cellular phones and the risk of cancer: new insights.

Young mother speaking at her mobile phone, Hell Ville, Madagascar

There is an increasing concern in the  media  in the USA about the fact that long-term exposure to microwaves from cellular phones may lead to an increased risk of brain tumors, as well breast cancer and sperm reduction. Most of us have no idea that cell phones are small microwave radios that should not be kept directly on the body. Many researchers have demonstrated that the current standard of exposure to microwave during mobile phone use (cellular or cordless phones) is  not safe for long-term exposure. Although some studies have found no association, others suggest that the more hours of cellular phone use over time, the higher the risk of developing brain tumors. Risk also increases along with the level of power from the wireless device, years since first use, total exposure, and younger age when starting wireless phone use.
Cell phone’s microwave radiation seeps directly into soft fatty tissue of the breast and there already are some cases reported of breast cancer developed in close proximity to the site in the bra where cell phones are tucked and used for hours a day with a hands-free headset. For many young women today, tucking cell phones in the bra has become a cool, hip way to have simple access to these essential devices. As a way to get their newborn infant son to sleep through the night, some moms use i-Phone for the often-difficult task of pacifying them. They download several applications, including “BabySoothe” and “Lullabies”, and set them running throughout the night in close proximity to their baby’s head. Children’s brain (which double in size during the first year of life) is especially vulnerable to the emission of these two-way microwave radios, with their pulsed digital signals. Brains are not the only part of our anatomy that we need to be concerned about. According to several different studies, sperm count is 50% lower in men who use cell phones four hours a day—which is the case for a growing number of teenagers and young men.  Cells in human sperm exposed to cell phone radiation have been shown to die three times faster and become much sicker than those left alone. One may say that Africa is still free of this risk because of its poor economy and different lifestyle of inhabitant people. This is not completely true. I am not wrong if I believe that in most African countries, even the poorest, there is a widespread coverage by wireless communications facilities. These people may have no access to safe drinking water, or efficient health system, but, meanwhile, have no problem to use a cellular phone. The young mother shown in the photograph above, speaking at her mobile phone depicts this phenomenon: she lives in a country where prevention or early diagnosis of breast cancer or cervical cancer is not available but cellular phones are widespread among local people. Is the cellular phone lacking technologies to reduce exposure to microwave emissions an additional danger the developed countries are exporting to the low-income developing world ?.

Evita and the Pap smear

Evita Peron (Wikipedia)

Evita Duarte Peron, the wife of Juan Peron, the famous argentinian politician and statesman in the late 1940ies, died from aggressive, widespread cervical cancer at the age of 33, in 1952. At the time of her death, because of her genuine interest in the poor, she was greatly loved and respected by large numbers of the working class. When authorities announced her demise, the entire country went into mourning. After her death, thousands of people stood in line to view her body. 
The tumor must have been extremely aggressive, judging by the early age of onset and the rapid clinical course. On a first surgery, it was interpreted as an appendiceal carcinoma but the correct diagnosis was made one year later, on a second operation, when, probably, the tumor was not operable anymore.

Evita Perón had several risk factors that led to the eventual development of cervical cancer. Sexual activity presumably began at an early age. She married a man who had had multiple sexual partners. Even more important, Juan Perón's first wife, died from cervical cancer when she was only 28 years old. In addition, there was another possible risk factor; Evita's mother died of cervical cancer at age 77. We now know that infection with human papillomavirus (HPV), a common sexually transmitted disease, is the main cause of cervical cancer. Did Peron carry a particularly aggressive strain of HPV, the virus that we now know causes cervical cancer, and unknowingly transmit the infection to both his wives? 
What we do know today is that Evita’s death due to cervical cancer would likely never have happened if she had had a Pap smear in the due time.  The Pap smear was invented by George Papanicolaou in about 1920 and a regular screening based on pap smear examination was first started in 1939 at the New York Hospital. This diagnostic procedure was still unpracticed in Argentina in the late 1940ies otherwise Evita could have ben saved!

Dr. George Papanicolaou (Wikipedia)

How many women are nowadays, i.e. 70 years later, in the same situation as Evita's in most of the countries of the developing world where women do not have access to cervical cancer screening programmes?.

Suggested readings:

Lerner BH. The illness and death of Eva Perón: cancer, politics, and secrecy. The Lancet 2000;355(9219):1988-91.

Rodriguez AO. Curr.Opin.Obstet.Gynecol. Eva Perón: cervical cancer and the effect on a nation. 2009;21(1):1-3.

Fisher JW, Brundage SI. The challenge of eliminating cervical cancer in the United States: a story of politics, prudishness, and prevention. Women Health. 2009; 49 (2-3);246-261

Patterns of cancer in developed and developing countries

 

In other posts I have been talking about the differences in rankings between developed and developing (low- and middle-income) countries in both incidence and mortality for cancer. The patterns vary by geography and economic status, which correlate roughly with the causes of cancer in the "environment" in its broadest sense.
The majority of cancers in more developed countries are those associated with more affluent lyfestyles - cancers of the lung, colon and rectum, breast, and prostate. In contrast, cancers of the liver, stomach, esophagus, and cervix - all related directly or indirectly to infectious agents - are relatively more common in developing countries.  The mix of common cancer in females varies as seen in the following table (source: Cancer Control Opportunities in low- and middle-income countries; see website in the list). Click to enlarge:

In developed countries the incidence of tumors of the breast, colon, lung and corpus uteri is higher than in low- and middle-income countries with a ratio, respectively, of 1.23/1; 1.95/1; 1.02/1; and 2.19/1. The mortality of these malignancies, however, is lower than in developing countries: breast 29.8% vs. 42.8%; colon and rectum 49.3% vs. 60.0%; lung 82.5% vs. 86.5%; and corpus uteri 21.32% vs. 33.8%. The higher mortality of these tumors in the developing world is mainly due to a significant delay in the diagnosis of the disease, i.e. the tumor is disclosed in a more advanced stage of progression, when therapy is less effective or useless. Because of these factors, the number of people dying of breast cancer and lung cancer in developing countries is likely to be equal to or even higher than the number of subjects dying of these tumors in the developed world.
In developing countries the incidence of tumors of the cervix uteri, stomach, liver, and esophagus, is much higher than in developed countries with ratios, respectively, of 6.49/1; 1.86/1; 4.08/1, and 8.12/1. The higher incidence of these tumors is broadly explicable by differences in exposure to certain infectious agents (HPV, HBV, HIV, etc) or carcinogens, but it is also strongly related to the lack of primary prevention (vaccination against HPV and HBV), to an ineffective secondary prevention (i.e., screening of carcinoma of cervix uteri), and to the lack of health facilities for early diagnosis and treatment. In fact, it is very frustrating to realize that in developing countries a significant proportion of people dying for cancer were suffering from preventable and/or curable malignancies. It is for this reason that all efforts should be made by the global cancer community to take immediate steps to slow and ultimately reverse the phenomenon.

Ho avuto già occasione di parlare delle differenze in termini di incidenza e mortalità dei tumori nei paesi sviluppati in confronto con quelli in via di sviluppo. Tali differenze si articolano in base alla geografia e alle condizioni economiche e quindi, in generale, alle condizioni ambientali nel senso più largo del termine. In genere, nei paesi sviluppati l'incidenza più elevata di alcune forme tumorali  (carcinoma del polmone, colon e retto, mammella e prostata) è correlata agli stili di vita più seguiti. Nei paesi in via di sviluppo, invece, si osserva una maggiore incidenza dei tumori associati, direttamente o indirettamente, all'esposizione ad agenti infettivi (carcinoma del fegato, della cervice uterina, dello stomaco e dell'esofago). Tutte queste forme tumorali sono molto aggressive ad eccezione, almeno in parte, del carcinoma della cervice uterina. La variabilità di incidenza e mortalità nel sesso femminile sono ben illustrate nella tabella.
Nei paesi sviluppati l'incidenza del carcinoma della mammella, colon, polmone, corpo uterino, è più elevata che nei paesi in via di sviluppo in ragione, rispettivamente, di 1.23/1; 1.95/1; 1.02/1; e 2.19/1.  La mortalità di questi tumori, però, è meno elevata che nei paesi in via di sviluppo: mammella 29.8% vs. 42.8%; colon e retto 49.3% vs. 60.0%; polmone 82.5% vs. 86.5%; corpo uterino 21.32% vs. 33.8%. Tutto ciò è dovuto al ritardo con il quale viene identificata la malattia che preclude l'efficacia delle terapie perchè il tumore si trova in una fase più avanzata. Come diretta conseguenza, la mortalità almeno per cancro della mammella e del polmone è più elevata nei paesi in via di sviluppo anche se l'incidenza è inferiore rispetto ai paesi sviluppati.
Nei paesi in via di sviluppo l'incidenza del carcinoma della cervice uterina, dello stomaco, del fegato, e dell'esofago è molto superiore a quella che si riscontra nei paesi sviluppati, in ragione, rispettivamente, di 6.49/1; 1.86/1; 4.08/1, e 8.12/1. L'incidenza più elevata è riconducibile alla diversa esposizione ad agenti infettivi (HPV, HBV, HIV, ecc) o carcinogeni, ma anche alla totale mancanza di misure di prevenzione primaria (vaccinazioni anti HBV o HPV), o all'insufficienza di misure di prevenzione secondaria (p.es. lo screening per il carcinoma della cervice uterina) e, infine, alla mancanza di strutture sanitarie che consentano una diagnosi precoce con relativo trattamento. E' sconfortante pensare che nei paesi in via di sviluppo la maggioranza dei decessi per cancro sia correlata a tumori prevenibili o curabili se diagnosticati in tempo. Tutto ciò deve rappresentare per la comunità globale che si occupa di cancro un motivo per attivarsi in modo fattivo affinchè tale tendenza venga ridotta o addirittura invertita.

children in Sakatia and Nosy Be

This post is dedicated to the children we happened to meet in the last September while traveling by car on the roads of Nosy Be island or walking through the village in the island of Sakatia, Madagascar.




We were expecting to meet sad people, badly nourished and suffering, victims of a destiny which gave birth to them in one of the poorest countries of the world; and yet we will never be able to forget the hands tended for a contact, the smiles, the hearty welcome of most of them. At first glance one may easily perceive these villages as a community overrun by children. Children looked enthusiastic, curious, kind, joyful, inclined to interaction with us, always very decent.



Their mood was strikingly positive and it was a great pleasure to meet them. Adult men are practically missing, maybe because they are working far from the villages or even fishing on the sea or trading their goods. Women are actually present but still very few in number. They work hard and you often see them while carrying on their head incredibly large baskets.

These children and their families live in houses built out of ground, made up by only one or to the maximum two parts, where sleep sometimes eight, ten people. During a few days we shared their humble life by holding hands and laughing together without understanding each other but feeling the same emotions. These children and their parents need our help. Not only toys or our disused garments, but the chance of constructing theirselves their own life, and with the dignity they deserve.

Photos by Andrea Gherardi