Cancer incidence in airline cabin crew: experience from Sweden.

AIMS: To determine the cancer incidence in Swedish cabin crew. METHODS: Cancer incidence of cabin crew at the Swedish Scandinavian Airline System (SAS) (2324 women and 632 men) employed from 1957 to 1994 was determined during 1961-96 from the Swedish National Cancer Register. The cancer incidence in cabin crew was compared with that of the general Swedish population by comparing observed and expected number of cases through standardised incidence ratios (SIR). A nested case-control study was performed, including cancer cases diagnosed after 1979 and four controls per case matched by gender, age, and calendar year. RESULTS: The SIR for cancer overall was 1.01 (95% CI 0.78 to 1.24) for women and 1.16 (95% CI 0.76 to 1.55) for men. Both men and women had an increased incidence of malignant melanoma of the skin (SIR 2.18 and 3.66 respectively) and men of non-melanoma skin cancer (SIR 4.42). Female cabin attendants had a non-significant increase of breast cancer (SIR 1.30; 95% CI 0.85 to 1.74). No clear associations were found between length of employment or cumulative block hours and cancer incidence. CONCLUSIONS: Swedish cabin crew had an overall cancer incidence similar to that of the general population. An increased incidence of malignant melanoma and non-melanoma skin cancer may be associated with exposure to UV radiation, either at work or outside work. An increased risk of breast cancer in female cabin crew is consistent with our results and may in part be due to differences in reproductive history.

Ocular, nasal, dermal and general symptoms among commercial airline crews.

OBJECTIVE: To study symptoms among a commercial cabin crew, in relation to personal risk factors, perceived psychosocial work environment, occupation, and work on intercontinental flights, with exposure to environmental tobacco smoke (ETS). METHODS: A standardized questionnaire (MM 040 NA) was mailed in February-March 1997 to all Stockholm aircrew on duty in a Scandinavian flight company ( n=1,857), and office workers from the same company ( n=218). During this time, smoking was allowed only on intercontinental flights. The participation rate was 81% ( n=1,513) of the aircrew, and 77% ( n=168) of the office group. Statistical analysis was performed by multiple logistic regression analysis, keeping age, gender, atopy, current smoking, occupation, and perceived psychosocial work conditions simultaneously in the model. RESULTS: The most common symptoms among the aircrew were fatigue (21%), nasal symptoms (15%), ocular symptoms (11%), dry or flushed facial skin (12%), and dermal hand symptoms (12%). The aircrew had more nasal (odds ratio (OR) = 3.12), throat (OR=5.75), and dermal symptoms on the face (OR=2.03), and hands (OR=3.68), than the office workers. The aircrew with a history of atopy had an increase of most symptoms (OR=1.5-3.8), but age, gender, or smoking was not associated with symptoms. Perceived stress due to excess of work was associated with fatigue (OR=7.33), feeling heavy-headed (OR=9.52), headache (OR=5.10), and facial dermal symptoms (OR=3.75), while those crew with better work control and work satisfaction had less fatigue. For most symptoms, there were no differences between different categories onboard, but pilots had fewer ocular (OR=0.28) nasal (OR=0.52), and dermal hand symptoms (OR=0.39). Airline crew that had been on an intercontinental flight the previous week had more complaints of fatigue (OR=1.87), heavy-headedness (OR=1.89), and difficulties concentrating (OR=3.22). CONCLUSION: There was an association between symptoms and work stress, lack of influence on working conditions, atopy, and work on intercontinental flights where smoking was allowed. In view of the increase of civil aviation, the working conditions for aircrews need further attention.

Cabin environment and perception of cabin air quality among commercial aircrew.

OBJECTIVE: Our objective was to study the perception of cabin air quality (CAQ) and cabin environment (CE) among commercial cabin crew, and to measure different aspects of CAQ on intercontinental flights. METHODS: A standardized questionnaire was mailed in February-March 1997 to all Stockholm-based aircrew on duty in a Scandinavian flight company (n = 1,857), and office workers from the same company (n = 218). The answers were compared with an external reference group for the questionnaire (MM 040 NA). During this time, smoking was allowed on intercontinental flights, but not on other shorter flights. Smoking was prohibited on all flights after 1 September 1997. The participation rate was 81% (n = 1,513) in the aircrew, and 77% (n = 168) in the office group. Air humidity, temperature, carbon dioxide (CO2) and respirable dust were measured during intercontinental flights, during both smoking and nonsmoking conditions. Statistical analysis was performed by multiple logistic regression analysis, keeping age, gender, smoking, current smoking, occupation, and perceived psychosocial work environment simultanously in the model. RESULTS: Air humidity was very low (mean 5%) during intercontinental flights. In most cases (97%) the CO2 concentration was below 1,000 ppm. The average concentration of respirable particles was 67 microg x m during smoking conditions, and 4 microg x m(-3) during non-smoking conditions. Complaints of draftiness, too high temperature, varying temperature, stuffy air, dry air, static electricity, noise, inadequate illumination, and dust were more common among aircrew as compared with office workers from the same company. Female crew had more complaints on too low temperature, dry air, and dust. Current smokers had less complaints on stuffy air and environmental tobacco smoke (ETS). Younger subjects and those with atopy (childhood eczema, allergy to tree or grass pollen, or furry animals) reported more complaints. Reports on work stress and lack of influence on working conditions were strongly related to perception of a poor cabin environment. Flight deck crew had more complaints about inadequate illumination and dust, but less complaints about other aspects of the cabin environment, as compared with flight attendants. Aircrew who had been on a flight the previous week, where smoking was allowed, had more complaints on dry air and ETS. CONCLUSION: Complaints about work environment seems to be more common among aircrew than office workers, particularly draft, stuffy air, dry air, static electricity, noise, inadequate illumination and dust. We could identify personal factors of importance, and certain conditions that could be improved, to achieve a better perception of the cabin environment. Important factors were work stress, lack of influence on the working conditions, and environmental tobacco smoke on some longer flights. The hygienic measurements in the cabin, performed only on intercontinental smoking flights, showed that air humidity is very low onboard, and tobacco-smoking onboard leads to significant pollution from respirable dust.