The last time you were hired for a new job, you were probably concerned about salary, hours, and work satisfaction. Did you think about possible bodily harm that could occur because of the job? Most of us take work-related safety for granted, unless you’re in a field like logging, fishing/hunting, or roofers. Those are the top three of Forbes Magazine’s 10 Most Dangerous Jobs in America for 2024.

Number four on their list is aircraft pilots and flight engineers, with 48 fatalities per 100,000 workers. The deaths are primarily due to plane or helicopter crashes, especially on privately owned aircraft which have less safety equipment and piloting technology than commercial craft. However, some studies suggest that male flight personnel, particularly pilots who spend long hours in the cockpit, face a sneaky occupational hazard: prostate cancer (PCa).

For example, a 1996 study analyzed the health records of Air Canada male pilots (with at least one year on the job) for the incidence of cancer.^[i] While the rate of several cancers (including rectal, lung, and bladder cancers) was significantly decreased compared with the general Canadian population, the authors found a significant increase in PCa among pilots.

A 2015 paper reported data calculated from eight previous studies of PCa risk in pilots. It concluded, “Pilots are at least twice as likely to develop prostate cancer compared to the general population. The implications of these findings are important considering the high prevalence of prostate cancer and the large number of pilots in the workforce.”^[ii] A 2017 study found that for licensed commercial male airline pilots followed from 1955 to 2015, the risk of PCa grew as the years of service increased.^[iii]

Most recently, in January 2023 the U.S. Department of Defense issued a technical report on the incidence of cancer in military aviators.^[iv] Compared to the general male population, military aircrew had 16% increased rate of PCa. (They also had 87% higher rates of the deadly skin cancer melanoma, 37% higher for thyroid cancer, and 24% higher rate of all cancers combined.

Possible explanations

What is it about long hours in the flight cockpit that might raise PCa risk? The most common explanation is exposure to radiation, which is known to cause various cancers. To some extent, all of us are exposed to radiation every day because cosmic radiation (radiation from space) is constantly hitting the earth. The U.S. Environmental Protection Agency (EPA) explains, “Our solar system’s Sun and other stars in the galaxy emit a constant stream of cosmic radiation. In the United States, a person gets about 5% of their annual radiation exposure from cosmic radiation.” However, pilots are bombarded with much more. As the International Atomic Energy Agency (IAEA) notes, “Aircrew and frequent flyers receive higher radiation doses from cosmic radiation than the general public. Astronauts receive even higher radiation doses.” In fact, cockpit crews have significantly higher rates of skin cancers, which is definitively associated with exposure to ultraviolet (UV) radiation, but improvements in fabric and window glass are aimed at better protection against UV rays. Cosmic radiation at high altitude remains an occupational hazard for pilots.

One other explanation is flight schedules that disrupt normal circadian sleep rhythms, a factor that has been linked with higher incidence of PCa. As I posted in a 2017 blog, “The genes that regulate normal cells and keep tumors from starting – or keep them in check if a cell mutates into a cancer cell – become dysfunctional when circadian disruption occurs.”

Interestingly, at one time a pilot who developed cancer, including prostate cancer, could be barred from his job. It was considered a disqualification for medical certification needed to continue commercial piloting. More recently, pilots with a history of cancer can receive clearance. Since 2013, Aviation Medical Examiners (AMEs) can clear airmen with PCa for flying if cancer is confined to prostate.

The Occupational Safety and Health Administration (OSHA) reminds employers that they have responsibilities that may pertain to increased PCa risks for male pilots:

• Provide a workplace free from serious recognized health hazards (my comment: it would be extremely difficult to protect pilots at 35,000 feet from cosmic radiation)
• Warn employees of potential hazards (my comment: increased PCa risk for pilots continues to be researched and is considered debatable)
• Provide medical examinations and training in accordance with OSHA standards (my comment: I would highly recommend annual PSA screening for male pilots, followed by MRI for any suspicious blood test result)

I was unable to find evidence that major commercial airlines acknowledge PCa as an occupational hazard for its aircraft crews. Therefore, I am posting this blog with the intent to raise consciousness among commercial, private and military male pilots, in hopes that they will be diligent about their own annual PSA screening if it’s not mandated by their employers.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Band PR, Le ND, Fang R, Deschamps M, Coldman AJ et al. Cohort study of Air Canada pilots: mortality, cancer incidence, and leukemia risk. Am J Epidemiol. 1996 Jan 15;143(2):137-43.
[ii] Raslau D, Summerfield DT, Abu Dabrh AM, Steinkraus LW, Murad MH. The risk of prostate cancer in pilots: a meta-analysis. Aerosp Med Hum Perform. 2015 Feb;86(2):112-7. doi: 10.3357/AMHP.4075.2015. Retraction in: Bonato F.
[iii] Gudmundsdottir, E.M., Hrafnkelsson, J. & Rafnsson, V. Incidence of cancer among licenced commercial pilots flying North Atlantic routes. Environ Health 16, 86 (2017).
[iv] Department of Defense, Washington D.C. “Study on the Incidence of Cancer Diagnosis and Mortality among Military Aviators and Aviation Support Personnel.” Jan. 1, 2023. Approved for public release. Full report (PDF) available at https://apps.dtic.mil/sti/citations/trecms/AD1197386