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HomeMy WebLinkAboutCOM 0110.202 2024-2026P / COUNCIL. BILL 24 COMM. 110 From Study: SUBMITTED BY: Claudia Schimmer-Keawe Dode AC, et al, Mortality by neoplasia and cellular telephone base stations in the Belo Horizonte municipality, Minas Gerais state, Brazil, Sci Total Environ (2011) http://dx.doi.org/10.1016/a.scitotenv.2011.05.051 COUNTY CLERK 50 COUNTY OF HAWAI'I p O /� RECEIVED Time T- Date J �- 18 21 t' :' 45 a r 0 E 0 m W 30 until until until until until until until until until until 100 200 300 400 500 600 700 800 900 1.000 Distance from BS Rate of mortality by neoplasia, according to the distance from BS Null hypothesis Fig. 15. Rate of mortality by neoplasia, according to the distance from the B5 in Belo Horizonte municipality, from 1996 to 2006, and the null hypothesis. Notes: "Until 200" means the area from 100 to 200 meters, "BS" means Base Station or Cell Tower, Neoplasia is abnormal cell growth that can lead to cancer and death. New Hampshire 5G commission recommends 1,640 ft. Setback Even though 500 meter (1,640 ft.) set back still causes cancer, the risk starts to flatten out after 500 meters and it is a reasonable compromise between phone service and health. The cell towers have to be taller to achieve the setback requirements. Video: "NH Commission Setback Justification: htttps://www.Voutube.com/watch?v=DWK74ie7krc&list=PPSV Comm. ficl], Ref. To: Ref. Date 202 12/22/2021 Overview of New Hampshire Commission • The Commission was convened through bipartisan legislation that was passed by the legislature and signed by the Governor • This is the first legislation passed in the United States calling for the formation of a commission to explore the health effects of 5G • The 13 Commission members had backgrounds that included physics, toxicology, electromagnetics, epidemiology, biostatistics, occupational health, medicine, public health policy, business, and law • The Commission met over a one-year period and submitted its Final Report in November 2020 • The overarching conclusion of the Commission is that wireless radiation poses a significant threat to human health and the environment • More detailed information about the Commission can be found here and here Fundamental Question • What is a safe setback distance for a cell tower? • Why did the New Hampshire Commission pick a setback distance of 500 meters (1,640 feet)? • There are two basic approaches to identifying a safe setback 1. Look at disease prevalence as a function of the distance people live from a cell tower 2. Identify the lowest power densities known to cause negative health outcomes and determine the typical distance from a cell tower where those power density values are not exceeded 12/22/2021 3 Approach 1: Look at H Outcomes for People L Near Towers. AtWh Distance Do Elevated h Problems Diminish Mortality versus Distance People Live from Tower The article reports on research that analyzed the spatial correlation between how close people lived to a cell tower and cases of deaths by neoplasia. Data obtained from Brazilian government databases. Covered timeframe 1996-2006; conclusions based on study of 856 cell towers and 7,191 cancer deaths The largest power density measured during the study was 40.78 µW/cmz (407.8 mW/mz) Adilza C. Dode, Monica M.D. Leao, Francisco de A.F. Tejo, Antonio C.R. Gomes, Daiana C. Dode, Michael C. Dode, Cristina W. Moreira, Vania A. Condessa, Claudia Albinatti, Waleska T. Caiaffa, "Mortality by neoplasia and cellular telephone base stations in the Belo Horizonte municipality, Minas Gerais state, Brazil", Science of The Total Environment, Volume 409, Issue 19, 2011, Pages 3649-3665, ISSN 0048-9697 https:lldoi.org/10.1016/­i.scitotenv.2011.05.051 2 12/22/2021 0 Q_ Take -Away from Article Referenced on Previous Slide 8 00 Rate of mortality by neoplasia according to distance from cell tower 0 Rate of mortality by neoplasia for general population 45 40 t O $6 C 2 30 100 200 300 400 500 600 700 800 900 1000 Distance From Cell Tower (meters) Meta Analysis of Health vs Tower Distance Studies We found epidemiological studies pertaining to the health effects of mobile phone base station RF emissions to be quite consistent in pointing to a possible adverse health impact. Eight of the 10 studies reported increased prevalence of adverse neurobehavioral symptoms or cancer in populations living at distances < 500 meters from base stations... none of the studies that found adverse health effects of base stations reported RF exposures above accepted international guidelines, the implication being that if such findings continue to be reproduced, current exposure standards are inadequate in protecting human populations. Epidemiological Evidence for a Health Risk from Mobile Phone Base Stations, VINI G. KHURANA, LENNART HARDELL, JORIS EVERAERT, ALICJA BORTKIEWICZ, MICHAEL CARLBERG, MIKKO AHONEN, http:Zlciteseerx.ist.psu.edulviewdoc/download?doi=10.1.1.654.855i &rep=repl&type=odf 3 12/22/2021 pproach 2: Identif sure Levels Assoc' � egative Health Ef relate that Level b ince from a Cell Tc 7 Bleinit"iffil"Ve 2012 A Rationale for Biologically -based Exposure Standards for Lotion -Intensity Electromagnctic Radiation LOW EXPOSURE LEVELS ARE ASSOCIATED WITH BIOEFFECTS AND ADVERSE HEALTH EFFECTS AT CELL TOWER RFR EXPOSURE LEVELS At least five new cell tower studies are reporting bioeffects in the range of 0.03 to 0.5 mW/m2 at lower levels than reported in 2007 (0.5 to 1.0 mW/m2 was the range below which, in 2007, effects were not observed). htt s:' bioin iatve.or-' 8 N 12/22/2021 (� Power Density vs Distance for a Typical Cell Tower 12 Tower with 1739 watts ERP 10 Vj a E 8 CO E 6 a w 4 0 2 °1 2 3 0 0- 0 ... -*-Measured Power Density —Biolnitiative Threshold 0 100 200 300 400 500 Distance (m) Buckus, Raimondas et al. "A Technical Approach to the Evaluation of Radiofrequency Radiation Emissions from Mobile Telephony Base Stations." International journal of environmental research and public health vol. 14,3 244. 1 Mar. 2017, doi:10.3390/ijerph14030244 https://www.ncbi.nlm.nih.Qov/pmcZarticies/PMC5369080/ The Industry Has Consultants Who Are Paid to Discredit this and Similar Studies • In June 2021, 1 presented the findings of the NH Commission to a town that was considering adding cell antennas to a water tower. I used the Brazil study to show the dangers of living near such antennas • In the town's next meeting, they brought in a company that the town paid to evaluate the proposed installation. As seen in a recording of their presentation, the presenters claimed to be impartial regarding the proposed installation. • The second presenter never acknowledges being paid by the telecommunications industry, although his work for them is documented here • The second presenter sought to discredit the Brazil report from a supposedly non -biased perspective • He stated that "I'm not presenting my views about this", not mentioning that he submitted a paper challenging the findings of the Brazil report • He also did not mention that the authors of the Brazil study published a response to his criticisms • He only referenced government agency reports to discredit the paper. This is significant because the Commission found that many of the agencies involved in regulating radiation levels are captured. 5 12/22/2021 Conclusions • Significant Biological effects do not appear to occur at distances greater than 8 500 meters from a typical cell tower • The power density at 500 meters from a typical cell tower is near the power density considered not to cause biological effects in the laboratory • The telecom industry will claim that no setback is necessary because they do not recognize the danger of wireless radiation • Implementing setbacks will not inhibit robust cellphone coverage, although it may make cell tower siting more expensive • The setback will require the use of taller towers which will provide more uniform coverage without exposing people to harmful radiation 11 New Hampshire Commission to Study the Environmental and Health Effects of Evolving 5G Technology Video (21 min): "NH Commission Setback Justification" By Dr. Kent Chamberlain, Professor of electrical engineering and chair emeritus, New Hampshire Commission "This video describes the rationale behind one of the key recommendations of the New Hampshire Commission to Study The Environmental and Health Effects of Evolving 5G Technology. That recommendation is that cell towers be placed no nearer than 1,640 feet from places where people live, work or recreate." https://www.Voutube.com/watch?v=DWK74ie7krc&list=PPSV Slides for this presentation: http://www unh edu/ece/NHCommission/Justification%20for%20500%20m%20Setback. pdf Video (20 min): "Overview of the New Hampshire Commission on 5G" By Dr. Kent Chamberlain, Professor of electrical engineering and chair emeritus, New Hampshire Commission https://www.youtube.com/watch?v=gT9g5Mm3iSo Bio of Dr. Kent Chamberlain https://www.unh.edu/unhtoday/expert/chamberlin-kent Book Review: "Harvard Press Book on Telecom Industry Influence To The US FCC — Captured Agency by Norm Alster" https:Hehtrust.org/harvard-press-book-telecom-ind ustrV-influence-us-fcc-captu red - agency/ New Hampshire Final Report of the Commission to Study The Environmental and Health Effects of Evolving 5G Technology https://gc nh gov/statstudcomm/committees/1474/reports/5G%20final%20report.pdf The New Hampshire Final Report has 390 pages. It was too long for me to print. There are 2 pages from the appendixes. The other appendixes are a wealth of information. Appendix F Wireless Exposure Limits in Different Countries The exposure limits given below are from the website of Physicians for Safe Technology Japan 600 microwatts/cm2 PHYSICA NS U.S.A. 450 microwatts/cm2 0A FE = TECHNOLOGYCanada 450 microwatts/cm2 Physicians for Safe Australia 450 microwatts/cm2 Technology Austria 450 microwatts/cm2 France 450 microwatts/cm2 Germany 450 microwatts/cm2 Hungary 450 microwatts/cm2 Ireland 450 microwatts/cm2 Luxembourg 450 microwatts/cm2 Portugal 450 microwatts/cm2 Spain 450 microwatts/cm2 India 45 microwatts/cm2 China 40 microwatts/cm2 Russia 10 microwatts/cm2 Italy 10 microwatts/cm2 Bulgaria 10 microwatts/cm2 Poland 10 microwatts/cm2 Lichtenstein 10 microwatts/cm2 Switzerland 10 microwatts/cm2 Belgium 2.4 microwatts/cm2 Ukraine 2.5 microwatts/cm2 Cosmic <0.00000000001 microwatts/cm2 91 International Agency for Research on Cancer — RF: https•//publications.iarc.fr/Book-And-Report-Series/larc-Monographs-On-The- Identification-Of-Carcinogenic-Hazards-To-Humans/Non-ionizing-Radiation-Part- 2-Radiofrequency-Electromagnetic-Fields-2013 https•//www.iarc.fr/wp-content/uploads/2018/07/pr208 E.pdf Chou, 1992: https•/%nlinelibrory.wiley.com/doi/abs/10.1002/bem.2250130605 Repacholi, 1997: https://www.ncbi.nlm.nih.govlpubmedl9146709 As vulnerable individuals are exposed involuntarily every day in society to RF- radiation, caution should be universally used and set according to the Largest Observed Adverse Effect Distance (LOAED), using the experience from past and current 2G, 3G, and 4G networks. A conservative LOAED should include all observed health effects. Best engineering practice would therefore apply a set -back requirement for new cellular towers, including 5G micro -towers. From the 17 documents referred to in this appendix, shown below in historical order, this set -back for all new cell towers should be 500 meters which translates to 1,640 feet. All of these studies have been given support by a recent animal study from the Ramazzini Institute that links to them, as well as to the US National Toxicology Program result on cell phones. REFERENCES Paola Michelozzi, Alessandra Capon, Ursula Kirchmayer, Francesco Forastiere, Annibale Biggeri, Alessandra Barca, and Carlo A. Perucci. "Adult and Childhood Leukemia near a High -Power Radio Station in Rome," Italy. American Journal of Epidemiology, Vol. 155, No. 12, (2002) 1096-1103. Michelozzi et al 2002 describe an increased risk for childhood leukemia at distances up to 6 km from the powerful Vatican Radio transmitters near Cesano, Italy, which led to compensation by decision of Italy's Supreme Court (relative risk of 7 for lymphomas and myeloma, and 5 for non -Hodgkin's lymphoma and leukemia). https://pubmed.ncbi.nlm.nih.gov/12048223/­ 100 Study: "Mortality by neoplasia (cancer) and cellular telephone base stations in the Belo Horizonte municipality, Minas Gerais state, Brazil" By Adilza C. Dode, MonicaM.D. Leao, Francisco de A.F. Tejo, Ant6nio C.R. Gomes, DaianaC. Dode, Michael C. Dode, Cristina W. Moreira, VaniaA. Condessa, ClaudiaAlbinatti, WaleskaT. Caiaffa, o 1 1 This is a great study because of quantified the setback distance with mortality and the amount of data it used. Two Figures from this study are in the front. Overview of New Hampshire Commission: "The article reports on research that analyzed the spatial correlation between how close people lived to a cell tower and cases of deaths by neoplasia. Data obtained from Brazilian government databases." "Covered timeframe 1996-2006; conclusions based on study of 856 cell towers and 7,191 cancer deaths." Using this data, I calculated using straight-line interpolation the chance of dying per year. The cell towers increased the chance of dying per year with the setbacks are as follows: • 600 ft. 1.22 times • 1,200 ft. 1.105 times • 1,640 ft., 1.065 times However, these values are very likely understated: 1st is signal strength, The study covered 1996-2006 using less dangerous & powerful technology than 5G. Eger 2004 study, "The largest power density measured during the study was 40.78pW/cm2 (407.8mW/m2)" 40.78pW/cm2 in the Study is more than 10 times less than the US allowable radiation of 450 microwatts/cm2. See Appendix F in the New Hampshire Report. I At the same time 40.78pW/cm2 more than 4 times the amount 10 microwatts/cm2 allowed by Russia, Italy, Bulgaria, Poland, Lichtenstein, Switzerland. Some people have measure various places in Hilo and said the radiation was at dangerous levels. Exact numbers should be measured at various locations to assess the danger. 2nd is other time of exposure, Even though the study lasted 10 years, the study started out with one tower before it became 856 cell towers. If they added towers uniformly over the 10 years that would mean the average exposure time was 5 years. In the study by Eger in 2004, there was not a discernable difference for 5 years. Even if all the cell towers were installed in the first year, the vast majority of people will get more than 10 years of EMF exposure. The EMF radiation has a cumulative effect. I Science of the Total Environment xxx (2011) xxx-xxx Mortality by neoplasia and cellular telephone base stations in the Belo Horizonte municipality, Minas Gerais state, Brazil Adilza C. Dode a,b,e, Monica M.D. Ledo `, Francisco de A.F. Tejo d, Antonio C.R. Gomes e, Daiana C. Dode e,f Michael C. Dode e, Cristina W. Moreira b, Vania A. Condessa b, Claudia Albinatti b, Waleska T. Caiaffa g a Minas Methodist University Center Izabela Hendrix, Belo Horizonte City, Minas Gerais State, Brazil b Municipal Government of Belo Horizonte, Municipal Health Department, Belo Horizonte City, Minas Gerais State, Brazil UFMG—Universidade Federal de Minas Gerais -Belo Horizonte, Environmental and Sanitary Engineering Department, Belo Horizonte City, Minas Gerais State, Brazil a UFCG—Universidade Federal de Campina Grande, Center of Electrical Engineering and Informatics, Academic Unit of Electrical Engineering, Paraiba State, Brazil e MRE Engenharia (Electromagnetic Radiations Measurement —Engineering), Belo Horizonte City, Minas Gerais State, Brazil r Faculty of Medical Sciences, Medicine -Belo Horizonte, Belo Horizonte City, Minas Gerais State, Brazil 9 UFMG—Universidade Federal de Minas Gerais -Belo Horizonte, Urban Health Observatory, Belo Horizonte City, Minas Gerais State, Brazil A R T I C L E I N F O A B S T R A C T Article history: Received 14 January 2011 Received in revised form 25 May 2011 Accepted 25 May 2011 Available online xxxx Keywords: Assessment and management of impacts and environmental risks Non -ionizing electromagnetic radiation Public health Radio base station Environmental electromagnetic pollution Environmental electromagnetic field monitoring 1. Introduction Pollution caused by the electromagnetic fields (EMFs) of radio frequencies (RF) generated by the telecommunication system is one of the greatest environmental problems of the twentieth century. The purpose of this research was to verify the existence of a spatial correlation between base station (BS) clusters and cases of deaths by neoplasia in the Belo Horizonte municipality, Minas Gerais state, Brazil, from 1996 to 2006 and to measure the human exposure levels to EMF where there is a major concentration of cellular telephone transmitter antennas. A descriptive spatial analysis of the BSs and the cases of death by neoplasia identified in the municipality was performed through an ecological -epidemiological approach, using georeferencing. The database employed in the survey was composed of three data banks: 1. death by neoplasia documented by the Health Municipal Department; 2. BSs documented in ANATEL ("Agencia Naconal de Telecomunicagbes": Telecommunications National Agency'); and 3. census and demographic city population data obtained from official archives provided by IBGE ("Instituto Brasileiro de Geografia a Estatistica": 'Brazilian Institute of Geography and Statistics'). The results show that approximately 856 BSs were installed through December 2006. Most (39.60%) of the BSs were located in the "Centro -Sul" ('Central-Southem') region of the municipality. Between 1996 and 2006, 7191 deaths by neoplasia occurred and within an area of 500 m from the BS, the mortality rate was 34.76 per 10,000 inhabitants. Outside of this area, a decrease in the number of deaths by neoplasia occurred. The greatest accumulated incidence was 5.83 per 1000 in the Central -Southern region and the lowest incidence was 2.05 per 1000 in the Barreiro region. During the environmental monitoring, the largest accumulated electric field measured was 12.4 V/m and the smallest was 0.4 V/m. The largest density power was 40.78 µW/cmz, and the smallest was 0.04 µW/cmz. Mobile phone radio base stations (RBSs) are now found in cities and communities worldwide. They can be found near or even on top of homes, schools, hospitals, daycare centers and offices. In Brazil, the number of mobile phone users is estimated to be over 200 million and there are more than 5 billion users worldwide. In the municipality of Belo Horizonte, the capital of the state of Minas Gerais, there are approximately 1000 base stations (BSs) with 128.77 accesses by All the authors declare that they have no conflicts of interest. * Corresponding author at: Rua Desembargador Assis Rocha, 279, Bairro Belvedere, 30320-250, Belo Horizonte (MG), Brazil. Tel.: +55 0313286 1892. E-mail addresses: adilzadode@terra.com.br (A.C. Dode), monica@desa.ufmg.br (M.M.D. Lego). 0048-9697/$ - see front matter ® 2011 Elsevier B.V. All rights reserved. d oi:10.1016/j.s ci totenv.2011.05.051 © 2011 Elsevier B.V. All rights reserved. mobile phones per 100 inhabitants and in Brazil, there are 49,979 BSs licensed through April 2011 (ANATEL, 2011). The non -ionizing electromagnetic radiation from the BSs is of low intensity compared to the current guidelines on human exposure limits. However, its emission is continuous. This raises concerns as to whether the health and well-being of people living or working close to the BSs are at risk Khurana et al., 2010; Alanko et al., 2008. The emission of a BS is usually described by its effectively radiated power in watts (W), which describes the total amount of radiation emitted by the antenna of the BS. Their intensity, called the power density, is commonly measured in milliwatts per square centimeter (mW/cmz) or microwatt per square centimeter (µW/cmz) and it expresses the power per unit area impinging normally to the external surface of the subject. The immission (absorption) of the subject is measured by the specific absorption rate (SAR), which is reported in IN A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx—xxx watts per kilogram of body tissue (W/kg). The SAR reflects the power that is locally absorbed in a certain volume of biological tissue and is proportional to the square of the local magnitude of the electric field intensity. For ethical reasons, the SAR can only be assessed on animal models or inferred from virtual (computational) models of animal or human subjects (Lai, 2000). Some scientific studies have shown evidence of increased numbers of cancer cases for people living less than 500 m from the BSs (Eger et al., 2004; Wolf and Wolf, 2004; Eger and Jahn, 2010). In the Belo Horizonte municipality and in many other urbanized cities and communities in Brazil, the mobile phone network is deployed in regions of high demographic density close to homes and on the facades and roofs of public or private buildings. It is also common to have several antennas sharing the same support structure. This situation motivated the research of Dode (bode, 2003) in the Belo Horizonte municipality, where a methodology designed to assess the levels of electromagnetic radiation exposure of the dwellers was used, based on the technical specifications of a sample of the installed BSs. Those estimated data were then compared to measured in situ data for the same set of BSs. Fig. 1 illustrates the site of a typical BS (Base Station BH 20) in a residential area of the Serra neighborhood, in the Belo Horizonte municipality and Fig. 2 shows its geographical location. Fig. 3 represents the horizontal and vertical radiation patterns per sector of the same BS. This diagram has been obtained from the technical archives documented by the operators in the Secretaria Municipal de Meio Ambiente (Municipal Environmental Department), the official organization of the municipality that is responsible for the environmental licensing of the BSs. Some studies have shown evidence of general risks to health and specific risks of cancer associated with the physical proximity of the transmitter antennas of the telecommunication network. One of the first of these studies indicated an association between cancer growth and a residence near a transmitter antenna (Cherry, 1999). Later, Santini et al. (Santini et al., 2002) carried out a qualitative survey of 530 people living within 300 m of a certain BS. Despite the subjective methodology, the study showed a peak of symptoms occurred at locations in the interval between 50 and 100 m from the BS, which coincided with the typical distances at which the main lobe reached the ground. In another study, also in France, Santini et al. (2003 ) surveyed dwellers living 300 m from the BS and others who lived farther away and found more complaints about irritability, depressive tendency, memory loss, problems with concentration, dizziness, within 100 m; headache, sleeping disorder, discomfort, skin problem within 200 m; and fatigue within 300 m, among those living closer to the BS and showed more variability in disease occurrence with distance. Again, this study contained some biases because it was subjective and therefore did not result in a conclusion about the relationship between cancer and the amount of radiation exposure. Navarro et al. (2003) conducted a study of 145 people in Murcia, Spain, but only included 101 questionnaires in the analysis. Two groups of participants were formed: one that was living within 150 m of the BS and another beyond 150 m. The average measured power density was 1.1 µW/cmZ at locations within 150 m and 0.1 µW/cmZ beyond 150 m. This study also showed that complaints (insomnia, headaches, difficulty in concentration, discomfort) were greater at locations where the power density was higher, inside the 150 m range. In Poland, Gadzicka (Gadzicka et al., 2006) also used a questionnaire to conduct a neurobehavioral clinical study involving 500 subjects. The most important finding was the incidence of frequent headaches in subjects living less than 150 m from the BS. However, the study was limited because of the lack of information about the technical characteristics of the BS and the measurements of electromagnetic exposure. Eger et al. (2004) carried out research in the city of Naila, Germany, to examine whether people who live near mobile phone BSs were at any risk of becoming ill with malignant tumors. Their data bank consisted of records of patients from 1994 to 2004. While preserving the privacy of the information, the personal data of almost 1000 subjects were examined. The analysis showed that the number of newly developed cancer cases was significantly higher among those Fig. 1. BS site BH 20 in a residential area of the Serra neighborhood in Belo Horizonte municipality. '�3;n 3...v�`v... ''a .�.irxF.er.�`,.a ,,,.�t rs R?.i.a., ': „R5. £;x.�b.^ .... `E`aYv'3iv �r'i m 3�i?�.hn&..➢.�i ,:a.e. ... ��'�zFF'a ,. t.�v �,.., 1,i.££�, r:, ';':F„. �?.,.. CI A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx BS Site BH 20 — Maxitel Address 1373 Rua do Ouro Street - Bairro Serra neighborhood - Belo Horizonte municipality Latitude S 190 56' 33,7" Longitude W 43° 55' 8,7" 2 yjRUA FJ RA AAq o CCOLEGIO INTEGRAL PROMOVE ae Oz D� }'•.019644 R.DEP. 0g12 hDdERNAR I VIRIATO # 1zg18 SIA FIGUeREDO ,a MArcervHASf A t I F y °s'iy D q ✓ t c 8 4 ESC OLAL-UCIA ASC ASANTA € k D PU m 0� ? D I M`GUEI � 330 RUN RA5 0o CENTRO6EDUCACION L DA ODAT 'Q RUq P HENRJQUE R: RIO— • t �$ !) of OUV m CA Aj( i Q c )12413 ESCOLATHEODOR HERZL 3LU QH DU L HER j IU o 069202 ',*A-�N�IEL y07 3. rn L[jY. 'cD P J RV . n p05'��S —\P ""6 1RIFgNa�_... o O DONAARGENTINA,VIANACASTELO B R AN CO Q y` 6�pO F iul oo ✓rJ��o o e Mg�N�o � 012` 60 03 A P� f RV r 3 RbRUP�ROBET2T0 4- - 125888 -.--^^ y �1A 1A a tF 9a �P S 6i s/aq �fi a RUA NAGIB 300528 Fig. 2. Geographical location of BS Site BH 20 at 1373 Rua do Ouro Street, in the Serra neighborhood, Belo Horizonte municipality (bode, 2003). patients who had lived at distances within 400 m of the BS site, compared to the number of subjects who had lived beyond 400 m in the same period of time. The former subjects became sick eight years earlier, on average, than the latter subjects. The BS came into operation in 1993. From 1999 to 2004, that is, after five years' operation of the transmitting installation, the relative risk of suffering from cancer was three times higher for the subjects living within 400 m of the BS, compared to the dwellers beyond that distance. This study represents a milestone in the field because its results clearly demonstrate that the radiation from the BS may contribute to an increase in the clinical manifestation of the disease and the general development of cancer, even at exposure levels several orders of magnitude lower than the limits of the current guidelines. Wolf and Wolf (2004) led a study in the town of Netanya, Israel, which showed an increase of 4.15 times in cancer incidence among subjects living within 350 m of the BS, compared to those who had lived further away. The total number of participants (n = 622, group A) were individuals who had lived for a duration of three to seven years near a mobile phone BS and were also patients of a health care clinic. The exposure took place one year before the beginning of the study, when the BS came into operation. A second group of individuals (n=1222, group B), who received medical care in a clinic near the BS and had environmental, socioeconomic and occupational characteristics similar to the first group was used as the control group. In group A, eight types of cancer had been diagnosed within a period of only one year. This rate was compared both to the rate of 31 cases per 10,000 people per year in the general population and the rate of two cases per 1222 people recorded in group B. A 95% confidence interval to each rate was calculated and the rate of cancer occurrence in group A was found to be significantly higher than the rates of group B and the entire population. The relative cancer rate was 10.5 among the exposed women of group A, 0.6 among the women of group B and 1.0 for the entire town of Netanya. Therefore, the cancer A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx I 29 280' 270' 2W' 25 i5D' 0' 1W low t80, 170' 8o' 9V 100' 0' D ate Type 06.1995 Horizontal and Vertical 737658 KATNREI n Radiation Patterns Name 870 MHz Fig. 3. Horizontal and vertical radiation patterns per sector of BS site BH 20 (KATHREIN MOBILCOM BRASIL LTDA. HUEMER E. and LENSIG KI-, 1999). incidence in the women of group A was significantly higher (p<0.0001) than the cancer incidence of group B and the city as a whole. A relative risk comparison revealed that there were approximately 4.15 more cases of cancer in group A than in the population as a whole. The results, although still not conclusive, indicated a necessity to revise the current exposure limits in favor of more protective levels. Both the estimated and measured power densities in the entire exposed area in Netanya were far below 0.53 µW/cm2, that is, approximately 800 times lower than the exposure limit of 425 µW/cm2 for the frequency of 850 MHz from the ICNIRP guidelines. The aforementioned studies, which aimed to find evidences of an increase in cancer incidence with proximity to mobile phone BSs, warrant additional research, because the cellular phone technology is relatively new and the associated total amount of environmental radiation is far from negligible. The inhabitants of the Belo Horizonte municipality and the scientific community in general are also concerned about the number of already installed BSs and the proliferation of new wireless BSs, not only for telephony but also for television. The number of mobile phone BSs, which equaled 474 in 2003, had reached approximately 856 in 2006. Thus, this research to study health was conducted in a broad environmental context, aiming to verify if there is a spatial correlation between the cellular telephony system BS location and the cases of death by neoplasia during the period between 1996 and 2006. 2. Materials and methods 2.1. Area of study The Belo Horizonte municipality, with an area of approximately 300 kM2 of area, has a tropical climate and is located at an average altitude of 900 m (minimum of 800 m and maximum of 1200 m) A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx Fig. 4. The Belo Horizonte municipality and the nine SDs. above sea level. The geology of the city includes several kinds of minerals and its soil of crystalline rocks is composed of dolomite, quartzite, phyllite and various schists. Constructed over many hills, the city is surrounded by a mountain named "Serra do Curral". The municipality is divided into nine regions or sanitary and administra- tive districts (SDs): "Centro -Sul" ("Central -Southern"), "Norte" ("Northern"), "Leste" ("Eastern"), "Oeate" ("Western"), "Noroeste" ("Northwestern"), "Nordeste" ("Northeastern"), "Venda Nova", "Pam- pulha" and 'Barreiro'. Fig. 4 shows the Belo Horizonte municipality and the nine SDs. The municipality has 55 universities and colleges, 36 hospitals, and a subway system containing 19 stations and 29 km of track, which transports 145,000 passengers a day. The majority of households are served by potable water (99.3%), garbage collection (96.6%), sewage (93.2%), electric power (99.83%), and landline phones (81.43%) (UNDP, 2008) and 128.77 accesses by mobile phones per 100 inhabitants through April 2011 (ANATEL, 2011). With these data, one can conclude that much of the population possesses a cellular phone and more than 28% of the inhabitants have more than one. The city has road and railroad networks that link it to the main centers of the country, as well as three airports. More than 80% of the municipal economy is focused on commerce, financial services, real estate activities and public administration. The metallurgical industries, including iron and steel metallurgy, and ore mining are located in the areas surrounding the metropolitan region but not in the Central -Southern region. The city of Belo Horizonte has been selected by the Population Crisis Committee of the United Nations (UN, 2007) as the metropolis with the best quality of life in Latin America and was ranked 45th in the world. Its health system is considered very good, according to the Atlas of Human Development (2000)/United Nations Development Programme (UNDP, 2008). The city had 2,238,332 inhabitants in 2003 and 2,258,096 in 2010 (IBGE, 2010), which suggests that the population in the city is stable. However, the city, as in any urban area in Brazil, has a concentrated population, with a large number of people living in apartment buildings. This fact, along with the mountainous landscape, force mobile phone operators to install their BSs at strategic points in the city, mainly on top of towers and poles, as on the terraces of public or residential buildings, to ensure good coverage of the mobile phone network. Of the nine SDs, the Central -Southern region is the richest region of the city and is the third largest in number of inhabitants with 249,862. There are plenty of commercial and service shops, several shopping centers, and many households with one or more families. This SD also has several hospitals, parks and leisure areas. Most of the dwellers are highly educated and belong to the middle and upper classes. The traffic is heavy because of the large number of vehicles that travel in that region. The Western region is less densely populated, has no skyscrapers and its inhabitants have low revenues. The Barreiro region is the most populated after the Central -Southern SD, and has many industries. The most populated region, with 338,753 inhabi- tants, is the Northwestern (IBGE, 2000). 2.2. Study design This ecological study consists of an exploratory spatiotemporal analysis to determine whether there is an association between clusters of BSs and deaths by neoplasia in the Belo Horizonte municipality, in the southeastern part of Brazil. This design was chosen because of the possibility of using geographic areas as units of analysis, where each unit of analysis is composed of a group of individuals or communities. Therefore, it is possible to determine whether there is a correlation between a certain risk and the occurrence of certain grievances within the population. In this type of study, it is not possible to consider individual characteristics, such as food and life habits, activity level, smoking, self -medication, individual pathologies, or genetic factors (GORDIS, 2004). The analysis was based on the following databases: 1. A database of deaths by neoplasia documented in the Mortality Information 6 A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx System (SIM: "Sistema de lnforma45o ern Mortalidade"), provided by interviewers, taking into account the existence of geographical the City Health Department; 2. A database of the site register of BSs, barriers, the population size and traffic flow. There were a total of provided by the Brazilian Telecommunications Agency (ANATEL); 3. A 2563 CTs in the Belo Horizonte municipality (IBGE, 2000). database of the city census, including demographic information provided by the Brazilian Institute of Geography and Statistics (IBGE). The death, BS and population data were geocoded according to 2.2.1. Cancer death variable census tracts (CPs) or censitarian sectors (CSs), which are "territorial The main outcome that was studied was the number of deaths by units defined by IBGE (IBGE, 2000) to orient the spatial distribution of neoplasia of Belo Horizonte municipality residents that occurred from a population". The definition of a CT is related to a specific 1996 to 2006, were reported to the City Health Department and were geographical zone whose population can be counted by local routinely confirmed by established criteria, under the responsibility of Table t International classification of diseases - ICD-10. Disease ICD-10 - According to WHO ICD10 homepage Bibliographical references Primary Secondary Primary: Malignant melanoma of skin; Other C43 and C44 C79.2 Eger et al., 2004. malignant neoplasms of skin./Secondary malignant neoplasm of skin. Primary: Malignant neoplasm of C50 C79.8 Eger et al., 2004: Wolf and Wolf, 2004; Bioinitiative breast./Secondary malignant Report, 2007; Guenel et al., 1996; Feychting et al., neoplasm of other specified sites. 1997: Wakeford, 2004; Mack et al., 1991; Beall et al., 1996; Beniashvili et al., 2005; Hardell and Sage, 2007. Primary and secondary: Malignant neoplasm C80 C80 Khurana, 2008; Hardell et al., 2007; Bioinitiative without specification of site. Report, 2007; Mack et al., 1991; Beall et al., 1996: Guenel et al., 1996: Wakeford, 2004, Primary: Malignant neoplasm of ovary./Secondary C56 C79.6 Eger et al., 2004; Wolf and Wolf, 2004 malignant neoplasm of ovary. Primary: Hodgkin's Disease/Secondary and unspecified C81 C77 Wolf and Wolf, 2004. malignant neoplasm of lymph nodes. Primary: Malignant neoplasm of bronchus and C34 C78.0 Eger et al., 2004; Wolf and Wolf, 2004 lung/Secondary malignant neoplasm of lung Primary: Malignant neoplasm of kidney, except renal C64 C79.0 Wolf and Wolf, 2004. pelvis./Secondary malignant neoplasm of other sites. Primary: Malignant neoplasm of prostate./Secondary C61 C79.8 Eger et al., 2004. malignant neoplasm of other specified sites. Primary: Malignant neoplasm of pancreas; Pancreas, C25 and C25.9 C78.8 Eger et al., 2004. unspecified./Secondary malignant neoplasm of other and unspecified digestive organs. Primary: Malignant neoplasm of other and ill-defined C26.0; C17; C18; C19 C78.4; C78.5 Eger et al., 2004. digestive organs: Intestinal tract, part unspecified; Malignant neoplasm of small intestine; Malignant neoplasm of colon; Malignant neoplasm of rectosigmoid junction./Secondary malignant neoplasm of small intestine; Secondary malignant neoplasm of large intestine and rectum. Primary: Malignant melanoma of skin; Melanoma C43 and D03 C79.2 Eger et al., 2004; Hallberg, 2004; johansson, 2006. in situ./Secondary malignant neoplasm of skin Primary: Malignant melanoma of skin./Secondary C43 C79.2 Stang, 2001. malignant neoplasm of skin. Primary: Malignant neoplasm of kidney, except renal C64 and C65 C79.0 Eger et al., 2004. pelvis; Malignant neoplasm of renal pelvis./Secondary malignant neoplasm of kidney and renal pelvis. Primary: Malignant neoplasm of stomach./Secondary C16 C78.8 Eger et al., 2004. malignant neoplasm of other and unspecified digestive organs. Primary: Malignant neoplasm of bladder./Secondary C67 C79.1 Eger et al., 2004. malignant neoplasm of bladder and other and unspecified urinary organs. Primary: Multiple myeloma and malignant plasma cell C90: C91; C92; C93; Eger et al., 2004. neoplasms; Lymphoid leukemia; Myeloid leukaemia; C94; C95 and C96 Monocytic leukemia; Other leukemias of specified cell type; Leukemia of unspecified cell type; Other and unspecified malignant neoplasms of lymphoid, haematopoietic and related tissue. Primary: Hodgkin's disease; Follicular [nodular] C81; C82: C83; C84 and C85 C77 Hardell et al., 2007. non -Hodgkin's lymphoma; Diffuse non -Hodgkin's lymphoma; Peripheral and cutaneous T-cell lymphomas; Other and unspecified types of non -Hodgkin's lymphoma./Secondary and unspecified malignant neoplasm of lymph nodes. Primary: Malignant neoplasm of brain./Secondary C71 C79.3 Khurana, 2008; Hardell et al., 2007; malignant neoplasm of brain and cerebral meninges. Schoemaker et al., 2005. A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx the epidemiology officers of the city, accredited by federal and local health authorities (BRAZIL, 2011). All deaths by neoplasia, based on death certificates, were provided. Then, they were re -selected according to a subset of the International Classification of Diseases (ICD) previously organized and extracted from a careful review of the scientific literature, linking cancer and non -ionizing electromagnetic radiation, as can be seen in Table 1. Out of 22,493 deaths that occurred in the analyzed period (1996 to 2006), 7191 were initially eligible for the study. The selected death by neoplasia cases were grouped according to the CT of the residences, based on the residents' postal address. The data bank of SIM did not possess the address of the persons who died by neoplasia in 1998. So, about 780 deaths that occurred in that year could not be georefer- enced. To identify the CT, the cartographic map was used, within the borders delimited by IBGE (IBGE, 2000). Fig. 5 shows the fluxogram of deaths by neoplasia in the period from 1996 to 2006. The death cases were further analyzed according to age, gender, site of residence and year of occurrence and the death rates were determined as described below. After aggregation of the deaths and BS exposure (explained below) in the CT, differing numbers of deaths were determined, depending on whether the date of first exposure was taken to be the date of the first license of the BS (7191 deaths) or the date of the register of the BS (8082 deaths). We opted to work with the date of first license; an option that makes our analysis even more conservative. 2.2.2. Base stations The BS database and their respective geographical locations were obtained from the ANATEL database (site: http:/'/www.anatel.gov.br) and were further geoprocessed according to their CT in two distinct years: 2003 and 2006. In 2003, there were approximately 474 BSs, and in 2006, there were approximately 856 in the city. Clusters (the so- called "hotspots") were the identified in each SO. This explanatory analysis was carried out through thematic maps, using the software MAPINFO m, version 7.0, and the Kernel estimator. 2.2.3. Data processing and mapping of the BSs and deaths in the Belo Horizonte municipality Eligible deaths by neoplasia were then plotted inside circles with radii varying from 100 m to 1000 m, centered at the location of the first transmitter antenna of the mobile phone network to which the resident was possibly exposed. This selection took into account the date of the death and either the date of registration or of the first Period: 1996 to 2006 1 Total amount of deaths by neoplasia: 22,493 Total amount of deaths select according to literature revision: 12,094 Deaths with positive exposure Deaths with positive exposure from register date: 8,082 from first license: 7,191 Fig. 5. Fluxogram of deaths by neoplasia in the period from 1996 to 2006. license of the given BS. To detect case conglomerates in space, the total amount (2563) of CI's and the corresponding nine DSs of the city were used again. Software was developed to calculate the shortest distance between the death and the antenna and to estimate the time of exposure of the deaths to the radiation of the antennas. 2.2.4. Death rates The mortality by neoplasia rates per CT were determined from the neoplasia diagnoses in compliance with the ICD-10 during the period of the study, using the CT as defined by IBGE for the 2000 national census as the spatial analysis unit. The deaths in every CT were used as the numerator. The temporal unit was the calendar year. The death data were then georeferenced to the address of the subject's and the IBGE census data (IBGE, 2000) for each CT. The estimated population at risk was used as the denominator. The accumulated incidence in the Belo Horizonte municipality was calculated by dividing the total amount of deaths in each region by region's entire population. 2.2.5. Estimates of the mortality rates according to distance and duration of exposure to the radiation of the BSs To understand the spatiotemporal exposure to the radiation of the BSs, the duration of possible exposure corresponding to each death was estimated, using a proxy to the subject's residential addresses, in terms of the duration of his or her exposure to the first installed transmitter antenna of the mobile phone network. To estimate the number of days of exposure, the elapsed time period from the date of installation of the first antenna to the date of the death was calculated, in spite of the exposure to the radiation of other antennas that might have been installed afterward. Some subjects may have been exposed to many antennas at different times, but in this study we considered only the date of installation of the first antenna. The delimitation of the distance intervals of the BSs was then performed. Each interval with a radius of 100 m had a BS as its center, from which the distance was increased to 1000 m. For each 100-meter interval, the deaths that occurred within the elapsed period of time, as well as the estimated population living within that radius, was then observed. To obtain the population at risk, the estimates of all of the CTs were considered, even those which were only partially included within those radii. Therefore, the population at risk was conservatively overestimated. To estimate the mortality rate within each radius, the number of deaths was divided by the estimated population included in the radius of each CT. For example, for the 100-meter radius, the 3569 deaths were divided by the 821,890 estimated exposed subjects living inside that radius. For the rates between 200 m and 1000 m, both the number of deaths and the included population were cumulatively considered. This was necessary because the subjects included in the 100-meter radius must be considered to perform the calculation inside the 200-meter radius (Fig. 6) (Table 5). 2.3. Environmental monitoring of the electromagnetic field (EMF) In 2008, one began monitoring the environmental EMF in the CT with the largest concentration of antennas in the Belo Horizonte municipality. The survey used an electric field meter and isotropic probe, with a frequency range of 0.2 MHz to 3.0 GHi; a spectrum analyzer, with a frequency range of 10.0 MHz to 6.0 GHz; a datalogging multimeter; a GPS unit and a laptop. For the field measurements, the following guidelines were observed: IEEE, 1999, 1992; NCRP, 1993; ANATEL Annex to Resolution no. 303 (ANATEL, 2000a, 2000b), and the environmental field survey of two particular nearby BSs, carried out by Dode (Dade, 2003). The analyzed frequencies of the BSs were corresponded to the bands A, B, C and D. During the measurements, stronger electric field intensities were usually found when the probe was far from the ground. Approximately 400 points in the Central -Southern 3 e •"•S'5...... .. < ,... ., � .: .. : ; .. s.... �ai:���ik.,' ski....<ae. �., �%... ,. ��4 .>E�, F.. x. . . ... . .. ... . ....a , > ..3I .. �.....,.....�., . A.0 Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx Within 100 meters = 3,569 deaths Within 200 meters = 3,569 +1.408 deaths= 4,977 deaths Within 300 meters = 4,977 + 973 deaths= 5,950 deaths Within 400 meters = 5,950 + 482 deaths= 6,432 deaths Within 500 meters = 6,432 + 292 deaths— 6,724 deaths and so on within 1000 meters Beyond 1000 meters + 147 deaths Total amount of .........= 7,191 deaths Fig. 6. Total amount of deaths by neoplasia per 100-meter distance band, in census tracts inside a radius of up to 1000 m from the mobile phone transmitter antennas, in the Belo Horizonte municipality, from 1996 to 2006. Total: 7044 deaths. region of the municipality, which were located in squares, parks, schools and households nearby BSs, were considered in the survey. 2.4. Ethical committees Because this study includes data on human beings, it was approved by the ethical committees of the Institutional Review Boards of the Federal University of Minas Gerais and the Belo Horizonte City Health Department, with the purpose of accomplishing the Resolution 196/1996 of the Brazilian Health Ministry. 3. Results 3.1. Total deaths by neoplasia selected in the period from 1996 to 2006 Fig. 7 shows the geographic location of the cases of deaths by neoplasia that were confirmed in the literature and selected according to Table 1, totaling 7191 deaths. The detailed geographic description of deaths location can be seen in Table 2. The Central -Southern SD contained the greatest absolute number of deaths, followed by the Northwestern and Eastern SDs. 3.2. Base station All registered BSs that were georeferenced through 2006 are plotted in Fig. 8. The percentage of BSs installed through December 2003 was the greatest in the Central -Southern region, comprising 38.60% (182 out of 474); until December 2006, the percentage was approximately 39.60% (338 out of 856). The BS percentage by region in the Belo Horizonte municipality in 2003 and 2006 can be seen in Fig. 9. 3.3. Data processing and mapping of the base stations and deaths in the Belo Horizonte municipality Fig. 10 portrays a sample of the georeferencing of the BSs and the deaths by neoplasia in downtown Belo Horizonte City located 7 � p a g, a�i � , ce ♦ a 5 s �C C ,�€ P,i� ; fi H, 9� �£ 'v r ` � , x \ v A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx 9 Table 2 Description of the death coding and geographic location Deaths Regions or sanitary districts codification Barreiro Central -Southern Eastern Northeastern Northwestern Northern Western Pampulha Venda Nova Total C16 83 143 132 124 183 75 125 57 89 1011 C17 2 3 4 1 3 2 4 4 0 23 C18 1 2 2 2 1 1 3 0 1 13 C19 4 8 13 9 16 2 7 1 5 65 C25 30 155 88 74 137 23 77 42 39 665 C26 4 27 17 12 17 19 23 14 14 147 C34 88 300 194 140 233 89 187 75 99 1405 C43 0 0 0 0 0 0 0 0 1 1 C50 43 210 145 68 177 23 94 35 34 829 C61 42 174 131 84 186 51 122 56 58 904 C64 17 40 28 19 28 16 20 10 11 189 C65 0 1 0 1 0 0 1 0 3 6 C67 18 51 42 28 40 10 30 21 12 252 C71 37 105 54 37 94 23 63 30 28 471 C80 36 86 71 55 83 36 61 21 34 483 C81 5 19 8 4 9 3 9 3 5 65 C83 0 2 0 0 1 0 0 0 0 3 C84 0 0 0 0 0 0 1 0 0 1 C90 11 40 39 21 41 14 33 13 16 228 C91 4 11 6 10 12 3 15 7 7 75 C92 19 62 34 24 43 13 34 14 16 259 C93 0 1 0 0 1 0 0 0 1 3 C94 0 2 0 0 0 0 0 0 0 2 C95 7 17 10 4 18 7 12 4 12 91 Total 451 1459 1018 717 1323 410 921 407 485 7191 in Central -Southern region. A given BS can have three, six, nine, twelve or more antennas, depending on the requirements in the region. To detect clusters of cases in space, the nine SDs in the Belo Horizonte and their 2563 Cfs were used as units of analysis. In Fig. 11, there are Cfs with 12, 13, 14 and even 18 deaths. Table 3 Percentage of deaths by age and gender in Belo Horizonte municipality Age Male Female Deaths total Percentage% 00-04 10 16 26 0.36 05-09 13 10 23 0.32 10-14 12 8 20 0.28 15-19 11 8 19 0.26 20-29 34 34 68 0.95 30-39 80 120 200 2.78 40-49 247 322 569 7.91 50-59 535 559 1,094 15.21 60-69 920 686 1,606 22.33 70-79 1,217 797 2,014 28.00 80-89 708 550 1,258 17.49 90-99 136 158 294 4.08 TOTAL 3,923 3,268 7,191 Table 4 Accumulated incidence rate of all deaths in the Belo Horizonte municipality. Regions or sanitary Population Death number Accumulated incidence districts rate/1000 Centro -Sul 249,862 1459 5.83 Leste 251,118 1018 4.05 Noroeste 338,753 1323 3.90 Pampulha 106,330 407 3.82 Oeste 249,059 921 3.69 Nordeste 248,406 717 2.88 Norte 153821 410 2.66 Venda Nova 198:475 485 2.44 Barreiro 219,873 451 2.05 TOTAL 2,015,697 7191 3.4. Death rate The percentage of deaths by neoplasia per year in the Belo Horizonte municipality from 1996 to 2006, considering the start of exposure to be the date of the first license, is shown in Fig. 12. The accumulated incidence rate per 1000 residents for each SD is shown in Table 4. Again the Central -Southern SD presented the highest accumulated incidence rate, i.e., 5.83 incidents per 1000 inhabitants and the lowest rate was 2.05 incidents per 1000 inhabitants in the Barreiro SD. The same trend was observed for both women and men with similar profiles during the studied years. As expected the incidence of death of women and men was higher in those older than 40, and in this group, the number of deaths was 3923 for men and 3268 for women. After the age of 40, the death rate (7.91%) grew for both sexes, as shown in Table 3. After the age of 60, the rate was even higher (22.33%). Supplementary Graphics 1 shows the rate of death by neoplasia, according to ICD classification. The most significant causes were malignant neoplasm of bronchus and lung (C34), 19.55%; malignant neoplasm of stomach (Cl 6), 14.05%; malignant neoplasm of prostrate Table 5 Mortality rates by neoplasia in the Belo Horizonte municipality, according to distance from the BS. Distance (meters) Deaths total Population total Mortality rate/ 10,000 Relative risk Until100 3569 821,890 43.42 1.35 Until200 4977 1,237,368 40.22 1.25 Until300 5950 1,602,869 37.12 1.15 Until400 6432 1,796,604 35.80 1.11 Until500 6724 1,934,032 34.76 1.08 Until600 6869 2,030,093 33.83 1.05 Until700 6947 2,055,325 33.80 1.05 Until800 6989 2,086,712 33.49 1.04 Until900 7000 2,107,277 33.21 1.03 Until 1000 7044 2,148,327 32.78 1.00 Null hypothesis 7,191 2,238,332 32.12 1.00 10 AC Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx VENDA �°p•� �Cio o�°o •°'I:a v � Sao A °E ° W 80 o o Qei o e om m ®e ° 0 • g °•cp e NORTE ,800° oy re 0�.0° 1°8 B I. o _6 °e o•. •o°PA MPULHA •o° mom' fe�F do •�' • oWl p o• t� ••dii �ONOR�OE o i�! oo °- NQRDE-STE 0 � a�°$ �g��tl' �: ° � � � moo•° s • ° • a ; °� �°' a °110 ,�,g• o� ab �d � o•m •mo � m°A°i�&°� °pa ° �� �BARI2EI°RO � am Classification ICD - Total C16 (1011) ® C17 (23 ■ C18 (13 C19 (65 C25 (665) C26 147 ■ C34 (1405) El C43 (1) ■ C50 829 0 C61 904 ■ C64 189 C65 (6) O C67 252 0 C71 �471 ❑ C80 483 C81 (65 ■ C83 (3 ❑ C84 1 C90 (228) ■ C91 (75) C92 (259) 0 C93 (3) ® C94 2 C95 (91) Fig. 7. Map of the total deaths by neoplasia in the Belo Horizonte municipality from 1996 to 2006, classified according to ICD. Total: 7191 deaths. (C61), 12.57%; and malignant neoplasm of breast (C50), 11.53%. The largest absolute number of deaths was found in the Central -Southern region, followed by the Northwestern region. Also, the highest absolute numbers of lung cancer deaths (300 cases) and breast cancer deaths (210 cases) were found in Central -Southern SD (Table 2). The proportional mortality by gender can be seen in Figs. 13 and 14. 3.5. Estimates of the mortality rates by distance and time of exposure to BS The mortality rates were estimated by correcting the population mortality by 10,000, according to the radius of distance from the BS within 1000 m. In the region within 100 m, the absolute number of deaths was 3569 (a percentage of 49.63%), and the mortality rate was 43.42 persons per 10,000 inhabitants. Compared to with the total population mortality rate, the relative risk in this area was 1.35. In the area up to 200 m there was a growth of 1408 deaths, a total of 4977 deaths, a mortality rate of 40.22 persons per 10,000 inhabitants and a relative risk of 1.25 (Table 5). In this way, the estimates of mortality by neoplasia were calculated inside radii up to 1000 m from the BSs. The relative risks presented a decreased dose —response gradient with residents' distance from the first licensed BSs. Fig. 15 shows the mortality rate by neoplasia according to the distance from the BS in the Belo Horizonte municipality, during the studied period. The accumulated mortality rates by neoplasia, ,�•� 11 ' �� r ���� ��' :,r � '<. � � £ � ��,�.Y i,. �� A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx 11 * * * fz YF:NaA NOVA Nanra * * * * pANVU A * * * No`1AMM * * 'lioNocsrc * * *�s5rL * A *W * ** Y4* * * * C� �crowal. Fig. 8. Installed BSs in the Belo Horizonte municipality until 2006. Total amount=856. determined by dividing the total number of deaths during the period 400 points were measured in the Central -Southern region in 2008, (n = 7191) by the total population living in the municipality where a major concentration of cellular telephony antennas was found. (2,238,332), showed that there was a risk of dying of 32.12 per 10,000 The mean intensity of the measured electric field was 7.32 V/m, varying inhabitants, as seen in Fig.15. In this study, this figure represents the null from 0.4 to 12.4 V/m. It was common to find a stronger electric field at hypothesis, i.e., the total number of deaths occurring in the period locations above the ground. The BS frequency bands ranged from divided by the population, independent of the proximity to the BSs. approximately 800 MHz to 1800 MHz. In 2003, the power density Fig. 16 shows the distribution of the number of deaths by neoplasia varied from 0.898 11W/cm2 to 3.066 µW/cmZ- versus duration of exposure since the date of operation of the first antenna in each analyzed CT. 4. Discussion 3.6. Environmental monitoring of the electromagnetic field Electric and EMFs interact with biological systems because they penetrate into organs and tissues, and the biological systems are ruled by The EMF results provided essential information for the assessment of delicate bioelectrochemical reactions that sustain the vital processes and risks to the health of the exposed persons in the community. A total of receive the influence from those fields. As demonstrated in the literature 12 A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx Pampulha Western Center - Southern Northwestern Barreiro Northeastern Venda Nova Eastern Northern 0% 5 % 10 % 15% 20% 25% 30 % 35% 40% 45% Percentage of installed Base Stations ■ 2006 El 2003 Fig. 9. BS percentage by Sanitary Districts in the Belo Horizonte municipality in 2003 and in 2006. (Kundi and Huffer, 2009; Sage and Carpenter, 2009; Khurana, 2008; BIOINITIATIVE REPORT, 2007; Cherry, 2006; Cherry, 2007; Hardell and Sage, 2007), exposure to electromagnetic radiation of low intensities for long periods of time is a determinant for the aggravation and the emergence of diseases in humans. Studies point to observations of environmental carcinogens as an alert to the scientific community (Hardell et al., 2007). Bioeffects and adverse health effects occur at frequencies much lower than RF and extremely low frequencies (ELF), without any heating effect. Khurana et al. (2010) identified by searching PubMed ten epidemi- ological studies that indicate the occurrence of neurobehavioral effects or cancer. In eight of those studies, the population lived within 500 m of a BS. However, all exposures were under the accepted international guidelines. Therefore, it is suggested that those guidelines may be inadequate in protecting the health of human populations. Additionally, more compre- hensive epidemiological studies are necessary to evaluate long-term exposure to RF from mobile phones BSs to understand its health impact. This research bases on the ecological study that uses geographical areas as units of pre-existing data to identify areas of risk. The data is already aggregated, and one does not know about the genetic characteristics, life habits, food choices and other factors of each individual. The ecological studies frequently begin the epidemiological process, and the discoveries are considered to be an alert. In the Belo Horizonte municipality, the mortality rate was concentrated near the antennas and was not diffuse over the whole city. At a distance of up to 100 m, the absolute number of deaths was 3569, 49.63% of all deaths, the mortality rate was 43.42 persons per 10,000 and the relative risk was 1.35. When one does not consider the distances from the BSs for all the entire population of the Belo Horizonte municipality (2,238,332 inhabitants), the mortality rate was 32.12 per 10,000 inhabitants, which is the null hypothesis. In this research, we found a mortality rate for the residents living within 500 m of the transmitter antennas of a BS greater than 34.76 per 10,000 inhabitants. This rate decreased for residents living farther from the BS, as shown in Fig. 15. We concluded that the relative risk of death by neoplasia, according to the distance from a BS in the Belo Horizonte municipality, from 1996 to 2006, was greater within a radius of up to 500 m from the BSs (Table 5). In the town of Netanya, Israel, in 2004, the authors also found an increase of 4.15 times in the cancer incidence of the residents of a zone up to 350 m from the BS, compared to those who lived outside that area (Wolf and Wolf, 2004). A retrospective study in Naila, Germany, showed that the risk of new cancer cases was three times greater among the patients who had lived at a distance less than 400 m from a cellular telephone transmitter antenna during the last ten years (1994 and 2004), compared to those who lived at greater distances (Eger et al., 2004). In addition, only the deaths of those who were exposed since the first license date of the BS were included in the study, even though there were antennas that were installed in the register date (before the licensing date). Also, we observed that the Central -Southern SD possessed the greatest antenna concentration in the city and the most electromagnetic contamination. This region contained 38.60%of the installed antennas in 2003 and 39.60%in 2006. Again, through georeferencing, we observed a greater concentration of specific cases of death by neoplasia in the region. The accumulated incidence rate per 1000 residents was the largest in Central -Southern SD, reaching 5.83; this rate was the lowest (2.05) in Barreiro region. In the Central -Southern SD, there are no factories; it is a strictly residential area, with some services and commerce. No power lines, highways, airports or railroads exist in the area. However, many private vehicles come and go in the region, and its inhabitants possess higher social status and affluence. It contains many wooded streets and gardens. The Central -Southern SD has other aggravating exposures, including noise, gases, fumes, aerodispersoids, and hydrocarbonates, each of which also damage human health. Despite the presence of diverse and aggressive potential agents that may have influenced the quality of life and the health of the dwellers living in the area, the mortality rates remained concentrated near the antennas, with a dose — response gradient, and were not diffuse all over the city. Age and sex did not appear to be a confounder in this study. In Belo Horizonte municipality, like all of Brazil, the population suffers from a demographic transition characterized by the aging of the population, and this is a possible confounder for all chronic degenerative diseases. Looking at the profile of the proportional mortality by age and gender throughout the 10 years studied, there is no specific trend for either men or women, and the highest percentage started at age 40 and increased to age 60. Irrespective of the year, the proportional mortality by gender and age remained stable during the period, suggesting there is no relevant change in the proportion of deaths by cancer when age is taken into consideration. According to the ICNIRP guidelines, the human levels to the public at large (ICNIRP, 1998), for the frequency (f) band ranged from 400 to 2000 MHz, the electric field intensity E (V.m-1) equals 1.375 f 11 V/m, which equals 1.375 -Jf V/m. These values are according to the reference level patterns for the public at large when compared with the current Brazilian federal law which establishes the following limits: for a 900 MHz field intensity an electric field of 41.25 V/m and a power density of451.34 µW/cm2, fora 1800 MHz field intensity an electric field of 58.33 V/m and a power density of 902A9 µW/cm2. These human exposure limits are exclusively based on thermal effects. go", -AS ,11,�NM A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx t �O P� APE A Q� l ,r _- — f,Y 6 �O S LrR v P, 4A��O- PO/�OF'RR RUgQ� a SOON y m `DOS-- S P �pp DRU `,. g�Pj -_gt '0 9 �-P AN� BASA S ai '1> ar _ , o c DOsb 01 7, A h' `` c tUAIP e p a O R" A Sri ees` fr��Cqq-yrt`�,��� q 'P�LPy K NO MUNICIPAL 2PARQUE ReAp AC' r _p �: aRtrgRO. J5027� ¢ - A(iODs ✓ ! FG'�Fy \ INECK F 9 r(� O S ,zmO P 9 p � AV q B 10 5 ' 1, - D O N Al AVF - � � m P�� - Rpq 0 s u yt z T"WAL /o tr e O,' O /�_ J \� �'A C - AQ �QGU O ,,�4•'�'. J ,. ,OO -� Jam: _ RU W a4 a p TO O �� ASS ��� O - � �O _ U / tI/ C(qU^•P � a4�';� �D'.�,�DIAS O & _�A gF p p -AP, , - ID7gNOF �' .��•� GON I A FS tA ue Fe F C>; RIB n + DealhS !;' E t Anlenn" S j ry u Quartets Fig. 10. Sample of geocoded deaths and BS locations in downtown Belo Horizonte City located in Central -Southern region 13 a 14 A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx—xxx Fig. 11. Map of 7191 cancer deaths geocoded by Cr. In 2003, the largest electric field found during environmen- tal monitoring of the BSs was 3.4 V/m and the greatest power density was 3.06 µW/cmZ. In 2008, the largest electric field found during environmental monitoring of the BSs was 12.4 V/m, and the greatest power density was 40.78 µW/cmZ near the cellular antennas in the 890 to 1800 MHz frequency band. These values were much larger than those reported in the Netanya study (approximately 0.53 µW/cmZ). The smallest values found in the measurements were a field intensity of 0.4 V/m and a power density of 0.04 µW/cmZ. A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx 15 C a 25% 20% 15°% 10% 5% 0% 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 ® 15� license Fig. 12. Percentage of neoplasia deaths per year in the Belo Horizonte municipality, from 1996 to 2006, using the first license date. Proportional mortality by year for females 80,00 60,00 , 40,00 s. 20,00 1999 2000 2001 2002 2003 2004 2005 2006 0 to 29 ■ 30 to 59 0 Over 60 years old Fig. 13. Proportional mortality by year for females. The major advantage of this ecological study is that it is the first epidemiological approach to determine the existence of a possible association between a determined exposure and a health outcome using the group characteristics. The principal limitations of the present study concern the study design and the use of secondary data. By design, the group results could not be extrapolated to each person in the population. Although the data were well standardized and collected from official personnel in the City Health Department, they are subject to misclassification due to lack of information and errors in the entering of data and diagnosis. Finally, neither the life habits nor the genetic factors of the residents could be taken into account. Despite these limitations, the present study has brought important contributions to the issue, the most important of which is the existence of a cluster of deaths by neoplasia associated with BS clusters. Although the direction of this relationship could not be specified, this work has demonstrated the existence of such clusters. Until more extensive studies are conducted, we urge the adoption of the Precautionary Principle and a revision of national policies toward stronger restrictions of the human limits associated with this Proportional mortality by year for males 80,00 — --- 60,00 E?i$_ 40,00 «. r 1999 2000 2001 2002 2003 2004 2005 2006 0 to 29 ■ 30 to 59 r Over 60 years old Fig. 14. Proportional mortality by year for males. technology. The adoption of EMF and radiation levels similar to the more restrictive exposure limits of many other countries and towns would be one important public health provision. On this matter, we refer to the Porto Alegre Resolution. The Precautionary Principle states that when there are signs of possible adverse effects to health or to the environment, although uncertain, the risks of inaction can be greater than the risks of acting, especially in relation to the control of human exposures to non - ionizing radiation. The Precautionary Principle reverses the burden of proof from those who suspect a risk on those who take the actions and affirm that only when new scientific discoveries will be recognized as the unique criterion to establish or to change guidelines. The principle asserts that precaution be maintained until new proven researches be done. From May 18th to 19th, 2009. in Porto Alegre City, Rio Grande do Sul State, Brazil, occurred The International NIR (Non -Ionizing Radiation) and Health Workshop ("Seminario Internacional sobre RNI, a Saude e o Ambiente"), sponsored by the Federal University of Rio Grande do Sul. The purpose of the workshop was to present lectures as a basis to initiate discussions among Brazilian and foreign scientists and public health authorities on the potential biological and health consequences and the setting of exposure limits of non - ionizing electromagnetic fields/radiation (NIR). The workshop also was under the sponsorship of the Brazilian Ministry of Health, as well as some other governmental and non- 0 so C 0 T 45 o. 40 0 0 E 35 0 d m 30 until until until until until until until until until until 100 200 300 400 500 600 700 800 900 1.000 Distance from BS — Rate of mortality by neoplasia, according to the distance from BS — Null hypothesis Fig. 15. Rate of mortality by neoplasia, according to the distance from the BS in Belo Horizonte municipality, from 1996 to 2006, and the null hypothesis. ^�,, �, 7,� @` a� <:y ` E 'a. £ N ;; y .rye �'h i �� s _. �'� .,, w n •.z,;�•� � u �.^..�: ,, • k .. > � a � • ,� �� �� ><. � '`•'�.�i` ,�.�, �: <p� r°�'.•• .: ; "fir ..s>::3; f: „ , .w. ,s .. £r . E�� ,.N .33M. 3Ci,,.�`,. "u�`3#'�.`A C...£Rb1`s.5,r... `e ,., 3fi�i�,.:,...,sa .�'�: 1`.. .: .. aL`3 h � ;`,oX',^\' ,,. • ... " � r, A 16 A.C. Dode et al. / Science of the Total Environment xxx (2011) xxx-xxx Number of 2000 1800 deaths by 1600 neoplasia 1400 1200 1000 800 600 400 200 1929 0 <1 1<2 2<3 3<4 4<5 5<6 6<7 7<8 8<9 9<10 Years Fig. 16. Distribution of the number of deaths by neoplasia versus duration of exposure since the date that the first antenna in each analyzed CT came into operation. governmental organizations. International researchers from several countries delivered talks on selected subjects. Researchers, public health authorities, as well as authorities from the legislative, executive and judiciary governmental bodies from Brazil and other South American countries were also present. Site: www.ufrgs.br;'ppgee/rni.htm After the event, the Porto Alegre Resolution was approved by the scientists from many countries and participants who have understood that the health protection, the well-being and the environment require the immediate adoption of the Precautionary Principle and some precautionary practices. Site: http:/,-www.items.eu/dotslresolutions/Poi,to_Alegre_Resolution. pdf 5. Conclusion This research showed the existence of a spatial correlation between cases of death by neoplasia and the locations of the BSs, in the Belo Horizonte municipality from 1996 to 2006. The mortality rates and the relative risk were higher for the residents inside a radius of 500 m from the BS, compared to the average mortality rate of the entire city, and a decreased dose — response gradient was observed for residents who lived farther away from the BS. The major antenna concentration was located in the Central -Southern SD of the city, which also had the largest accumulated incidence (5.83/1000 inhabitants). The measured values of the EMF, determined in 2008 and 2003, were substantially below the values allowed by the Brazilian federal law nr. 11934, May 5, 2009. Nevertheless, the values encountered in this study surpassed the limits of human exposure adopted by many other countries and cities in the world, including Italy (10 µW/cm2); China (6.6 µW/cm2); Switzerland (4.2 µW/cm2); Paris, France (1 µW/cm2); Salzburg, Austria (0.1 µW/cm2); and Porto Alegre, Brazil (4.2 µW/cm2). 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From Study: Dode AC, et al, Mortality by neoplasia and cellular telephone base stations in the Belo Horizonte municipality, Minas Gerais state, Brazil, Sci Total Environ (2011) http://dx.doi.org/l 01016/i.scitotenv.2011.05.051 Table 5 Mortality rates by neoplasia in the Belo Horizonte municipality, according to distance from the BS. Distance Deaths Population Mortality rater Relative (meters) total total 10.000 risk Until100 3569 821.890 43.42 1.35 Until 200 4977 1,237,368 40.22 1.25 Until300 5950 1,602,869 37.12 1.15 Until400 6432 1,796,604 35.80 1.11 Until500 6724 1,934,032 34.76 1.08 Until600 6869 2,030,093 33.83 1.05 Until700 6947 2,055,325 33.80 1.05 Until800 6989 2.086,712 33.49 1.04 Until 900 7000 2,107,277 33.21 1.03 Until 1000 7044 2,148.327 32.78 1.00 Null hypothesis 7, 191 2,238,332 32.12 1.00 Notes: "Until 200" means the area from 100 to 200 meters. "BS" means Base Station or Cell Tower Neoplasia is abnormal cell growth that can lead to cancer and death