Martina Sanlorenzo1, Mackenzie R Wehner2, Eleni Linos3, John Kornak4, Wolfgang Kainz5, Christian Posch6, Igor Vujic6, Katia Johnston3, Deborah Gho3, Gabriela Monico3, James T McGrath3, Simona Osella-Abate7, Pietro Quaglino7, James E Cleaver3, Susana Ortiz-Urda3. 1. Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco2Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy. 2. Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco3School of Medicine, Stanford University, Stanford, California. 3. Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco. 4. Department of Epidemiology and Biostatistics, University of California, San Francisco. 5. Center for Devices and Radiological Health, Division of Physics, US Food and Drug Administration, Silver Spring, Maryland. 6. Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco6Department of Dermatology,The Rudolfstiftung Hospital, Vienna, Austria. 7. Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.
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.
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.
Authors: Niklas Hammar; Anette Linnersjö; Lars Alfredsson; Bo-Gödran Dammström; Maritha Johansson; Harald Eliasch Journal: Aviat Space Environ Med Date: 2002-01
Authors: Martina Sanlorenzo; Igor Vujic; Christian Posch; James E Cleaver; Pietro Quaglino; Susana Ortiz-Urda Journal: JAMA Dermatol Date: 2015-04 Impact factor: 10.282
Authors: Jonathan J Lee; Lynette M Sholl; Neal I Lindeman; Scott R Granter; Alvaro C Laga; Priyanka Shivdasani; Gary Chin; Jason J Luke; Patrick A Ott; F Stephen Hodi; Martin C Mihm; Jennifer Y Lin; Andrew E Werchniak; Harley A Haynes; Nancy Bailey; Robert Liu; George F Murphy; Christine G Lian Journal: Clin Epigenetics Date: 2015-06-09 Impact factor: 6.551