Cancer incidence in professional flight crew and air traffic control officers: disentangling the effect of occupational versus lifestyle exposures.

Flight crew are occupationally exposed to several potentially carcinogenic hazards; however, previous investigations have been hampered by lack of information on lifestyle exposures. The authors identified, through the United Kingdom Civil Aviation Authority medical records, a cohort of 16,329 flight crew and 3,165 air traffic control officers (ATCOs) and assembled data on their occupational and lifestyle exposures. Standardised incidence ratios (SIRs) were estimated to compare cancer incidence in each occupation to that of the general population; internal analyses were conducted by fitting Cox regression models. All-cancer incidence was 20-29% lower in each occupation than in the general population, mainly due to a lower incidence of smoking-related cancers [SIR (95% CI) = 0.33 (0.27-0.38) and 0.42 (0.28-0.60) for flight crew and ATCOs, respectively], consistent with their much lower prevalence of smoking. Skin melanoma rates were increased in both flight crew (SIR = 1.87; 95% CI = 1.45-2.38) and ATCOs (2.66; 1.55-4.25), with rates among the former increasing with increasing number of flight hours (p-trend = 0.02). However, internal analyses revealed no differences in skin melanoma rates between flight crew and ATCOs (hazard ratio: 0.78, 95% CI = 0.37-1.66) and identified skin that burns easily when exposed to sunlight (p = 0.001) and sunbathing to get a tan (p = 0.07) as the strongest risk predictors of skin melanoma in both occupations. The similar site-specific cancer risks between the two occupational groups argue against risks among flight crew being driven by occupation-specific exposures. The skin melanoma excess reflects sun-related behaviour rather than cosmic radiation exposure.

Safety management as a foundation for evidence-based aeromedical standards and reporting of medical events.

The different interpretations by States (countries) of the aeromedical standards established by the International Civil Aviation Organization has resulted in a variety of approaches to the development of national aeromedical policy, and consequently a relative lack of harmonization. However, in many areas of aviation, safety management systems have been recently introduced and may represent a way forward. A safety management system can be defined as "A systematic approach to managing safety, including the necessary organizational structures, accountabilities, policies, and procedures" (1). There are four main areas where, by applying safety management principles, it may be possible to better use aeromedical data to enhance flight safety. These are: 1) adjustment of the periodicity and content of routine medical examinations to more accurately reflect aeromedical risk; 2) improvement in reporting and analysis of routine medical examination data; 3) improvement in reporting and analysis of in-flight medical events; and 4) support for improved reporting of relevant aeromedical events through the promotion of an appropriate culture by companies and regulatory authorities. This paper explores how the principles of safety management may be applied to aeromedical systems to improve their contribution to safety.

Lifestyle of UK commercial aircrews relative to air traffic controllers and the general population.

INTRODUCTION: Commercial aircrews are exposed to potential occupational hazards and, recently, epidemiological studies have examined their morbidity and mortality relative to the general population. Aircrews are, however, likely to differ from the general population in several respects which may affect the validity of such comparisons. METHODS: A cohort of 17,990 commercial aircrews was identified through the United Kingdom (UK) Civil Aviation Authority medical records and is being followed for morbidity and mortality. Demographic, lifestyle, reproductive, and medical characteristics of commercial aircrews were compared with those of: 1) UK air traffic control officers (ATCOs; N = 3386) identified in a similar way as aircrews; and 2) estimates for the UK general population. RESULTS: Aircrews and ATCOs had similar characteristics, except that sex-age-adjusted prevalences for current smoking, obesity, and hypertension were statistically significantly higher in the latter. Both aircrews and ATCOs differed considerably from the general population with, for instance, much lower sex-age-adjusted prevalences of current smoking, obesity, and hypertension but higher levels of regular physical exercise. Age-adjusted fertility rates among female aircrews and ATCOs were only one-third of those in the general population. These differences were slightly attenuated when comparisons with the general population were restricted to its highest socio-economic stratum. DISCUSSION: The differences between aircrews and the general population are consistent with a strong "healthy worker effect." Aircrews and ATCOs undergo a similar employment selection process and thus taking the latter as the reference population, in addition to the general population, will help to minimize the "healthy worker effect" and gain insight into its biases.

Cardiac effects of anthracycline treatment and their implications for aeromedical certification.

INTRODUCTION: In 1997 an autopsy on a professional pilot killed in an aircraft accident demonstrated myocardial fibrosis, thought to be the result of previous anthracycline treatment. The United Kingdom (UK) Civil Aviation Authority (CAA) was tasked with investigating the possible dangers to flight safety of treatment with this type of chemotherapy. METHODS: From CAA computer records of 18,319 professional license holders, 14 were identified as having received anthracycline treatment. These subjects underwent clinical cardiological examination, exercise and 24 h ambulatory electrocardiography, and echocardiography. Other studies were performed as needed. RESULTS: Of the 14 subjects, 9 demonstrated arrhythmias on ambulatory electrocardiography, including 4 with ventricular tachycardia and 5 with supraventricular tachycardia, a much higher incidence than expected. One pilot had evidence of left ventricular dysfunction and another developed symptomatic sinus arrest at first follow-up. Another died shortly after completing the investigations from acute lymphatic leukemia, probably a complication of his original chemotherapy for Hodgkin's disease. In this small cohort there seemed to be no correlation of abnormal findings with anthracycline dose nor with time since completion of treatment. CONCLUSIONS: The results presented strongly suggest the need for cardiological review of individuals who have received anthracycline treatment and who are seeking initial certification or recertification for professional aviation licensing.