title: Cancer incidence among Nordic airline cabin crew.
abstract: Airline cabin crew are occupationally exposed to cosmic radiation and jet lag with potential disruption of circadian rhythms. This study assesses the influence of work-related factors in cancer incidence of cabin crew members. A cohort of 8,507 female and 1,559 male airline cabin attendants from Finland, Iceland, Norway and Sweden was followed for cancer incidence for a mean follow-up time of 23.6 years through the national cancer registries. Standardized incidence ratios (SIRs) were defined as ratios of observed and expected numbers of cases. A case-control study nested in the cohort (excluding Norway) was conducted to assess the relation between the estimated cumulative cosmic radiation dose and cumulative number of flights crossing six time zones (indicator of circadian disruption) and cancer risk. Analysis of breast cancer was adjusted for parity and age at first live birth. Among female cabin crew, a significantly increased incidence was observed for breast cancer [SIR 1.50, 95% confidence interval (95% CI) 1.32-1.69], leukemia (1.89, 95% CI 1.03-3.17) and skin melanoma (1.85, 95% CI 1.41-2.38). Among men, significant excesses in skin melanoma (3.00, 95% CI 1.78-4.74), nonmelanoma skin cancer (2.47, 95% CI 1.18-4.53), Kaposi sarcoma (86.0, 95% CI 41.2-158) and alcohol-related cancers (combined SIR 3.12, 95% CI 1.95-4.72) were found. This large study with complete follow-up and comprehensive cancer incidence data shows an increased incidence of several cancers, but according to the case-control analysis, excesses appear not to be related to the cosmic radiation or circadian disruptions from crossing multiple time zones.
authors.affiliation: Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland. eero.pukkala@cancer.fi
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.forename: Mika
authors.initials: M
authors.lastname: Helminen
authors.forename: Tor
authors.initials: T
authors.lastname: Haldorsen
authors.forename: Niklas
authors.initials: N
authors.lastname: Hammar
authors.forename: Katja
authors.initials: K
authors.lastname: Kojo
authors.forename: Anette
authors.initials: A
authors.lastname: Linnersjö
authors.forename: Vilhjálmur
authors.initials: V
authors.lastname: Rafnsson
authors.forename: Hrafn
authors.initials: H
authors.lastname: Tulinius
authors.forename: Ulf
authors.initials: U
authors.lastname: Tveten
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
mesh_terms: D001359:Aviation; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D000078329:Workforce