both genders were included, aged 20-80 and 18-75 years, respectively, at the time of diagnosis. Population-based controls, matched according to age and gender, were enrolled. Exposure was assessed by questionnaire. In the entire study, cases with all brain tumor types were included. The whole reference group was used in the unconditional logistic regression analysis on meningioma, with adjustments for gender, age, year of diagnosis and socioeconomic index (SEI). In total, 1,625 meningioma cases and 3,530 controls were analyzed. Overall no association with use of mobile or cordless phones was found. In the fourth quartile of use (>1,436 h) somewhat increased risk was found for mobile phones yielding an odds ratio (OR)=1.2, 95% confidence intervals (CI)=0.9-1.6 and cordless phones OR=1.7, 95% CI=1.3-2.2. Higher risk was calculated in the highest decile (>3,358 h), OR=1.5, 95% CI=0.99-2.1 and OR=2.0, 95% CI=1.4-2.8, respectively. In addition, the longest latency time gave somewhat increased risk for both phone types although the result was not statistically significant. There was no association for ipsilateral use or anatomical tumor location. The present study showed a somewhat increased risk among heavy users of mobile and cordless phones. Since meningioma is generally a slow-growing tumor, longer latency period is necessary for definitive conclusions.
24.	Dreifaldt, Ann Charlotte, 1964- (author) Epidemiological aspects on malignant diseases in childhood 2006 Doctoral thesis (other academic/artistic)abstract The trends of malignant diseases in children aged 0 to 14 years, reported to the Swedish Cancer Registry 1960–1998 (n=9 298) were analyzed. The most common diagnoses were leukemia, 29.7%, tumors of the central nervous system (CNS), 27.6%, and lymphomas, 10.2%. The average annual incidence rate of childhood malignant diseases 1990–1998 was 16.19/100 000 person-years. Average annual change in incidence rate of all childhood cancer was +1.01% (95% confidence interval (CI)=0.80-1.22). Statistically significant increase was seen for leukemia +0.85% (95% CI=0.42–1.28), lymphomas +1.87% (95% CI=1.17–2.58), CNS tumors +1.45% (95% CI=1.02–1.88), sympathetic nervous system tumors +1.61% (95% CI=0.79–2.44), hepatic tumors +2.62% (95% CI=2.02–3.21), and germ cell and gonadal tumors +1.21% (95% CI=0.23–2.19). Children are exposed to persistent organic pollutants (POPs) during fetal life and breast-feeding. In a case-control study including cases of childhood cancer reported to the Cancer Registry 1988–1991 (n=962) we used breastfeeding duration as a surrogate for exposure to POPs. One matched control per case was used. Information on breast-feeding, vaccinations and chronic illness was collected from copies of the children’s Child Health Center records. Overall, breast-feeding did not affect the risk of childhood cancer, OR=1.0 (95% CI=0.7–1.3) using breast-feeding up to one month as reference. For non-Hodgkin lymphoma (NHL) OR for breast-feeding for >1 month yielded OR=5.0 (95% CI=1.1–23). No association was seen between preschool vaccinations and childhood cancer except for lymphomas and measles/measles-mumps-rubella vaccination, OR=0.2 (95% CI=0.1–0.6). Increased risk of all cancer was found for congenital malformations, OR=1.7 (95% CI=0.97–2.9), especially of leukemia, OR=3.0 (95% CI=1.5–5.8). Children with disorders of brain function had an increased risk of all cancer, OR=6.0 (95% CI=1.3–27), especially of brain tumors, OR=10 (95% CI=1.3–78). A childhood population expected to be more exposed to POPs is children of fishermen. In a register-based study, the cancer incidence rates in a cohort of fishermen children (at age 0-19 years) were compared to the rates of referent children. A modestly increased incidence rate ratio (IRR) of childhood cancer was found, IRR=1.38 (95% CI=0.96–2.00) and an increased IRR for acute lymphoid leukemia, IRR=2.65 (95% CI=1.005–6.97). In west coast fishermen children, an increased IRR was observed for NHL, IRR=3.19 (95% CI=0.98–10.4).
25.	Dreifaldt, Ann Charlotte, et al. (author) Incidence rates of malignant diseases in childhood and adolescence in children to Swedish fishermen Other publication (other academic/artistic)

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