Pilots, flight attendants face greater risk of radiation-related cancer death
Pilots and flight attendants face greater risk of radiation-related cancer death, posing implications for radiologists and screening programs, according to new research published Monday.
Aircrew members receive the largest average effective dose of ionizing radiation of any occupational group in the U.S., mostly due to cosmic rays encountered at commercial flight altitudes. However, little is known about whether this exposure translates to increased risk of cancer-related death, experts write in JAMA Internal Medicine.[1]
Harvard researchers aimed to better understand, using data from U.S. death certificates spanning 2020 to 2024. They found that flight attendants and pilots have the highest proportion of radiation-related cancer morality across over 500 occupations, exceeding even nuclear technologists, who are routinely exposed to radiation.
“Specificity of these findings to aircrew suggests an association between large, cumulative in-flight cosmic radiation exposure and a heterogeneous group of radiation-related cancers,” corresponding author Anupam B. Jena, MD, PhD, with the Department of Health Care Policy at Harvard, and colleagues concluded.
Researchers used nuclear technologists as their positive control group, given their known exposure to radiation. Meanwhile, aircraft assemblers and mechanics also served as the negative control group, as they are disproportionately exposed to planes, but not air travel and cosmic radiation. Jena and co-authors calculated risk-adjusted odds ratios of death from various radiation-related cancers by occupation.
Altogether, the study included 12.7 million deceased individuals across 503 occupations, including over 14,000 pilots and 7,000-plus flight attendants. Out of hundreds of occupations included, flight attendants (6.9%) and pilots (6.7%) had the highest and second highest risk-adjusted percentage of deaths from radiation-related cancers. Risk of death remained elevated for both male and female flight attendants and pilots.
Aircraft mechanics and assemblers did not experience this increased cancer risk. Meanwhile, nuclear technologists had the 12th highest percentage of radiation-related cancer death, consistent with their established ionizing radiation exposure, the authors noted. Risk of death from the disease was higher for aircrew members across each cancer type studied. Odds ratios reached statistical significance for cancers of the breast, central nervous system, prostate, and melanoma—in both flight attendants and pilots.
In a corresponding editorial, experts charged that population-based breast cancer screening guidelines may underestimate individual risk for female aircrew members with long job tenures.[2] This may warrant earlier and more frequent mammographic surveillance among this population.
“Beyond melanoma and breast cancer, the elevated risks for other malignant neoplasms identified in both the current study and prior literature suggest that a heightened index of suspicion is appropriate when evaluating symptomatic aircrew across a range of clinical presentations,” Catherine M. Olsen, PhD, and Ken Karipidis, PhD, with the University of Queensland and Australian Radiation Protection and Nuclear Safety Agency, respectively, wrote Aug. 17.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.