title: The risk of melanoma in airline pilots and cabin crew: a meta-analysis.
abstract: OBJECTIVE
  Airline pilots and cabin crew are occupationally exposed to higher levels of cosmic and UV radiation than the general population, but their risk of developing melanoma is not yet established.
  
  
  OBJECTIVE
  To assess the risk of melanoma in pilots and airline crew.
  
  
  METHODS
  PubMed (1966 to October 30, 2013), Web of Science (1898 to January 27, 2014), and Scopus (1823 to January 27, 2014).
  
  
  METHODS
  All studies were included that reported a standardized incidence ratio (SIR), standardized mortality ratio (SMR), or data on expected and observed cases of melanoma or death caused by melanoma that could be used to calculate an SIR or SMR in any flight-based occupation.
  
  
  METHODS
  Primary random-effect meta-analyses were used to summarize SIR and SMR for melanoma in any flight-based occupation. Heterogeneity was assessed using the χ2 test and I2 statistic. To assess the potential bias of small studies, we used funnel plots, the Begg rank correlation test, and the Egger weighted linear regression test.
  
  
  METHODS
  Summary SIR and SMR of melanoma in pilots and cabin crew.
  
  
  RESULTS
  Of the 3527 citations retrieved, 19 studies were included, with more than 266 431 participants. The overall summary SIR of participants in any flight-based occupation was 2.21 (95% CI, 1.76-2.77; P < .001; 14 records). The summary SIR for pilots was 2.22 (95% CI, 1.67-2.93; P = .001; 12 records). The summary SIR for cabin crew was 2.09 (95% CI, 1.67-2.62; P = .45; 2 records). The overall summary SMR of participants in any flight-based occupation was 1.42 (95% CI, 0.89-2.26; P = .002; 6 records). The summary SMR for pilots was 1.83 (95% CI, 1.27-2.63, P = .33; 4 records). The summary SMR for cabin crew was 0.90 (95% CI, 0.80-1.01; P = .97; 2 records).
  
  
  CONCLUSIONS
  Pilots and cabin crew have approximately twice the incidence of melanoma compared with the general population. Further research on mechanisms and optimal occupational protection is needed.
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco2Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Sanlorenzo
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco3School of Medicine, Stanford University, Stanford, California.
authors.forename: Mackenzie R
authors.initials: MR
authors.lastname: Wehner
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco.
authors.forename: Eleni
authors.initials: E
authors.lastname: Linos
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco.
authors.forename: John
authors.initials: J
authors.lastname: Kornak
authors.affiliation: Center for Devices and Radiological Health, Division of Physics, US Food and Drug Administration, Silver Spring, Maryland.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kainz
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco6Department of Dermatology,The Rudolfstiftung Hospital, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Posch
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco6Department of Dermatology,The Rudolfstiftung Hospital, Vienna, Austria.
authors.forename: Igor
authors.initials: I
authors.lastname: Vujic
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco.
authors.forename: Katia
authors.initials: K
authors.lastname: Johnston
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco.
authors.forename: Deborah
authors.initials: D
authors.lastname: Gho
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Monico
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco.
authors.forename: James T
authors.initials: JT
authors.lastname: McGrath
authors.affiliation: Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Osella-Abate
authors.affiliation: Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Quaglino
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco.
authors.forename: James E
authors.initials: JE
authors.lastname: Cleaver
authors.affiliation: Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco.
authors.forename: Susana
authors.initials: S
authors.lastname: Ortiz-Urda
mesh_terms: D000401:Aircraft; D001359:Aviation; D003359:Cosmic Radiation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008545:Melanoma / Q000453:epidemiology* / Q000209:etiology; D009784:Occupational Diseases / Q000453:epidemiology* / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects; D012306:Risk; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology; D014466:Ultraviolet Rays / Q000009:adverse effects