1. Mobile phone use and acoustic neuroma risk in Korea Jae-wook Choi 1) Songyi Yoon 1) Dong-Soo Yoo 2) Hae-Joon Kim 1) Joon-young Lee 3) Soo-Ho Shim 1) Mun-seob Ahn 1) Kyong-Hee Kim ) Jeung-Hun Kim 4) Chul-Ki Park 5) Sung-Suk Lee 6) Hae-Rim Park 7) Yong-Ku Jeong 8) Yong-Sik Kim 9) Kyung-Mi Park 10) Department of Preventive Medicine, College of Medicine, Korea University 1) Graduate School Korea University 2) Department of Biostatistics, Korea university 3) Seoul Asan Hospital 4) Seoul National Hospital 5) Korea Canter Center Hosptial 6) Hanrim Unversity Hospital 7) Korea University Anam Hospital 8) Korea University Ansan Hospital 9) Sanggye Paik Hospital 10 ) *Corresponding author: Jae-wook Choi(shine@korea.ac.kr)shine@korea.ac.kr

2. 2 Background The question about the effect of an electromagnetic wave produced by a cellular phone to the human being prevails internationally due to dramatic incease of the number of cellular phone user the studies are about the epidemiology study about the correlation with a brain tumor, the study about the effect to a human being with the short time exposure, the experimental study about tumor, gene expression and the effect of DNA with animals, and mainly the study in vitro about the effect to the cell ----> Among these, some of the results of the studies have been released and exposed to the users of a cellular phone so that the insecurity of the health statue of them rises

3. 3 Background The active epidemiology study about the effect of an electromagnetic waves produced by a cellular phone to human being has been proceeded as a form of collaborated epidemiology study in the WHO IARC interphone study team since 2000, which 13 nations leaded by Europe have participated in Among them, the first study has been completed in 2003; and the results of 9 studies have been released recently. Six studies of them has been proved to be not correlated. Also three is not directly correlated but they still have the potential of a damage to heath, which is still required to be further studied.

4. 4 Study Years Study Type Age No.of Cases Odds ratio 95% CI Comments Inskip et al 2001 USA 1994-1998 Case-Control >-18years5 1.9 (0.6-5.9) >-5 years of cell phone use Muscat et al 2002 USA 1997-1999 Case-Control >-18years 11 1.7 (0.5-5.1) 3-6 years of cell phone use Lonn et al 2004 sweden (Interphone) 1999-2002 Case-Control 20-69 years 14 1.8 (0.8-4.3) >-10 years since first ‘regular’mobile phone use, result for either side of head Christensen et al 2004 Denmark (Interphone) 2000-2002 Case-Control 20-69 years 45 0.9 (0.5-1.6) Regular use Summary of eight studies on acoustic neuroma and mobile phones

5. 5 Study Years Study Type Age No.of Case s Odds ratio 95% CI Comments Schoemaker et al 2005 Denmark,Finland, Sweden, Norway, Scotland, England (Interphone) 1999-2004 Case-Control 18- 69years (variable) 360 0.9 (0.7-1.1) Regular use Hardell et al 2006 Sweden 1997-2003 Case-Control 20- 28years 130 1.7 (1.2-2.3) >/1 year latency of mobile phone use Schuz et al 2006 Denmark 1982-2002 Cohort 18 years32 SIR0.7 (0.5-1.03) No data on latency or laterality of tumour and use of mobile phone Takebayashi et al 2006 Tokyo 2000-2004 Case-Control 30- 69years 51 0.7 (0.4-1.2) Regular use Summary of eight studies on acoustic neuroma and mobile phones

6. 6 Background

7. 7 Cancer incidence by region, Age-standardized incidence rate (ASR) Unit: cases, per 100,000 Male (Left), Female (Right)

8. 8 Background

9. 9 Male (Left) Female (Right) Brain Tumor (Blue) Acoustic Neuroma (Red)

10. 10 Background It should be noticed since it was reported that some studies about an acoustic neuroma or immunologic studies in a cellular level reported the relationship with the exposure 95 % of an acoustic neuroma occurs ipsilaterally and non-genetically. Around 5 % is a form of a neurofibroma, which is a genetic disease; the type 1 is due to a genetic damage on chromosome 17, while the type 2 is due to a genetic damage on chromosome 22

11. 11 Background Considering other studies about the relationship between the acoustic neuroma and the exposure of the electromagnetic wave produced by a cellular phone, the epidemiologic characteristics of the tumor, and the anatomical position which corresponds to the actual exposure spot, the study about the risk of the acoustic neuroma is definitely needed to be accomplished.

12. 12 Subjects of study Method of study A disease of a subject group was Acoustic neuroma; C72. A Subject group was a group with 51 patients out of 64 patient diagnosed pathologically or radiologically that was reported to the clinical laboratory and the otorihinoaryngology of 9 hospitals with the age of 15 to 69, excluded 13 patients of dead people, people who refused to do, and not eligible people A control group was preceded in the same way. It was 102 matched to Acoustic neuroma; C72 with the ratio of 1:2, which was age (±5), sex, address The ratio of control and subject according to a disease was based on he protocol about the control-subject study of Feasibility study in 1999 presented by WHO IARC Interphone study team The study was on process from February 1st, 2002 to December 31st, 2006.

13. 13 Method Of Study Method of study The epidemiology study about the effect of the electromagnetic waves produced by a cellular phone and a process system through its questionnaire was the same with Figure 1. The participating hospitals reported the subjects to the study team within one week of the diagnosis and the nurse who was trained about the epidemiology study accomplished the questionnaire within one month with cooperation of the doctor in charge. IRB of each hospital during the questionnaire examined the moral part of this study, and the examination was completed in 2005. The theme and purpose of this study were fully explained and the questionnaire was accomplished with agreement of a patient, and informed consent was obtained.

14. 14 Method Of Study Method of study Categories included in the questionnaire were 148 in total Basic categories were about individual’s social economic state, medial insurance, smoking and drinking habit, sleeping and exercise habit, eating habit, subjective symptoms before hospitalization, job history, electronics and method of transportation. The categories related to a mobile phone were calling time, total calling time, monthly average calling fee, the type of phone, text message, calling spot ( on body), symptoms related to a mobile phone use.

15. 15 Target Disease Selection Establishment of target disease reporting system Exposure Assessment Pathology, Neurosurgery and ENT department of Nine University hospital in Seoul and Kyungi province Validity verification of Exposure Assessment model Case-Control selection (Sex-age-matching) A part of mobile phone user Total call time Case-control research accomplishment Exposure Assessment model (Analog/Digital, Total call time, Average daily minutes of use) Comparison YesNo Electromagnetic waves Exposure Assessment Derivation Development Odds Ratio Figure 1. Case-control study design Figure 1. Case-control study design

16. 16 Method of study The calculated credibility was used to demonstrate that the Korean questionnaire was suitable for the study. The analysis of the data was the evaluation standard about the credibility (consistency) of the two questionnaires obtained by Test-retest; it calculated kappa value ( or Kapa value with weight) and 95% credibility range of Kapa value. For the matter of Kapa value of each category about the subjective symptoms due to a mobile use was 0.477-1.000; and it was consistent in the credibility and the appropriateness.

17. 17 Data Analysis Method of study Data analysis is about the frequency of the basic characteristics of both the control and the subject groups, the distribution of a mobile phone related categories, and the distribution of subjective symptoms after a mobile phone use. To demonstrate the consistency with the characteristics of the variables such as the type of a mobile phone, the variables, SPSS-PC 10.0 program was used.

18. RESULT (Case 51, Control 102 RESULT (Case 51, Control 102)

19. 19 Table 1. General characteristics of case and control group Table 1. General characteristics of case and control group † χ 2 -test. * Student t-test. Cases (n=51)Controls (n=102)p-value Gender † Male21 (41.2)42 (41.2) 1.000 Female30 (58.8)60 (58.8) Age § 46.47±13.5 (19.0-68.0)43.65±14.2 (19.0-73.0)0.527 Education § 12.02±3.0 (6.0-18.0)12.43±4.1 (0-19.0)0.604 Smoking † Yes6 (11.8)15 (14.7) 0.618 No45 (88.2)87 (85.3) Drinking † Yes21 (41.2)56 (55.4) 0.097 No30 (58.8)45 (44.6) Region † Urban37 (74.0)83 (87.4) 0.043 Rural13 (26.0)12 (12.6) Sleeping hours § 6.92±1.5 (4.0-10.0)6.6±1.1 (4.0-9.0)0.053 Hair dye use † Yes30 (58.8)68 (66.7) 0.341 No21 (41.2)34 (33.3) Family cancer decease history † Yes11 (21.6)30 (29.4) 0.302 No40 (78.4)72 (70.6) Stress § 82.15±57.7 (16.0-276.0)75.54±78.0 (11.0-420.0)0.170

20. 20 Characteristics Table 2. Characteristics of mobile phone usage † χ²-test. § student t-test: * p<0.05, ** p<0.001. Cases (n=51)Controls (n=102) Wireless phone use Yes 44 (86.3) 79(77.5) No 7 (13.7) 23(22.5) Months of use 66.46±28.7 (12-120) 65.99±34.9 (10-145) Average daily minutes of use 17.21±16.1 (2-60) 32.29±38.6 (1-240) Antenna use Yes 5 (13.5) 9(12.3) No 32 (86.5) 64(87.7) Monthly expenses for Wireless phone (won) 43951±35401(13000-200000)42014±26287(14000-180000) N(%), Mean±SD(min-max

21. 21 Table 3. Subjective symptoms against mobile phone use Symtoms Cases (n=51) Controls (n=102) Symtoms Cases (n=51) Controls (n=102) Headache Yes1(2.3)4(5.1) Heating on Ear Yes 11(25.6)31(39.2) No42(97.7)75(94.9)No 32(74.4)48(60.8) Dizziness Yes1(2.3)3(3.8) Heating on face Yes 3(7.0) 10(12.7) No42(97.7)76(96.2)No 40(93.0)69(87.3) Concentration Disturbance Yes1(2.3)3(3.8) Skin drying Yes 1(2.3) 4(5.1) No42(97.7)76(96.2)No 42(97.7)75(94.9) Displeasure Yes3(7.0)4(5.1) Facial pain Yes 0(0.0) 2(2.5) No40(93.0)75(94.9)No 43(100.0)77(97.5) Physical fatigue Yes1(2.3)4(5.1) Eye pain Yes 2(4.7) 2(2.5) No42(97.7)75(94.9)No 41(95.3)77(97.5) Memory Disturbance Yes 0(0.0)5(6.3) No43(100.0)74(93.7) † χ 2 -test.

22. 22 Table 4. Odds ratio of Acoustic neuroma between mobile phone types Cases (n=51)Controls (n=102)OR (95% CI) Non use Analog Digital+Analog Digital 7(13.7) 5(9.8) 22(43.1) 17(33.3) 23(22.5) 10(9.8) 44(43.1) 25(24.5) 1.0 0.45(0.16-1.28) 0.74(0.21-2.54) 0.74(0.33-1.64)

23. 23 Table 5. Odds ratio of Acoustic Neuroma between mobile phone usages † The odds ratio (OR) and 95% confidence interval (CI) were calculated by unconditional multiple logistic regression analysis with fifteen categorize variables [ gender(1:male, 0:female); age(1:>20years, 2:20-29years, 3:30-39years, 4:40-49years, 5:50-59years, 6:≤60) years; residential district(1:rural area, 0:urban area); smoking habits(1:yes, 0:no); drinking habits(1:yes, 0:no); sleeping hours(1:<7hours, 0:≥7hours); hair dyeing(1:yes, 0: no); cancer in family members in a direct line(1:yes, 0:no); stress(1:yes, 0:no); Mobile phone use(1:yes, 0:no); Cumulative length of use(1:Non use, 2: <48months, 3:48-83months, 4:≥84months); Cumulative call time(1:Non use, 2:<300hours, 3: 300—899hours, 4:≥900hours); monthly fee (1:Non use, 2:<30,000won, 3:30,000-49,999won, 4:50,000-79,999won, 5:≥80,000won); Regular side of mobile phone use(1:right, 2:left, 3:both, 4:don’t know); Laterality(1:Non use, 2:Ipsi-use, 3:Contra-use, 4:both). Mobile phone usagesCases (n=51)Controls (n=102)OR (95% CI) Mobile phone useNo Yes 7(13.7) 44(86.3) 23(22.5) 79(77.5) 1.0 1.83(0.73-4.61) Cumulative Length of use (month) Non use <48 48-83 ≥84 7(13.7) 11(21.6) 19(37.3) 14(27.5) 23(22.5) 19(18.6) 38(37.3) 22(21.6) 1.0 1.90(0.62-5.86) 1.64(0.60-4.51) 2.09(0.71-6.15) Cumulative call time (hour) Non use <300 300--899 ≥900 7(14.3) 17(34.7) 15(30.6) 10(20.4) 23(22.5) 25(24.5) 18(17.6) 36(35.3) 1.0 2.23(0.79-6.36) 2.74(0.92-8.13) 0.91(0.30-2.74) Monthly fee (won) Non use <30,000 30,000-49,999 50,000-79,999 ≥80,000 7(14.0) 12(24.0) 23(46.0) 4(8.0) 23(23.0) 26(26.0) 27(27.0) 19(19.0) 5(5.0) 1.0 1.52(0.51-4.50) 2.80(1.02-7.70) 0.69(0.18-2.72) 2.63(0.55-12.55)

24. 24 Table 6. The locations of Acoustic neuroma and mobile phone usage p<0.05 Tumor Site Phone usage Right (%)Left (%)Both (%)Total (%) Right3(42.9)10(83.3)1(50.0)14(66.7) Left4(57.1)1(8.3)0(0.0)5(23.8) Both0(0.0)1(8.3)1(50.0)2(9.5) Total7(100.0)12(100.0)2(100.0)21(100.0)

25. 25 Discussion A mobile phone has been generalized in Korea so that the mobile phone user explosively has increased since 1995. The distribution rate exceeded 70 % with the 33,592,000 members of a mobile phone now on December in 2004;also it increased to 79% with the 38,342,000 in 2006 The effect of the electromagnetic waves by a mobile phone to human was in the middle of interest so that there are many epidemiology studies about it. According to the results, there is not significant relevancy between the use of a mobile phone and the rate of cancer

26. 26 Discussion The matter about the use of cellular phone and health has not been fully studied, and the latency period to become a cancer after the exposure is more than at least 10 years since the initial exposure. When considering some results of the epidemiology study in the residential area, the study was to prove the relationship between a user of a analogue and a digital mobile phone who lived in countryside and a user in the city in central Sweden. In this study, it was reported that the urban people was likely to have a brain tumor than the people in countryside, which was indicated in some results of some users of an analogue and digital mobile phone for 10 years  The result of this study, it was also consistent with the different locations of residence.

27. 27 Discussion In this study, the subjective symptoms after a mobile phone use in each brain tumor group was examined in details: a headache, dizziness, deterioration of concentration, physical fatigue, memory impairment, ear burning, facial flush and burning, skin dryness, facial itchiness and stinginess and eye hurt and tear. The control group had more frequency of headache, dizziness and deterioration of concentration than the subject group. The symptoms of pain or dizziness of the subject group were mainly dependent on their own memory; it should be considered that the recall bias due to the headache produced by an acoustic neuroma could have affected the results of the study.

28. 28 Discussion In the study about the relevancy of an acoustic neuroma with the calling spot, the incidence was 42.9 % for the right ear, while the incidence was 57.1 % for the left when the mobile phone was used on each ear; but it was not statically significant. The analysis method used in this study was a case only design, which was the practical application of the method suggested by Inksip (2001)

29. 29 Donclusion To prove the interaction, the sample and the exposure evaluation for analysis are made as well as the epidemiology studies about the possible brain tumor by the electromagnetic waves and its related factors. And this study will present the basic data for the studies about a mobile phone use and its related brain tumor in the future.

30. 30 Thank you !!