Christian Brabant, Anton Geerinck, Charlotte Beaudart, Ezio Tirelli, Christophe Geuzaine, Olivier Bruyère. Exposure to magnetic fields and childhood leukemia: a systematic review and meta-analysis of case-control and cohort studies. Reviews on Environmental Health. Published online March 15, 2022. doi: 10.1515/reveh-2021-0112.
The association between childhood leukemia and extremely low frequency magnetic fields (ELF-MF) generated by power lines and various electric appliances has been studied extensively during the past 40 years. However, the conditions under which ELF-MF represent a risk factor for leukemia are still unclear. Therefore, we have performed a systematic review and meta-analysis to clarify the relation between ELF-MF from several sources and childhood leukemia. We have systematically searched Medline, Scopus, Cochrane Database of Systematic Review and DARE to identify each article that has examined the relationship between ELF-MF and childhood leukemia. We have performed a global meta-analysis that takes into account the different measures used to assess magnetic field exposure: magnetic flux density measurements (<0.2 µT vs. >0.2 µT), distances between the child’s home and power lines (>200 m vs. <200 m) and wire codings (low current configuration vs. high current configuration). Moreover, meta-analyses either based on magnetic flux densities, on proximity to power lines or on wire codings have been performed. The association between electric appliances and childhood leukemia has also been examined. Of the 863 references identified, 38 studies have been included in our systematic review. Our global meta-analysis indicated an association between childhood leukemia and ELF-MF (21 studies, pooled OR=1.26; 95% CI 1.06–1.49), an association mainly explained by the studies conducted before 2000 (earlier studies: pooled OR=1.51; 95% CI 1.26–1.80 vs. later studies: pooled OR=1.04; 95% CI 0.84–1.29). Our meta-analyses based only on magnetic field measurements indicated that the magnetic flux density threshold associated with childhood leukemia is higher than 0.4 µT (12 studies, >0.4 µT: pooled OR=1.37; 95% CI 1.05–1.80; acute lymphoblastic leukemia alone: seven studies, >0.4 µT: pooled OR=1.88; 95% CI 1.31–2.70). Lower magnetic fields were not associated with leukemia (12 studies, 0.1–0.2 µT: pooled OR=1.04; 95% CI 0.88–1.24; 0.2–0.4 µT: pooled OR=1.07; 95% CI 0.87–1.30). Our meta-analyses based only on distances (five studies) showed that the pooled ORs for living within 50 m and 200 m of power lines were 1.11 (95% CI 0.81–1.52) and 0.98 (95% CI 0.85–1.12), respectively. The pooled OR for living within 50 m of power lines and acute lymphoblastic leukemia analyzed separately was 1.44 (95% CI 0.72–2.88). Our meta-analyses based only on wire codings (five studies) indicated that the pooled OR for the very high current configuration (VHCC) was 1.23 (95% CI 0.72–2.10). Finally, the risk of childhood leukemia was increased after exposure to electric blankets (four studies, pooled OR=2.75; 95% CI 1.71–4.42) and, to a lesser extent, electric clocks (four studies, pooled OR=1.27; 95% CI 1.01–1.60). Our results suggest that ELF-MF higher than 0.4 µT can increase the risk of developing leukemia in children, probably acute lymphoblastic leukemia. Prolonged exposure to electric appliances that generate magnetic fields higher than 0.4 µT like electric blankets is associated with a greater risk of childhood leukemia.Excerpt
Our results have practical implications. Our meta-analysis suggests that exposure to residential magnetic fields higher than 0.4 µT can increase the risk of leukemia in children. Nevertheless, it is important to emphasize the fact that very few homes are exposed to magnetic fields higher than 0.4 µT generated by overhead power lines in high income countries [11, 30]. Moreover, the annual incidence of childhood leukemia is very low and ranges between 35 and 50 cases per million children in western European countries and North America . Since the absolute risk of childhood leukemia is very low and children are rarely continuously exposed to magnetic fields higher than 0.4 µT in high income countries, the increased leukemia risk found in our meta-analysis does not represent a major public health concern in these countries. Magnetic flux densities higher than 0.4 µT are usually within 50 m of overhead power lines  even if Crespi et al.  found some subjects living between 50 and 200 m away from overhead power lines (over 200 kV) that were exposed to ELF-MF higher than 0.4 µT. Magnetic flux density measurements should be performed if children live within 200 m of overhead power lines to guarantee that they are not exposed to ELF-MF higher than 0.4 µT. In contrast, living more than 200 m away from overhead power lines could be considered a safe distance for children that is not linked to a higher leukemia risk. Our systematic review suggests that children from middle income countries like Mexico and Iran are more likely to be exposed to magnetic fields above 0.4 µT and the risk of leukemia attributable to ELF-MF is probably higher in these countries. It is noteworthy that none of the studies included in our review have been performed in low income countries or in Africa. More research on ELF-MF and childhood leukemia is needed in these countries, particularly in African countries.
Our meta-analyses suggest that exposure to electric appliances like electric blankets and bedside electric clocks increase the risk of leukemia in children. However, it is important to note that the studies that have found an association between these electric appliances and childhood leukemia have been performed more than 20 years ago and our findings should be interpreted based on the electric equipment used today. Electric blankets and bedside electric clocks used at the end of the twentieth century could generate magnetic fields higher than 0.4 µT and children were typically exposed to these electric appliances during several hours in a row . In contrast, hair dryers can also generate magnetic fields higher than 0.4 µT but are usually used during a shorter period of time  and we did not find a significant association between the use of hair dryers and childhood leukemia. These findings are relevant today in the sense that the duration of exposure to ELF-MF plays a role and that children should not be exposed to electric appliances that generate magnetic fields higher than 0.4 µT during long periods of time. Importantly, Magne and colleagues  have measured personal exposure to ELF-MF in French children between 2007 and 2009. They have found that alarm clocks were the main variable linked to the magnetic field exposure of the children. The proportion of children exposed to magnetic fields higher than 0.4 μT was 3.1% when all children were included in the analysis and 0.8% when the analysis was restricted to children for which no alarm clock had been identified. Taken together, these results and ours suggest that “bedside” electric clocks and alarm clocks that generate magnetic fields higher than 0.4 μT at close distance should be located at least 1 m away from the bed of the child, because the magnetic flux density generated by electric clocks was lower than 0.4 μT at this distance in the study by Preece et al. . To the best of our knowledge, there is no recent update of the study by Behrens et al.  that has performed reliable magnetic flux density measurements for electric appliances manufactured recently that generate ELF-MF. Studies with reliable exposure characterization with respect to sources of ELF-MF are needed, especially for the electric appliances manufactured recently that we use on a daily basis.
In summary, our study suggests that exposure to ELF-MF higher than 0.4 µT increases the risk of developing leukemia in children. Acute lymphoblastic leukemia is probably the subtype of leukemia associated with ELF-MF. Prolonged exposure to electric appliances that generate magnetic fields higher than 0.4 µT like electric blankets is associated with a more elevated risk of childhood leukemia. The distance from power lines linked to leukemia is difficult to determine but living more than 200 m away from power lines is likely a safe distance for children not associated with a higher leukemia risk.
Corresponding author: Christian Brabant, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate, 13/B-23, B-4000 Liège, Belgium; and Department of Psychology, Cognition and Behavior, University of Liège, Place des Orateurs, 2/B-32, Liège, Belgium, Phone: +32 43 66 25 81, Fax: +32 43 66 28 12, E-mail: firstname.lastname@example.org