|Year : 2016 | Volume
| Issue : 2 | Page : 111-118
Prevalence of risk factors including cell phone use among patients with brain tumors
Yosria A Al Taweel1, Amr E Kamel1, Alaa A. M. Abd El Ghany1, Rania S Nageeb1, Sarah A Bolbol2, Momen I. R. Elsayed3
1 Department of Neurology, Zagazig University, Zagazig, Egypt
2 Department of Community, Environmental and Occupational Medicine, Zagazig University, Zagazig, Egypt
3 Department of Neurosurgery, Zagazig University, Zagazig, Egypt
|Date of Submission||21-Jan-2016|
|Date of Acceptance||10-Oct-2016|
|Date of Web Publication||2-Jun-2016|
Rania S Nageeb
MD, Department of Neurology, Zagazig University, Zagazig
Source of Support: None, Conflict of Interest: None
Central nervous system tumors represent a major public health problem as they bear unfavorable clinical prognosis merely by their localization. Epidemiological data of central nervous system tumors in Egypt have been rather incomplete, although there are some regional reports.
The aim of this study was to investigate the relationship between suspected risk factors including cell phone use and primary brain tumors.
Patients and methods
This study included 100 patients with a settled diagnosis of primary brain tumors and 100 controls. They were subjected to the following: detailed medical and neurological history taking with special emphasis on risk factors that are common with primary brain tumor. Data were obtained by means of personal interviews, designed to take full data about the suspected risk factors. Thorough general and neurological examination was carried out. All patients were investigated using routine laboratory investigations and MRI of the brain. Histopathological studies were carried out to confirm the nature of brain tumors. Patients with metastatic brain tumor and/or cancer outside the brain were excluded.
Our study showed that urban residence was more prevalent in the patient group. Meningioma was higher among female patients, whereas other types of primary brain tumors were higher among male patients. Risk for primary brain tumors was significantly higher among patients with ipsilateral regular cell phone use of more than 10 years. The risk significantly increased in astrocytic tumors in relation to meningioma and other types of primary brain tumors.
Significant risk factors for primary brain tumors in our study were urban residence, female sex in meningioma, and ipsilateral regular cell phone use more than 10 years.
Keywords: Brain tumors, cell phone, risk factors
|How to cite this article:|
Al Taweel YA, Kamel AE, Abd El Ghany AA, Nageeb RS, Bolbol SA, Elsayed MI. Prevalence of risk factors including cell phone use among patients with brain tumors. Egypt J Neurol Psychiatry Neurosurg 2016;53:111-8
|How to cite this URL:|
Al Taweel YA, Kamel AE, Abd El Ghany AA, Nageeb RS, Bolbol SA, Elsayed MI. Prevalence of risk factors including cell phone use among patients with brain tumors. Egypt J Neurol Psychiatry Neurosurg [serial online] 2016 [cited 2021 Apr 23];53:111-8. Available from: http://www.ejnpn.eg.net/text.asp?2016/53/2/111/183447
| Introduction|| |
Brain tumor is the growth of abnormal cells in the tissues of the brain. It can be benign or malignant . Central nervous system (CNS) tumors constitute 1-2% of all human neoplasms. In an epidemiological study conducted in the Egyptian National Cancer Institute, CNS neoplasms constituted about 3% of primary malignant tumors. They are responsible for about 18% of malignant tumors . CNS tumors account for 2.1% of all cancer deaths worldwide. It is accepted that some of the increase in its incidence was not real but a result of advances in neuroimaging, better registration of nonmalignant CNS tumors, greater availability of neurologists, and attitude change in the delivery of healthcare to the elderly .
Many factors, exogenous and endogenous, have been suspected of playing a role in the development of CNS tumors .
| Aim of the work|| |
Our study was conducted to study the relation between suspected risk factors including cell phone use and brain tumors, to pave the way for strategic planning for designing a prophylactic protocol against brain tumors.
| Patients and methods|| |
This study was conducted in Zagazig University Hospitals, Egypt, during the period from June 2011 to November 2014. Two groups were recruited for the study: the patient group, which included 100 patients with a settled diagnosis of primary brain tumors selected from Neurology and Neurosurgery departments (42 female and 58 male, with an age range of 4-69 years; median = 39 years); and the control group, which included 100 age-matched and sex-matched tumor-free healthy individuals between 4 and 71 years of age (median = 40 years) (40 female and 60 male) selected from staff members of the hospital (medical and nonmedical) and visitors of the patients. Informed consent was obtained from the patients or their relatives for participation in the study. In addition, consent was obtained from the control group. The study was approved by the Institutional Ethical Committee of Faculty of Medicine, Zagazig University, Egypt. Patients with metastatic brain tumor and/or cancer in any other organ system were excluded.
Patients and controls were subjected to detailed medical and neurological history taking with special emphasis on risk factors that are common with primary brain tumor. Data were obtained by means of personal interviews that were designed from different questionnaires to obtain full data about the suspected risk factors. Thorough general and neurological examination was carried out. All patients were subjected to routine laboratory investigations and MRI of the brain. Histopathological studies were performed to confirm the nature of brain tumors.
The data were collected, tabulated, plotted in graphs, and statistically analyzed using statistical package of social science, version 14.0.0 software package (SPSS programming and Data Management: A Guide for SPSS and SAS Users, 4 th Edition, SPSS Inc., Chicago Ill) (Levesque, 2007). The results of both groups were presented and analyzed statistically using Student's t-test to compare means of the two groups. Pearson's χ2 -test was used to compare distribution (proportion) of the two groups and the multivariate logistic regression to assess risk factors by priority. A P value of 0.05 or less was considered statistically significant.
| Results|| |
The sociodemographic characters of the study population is shown in [Table 1]. Brain tumors were more prevalent among patients of urban residence compared with controls (P < 0.001).
|Table 1: Sociodemographic characteristics of primary brain tumor patients and controls|
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We found no statistically significant difference between patients and controls with regard to perinatal history, family history of cancer, smoking status, alcohol consumption, diet intake, BMI, occupation, exposure to pesticide, head trauma, medications, and exposure to radiation [Table 2] and [Table 3].
Authors of this study found that primary brain tumors have many risk factors that have significant influence on its occurrence. The risk for primary brain tumors was significantly higher among patients with regular cell phone use of more than 10 years (P = 0.034) and ipsilateral phone use (P = 0.041) [Table 3] and [Table 4]. Moreover, these risk factors include the influence of male sex on all primary brain tumors occurrence except in meningioma, where female sex was predominant (P < 0.001) [Table 5]. The risk for primary brain tumors significantly increased with higher cell phone use scale, being higher in astrocytic tumors (P = 0.006) in relation to meningioma and other types of primary brain tumors [Table 6]. The social risk perception is significantly higher among patients compared with radiation and driving risks (P < 0.001) [Table 7].
|Table 2: Comparing different risk factors for primary brain tumors in patients versus controls|
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|Table 3: Comparison of exposure to radiation and cell phone use (as risk factors for primary brain tumors) in patients and controls|
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|Table 4: Comparison between the patient group and the control group as regards cell phone exposure|
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|Table 5: Relation between sociodemographic characteristics and different primary brain tumors|
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|Table 6: Relation between cell phone exposure and different primary brain tumors|
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|Table 7: Risk perception among patients based on the types of risks related to cell phone use|
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| Discussion|| |
In meningioma, female sex was predominant and this is in agreement with the study by El-Gaidi and colleagues ,.
As regards perinatal history of drug intake, radiation exposure, miscarriage, pesticide exposure, smoking, alcohol intake, history of congenital malformations, baby birth order, gestational age, baby weight, paternal and maternal age, and breast feeding, that there was no statistically significant influence between the patient and the control group. This is in agreement with the findings of Brandes and colleagues ,,,.
In contrast to our results, Bunin et al.  reported an increased risk for primitive neuroectodermal tumor among individuals exposed to beer. Stalberg et al.  reported that a tendency of protective effect was seen for prenatal exposure to folic acid, and an increased risk for brain tumor in children exposed to β-blocking agents during fetal life. However, because of the low number of exposures the interpretation of this finding should be made with caution.
Most of our primary brain tumor patients were illiterate (26%), with no statistically significant association with brain tumors. Most of our primary brain tumor patients were of low socioeconomic status (50%); it was not statistically significant as a risk for brain tumors. This finding is in accordance with the findings of Blettner et al.  and Samkange-Zeeb et al. .
Brain tumors were more prevalent in patients with a family history of cancer in the current study, and the difference was not statistically significant. Bondy et al.  and Brandes et al.  mentioned that the familial aggregation of brain tumors is of genetic origin. Familial aggregation of gliomas has been reported in 5% of cases.
In our study, the brain tumors were more prevalent in patients of urban residence compared with rural residence, and the difference was statistically significant. The same finding was reported by Dey et al. . This is in disagreement with the study by Graham , who mentioned that rural residence has been shown to be associated with increased risk for glioma. This has been hypothesized to be related to agricultural exposures (e.g. zoonotic virus and pesticide). Schlehofer et al.  found that most acoustic neuroma patients were residing in rural areas (75%).
There was no statistically significant association with smoking; this is in accordance with the study by Samkange-Zeeb et al.  and Braganza et al. . However, Hu et al.  reported a highly significant increase in the risk for meningioma in female smokers. As regards alcohol consumption, we did not find any significant association. Similar finding was reported by Braganza et al. .
Authors of the present study did not find any significant difference in the type of diet intake between patients and controls. This is in accordance with the findings of Terry et al. . Terry et al.  found that there was no association between adult brain tumor risk and cured meat consumption. However, they found that noncured meat, egg, grain, and citrus fruit consumption was associated with a modest increase in glioma risk. There were inverse associations between some vegetable groups and glioma risk.
Pogoda et al.  found that foods associated with increased adult brain tumors risk were cured meats, eggs/dairy, and oil products; foods associated with decreased adult brain tumors risk were yellow orange vegetables, fresh fish, and grains. Wei et al.  suggested that processed meat consumption might increase the risk for glioma. The differences in this result may be due to the difference in the studied population.
We did not find any significant difference in BMI between patients and controls. This is in accordance with the findings of Brenner et al.  and Schneider et al. , whereas it is in contrast to the study by Jhawar et al. , who described an increasing risk for meningioma with increasing BMI. Moreover, we did not find any significant difference between patients and controls with regard to occupation. This is in agreement with the findings of Schlehofer et al.  and Samkange-Zeeb et al. .
Exposure to pesticide did not show any significant difference between patients and controls. The same finding was reported by Chen et al.  and Nasterlack . Samanic et al.  also reported similar findings, but they added that there was a significant trend of increasing risk for meningioma in women with increasing years of herbicide exposure and increasing cumulative exposure.
As regards head trauma, we did not find any significant difference between patients and controls. Similar finding was reported by Marosi et al. . Moreover, medications and vitamins were not found to have any significant difference between patients and controls; this finding is in accordance with those of Stalberg et al. . Bondy et al.  had generally reported an insignificant association between tumors and medications. However, they also found lower association between antihistamine use and adult glioma, but a 60% increased relative risk for meningioma. Moreover, we found that exposure to radiation did not show any significant difference between patients and controls. Schlehofer et al.  and Brandes et al.  reported that exposure to diagnostic ionizing radiation is not a proven risk factor for brain tumors; however, Blettner et al.  and Nasseri and Mills  reported that therapeutic ionizing radiation is a strong risk factor.
As regards cell phone exposure, we found that duration of cell phone use of 10 or more years, average daily use for 0.5-2.5 h, time of calls since first use 1351-4320 h, and ipsilateral cell phone use were statistically higher among patients compared with controls. The risk for primary brain tumor significantly increased with higher cell phone use scale, being higher in astrocytic tumors in relation to meningioma and other types of primary brain tumors. The risk for primary brain tumor was significantly higher among patients with ipsilateral regular cell phone use more than 10 years. This finding is in accordance with that of Khurana et al. , Levis et al. , Hardell et al. , and Roda and Perry  and in contrast to the findings of Mornet et al. , Benson et al. , and Jung and Kim .
Cell phone studies relied on self-reported cell phone use through various questionnaires. The results of these studies remain controversial because most studies suffer from various methodological deficiencies, including insufficient statistical power to detect an excess risk for brain tumors, reliance on small populations, short-term exposure periods, and difficulty in characterizing changing exposures throughout a lifetime in large populations. In addition, most negative studies have been substantially funded by the cell phone industry ,.
In our study, we also found that risk perception among patients based on the types of risks related to cell phone use showed that the social risk perception is significantly higher among patients compared with radiation and driving risks. There is a significantly high mean score with regard to social and radiation risk perception compared with medium mean score of driving risk perception. Martha and Griffet  stated that adolescents had a high perception of the risks linked with driving. Risks related to radiation were perceived as significantly less harmful in comparison with both risks related to driving and social risk. This difference from our results may be related to the difference in the study population.
Subject proximities to base station did not show any significant difference between patients and controls. This finding is in accordance with that of Rothman . An inverse association between malignant primary brain tumor frequency and residence near cell phone towers was observed. This may be attributed to the fact that there is no electromagnetic field on the lower part of the base stations, or because cell phone connections are better near towers, the cell phones emit less radiation .
| Conclusion|| |
Primary brain tumors have many risk factors that have significant influence on its occurrence. These risk factors include urban residence, female sex in meningioma, and ipsilateral regular cell phone use more than 10 years.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]