Rigor Reviewed

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Exposure to radiofrequency radiation increases the risk of breast cancer: A systematic review and meta-analysis

Name: Αlpha¹ Rigor Record — Exposure to radiofrequency radiation increases the risk of breast cancer: A systematic review and meta-analysis
Item: Exposure to radiofrequency radiation increases the risk of breast cancer: A systematic review and meta-analysis
Rating: 95
Author: Αlpha¹

Shih YW, O'Brien AP, Hung CS, Chen KH, Hou WH, Tsai HT.

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Αlpha¹ Rigor Review — 4.25★ (Strong), 0 critical, 3 high issues for “Exposure to radiofrequency radiation increases the risk of breast cancer: A systematic review and meta-analysis”

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Αlpha¹ Editorial

This rigor review was examined and confirmed by Αlpha¹ Editorial · August 5, 2026

Αlpha¹ Rigor Review

Rigor Reviewed

4.25 / 5

Strong — minor issues to address

Meta-Analysis / Systematic Review

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern−0.5★
ReportingBiological variables partially met−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.15.0Source: full text

Not verified in this report

No data or code availability links were detected to verify.

Problems surfaced2 types

Biological variables underreported (sex, age, strain)
Methods and results do not match

This Αlpha¹ Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This meta-analysis is methodologically sound with a registered protocol, clear inclusion criteria, appropriate statistical tests, and transparent reporting. The principal weakness is the incomplete reporting of participant-level biological variables (age, sex, health status) across the included studies, which limits the ability to assess potential confounding or effect modification.

This meta-analysis of eight observational studies was evaluated across eight rigor dimensions. Several sub-criteria within dimensions (e.g., randomization, blinding, power analysis) were not applicable due to the meta-analysis design. The three independent reviewers largely converged on all dimensions; minor disagreements on sub-criteria (e.g., power analysis, exact p_values) were resolved by weighing the evidence and the paper's methodology.

11 major claims checked against the paper's own evidence: all adequately supported.

Recomputed 5 tests: 5 consistent, 0 inconsistent; 5 via agent-written checks.

1 integrity concern flagged (0 high).

Reporting

Eight Dimensions6 pass · 1 warn

The Introduction cites relevant literature on radiofrequency and cancer, including IARC classification, and identifies a gap in the literature regarding a meta-analysis on radiofrequency radiation and breast cancer specifically. The hypothesis follows from the cited evidence. However, limitations of prior reviews are not explicitly addressed.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedNOT REPORTED

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The scientific premise is well-established with citations to prior work on radiofrequency radiation, breast cancer risk factors, and biological mechanisms, and a clear rationale for the meta-analysis.

Evidence

direct quote[Introduction, paragraph 2]

“Previous studies have also focused on the effects of the exposure to non-ionizing radiofrequencies on brain tumors, leukemia, salivary gland tumors, infertility and electro-hypersensitivity”

direct quote[Introduction, paragraph 3]

“it was hypothesized that exposure to radiofrequency radiation may induce breast cancer development due to the induction of oxidative stress and apoptosis in breast cancer cells.”

direct quote[Introduction, final paragraph]

“to the best of our knowledge, the present study performed the first meta-analysis aiming to evaluate and obtain more precise and comprehensive estimates of the association between radiofrequency radiation exposure and the risk of breast cancer.”

PASSReviewer 2· 95% conf

The paper clearly establishes the scientific premise by citing prior research on radiofrequency radiation and cancer, and provides a logical rationale for the meta-analysis.

Evidence

direct quote[Introduction, paragraph 1-3]

“Radiofrequency radiation, which is a subcategory of non-ionizing radiation, has been indicated to exhibit harmful effects that are similar to those of ionizing radiation, and to increase the risk of cancer ().”

direct quote[Introduction, last paragraph]

“the majority of meta-analysis studies have focused on the association between mobile phones and tumors () or electromagnetic fields and breast cancer ().”

absence[Introduction]

Limitations of prior research are not explicitly addressed.

PASSReviewer 3· 85% conf

The paper establishes a clear scientific foundation by citing prior research on radiofrequency radiation and breast cancer, and provides a logical rationale for the study.

Evidence

paraphrase[Introduction, paragraph 2]

“In 2011 the International Agency for Research on Cancer () classified non-ionizing radiofrequency radiation as possibly carcinogenic to humans categorizing it in group 2B ().”

direct quote[Introduction, paragraph 5]

“To the best of our knowledge, the present study performed the first meta-analysis aiming to evaluate and obtain more precise and comprehensive estimates of the association between radiofrequency radiation exposure and the risk of breast cancer.”

paraphrase[Introduction]

“The paper does not describe limitations of prior research or how they are mitigated; it only notes that previous meta-analyses focused on other exposures.”

The paper reports a detailed search strategy across nine databases, PRISMA flow diagram, inclusion/exclusion criteria, and quality assessment using the Newcastle-Ottawa Scale. While no formal power analysis was performed, search completeness is demonstrated by the extensive search. Heterogeneity was assessed, and a sensitivity analysis was conducted. The study registration with PROSPERO is provided.

Sub-criteria

controlsADEQUATE

power analysisADEQUATE

blinding levelsN/A

outlier handlingADEQUATE

randomization unitN/A

inclusion exclusionADEQUATE

randomization methodN/A

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 80% conf

The meta-analysis follows a systematic review protocol (PROSPERO-registered) with clear inclusion/exclusion criteria, risk-of-bias assessment, and sensitivity analysis. The search strategy is comprehensive, though no formal power analysis is reported.

Evidence

paraphrase[Materials and methods, Inclusion and exclusion criteria]

“Studies were included if they: i) Evaluated associations between radiofrequency radiation and the risk of breast cancer; ii) studied a human population; iii) provided detailed data for calculating the relative risk (RR) or odds ratio (OR) and 95% confidence interval (CI); and iv) investigated radiofrequency radiation or any frequency classified as radiofrequency.”

paraphrase[Materials and methods, Methodological assessment]

“Methodological quality assessment... based on the Newcastle-Ottawa Scale... scores of all selected studies ranged from 5-7.”

direct quote[Materials and methods, Statistical analysis]

“a sensitivity analysis was conducted via deleting one study to examine the influence of individual datasets”

PASSReviewer 2· 70% conf

The meta-analysis design is adequately described with clear inclusion/exclusion criteria, quality assessment, and sensitivity analysis, though search completeness is not formally assessed.

Evidence

direct quote[Materials and methods, Inclusion and exclusion criteria]

“For inclusion, the studies were required to meet all the following criteria: i) Evaluated associations between radiofrequency radiation and the risk of breast cancer; ii) studied a human population; iii) provided detailed data for calculating the relative risk (RR) or odds ratio (OR) and 95% confidence interval (CI); and iv) investigated radiofrequency radiation or any frequency classified as radiofrequency.”

paraphrase[Materials and methods, Methodological assessment]

“A quality assessment method for case and control studies was developed based on the Newcastle-Ottawa Scale (NOS).”

direct quote[Results, Outcomes of the meta-analysis]

“sensitivity analysis was conducted by removing one study () from the analysis to detect the pooled RR estimates”

PASSReviewer 3· 90% conf

The meta-analysis follows standard methodology with a comprehensive search, clear inclusion/exclusion criteria, quality assessment using NOS, sensitivity analysis, and publication bias assessment.

Evidence

direct quote[Materials and methods, Inclusion and exclusion criteria]

paraphrase[Materials and methods, Methodological assessment]

“A quality assessment method for case and control studies was developed based on the Newcastle-Ottawa Scale (NOS).”

paraphrase[Results, Outcomes of the meta-analysis]

“To estimate how the robustness of the findings affected the final results, a sensitivity analysis was conducted by removing one study () from the analysis to detect the pooled RR estimates (RR=1.164; 95% CI, 1.049-1.291) in the random-effects model.”

The included studies are on breast cancer, so the population is assumed female, but sex is not explicitly stated for all studies. Age is partially reported in subgroup analyses but not in the study characteristics table. No information on health status, race/ethnicity, or comorbidities is provided. The paper does not meet the 60% adequacy threshold for applicable biological variables.

Sub-criteria

demographicsNOT REPORTED

sex reportedADEQUATE

sex justifiedN/A

age weight healthNOT REPORTED

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 70% conf

The meta-analysis does not systematically report biological variables across included studies. Sex is implicitly female, but age, health status, and demographics are not consistently presented.

Evidence

direct quote[Abstract]

“radiofrequency radiation exposure significantly increased the risk of breast cancer, especially in women aged ≥50 years”

absence[Table I]

Age is not systematically reported across all included studies.

absence[Table I and Results]

No demographic information (race/ethnicity, comorbidities) is reported.

WARNReviewer 2· 70% conf

The paper partially reports biological variables of the included studies, but key variables such as age, sex, and health status are not systematically presented in the characteristics table.

Evidence

paraphrase[Table I]

“Table I: Characteristics of the included studies (n=8).”

paraphrase[Table I]

“The table includes country, number of cases, study design, exposure type, confounders, and principal results, but no age column.”

absence[Table I]

Health status is not reported.

WARNReviewer 3· 70% conf

The paper provides limited reporting of biological variables across the included studies; sex is implied but not systematically reported, age is partially reported for some studies, and demographic details are sparse.

Evidence

direct quote[Abstract, Table I]

“Exposure to radiofrequency radiation increases the risk of breast cancer: A systematic review and meta-analysis”

direct quote[Results, Characteristics of the included studies]

“A total of three studies evaluated an age group of ≥50 years old.”

paraphrase[Table I]

“The table includes country, number of cases, study design, exposure type, confounder variables, and principal results, but no race/ethnicity or comorbidity data.”

The paper states 'Ethics approval and consent to participate Not applicable.' The study does not involve new subject data.

Sub-criteria

iacuc statementN/A

informed consentN/A

irb ethics statementN/A

regulatory complianceN/A

Per reviewer (3) — the votes behind the verdict

N/AReviewer 1· 95% conf

The meta-analysis synthesizes published data and does not involve new human or animal subject data, so ethics approval and consent are not applicable.

Evidence

direct quote[Ethics approval and consent to participate]

“Ethics approval and consent to participate Not applicable.”

N/AReviewer 2· 100% conf

This is a meta-analysis of published studies, so ethical approval for the current study is not applicable.

Evidence

direct quote[Ethics approval and consent to participate]

“Not applicable.”

N/AReviewer 3· 95% conf

This is a meta-analysis of published studies; no new human or animal subject data were collected, so ethical approvals are not applicable.

Evidence

direct quote[Ethics approval and consent to participate]

“Not applicable.”

The paper uses Comprehensive Meta-Analysis v2.0 (Biostats, Inc.) and identifies it by name and version. No other biological or chemical resources are used.

Sub-criteria

mycoplasma testingN/A

reagents identifiedN/A

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The only key resource applicable to this meta-analysis is the statistical software, which is adequately identified.

Evidence

direct quote[Materials and methods, Statistical analysis]

“All data analyses were performed with Comprehensive Meta-Analysis v2.0 software (Biostats, Inc.).”

PASSReviewer 2· 100% conf

The only applicable resource is the statistical software, which is adequately identified.

Evidence

direct quote[Materials and methods, Statistical analysis]

“All data analyses were performed with Comprehensive Meta-Analysis v2.0 software (Biostats, Inc.).”

PASSReviewer 3· 90% conf

The only key resource identified is the statistical software, which is adequately reported; all other resource types are not applicable for a meta-analysis.

Evidence

direct quote[Materials and methods, Statistical analysis]

“All data analyses were performed with Comprehensive Meta-Analysis v2.0 software (Biostats, Inc.).”

The Cochran Q-test and I² are used to assess heterogeneity, and Egger's test and trim-and-fill for publication bias. The overall and subgroup results are presented as RR with 95% CI. The software is identified. The paper does not report exact p-values for the main effect, but this is not required for a meta-analysis that relies on effect estimates and CIs.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 85% conf

Statistical methods are clearly described, including tests for heterogeneity, publication bias, and sensitivity analysis. Effect sizes are reported with 95% confidence intervals. All applicable sub-criteria are adequately addressed.

Evidence

paraphrase[Materials and methods, Statistical analysis]

“Cochran Q-test and I 2 test... Egger's regression intercept test... trim-and-fill method”

direct quote[Results, Outcomes of the meta-analysis]

“pooled RR=1.189; 95% CI, 1.056-1.339”

direct quote[Materials and methods, Statistical analysis]

“Comprehensive Meta-Analysis v2.0 software (Biostats, Inc.)”

PASSReviewer 2· 80% conf

Statistical methods are adequately described and reported, with exact p-values for heterogeneity and publication bias, and effect sizes with confidence intervals.

Evidence

paraphrase[Materials and methods, Statistical analysis]

“Heterogeneity was examined using the Cochran Q-test and I 2 test. ... Egger's regression test <0.05 indicated publication bias.”

direct quote[Results, Outcomes of the meta-analysis]

“pooled RR=1.189; 95% CI, 1.056-1.339”

direct quote[Materials and methods, Statistical analysis]

“All data analyses were performed with Comprehensive Meta-Analysis v2.0 software (Biostats, Inc.).”

PASSReviewer 3· 85% conf

The paper reports appropriate statistical tests, effect sizes with confidence intervals, and software, but exact p-values for the main effect are not provided.

Evidence

paraphrase[Materials and methods, Statistical analysis]

“Heterogeneity was examined using the Cochran Q-test and I 2 test. Funnel plot asymmetry was measured using Egger's regression intercept test.”

direct quote[Results, Outcomes of the meta-analysis]

“pooled RR=1.189; 95% CI, 1.056-1.339”

paraphrase[Results, Outcomes of the meta-analysis and Publication bias]

“The overall pooled effect is reported without a p-value, but heterogeneity Q=17.6, P=0.014 and Egger's test t=2.46, P=0.048 are given.”

The paper states 'All data generated or analyzed during this study are included in this published article.' No repository deposit is needed as the data are presented in tables. No custom code was used.

Sub-criteria

code sharingN/A

accession numbersN/A

repository depositN/A

data availability statementADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

A data availability statement is provided, stating that all data are included in the published article. No custom code or repository deposit is applicable.

Evidence

direct quote[Availability of data and materials]

“All data generated or analyzed during this study are included in this published article.”

PASSReviewer 2· 100% conf

The data availability statement indicates that all data are included in the published article, which is appropriate for a meta-analysis.

Evidence

direct quote[Availability of data and materials]

“All data generated or analyzed during this study are included in this published article.”

PASSReviewer 3· 85% conf

The data availability statement states that all data are included in the article, which is adequate for a meta-analysis; no code was written.

Evidence

direct quote[Availability of data and materials]

“All data generated or analyzed during this study are included in this published article.”

The paper is registered with PROSPERO, follows PRISMA guidelines, reports all outcomes, discusses limitations (sample size, dose-response, publication bias), and provides funding and competing interests.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The manuscript is well-structured with a registered protocol, PRISMA flow diagram, transparent reporting of all outcomes, and discussion of limitations. All applicable sub-criteria are adequate.

Evidence

direct quote[Abstract]

“registered with the PROSPERO database (registration no. CRD42018087283)”

direct quote[Materials and methods, Data sources and search strategy]

“In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis, an evaluation protocol was prepared and registered with the PROSPERO database”

paraphrase[Discussion]

“The current study presents certain limitations. Firstly, only results in the selected papers were used... Secondly, a dose-response relationship was not determined... Finally, the quality of the included studies was assessed using NOS... publication bias”

PASSReviewer 2· 100% conf

The paper is transparent and complete, with a registered protocol, PRISMA adherence, limitations discussion, and funding disclosure.

Evidence

direct quote[Abstract]

“registered with the PROSPERO database (registration no. CRD42018087283).”

paraphrase[Materials and methods]

“In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis, an evaluation protocol was prepared.”

direct quote[Discussion]

“The current study presents certain limitations. Firstly, only results in the selected papers were used, which limited the analyses.”

PASSReviewer 3· 90% conf

The paper is transparently reported with a registered protocol, PRISMA adherence, comprehensive methods, and balanced conclusions.

Evidence

direct quote[Abstract, Materials and methods]

“an evaluation protocol was prepared and registered with the PROSPERO database (registration no. CRD42018087283).”

direct quote[Results, Study selection]

“The Preferred Reporting Items for Systematic Reviews and Meta-Analyses () flow diagram of the review process is presented in .”

direct quote[Discussion, paragraph 6]

“The current study presents certain limitations. Firstly, only results in the selected papers were used, which limited the analyses.”

9 copyedit issues flagged: mostly consistency, grammar, other.

Checked 57 references by DOI: 52 verified — 5 no DOI (shown, not verified).

Reproducibility

Registered (1 ID: PROSPERO). No reporting guideline cited.

Αlpha¹ Rigor Action ItemsFinal pass before journal submission

Published paper is methodologically robust but has a gap in reporting participant-level biological characteristics; readers should be aware that the meta-analysis does not provide a systematic breakdown of age, sex, or health status across studies. The missing p-value for the main effect is not a flaw given estimation-based reporting. The Newcastle-Ottawa Scale table labeling issue (Table II header says 'Case control study' but includes cohort studies) is a minor inconsistency that may warrant a correction.

1.
HIGHrigor
Correct the mislabeling of Table II: the header currently reads 'Case control study' but includes cohort studies. Adapt the Newcastle-Ottawa Scale assessment to be appropriate for both study designs, or present separate tables. This is a methodological inconsistency that should be addressed in a correction.
Using an identical quality assessment scale for case-control and cohort studies without adaptation may affect the validity of the quality assessment and could mislead readers.
2.
HIGHreporting
Add a column to Table I explicitly reporting the sex of participants for each included study. If all studies are on women, state this clearly in the table.
Sex is a fundamental biological variable; its absence from the characteristics table limits the ability to assess the applicability of the findings and potential confounding.
3.
HIGHcopyedit
Correct the typo in the author name 'Cigand Naziroglu' in the Introduction (reference citation appears to have a misspelled author name).
Incorrect author names in citations undermine the credibility of the reference list and could cause confusion for readers.
4.
MEDIUMreporting
Add demographic and health status information (e.g., age range, race/ethnicity, comorbidities) to Table I if available from the original studies.
Comprehensive reporting of participant characteristics enhances transparency and allows readers to evaluate the generalizability of the meta-analysis results.
5.
MEDIUMcopyedit
Fix grammar errors: change 'each databases' to 'each database' in the Data sources and search strategy section; remove redundant 'A total of' phrases throughout the manuscript.
These minor errors reduce the professional polish of the manuscript and could be distracting to reviewers and readers.
6.
MEDIUMcopyedit
Add commas between author names in the abstract author list to improve clarity.
The current run-together author names may cause confusion about individual names.
7.
LOWreporting
Include a note in the Discussion about the absence of a formal search completeness assessment, acknowledging that the comprehensiveness of the search was not formally quantified.
While the search strategy appears comprehensive, transparency about its limitations would strengthen the methodological disclosure.
8.
LOWreporting
In the Introduction, elaborate on how the limitations of prior research (e.g., lack of dose-response data, exposure misclassification) are addressed in this meta-analysis.
A more explicit discussion of how the current study improves upon previous work would strengthen the scientific premise.
9.
LOWdata code
Consider adding a supplementary data file containing the extracted study-level data (e.g., effect sizes, confidence intervals, and study characteristics) to a repository for reproducibility.
Although the data are reported in the article, providing a machine-readable table would facilitate independent re-analysis and meta-analytic updates.

Full text (34,836 chars)Analyzed: Aug 5, 2026

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