Occupational Health Challenges for Aviation Workers Amid the Changing Climate: A Narrative Review

Although there are many forecasts regarding the impact of climate change on the aviation sector, a critical but frequently neglected dimension is the occupational safety risks faced by aviation professionals. This narrative review explores the potential impacts of the changing climate on the health and safety of aviation personnel. Furthermore, we examine the significance of resilience in helping these workers adapt and effectively manage climate-related challenges in their professional lives. Climate change poses increasing threats to the well-being of flight personnel through elevated temperatures, heightened ultraviolet radiation exposure, increased mental workload from extreme weather events, and other psychological stressors. Building resilience through workforce training, planning, and adaptation can reduce vulnerability. In future research, the iterative process of selecting measurement components to gauge the impact of climate change should balance feasibility, relevance for stakeholders, and accurately capturing exposure effects. For instance, while salivary cortisol measures stress biologically, assessments of depression or burnout may provide more nuanced insights on pilot health for industry decision-makers managing climate impacts. In conclusion, a strategic emphasis on enhancing the physical and psychological well-being of the aviation workforce is imperative for facilitating a more efficient adaptation within the sector. This is of paramount importance, considering the critical function that aviation serves in fostering human connectivity. Consequently, it is essential for regulatory bodies and policymakers to prioritize the safeguarding of employee health in the face of climate change challenges.

Low-dose X-ray radiation induces an adaptive response: A potential countermeasure to galactic cosmic radiation exposure

Space exploration involves many dangers including galactic cosmic radiation (GCR). This class of radiation includes high-energy protons and heavy ionizing ions. NASA has defined GCR as a carcinogenic risk for long-duration space missions. To date, no clear strategy has been developed to counter chronic GCR exposure. We hypothesize that preconditioning cells with low levels of radiation will be protective from subsequent higher radiation exposures. H9C2 cells were pretreated with 0.1 to 1.0 Gy X-rays. The challenge radiation exposure consisted of either 8 Gy X-rays or 75 cGy of GCR, using a five-ion GCRsim protocol. A cell doubling time assay was used to determine cell viability. An 8 Gy X-ray challenge alone significantly (P < 0.05) increased cell doubling time compared to the no-radiation control group. Low-dose radiation pre-treatment ameliorated the 8 Gy X-ray-induced increases in cell doubling time. A 75 cGy GCR challenge alone significantly increased cell doubling time compared to the no-radiation group. Following the 75 cGy challenge, only the 0.5 and 1.0 Gy pre-treatment ameliorated the 75 cGy-induced increases in cell doubling time. DNA damage or pathological oxidant stress will delay replicative functions and increase cell doubling time. Our results suggested that pretreatment with low-dose X-rays induced an adaptive response which offered a small but significant protection against a following higher radiation challenge. Although perhaps not a practical countermeasure, these findings may serve to offer insight into cell signalling pathways activated in response to low-dose irradiation and targeted for countermeasure development.

Increased Peripheral Blood DNA Damage and Elevated Serum Levels of Melanoma Inhibitory Activity Protein: Clues to Excess Skin Cancer Risk in Airline Pilots?

Background and objective The risk of malignant melanoma (MM) and other forms of skin cancer appears to be higher in airline pilots (APs), potentially due to their exposure to ionizing and ultraviolet (UV) radiation. We explored the possibility of increased peripheral blood DNA damage and elevated serum levels of the melanoma inhibitory activity (MIA) protein - a serological marker for MM known to be stimulated by UV radiation - in this professional group. Methods This was a case-control study involving 40 male APs, each of whom was age- and tenure-matched (≥5 years of service) with 40 male office workers (OWs). We assessed DNA damage in the two professional groups by performing comet and micronucleus (MN) assays on peripheral blood. Serum levels of MIA protein were quantified using an immunoassay. Results The comet tail lengths and the frequency of MN were significantly higher in APs (4.57 ± 0.79 µm and 2.05 ± 0.26 per 1000 cells, respectively) than in OWs (3.81 ± 0.60 µm and 1.76 ± 0.31 per 1000 cells, respectively, both p<0.001). Furthermore, serum MIA levels were also significantly higher in APs (7.45 ± 0.95 ng/mL) than in OWs (5.78 ± 0.54 ng/mL, p<0.001). A significant positive correlation was found between comet tail lengths in APs and their serum MIA concentrations (r=0.68, p<0.01). Conclusions The increased burden of DNA damage and elevated serum MIA levels in APs may offer an explanation for their higher susceptibility to MM and other types of skin cancers.

A review of skin disease in military soldiers: challenges and potential solutions

Introduction: Military soldiers comprised 1,195 million United States active-duty members and 778,000 reserve members in 9/2021. Soldiers are often exposed to drastic climates, environments, and living conditions which may make them more susceptible to cutaneous diseases.Methods: A PubMed search of studies published between 1/1/2002 - 8/30/2022, using MeSH terms: ((("Military Personnel"[Majr]) OR "Military Hygiene"[Majr])) OR "Military Medicine"[Majr]) AND "Skin Diseases"[Majr]), the reference lists of select articles, and other applicable sources were reviewed to identify articles on skin conditions affecting military soldiers and treatment options.Discussion: In this article, we review skin conditions that affect military soldiers in both the deployed and non-deployed settings including infectious diseases, arthropod associated diseases, sexually transmitted infections, ultraviolet radiation related skin disease, acne, diseases of hair and hair follicles, dermatitis, onychocryptosis, and conditions caused by extreme weather conditions and occupational exposures. We also discuss treatment options and prevention methods as they relate to military settings.Conclusion: Dermatological conditions can considerably impact soldiers' wellbeing and military performance, often lead to evacuation of military personnel, and are associated with high financial costs. Cutaneous disease is one of most common reasons for soldiers to seek medical care and may cause significant morbidity. Serving in the military often impacts and limits treatment options.

A Preliminary Study of Gut Microbiota in Airline Pilots: Comparison With Construction Workers and Fitness Instructors

INTRODUCTION

The term "WORKbiota" has been used to describe the impact of occupational exposure and work types on human microbiota composition. Airline pilots, construction workers, and fitness instructors encompass three diverse professional groups, each with distinct work environments and lifestyle factors that may significantly influence their intestinal "WORKbiota."

OBJECTIVES

The current preliminary investigation was aimed to compare the relative abundance of specific gut microbes among airline pilots, construction workers, and fitness instructors to shed light on any significant differences. By scrutinizing these diverse professional groups, our objective was to enhance our understanding of how occupational factors influence gut microbiota while identifying possible implications for occupational medicine.

METHODS

A convenience sample consisting of 60 men representing three different professional domains - airline pilots, construction workers, and fitness instructors (with 20 individuals in each group) - was selected during regular outpatient occupational health consultations. The abundance of selected gut microbiota constituents, including Escherichia coli, Methanobrevibacter smithii, Akkermansia muciniphila, Faecalibacterium prausnitzii, Lactobacillus spp., Bifidobacterium spp., and Bacteroides spp., was quantified using quantitative SYBR Green quantitative real-time polymerase chain reaction (qRT-PCR) in stool samples.

RESULTS

There were no significant variations among the groups concerning Escherichia coli, Methanobrevibacter smithii, Bifidobacterium spp., and Bacteroides spp. However, Lactobacillus spp. and Faecalibacterium prausnitzii were significantly more abundant in the microbiota of fitness instructors compared to both airline pilots and construction workers, with no significant differences observed between the latter two groups. Notably, the abundance of Akkermansia muciniphila demonstrated a progressive decline from fitness instructors to construction workers and ultimately to airline pilots, who exhibited the lowest levels.

CONCLUSION

Airline pilots' gut microbiota was characterized by a lower abundance of health-promoting bacterial species, including Lactobacillus spp., Faecalibacterium prausnitzii, and Akkermansia muciniphila. Future research is essential to determine whether targeted interventions, such as probiotic and prebiotic supplementation, could potentially enhance gut microbiota composition and overall health in particular occupational groups.

Health in the Skies: A Narrative Review of the Issues Faced by Commercial Airline Pilots

While the health of airline pilots is crucial to ensuring the safe travel of millions of people worldwide, they remain vulnerable to a variety of health challenges due to the nature of their job. The purpose of this narrative review is to provide a comprehensive summary of the most common health issues experienced by commercial airline pilots. By examining the published literature on this topic, we sought to identify areas where further research is needed to understand better the health risks associated with being a pilot and to develop effective interventions to address these risks. We also highlight how recent technological advances in digital health can be leveraged to conduct research into the potential usefulness of telehealth assessments for identifying occupational hazards in the aviation sector and providing targeted interventions. Overall, addressing the challenges of taking care of pilots' health and ensuring public safety will require a collaborative effort among airlines, governments, and regulators. Prioritizing pilot health and safety can actually improve profitability in the aviation sector by reducing costs associated with absenteeism, turnover, and accidents.

Incident skin melanoma in Danish male military pilots: a nested case-control study

OBJECTIVES

A growing body of research has reported that pilots have an increased risk of skin melanoma, which may be caused by occupational exposure to cosmic and solar ultraviolet A radiation in aircraft cockpits. However, the existing literature cannot rule out confounding, for example, that pilots may spend more leisure time in the sun compared with the general population, which therefore leaves the current evidence inconclusive. The present study aimed to provide more knowledge regarding this association.

METHODS

This nested case-control study included 199 male cases of skin melanoma diagnosed between 1990 and 2003, and 1126 male cancer-free controls identified from a large Danish military population. Among these individuals, 10 cases had ever worked as a pilot.Detailed information on military service and other held jobs together with socioeconomic and lifestyle characteristics, for example, leisure-time sun exposure habits, had been obtained from a structured questionnaire.

RESULTS

Adjusted results showed a positive association between work onboard aircraft and skin melanoma (OR=2.30, 95% 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). A positive association between longer duration of employment as a pilot and skin melanoma was also observed (OR_{per year}=1.07, 95% CI: 1.01-1.14).

CONCLUSIONS

The findings from this study conducted among Danish military personnel suggest that pilots have an increased risk of skin melanoma after accounting for leisure-time sun exposure and socioeconomic status. Future large-scale studies focusing on the risk of skin melanoma in pilots, including detailed objective information on dimensions of exposure and potential confounders, are warranted.

Predictive factors of sun protection behaviour among global airline pilots

BACKGROUND

Airline pilots face significant ultraviolet radiation exposure resulting in an increased risk of sun damage and skin cancers. We aimed to evaluate sun-protective practices and associated factors among airline pilots.

METHODS

We disseminated an online questionnaire evaluating the use of sunscreen, sunglasses, hats and protective clothing during daytime hours in the cockpit and during outdoor activities to 346 global commercial airline pilots, and we received 220 completed responses. The Pearson chi-squared test or Fisher's exact test where necessary were used to determine possible factors associated with the use of sun-protective practices. Potential confounders were adjusted for using multivariate analyses.

RESULTS

The most common sun protective behaviour was the wearing of sunglasses during daytime flights (89.5%), followed by the use of caps during outdoor activities (47.7%). More pilots applied sunscreen during daytime flights (14.1%) compared with walk-arounds (8.2%). Males were less likely to use sunscreen during flights (adjusted odds ratio, aOR = 0.76), use sunscreen for walk-arounds (aOR = 0.175) and wear long sleeves (aOR = 0.013). Pilots who flew less than 30 h a month in high latitude regions were less likely to use a cap or hat outdoors (aOR = 0.419) or use sunscreen during walk-arounds (aOR = 0.241). Younger pilots were also less likely to use caps or hats outdoors (aOR = 0.446).

CONCLUSION

Male pilots and those who spent less time in high latitudes were less likely to practice sun protection. Targeted educational efforts may be implemented to reduce occupational ultraviolet exposure.

Evolution and Applications of Recent Sensing Technology for Occupational Risk Assessment: A Rapid Review of the Literature

Over the last decade, technological advancements have been made available and applied in a wide range of applications in several work fields, ranging from personal to industrial enforcements. One of the emerging issues concerns occupational safety and health in the Fourth Industrial Revolution and, in more detail, it deals with how industrial hygienists could improve the risk-assessment process. A possible way to achieve these aims is the adoption of new exposure-monitoring tools. In this study, a systematic review of the up-to-date scientific literature has been performed to identify and discuss the most-used sensors that could be useful for occupational risk assessment, with the intent of highlighting their pros and cons. A total of 40 papers have been included in this manuscript. The results show that sensors able to investigate airborne pollutants (i.e., gaseous pollutants and particulate matter), environmental conditions, physical agents, and workers' postures could be usefully adopted in the risk-assessment process, since they could report significant data without significantly interfering with the job activities of the investigated subjects. To date, there are only few "next-generation" monitors and sensors (NGMSs) that could be effectively used on the workplace to preserve human health. Due to this fact, the development and the validation of new NGMSs will be crucial in the upcoming years, to adopt these technologies in occupational-risk assessment.

Multimode Representation of the Magnetic Field for the Analysis of the Nonlinear Behavior of Solar Activity as a Driver of Space Weather

Estimating and predicting space weather is important to the space industry and space missions. The driver of space weather, especially near the Earth, is solar activity, the study of which is an important task. In particular, there is a direction of problems based on models of solar magnetic field generation that require research. In our work, we build a nonlinear dynamic system of equations that describes the behavior of the solar magnetic field harmonics based on the alpha-omega dynamo model. We found that, at the beginning of the magnetic field generation process, when the dynamo number significantly exceeds the threshold, the most rapidly growing waves are in the lead. Then, over time, these waves stop growing quite quickly. In this case, the initially slowly increasing harmonics of the magnetic field become the leaders, which then make the main contribution to the process of magnetic field generation.

Prevalence of cataract among Australian commercial airline pilots

Because little is known about cataract in pilots, we estimated prevalence by anonymously ascertaining all commercial airline pilots diagnosed with cataract 2011-2016 using the electronic Medical Records System of the Australian Civil Aviation Safety Authority. Of 14,163 Australian male commercial pilots licensed in 2011, 1286 aged ≥60 had biennial eye examinations showing a cataract prevalence of 11.6%. Among 12,877 pilots aged <60, based on compulsory eye examinations only when first licensed, prevalence was 0.5%. There was no significant difference by ambient ultraviolet (UV) radiation levels in state of residence though lowest prevalence was seen in the low-UV state of Victoria. Most cataract in pilots ≥60 years was bilateral and of mild severity, while cataract in pilots <60 were more likely to be unilateral and of greater severity.

The prevalence and distribution of health risk factors in airline pilots: a cross-sectional comparison with the general population

OBJECTIVE

To explore the prevalence and distribution of health risk factors in airline pilots and compare these with the general population.

METHODS

Health risk measures: age, sex, weight, height, body mass index (BMI), blood pressure, sleep, physical activity (PA) and fruit and vegetable intake (FV) were analysed to determine the prevalence and distribution of health risk.

RESULTS

Obesity prevalence and BMI was lower in pilots (p=<0.001, -17.5%, d=-0.41, and p=<0.05, -1.8, d=-0.37, respectively), yet overall overweight and obesity prevalence did not differ between groups (p=0.20). No difference was observed between groups for hypertension (p=0.79, h=-0.01), yet a higher proportion of pilots were 'at risk' for hypertension (p=<0.001, h=-0.34). The general population had longer sleep duration (p=<0.001, d=0.12), achieved more total PA minutes (p=<0.001, d=0.75), and had a higher prevalence of positive self-rated health (p=<0.001, h=0.31). More pilots achieved >5 servings of FV daily (p=0.002, h=0.16).

CONCLUSION

Pilots had lower obesity prevalence, higher FV, yet lower positive self-health ratings and total PA minutes, and shorter sleep duration overall.

IMPLICATIONS FOR PUBLIC HEALTH

The results indicate notable health risk factor prevalence in airline pilots and the general population. Based on present findings, aviation health researchers should further examine targeted, cost-effective intervention methods for promoting healthy bodyweight, managing blood pressure, and enhancing health behaviours to mitigate the risks of occupational morbidity, medical conditions causing loss of licence, medical incapacity, and to support flight safety.

Cancer incidence and mortality in the USA Astronaut Corps, 1959-2017

OBJECTIVES

Cancer incidence and mortality are important outcomes in the surveillance of long-term astronaut health. We compare cancer incidence rates, cancer-specific mortality rates, and cancer case-fatality ratios in US astronauts with those in the US general population.

METHODS

We use standardised incidence ratios (SIRs) and standardised mortality ratios (SMRs) to index the incidence and mortality of various cancers against rates in the US general population, from the US astronaut cohort inception in April 1959 through 31 December 2017. We compare the lethality of these cancers using the relative case-fatality ratio.

RESULTS

Overall cancer incidence and mortality were slightly lower than expected from national rates with SIR 82 (95% CI 63 to 104) and SMR 72 (95% CI 44 to 111) with a modest 14% reduction in case-fatality ratio. Prostate cancer and melanoma skin cancer had significant increases in incidence, with SIR of 162 (95% CI 109 to 232) and 252 (95% CI 126 to 452), respectively, though only melanoma had a significant increase in mortality, with SMR 508 (95% CI 105 to 1485). Lung cancer had a significant deficit of both cases and deaths, while colon cancer had sizeable (but not significant) reductions in incidence and mortality.

CONCLUSIONS

The increase in incidence of melanoma is consistent with that observed in aircraft pilots, suggesting this may be associated with ultraviolet radiation or lifestyle factors rather than any astronaut-specific exposure. Reductions in lung cancer incidence and mortality, and trends towards such reductions in colon cancer, may be explained in part by healthy lifestyle, as well as differential screening among astronauts.

Occupation and cutaneous melanoma: a 45-year historical cohort study of 14·9 million people in five Nordic countries

BACKGROUND

The age-adjusted incidence of cutaneous melanoma (CM) in the Nordic countries has increased during the last 60 years. Few prospective population-based studies have estimated the occupational variation in CM risk over time.

OBJECTIVES

To determine occupational variation in CM risk.

METHODS

A historical prospective cohort study with a 45-year follow-up from 1961 to 2005 (Nordic Occupational Cancer Study, NOCCA) based on record linkages between census and cancer registry data for Nordic residents aged 30-64 years in Denmark, Finland, Iceland, Norway and Sweden. National occupational codes were converted to 53 occupational categories, and stratified into indoor, outdoor and mixed work, and into socioeconomic status. The standardized incidence ratios (SIRs) were estimated as observed number of CM cases divided by the expected number calculated from stratum-specific person-years and national CM incidence rates.

RESULTS

During a follow-up of 385 million person-years, 83 898 incident cases of CM were identified. In all countries combined, men with outdoor work had a low SIR of 0·79 [95% confidence interval (CI) 0·77-0·81] and men with indoor work had a high SIR of 1·09 (95% CI 1·07-1·11). Differences in women pointed in the same direction. High socioeconomic status was associated with an excess risk: SIR 1·34 (95% CI 1·28-1·40) in men and SIR 1·31 (95% CI 1·26-1·36) in women. Technical, transport, military and public safety workers with potential skin exposure to carcinogens had excess risks.

CONCLUSIONS

Occupational variation in CM risk may be partly explained by host, socioeconomic and skin exposure factors. Differences in CM risk across socioeconomic groups attenuated slightly over time.

MicroRNA-21-Enriched Exosomes as Epigenetic Regulators in Melanomagenesis and Melanoma Progression: The Impact of Western Lifestyle Factors

DNA mutation-induced activation of RAS-BRAF-MEK-ERK signaling associated with intermittent or chronic ultraviolet (UV) irradiation cannot exclusively explain the excessive increase of malignant melanoma (MM) incidence since the 1950s. Malignant conversion of a melanocyte to an MM cell and metastatic MM is associated with a steady increase in microRNA-21 (miR-21). At the epigenetic level, miR-21 inhibits key tumor suppressors of the RAS-BRAF signaling pathway enhancing proliferation and MM progression. Increased MM cell levels of miR-21 either result from endogenous upregulation of melanocytic miR-21 expression or by uptake of miR-21-enriched exogenous exosomes. Based on epidemiological data and translational evidence, this review provides deeper insights into environmentally and metabolically induced exosomal miR-21 trafficking beyond UV-irradiation in melanomagenesis and MM progression. Sources of miR-21-enriched exosomes include UV-irradiated keratinocytes, adipocyte-derived exosomes in obesity, airway epithelium-derived exosomes generated by smoking and pollution, diet-related exosomes and inflammation-induced exosomes, which may synergistically increase the exosomal miR-21 burden of the melanocyte, the transformed MM cell and its tumor environment. Several therapeutic agents that suppress MM cell growth and proliferation attenuate miR-21 expression. These include miR-21 antagonists, metformin, kinase inhibitors, beta-blockers, vitamin D, and plant-derived bioactive compounds, which may represent new options for the prevention and treatment of MM.

Influence of the Exposome on Skin Cancer

Skin cancer is the most frequent type of cancer in humans. While exposure to solar radiation is the most widely known and relevant causal factor, the different degrees of individual risk have not been fully elucidated. Epidemiological studies show how the risk of skin cancer is affected by other types of radiation (eg, ionizing radiation), pesticides, particulate matter in air pollution, toxins (eg, arsenic) in water and some foods. Some living entities, such as polyomavirus and human papillomavirus, can also cause specific types of cancer. Lastly, lifestyle factors such as stress, sleep, and exercise may play a role, although only a few studies shed light on these factors. The abovementioned factors make up the exposome of skin cancer, that is, the set of environmental exposures that, together with the genome and microbiome, determine the onset of disease.

Measurements of UV—A Exposure of Commercial Pilots Using Genesis-UV Dosimeters

A number of studies suggest that pilots are at twice the risk of melanoma and keratinocyte skin cancers than the general population, and that they have a raised mortality from melanoma. No conclusive links with in-flight exposure to ionising radiationor circadian rhythm disruption due to the pilots’ shift work were found. Possible over-exposure to ultraviolet radiation (UVR) may be implicated as pilots may be exposed to higher UV-A levels at cruise altitude compared with those at ground levels. The direct method of making in-flight spectral measurements has been carried out on a limited number of flights, but this technique is challenging; the use of small wearable sensors may be more appropriate but there are a few issues that should be addressed for their use in cockpit measurements. While the spectral response of sensors for erythema effective values usually closely matches the corresponding weighting function, the response of UV-A sensors may not be spectrally flat, which, if not corrected to account for the transmission of the aircraft windshield, could potentially result in large errors. In this paper, the spectral correction method was applied to the UV-A sensor of the Genesis-UV unit to measure UVR exposure of commercial pilots on 312 flights to a range of destinations from four UK airports from September 2016 to August 2017.

Cohort study of occupational cosmic radiation dose and cancer mortality in German aircrew, 1960–2014

Objectives

To determine cancer mortality compared with the general population and to examine dose-response relationships between cumulative occupational radiation dose and specific cancer outcomes in the German aircrew cohort.

Methods

For a cohort of 26 846 aircrew personnel, standardised mortality ratios (SMR) were calculated. Dose-response analyses were carried out using Poisson regression to assess dose-related cancer risks for the period 1960–2014. Exposure assessment comprises recently available dose register data for all cohort members and newly estimated retrospective cabin crew doses for 1960–2003.

Results

SMR for all-cause, specific cancer groups and most individual cancers were reduced in all aircrew groups. The only increases were seen for brain cancer in pilots (n=23, SMR 2.01, 95% CI 1.15 to 3.28) and for malignant melanoma (n=10, SMR 1.88, 95% CI 0.78 to 3.85). Breast cancer mortality among female cabin crew was similar to the general population (n=71, SMR 1.06, 95% CI 0.77 to 1.44). Overall median cumulative effective dose was 34.2 mSv (max: 116 mSv) for 1960–2014. No dose-response associations were seen in any of the models. For brain cancer, relative risks were elevated across dose categories. An indicative negative trend with increasing dose category was seen for large intestine cancer in female cabin crew (n=23).

Conclusions

There was no evidence for significant dose-response patterns for the considered cancer types. Interpretation of results remains difficult as cumulative dose is closely related to age. Future work should focus on investigating radiation jointly with other risk factors that may contribute to risks for specific cancers among aircrew.

Melanoma incidence in Australian commercial pilots, 2011-2016

OBJECTIVES

Occupational exposure to cosmic and ultraviolet radiation may increase airline pilots' risk of cutaneous melanoma. Meta-analyses of available data show a higher than average incidence of melanoma in airline pilots, but the most recent systematic review revealed that few contemporary data are available. Moreover, all relevant studies have been conducted in Northern Hemisphere populations. We therefore aimed to examine if Australian commercial pilots have a raised incidence of melanoma compared with the general population.

METHODS

We examined all melanoma histologically diagnosed among Australian-licensed commercial pilots in the period 2011-2016 by manually reviewing de-identified data in the medical records system of the Australian Civil Aviation Safety Authority. We estimated age-specific incidence rates and compared these with corresponding population rates using standardised incidence ratios (SIRs) as measures of relative risk. Expected numbers were calculated by multiplying age- and calendar period-specific person-years (PYs) with corresponding rates from the entire Australian population; 95% CI were calculated assuming a Poisson distribution of the observed cases.

RESULTS

In this cohort of Australian-licensed commercial pilots observed for 91 370 PYs, 114 developed a melanoma (51 invasive, 63 in situ). More than 50% of melanomas occurred on the trunk, and the predominant subtype was superficial spreading melanoma. The SIR for invasive melanoma was 1.20 (95% CI 0.89 to 1.55) and for melanoma in situ, 1.39 (95% CI 1.08 to 1.78).

CONCLUSION

Australian-licensed commercial pilots have a modestly raised risk of in situ melanoma but no elevation of invasive melanoma compared with the general population.