Over the years we’ve seen some studies about the general health risks associated with being a frequent flyer. Environment Health has just released a study that’s specific to flight attendants, which has some pretty disturbing (though probably not surprising) findings.
Increased cancer risks for flight attendants
This study was conducted because researchers found that flight attendants are an understudied occupational group, despite the wide range of conditions they deal with. So the goal of the study was to characterize the prevalence of cancer among US cabin crew relative to the general population.
5,366 flight attendants participated in the study and were compared to those with a similar socioeconomic status. The study found that flight attendants had a higher prevalence of every cancer they examined, especially breast cancer, melanoma, and non-melanoma skin cancer among females.
Across the board the increased risk here is huge, with the study finding that risk of breast cancer increased by nearly 50%, and risk of stomach cancer increased by nearly 75%. That’s extremely alarming, obviously, especially since the higher risk was true across the board in this study.
Here’s a chart comparing the prevalence as a percent, with the “FAHS” category being flight attendants, and “NHANES” being non-flight attendants:
Do these results concern me as a frequent flyer?
While this study is specific to flight attendants, I think it wouldn’t be unreasonable to assume that frequent flyers are potentially subjected to similar risks, given sleep patterns, exposure to radiation, irregular eating patterns, and more.
It’s a question I’m often asked about. “Aren’t you worried about the health implications of the amount of flying you do?” Yes, I am. Actually, it’s something I think about all the time, and I’m conflicted.
On one hand, I tend to think you should live your best life (whatever that might be). It’s not worth living in fear or missing out on something you truly love because of a risk (aside from, like, jumping off a bridge and wondering what will happen). If you truly do evaluate every risk you face on a daily basis, I don’t think any of us would be able to function. Should we only drive in cars that have the best possible safety ratings? Should we never eat junk food or drink? Should we never have a long or stressful day of work?
While my flying habits are bad, I’d like to think that many of my other habits are fairly decent. When I’m in the US I get lots of sleep, go to bed early, and wake up naturally.
At the same time, I fully recognize that the type of traveling that many of us do isn’t necessarily “moderate.” It’s one thing to take one or two international trips per year, but a dozen plus? Less so, certainly.
These risks also seem to be very real. We’re not talking about a one in a billion chance of getting something. Is flying excessively reckless? Is this no different than being addicted to harmful drugs or riding a motorcycle down a highway without a helmet?
I don’t know… so it’s something I do think about all of the time. I do wonder if I should just never get on a plane or go anywhere again. Certainly there’s a happy medium, but I’ve never been great at moderation. I really do love flying, and flying also happens to be a vital part of my job, so…
To flight attendants and/or frequent flyers, does this data disturb you? What’s your perspective on the dangers of spending too much time up in the air?
(Tip of the hat to Vijay)
Plenty of people on the ground who never/rarely travel have poor diets, little/no exercise, & essentially don’t do what they are supposed to (i.e. floss, wear sunscreen, or sleep 8 hrs!).
Enjoy your life now how you want, Lucky - age catches up regardless & in ways we cannot foresee. At least you will have had a lot of great experiences & memories to reflect back on whatever your future brings.
I worry about this as well. These numbers are a little worrisome for me. I travel a lot. I figured flight attendants travelled more than me. However, recently, I've had a number of delayed flights and an opportunity to chat with the flight attendants for my flight.
It turns out that I actually travel as much as many flight attendants.
Occasionally the person sitting beside me will leave the window open. As the sun shines...
I worry about this as well. These numbers are a little worrisome for me. I travel a lot. I figured flight attendants travelled more than me. However, recently, I've had a number of delayed flights and an opportunity to chat with the flight attendants for my flight.
It turns out that I actually travel as much as many flight attendants.
Occasionally the person sitting beside me will leave the window open. As the sun shines on me I wonder if it has any ill effects. Most the time I figure it shouldn't be that bad.
After reading this article I might think twice and ask of they could close the window.
Glad to see lots of good comments about the very wide 95% CIs and absolute vs relative risk and small sample size.
Thanks for publishing the tables so we could at least pick up on some of the issues, Ben - sadly the media normally don't do this.
For more about interpretation of scientific literature in the media I would highly recommend the book Bad Science by Ben Goldacre.
@Axel, thanks for your excellent remark on absolute vs relative risks! This is what we teach the students but as you say the press and general public usually do not get this. I was surprised about the many reasonable comments up here, but some BS as well
Moderation is key. Sometimes you fly waaaaay too much back to back. I would recommend at least 2 full months out of the year of zero flying for you. I know this might sound absurd, but health is important. Eating right, exercising, and staying hidrated is as well. Take care of yourself without loosing your passion and job, which is flying! ;)
I already had cancer once. Based on the type of cancer I had, statistically I am extremely likely to get it again. I'm also pretty young.
If I spend the rest of my life worry that cancer will take me then cancer is the winner.
I'm not concern. Every time I book a business class flight I win a little more.
As a Clinical Physiologist with over a quarter of a century of clinical and research experience, I find remarks such as those from "Ryan" troubling. Sad, even. My father used to say: "lack of knowledge might be excusable but wearing your lack of knowledge like a crown is inexcusable".
Lucky,
Nowadays we know that food is an important environmental component in diseases (cancer included), so I would guess that eating plane food (with all salt and additives and preservatives) would be a major player in it. Like eating sausage a lot is a major contribute for some kinds of cancer I think that the same goes to the food served on planes. So, unless your are eating yourself to death in planes I wouldn't worry too much.
This is a cross-sectional study and we don't know how representative the subjects are in regard to FAs worldwide (also known as selection bias). Another cross-sectional study may well show different results. More interesting would be a longitudinal study over many years to determine how the risk changes with time. (I am a PhD clinical trial designer, analyst, biostatistician, and epidemiologist.)
I’m not convinced that the risk is elevated to a level that would cause me to make a career change or modify my future vacation plans. However, I inform my doctors of my lifestyle risks and I get tested regularly. Early Detection will save your life most of the time. Don’t skimp on medical insurance coverage and make sure you use it.
I know someone who worked as an electrician at the nuclear power station here in Canada. He'd have full physicals every 6 months including measuring his "glow" (residual radioactivity) to make sure he's healthy.
One check up the doctor was worried because his numbers were suddenly higher. He just came back from a vacation to Jamaica.
Here's a visualization of radiation dosages from a science-y web comic: https://xkcd.com/radiation/
And here where you can calculate your...
I know someone who worked as an electrician at the nuclear power station here in Canada. He'd have full physicals every 6 months including measuring his "glow" (residual radioactivity) to make sure he's healthy.
One check up the doctor was worried because his numbers were suddenly higher. He just came back from a vacation to Jamaica.
Here's a visualization of radiation dosages from a science-y web comic: https://xkcd.com/radiation/
And here where you can calculate your dosage based on flight route and altitude (you can assume 33,000 ft for most long haul flights if you're lazy, or use flightaware and get the real numbers). http://jag.cami.jccbi.gov/cariprofile.asp
What is far worse than the radiation? The spraying with pesticides (Pyrethroids) before flight or even during flight.
The spraying is mandatory on certain routes and destinations. If it is done before the flight, it has to be done with persisting Pyrethroids wich remain for a long time on all the surfaces in the plane and from there on slowly evaporate to the cabin air. If it´s done during flight, it is simply sprayed...
What is far worse than the radiation? The spraying with pesticides (Pyrethroids) before flight or even during flight.
The spraying is mandatory on certain routes and destinations. If it is done before the flight, it has to be done with persisting Pyrethroids wich remain for a long time on all the surfaces in the plane and from there on slowly evaporate to the cabin air. If it´s done during flight, it is simply sprayed over the heads of all passengers and into the opened luggage bins. After landing, the cabin crew has to give the empty canisters to the ground crew. If they don´t do this, they are not allowed to beginn with disembarkment.
Pyrethroids kill all kinds of nerve cells. No matter if they are from insects or humans. The only thing wich matters is, who has enough functioning nerve-cells left after the chemical attack, to continue life.
A friend of mine experienced this with her partner during a flight to Madeira. They felt like being in a gas chamber in Auschwitz and were sick for several weeks. Nice holiday!
Cabin crew on this flights have to bear this shit many times.
Avoid by all means flights to such destinations and planes wich are regurlarly used on such routes!
Here you can find the destinations where it is mandatory:
https://www.transportation.gov/airconsumer/spray
Of cause the official read is that this is absolutely harmless, but I can tell you from my working life, that a lot of people fell severely ill, some of them permanently disabled, after using Pyrethroids in their homes because of fleas brought in by their dogs or cats or because of cockroaches etc.
Unfortunately the airlines are very reserved with giving informations whether a certain plane or route is sprayed or not. I tried once with Thai-Airways and didn´t get any answer after three e-mails.
Correction: that should have been 5 out of 1000 instead of 3 out of 1000 for gastrointestinal cancer in non-flight-attendants (0.47% and 0.27%, respectively).
As has been mentioned, a lot of the confidence intervals reported are very wide, indicating great uncertainty. Uncertainty may arise if the rate is based on small numbers: 6 out of 9 rates in the control group are based on less than 20 cases. As a rule of thumb: when your rate is based on less than 20 cases, it is unreliable, no matter how large your sample is.
But even if you take the...
As has been mentioned, a lot of the confidence intervals reported are very wide, indicating great uncertainty. Uncertainty may arise if the rate is based on small numbers: 6 out of 9 rates in the control group are based on less than 20 cases. As a rule of thumb: when your rate is based on less than 20 cases, it is unreliable, no matter how large your sample is.
But even if you take the reported rates as a true reflection of the actual prevalence of cancer rates in flight attendants, you may want to consider the following points.
Presumably, what most people (flight attendants) want to know is: "how likely am I gonna get it?". To answer this question, you should look at absolute, not relative risk.
In abolute terms, 3 out of 100 flight attendants get breast cancer instead of 2 out of 100 of non-flight-attendants (3.4% instead of 2.3%). Thats's an increase in absolute risk of 1.1% you get by being a flight attendant.
The same applies to gastrointestinal cancer: 4 out of 1000 instead of 5 out of 1000 (0.47% and 0.27%, respectively), an increase of absolute risk of 0.2%.
If you look at absolute risk, I don't exactly find the figures "extremely alarming".
What people tend to forget is that you need to take the frequency of an event into account ("base rate neglect").
If a type of cancer is rare, even a huge increase in relative risk will not substantially affect my absolute risk.
If a cancer is common AND the findings regarding relative risk are reliable (e.g. breast and non-melanoma skin cancer), I would worry, otherwise: not so much.
Unfortunately, the media love to report increases in relative risk even for rare conditions. Don't fall in the trap.
radiation levels are much lower or not a problem at night. I tend to take night flights whenever I can
Lucky, I wouldn't think much about the cancer risk. This is just one of a million things in life that could potentially hit you.
I would, however, recommend you to have an eye on your general health, well-being, and fitness. When you notice that the intense travelling starts wearing you out, it might be time to cut back a bit. You can focus on some flagship reviews, and let the young guys do more...
Lucky, I wouldn't think much about the cancer risk. This is just one of a million things in life that could potentially hit you.
I would, however, recommend you to have an eye on your general health, well-being, and fitness. When you notice that the intense travelling starts wearing you out, it might be time to cut back a bit. You can focus on some flagship reviews, and let the young guys do more of the bread and butter flying. You hired some great contributors already, like James.
Apart from the radiation issue, FAs on long haul have relatively little sleep or none, depending on the length of flights and whether or not there are bunks. Continually having nights out of bed (as opposed to passengers who can sleep through night flights, albeit not very well in economy) has got to be health risk factor, especially when getting older. It can take days for a FA to recover from several nights out of...
Apart from the radiation issue, FAs on long haul have relatively little sleep or none, depending on the length of flights and whether or not there are bunks. Continually having nights out of bed (as opposed to passengers who can sleep through night flights, albeit not very well in economy) has got to be health risk factor, especially when getting older. It can take days for a FA to recover from several nights out of bed on a longhaul itinerary. Also, for the first time in history, FAs now can have been flying for 30-40yrs plus - they are an ongoing piece of research.
As a dental student, we often use a transcon flight as a point of comparison for people who are worried about radiation. A full mouth series (18 x-rays) is roughly the same exposure (0.035 mSv) as a transcon flight, which is tiny in comparison to the average person's annual exposure (6.2 mSv) just walking around. So that one flight is about 0.56% of the average annual exposure.
If you're worried about it, my advice...
As a dental student, we often use a transcon flight as a point of comparison for people who are worried about radiation. A full mouth series (18 x-rays) is roughly the same exposure (0.035 mSv) as a transcon flight, which is tiny in comparison to the average person's annual exposure (6.2 mSv) just walking around. So that one flight is about 0.56% of the average annual exposure.
If you're worried about it, my advice is to talk to your doctor about your risks and establish a baseline for health. Think about what's normal for you and pay attention when that changes. Know what to look for. For a skin cancer example, the occasional sun spot might be normal, but an asymmetrical, shape-changing dark spot is not. And keep in mind that higher risk isn't a death sentence. It's just something to be aware of.
As noted above the studies just are not strong enough to be useful. Furthermore there is absolutely no control for the other health issues and habits the individual FAs may have. In short, correlation does not equal causation.
Strange that thyroid CA risk isn't really different, the one organ that is known to be extremely sensitive to radiation in regards to developing thyroid CA.
It is also a bit strange that the overall NHANES count is so low. Why did they not include more non-flight-attendants in the study? That should not be too hard to do.
@Jetset
The equation more radiation = more cancer is actually not existent up to a certain radiation threshold. There are numerous areas in the world with higher natural radiation levels due to naturally occurring radon gas where people do not have higher cancer rates.
Radiation exposure also makes the breasts grow. Just check yourself out in the mirror. If you still look like a man you don't need to worry.
Related point: report those confidence intervals along with those risk estimates!
they are reported, at least in the table.
"Ben, pay attention to the statistics. For 6 of the 9 cancer types studied, the increases are not statistically significant."
This is correct.
Those confidence intervals are very wide, beyond meaningless.
for instance: a CI of 0.81 to 18 means that any difference you see is most likely by chance.
In addition:
Even if the study was statistically significant, I would not put Ben/Lucky in the same category as a flight attendant....
"Ben, pay attention to the statistics. For 6 of the 9 cancer types studied, the increases are not statistically significant."
This is correct.
Those confidence intervals are very wide, beyond meaningless.
for instance: a CI of 0.81 to 18 means that any difference you see is most likely by chance.
In addition:
Even if the study was statistically significant, I would not put Ben/Lucky in the same category as a flight attendant.
The only thing he shares with them is a plane
otherwise his entire life existence is completely different.
It would be interesting to see if there are negative health effects to being a flight attendant.
My suspicion is that they are largely caused by
-irregular sleep habits
-poor diet (eating out)
-poor exercise (exhausted due to jet lag, etc)
-drinking
Shift working has been shown to cause significant health issues (examples include nurses, doctors, 3rd shifters, etc). and Flight attendants have quite the shift schedule life...
One of my cousins is a long term FA with AA. Her union is particularly concerned about the even greater lack of shielding with the newer carbon fiber fuselages, as compared to the older aluminum fuselages. But yes, anyone in any type of aircraft gets radiation exposure when flying.
Harvard guy up there might be one of those guys who tells everyone he went to Harvard, but he has a point here. Related point: report those confidence intervals along with those risk estimates!
mallthus,
Studies have suggested that flight crews have a higher exposure to UV-A rays, as well as gamma rays and X-rays, as a result of sun exposure through the windows on airplanes. This study suggests that the plastic and glass in airplane windows doesn't do a very good job of blocking UV-A rays from sunlight, which are much stronger at 30,000+ feet.
Even a frequent flyer like you lucky (I think it’s a new class...maybe obsessive flyer ? ) doesn’t fly as much as a flight attendant, so I don’t think you need to be overly concerned
@Lucky, interesting article but I think I'd worry more about the lack of sleep, high stress (hey, travel and changing time zones is stressful), high calories and (potentially) missed opportunities for exercise...Actually from what I can tell you and Ford stay pretty fit despite all the amazing meals you guys eat, I'd be curious to see a post on exercising and eating healthy when you're on the road or in the air (obviously for a...
@Lucky, interesting article but I think I'd worry more about the lack of sleep, high stress (hey, travel and changing time zones is stressful), high calories and (potentially) missed opportunities for exercise...Actually from what I can tell you and Ford stay pretty fit despite all the amazing meals you guys eat, I'd be curious to see a post on exercising and eating healthy when you're on the road or in the air (obviously for a trip report you have to try all the good stuff, but for people travelling regularly for work and not writing about it these are very real issues).
Wrote to you about this a few years ago. For me it was an increase in skin cancer that alerted my doctor to the amont of travel cause in effect. Used to limit my hours flying to that of a QF Captain based on their union recommendation. Still flying but no longer Platinum figured my health was more important than status.
Aside from radiation my main concern is the sleep pattern. You may sleep more when you are in the US but sleep is not something we can make up regularly later. Our body prefers a regular sleep pattern and it is highly affected by exposure to sun. Constant irregular sleep pattern causes insomnia, which is much more difficult to deal with when you get older. Often times humans are time inconsistent so be mindful about your future
The only disturbingly heightened incidence rate is for skin cancers, which may have nothing to do with flying and more to do with an increased rate of outdoor leisure activity (sunbathing, swimming, etc) amongst flight attendants.
More study may be warranted, but this is hardly a red flag.
Seems to be a correlation at my company. All the road warriors seem to die early due to problems like cancer, diabetes, and early onset Alzheimer's. Much higher than other long time employees who don't travel.
(Biology professor with a Harvard PhD who studies cancer here) Ben, pay attention to the statistics. For 6 of the 9 cancer types studied, the increases are not statistically significant. It’s within survey error. So there are some noteworthy observations here, but not as dramatic as your article warns.
This is a known fact but the figures seem much higher than i thought they were. Ofcourse there are careers where we have higher risks involved but they still have to be done.
Being exposed to a risk doesn't mean that you're most certainly going to have whatever disease that one might have.
Lucky i'm pretty sure that you don't fly as often an B777 pilot based at Heathrow.
Apparently there're regulations in Europe...
This is a known fact but the figures seem much higher than i thought they were. Ofcourse there are careers where we have higher risks involved but they still have to be done.
Being exposed to a risk doesn't mean that you're most certainly going to have whatever disease that one might have.
Lucky i'm pretty sure that you don't fly as often an B777 pilot based at Heathrow.
Apparently there're regulations in Europe to ensure less exposure to radioactive waves with FAs & Pilots though i couldn't find any solid info on that.
Now don't sulk up and enjoy that arabic mezze on EK!
@Ryan how so? You are exposed to elevated levels of radiation every time you fly as you're closer to waves coming in from the sun, which get diluted as they go through layers of atmosphere.
Obviously the more you fly = more radiation = higher cancer risk. Pretty straightforward.
Come on man this is a waste these studies are ridiculous Andhave no merit... please don’t post this horeshit.
My advice...don't show this to your doctor, Lucky!
My advise.........Don't show this to your parents Lucky ;)
Interesting.
Part of the equation to me would be how much travelling for work Vs. How much traveling for travel.
In other words, flights and reviews are part of your income process. But I doubt you need to fly as often as you do to see the world.
Maybe... world cruise!?