Do airline pilots and cabin crew have raised risks of melanoma and other skin cancers? Systematic review and meta-analysis

BACKGROUND: Airline pilots and cabin crew are potentially exposed to hazardous ultraviolet (UV) and cosmic radiation that may increase their risk of melanoma and other skin cancers.

OBJECTIVES: To establish precise risks of melanoma and keratinocyte cancer (KC) for airline pilots and for cabin crew based on all studies published to date.

METHODS: We searched Medline, ISI science citation index, EMBASE, SCOPUS, and CINAHL to June 2018. All studies of melanoma and KC risk and mortality in airline pilots and cabin crew compared with the general population were eligible. Standardised incidence ratios (SIRs) and mortality ratios (SMRs) were pooled using random effects models.

RESULTS: From 5866 articles, we reviewed 44 full-text articles, of which 12 studies whose data were collected mostly between the 1970s-1990s, were eligible for inclusion. The pooled SIR (pSIR) for melanoma in pilots was 2·03 (95% confidence interval (CI) 1·71-2·40) and in cabin crew was 2·12 (95% CI 1·71-2·62). For pilots, pSMR for melanoma was 1·99 (95% CI 1·17-3·40) and for cabin crew was 1·18 (95% CI 0·73-1·89). For KC, the pSIR was 1·86 (95% CI 1·54-2·25) in pilots and 1·97 (95% CI 1·25-2·96) in cabin crew. There was no evidence of study heterogeneity.

CONCLUSIONS: Available evidence shows that airline pilots and cabin crew have about twice the risk of melanoma and other skin cancers compared with the general population, with pilots more likely to die from melanoma. However, most of evidence was collected several decades ago and their relevance to contemporary levels of risk is uncertain. This article is protected by copyright. All rights reserved.