Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Literature Search
2.2. Selection Criteria
2.3. Selection of Relevant Studies
2.4. Assessment of Methodological Quality
2.5. Main and Subgroup Analyses
2.6. Statistical Analysis
3. Results
3.1. Study Selection
3.2. General Characteristics of Studies and Participants
3.3. Overall Use of Cellular Phone and Risk of Tumors
3.4. Use of Cellular Phones and Risk of Tumors in Subgroup Meta-analysis By Various Factors
3.5. Exposure–Response Relationship Between Use of Cellular Phones and Risk of Tumors
3.6. Use of Cellular Phones and Risk of Tumors in Subgroup Meta-analysis By Type of Tumor
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Study a | Country | Study Design b | Study Period | Type of Tumor (Age Range, Years) | Type of Cellular Phone Used in Analysis | Exposure | OR (95% CI) | Adjusted Variables | No. (Response Rate) | |
---|---|---|---|---|---|---|---|---|---|---|
Cases | Controls | |||||||||
Hardell et al. studies (n = 11) | ||||||||||
Hardell et al., 1999 [13] | Sweden | PCC | 1994–1996 | Brain tumor (20–80) | Digital | Use vs. no use (latency period >1 year) | 0.97 (0.61 to 1.56) | Age, sex, and study region (matched) | 209 (90%) | 425 (91%) |
Hardell et al., 2002 [14] | Sweden | PCC | 1997–2000 | Brain tumor (20–80) | Digital | Use vs. no use (latency period >1 year) | 1.0 (0.8 to 1.2) | Use of different types of phones | 1429 (88%) | 1470 (91%) |
Hardell et al., 2003 [15] | Sweden | PCC | 1997–2000 | Vestibular schwannoma (All ages) | Digital | Use vs. no use (latency period >1 year) | 1.21 (0.66 to 2.22) | Sex, age, and geographical area | 159 (89%) | 159 (89%) |
Hardell et al., 2004 [16] | Sweden | PCC | 1994–2000 | Salivary gland tumors (21–80) | Digital | Use vs. no use (latency period >1 year) | 1.01 (0.68 to 1.50) | Age and sex | 267 (91%) | 1053 (90%) |
Hardell et al., 2005 [17] | Sweden | PCC | 1999–2002 | Non-Hodgkin’s lymphoma (18–74) | Digital | Use vs. no use (latency period >1 year) | 1.04 (0.79 to 1.38) | Age, sex, and year of diagnosis (cases) or enrollment (controls) | 910 (91%) | 1016 (92%) |
Hardell et al., 2006 [18] | Sweden | PCC | 2000–2003 | Malignant brain tumor (20–80) | Digital | Use vs. no use (latency period >1 year) | 1.9 (1.3 to 2.7) | Age, sex, socioeconomic index, and year of diagnosis | 317 (88%) | 692 (84%) |
Hardell et al., 2007 [19] | Sweden | PCC | 1993–1997 | Testicular cancer (20–75) | Digital | Use vs. no use (latency period >1 year) | 1.1 (0.8 to 1.5) | Age, year of diagnosis, and cryptorchidism | 889 (91%) | 870 (89%) |
Hardell et al., 2010 [20] | Sweden | PCC | 1997–2003 | Malignant brain tumor (20–80) | Digital | Use vs. no use (latency period >1 year) | 1.4 (0.97 to 2.1) | Age, sex, socio-economic index code, and year of diagnosis | 346 (75%) | 619 (67%) |
Hardell et al., 2011 [21] | Sweden | PCC | 2000–2003 | Malignant melanoma (20–77) | Analog and digital | Use vs. no use (latency period >1 year) | 1.0 (0.7 to 1.3) | Age, gender, and year of diagnosis | 347 (82%) | 1184 (80%) |
Söderqvist et al., 2012 [22] | Sweden | PCC | 2000–2003 | Salivary gland tumor (22–80) | Digital | Use vs. no use (latency period >1 year) | 0.9 (0.4 to 1.7) | Age, sex, year of diagnosis, and socio-economic index code | 69 (88%) | 262 (83%) |
Hardell et al., 2013 [23] | Sweden | PCC | 2007–2009 | Malignant brain tumor (18–75) | Digital | Use vs. no use (latency period >1 year) | 1.7 (1.04 to 2.8) | Age, gender, socio-economic index code, and year of diagnosis | 593 (87%) | 1368 (85%) |
INTERPHONE-related studies (n = 19) | ||||||||||
Christensen et al., 2004 [24] | Denmark | PCC | 2000–2002 | Acoustic neuroma (20–69) | Cellular | Used regular vs. never or rarely used | 0.90 (0.51 to 1.57) | Education level, marital status, use of hands-free devices, and region | 107 (82%) | 214 (64%) |
Lönn et al., 2004 [25] | Sweden | PCC | 1999–2002 | Acoustic neuroma (20–69) | Digital | Regular use vs. Never or rarely | 0.9 (0.6 to 1.4) | Age, sex, residential area, and education | 148 (93%) | 604 (72%) |
Christensen et al., 2005 [26] | Denmark | PCC | 2000–2002 | Low- grade glioma (20–69) | Cellular | Regular use vs. no regular use | 0.58 (0.37 to 0.90) | Sex, age, education, hands-free devices in cars, marital status, and region | 171 (74%) | 330 (64%) |
High-grade glioma (20–69) | 1.08 (0.58 to 2.00) | 81 (74%) | 155 (64%) | |||||||
Meningioma (20–69) | 0.83 (0.54 to 1.28) | 175 (74%) | 316 (64%) | |||||||
Lönn et al., 2005 [27] | Sweden | PCC | 2000–2002 | Glioma (20–69) | Digital | Regular use vs. never or rarely use | 0.8 (0.6 to 1.0) | Age, gender, geographic region, and education | 371 (74%) | 674 (71%) |
Meningioma (20–69) | 0.6 (0.5 to 0.9) | |||||||||
Schoemaker et al., 2005 [28] | Denmark, Finland, Norway, Sweden, and UK | PCC | 1999–2004 | Acoustic neuroma (18–69) | Digital | Regular use vs. Never/non-regular use | 0.9 (0.7 to 1.1) | Highest educational level and combinations of interview year and interview lag time | 678 (83%) | 3553 (51%) |
Hepworth et al., 2006 [29] | UK | PCC | 2000–2003 | Glioma (18–69) | Mobile | Regular use vs. never/non-regular | 0.94 (0.78 to 1.13) | Age, sex, region, Townsend deprivation category, and interview reference date category | 966 (51%) | 1716 (45%) |
Schuz et al., 2006 [30] | Germany | PCC | 2000–2003 | Glioma (30–69) | Cellular | Ever use vs. never use | 0.98 (0.74 to 1.29) | Age, socioeconomic status, and living in a city | 366 (80%) | 732 (60%) |
Meningioma (30–69) | 0.84 (0.62 to 1.13) | 381 (80%) | 762 (60%) | |||||||
Lönn et al., 2006 [31] | Denmark and Sweden | PCC | 2000–2002 | Benign pleomorphic adenomas (20–69) | Mobile | Regular use vs. never or rarely use | 0.9 (0.5 to 1.5) | Age, gender, geographic region, and education | 112 (88%) | 321 (70%) |
Malignant parotid gland tumors (20–69) | 0.7 (0.4 to 1.3) | 60 (85%) | 681 (70%) | |||||||
Takebayashi et al., 2006 [32] | Japan | PCC | 2000–2004 | Acoustic neuroma (30–69) | Digital | Regular user vs. non-user | 0.68 (0.40 to 1.18) | Education and marital status | 101 (84%) | 339 (52%) |
Klaeboe et al., 2007 [33] | Norway | PCC | 2001–2002 | Glioma (19–69) | Digital | Regular use vs. no or irregular use | 0.6 (0.4 to 0.8) | Age, sex, residential area, and education | 289 (77%) | 358 (69%) |
Meningioma (19–69) | 0.6 (0.4 to 1.0) | |||||||||
Lahkola et al., 2007 [34] | Denmark, Finland, Norway, Sweden, and UK | PCC | 2000–2004 | Glioma (20–69) | Digital | Regular use vs. never /non- regular use | 0.75 (0.65 to 0.87) | None (adjustment for education and family history of glioma did not affect the result) | 1521 (60%) | 3301 (50%) |
Schlehofer et al., 2007 [35] | Germany | PCC | 2000–2003 | Acoustic neuroma (30–69) | Mobile | Ever use vs. never use | 0.67 (0.38 to 1.19) | SES, living area, age at diagnosis, and study center | 97 (89%) | 194 (55%) |
Lahkola et al., 2008 [36] | Denmark, Finland, Norway, Sweden, and UK | PCC | 2000–2004 | Meningioma (18–69) | Digital | Regular use vs. never/non-regular | 0.74 (0.63 to 0.87) | Sex, five-year age group, region, and country | 1209 (74%) | 3299 (50%) |
Sadetzki et al., 2008 [37] | Israel | PCC | 2001–2003 | Parotid gland tumors (≥18) | Cellular | Regular user vs. no regular user (<1 year) | 0.87 (0.68 to 1.13) | None (adjustment for cigarette smoking did not affect the result) | 460 (87%) | 1266 (66%) |
Takebayashi et al., 2008 [38] | Japan | PCC | 2000–2004 | Glioma (30–69) | Digital | Regular user vs. non-user | 1.29 (0.66 to 2.53) | Education and marital status | 88 (59%) | 196 (53%) |
Meningioma (30–69) | 0.67 (0.40 to 1.13) | 132 (78%) | 279 (52%) | |||||||
Pituitary adenoma (30–69) | 0.95 (0.53 to 1.71) | 102 (76%) | 208 (49%) | |||||||
Schoemaker et al., 2009 [39] | UK | PCC | 2001–2005 | Pituitary tumor (18–59) | Digital | Regular use vs. never/non-regular use | 0.9 (0.7 to 1.3) | Sex, age category, geographic area within study region, reference date, and Townsend deprivation score | 291 (63%) | 630 (43%) |
The INTERPHONE Study Group, 2010 [40] | 13 c Countries | PCC | 2000–2004 | Glioma (30–59) | Mobile | Regular use vs. no regular use | 0.81 (0.70 to 0.94) | Sex, age, study center, ethnicity in Israel, and education | 2708 (64%) | 2972 (53%) |
Meningioma (30–59) | 0.79 (0.68 to 0.91) | 2409 (78%) | 2662 (53%) | |||||||
The INTERPHONE Study Group, 2011 [41] | 13 c Countries | PCC | 2000–2004 | Acoustic neuroma (30–59) | Mobile | Regular use vs. no regular use | 0.85 (0.69 to 1.04) | Sex, age, study center, ethnicity, and education | 1105 (85%) | 2145 (53%) |
Shrestha et al., 2015 [42] | Finland | PCC | 2000–2002 | Pituitary tumor (20–69) | Digital | Regular use vs. never /non-regular use | 0.38 (0.21 to 0.68) | Not described | 80 (42%) | 240 (77%) |
Studies by other groups (n = 16) | ||||||||||
Muscat et al., 2000 [43] | US | HCC | 1994–1998 | Brain cancer (18–80) | Cellular | Regular use vs. no use | 0.8 (0.6 to 1.2) | Age, education, sex, race, study center, proxy subject, and month and year of interview | 469 (82%) | 346 (90%) |
Inskip et al., 2001 [44] | US | HCC | 1994–1998 | Brain tumor (≥18) | Cellular | Use vs. no use | 0.9 (0.7 to 1.1) | Age, sex, race, hospital, distance from patient’s residence to hospital, education, household income, date of interview, and interview respondent | 782 (80%) | 799 (86%) |
Auvinen et al., 2002 [45] | Finland | PCC | 1996 | Brain tumor (20–69) | Digital | Ever use vs. never use | 0.9 (0.5 to 1.5) | Described that adjusted odds ratios were calculated, and potential confounding factors were urban residence, socioeconomic status, and occupation | 398 (n.a.) | 2160 (n.a.) |
Warren et al., 2003 [46] | US | HCC | 1995–2000 | Infratemporal facial nerve tumor (mean 47) | Cellular | Use vs. no use | 0.6 (0.2 to 1.9) | Described that a multivariate model was used, but not presented | 18 (n.a.) | 141 (n.a.) |
Linet et al., 2006 [47] | US | PCC | 1998–2000 | Non-Hodgkin’s lymphoma (20–74) | Cellular | Ever used vs. ever used | 1.0 (0.7 to 1.3) | Age, ethnic group, education, and geographic site | 551 (79%) | 462 (55%) |
Kaufman et al., 2009 [48] | Thailand | HCC | 1997–2003 | Leukemia (≥18) | Cellular | Use vs. no use | 1.5 (1.0 to 2.4) | Age, sex, income, use of cellphones, benzene and other solvent exposure, occupational and non-occupational pesticide exposure, pesticides used near the home, working with power lines, and living near power lines | 180 (n.a.) | 756 (n.a.) |
Stang et al., 2009 [49] | Germany | HCC | 2002–2004 | Uveal melanoma (20–74) | Mobile | Regular use vs. never | 0.7 (0.5 to 1.0) | Age, sex, and residence | 827 (94%) | 455 (57%) |
Cooke et al., 2010 [50] | UK | PCC | 2003–2009 | Leukemia (18–59) | Mobile | Regular use vs. never/non-regular use | 1.06 (0.76 to 1.46) | Age, sex, socio-economic status, area of residence, ethnicity, smoking status, and interview lag time/period | 806 (50%) | 589 (75%) |
Spinelli et al., 2010 [51] | France | HCC | 2005 | Brain cancer (20–87) | Cellular | >36 h-years vs. no use | 1.07 (0.41 to 2.82) | Age and sex | 116 (75%) | 116 (90%) |
Aydin et al., 2011 [52] | Denmark, Norway, Sweden, and Switzerland | PCC | 2004–2008 | Brain tumors (7–19) | Mobile | Regular use vs. no regular use | 1.36 (0.92 to 2.02) | Unadjusted (SES, family history of cancer, past medical radiation exposure to the head, maternal smoking during pregnancy, past head injuries, and use of baby monitors did not change the results) | 352 (83%) | 646 (71%) |
Duan et al., 2011 [53] | China | HCC | 1993–2000 | Epithelial parotid gland malignancies (7–80) | Cellular | Regular use vs. never or rarely use | 1.14 (0.72 to 1.81) | Gender, age, resident area, marital status, education background, monthly income, and smoking status | 136 (62%) | 2051 (78%) |
Corona et al., 2012 [54] | Brazil | HCC | 2000–2010 | Vestibular schwannoma (mean 49 in cases, 53 in controls) | Cellular | Regular use vs. no use/irregular use | 1.19 (0.54 to 2.59) | Not described | 44 (52%) | 104 (57%) |
Coureau et al., 2014 [55] | France | PCC | 2004–2006 | Glioma (≥16) | Mobile | Regular user vs. no regular user | 1.24 (0.86 to 1.77) | Education and ionizing radiation exposure | 253 (66%) | 504 (45%) |
Meningioma (≥16) | 0.90 (0.61 to 1.34) | 194 (75%) | 388 (45%) | |||||||
Feltbower et al., 2014 [56] | UK | PCC | 2007–2010 | Brain tumor (0–24) | Mobile | Spoken on a mobile phone more than 20 times vs. not | 0.9 (0.2 to 3.3) | Age, sex, and Townsend deprivation index | 49 (52%) | 78 (32%) |
Pettersson et al., 2014 [57] | Sweden | PCC | 2002–2007 | Acoustic neuroma (20–69) | Digital | Regular use vs. never or rarely use | 1.26 (0.90 to 1.75) | Unadjusted (smoking, education, marital status, parity, and hands-free use did not affect the results) | 422 (83%) | 643 (65%) |
Yoon et al., 2015 [58] | Korea | HCC | 2002–2007 | Glioma (15–69) | Mobile | User vs. non-user | 1.17 (0.63 to 2.14) | Age, sex, area, education, respondent type, hair coloring, alcohol drinking, computer use, and electro-blanket use | 285 (32%) | 285 (27%) |
Factor | All | Hardell et al. Studies | INTERPHONE-Related Studies | Studies by Other Groups | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No. | OR (95% CI) | I2 (%) | No. | OR (95% CI) | I2 (%) | No. | OR (95% CI) | I2 (%) | No. | OR (95% CI) | I2 (%) | |||
36 | 0.99 (0.91 to 1.07) | 47.4 | 10 | 1.15 (1.00 to 1.33) * | 40.1 | 9 | 0.81 (0.75 to 0.88) | 1.3 | 17 | 1.02 (0.92 to 1.13) | 8.1 | |||
Difference in response rates a | Smaller (<14.5%) | 16 | 1.07 (0.94 to 1.21) | 54.2 | 10 | 1.15 (1.00 to 1.33) * | 40.1 | 1 | 0.81 (0.70 to 0.94) | n.a. | 5 | 0.99 (0.81 to 1.2) | 21.1 | |
Larger (>14.5%) | 17 | 0.91 (0.82 to 1.02) | 23.8 | n.a. | 8 | 0.81 (0.73 to 0.91) | 13.7 | 9 | 1.02 (0.90 to 1.17) | 0.0 | ||||
Use of blinding at interview | Used | 10 | 1.16 (1.01to 1.34) * | 39.4 | 9 | 1.16 (1.00 to 1.35) * | 45.4 | n.a. | 1 | 1.19 (0.54 to 2.59) | n.a. | |||
Not used | 26 | 0.91 (0.84 to 0.99) | 32.1 | 1 | 0.90 (0.44 to 1.70) | n.a. | 9 | 0.81 (0.75 to 0.88) | 1.3 | 16 | 1.02 (0.91 to 1.13) | 13.0 | ||
Methodolog-ical quality b | High | NOS | 17 | 1.11 (1.00 to 1.22) * | 20.1 | 9 | 1.16 (1.00 to 1.35) * | 45.4 | 1 | 0.90 (0.66 to 1.23) | n.a. | 7 | 1.08 (0.92 to 1.27) | 0.0 |
NHLBI | 20 | 1.09 (0.99 to 1.20) | 29.3 | 8 | 1.18 (1.00 to 1.40) | 50.7 | 2 | 0.80 (0.54 to 1.20) | 0.0 | 10 | 1.03 (0.91 to 1.15) | 0.0 | ||
Low | NOS | 19 | 0.88 (0.80 to 0.97) | 33.9 | 1 | 0.90 (0.44 to 1.70) | n.a. | 8 | 0.81 (0.74 to 0.88) | 8.5 | 10 | 0.99 (0.85 to 1.16) | 30.5 | |
NHLBI | 16 | 0.86 (0.78 to 0.95) | 27.2 | 2 | 0.95 (0.64 to 1.41) | 0.0 | 7 | 0.81 (0.74 to 0.90) | 22.4 | 7 | 0.99 (0.79 to 1.24) | 31.2 | ||
Funding by cellular phone industry | Not funded | 28 | 1.07 (0.98 to 1.17) | 21.9 | 10 | 1.15 (1.00 to 1.33) * | 40.1 | 1 | 0.95 (0.53 to 1.71) | n.a. | 17 | 1.02 (0.92 to 1.13) | 8.1 | |
Funded | 8 | 0.81 (0.74 to 0.89) | 10.6 | n.a. | 8 | 0.81 (0.74 to 0.89) | 10.6 | n.a. | ||||||
Type of case-control study | HCC | 9 | 0.95 (0.80 to 1.12) | 22.4 | n.a. | n.a. | 9 | 0.95 (0.80 to 1.12) | 22.4 | |||||
PCC | 27 | 1.00 (0.91 to 1.09) | 53.7 | 10 | 1.15 (1.00 to 1.33) * | 40.1 | 9 | 0.81 (0.75 to 0.88) | 1.3 | 8 | 1.10 (0.96 to 1.26) | 0.0 | ||
Malignancy | Malignant | 21 | 1.08 (0.97 to 1.20) | 31.4 | 9 | 1.18 (1.02 to 1.37) | 38.5 | 2 | 0.84 (0.54 to 1.31) | 0.0 | 10 | 0.97 (0.84 to 1.12) | 8.8 | |
Benign | 14 | 0.86 (0.77 to 0.95) | 21.9 | 3 | 0.92 (0.74 to 1.14) | 38.6 | 8 | 0.81 (0.72 to 0.90) | 14.6 | 3 | 1.07 (0.83 to 1.39) | 4.3 |
Factor | All | Hardell et al.’s Studies | INTERPHONE-Related Studies | Other Groups | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No. | OR (95% CI) | I2 | No. | OR (95% CI) | I2 | No. | OR (95% CI) | I2 | No. | OR (95% CI) | I2 | ||
Time since first use or latency (years) | <5 | 25 | 0.97 (0.86 to 1.09) | 39.0 | 10 | 1.05 (0.92 to 1.19) | 0.0 | 8 | 0.78 (0.64 to 0.94) | 36.2 | 8 | 1.10 (0.92 to 1.32) | 14.6 |
5–9 | 23 | 1.00 (0.86 to 1.16) | 51.0 | 10 | 1.20 (0.88 to 1.63) | 44.4 | 8 | 0.80 (0.70 to 0.92) | 13.7 | 5 | 1.19 (0.99 to 1.44) | 0.0 | |
≥10 | 18 | 1.29 (0.90 to 1.85) | 87.8 | 5 | 1.62 (1.03 to 2.57) * | 39.9 | 8 | 0.99 (0.79 to 1.24) | 25.3 | 5 | 1.57 (0.72 to 3.42) | 93.3 | |
Cumulative or lifetime use (years) | <5 | 14 | 0.81 (0.74 to 0.90) | 19.6 | n.a. | 9 | 0.77 (0.69 to 0.86) | 15.8 | 5 | 0.99 (0.81 to 1.21) | 0.0 | ||
5–9 | 14 | 0.89 (0.78 to 1.01) | 22.9 | 9 | 0.83 (0.73 to 0.94) | 0.0 | 5 | 1.04 (0.75 to 1.46) | 54.4 | ||||
≥10 | 9 | 1.04 (0.69 to 1.59) | 36.9 | 5 | 0.92 (0.54 to 1.59) | 0.0 | 5 | 1.15 (0.61 to 2.18) | 77.1 | ||||
Cumulative call time (hours) | <300 | 26 | 0.99 (0.90 to 1.08) | 0.0 | 9 | 1.08 (0.94 to 1.23) | 9.2 | 9 | 0.78 (0.66 to 0.93) | 0.0 | 8 | 1.05 (0.89 to 1.24) | 0.0 |
300–1000 | 7 | 1.14 (0.91 to 1.41) | 40.9 | 1 | 1.00 (0.40 to 2.60) | 2 | 1.07 (0.77 to 1.49) | 0.0 | 4 | 1.21 (0.79 to 1.84) | 40.9 | ||
>1000 | 8 | 1.60 (1.12 to 2.30) * | 74.5 | 2 | 3.65 (1.69 to 7.85) * | 0.0 | 4 | 1.25 (0.96 to 1.62) | 23.7 | 2 | 1.73 (0.66 to 4.48) | 91.8 | |
Cumulative number of calls | <1000 | 7 | 1.07 (0.87 to 1.32) | 9.6 | n.a. | 2 | 0.70 (0.38 to 1.29) | 0.0 | 5 | 1.13 (0.92 to 1.39) | 0.0 | ||
1000–7000 | 5 | 1.00 (0.69 to 1.43) | 51.6 | n.a. | n.a. | 5 | 1.00 (0.69 to 1.43) | 51.6 | |||||
>7000 | 10 | 1.14 (0.39 to 3.32) | 98.6 | n.a. | 5 | 0.85 (0.56 to 1.29) | 55.1 | 5 | 1.68 (0.36 to 7.94) | 99.0 |
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Choi, Y.-J.; Moskowitz, J.M.; Myung, S.-K.; Lee, Y.-R.; Hong, Y.-C. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 8079. https://doi.org/10.3390/ijerph17218079
Choi Y-J, Moskowitz JM, Myung S-K, Lee Y-R, Hong Y-C. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2020; 17(21):8079. https://doi.org/10.3390/ijerph17218079
Chicago/Turabian StyleChoi, Yoon-Jung, Joel M. Moskowitz, Seung-Kwon Myung, Yi-Ryoung Lee, and Yun-Chul Hong. 2020. "Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 17, no. 21: 8079. https://doi.org/10.3390/ijerph17218079