Abstract
BackgroundFlight attendants are an understudied occupational group, despite undergoing a wide range of adverse job-related exposures, including to known carcinogens. In our study, we aimed to characterize the prevalence of cancer diagnoses among U.S. cabin crew relative to the general population.MethodsIn 2014–2015, we surveyed participants of the Harvard Flight Attendant Health Study. We compared the prevalence of their self-reported cancer diagnoses to a contemporaneous cohort in the National Health and Nutrition Examination Survey (NHANES 2013–2014) using age-weighted standardized prevalence ratios (SPRs). We also analyzed associations between job tenure and the prevalence of selected cancers, using logistic regression and adjusting for potential confounders.ResultsCompared to NHANES participants with a similar socioeconomic status (n = 2729), flight attendants (n = 5366) had a higher prevalence of every cancer we examined, especially breast cancer, melanoma, and non-melanoma skin cancer among females. SPR for these conditions were 1.51 (95% CI: 1.02, 2.24), 2.27 (95% CI: 1.27, 4.06), and 4.09 (95% CI: 2.70, 6.20), respectively. Job tenure was positively related to non-melanoma skin cancer among females, with borderline associations for melanoma and non-melanoma skin cancers among males. Consistent with previous studies, we observed associations between job tenure and breast cancer among women who had three or more children.ConclusionsWe observed higher rates of specific cancers in flight attendants compared the general population, some of which were related to job tenure. Our results should be interpreted in light of self-reported health information and a cross-sectional study design. Future longitudinal studies should evaluate associations between specific exposures and cancers among cabin crew.
Highlights
Flight attendants are an understudied occupational group, despite undergoing a wide range of adverse job-related exposures, including to known carcinogens
Wave 2 Flight Attendant Health Study (FAHS) participants presented with a mean age of 52 years (15% were between ages 18–39, 54% were between ages 40–59, and 32% were over age 60) and an average net job tenure of 20 years
Mean number of live births differed between the females in the two study populations (0.8 for FAHS vs. 2.1 for National Health and Nutrition Examination Survey (NHANES)), despite NHANES having a higher percentage of women still in their childbearing years than the FAHS
Summary
Flight attendants are an understudied occupational group, despite undergoing a wide range of adverse job-related exposures, including to known carcinogens. Flight attendants are a highly understudied occupational cohort that is consistently exposed to several known and probable carcinogens in the cabin environment [1]. These include cosmic ionizing radiation at flight altitude, Circadian rhythm disruption due to night shift work, irregular schedules and frequently crossing time zones, and poor cabin air quality from a number of sources [2,3,4]. Studies regarding cancer risk or prevalence among flight attendants are relatively sparse and of varying quality [2]. Results from these studies have been mixed, but overall point towards associations between inflight exposures or job tenure as a flight attendant and McNeely et al Environmental Health (2018) 17:49 increased rates of breast and skin cancers, as well as aggregated cancers at all sites [7,8,9,10,11]
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