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Incidence of cancer among Nordic airline pilots over five decades: occupational cohort study

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7364.567 (Published 14 September 2002) Cite this as: BMJ 2002;325:567
  1. Eero Pukkala, epidemiologist (eero.pukkala{at}cancer.fi)a,
  2. Rafael Aspholm, airline pilotb,
  3. Anssi Auvinen, professorc,
  4. Harald Eliasch, medical consultantd,
  5. Maryanne Gundestrup, senior registrare,
  6. Tor Haldorsen, epidemiologistf,
  7. Niklas Hammar, epidemiologistg,
  8. Jón Hrafnkelsson, medical doctori,
  9. Pentti Kyyrönen, statisticiana,
  10. Anette Linnersjö, statisticianh,
  11. Vilhjálmur Rafnsson, professorj,
  12. Hans Storm, medical doctork,
  13. Ulf Tveten, senior scientistl
  1. a Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Liisankatu 21 B, FIN-00170 Helsinki, Finland,
  2. bFinnish Airline Pilots' Association, FIN-01530 Vantaa, Finland,
  3. cSTUK, Radiation and Nuclear Safety Authority, FIN-00881 Helsinki, Finland,
  4. dSwedish SAS, S-19587 Stockholm, Sweden
  5. eNational Clinic of Aviation Medicine, Heart Centre, University Hospital, DK-2220 Copenhagen N, Denmark
  6. fKreftregisteret, Institute of Population-based Cancer Research, N-0310 Oslo, Norway
  7. gInstitute of Environmental Medicine, Karolinska Institute, S-17177 Stockholm, Sweden,
  8. hDepartment of Epidemiology, Stockholm Centre of Public Health, S-17176 Stockholm, Sweden
  9. iDepartment of Oncology, Landspitalinn, ICE-105 Reykjavik, Iceland
  10. jDepartment of Preventive Medicine, University of Iceland, ICE-105 Reykjavik, Iceland
  11. kCancer Prevention and Documentation, Danish Cancer Society, DK-2100 Copenhagen Ø, Denmark
  12. lInstitute for Energy Technology, N-2007 Kjeller, Norway
  1. Correspondence to: E Pukkala
  • Accepted 23 April 2002

Abstract

Objective: To assess the incidence of cancer among male airline pilots in the Nordic countries, with special reference to risk related to cosmic radiation.

Design: Retrospective cohort study, with follow up of cancer incidence through the national cancer registries.

Setting: Denmark, Finland, Iceland, Norway, and Sweden.

Participants: 10 032 male airline pilots, with an average follow up of 17 years.

Main outcome measures: Standardised incidence ratios, with expected numbers based on national cancer incidence rates; dose-response analysis using Poisson regression.

Results: 466 cases of cancer were diagnosed compared with 456 expected. The only significantly increased standardised incidence ratios were for skin cancer: melanoma 2.3 (95% confidence interval 1.7 to 3.0), non-melanoma 2.1 (1.7 to 2.8), basal cell carcinoma 2.5 (1.9 to 3.2). The relative risk of skin cancers increased with the estimated radiation dose. The relative risk of prostate cancer increased with increasing number of flight hours in long distance aircraft.

Conclusions: This study does not indicate a marked increase in cancer risk attributable to cosmic radiation, although some influence of cosmic radiation on skin cancer cannot be entirely excluded. The suggestion of an association between number of long distance flights (possibly related to circadian hormonal disturbances) and prostate cancer needs to be confirmed.

Footnotes

  • Funding Nordic Cancer Union and the participating institutes

  • Competing interests RA has been employed by Finnair as an airline pilot since 1988 and has shares in Finnair. He is also an active member of the Finnish Pilots' Association and has been reimbursed by the association for attending medical symposiums and conducting scientific research. HE has worked as an medical consultant for Scandinavian Airlines. The other authors have no connections to airline companies.

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