Mortality from Cancer and Other Causes among Airline Cabin Attendants in Europe: A Collaborative Cohort Study in Eight Countries

Zeeb, Hajo; Blettner, Maria; Langner, Ingo; Hammer, Gaël P.; Ballard, Terri J.; Santaquilani, Mariano; Gundestrup, Maryanne; Storm, Hans H.; Haldorsen, Tor; Tveten, U.; Hammar, Niklas; Linnersjö, Anette; Velonakis, Emmanuel; Τζώνου, Αναστασία; Auvinen, Anssi; Pukkala, Eero; Rafnsson, Vilhjálmur; Hrafnkelsson, Jón

doi:10.1093/aje/kwg107

Cited by 90 publications

(85 citation statements)

References 31 publications

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“…A pooling study on cancer mortality, published in 2003, 14 was carried out in a large cohort of European female flight attendants. The authors reported a reduction in all-site cancer mortality (meta-standardized mortality ratio, meta-SMR 0.78, CI 0.66, 0.95) and a slight but nonsignificant excess in mortality from breast cancer (meta-SMR 1.11, CI 0.82, 1.48).…”

Section: Introduction Fmentioning

confidence: 99%

Cancer Incidence among Female Flight Attendants: A Meta-Analysis of Published Data

Buja

Mastrangelo

Perissinotto

et al. 2006

Journal of Women's Health

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Background: Flight attendants are exposed to cosmic ionizing radiation and other potential cancer risk factors, but only recently have epidemiological studies been performed to assess the risk of cancer among these workers. The aim of the present work was to evaluate the incidence of various types of cancer among female cabin attendants by combining cancer incidence estimates reported in published studies.Methods: All follow-up studies reporting standardized incidence ratio (SIR) for cancer among female flight attendants were obtained from online databases and analyzed. A metaanalysis was performed by applying Bayesian hierarchical models, which take into account studies that reported SIR ‫؍‬ 0 and natural heterogeneity of study-specific SIRs.Results: A total of seven published studies reporting SIR for several cancer types were extracted. Meta-analysis showed a significant excess of melanoma (meta-SIR 2.15, 95% posterior interval [PI] 1.56-2.88) and breast carcinoma (meta-SIR 1.40; PI 1.19-1.65) and a slight but not significant excess of cancer incidence across types (meta-SIR 1.11, PI 0.98-1.25).Conclusions: Although further studies are necessary to clarify the exact role of occupational exposure, all airlines should, as some companies do, estimate radiation dose, organize the schedules of crew members in order to reduce further exposure in highly exposed flight attendants, inform crew members about health risks, and give special protection to pregnant women.

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Section: Introduction Fmentioning

confidence: 99%

Cancer Incidence among Female Flight Attendants: A Meta-Analysis of Published Data

Buja

Mastrangelo

Perissinotto

et al. 2006

Journal of Women's Health

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“…A large pooled analysis of mortality data from several European countries confirmed the increased risks for skin melanoma, but did not observe increases for any other cancer sites. [9][10][11] Flight and cabin crew members have a complicated exposure history because their occupation leads to specific lifestyle characteristics, and these may act as possible confounders to the health effects of occupational hazards. Such lifestyle characteristics include recreational sunlight exposure during rest periods in hot places overseas or leisure activities.…”

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confidence: 99%

Cancer incidence in professional flight crew and air traffic control officers: Disentangling the effect of occupational versus lifestyle exposures

dos‐Santos‐Silva

Stavola

Pizzi

et al. 2012

Intl Journal of Cancer

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Flight crew are occupationally exposed to several potentially carcinogenic hazards; however, previous investigations have been hampered by lack of information on lifestyle exposures. The authors identified, through the United Kingdom Civil Aviation Authority medical records, a cohort of 16,329 flight crew and 3,165 air traffic control officers (ATCOs) and assembled data on their occupational and lifestyle exposures. Standardised incidence ratios (SIRs) were estimated to compare cancer incidence in each occupation to that of the general population; internal analyses were conducted by fitting Cox regression models. Allcancer incidence was 20-29% lower in each occupation than in the general population, mainly due to a lower incidence of smoking-related cancers [SIR (95% CI) 5 0.33 (0.27-0.38) and 0.42 (0.28-0.60) for flight crew and ATCOs, respectively], consistent with their much lower prevalence of smoking. Skin melanoma rates were increased in both flight crew (SIR 5 1.87; 95% CI 5 1.45-2.38) and ATCOs (2.66; 1.55-4.25), with rates among the former increasing with increasing number of flight hours (p-trend 5 0.02). However, internal analyses revealed no differences in skin melanoma rates between flight crew and ATCOs (hazard ratio: 0.78, 95% CI 5 0.37-1.66) and identified skin that burns easily when exposed to sunlight (p 5 0.001) and sunbathing to get a tan (p 5 0.07) as the strongest risk predictors of skin melanoma in both occupations. The similar sitespecific cancer risks between the two occupational groups argue against risks among flight crew being driven by occupationspecific exposures. The skin melanoma excess reflects sun-related behaviour rather than cosmic radiation exposure.

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“…Overall the conclusion from Zeeb et al (56) was that among airline cabin crew in Europe, there was no increase in mortality that could be attributed to cosmic radiation or other occupational exposures to any substantial extent.…”

Section: Epidemiologymentioning

confidence: 92%

“…In the study by Zeeb et al (56), the excess mortality from malignant melanoma was restricted to male cabin crew members.…”

Section: Epidemiologymentioning

confidence: 99%

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Cosmic radiation in commercial aviation

Bagshaw

2008

Travel Medicine and Infectious Disease

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This paper reviews the current knowledge of cosmic radiation and its applicability to commercial aviation. Galactic cosmic radiation emanates from outside the solar system, while occasionally a disturbance in the sun's atmosphere leads to a surge in radiation particles. Protection is provided by the sun's magnetic field, the earth's magnetic field, and the earth's atmosphere. Dose rates are dependent on the altitude, the geomagnetic latitude and the solar cycle. For occupational exposure to ionising radiation, which includes aircrew, the International Commission on Radiological Protection recommends maximum mean body effective dose limits of 20 mSv per year (averaged over 5 years, with a maximum in any one year of 50 mSv). Radiation doses can be measured during flight or may be calculated using a computermodelling program such as CARI, EPCARD, SIEVERT or PCAIRE. Mean ambient equivalent dose rates are in the region of 4 -5 µSv per hour for long-haul pilots and 1 -3 µSv per hour for short-haul, giving an annual mean effective exposure of the order 2 -3 mSv for long-haul and 1 -2 mSv for short-haul pilots. Epidemiological studies of flight crew have not shown any increase in cancer mortality or cancer incidence that could be directly attributable to ionising radiation exposure. Whilst it is accepted that there is no level of radiation exposure below which effects do not occur, all the current evidence indicates that the probability of airline crew or passengers suffering any abnormality or disease as a result of exposure to cosmic radiation is very low.Keywords: Galactic cosmic radiation, solar flare, coronal mass ejection, ground level enhancement (GLE), International Commission on Radiological Protection (ICRP), dose rate effectiveness (DREF), linear energy transfer (LET), relative biological effectiveness (RBE), quality factor (QF), chromosome aberrations, CARI, EPCARD, SIEVERT, PCAIRE. IntroductionThe planet earth is continuously bathed in high-energy ionising radiation known as galactic cosmic radiation (GCR), emanating from outside the solar system, and sporadically exposed to bursts of energetic particles from the sun referred to as solar particle events (SPEs).The main source of GCR is believed to be supernovae (exploding stars), while occasionally a disturbance in the sun's atmosphere (solar flare or coronal mass ejection) leads to a surge of radiation particles with sufficient energy to penetrate the earth's magnetic field and enter the atmosphere. Ionising RadiationIonising radiation refers to subatomic particles that, on interacting with an atom, can directly or indirectly cause the atom to lose an electron or even break apart its nucleus. It is when these events occur in body tissue that health effects may result if the human body's self-repair mechanism fails.Ionising radiation is a normal part of the environment. It is emitted in all normal human tissue cells, and emanates from the ground and some building materials. It is used as a medical diagnostic and treatment tool, and is received from GCR. 2Io...

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Mortality from Cancer and Other Causes among Airline Cabin Attendants in Europe: A Collaborative Cohort Study in Eight Countries

Cited by 90 publications

References 31 publications

Cancer Incidence among Female Flight Attendants: A Meta-Analysis of Published Data

Cancer Incidence among Female Flight Attendants: A Meta-Analysis of Published Data

Cancer incidence in professional flight crew and air traffic control officers: Disentangling the effect of occupational versus lifestyle exposures

Cosmic radiation in commercial aviation

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