Breast cancer risk among Finnish cabin attendants: a nested case-control study

Background: Earlier studies have found increased breast cancer risk among female cabin crew. This has been suggested to reflect lifestyle factors (for example, age at first birth), other confounding factors (for example, age at menarche), or occupational factors such as exposure to cosmic radiation and circadian rhythm alterations due to repeated jet lag.     

Radiation dose estimation for epidemiologic studies of flight attendants.

BACKGROUND: NIOSH is conducting health studies of female flight attendants. Exposures of interest include cosmic radiation and circadian rhythm disruption, however, the data needed to estimate cumulative radiation dose are not found in work histories. METHODS: We developed an algorithm to generate from work histories the required input data for Federal Aviation Administration radiation estimation software and evaluated whether effects of cumulative radiation dose could be distinguished analytically from effects of circadian rhythm disruption. RESULTS: The algorithm has relatively low bias (< 6%) for longer flights, which contribute most to cumulative radiation dose. In one NIOSH study, 44 crew incurred an estimated average annual occupational dose of 1.5-1.7 mSv. Selection of a study population flying predominantly North-South flights can provide the necessary distinction between radiation and time zone crossing exposures. CONCLUSIONS: Methods developed will be useful for exposure assessment in cabin crew studies with relatively short study periods, (e.g., reproductive health studies) for which limited flight history details are generally available.     

Cancer incidence among Norwegian airline cabin attendants

BACKGROUND: Cabin crews are exposed to cosmic radiation at work and this may increase their incidence of radiation-induced cancers. Former studies indicate an increased risk of breast cancer. METHODS: A retrospective cohort study was performed. The cohort was established from the files of the Civil Aviation Administration and included people with a valid licence as a cabin attendant between 1950 and 1994. The cohort was linked to the Cancer Registry of Norway. Observed number of cases was compared with expected, based on national rates. Breast cancer incidence was analysed, adjusting for individual fertility variables. RESULTS: A group of 3693 cabin attendants were followed over 72 804 person-years. Among the women, 38 cases of breast cancer were observed (standardized incidence ratio (SIR) = 1.1, 95% CI : 0.8-1.5). Among men excess risks were found for cancers in the upper respiratory and gastric tract (SIR = 6.0, 95% CI : 2.7-11.4) and cancer of the liver (two cases, SIR = 10.8, 95% CI : 1.3-39.2). For both sexes elevated risks were found for malignant melanoma and non-melanoma skin cancer; for men these were SIR = 2.9 (95% CI : 1.1-6.4) and SIR = 9.9 (95% CI : 4.5-18.8) respectively, while for women these were SIR = 1.7 (95% CI : 1.0-2.7) and SIR = 2.9 (95% CI : 1.0-6.9) respectively. For no cancer site was a significant decreased risk found. CONCLUSIONS: An increased risk of radiation-induced cancers was not observed. The excess risks of some other cancers are more probably explained by factors related to lifestyle.     

Estimating the cosmic radiation dose for a cabin crew with flight timetables

OBJECTIVE: Because of the lack of recorded flight history for cabin crew, a retrospective assessment of exposure to cosmic radiation is complicated. Our aim was to develop an assessment method for occupational exposure based on flight timetables. METHODS: The frequency of flights, aircraft types, and flight profiles from timetables were collected. The cosmic radiation dose was calculated with the EPCARD software. Based on annual doses and work history, the cumulative dose was estimated. RESULTS: The annual dose increased linearly: 0.7 milliSievert (mSv) in 1960, 1.6 mSv in 1980, 2.3 mSv in 1985, and 2.1 mSv in 1995. The median cumulative dose was 20.8 mSv (minimum 0.4 mSv, maximum 61.6 mSv). CONCLUSIONS: This method provides a simple algorithm for occupational dose assessment for cabin crew and can be used in other research settings as well.     

Spontaneous abortions among Finnish flight attendants.

We conducted a retrospective cohort study to investigate whether work as a cabin attendant is related to an increased risk for spontaneous abortion. Data on female cabin crew members were linked to medical records on pregnancies. There were 1751 eligible pregnancies for the final analysis. Flight attendants who worked during early pregnancy had a slightly elevated risk of spontaneous abortion, as compared with attendants who were pregnant outside a time span of active flying (odds ratio [OR] = 1.3; 95% confidence interval [CI], 0.9 to 1.8). During the earliest years of the study period (1973 through 1977), the risk seemed to be decreased (OR = 0.4; 95% CI, 0.2 to 1.1), whereas during the later years (1978 through 1994) the risk was increased (OR = 1.6; 95% CI, 1.1 to 2.4). The results are in agreement with earlier studies, showing suggestive evidence of a slightly increased risk of spontaneous abortion among female cabin crew members.     

Pregnancy outcome among offspring of airline pilots and cabin attendants

OBJECTIVES: This study assessed the occurrence of perinatal death, low birthweight, preterm birth, and birth defects (total, major, neural tube defects, total cleft, cleft palate, hypospadias, and Down syndrome) in the offspring of airline pilots and cabin attendants. METHODS: A cohort of offspring of airline pilots and cabin attendants was established and characterized in terms of parental exposure to cosmic radiation the year before birth or ever. Pregnancy outcome was derived from the Medical Birth Register of Norway. The reference group comprised offspring of parents without occupational exposure to cosmic radiation. RESULTS: No deviant risks were observed for the offspring of male pilots, either for the year preceding birth (N=2,111) or ever (N=2,356). Specific birth outcomes were fewer for the pilots than for the referents (N=1,621,186), except for Down syndrome, which was more frequent [odds ratio (OR) 1.41, 95% confidence interval (95% CI) 0.53-3.76]. For exposure the year preceding birth (N=2,512), the risk of low birthweight was lower for the female cabin attendants than for the referents (adjusted OR 0.83, 95% CI 0.69-1.00), while Down syndrome was more frequent (OR 1.44, 95% CI 0.60-3.47). For exposure ever (N=3346), the risk of low birthweight was lower (OR 0.82, 95% CI 0.70-0.96) for the cabin attendants, while hypospadias (OR 1.18, 95% CI 0.61-3.04) and Down syndrome (OR 1.79, 95% CI 0.03-3.45) were more frequent CONCLUSIONS: In general, offspring of air pilots and cabin attendants do not seem to be at increased risk of adverse pregnancy outcome.     

Pesticide illness among flight attendants due to aircraft disinsection

BACKGROUND: Aircraft "disinsection" is the application of pesticides inside an aircraft to kill insects that may be on board. Over a 1-year period, California's tracking system received 17 reports of illness involving flight attendants exposed to pesticides following disinsection. METHODS: Interviews, work process observations, and a records review were conducted. Illness reports were evaluated according to the case definition established by the National Institute for Occupational Safety and Health. RESULTS: Twelve cases met the definition for work-related pesticide illness. Eleven cases were attributed to the "Residual" method of disinsection, i.e., application of a solution of permethrin (2.2% w/w), solvents (0.8%), and a surfactant (1.4%); the method of disinsection could not be determined for one case. CONCLUSIONS: The aerosol application of a pesticide in the confined space of an aircraft cabin poses a hazard to flight attendants. Nontoxic alternative methods, such as air curtains, should be used to minimize disease vector importation via aircraft cabins. Employers should mitigate flight attendant pesticide exposure in the interim.     

Breast cancer risk in airline cabin attendants: a nested case-control study in Iceland

Aims: To investigate whether length of employment as a cabin attendant was related to breast cancer risk, when adjusted for reproductive factors.

Methods: Age matched case-control study nested in a cohort of cabin attendants. The cases were found from a nationwide cancer registry (followed up to end of year 2000) and the reproductive factors (age at first childbirth and number of children) from a registry of childbirth, in both instances by record linkage with the cabin attendants' identification numbers. The employment time of the cabin attendants at the airline companies and the reproductive factors had been systematically recorded prior to the diagnosis of breast cancer in the cohort. A total of 35 breast cancer cases and 140 age matched controls selected from a cohort of 1532 female cabin attendants were included in the study.

Results: The matched odds ratio from conditional logistic regression of breast cancer risk among cases and controls of cabin attendants was 5.24 (95% CI 1.58 to 17.38) for those who had five or more years of employment before 1971 compared with those with less than five years of employment before 1971, adjusted for age at first childbirth and length of employment from 1971 or later.

Conclusions: The association between length of employment and risk of breast cancer, adjusted for reproductive factors, indicates that occupational factors may be an important cause of breast cancer among cabin attendants; the association is compatible with a long induction period.

     

内镜逆行胰胆管造影术（ERCP）中放射工作人员有效剂量估算与分析

目的 通过调查取得ERCP手术的相关参数，模拟ERCP手术过程，借助仿真人体模型、热释光剂量计，测量计算吸收剂量，为估算放射工作人员受照剂量提供基础数据。方法 通过现场调查的ERCP过程的透视时间及摄片帧数，选取实验照射条件进行照射，用仿真人体模型替代放射工作人员，测量吸收剂量。结果 共选取5组实验条件，包括放射工作人员未穿铅衣的L、M、S组和穿铅衣后的M、L剂量组。S组（无铅衣）有效剂量为2.63 μSv，M组（无铅衣）有效剂量为9.38 μSv，M组（有铅衣）有效剂量为0.58 μSv，L组（无铅衣）有效剂量为29.11 μSv，L组（有铅衣）有效剂量为7.48 μSv。结论 放射工作人员有效剂量随着透视时间的增加而增加；穿戴铅衣组别的有效剂量明显低于未穿戴铅衣的组别。虽然在床侧装有铅帘，床旁设有铅屏，但放射工作人员的个人防护用品仍不容忽视。     

Occupational exposures and gastrointestinal cancers among Finnish women

A cohort including all female workers born 1906 through 1945 (n = 413,877) in Finland was identified through the Population Census of Finland of 1970. Incident cases of cancers of the gastrointestinal tract were explored during 1971 to 1995. Job titles in census records were converted to exposures of 31 occupational agents through a job-exposure matrix. For each agent, the product of level and probability of exposures was calculated and subdivided in three categories: zero, low and medium/high. Poisson regression models estimated relative risks (RR) for each agent, standardized for birth cohort, follow-up period, and socioeconomic status. Adjustment at job title level was done for alcohol use for cancers of the esophagus and liver and smoking for pancreatic cancer. The results showing either statistically significant RR at the medium/high level of exposure (RRH) or statistically significant trend (P < 0.05) over the exposure categories were considered as positive findings. Colon cancer risk (2009 cases) was positively associated with sedentary work (RRH 1.3, 95% CI = 1.1-1.6; P trend 0.001) and negatively associated with perceived workload (P trend = 0.007). For stomach cancer (1881 cases), we observed an association with exposure to electromagnetic fields (RRH 1.44, 95% CI = 1.01-2.05) and man-made vitreous fibers (MMVF) (p trend 0.03). Rectal cancer (1323 cases) showed an association with chromium (RRH 1.9, 95% CI = 1.2-3.1) and oil mist (RR 2.0; 95% CI = 1.0-3.9). For pancreas cancer (1302 cases) we found associations with exposure to chromium (RRH 1.8; 95% CI = 1.0-3.1; P trend 0.01), electromagnetic fields (RRH 1.8; 95% CI = 1.2-2.8; P trend 0.02), and sedentary work (RRH 1.3; 95% CI = 1.0-1.7; P trend 0.05). We found no significant associations between any FINJEM agents and cancers of the esophagus (389 cases), liver (389 cases), and gallbladder (651 cases). Having examined the associations between seven cancer sites and over 30 exposures there exists the real possibility that some of the associations detected are chance findings. Therefore, the associations observed should need to be confirmed in other studies.     

Mortality from cancer and other causes among airline cabin attendants in Germany, 1960-1997

Airline cabin attendants are exposed to several potential occupational hazards, including cosmic radiation. Little is known about the mortality pattern and cancer risk of these persons. The authors conducted a historical cohort study among cabin attendants who had been employed by two German airlines in 1953 or later. Mortality follow-up was completed through December 31, 1997. The authors computed standardized mortality ratios (SMRs) for specific causes of death using German population rates. The effect of duration of employment was evaluated with Poisson regression. The cohort included 16,014 women and 4,537 men (approximately 250,000 person-years of follow-up). Among women, the total number of deaths (n = 141) was lower than expected (SMR = 0.79, 95% confidence interval (CI): 0.67, 0.94). The SMR for all cancers (n = 44) was 0.79 (95% CI: 0.54, 1.17), and the SMR for breast cancer (n = 19) was 1.28 (95% CI: 0.72, 2.20). The SMR did not increase with duration of employment. Among men, 170 deaths were observed (SMR = 1.10, 95% CI: 0.94, 1.28). The SMR for all cancers (n = 21) was 0.71 (95% CI: 0.41, 1.18). The authors found a high number of deaths from acquired immunodeficiency syndrome (SMR = 40; 95% CI: 28.9, 55.8) and from aircraft accidents among the men. In this cohort, ionizing radiation probably contributed less to the small excess in breast cancer mortality than reproductive risk factors. Occupational causes seem not to contribute strongly to the mortality of airline cabin attendants.     

Software for the estimation of foetal radiation dose to patients and staff in diagnostic radiology.

Occasionally, it is clinically necessary to perform a radiological examination(s) on a woman who is known to be pregnant or an examination is performed on a woman who subsequently discovers that she was pregnant at the time. In radiological examinations, especially of the lower abdomen and pelvis area, the foetus is directly irradiated. It is therefore important to be able to determine the absorbed dose to the foetus in diagnostic radiology for pregnant patients as well as the foetal dose from occupational exposure of the pregnant worker. The determination of the absorbed dose to the unborn child in diagnostic radiology is of interest as a basis for risk estimates from medical exposure of the pregnant patient and occupational exposure of the pregnant worker. In this paper we describe a simple computer program, FetDose, which calculates the dose to the foetus from both medical and occupational exposures of the pregnant woman. It also calculates the risks of in utero exposure, compares calculated doses with published data in the literature and provides information on the natural spontaneous risks. The program will be a useful tool for the medical and paramedical personnel who are involved with foetal dose (and hence risks) calculations and counselling of pregnant women who may be concerned about in utero exposure of their foetuses.     

Trends in cabin air quality of commercial aircraft: industry and passenger perspectives

The small air space available per person in a fully occupied aircraft passenger cabin accentuates the human bioeffluent factor in the maintenance of air quality. The accumulation of carbon dioxide and other contributions to poor air quality that can occur with inadequate ventilation, even under normal circumstances, is related to the volume of available air space per person and various ventilation rates. This information is compared with established air quality guidelines to make specific recommendations with reference to aircraft passenger cabins under both normal and abnormal operating conditions. The effects of respiration on the air quality of any enclosed space from the respiration of a resting adult are estimated using standard equations. Results are given for different volumes of space per person, for zero air exchange, and for various air change rates. The required ventilation rates estimated in this way compared closely with results calculated using a standard empirical formula. The results confirm that the outside air ventilation required to achieve a target carbon dioxide concentration in the air of an occupied enclosed space remains the same regardless of the volume of that space. The outside air ventilation capability of older and more recent aircraft is then reviewed and compared with the actual measurements of cabin air quality for these periods. The correlation between calculated and measured aircraft cabin carbon dioxide concentrations from other studies was very good. Respiratory benefits and costs of returning to the 30% higher outside air ventilation rates and 8% higher cabin pressures of the 1960s and 1970s are outlined. Consideration is given to the occasional occurrence of certain types of aircraft malfunction that can introduce more serious contaminants to the aircraft cabin. Recommendations and suggestions for aircraft builders and operators are made that will help improve aircraft cabin air quality and the partial pressure of oxygen that is available to passengers at minimal cost. Also suggested are some measures that passengers can take to help improve their comfort and decrease their risk of illness, particularly on long-haul flights.     

The influence of ozone on self-evaluation of symptoms in a simulated aircraft cabin

Simulated 4-h flights were carried out in a realistic model of a three-row, 21-seat section of an aircraft cabin that was reconstructed inside a climate chamber. Twenty-nine female subjects, age 19-27 years, were split into two groups; each group was exposed to four conditions: two levels of ozone (<2 and 60-80 p.p.b.) at two outside air supply rates (2.4 and 4.7 l/s per person). A companion study measured the chemicals present in the cabin air during each of the simulated flights. The subjects completed questionnaires to provide subjective assessments of air quality and symptoms typical of complaints experienced during actual flight. Additionally, the subjects' visual acuity, nasal peak flow and skin dryness were measured. Based on self-recorded responses after 3(1/4) h in the simulated aircraft cabin, they judged the air quality and 12 of the symptoms (including eye and nasal irritation, lip and skin dryness, headache, dizziness, mental tension, claustrophobia) to be significantly worse (P<0.05) for the "ozone" condition compared to the "no ozone" condition. The results indicate that ozone and products of ozone-initiated chemistry are contributing to such complaints, and imply previously unappreciated benefits when ozone is removed from the ventilation air supplied to an aircraft cabin.