cellphones and the risk of cancer: new insights

Young mother speaking at her mobile phone, downtown
Hell Ville, Nosy Be Island, Madagascar

There is an increasing concern in the media in 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 and needs to be revised.  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 iPhone 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 her 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 cellphone. The young mother in the above shown photograph 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 cellphones are widespread among local people. Is the cellular phone lacking technologies to reduce exposure do microwave emissions an additional danger the developed countries are exporting to the low-income developing world ?.

Evita and the pap smear

 

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. It was first interpreted as an appendiceal carcinoma but  one year later she underwent 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.

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 yet in the late 1940ies otherwise Evita could have ben saved!

Dr. G. Papanicolaou

How many women are currently, 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?

In other posts I have been talking about the differences in rankings between developed and developing 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 lifestyles—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. Where treatment is largely unavailable, all cancers have a poor prognosis, but in this group, all but cervical cancer have poor outcomes everywhere. The mix of common cancers varies  as seen in the following table (source: Cancer Control Opportunities in Low- and Middle-Income Countries, see website link in the list).

 

In developed countries the incidence of tumors of the breast, colon, lung and corpus uteri is higher than in developing countries, with a ratio, respectively, of 1.23/1; 1.95/1; 1.02/1; and 2.19/1. The mortality of these tumors, however, is lower than in developing countries: breast 29.8% vs 42.8%; colon 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 caused by a 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. Due to these factors at least for breast cancer and lung cancer the number of people dying of these tumors in developing countries is likely to be higher than 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 (stomach and esophagus) 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 most of the people dying for cancer were suffering from preventable or somewhat 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.

Patterns of cancer in developed and developing countries

In other posts I have been talking about the differences in rankings between developed and developing 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 lifestyles—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. Where treatment is largely unavailable, all cancers have a poor prognosis, but in this group, all but cervical cancer have poor outcomes everywhere. The mix of common cancers varies  as seen in the following table (source: Cancer Control Opportunities in Low- and Middle-Income Countries, see website link 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 developing countries, with a ratio, respectively, of 1.23/1; 1.95/1; 1.02/1; and 2.19/1. The mortality of these tumors, however, is lower than in developing countries: breast 29.8% vs 42.8%; colon 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 caused by a 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. Due to these factors at least for breast cancer and lung cancer the number of people dying of these tumors in developing countries is likely to be higher than in the developed world.

 In developing or low-income 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 (stomach and esophagus) 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 most of the people dying for cancer were suffering from preventable or somewhat 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.

malagasy children

This post is inspired by what we recall of the malagasy people we happened to see and meet 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, may be 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.

This post is dedicated to what we recall of malagasy people we happened to see and meet while traveling by car in the roads of Nosy be or the sand pathways in the isle 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, may be 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. 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.

how large is africa?

Just few words to focus on this stunning eye-opening image I found on the GOOD BLOG (see under the list of blogs on the right column). Its author is Karl Krause. The image really puts the size of Africa into a whole new perspective. Its size is big enough to fit the United States, China, and much of Europe within its borders. Madagascar is as large as UK and Ireland combined. Its author is Karl Krause. The image really puts the size of Africa into a whole new perspective. Its size is big enough to fit the United States, China, and much of Europe within its borders. Madagascar is as large as UK and Ireland combined. Click on it to see it in larger size. This just reminds us of how important it is to think about the millions of poor people who live there and the number of people in Africa who don't have access to many "simple" things such as, for example, safe drinking water and health facilities

Medical expedition to Sakatia and Nosy Be islands: a preliminary report

This is the story of an expedition performed recently by three medical doctors including me, two anatomic pathologists and one general surgeon, supported by a young medical student, all from Milan, Italy, and volounteers of the Change onlus humanitarian organization, to the islands of Nosy Be and Sakatia in the northwestern part of Madagascar.
The aim of the mission was to test the incidence of pap-smear cytological abnormalities in a restricted female population which had never been screened before for cervical cancer and is at a presumed high risk of developing this malignancy.

We brought from Milan all the stuff which is required to collect, smear, and stain cytological samples including a light microscope for immediate on site interpretation. Our goal was to work together with a team approach trying to conclude the procedure of screening, including the release of all cytological reports, on a same-day basis.

Fig 1

Women had been invited in advance to be present for a clinical evaluation and pap smear sample collection in the days of September 14th, and 15th, 2010, at the Dispensaire of Sakatia (Fig 1), a first level health facility recently built up by Change onlus organization in that small island at just a 20 minutes boat ride from Nosy Be, and on September 16th, at the Infirmary facility of the Pecherie factory in Nosy Be island (see Fig. 2).

Fig 2

Fifty two women were seen in Sakatia and 42 women in the Pecherie Infirmary. The age ranged between16 to 57. Most of them were multiparous. After filling a questionnaire and providing her precise patient demographics, each woman had pelvic examination and pap smear sampling done. Smears were stained manually within two hours according to the Papanicolaou method (Figs 3 and 4).

Fig 3

Fig 4
Fig 5

Smears were then rapidly interpreted on site; the pathological report was generated according to the terminology of the 2001 edition of Bethesda System, using a portable personal computer.

Women’s attitude to the gynecological examination was very good and they reacted enthusiastically to our initiative. Fig 6 shows a group of them chatting outside the Sakatia Dispensaire and waiting for their turn.

Fig 6

Results

Diagnosis (Bethesda)	Pecherie	Sakatia	Further work-up
HSIL	1	1	Colp+bp
AGC-neo	1	1	Colp+bp
LSIL	2	2	Colp+bp
ASCUS-HPV	1	3	Colp+ bp+ HPV test
ASCUS		1	P-smear repeat

Legend to the figure: colp = colposcopy; bp = biopsy; P= pap.

HSILs were detected in two women aged respectively 27 and 37, while the women diagnosed as having AGC-neo lesions were 43 and 47 years’ old. The incidence of High grade (HSIL and AGC-neo) and Low grade (LSIL, ASCUS-HPV, and ASCUS) lesions cumulatively reached values which are rather high according to WHO’s estimates (see “Comprehensive Cervical Cancer Control. A guide to essential practice”, p. 40, World Health Organization, 2006) for previously unscreened population (see the following table)

SIL	Pecherie	Sakatia	WHO
High Grade	2 (4,76%)	2 (3,84%)	1-5%
Low Grade	3 (6,97%)	5 (9,61%)	3-10%

The 11 women who are candidates to further examination will be examined in November 2010 by a Gynecologist and colposcopist and the results of further tests, including biopsy and viral molecular tests, will be immediately reported on this blog.

Conclusion

Although the number of cases described in this report is fairly small, it is quite evident that women in Madagascar urgently need to be screened for uterine cervical cancer. Our effort will continue and we strongly hope that, under our guide and supervision, in few years the whole female population of the Nosy Be Island will be screened on the basis of a well organized plan and under the support of local Health authorities. We are deeply convinced that before starting to educate local health personnel and medical Doctors to the need of a well planned screening programme, and before teaching them to do theirselves, it is important to work hard locally as actively as possible to show the real advantages of it. In other words we still need to persuade them to the necessity of performing such screening procedure before trying to teach them how to do it. Our operative approach, consisting of a multidisciplinary team of physicians who intensively concentrated their efforts in few days, seems to be the best way to obtain such a result. In future expeditions also a Gynecologist will take part of the team with significant advantages in terms of speed of diagnosis and treatment. Doing first is, at least in this setting, much better than teaching first.

The Team.

From left to right: Stefania Rossi, MD and MIAC, Anatomic Pathologist, San Paolo University Hospital, Milano; Sofia Bronzato, intern Medical Student at the San Raffaele University Hospital, Milano; Adolf, the local Nurse on duty of the Dispensaire of Sakatia; Franco Silva MD, General Surgeon and Interventional Radiologist, Fatebenefratelli Hospital, Milano; Liza, Translator and patient herself; Giorgio Gherardi, MD, Anatomic Pathologist and Head of Pathology, Fatebenefratelli Hospital, Milano, Italy. Photographs by Andrea Gherardi: website and blog

future cancer epidemic in africa

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Cancer of the cervix uteri, a preventable tumor

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territory of nosy be

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la città futura, le ombre, i progetti, le speranze