Massimiliano Caldora

Mortality from cancer and other causes among male airline cockpit crew in Europe

Airline pilots and flight engineers are exposed to ionizing radiation of cosmic origin and other occupational and life‐style factors that may influence their health status and mortality. In a cohort study in 9 European countries we studied the mortality of this occupational group. Cockpit crew cohorts were identified and followed‐up in Denmark, Finland, Germany, Great Britain, Greece, Iceland, Italy, Norway and Sweden, including a total of 28,000 persons. Observed and expected deaths for the period 1960–97 were compared based on national mortality rates. The influence of period and duration of employment was analyzed in stratified and Poisson regression analyses. The study comprised 547,564 person‐years at risk, and 2,244 deaths were recorded in male cockpit crew (standardized mortality ratio [SMR] = 0.64, 95% confidence interval [CI] = 0.61–0.67). Overall cancer mortality was decreased (SMR = 0.68; 95% CI = 0.63–0.74). We found an increased mortality from malignant melanoma (SMR = 1.78, 95% CI = 1.15–2.67) and a reduced mortality from lung cancer (SMR = 0.53, 95% CI = 0.44–0.62). No consistent association between employment period or duration and cancer mortality was observed. A low cardiovascular mortality and an increased mortality caused by aviation accidents were noted. Our study shows that cockpit crew have a low overall mortality. The results are consistent with previous reports of an increased risk of malignant melanoma in airline pilots. Occupational risk factors apart from aircraft accidents seem to be of limited influence with regard to the mortality of cockpit crew in Europe.

The EUROCARE-5 study on cancer survival in Europe 1999–2007: Database, quality checks and statistical analysis methods

BACKGROUND Since 25years the EUROCARE study monitors the survival of cancer patients in Europe through centralised collection, quality check and statistical analysis of population-based cancer registries (CRs) data. The European population covered by the study increased remarkably in the latest round. The study design and statistical methods were also changed to improve timeliness and comparability of survival estimates. To interpret the EUROCARE-5 results on adult cancer patients better here we assess the impact of these changes on data quality and on survival comparisons. METHODS In EUROCARE-5 the survival differences by area were studied applying the complete cohort approach to data on nearly nine million cancer patients diagnosed in 2000-2007 and followed up to 2008. Survival time trends were analysed applying the period approach to data on about 10 million cancer cases diagnosed from 1995 to 2007 and followed up to 2008. Differently from EUROCARE-4, multiple primary cancers were included and relative survival was estimated with the Ederer II method. RESULTS EUROCARE-5 covered a population of 232 million resident persons, corresponding to 50% of the 29 participating countries. The population coverage increased particularly in Eastern Europe. Cases identified from death certificate only (DCO) were on average 2.9%, range 0-12%. Microscopically confirmed cases amounted to over 85% in most CRs. Compared to previous methods, including multiple cancers and using the Ederer II estimator reduced survival estimates by 0.4 and 0.3 absolute percentage points, on average. CONCLUSIONS The increased population size and registration coverage of the EUROCARE-5 study ensures more robust and comparable estimates across European countries. This enlargement did not impact on data quality, which was generally satisfactory. Estimates may be slightly inflated in countries with high or null DCO proportions, especially for poor prognosis cancers. The updated methods improved the comparability of survival estimates between recently and long-term established registries and reduced biases due to informative censoring.

A retrospective cohort mortality study of Italian commercial airline cockpit crew and cabin attendants, 1965-96.

Abstract A retrospective cohort mortality study was conducted among Italian commercial flight personnel for the period 1965-1996. The cohort was composed of 3,022 male cockpit crew members and 3,418 male and 3,428 female cabin attendants. Cause-specific standardized mortality ratios (SMRs) and exact 95% confidence intervals. (CIs) were calculated as estimates of the relative risk. Mortality from all cancers was less than expected forall categories (SMRs of 0.58 for male cockpit crew, 0.67 for male cabin attendants, and 0.90 for female cabin attendants). Among male flight persopnel, the SMR for leukemia was somewhat elevated (SMR 1.73; 95% CI: 0.75–3.41) based on eight deaths, with a positive trend by length of employment (p = 0.046). Additionally, an excess of death by suicide was seen among female cabin attendants (SMR 3.38; 95% CI: 1.24–7.35). Other Italian studies of flight personnel are under way, including a detailed assessment of cosmic radiation exposure and investigations of non-radiation occupational risk factors and prevalence of nonfatal outcomes.

Self perceived health and mental health among women flight attendants.

Aims: The authors investigated associations of work related risk factors with self perceived health as less than “good” and psychological distress among Italian women flight attendants. Methods: The authors conducted a cross sectional survey on health and mental health among 1955 former and current flight attendants, using a postal questionnaire. Results: More current than former flight attendants reported self perceived health as fair to poor and psychological distress measured as a GHQ-12 score of six or more. Among current flight attendants, reporting health as fair to poor was associated with low job satisfaction (OR 1.89) and recent experiences of sexual harassment by passengers (OR 2.83). Psychological distress was associated with low job satisfaction (OR 2.38) and frequent tension with partner over childcare (OR 1.79). Conclusions: Perceived health as fair to poor and psychological distress were greater among current flight attendants and were related to job characteristics and family difficulties. Perceived poor health has been shown in the literature to be related to mortality, high job strain, and early retirement, and psychological distress is associated with work absence. The effect of sexual harassment by passengers on perceived health of flight attendants may be relevant to other working women dealing with the public. The health effects of family/work conflicts, low job satisfaction, and sexual harassment should be explored more in depth, using qualitative as well as quantitative methods among working women in various occupations.

Health Risks from Radiation Exposure for Civilian Aviation Flight Personnel: A Study of Italian Airline Crew Members

Abstract De Angelis, G., Caldora, M., Santaquilani, M., Scipione, R. and Verdecchia, A. Health Risks from Radiation Exposure for Civilian Aviation Flight Personnel: A Study of Italian Airline Crew Members. Radiat. Res. 156, 689–694 (2001). A study of the effects of exposures of civilian aviation flight personnel to atmospheric ionizing radiation (including high-energy neutrons) is being performed. The results of previous studies and of the criteria required for a more satisfactory outcome in future studies are presented, along with a description of the protocol for the Italian national study. A description of the cohort is given in terms of its size, composition and member eligibility. The various ways of determining the exposure and the health status of past and current aircrew members are discussed, and follow-up procedures are described. An overview of the data management and processing philosophy adopted in the Italian study is given with regard to flight routes, radiation dose evaluation along the flight paths, and construction of exposure matrices. Other studies of potential interest are also discussed. The study is still in progress, so the results are preliminary.

Radiation-induced health effects on atmospheric flight crew members: clues for a radiation-related risk analysis

There are few human data on low-dose-rate-radiation exposure and the consequent acute and late effects. This fact makes it difficult to assess health risks due to radiation in the space environment, especially for long-term missions. Epidemiological data on civilian flight personnel cohorts can provide information on effects due to the low-dose and low-dose rate mixed high- and low-LET radiation environment in the earths atmosphere. The physical characteristics of the radiation environment of the atmosphere make the results of the studies of commercial flight personnel relevant to the studies of activities in space. The cooperative international effort now in progress to investigate dose reconstructions will contribute to our understanding of radiation risks for space exploration.

Trends in net survival lung cancer in six European Latin countries: results from the SUDCAN population-based study.

Survival is a key measure of the effectiveness of a healthcare system. European Latin countries have some similarities in their health systems; it is thus interesting to examine their differences in survival from cancer, here, lung cancer. The aim of the SUDCAN collaborative study was to compare the trends in the 1- and 5-year net survival from lung cancer and the trends in the excess mortality rates between six European Latin countries (Belgium, France, Italy, Portugal, Spain and Switzerland). The data were extracted from the EUROCARE-5 database. First, the net survival was studied over the 2000–2004 period using Pohar-Perme estimator. For trend analyses, the study period was specific to each country. The results are reported from 1992 to 2004 in France, Italy, Spain and Switzerland and from 2000 to 2004 in Belgium and Portugal. The analyses were carried out using a flexible excess rate modelling. Overall, the 1-year net survival from lung cancer ranged between 36 (Spain) and 43% (Belgium and Switzerland) and the 5-year net survival ranged between 11 (Spain) and 15% (Belgium and Switzerland). Between 1992 and 2004, the age-standardized survival increased considerably at 1 year, but increased less at 5 years after diagnosis. This increase was observed at ages 60 and 70, but was less obvious at age 80. There was little difference in net survival from lung cancer between European Latin countries, particularly in the more recent years. However, survival was slightly lower in Spain and Portugal than in France, Italy, Belgium and Switzerland. High-resolution studies with data on treatment, stage at diagnosis and comorbidities are needed to understand the reasons for these differences.

Trends in net survival from pancreatic cancer in six European Latin countries: results from the SUDCAN population-based study

Pancreatic cancer represents a real clinical challenge. The aim of the SUDCAN collaborative study was to compare the net survival from pancreatic cancer between six European Latin countries (Belgium, France, Italy, Portugal, Spain and Switzerland) and provide trends in net survival and dynamics of excess mortality rates up to 5 years after diagnosis. The data were extracted from the EUROCARE-5 database. First, net survival was studied over the period 2000–2004 using the Pohar-Perme estimator. For trend analyses, the study period was specific to each country. Results were reported from 1992 to 2004 in France, Italy, Spain and Switzerland and from 2000 to 2004 in Belgium and Portugal. These analyses were carried out using a flexible excess rate modelling strategy. There were little differences between countries in age-standardized net survivals (2000–2004). The 5-year net survival was poor (range: 6–10%). The changes in net survival from 1992 to 2004 were mostly related to early survival and patients aged 60 years. A slight decrease in the excess mortality rate between 1992 and 2004 was observed, limited to the 18 months after diagnosis. This study confirmed that, despite some improvement, survival from pancreatic cancer is still poor throughout European Latin countries. The major improvements in clinical imaging did not result in improvements in prognosis. Development of truly innovative treatments is highly needed to improve prognosis.

Trends in net survival from head and neck cancer in six European Latin countries: results from the SUDCAN population-based study.

Cancer survival is a key measure of the effectiveness of a healthcare system. As differences in healthcare systems are present among European Latin countries, it is of interest to look specifically at their similarities and differences in terms of cancer survival. Incident cases were extracted from the EUROCARE-V database for France, Italy, Spain, Switzerland, Portugal, and Belgium. One and 5-year net survivals (NS) were calculated for the period 2000–2004 using the Pohar-Perme estimator. Trends in NS over the 1992–2004 period and changes in the pattern of cancer excess mortality rate until 5 years after diagnosis were examined using a multivariate excess mortality rate model. There were moderate differences in age-standardized NS between countries (5-year NS range: 83–88%), but significant differences in the age groups 15–54 and 55–74 years (at 5 years up to +16 and +18% between any two countries). During the study period, excess mortality and NS improved in Italy, Spain, and Portugal. In Italy and Portugal, this improvement was slightly similar at ages 40, 55, and 70 whereas, in Spain, there was a sharp increase in NS at age 55. Because of this improvement, excess mortality and NS were similar in all six countries in 2004. Excess mortality peaked around 1 year after diagnosis in the youngest ages, but decreased gradually in the elderly. Detailed analyses showed differences in excess mortality and NS from cervical cancer between European Latin countries. However, these differences decreased over the study period because of the considerable improvement in Spain, Italy, and Portugal.

Radiation exposure of airline crew members to the atmospheric ionizing radiation environment

Abstract A study of radiation exposures in the ionizing radiation environment of the atmosphere is currently in progress for the Italian civil aviation flight personnel. After a description of the considered data sources, the philosophy of the study is presented, and an overview is given of the data processing with regard to flight routes, the computational techniques for radiation dose evaluation along the flight paths and for the exposure matrix building, along with an indication of the results that the study should provide.