Australian experts have called for greater cancer awareness and screening among these occupations in response to the findings.
“Come fly with me, let’s fly, let’s fly away” – Frank Sinatra
New research published in JAMA Internal Medicine has revealed that pilots and flight attendants are more likely to experience cancer-related mortality than other occupations due to their higher levels of exposure to cosmic and ultraviolet radiation.
A team of US researchers analysed population-based data from death certificates within the National Vital Statistics System between 2020 and 2024, where the cause of death and the decedent’s usual occupation were linked.
Pilots and flight attendants were the population of interest, with aircraft assemblers, aircraft mechanics, and nuclear technologists included as controls (the first two as they are disproportionally exposed to aircrafts without the air travel and cosmic radiation, with the third included as they are exposed to increased amounts of non-cosmic radiation through their work).
Specific emphasis was placed on deaths due to radiation-related cancers (breast, central nervous system, multiple myeloma, leukaemia [apart from chronic lymphocytic leukaemia], lymphoma, prostate, melanoma, and non-melanoma skin cancers) and non-radiation-related cancers (all other cancers). Lung cancer was excluded from the current study due to its strong association with smoking.
The researchers identified 12,710,517 deaths across 503 different occupations over the five-year study period. There were 14,190 pilots (97.3% male, mean age at death 78.6 years) and 7170 flight attendants (84.3% female, mean age at death 73.4 years) among the cohort, along with 22,355 aircraft mechanics, 664 aircraft assemblers, and 764 nuclear technologists.
After accounting for age at death, sex, race, ethnicity, educational level, and marital status, flight attendants (6.9%, 95% confidence interval 6.4%-7.5%) and pilots (6.7%, 6.3%-7.1%) were ranked first and second among the 500-odd careers in terms of the percentage of deaths attributable to radiation-related cancers. For contrast, nuclear technologists had the 12th highest percentage of radiation-related cancer deaths, while aircraft assemblers and aircraft mechanics did not display an increased risk compared to the remaining occupations.
The association between occupation and the proportion of radiation-related cancer deaths remained for both pilots and flight attendants when males and females were considered separately; 6.1% (5.8%-6.5%) for male pilots, 6.5% (5.0%-8.1%) for male flight attendants, 8.1% (5.7%-10.6%) for female pilots, and 7.8% (7.1%-8.5%) for female flight attendants.
“This pattern was not observed for non-radiation-related cancer deaths, for which aircrew ranked near the median of all occupations,” the researchers noted.
Pilots and flight attendants also had increased odds of dying from several radiation-related cancers compared to all other occupations, as well as radiation-related cancers as a whole (adjusted odds ratio and 95% CI 1.36 [1.28-1.45] for pilots and 1.50 [1.38-1.63] for flight attendants).
There were greater odds of pilots and flight attendants dying from breast cancer (1.57 [1.09-2.26] and 1.61 [1.44-1.81]), CNS cancer (1.28 [1.08-1.51], 1.51 [1.19-1.90]), prostate cancer (1.38 [1.26-1.51], 1.75 [1.22-2.51]), and melanoma (1.22 [1.03-1.59], 1.63 [1.15-2.33]) compared to other occupations.
Leukaemia mortality (1.27, 1.08-1.49) was higher in pilots but not flight attendants (1.12, 0.84-1.48). There was no association between pilot/flight attendant status and dying from multiple myeloma, lymphoma, or non-melanoma skin cancer.
In addition, there was no link to increased mortality for non-radiation-related cancers among pilots, although flight attendants remained at greater risk compared to the general population (1.21, 1.14-1.28).
“It is tempting to attribute the excess skin cancer risk in pilots to the romanticism of a bygone era – the 1960s and 1970s image of the sun-bronzed aviator enjoying extended layovers in sunny locations – an occupational perk that once distinguished the profession,” wrote Associate Professor Catherine Olsen (senior research fellow from the Cancer Control Group at QIMR Berghofer in Queensland) and Dr Ken Karipidis (PhD; a scientist from the Australian Radiation Protection and Nuclear Safety Agency) in an accompanying invited commentary.
“While recreational sun exposure may have been a factor in melanoma risk in earlier generations of aircrew, the modern aviation industry bears little resemblance to that golden age. Tighter scheduling, reduced layover times, and the unglamorous reality of back-to-back sectors have largely eliminated the long, sun-drenched stopovers of popular imagination.
“Yet melanoma and keratinocyte cancer rates in pilots remain elevated, suggesting that the cockpit itself, rather than the poolside, may be the more important exposure environment.”
Pilots and flight attendants are exposed to an estimated 3-6 millisieverts of cosmic radiation each year while at cruising altitude, as well as UV-A radiation from cockpit windows (for the former), circadian rhythm disruption, and repeated time zone crossing.
“Ionising radiation can induce DNA lesions with carcinogenic potential, including double-strand breaks, although whether cumulative doses encountered by aircrew are sufficient to meaningfully increase cancer risk remains unresolved,” said Professor Olsen and Dr Karipidis.
“UV-A and circadian rhythm disruption each carry independent carcinogenic potential, and studies examining individual exposures have produced inconsistent findings. Resolving this question will require prospective cohort studies, with validated individual-level dose estimation across all three exposures.”
The researchers said their findings were consistent with previous epidemiological studies on this topic.
“[They] extend the literature by ranking aircrew against 503 occupations using a single population-based data source and a common adjustment approach. Our method situated the magnitude of the aircrew signal within the full distribution of occupational cancer mortality, a comparison not achievable in prior studies of individual occupational cohorts or cancers,” they concluded.
Professor Olsen and Dr Karipidis ended their commentary with some practical advice for healthcare professionals.
“Occupational history taking should routinely include questions about aircrew work, years of service, and route types,” they wrote.
“Pilots should be counselled about occupational UV-A exposure and encouraged to adopt sun protection during flight. Annual skin examinations may be warranted for all aircrew, with a low threshold for dermatology referral.
“For female aircrew with long job tenure, population-based breast screening guidelines may underestimate individual risk, and earlier or more frequent mammographic surveillance may be appropriate.
“Beyond melanoma and breast cancer, the elevated risks for other malignant neoplasms identified in both the current study and prior literature suggest that a heightened index of suspicion is appropriate when evaluating symptomatic air crew across a range of clinical presentations.”
JAMA Internal Medicine, 17 August 2026 (manuscript)
JAMA Internal Medicine, 17 August 2026 (commentary)
