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Park S, Lee GB, Lee D, Cha ES, Han K, Cho M, Seo S. Cancer risk among air transportation industry workers in Korea: a national health registry-based study. BMC Public Health 2024; 24:2435. [PMID: 39244541 PMCID: PMC11380205 DOI: 10.1186/s12889-024-19904-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Flight attendants face various risk factors in their working environments, particularly occupational exposure to cosmic radiation. This study aimed to assess cancer risk among air transportation industry workers, including flight attendants, in Korea by constructing a cohort using national health registry-based data and analyzing cancer incidence risk. METHODS We used the Korea National Health Insurance Service database from 2002 to 2021 to construct a cohort of 37,011 workers in the air transportation industry. Cancer incidence was defined using the tenth version of the International Classification of Diseases. We calculated the age- and sex-specific standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) by applying the cancer incidence rate of the general population between 2002 and 2019. RESULTS Approximately 5% of the cohort developed cancer. Overall, the cancer incidence in the cohort was similar to or lower than that of the general population, with the SIRs for all cancers being lower. However, significantly higher SIRs were observed for nasopharyngeal cancer (SIR, 3.21; 95% CI, 1.71-5.48) and non-Hodgkin lymphoma (SIR, 1.57; 95% CI, 1.02-2.32) in male workers and breast and genital cancer (SIR, 1.51; 95% CI, 1.34-1.70) and thyroid cancer (SIR, 1.25; 95% CI, 1.05-1.47) in female workers. CONCLUSIONS The lower overall cancer incidence among air transportation industry workers observed in this study could indicate the "healthy worker effect"; however, the incidences of certain cancers were higher than those in the general population. Given that these workers are exposed to multiple occupational and lifestyle-related risk factors, including cosmic radiation, further studies are necessary to determine radiation-induced cancer risk while considering potential confounding factors.
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Affiliation(s)
- Soojin Park
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, 01812, Republic of Korea
| | - Ga Bin Lee
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, 01812, Republic of Korea
| | - Dalnim Lee
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, 01812, Republic of Korea
| | - Eun-Shil Cha
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, 01812, Republic of Korea
| | - Kyunghee Han
- Department of Health and Safety Convergence Science, Korea University College of Health Science, Seoul, South Korea
| | - Minsu Cho
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, 01812, Republic of Korea
| | - Songwon Seo
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, 01812, Republic of Korea.
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Little MP, Bazyka D, de Gonzalez AB, Brenner AV, Chumak VV, Cullings HM, Daniels RD, French B, Grant E, Hamada N, Hauptmann M, Kendall GM, Laurier D, Lee C, Lee WJ, Linet MS, Mabuchi K, Morton LM, Muirhead CR, Preston DL, Rajaraman P, Richardson DB, Sakata R, Samet JM, Simon SL, Sugiyama H, Wakeford R, Zablotska LB. A Historical Survey of Key Epidemiological Studies of Ionizing Radiation Exposure. Radiat Res 2024; 202:432-487. [PMID: 39021204 PMCID: PMC11316622 DOI: 10.1667/rade-24-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/23/2024] [Indexed: 07/20/2024]
Abstract
In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis.
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Affiliation(s)
- Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | | | - Alina V. Brenner
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Vadim V. Chumak
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | - Harry M. Cullings
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Grant
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Gerald M. Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay aux Roses France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Martha S. Linet
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | | | | | - Preetha Rajaraman
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - David B. Richardson
- Environmental and Occupational Health, 653 East Peltason, University California, Irvine, Irvine, CA 92697-3957 USA
| | - Ritsu Sakata
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Jonathan M. Samet
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Steven L. Simon
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Hiromi Sugiyama
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16 Street, 2 floor, San Francisco, CA 94143, USA
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Russo AC, Marqueze EC, Furst MSG, Benevides EADSE, Roscani RC, Salim CA, Guimarães PCV. Aircrew Health: A Systematic Review of Physical Agents as Occupational Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105849. [PMID: 37239575 DOI: 10.3390/ijerph20105849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 05/28/2023]
Abstract
The primary objective of this systematic review was to analyze the main physical agents representing risk factors for commercial aircrew, together with their consequences. The secondary objective was to identify the countries in which studies on the topic were conducted, as well as the quality of the publications available. Thirty-five articles, published between 1996 and 2020, were selected for the review, having met all inclusion criteria. The majority of studies were conducted in the United States, Germany, and Finland and had moderate or low methodological quality of evidence. The main risk factors for aircrew identified in publications were exposure to abnormal air pressure, cosmic radiation, noise, and vibrations. Hypobaric pressure was explored in response to demands for studies on this agent, a factor which may lead to otic and ear barotraumas, as well as acceleration of atherosclerosis of the carotid artery. However, there is a dearth of research exploring this phenomenon.
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Affiliation(s)
- Ana Carolina Russo
- Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho-Fundacentro, São Paulo 30180-100, Brazil
| | - Elaine Cristina Marqueze
- Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho-Fundacentro, São Paulo 30180-100, Brazil
| | - Mariana Souza Gomes Furst
- Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho-Fundacentro, São Paulo 30180-100, Brazil
| | | | - Rodrigo Caoduro Roscani
- Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho-Fundacentro, São Paulo 30180-100, Brazil
| | - Celso Amorim Salim
- Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho-Fundacentro, São Paulo 30180-100, Brazil
| | - Paulo Cesar Vaz Guimarães
- Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho-Fundacentro, São Paulo 30180-100, Brazil
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Pedersen JE, Hansen J. Incident skin melanoma in Danish male military pilots: a nested case-control study. Occup Environ Med 2023; 80:239-245. [PMID: 36927732 DOI: 10.1136/oemed-2022-108747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES A growing body of research has reported that pilots have an increased risk of skin melanoma, which may be caused by occupational exposure to cosmic and solar ultraviolet A radiation in aircraft cockpits. However, the existing literature cannot rule out confounding, for example, that pilots may spend more leisure time in the sun compared with the general population, which therefore leaves the current evidence inconclusive. The present study aimed to provide more knowledge regarding this association. METHODS This nested case-control study included 199 male cases of skin melanoma diagnosed between 1990 and 2003, and 1126 male cancer-free controls identified from a large Danish military population. Among these individuals, 10 cases had ever worked as a pilot.Detailed information on military service and other held jobs together with socioeconomic and lifestyle characteristics, for example, leisure-time sun exposure habits, had been obtained from a structured questionnaire. RESULTS Adjusted results showed a positive association between work onboard aircraft and skin melanoma (OR=2.30, 95% CI: 1.06-4.97) and the risk was indicated only to be increased in pilots (OR=7.08, 95% CI: 2.51-19.93). A positive association between longer duration of employment as a pilot and skin melanoma was also observed (ORper year=1.07, 95% CI: 1.01-1.14). CONCLUSIONS The findings from this study conducted among Danish military personnel suggest that pilots have an increased risk of skin melanoma after accounting for leisure-time sun exposure and socioeconomic status. Future large-scale studies focusing on the risk of skin melanoma in pilots, including detailed objective information on dimensions of exposure and potential confounders, are warranted.
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Affiliation(s)
| | - Johnni Hansen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
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5
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Yong SS, Han WH, Faheem NAA, Puvan N, Tan LL, Wong SM, Kwan Z. Predictive factors of sun protection behaviour among global airline pilots. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:541-547. [PMID: 35324018 DOI: 10.1111/phpp.12787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Airline pilots face significant ultraviolet radiation exposure resulting in an increased risk of sun damage and skin cancers. We aimed to evaluate sun-protective practices and associated factors among airline pilots. METHODS We disseminated an online questionnaire evaluating the use of sunscreen, sunglasses, hats and protective clothing during daytime hours in the cockpit and during outdoor activities to 346 global commercial airline pilots, and we received 220 completed responses. The Pearson chi-squared test or Fisher's exact test where necessary were used to determine possible factors associated with the use of sun-protective practices. Potential confounders were adjusted for using multivariate analyses. RESULTS The most common sun protective behaviour was the wearing of sunglasses during daytime flights (89.5%), followed by the use of caps during outdoor activities (47.7%). More pilots applied sunscreen during daytime flights (14.1%) compared with walk-arounds (8.2%). Males were less likely to use sunscreen during flights (adjusted odds ratio, aOR = 0.76), use sunscreen for walk-arounds (aOR = 0.175) and wear long sleeves (aOR = 0.013). Pilots who flew less than 30 h a month in high latitude regions were less likely to use a cap or hat outdoors (aOR = 0.419) or use sunscreen during walk-arounds (aOR = 0.241). Younger pilots were also less likely to use caps or hats outdoors (aOR = 0.446). CONCLUSION Male pilots and those who spent less time in high latitudes were less likely to practice sun protection. Targeted educational efforts may be implemented to reduce occupational ultraviolet exposure.
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Affiliation(s)
- Shin Shen Yong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Winn Hui Han
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nik Aimee Azizah Faheem
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nisha Puvan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Leng Leng Tan
- Thomson Hospital Kota Damansara, Petaling Jaya, Malaysia
| | - Su-Ming Wong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zhenli Kwan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Miller KB, Mi KL, Nelson GA, Norman RB, Patel ZS, Huff JL. Ionizing radiation, cerebrovascular disease, and consequent dementia: A review and proposed framework relevant to space radiation exposure. Front Physiol 2022; 13:1008640. [PMID: 36388106 PMCID: PMC9640983 DOI: 10.3389/fphys.2022.1008640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/29/2022] [Indexed: 09/05/2023] Open
Abstract
Space exploration requires the characterization and management or mitigation of a variety of human health risks. Exposure to space radiation is one of the main health concerns because it has the potential to increase the risk of cancer, cardiovascular disease, and both acute and late neurodegeneration. Space radiation-induced decrements to the vascular system may impact the risk for cerebrovascular disease and consequent dementia. These risks may be independent or synergistic with direct damage to central nervous system tissues. The purpose of this work is to review epidemiological and experimental data regarding the impact of low-to-moderate dose ionizing radiation on the central nervous system and the cerebrovascular system. A proposed framework outlines how space radiation-induced effects on the vasculature may increase risk for both cerebrovascular dysfunction and neural and cognitive adverse outcomes. The results of this work suggest that there are multiple processes by which ionizing radiation exposure may impact cerebrovascular function including increases in oxidative stress, neuroinflammation, endothelial cell dysfunction, arterial stiffening, atherosclerosis, and cerebral amyloid angiopathy. Cerebrovascular adverse outcomes may also promote neural and cognitive adverse outcomes. However, there are many gaps in both the human and preclinical evidence base regarding the long-term impact of ionizing radiation exposure on brain health due to heterogeneity in both exposures and outcomes. The unique composition of the space radiation environment makes the translation of the evidence base from terrestrial exposures to space exposures difficult. Additional investigation and understanding of the impact of low-to-moderate doses of ionizing radiation including high (H) atomic number (Z) and energy (E) (HZE) ions on the cerebrovascular system is needed. Furthermore, investigation of how decrements in vascular systems may contribute to development of neurodegenerative diseases in independent or synergistic pathways is important for protecting the long-term health of astronauts.
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Affiliation(s)
| | | | - Gregory A. Nelson
- Department of Basic Sciences, Division of Biomedical Engineering Sciences, Loma Linda University, Loma Linda, CA, United States
- NASA Johnson Space Center, Houston, TX, United States
- KBR Inc., Houston, TX, United States
| | - Ryan B. Norman
- NASA Langley Research Center, Hampton, VA, United States
| | - Zarana S. Patel
- NASA Johnson Space Center, Houston, TX, United States
- KBR Inc., Houston, TX, United States
| | - Janice L. Huff
- NASA Langley Research Center, Hampton, VA, United States
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Miura K, Coroneo M, Dusingize JC, Olsen CM, Tinker R, Karipidis K, Hosegood I, Green AC. Prevalence of cataract among Australian commercial airline pilots. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2022; 78:7-13. [PMID: 35343880 DOI: 10.1080/19338244.2022.2056110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Because little is known about cataract in pilots, we estimated prevalence by anonymously ascertaining all commercial airline pilots diagnosed with cataract 2011-2016 using the electronic Medical Records System of the Australian Civil Aviation Safety Authority. Of 14,163 Australian male commercial pilots licensed in 2011, 1286 aged ≥60 had biennial eye examinations showing a cataract prevalence of 11.6%. Among 12,877 pilots aged <60, based on compulsory eye examinations only when first licensed, prevalence was 0.5%. There was no significant difference by ambient ultraviolet (UV) radiation levels in state of residence though lowest prevalence was seen in the low-UV state of Victoria. Most cataract in pilots ≥60 years was bilateral and of mild severity, while cataract in pilots <60 were more likely to be unilateral and of greater severity.
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Affiliation(s)
- Kyoko Miura
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Faculty of Medicine, the University of Queensland, Brisbane, Queensland, Australia
| | - Minas Coroneo
- Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, Sydney, Australia
| | - Jean Claude Dusingize
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Catherine M Olsen
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Faculty of Medicine, the University of Queensland, Brisbane, Queensland, Australia
| | - Rick Tinker
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia
| | - Ken Karipidis
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia
| | - Ian Hosegood
- Qantas Airlines Limited, Mascot, Sydney, Australia
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- CRUK Manchester Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Hayes K, Megson D, Doyle A, O'Sullivan G. Occupational risk of organophosphates and other chemical and radiative exposure in the aircraft cabin: A systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 796:148742. [PMID: 34375198 DOI: 10.1016/j.scitotenv.2021.148742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/21/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
Occupational exposure to oil fumes, organophosphates, halogenated flame retardants, and other volatile and semi-volatile contaminants is a concern within the aviation industry. There is no current consensus on the risk attributed to exposure to these chemical classes within the aircraft cabin. Contaminant concentrations rarely exceed conventional air quality guidelines, but concerns have been raised about these guidelines' applicability within the aircraft environment. This systematic review, the largest and most comprehensive completed to date on the subject matter, aims to synthesize the existing research related to chemical and other exposures inside the aircraft cabin to determine the occupational risk that may be attributed said exposure, as well as, determine knowledge gaps in source, pathway, and receptor that may exist. The Science Direct, Scopus, and Web of Science databases were queried with five search terms generating 138 manuscripts that met acceptance criteria and screening. Several potential areas requiring future examination were identified: Potable water on aircraft should be examined as a potential source of pollutant exposure, as should air conditioning expansion turbines. Historical exposure should also be more fully explored, and non-targeted analysis could provide valuable information to comprehend the aircraft cabin exposome. Occupational risk under typical flight scenarios appears to be limited for most healthy individuals. Contaminants of concern were demonstrated to be extant within the cabin, however the concentrations under normal circumstances do not appear to be individually responsible for the symptomologies that are present in impacted individuals. Questions remain regarding those that are more vulnerable or susceptible to exposure. Additionally, establishing the effects of chronic low dose exposure and exposure to contaminant mixtures has not been satisfied. The risk of acute exposure in mitigable fume events is substantial, and technological solutions or the replacement of compounds of concern for safer alternatives should be a priority.
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Affiliation(s)
- Kevin Hayes
- Manchester Metropolitan University, Department of Natural Sciences, Chester Street, Manchester M1 5GD, UK; Mount Royal University, Department of Earth & Environmental Science, Calgary, Alberta T3E 6K6, Canada.
| | - David Megson
- Manchester Metropolitan University, Department of Natural Sciences, Chester Street, Manchester M1 5GD, UK
| | - Aidan Doyle
- Manchester Metropolitan University, Department of Natural Sciences, Chester Street, Manchester M1 5GD, UK
| | - Gwen O'Sullivan
- Mount Royal University, Department of Earth & Environmental Science, Calgary, Alberta T3E 6K6, Canada
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Toprani SM, Scheibler C, Nagel ZD. Interplay Between Air Travel, Genome Integrity, and COVID-19 Risk vis-a-vis Flight Crew. Front Public Health 2020; 8:590412. [PMID: 33392133 PMCID: PMC7775589 DOI: 10.3389/fpubh.2020.590412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/16/2020] [Indexed: 01/04/2023] Open
Abstract
During air travel, flight crew (flight attendants, pilots) can be exposed to numerous flight-related environmental DNA damaging agents that may be at the root of an excess risk of cancer and other diseases. This already complex mix of exposures is now joined by SARS-CoV-2, the virus that causes COVID-19. The complex exposures experienced during air travel present a challenge to public health research, but also provide an opportunity to consider new strategies for understanding and countering their health effects. In this article, we focus on threats to genomic integrity that occur during air travel and discuss how these threats and our ability to respond to them may influence the risk of SARS-CoV-2 infection and the development of range of severity of the symptoms. We also discuss how the virus itself may lead to compromised genome integrity. We argue that dauntingly complex public health problems, such as the challenge of protecting flight crews from COVID-19, must be met with interdisciplinary research teams that include epidemiologists, engineers, and mechanistic biologists.
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Affiliation(s)
- Sneh M. Toprani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Christopher Scheibler
- Environmental and Occupational Medicine and Epidemiology Program, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Zachary D. Nagel
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Abstract
Exposure of aircrew to cosmic radiation has been recognized as an occupational health risk for several decades. Based on the recommendations by the International Commission on Radiological Protection (ICRP), many countries and their aviation authorities, respectively have either stipulated legal radiation protection regulations, e.g., in the European Union or issued corresponding advisory circulars, e.g., in the United States of America. Additional sources of ionizing and non-ionizing radiation, e.g., due to weather phenomena have been identified and discussed in the scientific literature in recent years. This article gives an overview of the different generally recognized sources due to weather as well as space weather phenomena that contribute to radiation exposure in the atmosphere and the associated radiation effects that might pose a risk to aviation safety at large, including effects on human health and avionics. Furthermore, potential mitigation measures for several radiation sources and the prerequisites for their use are discussed.
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Dreger S, Wollschläger D, Schafft T, Hammer GP, Blettner M, Zeeb H. Cohort study of occupational cosmic radiation dose and cancer mortality in German aircrew, 1960–2014. Occup Environ Med 2020; 77:285-291. [DOI: 10.1136/oemed-2019-106165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/12/2019] [Accepted: 01/13/2020] [Indexed: 11/03/2022]
Abstract
ObjectivesTo determine cancer mortality compared with the general population and to examine dose-response relationships between cumulative occupational radiation dose and specific cancer outcomes in the German aircrew cohort.MethodsFor a cohort of 26 846 aircrew personnel, standardised mortality ratios (SMR) were calculated. Dose-response analyses were carried out using Poisson regression to assess dose-related cancer risks for the period 1960–2014. Exposure assessment comprises recently available dose register data for all cohort members and newly estimated retrospective cabin crew doses for 1960–2003.ResultsSMR for all-cause, specific cancer groups and most individual cancers were reduced in all aircrew groups. The only increases were seen for brain cancer in pilots (n=23, SMR 2.01, 95% CI 1.15 to 3.28) and for malignant melanoma (n=10, SMR 1.88, 95% CI 0.78 to 3.85). Breast cancer mortality among female cabin crew was similar to the general population (n=71, SMR 1.06, 95% CI 0.77 to 1.44). Overall median cumulative effective dose was 34.2 mSv (max: 116 mSv) for 1960–2014. No dose-response associations were seen in any of the models. For brain cancer, relative risks were elevated across dose categories. An indicative negative trend with increasing dose category was seen for large intestine cancer in female cabin crew (n=23).ConclusionsThere was no evidence for significant dose-response patterns for the considered cancer types. Interpretation of results remains difficult as cumulative dose is closely related to age. Future work should focus on investigating radiation jointly with other risk factors that may contribute to risks for specific cancers among aircrew.
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Miura K, Olsen C, Rea S, Marsden J, Green A. Do airline pilots and cabin crew have raised risks of melanoma and other skin cancers? Systematic review and meta‐analysis. Br J Dermatol 2019; 181:55-64. [DOI: 10.1111/bjd.17586] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- K. Miura
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston QLD 4006 Australia
| | - C.M. Olsen
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston QLD 4006 Australia
| | - S. Rea
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston QLD 4006 Australia
| | - J. Marsden
- Queen Elizabeth Hospital Birmingham B15 2GW U.K
| | - A.C. Green
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston QLD 4006 Australia
- CRUK Manchester Institute and Faculty of Biology, Medicine and Health University of Manchester Manchester Academic Health Science Centre Manchester U.K
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Liu GS, Cook A, Richardson M, Vail D, Holsinger FC, Oakley-Girvan I. Thyroid cancer risk in airline cockpit and cabin crew: a meta-analysis. CANCERS OF THE HEAD & NECK 2018; 3:7. [PMID: 31093360 PMCID: PMC6460828 DOI: 10.1186/s41199-018-0034-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/25/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Airline crew are exposed to ionizing radiation as part of their occupation and have a documented increased risk of melanoma and cataracts. However, whether their occupation predisposes them to an increased risk of thyroid cancer is not established. The purpose of this systematic review and meta-analysis was to assess the risk of thyroid cancer in airline cockpit and cabin crew compared with the general population. METHODS The MEDLINE database accessed via PubMed and Cochrane Database were searched. We included cohort studies reporting the standardized incidence ratio (SIR) or standardized mortality ratio (SMR) of thyroid cancers in any flight-based occupation. RESULTS Of the 1777 citations retrieved in PubMed, eight studies with a total of 243,088 aircrew members and over 3,334,114 person-years of follow-up were included in this meta-analysis. No relevant studies were identified on Cochrane Database. The overall summary SIR of participants in any flight-based occupation was 1.11 (95% CI, 0.79-1.57; p = 0.613; 6 records). The summary SIR for cockpit crew was 1.21 (95% CI, 0.75-1.95; p = 0.383; 4 records) and the summary SIR for cabin crew was 1.00 (95% CI, 0.60-1.66; p = 0.646; 2 records). The overall summary standardized mortality ratio for airline crew was 1.19 (95% CI, 0.59-2.39; p = 0.773; 2 records). CONCLUSION Airline crew were not found to have a significantly elevated risk of thyroid cancer incidence or mortality relative to the general population. Future research should capitalize on the growing occupational cohort dataset and employ innovative methods to quantify lifetime radiation exposure to further assess thyroid cancer risk in airline crew.
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Affiliation(s)
- George S. Liu
- Stanford University School of Medicine, Stanford University, 450 Serra Mall, Stanford, CA 94305 USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305 USA
| | - Austin Cook
- Stanford University School of Medicine, Stanford University, 450 Serra Mall, Stanford, CA 94305 USA
| | - Michael Richardson
- Stanford University School of Medicine, Stanford University, 450 Serra Mall, Stanford, CA 94305 USA
| | - Daniel Vail
- Stanford University School of Medicine, Stanford University, 450 Serra Mall, Stanford, CA 94305 USA
| | - F. Christopher Holsinger
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305 USA
| | - Ingrid Oakley-Girvan
- Cancer Prevention Institute of California, Fremont, CA 94538 USA
- Department of Health Research and Policy, the Canary Center at Stanford for Cancer Early Detection and the Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305 USA
- Public Health Institute, Oakland, CA 94607 USA
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14
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Pinkerton LE, Hein MJ, Anderson JL, Christianson A, Little MP, Sigurdson AJ, Schubauer-Berigan MK. Melanoma, thyroid cancer, and gynecologic cancers in a cohort of female flight attendants. Am J Ind Med 2018; 61:572-581. [PMID: 29687925 DOI: 10.1002/ajim.22854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Flight attendants may have an increased risk of some cancers from occupational exposure to cosmic radiation and circadian disruption. METHODS The incidence of thyroid, ovarian, and uterine cancer among ∼6000 female flight attendants compared to the US population was evaluated via life table analyses. Associations of these cancers, melanoma, and cervical cancer with cumulative cosmic radiation dose and metrics of circadian disruption were evaluated using Cox regression. RESULTS Incidence of thyroid, ovarian, and uterine cancer was not elevated. No significant, positive exposure-response relations were observed. Weak, non-significant, positive relations were observed for thyroid cancer with cosmic radiation and time zones crossed and for melanoma with another metric of circadian disruption. CONCLUSIONS We found little evidence of increased risk of these cancers from occupational cosmic radiation or circadian disruption in female flight attendants. Limitations include few observed cases of some cancers, limited data on risk factors, and misclassification of exposures.
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Affiliation(s)
- Lynne E. Pinkerton
- Industrywide Studies Branch; Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Misty J. Hein
- Industrywide Studies Branch; Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Jeri L. Anderson
- Industrywide Studies Branch; Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Annette Christianson
- Industrywide Studies Branch; Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Mark P. Little
- Radiation Epidemiology Branch; Division of Cancer Epidemiology and Genetics; National Cancer Institute; Bethesda Maryland
| | - Alice J. Sigurdson
- Radiation Epidemiology Branch; Division of Cancer Epidemiology and Genetics; National Cancer Institute; Bethesda Maryland
| | - Mary K. Schubauer-Berigan
- Industrywide Studies Branch; Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
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15
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Rafnsson V. The incidence of breast cancer among female flight attendants: an updated meta-analysis. J Travel Med 2017; 24:4049420. [PMID: 28931144 DOI: 10.1093/jtm/tax051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Vilhjalmur Rafnsson
- Department of Preventive Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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16
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Gudmundsdottir EM, Hrafnkelsson J, Rafnsson V. Incidence of cancer among licenced commercial pilots flying North Atlantic routes. Environ Health 2017; 16:86. [PMID: 28814301 PMCID: PMC5559846 DOI: 10.1186/s12940-017-0295-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND To evaluate cancer incidence among licenced commercial pilots in association with cosmic radiation. METHODS Cohort study where ionizing radiation dose of cosmic radiation was estimated from airline data and software program and cancer incidence was obtained by record linkage with nation-wide cancer registry. All licenced commercial male airline pilots were followed from 1955 to 2015, ever or never employed at airline with international routes. Standardized incidence ratios were calculated and relative risk by Poisson regression, to examine exposure-response relation. RESULTS Eighty three cancers were registered compared with 92 expected; standardized incidence ratios were 0.90 (95% CI 0.71 to 1.11) for all cancers, 3.31 (95% CI 1.33 to 6.81) for malignant melanoma, and 2.49 (95% CI 1.69 to 3.54), for basal cell carcinoma of skin. The risk for all cancers, malignant melanoma, prostate cancer, basal cell carcinoma of skin, and basal cell carcinoma of trunk increased with an increase in number of employment years, cumulative air hours, total cumulative radiation dose, and cumulative radiation dose sustained up to age of 40 years. The relative risk for the highest exposure categories of cumulative radiation dose were 2.42 (95% CI 1.50 to 3.92) for all cancers, 2.57 (95% CI 1.18 to 5.56) for prostate cancer, 9.88 (95% CI 1.57 to 190.78) for malignant melanoma, 3.61 (95% CI 1.64 to 8.48) for all basal cell carcinoma, and 6.65 (95% CI 1.61 to 44.64) for basal cell carcinoma of trunk. CONCLUSIONS This study was underpowered to study brain cancer and leukaemia risk. Basal cell carcinoma of skin is radiation-related cancer, and may be attributed to cosmic radiation. Further studies are needed to clarify the risk of cancers in association with cosmic radiation, other workplace exposure, host factors, and leisure sun-exposure, as clothes, and glass in cockpit windows shield pilots from the most potent ultraviolet-radiation.
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Affiliation(s)
| | - Jon Hrafnkelsson
- Department of Oncology, Landspitali University Hospital, Reykjavik, Iceland
| | - Vilhjalmur Rafnsson
- Department of Preventive Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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17
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Sena JS, Girão RJS, Carvalho SMFD, Tavares RM, Fonseca FLA, Silva PBA, Barbosa MCFP. Occupational skin cancer: Systematic review. Rev Assoc Med Bras (1992) 2017; 62:280-6. [PMID: 27310554 DOI: 10.1590/1806-9282.62.03.280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 05/25/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the epidemiological profile, risk factors in the workplace environment and prevention methods for professionals at risk of skin cancer. METHOD A systematic review of articles on occupational skin cancer, published in the Lilacs, Scielo, Medline and Cochrane Library from January 1st, 2008, to December 31st, 2013, was performed. The search included the following terms: "neoplasias cutâneas" (DeCS), "exposição ocupacional" (DeCS), "epidemiologia" (DeCS) as well as the keyword "prevenção", and their equivalents in English. RESULTS After analyzing the titles and summaries of articles, the search strategy resulted in 83 references, of which 22 articles met the eligibility criteria. DISCUSSION We found that sun exposure is the main occupational risk factor for skin cancer, causing outdoor workers to be the most vulnerable to developing occupational skin cancer. Professionals with low levels of education and European descent are at increased risk of developing this cancer. CONCLUSION Outdoor workers are more vulnerable to developing occupational skin cancer, estimating that professionals with low level of education and European descent are at increased risk of developing this cancer. Therefore, companies need to invest more in the health of workers by providing protective equipment and thus preventing occupational skin cancer.
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Affiliation(s)
- Jéssica Suellen Sena
- Faculdade Integral Diferencial, Faculdade Integral Diferencial, Teresina PI , Brazil, Medical Student, Faculdade Integral Diferencial (Facid/DeVry), Teresina, PI, Brazil
| | - Régio José Santiago Girão
- DeVry University, DeVry, Facid, Teresina PI , Brazil, MSc in Health Sciences from Faculdade de Medicina do ABC (FMABC). Dermatology Lecturer of the Facid/DeVry, Teresina, PI, Brazil
| | - Sionara Melo Figueiredo de Carvalho
- Universidade Federal do Ceará, Universidade Federal do Ceará, Fortaleza PI , Brazil, MSc in Health Sciences from FMABC. Oncology Lecturer of the Universidade Federal do Ceará (UFC), Fortaleza, PI, Brazil
| | - Rosielly Melo Tavares
- Faculdade Integral Diferencial, Faculdade Integral Diferencial, Teresina PI , Brazil, Medical Student, Faculdade Integral Diferencial (Facid/DeVry), Teresina, PI, Brazil
| | - Fernando Luiz Affonso Fonseca
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, Santo André SP , Brazil, Post-doctoral from Instituto Israelita de Ensino e Pesquisa Albert Einstein and the Roche Center for Medical Genomics. Adjunct Professor III, Universidade Federal de São Paulo, and Lecturer of Pharmaceutical Sciences and Environmental Health Management, FMABC, Santo André, SP, Brazil
| | - Patrícia Barros Aquino Silva
- Faculdade Integral Diferencial, Faculdade Integral Diferencial, Teresina PI , Brazil, Medical Student, Faculdade Integral Diferencial (Facid/DeVry), Teresina, PI, Brazil
| | - Maria Clara Fortes Portela Barbosa
- Faculdade Integral Diferencial, Faculdade Integral Diferencial, Teresina PI , Brazil, Medical Student, Faculdade Integral Diferencial (Facid/DeVry), Teresina, PI, Brazil
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18
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Liu T, Zhang C, Liu C. The incidence of breast cancer among female flight attendants: an updated meta-analysis. J Travel Med 2016; 23:taw055. [PMID: 27601531 DOI: 10.1093/jtm/taw055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/01/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Several studies have indicated an increased risk of breast cancer (BC) among female flight attendants (FFAs); however, the results from epidemiological studies were not consistent. We thus conducted an updated meta-analysis to re-assess the risk of BC among FFAs, according to the MOOSE guideline. METHODS A systematical search of PubMed and Embase for relevant observational studies up to March 2016 was performed, supplemented by manual reviews of bibliographies in relevant studies. A random effect model was conducted to calculate the combined standard incidence ratio (SIR) and 95% confidence interval (95% CI) in BC risk. RESULTS Of the 719 citations retrieved, 10 were included, with more than 31 679 participants and 821 new cases. The combined SIR (95% CI) for BC in FFAs was 1.40 (95%CI 1.30-1.50), with no significant heterogeneity (P = 0.744; I(2 )=( )0.0%) or publication bias (Begg's test: z = 0.72, P = 0.474; Egger's test: t = 0.25, P = 0.805) among the included studies. The results were not significantly modified by publication year, geographic area, study quality or whether the fertility variables were adjusted. CONCLUSIONS Our meta-analysis suggests that FFAs have a higher risk of BC compared with the general population. More vigorous studies with larger sample sizes based on other populations, including the Chinese, are needed.
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Affiliation(s)
- Tiebing Liu
- Civil Aviation Medicine Center, Civil Aviation Administration of China, Beijing, People's Republic of China
| | - Chanyuan Zhang
- Department of Clinical Laboratory, Civil Aviation General Hospital, Beijing, People's Republic of China
| | - Chong Liu
- Department of Information Engineering, Cangzhou Technical College, Cangzhou, Hebei, People's Republic of China
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Di Trolio R, Di Lorenzo G, Fumo B, Ascierto PA. Cosmic radiation and cancer: is there a link? Future Oncol 2016; 11:1123-35. [PMID: 25804126 DOI: 10.2217/fon.15.29] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cosmic radiation can cause genetic and cytogenetic damage. Certain occupations including airline pilots and cabin crew are acknowledged to have a greater exposure to cosmic radiation. In a systematic search of MEDLINE, performed from 1990 to 2014, we analyzed clinical studies using the keywords: cosmic radiation, cancer, chromosome aberration, pilots and astronauts. Increased incidence of skin cancers among airline cabin crew has been reported in a number of studies and appears to be the most consistent finding. However, as with other cancers, it is unclear whether increased exposure to cosmic radiation is a factor in the increased incidence or whether this can be explained by lifestyle factors. Further research is needed to clarify the risk of cancer in relation to cosmic radiation.
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Affiliation(s)
- Rossella Di Trolio
- Unit of Medical Oncology & Innovative Therapy, Department of Melanoma, Sarcoma & Head & Neck Cancers, G Pascale Institute of National Tumor Foundation, Napoli, Italy
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20
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Arbesman H. Hypothesis: Is frequent, commercial jet travel by the general public a risk factor for developing cutaneous melanoma? F1000Res 2015; 4:620. [PMID: 26672515 PMCID: PMC4670002 DOI: 10.12688/f1000research.6962.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/21/2022] Open
Abstract
Melanoma incidence has been increasing worldwide over the past 50 years and various risk factors have been identified. Interestingly, multiple studies have shown a multifold increased risk of developing melanoma in jet pilots and airline crew. There has also been a dramatic increase in the availability and frequency of jet travel by the general population during this time period.. Therefore, it is hypothesized that frequent commercial jet travel may represent an additional risk factor for the development of cutaneous melanoma in susceptible individuals of the general public.
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Affiliation(s)
- Harvey Arbesman
- Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, 14214-8001, USA ; Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA ; Department of Dermatology, Clinical and Translational Research Center, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, 14203, USA
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21
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Gordon D, Gillgren P, Eloranta S, Olsson H, Gordon M, Hansson J, Smedby KE. Time trends in incidence of cutaneous melanoma by detailed anatomical location and patterns of ultraviolet radiation exposure: a retrospective population-based study. Melanoma Res 2015; 25:348-56. [PMID: 26050147 DOI: 10.1097/cmr.0000000000000170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Given the wide public health implications of the melanoma epidemic, ultraviolet radiation (UVR) exposure patterns contributing to cutaneous melanoma development should be clearly identified. To describe time trends of anatomic sites of melanoma using a UVR exposure model based on clothing and sun habits, we reviewed the medical records of all patients diagnosed with primary invasive melanoma or melanoma in situ (MIS) during the years 1977-78, 1983-84, 1989-90, 1995-96, and 2000-01 (n=3058) in one healthcare region of Sweden. Age-standardized incidence rates and relative risks (RRs) of melanoma by calendar period were estimated for intermittent and chronic UVR exposure sites. From 1977-78 to 2000-01, the incidence rates of all melanomas at intermittent UVR exposure sites increased both among men (7.8-16.5/10 person-years) and among women (7.6-14.6/10 person-years), with a sex-adjusted and age-adjusted RR of 2.1 [95% confidence interval (CI) 1.8-2.4, Ptrend<0.0001]. This increase was evident for both invasive melanoma and MIS. Melanoma at chronic sites increased among men from 1.7 to 2.3/10 person-years, and among women from 1.4 to 1.8/10 person-years, with a corresponding adjusted RR of 1.4 (95% CI 1.0-1.9, Ptrend=0.01), driven primarily by MIS. For melanomas at intermittent UVR exposure sites, the male sex was positively associated with central (core) areas (chest, back, neck, shoulders, thighs; RR 1.7, 95% CI 1.5-1.9), but negatively associated with peripheral areas (lateral arms, lower legs, dorsum of feet; RR 0.3, 95% CI 0.3-0.4), compared with the female sex. Sex-specific intermittent UVR exposure patterns drove the observed increase in melanoma incidence, whereas chronic UVR exposure contributed less.
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Affiliation(s)
- Daniela Gordon
- aDepartment of Medicine Solna, Clinical Epidemiology Unit Departments of bClinical Science and Education cMedical Epidemiology and Biostatistics dOncology and Pathology eDepartment of Clinical Sciences, Danderyd Hospital, Karolinska Institutet fDepartment of Surgery, Stockholm South General Hospital gDepartment of Oncology, Karolinska University Hospital, Stockholm, Sweden
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22
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Sanlorenzo M, Wehner MR, Linos E, Kornak J, Kainz W, Posch C, Vujic I, Johnston K, Gho D, Monico G, McGrath JT, Osella-Abate S, Quaglino P, Cleaver JE, Ortiz-Urda S. The risk of melanoma in airline pilots and cabin crew: a meta-analysis. JAMA Dermatol 2015; 151:51-8. [PMID: 25188246 DOI: 10.1001/jamadermatol.2014.1077] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE 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. DATA SOURCES PubMed (1966 to October 30, 2013), Web of Science (1898 to January 27, 2014), and Scopus (1823 to January 27, 2014). STUDY SELECTION 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. DATA EXTRACTION AND SYNTHESIS 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. MAIN OUTCOMES AND MEASURES 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 AND RELEVANCE 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.
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Affiliation(s)
- Martina Sanlorenzo
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco2Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mackenzie R Wehner
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco3School of Medicine, Stanford University, Stanford, California
| | - Eleni Linos
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Wolfgang Kainz
- Center for Devices and Radiological Health, Division of Physics, US Food and Drug Administration, Silver Spring, Maryland
| | - Christian Posch
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco6Department of Dermatology,The Rudolfstiftung Hospital, Vienna, Austria
| | - Igor Vujic
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco6Department of Dermatology,The Rudolfstiftung Hospital, Vienna, Austria
| | - Katia Johnston
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco
| | - Deborah Gho
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco
| | - Gabriela Monico
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco
| | - James T McGrath
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco
| | - Simona Osella-Abate
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - James E Cleaver
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco
| | - Susana Ortiz-Urda
- Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco
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Jiang A, Rambhatla P, Eide M. Socioeconomic and lifestyle factors and melanoma: a systematic review. Br J Dermatol 2015; 172:885-915. [PMID: 25354495 DOI: 10.1111/bjd.13500] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/27/2022]
Affiliation(s)
- A.J. Jiang
- Stritch School of Medicine; Loyola University Chicago; Maywood IL U.S.A
| | - P.V. Rambhatla
- Department of Dermatology; Henry Ford Hospital; New Center One; 3031 West Grand Blvd, Suite 800 Detroit MI 48202 U.S.A
| | - M.J. Eide
- Department of Dermatology; Henry Ford Hospital; New Center One; 3031 West Grand Blvd, Suite 800 Detroit MI 48202 U.S.A
- Department of Public Health Sciences; Henry Ford Hospital; New Center One; 3031 West Grand Blvd, Suite 800 Detroit MI 48202 U.S.A
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24
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From animal cage to aircraft cabin: an overview of evidence translation in jet lag research. Eur J Appl Physiol 2014; 114:2459-68. [PMID: 25342081 DOI: 10.1007/s00421-014-3026-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/13/2014] [Indexed: 12/23/2022]
Abstract
Recent laboratory experiments on rodents have increased our understanding of circadian rhythm mechanisms. Typically, circadian biologists attempt to translate their laboratory-based findings to treatment of jet lag symptoms in humans. We aimed to scrutinise the strength of the various links in the translational pathway from animal model to human traveller. First, we argue that the translation of findings from pre-clinical studies to effective jet lag treatments and knowledge regarding longer-term population health is not robust, e.g. the association between circadian disruption and cancer found in animal models does not translate well to cabin crew and pilots, who have a lower risk of most cancers. Jet lag symptoms are heterogeneous, making the true prevalence and the effects of any intervention difficult to quantify precisely. The mechanistic chain between in vitro and in vivo treatment effects has weak links, especially between circadian rhythm disruption in animals and the improvement of jet lag symptoms in humans. While the number of animal studies has increased exponentially between 1990 and 2014, only 1-2 randomised controlled trials on jet lag treatments are published every year. There is one relevant Cochrane review, in which only 2-4 studies on melatonin, without baseline measures, were meta-analysed. Study effect sizes reduced substantially between 1987, when the first paper on melatonin was published, and 2000. We suggest that knowledge derived from a greater number of human randomised controlled trials would provide a firmer platform for circadian biologists to cite jet lag treatment as an important application of their findings.
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Yong LC, Pinkerton LE, Yiin JH, Anderson JL, Deddens JA. Mortality among a cohort of U.S. commercial airline cockpit crew. Am J Ind Med 2014; 57:906-14. [PMID: 24700478 PMCID: PMC4511278 DOI: 10.1002/ajim.22318] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND We evaluated mortality among 5,964 former U.S. commercial cockpit crew (pilots and flight engineers). The outcomes of a priori interest were non-chronic lymphocytic leukemia, central nervous system (CNS) cancer (including brain), and malignant melanoma. METHODS Vital status was ascertained through 2008. Life table and Cox regression analyses were conducted. Cumulative exposure to cosmic radiation was estimated from work history data. RESULTS Compared to the U.S. general population, mortality from all causes, all cancer, and cardiovascular diseases was decreased, but mortality from aircraft accidents was highly elevated. Mortality was elevated for malignant melanoma but not for non-chronic lymphocytic leukemia. CNS cancer mortality increased with an increase in cumulative radiation dose. CONCLUSIONS Cockpit crew had a low all-cause, all-cancer, and cardiovascular disease mortality but elevated aircraft accident mortality. Further studies are needed to clarify the risk of CNS and other radiation-associated cancers in relation to cosmic radiation and other workplace exposures.
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Affiliation(s)
- Lee C. Yong
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, CDC, Cincinnati, Ohio
| | - Lynne E. Pinkerton
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, CDC, Cincinnati, Ohio
| | - James H. Yiin
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, CDC, Cincinnati, Ohio
| | - Jeri L. Anderson
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, CDC, Cincinnati, Ohio
| | - James A. Deddens
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, CDC, Cincinnati, Ohio
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Gulati S, Mulshine JL. Lung cancer screening guidelines: common ground and differences. Transl Lung Cancer Res 2014; 3:131-8. [PMID: 25806292 PMCID: PMC4367688 DOI: 10.3978/j.issn.2218-6751.2014.06.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/27/2014] [Indexed: 12/19/2022]
Abstract
Lung cancer accounts for almost one-third of all cancer related deaths. Lung cancer risk persists even after smoking cessation and so many lung cancers now are diagnosed in former smokers. Five-year survival of lung cancer has marginally improved over decades and significantly lags behind that of colon, breast and prostate cancer. Over the past one decade, lung cancer screening trials have shown promising results. Results from National Lung Cancer Screening Trial (NLST), have shown a significant 20% reduction in mortality with annual low dose computed tomography (LDCT) screening. Based on these results, annual LDCT testing has been recommended for lung cancer screening in high risk population. However, development and acceptance of lung cancer screening as a public health policy is still in the nascent stages. Major concerns relate to risk of radiation, overdiagnosis bias, proportion of false positives and cost benefit analysis. This article reviews the literature pertaining to lung cancer screening guidelines and above mentioned concerns.
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Hammer GP, Auvinen A, De Stavola BL, Grajewski B, Gundestrup M, Haldorsen T, Hammar N, Lagorio S, Linnersjö A, Pinkerton L, Pukkala E, Rafnsson V, dos-Santos-Silva I, Storm HH, Strand TE, Tzonou A, Zeeb H, Blettner M. Mortality from cancer and other causes in commercial airline crews: a joint analysis of cohorts from 10 countries. Occup Environ Med 2014; 71:313-22. [PMID: 24389960 DOI: 10.1136/oemed-2013-101395] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Commercial airline crew is one of the occupational groups with the highest exposures to ionising radiation. Crew members are also exposed to other physical risk factors and subject to potential disruption of circadian rhythms. METHODS This study analyses mortality in a pooled cohort of 93 771 crew members from 10 countries. The cohort was followed for a mean of 21.7 years (2.0 million person-years), during which 5508 deaths occurred. RESULTS The overall mortality was strongly reduced in male cockpit (SMR 0.56) and female cabin crews (SMR 0.73). The mortality from radiation-related cancers was also reduced in male cockpit crew (SMR 0.73), but not in female or male cabin crews (SMR 1.01 and 1.00, respectively). The mortality from female breast cancer (SMR 1.06), leukaemia and brain cancer was similar to that of the general population. The mortality from malignant melanoma was elevated, and significantly so in male cockpit crew (SMR 1.57). The mortality from cardiovascular diseases was strongly reduced (SMR 0.46). On the other hand, the mortality from aircraft accidents was exceedingly high (SMR 33.9), as was that from AIDS in male cabin crew (SMR 14.0). CONCLUSIONS This large study with highly complete follow-up shows a reduced overall mortality in male cockpit and female cabin crews, an increased mortality of aircraft accidents and an increased mortality in malignant skin melanoma in cockpit crew. Further analysis after longer follow-up is recommended.
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Affiliation(s)
- Gaël P Hammer
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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Grajewski B, Pinkerton LE. Exposure assessment at 30 000 feet: challenges and future directions. THE ANNALS OF OCCUPATIONAL HYGIENE 2013; 57:692-4. [PMID: 23818455 PMCID: PMC4509733 DOI: 10.1093/annhyg/met039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Few studies of cancer mortality and incidence among flight crew have included a detailed assessment of both occupational exposures and lifestyle factors that may influence the risk of cancer. In this issue, Kojo et al. (Risk factors for skin cancer among Finnish airline cabin crew. Ann Occup. Hyg 2013; 57: 695-704) evaluated the relative contributions of ultraviolet and cosmic radiation to the incidence of skin cancer in Finnish flight attendants. This is a useful contribution, yet the reason flight crew members have an increased risk of skin cancer compared with the general population remains unclear. Good policy decisions for flight crew will depend on continued and emerging effective collaborations to increase study power and improve exposure assessment in future flight crew health studies. Improving the assessment of occupational exposures and non-occupational factors will cost additional time and effort, which are well spent if the role of exposures can be clarified in larger studies.
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Affiliation(s)
- Barbara Grajewski
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health (NIOSH), 4676 Columbia Pkwy (R-15), Cincinnati, OH 45226, USA.
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