A new paper in Frontiers in Public Health examines the radiation exposures which accumulate over time for flight crews. Flight attendants (FA) and pilots are consistently exposed to a complex variety of physical, chemical, biological, and psychosocial stressors. Physical exposures during flight include cosmic ionizing radiation (CIR), decreased oxygen levels, high noise and vibration levels, radiofrequency radiation, electromagnetic fields, and potentially ultraviolet radiation (UV). Chemical exposures in the aircraft include jet fuel and engine oil combustion products, ozone, flame retardants, pesticides, and disinfectants (1). Infectious biological agents pose a significant concern with today’s global travel as seen in the recent SARS-CoV-2 pandemic (2, 3). In addition to these exposures, aircrew perform physically and psychologically demanding work that includes circadian rhythm disruption due to shift work and crossing time zones as well as potentially stressful interaction with passengers (1, 4). Historically, FA have also been exposed to high levels of secondhand tobacco smoke in the aircraft cabin (5). The profiles of these exposures are unique during air travel, and therefore it is difficult to untangle a specific exposure from the overall “flight environment” to understand its respective health impacts.
Overall, the epidemiological literature provides little consistent evidence directly linking CIR exposure alone to cancer. However, study results do establish increased associations of certain cancers from occupational exposure to the flight environment and even suggest association with CIR for some outcomes. Evidence is mixed when stratifying based on aircrew position and gender, which is likely due to differing gender susceptibilities and physiology, lifestyle factors, in-flight exposures (predominantly female cabin crew and male cockpit crew) and methods of flight exposure estimations (e.g., better recordkeeping for pilots).
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