Table

Table 1. Methodologic Quality of Studies Included in the Final Analysis Based on the Newcastle-Ottawa Scale for Assessing the Quality of Case-Control Studies

Table 1. Methodologic Quality of Studies Included in the Final Analysis Based on the Newcastle-Ottawa Scale for Assessing the Quality of Case-Control Studies

Study Selection (score)
Comparability (score)
Exposure (score)
Total Score
Adequate Definition of Patient Cases Representativeness of Patient Cases Selection of Controls Definition of Controls Control for Important Factor or Additional Factor Ascertainment of Exposure (blinding) Same Method of Ascertainment for Participants Nonresponse Rate*
Hardell et al7 1 1 1 0 1 1 1 1 7
Muscat et al8 1 0 0 1 2 0 1 0 5
Inskip et al9 1 0 0 1 2 0 1 0 5
Stang et al10 (hospital based) 1 1 0 0 2 1 1 0 6
Stang et al10 (population based) 1 1 1 0 2 1 1 0 7
Auvinen et al11 1 1 1 1 1 1 0 1 0 6
Auvinen et al11 2 1 1 1 1 1 0 1 0 6
Hardell et al12 1 1 1 0 2 1 1 0 7
Warren et al13 1 1 0 1 1 0 1 0 5
Hardell et al14 1 1 1 0 1 1 1 1 7
Hardell et al15 1 1 1 0 2 1 1 1 8
Hardell et al16 1 1 1 0 2 1 1 0 7
Schoemaker et al17 1 1 1 1 2 0 1 0 7
Hardell et al18 1 1 1 0 2 1 1 1 8
Linet et al19 1 1 1 1 2 0 1 0 7
Lönn et al20 1 1 1 0 2 0 1 0 6
Schüz et al21 1 1 1 0 2 0 1 0 6
Takebayashi et al22 1 1 1 0 2 0 1 0 6
Hardell et al23 1 1 1 0 2 1 1 1 8
Hours et al24 1 1 1 0 2 0 1 0 6
Lahkola et al25 1 1 1 0 2 0 1 0 6
Lahkola et al26 1 1 1 0 1 0 1 0 5
Sadetzki et al27 1 1 1 0 1 0 1 0 5
Takebayashi et al28 1 1 1 0 2 0 1 0 6

*When there was no significant difference in the response rate between both groups by using a χ2 test (P > .05), one point was awarded.

†Total score could range from 0 to 9 points.

Table

Table 2. Mobile Phone Use (v never or rarely use) and the Risk of Tumors in Subgroup Meta-Analyses

Table 2. Mobile Phone Use (v never or rarely use) and the Risk of Tumors in Subgroup Meta-Analyses

Factor No. of Studies Summary OR 95% CI of OR Heterogeneity, I2 (%) Model Used
All 23 0.98 0.89 to 1.07 59.7 Random effects
Research group
    Hardell et al* 7 1.15 1.01 to 1.32 52.1 Random effects
    INTERPHONE 9 0.83 0.77 to 0.89 0 Fixed effects
    Other groups 7 0.99 0.86 to 1.14 30.6 Fixed effects
Research group (crude data) 23 0.97 0.87 to 1.08 73.6 Random effects
    Hardell et al 7 1.14 0.96 to 1.35 71.0 Random effects
    INTERPHONE 9 0.88 0.75 to 1.03 79.8 Random effects
    Other groups 7 0.90 0.79 to 1.03 22.6 Fixed effects
Methodologic quality
    High (low bias: ≥ 7 points)* 10 1.09 1.01 to 1.18 46.3 Fixed effects
        Hardell et al* 7 1.15 1.00 to 1.32 52.1 Random effects
        INTERPHONE 1 0.90 0.70 to 1.10 NA NA
        Other group 2 1.02 0.75 to 1.38 0 Fixed effects
    Low (high bias: < 7 points) 14 0.85 0.79 to 0.91 5.7 Fixed effects
        INTERPHONE 8 0.82 0.76 to 0.88 0 Fixed effects
        Other groups 6 0.97 0.83 to 1.14 24.2 Fixed effects
Malignancy of tumor
    Malignant 15 1.00 0.89 to 1.13 52.0 Random effects
        Hardell et al 6 1.11 0.96 to 1.29 50.5 Random effects
        INTERPHONE 4 0.78 0.67 to 0.91 0 Fixed effects
        Other groups 5 0.97 0.80 to 1.18 19.6 Fixed effects
    Benign 15 0.87 0.80 to 0.95 20.7 Fixed effects
        Hardell et al 4 1.17 0.97 to 1.42 3.8 Fixed effects
        INTERPHONE 8 0.81 0.73 to 0.90 0 Fixed effects
        Other groups 3 0.82 0.61 to 1.11 0 Fixed effects
Type of mobile phone
    Analog 12 0.96 0.87 to 1.07 49.9 Fixed effects
        Hardell et al 7 1.04 0.89 to 1.22 34.5 Fixed effects
        INTERPHONE 3 0.84 0.72 to 0.96 0 Fixed effects
        Other groups* 2 1.55 1.08 to 2.2 0 Fixed effects
    Digital 14 0.95 0.84 to 1.08 55.8 Random effects
        Hardell et al 7 1.10 0.97 to 1.24 12.7 Fixed effects
        INTERPHONE 5 0.78 0.71 to 0.85 0 Fixed effects
        Other groups 2 0.93 0.55 to 1.59 0 Fixed effects
Laterality of tumor
    Ipsilateral 12 1.22 0.99 to 1.51 85.9 Random effects
        Hardell et al* 4 1.80 1.24 to 2.62 84.9 Random effects
        INTERPHONE 8 1.00 0.91 to 1.10 37.0 Fixed effects
    Contralateral 11 0.94 0.77 to 1.15 82.3 Random effects
        Hardell et al 3 1.31 0.74 to 2.31 93.0 Random effects
        INTERPHONE 8 0.81 0.74 to 0.89 48.2 Fixed effects
Type of case-control study
    Hospital based (all other groups) 4 0.89 0.74 to 1.07 0.0 Fixed effects
    Population based 20 0.99 0.89 to 1.09 61.8 Random effects
        Hardell et al* 7 1.15 1.01 to 1.32 52.1 Random effects
        INTERPHONE 9 0.83 0.77 to 0.89 0 Fixed effects
        Other groups 4 1.14 0.91 to 1.43 0 Fixed effects

Abbreviations: OR, odds ratio; NA, not applicable.

*Statistically significant positive association.

†Statistically significant negative association.

Table

Table A1. Characteristics of Studies Included in the Final Meta-Analysis of Mobile Phone Use and Risk of Tumors

Table A1. Characteristics of Studies Included in the Final Meta-Analysis of Mobile Phone Use and Risk of Tumors

Study Year of Publication Country and Study Name Study Design Study Period Study Length (years) Type of Tumor Type of Mobile Phone and Exposure Study OR 95% CI Adjustment Exposed
Unexposed
No. of Patient Cases No. of Controls No. of Patient Cases No. of Controls
Hardell et al7 1999 Sweden PCC 1994-1996 2 Malignant and benign brain tumors (gliomas, meningiomas, and acoustic neuromas) Cellular phone (analog and digital); latency period > 1 year v within 1 year Hardell et al7 0.98 0.69 to 1.41 Age, sex, and study region (matched) 78 161 131 264
Muscat et al8 2000 United States HCC 1994-1998 4 Primary brain cancers (gliomas and other malignant brain tumors) Handheld cellular phone; regular past or current use v never use Muscat et al8 0.85* 0.6 to 1.2 Age, years of education, sex, race, study center, proxy subject, and month and year of interview 66 76 403 346
Inskip et al9 2001 United States HCC 1994-1998 4 Malignant and benign brain tumors (gliomas, meningiomas, and acoustic neuromas) Handheld cellular phone; cumulative use of > 100 hours v never or rarely use Inskip et al9 0.9* 0.7 to 1.1 Date of interview, type of respondent, educational level, annual household income, type of health coverage, marital status, religion, history of radiotherapy to the head or neck, and handedness 52 54 637 625
Stang et al10 2001 Germany HCC and PCC 1995-1998 3 Uveal melanomas Mobile phone; possible/probable/certain ever exposure v never exposure Stang et al10 2.8 1.0 to 7.9 Social class with 9 years at school or less 7 25 111 450
Auvinen et al11 2002 Finland PCC 1996 Malignant and benign brain tumors (gliomas and meningiomas) and salivary gland cancers Cellular phone (analog and digital); ever use v never use Auvinen et al11 Brain tumors: 1.3; salivary gland cancers: 1.3 Brain tumors: 0.9 to 1.8; salivary gland cancers: 0.4 to 4.7 Place of residence, occupation, and socioeconomic status Brain tumors: 56; salivary gland cancers: 4 Brain tumors: 223; salivary gland cancers: 18 Brain tumors: 342; salivary gland cancers: 30 Brain tumors: 1,763; salivary gland cancers: 152
Hardell et al12 2002 Sweden PCC 1997-2000 3 Malignant and benign brain tumors (gliomas, meningiomas, pituitary tumors, and acoustic neuromas) Cellular or cordless phone (analog and digital); use v no use Hardell et al12 Analog cellular phone: 1.3*; digital cellular phone: 1.0*; cordless phone: 1.0*; combined OR: 1.15 Analog cellular phone: 1.04 to 1.6; digital cellular phone: 0.8 to 1.2; cordless phone: 0.8 to 1.2; combined OR: 0.99 to 1.33 Use of different types of phones 650 618 779 852
Warren et al13 2003 United States HCC 1995-2000 5 Intratemporal facial nerve tumors Handheld cellular phone; use v no use Warren et al13 0.6 0.2 to 1.9 Age, sex, and race (matched) 5 53 13 88
Hardell et al14 2004 Sweden PCC 1994-2000 6 Malignant and benign salivary gland tumors Cellular or cordless phone; use v no use Hardell et al14 1.02* 0.75 to 1.38 Age and sex 91 352 176 701
Hardell et al15 2005 Sweden PCC 1999-2002 3 Non-Hodgkin's lymphomas Cellular or cordless phone (analog and digital); use v no use Hardell et al15 1.06* 0.87 to 1.31 Age, sex, and year of diagnosis (patient cases) or enrollment (controls) 607 695 303 321
Hardell et al16 2005 Sweden PCC 2000-2003 3 Benign brain tumors (meningiomas, acoustic neuromas, and other benign brain tumors) Cellular or cordless telephone (analog and digital); use v no use Hardell et al16 1.4* 1.03 to 1.9 Age, sex, socioeconomic index, and year of diagnosis 290 459 123 233
Schoemaker et al17 2005 Five North European countries: Denmark, Finland, Norway, Stockholm, and United Kingdom; followed a protocol of the INTERPHONE Study PCC 1999-2004 5 Benign brain tumors (acoustic neuromas) Mobile phone (analog and digital); regular use v never or nonregular use Schoemaker et al17 0.9* 0.7 to 1.1 Highest educational level and combination of interview year and interview lag time 360 1,934 316 1,612
Hardell et al18 2006 Sweden PCC 2000-2003 3 Malignant brain tumors (gliomas and other malignant tumors) Cellular or cordless phone (analog and digital; use v no use Hardell et al18 1.9* 1.3 to 2.7 Age, sex, socioeconomic index, and the year of diagnosis 254 459 63 233
Linet et al19 2006 United States PCC 1998-2000 2 Non-Hodgkin's lymphomas Cellular phone; lifetime ever use v never use Linet et al19 1.0* 0.7 to 1.3 Age, race, education, and geographic site 317 247 234 215
Lönn et al20 2006 Denmark and Sweden; part of the INTERPHONE Study PCC 2000-2002 2 Malignant and benign parotid gland tumors Mobile phone; regular use v never or rarely use Lönn et al20 0.80* (combined ORs of malignant parotid gland and benign pleomorphic adenoid) 0.54 to 1.20 Age, sex, geographic region, and education 102 603 70 399
Schüz et al21 2006 Germany; part of the INTERPHONE Study PCC 2000-2003 3 Malignant and benign brain tumors (glioma and meningioma) Cellular phone; ever regular use v never use Schüz et al21 0.91* (combined ORs of glioma and meningioma) 0.75 to 1.1 Age, socioeconomic status, and living in a city 242 517 505 977
Takebayashi et al22 2006 Japan; followed a protocol of the INTERPHONE Study PCC 2000-2004 4 Benign brain tumors (acoustic neuromas) Mobile phone (analog and digital); regular use v no use Takebayashi et al22 0.73* 0.43 to 1.23 Education and marital status 51 192 46 138
Hardell et al23 2007 Sweden PCC 1993-1997 4 Testicular cancers (seminomas and nonseminomas) Cellular or cordless phone; use v not use Hardell et al23 1.0* 0.8 to 1.2 Age, year of diagnosis, and cryptorchidism 372 358 516 512
Hours et al24 2007 France; part of the INTERPHONE Study PCC 2001-2003 2 Malignant and benign brain tumors (gliomas, meningiomas, and acoustic neuromas) Mobile phone; regular use v no or nonregular use Hours et al24 0.93* 0.69 to 1.27 Socioeconomic status, smoking status, and marital status 188 257 162 198
Lahkola et al25 2007 5 North European countries: Denmark, Finland, Norway, Sweden, and United Kingdom; followed a protocol of the INTERPHONE Study PCC 2000-2004 4 Malignant brain tumors (gliomas) Mobile phone (analog and digital); regular use v never or nonregular use Lahkola et al25 0.78* 0.68 to 0.91 Education and family history of glioma 867 1,853 629 1,281
Lahkola et al26 2008 5 North European countries: Denmark, Finland, Norway, Sweden, and United Kingdom; followed a protocol of the INTERPHONE Study PCC 2000-2004 4 Benign brain tumors (meningiomas) Mobile phone (analog and digital); regular use v never or nonregular use Lahkola et al26 0.76 0.65 to 0.89 Sex, 5-year age group, region, and county (matched) 573 1,696 631 1,249
Sadetzki et al27 2008 Israel; followed a protocol of the INTERPHONE Study PCC 2001-2003 2 Malignant and benign parotid gland tumors Cellular phone; regular use v nonregular use (< 1 year) Sadetzki et al27 0.87* 0.68 to 1.13 Cigarette smoking 285 691 175 575
Takebayashi et al28 2008 Japan; followed a protocol of the INTERPHONE Study PCC 2000-2004 4 Malignant and benign brain tumors Mobile phone (analog and digital; regular use v no use Takebayashi et al28 0.87* (combined ORs of glioma, meningioma, and pituitary) 0.63 to 1.22 Education and marital status 173 329 139 224

Abbreviations: OR, odds ratio; PCC, population-based case-control study; HCC, hospital-based case-control study.

*Adjusted OR.

Table

Table A2. Mobile Phone Use of 10 Years or Longer (v never or rarely use) and the Risk of Tumors in Subgroup Meta-Analyses

Table A2. Mobile Phone Use of 10 Years or Longer (v never or rarely use) and the Risk of Tumors in Subgroup Meta-Analyses

Factor No. of Studies Summary OR 95% CI of OR Heterogeneity, I2 (%) Model Used
All* 13 1.18 1.04 to 1.34 33.1 Fixed effects
Research group
    Hardell et al* 7 1.35 1.14 to 1.59 35.1 Fixed effects
    INTERPHONE 6 0.99 0.82 to 1.21 0 Fixed effects
Methodologic quality
    High (low bias: ≥ 7 points)* 8 1.32 1.12 to 1.54 29.1 Fixed effects
        Hardell et al* 7 1.35 1.14 to 1.59 35.1 Fixed effects
        INTERPHONE 1 1.10 0.70 to 1.80 NA NA
    Low (high bias: < 7 points, all INTERPHONE) 5 0.97 0.79 to 1.21 0 Fixed effects
Type of tumor
    Brain tumor* 8 1.24 1.00 to 1.55 50.8 Random effects
        Hardell et al* 4 1.54 1.26 to 1.89 0 Fixed effects
        INTERPHONE 4 1.00 0.81 to 1.22 10.9 Fixed effects
    Other tumors 5 1.00 0.76 to 1.30 0 Fixed effects
        Hardell et al 3 1.00 0.74 to 1.35 0 Fixed effects
        INTERPHONE 2 0.97 0.54 to 1.77 0 Fixed effects
Malignancy of tumor
    Malignant 7 1.15 0.78 to 1.71 58.8 Random effects
        Hardell et al 4 1.42 0.94 to 2.14 54.5 Random effects
        INTERPHONE 3 0.74 0.50 to 1.11 0 Fixed effects
    Benign* 8 1.33 1.11 to 1.58 39.3 Fixed effects
        Hardell et al* 3 1.66 1.32 to 2.09 1.9 Fixed effects
        INTERPHONE 5 0.98 0.75 to 1.28 0 Fixed effects
Type of mobile phone
    Analog* 10 1.34 1.07 to 1.66 29.8 Fixed effects
        Hardell et al* 7 1.52 1.19 to 1.95 0 Fixed effects
        INTERPHONE 3 0.82 0.51 to 1.32 0 Fixed effects
    Digital (all Hardell et al)* 3 1.68 1.01 to 2.81 0 Fixed effects
Laterality of tumor (all INTERPHONE)
    Ipsilateral* 5 1.32 1.02 to 1.70 0 Fixed effects
    Contralateral 4 0.89 0.68 to 1.15 0 Fixed effects

NOTE. All included studies were population-based case-control studies.

Abbreviations: OR, odds ratio; NA, not applicable.

*Statistically significant positive association.

†Salivary gland tumor, non-Hodgkin's lymphoma, and testicular tumor.

Table

Table A3. Mobile Phone Use (versus never or rarely use) and the Risk of Brain Tumors in Subgroup Meta-Analyses

Table A3. Mobile Phone Use (versus never or rarely use) and the Risk of Brain Tumors in Subgroup Meta-Analyses

Factor No. of Studies Summary OR 95% CI of OR Heterogeneity, I2 (%) Model Used
All brain tumors 15 0.97 0.86 to 1.10 70.3 Random effects
Type of brain tumor
    Gliomas 10 1.09 0.89 to 1.34 67.9 Random effects
        Hardell et al 3 1.37 0.88 to 2.12 68.5 Random effects
        INTERPHONE* 4 0.84 0.75 to 0.96 33.9 Fixed effects
        Other groups 3 1.06 0.76 to 1.48 51.3 Random effects
    Meningiomas* 9 0.83 0.75 to 0.92 11.9 Fixed effects
        INTERPHONE* 4 0.77 0.68 to 0.88 0 Fixed effects
        Other groups 5 0.95 0.80 to 1.13 18.0 Fixed effects
    Acoustic neuromas 6 0.94 0.79 to 1.11 5.4 Fixed effects
        Hardell et al 2 1.38 0.92 to 2.08 0 Fixed effects
        INTERPHONE 3 0.88 0.72 to 1.07 0 Fixed Effecst
        Other groups 1 0.80 0.50 to 1.40 NA NA
Malignancy of brain tumor
    Malignant 7 0.99 0.79 to 1.23 74.1 Random effects
        Hardell et al 3 1.26 0.88 to 1.81 74.9 Random effects
        INTERPHONE* 2 0.77 0.65 to 0.91 0 Fixed effects
        Other groups 2 0.87 0.67 to 1.14 0 Fixed effects
    Benign* 12 0.87 0.80 to 0.95 31.0 Fixed effects
        Hardell et al 3 1.16 0.96 to 1.40 17.5 Fixed effects
        INTERPHONE* 6 0.80 0.72 to 0.89 0 Fixed effects
        Other groups 3 0.82 0.61 to 1.11 0 Fixed effects
Type of mobile phone
    Analog 8 1.02 0.83 to 1.24 62.2 Random effects
    Digital 10 0.92 0.79 to 1.07 62.5 Random effects
Laterality of brain tumor
    Ipsilateral 10 1.23 0.97 to 1.58 88.2 Random effects
    Contralateral 8 0.92 0.74 to 1.15 82.0 Random effects
Research group
    Hardell et al 4 1.29 1.02 to 1.64 64.6 Random effects
    INTERPHONE* 7 0.82 0.76 to 0.89 0 Fixed effects
    Other groups 4 0.96 0.81 to 1.13 31.7 Fixed effects
Methodologic quality
    High (low bias: ≥ 7 points) 5 1.19 0.96 to 1.49 71.7 Random effects
        Hardell et al 4 1.29 1.02 to 1.64 64.6 Random effects
        INTERPHONE 1 0.90 0.70 to 1.10 NA NA
    Low (high bias: < 7 points)* 10 0.84 0.78 to 0.91 16.2 Fixed effects
        INTERPHONE* 6 0.81 0.75 to 0.89 0 Fixed effects
        Other groups 4 0.96 0.81 to 1.13 31.7 Fixed effects
Interview blinded to patient case/control status
    Blinded (all Hardell et al) 4 1.29 1.02 to 1.64 64.6 Random effects
    Not blinded or no description* 11 0.85 0.79 to 0.91 9.5 Fixed effects
        INTERPHONE* 7 0.82 0.76 to 0.89 0 Fixed effects
        Other groups 4 0.96 0.81 to 1.13 31.7 Fixed effects

Abbreviations: OR, odds ratio; NA, not applicable.

*Statistically significant negative association.

†Statistically significant positive association.

Table

Table A4. Mobile Phone Use (v never or rarely use) and the Risk of Tumors Other Than Brain Tumors in Subgroup Meta-Analyses

Table A4. Mobile Phone Use (v never or rarely use) and the Risk of Tumors Other Than Brain Tumors in Subgroup Meta-Analyses

Factor No. of Studies Summary OR 95% CI of OR Heterogeneity, I2 (%) Model Used
All 8 0.99 0.89 to 1.10 0 Fixed effects
Type of tumor
    Salivary gland tumor 4 0.91 0.76 to 1.08 0 Fixed effects
    Non-Hodgkin's lymphoma 2 1.04 0.88 to 1.24 0 Fixed effects
    Testicular cancer 1 1.00 0.80 to 1.20 NA NA
    Uveal melanoma* 1 2.80 1.00 to 7.90 NA NA
Malignancy of tumor
    Malignant 8 1.02 0.91 to 1.15 0 Fixed effects
        Hardell et al 3 1.03 0.90 to 1.17 0 Fixed effects
        INTERPHONE 2 0.84 0.54 to 1.31 0 Fixed effects
        Other groups 3 1.10 0.82 to 1.47 44.1 Fixed effects
    Benign 3 0.90 0.70 to 1.15 0 Fixed effects
        Hardell et al 1 2.03 0.55 to 7.50 NA NA
        INTERPHONE 2 0.87 0.68 to 1.12 0 Fixed effects
Type of mobile phone
    Analog 4 0.80 0.62 to 1.04 0 Fixed effects
        Hardell et al 3 0.80 0.61 to 1.03 0 Fixed effects
        Other group 1 1.00 0.30 to 4.00 NA NA
    Digital 4 1.10 0.89 to 1.31 0 Fixed effects
        Hardell et al 3 1.07 0.88 to 1.30 0 Fixed effects
        Other group 1 1.70 0.20 to 16.00 NA NA
Laterality of tumor (all INTERPHONE)
    Ipsilateral 2 1.12 0.89 to 1.42 24.7 Fixed effects
    Contralateral 2 0.78 0.60 to 1.01 20.6 Fixed effects
Research group
    Hardell et al 3 1.03 0.90 to 1.17 0 Fixed effects
    INTERPHONE 2 0.85 0.69 to 1.05 0 Fixed effects
    Other groups 3 1.10 0.82 to 1.47 44.1 Fixed effects
Methodologic quality
    High (low bias: ≥ 7 points) 3 1.02 0.90 to 1.17 0 Fixed effects
        Hardell et al 2 1.03 0.89 to 1.19 0 Fixed effects
        Other group 1 1.00 0.70 to 1.30 NA NA
    Low (high bias: < 7 points) 5 0.94 0.79 to 1.11 31.1 Fixed effects
        Hardell et al 1 1.02 0.75 to 1.38 NA NA
        INTERPHONE 2 0.85 0.69 to 1.05 0 Fixed effects
        Other groups 2 2.04 0.92 to 4.50 0 Fixed effects
Interview blinded to patient case/control status
    Blinded 4 1.04 0.92 to 1.19 19.3 Fixed effects
        Hardell et al 3 1.03 0.90 to 1.17 0 Fixed effects
        Other group* 1 2.80 1.00 to 7.90 NA NA
    Not blinded or no description 4 0.90 0.76 to 1.07 0 Fixed effects
        INTERPHONE 2 0.85 0.69 to 1.05 0 Fixed effects
        Other groups 2 1.02 0.75 to 1.37 0 Fixed effects

Abbreviations: OR, odds ratio; NA, not applicable.

*Statistically significant positive association.

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COMPANION ARTICLES

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ARTICLE CITATION

DOI: 10.1200/JCO.2008.21.6366 Journal of Clinical Oncology 27, no. 33 (November 20, 2009) 5565-5572.

Published online October 13, 2009.

PMID: 19826127

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