We know that people who spend a lot of time outdoors – such as groundskeepers, runners, construction workers – are at greater risk for skin cancer. But what about those who spend a lot of time in the sky?
Studies have shown that pilots and flight attendants are at higher risk for skin cancer. According to a study in JAMA Dermatology, published by the American Medical Association, flight crews have twice the incidence of melanoma compared with the general population. But much is still unknown as to why.
We can glean some ideas from other occupations and leisure activities associated with skin cancer risk, including less obvious ones like military personnel and truck drivers. But regardless of your career or hobbies, it’s important to control what you can when it comes to skin cancer prevention.
Why pilots and flight attendants might be at greater risk
Southwest Airlines and American Airlines both have their headquarters in North Texas, and their flight crews spend numerous hours every month, all year, soaring 35,000 feet above the earth. All this time spent at high elevations has been discussed as a contributing factor to pilots’ and flight attendants’ increased skin cancer risk.
First, the farther you ascend into the earth’s atmosphere, the more you are exposed to the sun’s ultraviolet (UV) rays. One study measuring UV radiation in the pilot seat of a turboprop airplane found that flying for under an hour at 30,000 feet had the same UVA carcinogenic radiation exposure as a 20-minute tanning bed session.
Higher altitudes also mean increased exposure to cosmic radiation, which is a high-energy radiation normally filtered by the time it reaches earth, but not as much when you’re in the sky. While pilots and flight attendants are exposed to less than the maximum recommended levels of cosmic radiation, it’s nevertheless one risk factor that has been speculated.
In addition to risk factors associated with altitude, there are other proposed associations that may increase one’s risk of skin cancer. Many flight crews travel frequently to tropical destinations, closer to the equator and therefore the sun. Exposure increases if they spend time outdoors at these destinations.
Other potential skin cancer risk factors include frequent disruption of one’s circadian rhythm, which is essentially the human body’s 24-hour internal clock. This disruption can occur due to jet lag, crossing time zones, and irregular work schedules.
'One study measuring UV radiation in the pilot seat of a turboprop airplane found that flying for under an hour at 30,000 feet had the same UVA carcinogenic radiation exposure as a 20-minute tanning bed session.'
Aviation organizations discuss skin cancer prevention
A June 2018 study published by researchers at the Harvard T.H. Chan School of Public Health found similar conclusions: Pilots and flight attendants have higher rates of various types of cancer than the general population, including skin cancer.
In response, the president of the Association of Flight Attendants-CWA union, Sara Nelson, said flight attendants would be immediately informed “of the results in order to raise awareness to improve early cancer detection and treatment.”
She also called for the Federal Aviation Administration (FAA) and Occupational Safety and Health Administration (OSHA) to require airlines to educate flight attendants about onboard radiation exposure.
The FAA’s policy states that pilots diagnosed with advanced skin cancer cannot fly until the cancer is removed. When it is, medical certification performed by an aviation medical examiner depends on the type of skin cancer and the extent of disease.
The Aviation Medicine Advisory Service – the aeromedical office of the Air Line Pilots Association, International (the largest airline pilot union in the world) – outlines on its website different types of skin cancers, their characteristics, treatment options, and prevention tips.
Other high-risk groups
In addition to pilots and flight crews, there are other jobs associated with an increased risk of skin cancer. Some of these occupations such as lifeguards, lawn care professionals, farmers, and construction workers are not surprising given their frequent time spent in the sun.
But there are several less obvious groups who also need to be extra mindful about sun protection. Some of these include:
- Military personnel. People who have worked in the military, particularly those who have spent time overseas and in tropical environments, often have had more intense UV exposure. Interestingly, compared to other branches of the military, members of the Air Force have an increased risk of skin cancer, similar to commercial flight crews.
- Truck drivers. We often see skin cancer in truck drivers, particularly on the left side of their faces and arms, which are by the driver’s side window. And if they have the window rolled down for long stretches, they might experience even higher levels of sun exposure.
- Welders. Welding tools emit the full spectrum of UV radiation, and frequent exposure increases their risk of skin cancer on the head and neck as well as ocular melanomas.
- Office workers near windows. Most windows filter out UVB wavelengths which lead to suntanning and the majority of skin cancers. However, most windows do not completely block UVA rays, which are associated with premature aging of the skin as well as skin cancers. We recommend patients move their desk away from the direct sunlight or turn their chair so they’re not constantly facing this exposure.
- Golfers and boaters. Golfers spend hours at a time outdoors, and many try to minimize sun exposure by wearing baseball caps and applying sunscreen at the start. However, many forget to reapply sunscreen every one to two hours. In addition, we try to remind golfers to protect their ears and neck which are not covered by a baseball cap.
Related reading: Golfer’s guide: 5 ways to avoid back pain
Boaters should be aware that they’re getting exposure not only from the sun, but also from UV reflection off the water – similar to how skiers and snowboarders should be aware of UV bounce-back from snow.
Who is most at risk for skin cancer?
Everyone faces some level of risk when exposed to UV rays. But people with fair skin and people who spend a lot of time outdoors are among the groups at an increased risk.
Quick prevention tips
When we see new patients at Harold C. Simmons Comprehensive Cancer Center, we find out about their occupation, hobbies, and other activities they like to do to help tailor our recommendations to prevent skin cancer occurrence.
- Apply sunscreen regularly, every day, and reapply it as recommended on the bottle.
- Wear sun-protective clothing to reduce skin exposure.
- If possible, choose outdoor time in the early morning and evening when the sun is not directly overhead and rays are less intense.
- Get screened regularly by a dermatologist to catch unusual moles, new spots, or non-healing lesions as soon as they develop. Catching skin cancer early can be the difference between life and death.
If you fall into one of these high-risk groups, be aware of the amount of sun and radiation exposure you’re getting. Consult with your dermatologist or primary care doctor to establish baseline care for prevention and detection of skin cancer.