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Reviews on Environmental Health

Editor-in-Chief: Carpenter, David O. / Sly, Peter

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Using the Hill viewpoints from 1965 for evaluating strengths of evidence of the risk for brain tumors associated with use of mobile and cordless phones1)

Lennart Hardell
  • Department of Oncology, University Hospital, Örebro, Sweden
  • :
/ Michael Carlberg
  • Department of Oncology, University Hospital, Örebro, Sweden
Published Online: 2013-11-06 | DOI: https://doi.org/10.1515/reveh-2013-0006


Background: Wireless phones, i.e., mobile phones and cordless phones, emit radiofrequency electromagnetic fields (RF-EMF) when used. An increased risk of brain tumors is a major concern. The International Agency for Research on Cancer (IARC) at the World Health Organization (WHO) evaluated the carcinogenic effect to humans from RF-EMF in May 2011. It was concluded that RF-EMF is a group 2B, i.e., a “possible”, human carcinogen. Bradford Hill gave a presidential address at the British Royal Society of Medicine in 1965 on the association or causation that provides a helpful framework for evaluation of the brain tumor risk from RF-EMF.

Methods: All nine issues on causation according to Hill were evaluated. Regarding wireless phones, only studies with long-term use were included. In addition, laboratory studies and data on the incidence of brain tumors were considered.

Results: The criteria on strength, consistency, specificity, temporality, and biologic gradient for evidence of increased risk for glioma and acoustic neuroma were fulfilled. Additional evidence came from plausibility and analogy based on laboratory studies. Regarding coherence, several studies show increasing incidence of brain tumors, especially in the most exposed area. Support for the experiment came from antioxidants that can alleviate the generation of reactive oxygen species involved in biologic effects, although a direct mechanism for brain tumor carcinogenesis has not been shown. In addition, the finding of no increased risk for brain tumors in subjects using the mobile phone only in a car with an external antenna is supportive evidence. Hill did not consider all the needed nine viewpoints to be essential requirements.

Conclusion: Based on the Hill criteria, glioma and acoustic neuroma should be considered to be caused by RF-EMF emissions from wireless phones and regarded as carcinogenic to humans, classifying it as group 1 according to the IARC classification. Current guidelines for exposure need to be urgently revised.

Keywords: acoustic neuroma; causation; glioma; Hill criteria; wireless phones

Corresponding author: Lennart Hardell, MD, PhD, Department of Oncology, University Hospital, SE-701 85 Örebro, Sweden, Phone: +46-19-6021000, Fax: +46-19-101768, E-mail:

Received: 2013-05-31

Accepted: 2013-09-13

Published Online: 2013-11-06

Published in Print: 2013-11-01

Citation Information: Reviews on Environmental Health. Volume 28, Issue 2-3, Pages 97–106, ISSN (Online) 2191-0308, ISSN (Print) 0048-7554, DOI: https://doi.org/10.1515/reveh-2013-0006, November 2013

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