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Breast Cancer Among Female Flight Attendants and the Role of the Occupational Exposures. J Occup Environ Med 2022; 64:822-830. [DOI: 10.1097/jom.0000000000002606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Assessment of risks for breast cancer in a flight attendant exposed to night shift work and cosmic ionizing radiation: a case report. Ann Occup Environ Med 2022; 34:e5. [PMID: 35425619 PMCID: PMC9005884 DOI: 10.35371/aoem.2022.34.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background Some epidemiological studies have estimated exposure among flight attendants with and without breast cancer. However, it is difficult to find a quantitative evaluation of occupational exposure factors related to cancer development individually in the case of breast cancer in flight attendants. That is, most, if not all, epidemiological studies of breast cancer in flight attendants with quantitative exposure estimates have estimated exposure in the absence of individual flight history data. Case presentation A 41-year-old woman visited the hospital due to a left breast mass after a regular check-up. Breast cancer was suspected on ultrasonography. Following core biopsy, she underwent various imaging modalities. She was diagnosed invasive ductal carcinoma of no special type (estrogen receptor positive in 90%, progesterone receptor positive in 3%, human epidermal growth factor receptor 2/neu equivocal) with histologic grade 3 and nuclear grade 3 in the left breast. Neoadjuvant chemotherapy was administered to reduce the tumor size before surgery. However, due to serious chemotherapy side effects, the patient opted for alternative and integrative therapies. She joined the airline in January, 1996. Out of all flights, international flights and night flights accounted for 94.9% and 26.2, respectively. Night flights were conducted at least four times per month. Moreover, based on the virtual computer program CARI-6M, the estimated dose of cosmic radiation exposure was 78.81 mSv. There were no other personal triggers or family history of breast cancer. Conclusions This case report shows that the potentially causal relationship between occupational harmful factors and the incidence of breast cancer may become more pronounced when night shift workers who work continuously are exposed to cosmic ionizing radiation. Therefore, close attention and efforts are needed to adjust night shift work schedules and regulate cosmic ionizing radiation exposure.
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Benna C, Rajendran S, Spiro G, Menin C, Dall'Olmo L, Rossi CR, Mocellin S. Gender-specific associations between polymorphisms of the circadian gene RORA and cutaneous melanoma susceptibility. J Transl Med 2021; 19:57. [PMID: 33549124 PMCID: PMC7866430 DOI: 10.1186/s12967-021-02725-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/28/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Melanoma is the deadliest of skin cancers and has an increasing annual incidence worldwide. It is a multi-factorial disease most likely arising from both genetic predisposition and environmental exposure to ultraviolet light. Genetic variability of the components of the biological circadian clock is recognized to be a risk factor for different type of cancers. Moreover, two variants of a clock gene, RORA, have been associated with melanoma patient's prognosis. Our aim is to test the hypothesis that specific single nucleotide polymorphisms (SNPs) of the circadian clock genes may significantly influence the predisposition to develop cutaneous melanoma or the outcome of melanoma patients. METHODS We genotyped 1239 subjects, 629 cases of melanoma and 610 healthy controls in 14 known SNPs of seven selected clock genes: AANAT, CLOCK, NPAS2, PER1, PER2, RORA, and TIMELESS. Genotyping was conducted by q-PCR. Multivariate logistic regression was employed for susceptibility of melanoma assessment, modeled additively. Subgroup analysis was performed by gender. For the female subgroup, a further discrimination was performed by age. For prognosis of melanoma assessment, multivariate Cox proportional hazard regression was employed. The Benjamini-Hochberg method was utilized as adjustment for multiple comparisons. RESULTS We identified two RORA SNPs statistically significant with respect to the association with melanoma susceptibility. Considering the putative role of RORA as a nuclear steroid hormone receptor, we conducted a subgroup analysis by gender. Interestingly, the RORA rs339972 C allele was associated with a decreased predisposition to develop melanoma only in the female subgroup (OR 0.67; 95% CI 0.51-0.88; P = 0.003) while RORA rs10519097 T allele was associated with a decreased predisposition to develop melanoma only in the male subgroup (OR 0.62; 95% CI 0.44-0.87; P = 0.005). Moreover, the RORA rs339972 C allele had a decreased susceptibility to develop melanoma only in females aged over 50 years old (OR 0.67; 95% CI 0.54-0.83; P = 0.0002). None of the studied SNPs were significantly associated with the prognosis. CONCLUSIONS Overall, we cannot ascertain that circadian pathway genetic variation is involved in melanoma susceptibility or prognosis. Nevertheless, we identified an interesting relationship between melanoma susceptibility and RORA polymorphisms acting in sex-specific manner and which is worth further future investigation.
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Affiliation(s)
- Clara Benna
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy. .,First Surgical Clinic, Azienda Ospedaliera Padova, Padova, Italy.
| | - Senthilkumar Rajendran
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giovanna Spiro
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Chiara Menin
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology (IOV - IRCCS), Padova, Italy
| | - Luigi Dall'Olmo
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Carlo Riccardo Rossi
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Simone Mocellin
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
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Pariollaud M, Lamia KA. Cancer in the Fourth Dimension: What Is the Impact of Circadian Disruption? Cancer Discov 2020; 10:1455-1464. [PMID: 32934020 PMCID: PMC7541588 DOI: 10.1158/2159-8290.cd-20-0413] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022]
Abstract
Circadian rhythms integrate many physiological pathways, helping organisms to align the timing of various internal processes to daily cycles in the external environment. Disrupted circadian rhythmicity is a prominent feature of modern society, and has been designated as a probable carcinogen. Here, we review multiple studies, in humans and animal models, that suggest a causal effect between circadian disruption and increased risk of cancer. We also discuss the complexity of this connection, which may depend on the cellular context. SIGNIFICANCE: Accumulating evidence points to an adverse effect of circadian disruption on cancer incidence and progression, indicating that time of day could influence the effectiveness of interventions targeting cancer prevention and management.
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Affiliation(s)
- Marie Pariollaud
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, California
| | - Katja A Lamia
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, California.
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Jahan F, Duncan EW, Cramb SM, Baade PD, Mengersen KL. Augmenting disease maps: a Bayesian meta-analysis approach. ROYAL SOCIETY OPEN SCIENCE 2020; 7:192151. [PMID: 32968502 PMCID: PMC7481717 DOI: 10.1098/rsos.192151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
Analysis of spatial patterns of disease is a significant field of research. However, access to unit-level disease data can be difficult for privacy and other reasons. As a consequence, estimates of interest are often published at the small area level as disease maps. This motivates the development of methods for analysis of these ecological estimates directly. Such analyses can widen the scope of research by drawing more insights from published disease maps or atlases. The present study proposes a hierarchical Bayesian meta-analysis model that analyses the point and interval estimates from an online atlas. The proposed model is illustrated by modelling the published cancer incidence estimates available as part of the online Australian Cancer Atlas (ACA). The proposed model aims to reveal patterns of cancer incidence for the 20 cancers included in ACA in major cities, regional and remote areas. The model results are validated using the observed areal data created from unit-level data on cancer incidence in each of 2148 small areas. It is found that the meta-analysis models can generate similar patterns of cancer incidence based on urban/rural status of small areas compared with those already known or revealed by the analysis of observed data. The proposed approach can be generalized to other online disease maps and atlases.
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Affiliation(s)
- Farzana Jahan
- School of Mathematical Science, ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Queensland, Australia
| | - Earl W. Duncan
- School of Mathematical Science, ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Queensland, Australia
| | | | - Peter D. Baade
- Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Kerrie L. Mengersen
- School of Mathematical Science, ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Queensland, Australia
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Breast Cancer Rate and Mortality in Female Flight Attendants: A Systematic Review and Pooled Analysis. Clin Breast Cancer 2020; 20:371-376. [PMID: 32605812 DOI: 10.1016/j.clbc.2020.05.003] [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: 03/01/2020] [Revised: 04/15/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
Previous reports have suggested that breast cancer is more common among flight attendants than that in the general population. Constant exposure to cosmic radiation and circadian disruption are postulated to be the culprits of the problem. A systematic review was performed by 2 independent reviewers with predefined search strategy, in line with the PRISMA protocol. A total of 43 studies were identified using the preset keywords defined in the study protocol. After excluding irrelevant papers, 12 studies were included for pooled analysis. Ten studies evaluated the breast cancer prevalence in flight attendants, whereas 3 studies evaluated the breast cancer-related deaths. Pooled analysis found that, of the 45,111 flight attendants censored, 1061 (2.35%) had breast cancer. The standardized prevalence ratios were 1.08 (95% confidence interval [CI], 0.37-1.59) and 1.09 (95% Cl, 0.37-1.60), respectively, when compared with the American and European general population. Pooled analysis of the 3 studies on breast cancer mortality found that, of the 44,508 flight attendants censored, 139 (0.32%) had breast cancer-related mortality. Standardized mortality ratios to the American/European general population were 1.8 (95% CI, 0.63-4.25) and 1.3 (95% CI, 0.47-3.15), respectively. A review of the available literature indicates that there is insufficient evidence to suggest an association between cosmic irradiation, circadian disruption, and breast cancer in flight attendants. Breast cancer prevalence and mortality among flight attendants are comparable with that of the general population.
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Cancer Incidence Among Air Transportation Industry Workers Using the National Cohort Study of Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162906. [PMID: 31416127 PMCID: PMC6727080 DOI: 10.3390/ijerph16162906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 11/27/2022]
Abstract
Background: There are increasing concerns regarding increased cancer risks in professional flight attendants due to their exposure to occupational hazards that are known or suspected to be carcinogenic. In this study, we aimed to analyze various cancer risks among a cohort of Korean air transportation industry workers. Methods: We used data from the Korean National Health Insurance Service (NHIS) database from 2002 to 2015. The age-standardized incidence ratios (SIRs) for all types of cancers in the aircraft transport industry workers compared to government employees and the entire employee population were calculated with adjustment for five-year age ranges via the indirect standardized method with gender stratification. Results: Leukemia (ICD-10; C91–C95) showed significantly higher SIRs (95% confidence interval (CI)) compared to the government employee group (1.86, 1.15–2.84) and the whole employee group (1.77, 1.10–2.70). Conclusion: Air transportation industry workers have an increased risk of leukemia compared to other occupational groups.
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Neilsen BK, Frodyma DE, McCall JL, Fisher KW, Lewis RE. ERK-mediated TIMELESS expression suppresses G2/M arrest in colon cancer cells. PLoS One 2019; 14:e0209224. [PMID: 30629587 PMCID: PMC6328106 DOI: 10.1371/journal.pone.0209224] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/30/2018] [Indexed: 01/04/2023] Open
Abstract
The cell cycle is under circadian regulation. Oncogenes can dysregulate circadian-regulated genes to disrupt the cell cycle, promoting tumor cell proliferation. As a regulator of G2/M arrest in response to DNA damage, the circadian gene Timeless Circadian Clock (TIMELESS) coordinates this connection and is a potential locus for oncogenic manipulation. TIMELESS expression was evaluated using RNASeq data from TCGA and by RT-qPCR and western blot analysis in a panel of colon cancer cell lines. TIMELESS expression following ERK inhibition was examined via western blot. Cell metabolic capacity, propidium iodide, and CFSE staining were used to evaluate the effect of TIMELESS depletion on colon cancer cell survival and proliferation. Cell metabolic capacity following TIMELESS depletion in combination with Wee1 or CHK1 inhibition was assessed. TIMELESS is overexpressed in cancer and required for increased cancer cell proliferation. ERK activation promotes TIMELESS expression. TIMELESS depletion increases γH2AX, a marker of DNA damage, and triggers G2/M arrest via increased CHK1 and CDK1 phosphorylation. TIMELESS depletion in combination with Wee1 or CHK1 inhibition causes an additive decrease in cancer cell metabolic capacity with limited effects in non-transformed human colon epithelial cells. The data show that ERK activation contributes to the overexpression of TIMELESS in cancer. Depletion of TIMELESS increases γH2AX and causes G2/M arrest, limiting cell proliferation. These results demonstrate a role for TIMELESS in cancer and encourage further examination of the link between circadian rhythm dysregulation and cancer cell proliferation.
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Affiliation(s)
- Beth K. Neilsen
- Eppley Institute, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Danielle E. Frodyma
- Eppley Institute, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Jamie L. McCall
- Eppley Institute, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Kurt W. Fisher
- Eppley Institute, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Robert E. Lewis
- Eppley Institute, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail:
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McNeely E, Mordukhovich I, Staffa S, Tideman S, Gale S, Coull B. Cancer prevalence among flight attendants compared to the general population. Environ Health 2018; 17:49. [PMID: 29940975 PMCID: PMC6019786 DOI: 10.1186/s12940-018-0396-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 05/13/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND Flight attendants are an understudied occupational group, despite undergoing a wide range of adverse job-related exposures, including to known carcinogens. In our study, we aimed to characterize the prevalence of cancer diagnoses among U.S. cabin crew relative to the general population. METHODS In 2014-2015, we surveyed participants of the Harvard Flight Attendant Health Study. We compared the prevalence of their self-reported cancer diagnoses to a contemporaneous cohort in the National Health and Nutrition Examination Survey (NHANES 2013-2014) using age-weighted standardized prevalence ratios (SPRs). We also analyzed associations between job tenure and the prevalence of selected cancers, using logistic regression and adjusting for potential confounders. RESULTS Compared to NHANES participants with a similar socioeconomic status (n = 2729), flight attendants (n = 5366) had a higher prevalence of every cancer we examined, especially breast cancer, melanoma, and non-melanoma skin cancer among females. SPR for these conditions were 1.51 (95% CI: 1.02, 2.24), 2.27 (95% CI: 1.27, 4.06), and 4.09 (95% CI: 2.70, 6.20), respectively. Job tenure was positively related to non-melanoma skin cancer among females, with borderline associations for melanoma and non-melanoma skin cancers among males. Consistent with previous studies, we observed associations between job tenure and breast cancer among women who had three or more children. CONCLUSIONS We observed higher rates of specific cancers in flight attendants compared the general population, some of which were related to job tenure. Our results should be interpreted in light of self-reported health information and a cross-sectional study design. Future longitudinal studies should evaluate associations between specific exposures and cancers among cabin crew.
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Affiliation(s)
- Eileen McNeely
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Dr, Boston, MA 02215 USA
| | - Irina Mordukhovich
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Dr, Boston, MA 02215 USA
| | - Steven Staffa
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Samuel Tideman
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Sara Gale
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Dr, Boston, MA 02215 USA
| | - Brent Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
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McNeely E, Mordukhovich I, Tideman S, Gale S, Coull B. Estimating the health consequences of flight attendant work: comparing flight attendant health to the general population in a cross-sectional study. BMC Public Health 2018; 18:346. [PMID: 29566648 PMCID: PMC5865289 DOI: 10.1186/s12889-018-5221-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 02/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flight attendants are an understudied occupational group, despite undergoing a wide and unique range of adverse job-related exposures. In our study, we aimed to characterize the health profile of cabin crew relative to the U.S. general population. METHODS In 2014-2015, we surveyed participants of the Harvard Flight Attendant Health Study. We compared the prevalence of their health conditions to a contemporaneous cohort in the National Health and Nutrition Examination Survey (NHANES 2013-2014) using age-weighted standardized prevalence ratios (SPRs). We also analyzed associations between job tenure and selected health outcomes, using logistic regression and adjusting for potential confounders. RESULTS Compared to the NHANES population (n = 2729), flight attendants (n = 5366) had a higher prevalence of female reproductive cancers (SPR = 1.66, 95% CI: 1.18-2.33), cancers at all sites (SPR = 2.15, 95% CI: 1.73-2.67 among females), as well as sleep disorders, fatigue, and depression, with SPRs ranging between 1.98 and 5.57 depending on gender and the specific condition examined. In contrast, we observed a decreased prevalence of cardiac and respiratory outcomes among flight crew relative to NHANES. Health conditions that increased with longer job tenure were sleep disorders, anxiety/depression, alcohol abuse, any cancer, peripheral artery disease, sinusitis, foot surgery, infertility, and several perinatal outcomes. CONCLUSIONS We observed higher rates of specific adverse health outcomes in U.S. flight attendants compared to the general population, as well as associations between longer tenure and health conditions, which should be interpreted in light of recall bias and a cross-sectional design. Future longitudinal studies should evaluate specific exposure-disease associations among flight crew.
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Affiliation(s)
- Eileen McNeely
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Irina Mordukhovich
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Samuel Tideman
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sara Gale
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brent Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Gray JM, Rasanayagam S, Engel C, Rizzo J. State of the evidence 2017: an update on the connection between breast cancer and the environment. Environ Health 2017; 16:94. [PMID: 28865460 PMCID: PMC5581466 DOI: 10.1186/s12940-017-0287-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/17/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND In this review, we examine the continually expanding and increasingly compelling data linking radiation and various chemicals in our environment to the current high incidence of breast cancer. Singly and in combination, these toxicants may have contributed significantly to the increasing rates of breast cancer observed over the past several decades. Exposures early in development from gestation through adolescence and early adulthood are particularly of concern as they re-shape the program of genetic, epigenetic and physiological processes in the developing mammary system, leading to an increased risk for developing breast cancer. In the 8 years since we last published a comprehensive review of the relevant literature, hundreds of new papers have appeared supporting this link, and in this update, the evidence on this topic is more extensive and of better quality than that previously available. CONCLUSION Increasing evidence from epidemiological studies, as well as a better understanding of mechanisms linking toxicants with development of breast cancer, all reinforce the conclusion that exposures to these substances - many of which are found in common, everyday products and byproducts - may lead to increased risk of developing breast cancer. Moving forward, attention to methodological limitations, especially in relevant epidemiological and animal models, will need to be addressed to allow clearer and more direct connections to be evaluated.
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Affiliation(s)
- Janet M. Gray
- Department of Psychology and Program in Science, Technology, and Society, Vassar College, 124 Raymond Avenue, Poughkeepsie, NY 12604-0246 USA
| | - Sharima Rasanayagam
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Connie Engel
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Jeanne Rizzo
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
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Al-Zalabani AH, Stewart KFJ, Wesselius A, Schols AMWJ, Zeegers MP. Modifiable risk factors for the prevention of bladder cancer: a systematic review of meta-analyses. Eur J Epidemiol 2016; 31:811-51. [PMID: 27000312 PMCID: PMC5010611 DOI: 10.1007/s10654-016-0138-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/08/2016] [Indexed: 02/07/2023]
Abstract
Each year, 430,000 people are diagnosed with bladder cancer. Due to the high recurrence rate of the disease, primary prevention is paramount. Therefore, we reviewed all meta-analyses on modifiable risk factors of primary bladder cancer. PubMed, Embase and Cochrane database were systematically searched for meta-analyses on modifiable risk factors published between 1995 and 2015. When appropriate, meta-analyses (MA) were combined in meta-meta-analysis (MMA). If not, the most comprehensive MA was selected based on the number of primary studies included. Probability of causation was calculated for individual factors and a subset of lifestyle factors combined. Of 1496 articles identified, 5 were combined in MMA and 21 were most comprehensive on a single risk factor. Statistically significant associations were found for current (RR 3.14) or former (RR 1.83) cigarette smoking, pipe (RR 1.9) or cigar (RR 2.3) smoking, antioxidant supplementation (RR 1.52), obesity (RR 1.10), higher physical activity levels (RR 0.86), higher body levels of selenium (RR 0.61) and vitamin D (RR 0.75), and higher intakes of: processed meat (RR 1.22), vitamin A (RR 0.82), vitamin E (RR 0.82), folate (RR 0.84), fruit (RR 0.77), vegetables (RR 0.83), citrus fruit (RR 0.85), and cruciferous vegetables (RR 0.84). Finally, three occupations with the highest risk were tobacco workers (RR 1.72), dye workers (RR 1.58), and chimney sweeps (RR 1.53). The probability of causation for individual factors ranged from 4 to 68 %. The combined probability of causation was 81.8 %. Modification of lifestyle and occupational exposures can considerably reduce the bladder cancer burden. While smoking remains one of the key risk factors, also several diet-related and occupational factors are very relevant.
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Affiliation(s)
- Abdulmohsen H Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, P.O. Box 42317, Madinah, 41541, Saudi Arabia
| | - Kelly F J Stewart
- Department of Complex Genetics, School of Nutrition, and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, P. O. Box 616, 6200 MS, Maastricht, The Netherlands.
| | - Anke Wesselius
- Department of Complex Genetics, School of Nutrition, and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, P. O. Box 616, 6200 MS, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, P. O. Box 616, 6200 MS, Maastricht, The Netherlands
| | - Maurice P Zeegers
- Department of Complex Genetics, School of Nutrition, and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, P. O. Box 616, 6200 MS, Maastricht, The Netherlands
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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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Gutierrez D, Arbesman J. Circadian Dysrhythmias, Physiological Aberrations, and the Link to Skin Cancer. Int J Mol Sci 2016; 17:ijms17050621. [PMID: 27128901 PMCID: PMC4881447 DOI: 10.3390/ijms17050621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 12/21/2022] Open
Abstract
Circadian rhythms are core regulators of a variety of mammalian physiologic processes and oscillate in a 24-h pattern. Many peripheral organs possess endogenous rhythmicity that is then modulated by a master clock; the skin is one of these peripheral organs. The dysregulation of rhythms is associated with decreased ability to ameliorate cellular stressors at a local and global level, which then increases the propensity for the development of neoplastic growths. In this article, we review the implications of altered circadian rhythms on DNA repair as well as modified gene expression of core clock proteins with particular focus on skin models. These findings are then correlated with epidemiologic data regarding skin cancer to showcase the effects of circadian disruption on this phenomenon.
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Affiliation(s)
- Daniel Gutierrez
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Joshua Arbesman
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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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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Vidotti HGM, Sticca MG, Silva TNRD, Menegon NL. Trabalho e saúde dos comissários de bordo: uma revisão. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2016. [DOI: 10.1590/2317-6369000116015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: com o aumento do número de voos e passageiros, as tarefas atribuídas aos comissários de bordo tornam-se mais complexas, podendo gerar sobrecarga e prejuízo à saúde e ao desempenho desses trabalhadores. Objetivos: identificar e sistematizar os artigos publicados em periódicos científicos, sobre o impacto de fatores físicos, ambientais e organizacionais do trabalho dos comissários de bordo na saúde desses trabalhadores. Método: revisão sistemática da literatura, em português e inglês, utilizando as palavras-chave "aeronave", "cabine", "transporte aéreo", "comissário de bordo" e "trabalho", nas bases de dados ScienceDirect, PubMed, Scopus, ProQuest e SciELO, considerando o período de 1983 a 2013. Resultados: 65 artigos atenderam aos critérios de inclusão. Verificou-se um predomínio de trabalhos com foco em fatores físicos e/ou relacionados à saúde/doença e em fatores relacionados à satisfação no trabalho e poucos estudos abordando a organização do trabalho. Conclusão: os estudos encontrados analisaram os fatores presentes nas situações de trabalho de comissários de bordo de forma isolada. Não foram encontrados estudos que adotassem uma metodologia de análise das situações de trabalho que possibilitasse estabelecer inter-relações entre os fatores determinantes da carga de trabalho desses trabalhadores e os impactos para sua saúde.
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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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18
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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: 55] [Impact Index Per Article: 6.1] [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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20
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Les hôtesses de l’air sont-elles à risque accru de cancer du sein ? ACTA ACUST UNITED AC 2015; 43:41-8. [DOI: 10.1016/j.gyobfe.2014.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/08/2014] [Indexed: 01/23/2023]
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Liu R, Dix-Cooper L, Hammond SK. Modeling flight attendants' exposure to secondhand smoke in commercial aircraft: historical trends from 1955 to 1989. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:145-155. [PMID: 25587876 DOI: 10.1080/15459624.2014.957830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Flight attendants were exposed to elevated levels of secondhand smoke (SHS) in commercial aircraft when smoking was allowed on planes. During flight attendants' working years, their occupational SHS exposure was influenced by various factors, including the prevalence of active smokers on planes, fliers' smoking behaviors, airplane flight load factors, and ventilation systems. These factors have likely changed over the past six decades and would affect SHS concentrations in commercial aircraft. However, changes in flight attendants' exposure to SHS have not been examined in the literature. This study estimates the magnitude of the changes and the historic trends of flight attendants' SHS exposure in U.S. domestic commercial aircraft by integrating historical changes of contributing factors. Mass balance models were developed and evaluated to estimate flight attendants' exposure to SHS in passenger cabins, as indicated by two commonly used tracers (airborne nicotine and particulate matter (PM)). Monte Carlo simulations integrating historical trends and distributions of influence factors were used to simulate 10,000 flight attendants' exposure to SHS on commercial flights from 1955 to 1989. These models indicate that annual mean SHS PM concentrations to which flight attendants were exposed in passenger cabins steadily decreased from approximately 265 μg/m(3) in 1955 and 1960 to 93 μg/m(3) by 1989, and airborne nicotine exposure among flight attendants also decreased from 11.1 μg/m(3) in 1955 to 6.5 μg/m(3) in 1989. Using duration of employment as an indicator of flight attendants' cumulative occupational exposure to SHS in epidemiological studies would inaccurately assess their lifetime exposures and thus bias the relationship between the exposure and health effects. This historical trend should be considered in future epidemiological studies.
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Affiliation(s)
- Ruiling Liu
- a Department of Environmental Health Sciences, School of Public Health , University of California , Berkeley , California
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22
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Circadian disrupting exposures and breast cancer risk: a meta-analysis. Int Arch Occup Environ Health 2014; 88:533-47. [DOI: 10.1007/s00420-014-0986-x] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 09/16/2014] [Indexed: 12/11/2022]
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Winter M, Blettner M, Zeeb H. Prevalence of risk factors for breast cancer in German airline cabin crew: a cross-sectional study. J Occup Med Toxicol 2014; 9:27. [PMID: 25067940 PMCID: PMC4110375 DOI: 10.1186/1745-6673-9-27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/08/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many epidemiological studies point to an increased risk of breast cancer among female airline cabin crew. Possible causes include occupational factors (e.g. cosmic radiation exposure, chronodisruption), as well as lifestyle and reproductive factors. AIMS To investigate the frequency of various risk factors in German flight attendants which are recognised to be associated with breast cancer. METHODS 2708 current and former female cabin crew were randomly selected by a flight attendants' union and mailed a questionnaire; 1311 responded (48% response). Descriptive statistics were used to compare the distribution of breast cancer risk factors with general German population data. RESULTS On average, cabin crew were 3.0 cm (95% CI 2.7-3.3) taller than the comparison group, while their body mass index was 2.5 kg/m(2) (95% CI 2.4-2.6) lower. We found less use of hormone replacement therapy, but longer average use of oral contraceptives. Nulliparity among respondents aged 45+ was 57% (95% CI 54%-60%) compared to 16%. Average age at first birth was 32.1 years (95% CI 31.7-32.4) vs. 25.5 years. The birth rate was 0.62 (95% CI 0.58-0.67), less than half the population average of 1.34. Alcohol consumption was considerably higher, whereas cabin crew tended to smoke less and performed more physical exercise. CONCLUSION We found important differences in terms of anthropometric, gynaecological, reproductive and lifestyle factors. Some of these differences (e.g. higher nulliparity, alcohol consumption, taller size) could contribute to a higher breast cancer risk, whereas others could lead to a reduction (e.g. increased physical exercise, lower BMI, less HRT use).
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Affiliation(s)
- Mareen Winter
- Institute for Medical Statistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany
| | - Maria Blettner
- Institute for Medical Statistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Dep. of Prevention and Evaluation, Achterstr. 30, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, Germany, Bibliothekstr 1, 28359 Bremen, Germany
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McNeely E, Gale S, Tager I, Kincl L, Bradley J, Coull B, Hecker S. The self-reported health of U.S. flight attendants compared to the general population. Environ Health 2014; 13:13. [PMID: 24612632 PMCID: PMC4007523 DOI: 10.1186/1476-069x-13-13] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/28/2014] [Indexed: 05/09/2023]
Abstract
BACKGROUND Few studies have examined the broad health effects of occupational exposures in flight attendants apart from disease-specific morbidity and mortality studies. We describe the health status of flight attendants and compare it to the U.S. population. In addition, we explore whether the prevalence of major health conditions in flight attendants is associated with length of exposure to the aircraft environment using job tenure as a proxy. METHODS We surveyed flight attendants from two domestic U.S. airlines in 2007 and compared the prevalence of their health conditions to contemporaneous cohorts in the National Health and Nutrition Survey (NHANES), 2005-2006 and 2007-2008. We weighted the prevalence of flight attendant conditions to match the age distribution in the NHANES and compared the two populations stratified by gender using the Standardized Prevalence Ratio (SPR). For leading health conditions in flight attendants, we analyzed the association between job tenure and health outcomes in logistic regression models. RESULTS Compared to the NHANES population (n =5,713), flight attendants (n = 4,011) had about a 3-fold increase in the age-adjusted prevalence of chronic bronchitis despite considerably lower levels of smoking. In addition, the prevalence of cardiac disease in female flight attendants was 3.5 times greater than the general population while their prevalence of hypertension and being overweight was significantly lower. Flight attendants reported 2 to 5.7 times more sleep disorders, depression, and fatigue, than the general population. Female flight attendants reported 34% more reproductive cancers. Health conditions that increased with longer job tenure as a flight attendant were chronic bronchitis, heart disease in females, skin cancer, hearing loss, depression and anxiety, even after adjusting for age, gender, body mass index (BMI), education, and smoking. CONCLUSIONS This study found higher rates of specific diseases in flight attendants than the general population. Longer tenure appears to explain some of the higher disease prevalence. Conclusions are limited by the cross-sectional design and recall bias. Further study is needed to determine the source of risk and to elucidate specific exposure-disease relationships over time.
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Affiliation(s)
- Eileen McNeely
- Department of Environmental Health, Harvard School of Public Health, Building 1, Room 1401, 655 Huntington Avenue, Boston, MA, USA
| | - Sara Gale
- Department of Environmental Health, Harvard School of Public Health, Building 1, Room 1401, 655 Huntington Avenue, Boston, MA, USA
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA 94720-7360, USA
| | - Ira Tager
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA 94720-7360, USA
| | - Laurel Kincl
- Oregon State University, College of Public Health and Human Sciences, 116 Milam Hall, Corvallis, OR 97331-6102, USA
| | - Julie Bradley
- Department of Environmental Health, Harvard School of Public Health, Building 1, Room 1401, 655 Huntington Avenue, Boston, MA, USA
| | - Brent Coull
- Department of Environmental Health, Harvard School of Public Health, Building 1, Room 1401, 655 Huntington Avenue, Boston, MA, USA
| | - Steve Hecker
- University of Oregon, Labor Education and Research Center, 1675 Agate St, Eugene, OR 97403, USA
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Lengyel Z, Battyáni Z, Szekeres G, Csernus V, Nagy AD. Circadian clocks and tumor biology: what is to learn from human skin biopsies? Gen Comp Endocrinol 2013; 188:67-74. [PMID: 23608545 DOI: 10.1016/j.ygcen.2013.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/28/2013] [Accepted: 03/31/2013] [Indexed: 01/27/2023]
Abstract
Some of the components of the circadian molecular clock have been shown to link directly to tumor suppression. Most studies on human tumorous biopsies with consistently down-regulated clock gene expression suggested a protective role for these genes against cancer formation. To highlight some limitations of this hypothesis we review these data in light of recent evidences from animal research, epidemiologic studies, and clinical data on skin tumors. We emphasize the role of circadian rhythmic orchestration in cellular metabolism with a potential in cancer development.
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Affiliation(s)
- Zsuzsanna Lengyel
- Department of Dermatology, Medical School, University of Pécs, H-7624 Pécs, Kodály Z.u. 20, Hungary.
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Kojo K, Helminen M, Pukkala E, Auvinen A. Risk factors for skin cancer among Finnish airline cabin crew. ACTA ACUST UNITED AC 2013; 57:695-704. [PMID: 23316078 DOI: 10.1093/annhyg/mes106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Increased incidence of skin cancers among airline cabin crew has been reported in several studies. We evaluated whether the difference in risk factor prevalence between Finnish airline cabin crew and the general population could explain the increased incidence of skin cancers among cabin crew, and the possible contribution of estimated occupational cosmic radiation exposure. A self-administered questionnaire survey on occupational, host, and ultraviolet radiation exposure factors was conducted among female cabin crew members and females presenting the general population. The impact of occupational cosmic radiation dose was estimated in a separate nested case-control analysis among the participating cabin crew (with 9 melanoma and 35 basal cell carcinoma cases). No considerable difference in the prevalence of risk factors of skin cancer was found between the cabin crew (N = 702) and the general population subjects (N = 1007) participating the study. The mean risk score based on all the conventional skin cancer risk factors was 1.43 for cabin crew and 1.44 for general population (P = 0.24). Among the cabin crew, the estimated cumulative cosmic radiation dose was not related to the increased skin cancer risk [adjusted odds ratio (OR) = 0.75, 95% confidence interval (CI): 0.57-1.00]. The highest plausible risk of skin cancer for estimated cosmic radiation dose was estimated as 9% per 10 mSv. The skin cancer cases had higher host characteristics scores than the non-cases among cabin crew (adjusted OR = 1.43, 95% CI: 1.01-2.04). Our results indicate no difference between the female cabin crew and the general female population in the prevalence of factors generally associated with incidence of skin cancer. Exposure to cosmic radiation did not explain the excess of skin cancer among the studied cabin crew in this study.
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Affiliation(s)
- Katja Kojo
- STUK-Radiation and Nuclear Safety Authority, PO Box 14, FI-00880 Helsinki, Finland.
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28
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Pukkala E, Helminen M, Haldorsen T, Hammar N, Kojo K, Linnersjö A, Rafnsson V, Tulinius H, Tveten U, Auvinen A. Cancer incidence among Nordic airline cabin crew. Int J Cancer 2012; 131:2886-97. [PMID: 22447246 DOI: 10.1002/ijc.27551] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 03/05/2012] [Indexed: 11/11/2022]
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.
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Affiliation(s)
- Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.
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Zeeb H, Hammer GP, Blettner M. Epidemiological investigations of aircrew: an occupational group with low-level cosmic radiation exposure. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2012; 32:N15-N19. [PMID: 22395103 DOI: 10.1088/0952-4746/32/1/n15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Aircrew and passengers are exposed to low-level cosmic ionising radiation. Annual effective doses for flight crew have been estimated to be in the order of 2-5 mSv and can attain 75 mSv at career end. Epidemiological studies in this occupational group have been conducted over the last 15-20 years, usually with a focus on radiation-associated cancer. These studies are summarised in this note. Overall cancer risk was not elevated in most studies and subpopulations analysed, while malignant melanoma, other skin cancers and breast cancer in female aircrew have shown elevated incidence, with lesser risk elevations in terms of mortality. In some studies, including the large German cohort, brain cancer risk appears elevated. Cardiovascular mortality risks were generally very low. Dose information for pilots was usually derived from calculation procedures based on routine licence information, types of aircraft and routes/hours flown, but not on direct measurements. However, dose estimates have shown high validity when compared with measured values. No clear-cut dose-response patterns pointing to a higher risk for those with higher cumulative doses were found. Studies on other health outcomes have shown mixed results. Overall, aircrew are a highly selected group with many specific characteristics and exposures that might also influence cancers or other health outcomes. Radiation-associated health effects have not been clearly established in the studies available so far.
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Affiliation(s)
- Hajo Zeeb
- Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany.
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Pinkerton LE, Waters MA, Hein MJ, Zivkovich Z, Schubauer-Berigan MK, Grajewski B. Cause-specific mortality among a cohort of U.S. flight attendants. Am J Ind Med 2012; 55:25-36. [PMID: 21987391 DOI: 10.1002/ajim.21011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND We evaluated mortality among 11,311 former U.S. flight attendants. The primary a priori outcomes of interest were breast cancer and melanoma. METHODS Vital status was ascertained through 2007, and life table analyses was conducted. Cumulative exposure to cosmic radiation and circadian rhythm disruption were estimated from work history data and historical published flight schedules. RESULTS All-cause mortality was less than expected among women but was elevated among men, primarily due to elevated HIV-related disease mortality. Mortality from breast cancer among women and melanoma was neither significantly elevated nor related to metrics of exposure. Mortality was elevated for non-Hodgkin's lymphoma among men; for alcoholism, drowning, and intentional self-harm among women; and for railway, water, and air transportation accidents. CONCLUSIONS We found no evidence of increased breast cancer or melanoma mortality. Limitations include reliance on mortality data and limited power resulting from few melanoma deaths and relatively short employment durations.
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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 45226, USA.
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Grajewski B, Waters MA, Yong LC, Tseng CY, Zivkovich Z, Cassinelli RT. Airline pilot cosmic radiation and circadian disruption exposure assessment from logbooks and company records. THE ANNALS OF OCCUPATIONAL HYGIENE 2011; 55:465-75. [PMID: 21610083 PMCID: PMC3113148 DOI: 10.1093/annhyg/mer024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 03/23/2011] [Indexed: 11/13/2022]
Abstract
OBJECTIVES US commercial airline pilots, like all flight crew, are at increased risk for specific cancers, but the relation of these outcomes to specific air cabin exposures is unclear. Flight time or block (airborne plus taxi) time often substitutes for assessment of exposure to cosmic radiation. Our objectives were to develop methods to estimate exposures to cosmic radiation and circadian disruption for a study of chromosome aberrations in pilots and to describe workplace exposures for these pilots. METHODS Exposures were estimated for cosmic ionizing radiation and circadian disruption between August 1963 and March 2003 for 83 male pilots from a major US airline. Estimates were based on 523 387 individual flight segments in company records and pilot logbooks as well as summary records of hours flown from other sources. Exposure was estimated by calculation or imputation for all but 0.02% of the individual flight segments' block time. Exposures were estimated from questionnaire data for a comparison group of 51 male university faculty. RESULTS Pilots flew a median of 7126 flight segments and 14 959 block hours for 27.8 years. In the final study year, a hypothetical pilot incurred an estimated median effective dose of 1.92 mSv (absorbed dose, 0.85 mGy) from cosmic radiation and crossed 362 time zones. This study pilot was possibly exposed to a moderate or large solar particle event a median of 6 times or once every 3.7 years of work. Work at the study airline and military flying were the two highest sources of pilot exposure for all metrics. An index of work during the standard sleep interval (SSI travel) also suggested potential chronic sleep disturbance in some pilots. For study airline flights, median segment radiation doses, time zones crossed, and SSI travel increased markedly from the 1990s to 2003 (P(trend) < 0.0001). Dose metrics were moderately correlated with records-based duration metrics (Spearman's r = 0.61-0.69). CONCLUSIONS The methods developed provided an exposure profile of this group of US airline pilots, many of whom have been exposed to increasing cosmic radiation and circadian disruption from the 1990s through 2003. This assessment is likely to decrease exposure misclassification in health studies.
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Affiliation(s)
- Barbara Grajewski
- Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA.
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Schernhammer ES, Razavi P, Li TY, Qureshi AA, Han J. Rotating night shifts and risk of skin cancer in the nurses' health study. J Natl Cancer Inst 2011; 103:602-6. [PMID: 21335547 DOI: 10.1093/jnci/djr044] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Night shift work is associated with increased risk of several cancers, but the risk of skin cancer among night shift workers is unknown. We documented 10,799 incident skin cancers in 68,336 women in the Nurses' Health Study from June 1988 to June 2006 and examined the relationship between rotating night shifts and skin cancer. We used Cox proportional hazard models, adjusted for confounding variables (phenotypic and established risk factors of skin cancer), and performed stratified analysis to explore the modifying effect of hair color. Working 10 years or more on rotating night shifts was associated with a 14% decreased risk of skin cancer compared with never working night shifts (age-standardized incidence rate: 976 per 100,000 person-years (PY) vs 1070 per 100,000 PY, respectively; adjusted hazard ratios = 0.86, 95% confidence interval = 0.81 to 0.92, P(trend) < .001). This association was strongest for cutaneous melanoma; working 10 years or more of rotating night shifts was associated with 44% decreased risk of melanoma, after adjustment for melanoma risk factors (age-standardized incidence rate: 20 per 100,000 PY vs 35 per 100,000 PY, respectively; adjusted hazard ratios = 0.56, 95% confidence interval = 0.36 to 0.87, P(trend) = .005). Hair color, a surrogate for an individual's susceptibility to skin cancer, was a statistically significant effect modifier for the observed associations; darker-haired women had the lowest risk (P(interaction) = .02).
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Affiliation(s)
- Eva S Schernhammer
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School Boston, MA 02115, USA.
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Weed DL. Meta-Analysis and Causal Inference: A Case Study of Benzene and Non-Hodgkin Lymphoma. Ann Epidemiol 2010; 20:347-55. [DOI: 10.1016/j.annepidem.2010.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 02/01/2010] [Accepted: 02/05/2010] [Indexed: 12/20/2022]
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Abstract
Many circadian rhythms are controlled by the central clock of the suprachiasmatic nucleus of the hypothalamus, as well as clocks located in other brain regions and most peripheral tissues. These central and peripheral clocks are based on clock genes and their protein products. In recent years, the expression of clock genes has started to be investigated in human samples, primarily white blood cells, but also skin, oral mucosa, colon cells, adipose tissue as well as post-mortem brain tissue. The expression of clock genes in those peripheral tissues offers a way to monitor human peripheral clocks and to compare their function and regulation with those of the central clock, which is followed by markers such as melatonin, cortisol and core body temperature. We have recently used such an approach to compare central and peripheral rhythms in subjects under different lighting conditions. In particular, we have monitored the entrainment of the clock of blood cells in subjects undergoing a simulated night shift protocol with bright light treatment, known to efficiently reset the central clock. This line of research will be helpful for learning more about the human circadian system and to find ways to alleviate health problems of shift workers, and other populations experiencing altered circadian rhythms.
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Affiliation(s)
- N Cermakian
- Laboratory of Molecular Chronobiology, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada.
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Waters MA, Grajewski B, Pinkerton LE, Hein MJ, Zivkovich Z. Development of historical exposure estimates of cosmic radiation and circadian rhythm disruption for cohort studies of Pan Am flight attendants. Am J Ind Med 2009; 52:751-61. [PMID: 19722196 DOI: 10.1002/ajim.20738] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The National Institute for Occupational Safety and Health is conducting cohort studies of flight crew employed by the former Pan American World Airways company (Pan Am) as part of an effort to examine flight crew workplace exposures and health effects. Flight crew are exposed to elevated levels of cosmic radiation and to disruption of circadian rhythm when flying across multiple time zones. Methods exist to calculate cosmic radiation effective doses on individual flights; however, only work histories which provided an employee's domicile (home base) history rather than a record of every flight flown were available. METHODS/RESULTS We developed a method for estimating individual cumulative domicile-based cosmic radiation effective doses and two metrics for circadian rhythm disruption for each flight attendant: cumulative times zones crossed and cumulative travel time during the standard sleep interval. CONCLUSIONS The domicile-exposure matrix developed was used to calculate exposure estimates for a cohort mortality study of former Pan Am flight attendants.
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Affiliation(s)
- Martha A Waters
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA
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Hammer GP, Blettner M, Zeeb H. Epidemiological studies of cancer in aircrew. RADIATION PROTECTION DOSIMETRY 2009; 136:232-239. [PMID: 19608578 DOI: 10.1093/rpd/ncp125] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Exposure to cosmic ionising radiation, in addition to other specific occupational risks, is of concern to aircrew members. Epidemiological studies provide an objective way to assess the health of this occupational group. We systematically reviewed the epidemiological literature on health of aircrew members since 1990, focusing on cancer as the endpoint of interest. Sixty-five relevant publications were identified and reviewed. Whereas overall cancer incidence and mortality was generally lower than in the comparison population, consistently elevated risks were reported for breast cancer incidence in female aircrew members and for melanoma in both male and female aircrew members. Brain cancer was increased in some studies among pilots. Occasionally trends of increasing cancer mortality or incidence with increasing estimated radiation dose were reported. Ionising radiation is considered to contribute little if at all to the elevated risks for cancers among aircrew, whereas excess ultraviolet radiation is a probable cause of the increased melanoma risk.
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Affiliation(s)
- Gaël P Hammer
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg-University, Langenbeckstr. 1, D-55101 Mainz, Germany.
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Barish RJ. Health physics and aviation: solar cycle 23 (1996-2008). HEALTH PHYSICS 2009; 96:456-464. [PMID: 19276706 DOI: 10.1097/01.hp.0000338338.71484.3c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We continue our description of the scientific and professional activities that were initiated by the classification of airline flight crewmembers as occupational radiation workers in 1994, specifically looking at the period between 1996 and 2008. During this period, radiation measurement programs were conducted on numerous commercial aircraft flights. Epidemiological studies have looked at the incidence of cancer in pilots and flight attendants, with mixed conclusions. The Federal Aviation Administration (FAA) released revised versions of its CARI software, the computer program designed to evaluate radiation exposures received on user-defined flight plans. Additional dose-evaluation programs have been made available by other entities. In May 2000, member states of the European Union (EU) adopted regulations that apply to the air carriers in all twenty-seven nations requiring education on health risks of in-flight radiation as well as dose assessment for all EU flight crewmembers. The National Oceanic and Atmospheric Administration (NOAA) revised its classification scheme for space weather events including radiation-producing solar storms. In 2005, the FAA created a Solar Particle Alert system to warn aircraft of high radiation levels caused by significant events of this type. There is now an early-warning system for potentially harmful solar particle events. This new system depends on the earlier arrival time of relativistic electrons compared with the heavier particulate radiation.
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Lamont EW, James FO, Boivin DB, Cermakian N. From circadian clock gene expression to pathologies. Sleep Med 2007; 8:547-56. [PMID: 17395534 DOI: 10.1016/j.sleep.2006.11.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 10/23/2006] [Accepted: 11/03/2006] [Indexed: 11/28/2022]
Abstract
In most organisms, circadian rhythms are generated by a molecular clockwork involving so-called clock genes. These circadian clock genes participate in regulatory feedback loops, in which proteins regulate their own expression. The outcome is that ribonucleic acids (RNAs) and proteins produced from many of these genes oscillate with a circadian rhythm. Here, we describe the regulation of clock genes and proteins, as deduced from work in rodents. Furthermore, we summarize the work done on human clock genes and their expression in peripheral tissues. Importantly, the research reviewed here points to an implication of clock gene defects in circadian rhythm disorders, including the advanced and delayed sleep phase disorders. Moreover, circadian clock gene dysfunction is likely to be of importance in the development of cancer as well as various other diseases.
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Kim JN, Lee BM. Risk factors, health risks, and risk management for aircraft personnel and frequent flyers. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2007; 10:223-34. [PMID: 17454553 DOI: 10.1080/10937400600882103] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Health risks associated with long periods of time in flight are of concern to astronauts, crew members, and passengers. Many epidemiological studies showed that occupational and frequent flyers may be susceptible to ocular, cardiovascular, neurological, pulmonary, gastrointestinal, sensory, immunological, physiological, and even developmental disorders. In addition, the incidences of cancer and food poisoning are expected to be higher in such individuals. This article reviews health risks and risk factors associated with air travel, and discusses risk management strategies. To reduce adverse health risks, risk factors such as radiation, infection, stress, temperature, pressure, and circadian rhythm need to be avoided or reduced to levels that are as low as technologically achievable to protect flight personnel and passengers.
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Rafnsson V. Shortcomings in discussion. J Travel Med 2006; 13:388-9; author reply 389-90. [PMID: 17107439 DOI: 10.1111/j.1708-8305.2006.00077.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Evidence-Based Practice. J Midwifery Womens Health 2006. [DOI: 10.1016/j.jmwh.2006.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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