Prostate Cancer Incidence in U.S. Air Force Aviators Compared with Non-Aviators

Abstract

Introduction Several studies investigating whether prostate cancer incidence is elevated in aviators both in the civilian and military sectors have yielded inconsistent findings. Most investigations have compared aviators to the general population. Instead, our study compared prostate cancer incidence rates among officer aviator and non-aviators in the United States Air Force to reduce confounding by socioeconomic status and frequency of medical exams. Methods This retrospective analysis ascertained prostate cancer cases using the Automated Cancer Tumor Registry of the Department of Defense linked to personnel records from the USAF Personnel Center to identify aviators and non-aviators. Survival analysis using the Cox Proportional Hazards model allowed comparison of prostate cancer incidence rates in USAF aviators and non-aviators. Results After adjustment for age and race, the hazards ratio for prostate cancer incidence comparing aviators with non-aviators was 1.15 (95 % confidence interval, 0.85-1.44). Neither prostate cancer incidence nor time to diagnosis differed significantly between the two groups. Conclusion Our study compared prostate cancer rates in aviators with a reference group of non-aviators similar in socio-economic level and frequency of exams. When compared to this internal reference group the risk of prostate cancer in USAF officer aviators appeared similar with no significant excess.

Retracted: Many young men with prostate‐specific antigen (PSA) screen‐detected prostate cancers may be candidates for active surveillance

“…Second, annual and retirement physical examinations (93% of DoD servicemen retire by the age of 50 years) are mandatory for all personnel, and this heightened vigilance probably increases PSA screening and disease detection, compared with screening in the general population. Our earlier study argued against the possibility that this elevated prostate cancer rate resulted from occupational factors. Third, the argument that financial considerations and medicolegal issues bias physicians toward aggressive management of even very‐low‐risk disease is not pertinent to the Armed Forces, in which there is no case‐volume reimbursement, and litigation by servicemen is prohibited.…”

Malignancy in U.S. Air Force fighter pilots and other officers, 1986–2017: A retrospective cohort study

“…The association seen in the former study disappeared after adjustment for socioeconomic status; similar adjustment was not performed in the latter study. A study evaluating prostate cancer incidence in the active duty U.S. Air Force population from 1987 through 2008 found no difference between aviators and non-aviators [27]. A large study of male active duty U.S. Air Force officers from 1975 through 1989 (officers followed an average of 7.1 years), which relied entirely on hospitalization records (apparently not confirmed by chart review), found that aviators had higher rates of all cancers combined, testicular cancer, and bladder cancer, compared to non-flying officers.…”

Cancer Incidence and Mortality Among Fighter Aviators in the United States Air Force

“…First, each featured a relatively small number of cases. The largest cancer-specific sample size was 73 cases of prostate cancer 7 ; most cancer counts were in the single digits. Second, they had variable inclusion criteria regarding airframe type and seat position, such as combining fixed-wing and rotary-wing airframes or restricting to pilots proper, thus complicating generalizability.…”