Review date
April 2023
Article publication date
March 2023
Summary
This nested case–control study evaluated risk of skin melanoma associated with occupational exposure to cosmic (ionising) radiation and solar ultraviolet (UV) radiation among military pilots. The study included 199 male cases (10 of which had ever worked as a pilot) of skin melanoma diagnosed between 1990 and 2003, and 1,126 male cancer-free controls identified from a large Danish military population. The Danish National Cancer Registry provided data on the male cases for skin melanoma; whilst data on all participants’ work history in military service and other jobs, socioeconomic and lifestyle characteristics (e.g., leisure-time sun exposure habits) were obtained from a self-reported questionnaire. The study found a positive association between work onboard aircraft and skin melanoma (Odds Ratio (OR)=2.30, 95% Confidence Intervals (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). Similarly, a positive association between longer duration of employment as a pilot and skin melanoma was also found (OR per year =1.07, 95% CI:1.01–1.14).
Link to
Incident skin melanoma in Danish male military pilots: a nested case-control study
Published in
Occupational Environmental Medicine
Commentary by ARPANSA
The overall conclusion of the study indicates that occupational exposure to cosmic and solar UV radiation among male pilots increases risk of skin melanoma, and the risk increases with longer duration of the employment. These findings are consistent with the findings of previous systematic reviews and meta-analyses ( Sanlorenzo et al., 2015; Miura et al., 2019). A cohort study (Olsen et al., 2019) conducted among Australian-licensed commercial pilots showed a modestly raised risk of in situ melanoma, but no increased risk of invasive melanoma compared with the general population. Limitations of this study include likely inaccuracies in the assessment of cosmic and UV exposure levels, and recall bias in the exposure reporting. Further, a modest participation rate of male cases and controls may have also instigated selection bias, which partly could be a reason for relatively high risk estimates for skin melanoma among pilots compared with previous findings. The Australian Radiation Protection and Nuclear Safety Agency’s (ARPANSA) Guide for Radiation Protection in Existing Exposure Situations Radiation Protection Series G-2 provides framework for managing existing exposure situations, including exposure of aircrew due to cosmic radiation. Similarly, ARPANSA’s Radiation Protection Standard for Occupational Exposure to Ultraviolet Radiation (2006) sets fundamental requirements for safety in relation to occupational UV radiation exposure. Though an elevated risk of skin melanoma among commercial pilots has been indicated by recent epidemiological studies, generally, there is no increase in health risk from exposure to cosmic or UV radiation for casual flyers. However, some of the frequent flyers (critical population groups e.g., pregnant women and children) may exceed reference levels of cosmic radiation (Tate et al., 2021), and hence additional awareness or protection may be considered.
