title: Cancer incidence and mortality among flight personnel: a meta-analysis.
abstract: BACKGROUND
  Increased cancer risk among flight personnel have previously been noted, including breast cancer among flight attendants and acute myeloid leukemia among pilots.
  
  
  OBJECTIVE
  Exposure to cosmic radiation and other physical or chemical agents may pose health risks for flight personnel.
  
  
  METHODS
  We performed an exhaustive search for published and unpublished cohort studies of flight personnel from 1986-98. We combined relative risks (RR) for selected causes from four mortality and/or incidence studies of pilots and two incidence studies of flight attendants, using standard meta-analytic methods. Heterogeneity among the combined studies was explored and adjustments were made for possible confounding by socioeconomic status (SES), where indicated, using correction factors from published studies.
  
  
  RESULTS
  SES-adjusted combined RRs were elevated (>1.2) among male pilots for mortality from melanoma 11.97 (95%, CI: 1.02-3.82)] and brain cancer [1.49 (0.89-2.20)], and for cancer incidence of the prostate [1.65 (1.19-2.29)] and the brain [1.74 (0.87-3.30)]. Among female flight attendants, increases were seen for incidence of all cancers [1.29 (0.98-1.70)], melanoma [11.54 (0.83-2.87)], and breast cancer [1.35 (1.00-1.83)].
  
  
  CONCLUSIONS
  Flight personnel appear to be at increased risk for several types of cancer. Both occupational exposures and well-established non-occupational risk factors may contribute to this increased risk. To better control for confounding factors and to identify exposures potentially amenable to preventive measures, future studies should compare risks within cohorts by flight routes, work history, and exposure to cosmic and UV radiation, electromagnetic fields, and chemical substances.
authors.affiliation: Istituto Superiore di Sanità, Laboratorio di Igiene Ambientale, Rome, Italy. ballard@iss.it
authors.forename: T
authors.initials: T
authors.lastname: Ballard
authors.forename: S
authors.initials: S
authors.lastname: Lagorio
authors.forename: G
authors.initials: G
authors.lastname: De Angelis
authors.forename: A
authors.initials: A
authors.lastname: Verdecchia
mesh_terms: D000328:Adult; D000368:Aged; D000401:Aircraft; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D016273:Occupational Exposure; D018570:Risk Assessment