Cancer and the Aviator

1. Cancer and the Aviator John T. Carmack, MD, MPH Lt Col, PAANG, MC, SFS 193 Special Operations Squadron

2. Preview • The Big Cancers • Other Cancers • Cancer and Aviation • Prevention and Screening Recommendations

3. The Big Cancers • Breast Cancer • 1/7 women • #1 cancer in women • 2nd leading cause cancer death • Colorectal Cancer– #1 leading cause CA death • 15-30 cases/100,000 population • Lung Cancer • Leading cause of cancer death men • ~73 cases /100,000 population

4. The Big Cancers • Gynecologic Cancers • Prostate Cancer • Most common cancer in men • 80-200 cases/100,000 • Death rates ~ 12-60/100,000 • Skin Cancer • Who is at risk? • ~20 cases/100,000

5. Other Cancers • Testicular Cancer • Rare – most common ages 15-34 • Overall 5 year survival 95-99% • 0.01-0.04 cases/100,000 population • Pancreatic Cancer • 1/76 people in the U.S. • Brain Cancer—”doo-doo happens” • Time trends (1998-2007) in brain cancer incidence rates in relation to mobile phone use in England. Bioelectromagnetics. 2011 Jul;32(5):334-9. doi: 10.1002/bem.20648. Epub 2011 Jan 28. de Vocht F, Burstyn I, Cherrie JW. • These data do not indicate a pressing need to implement a precautionary principle by means of population-wide interventions to reduce RF exposure from mobile phones.

6. Testicular Cancer in U.S. Air Force Officers • Lt Col Christopher Walker – June 2011 • Air Force Research Laboratory • Association between TC and aviators • Retrospective 1998-2008 • 63 cases in a population 632,323 • ~10 cases/100,000 population • Aviators: 16.9/100,000 • Nonaviators: 7.8/100,000 • Did suggest an association however not statistically significant

7. Cosmic Radiation “Exposure to ionizing radiation in the aviation cohort has been examined many times as a potential occupational hazard that can lead to increased cancer rates. The results of these studies, when looking specifically at testicular cancer, have not been consistent.” Sigurdson AJ, Ron E. “Cosmic Radiation Exposure and Cancer Risk Among Flight Crew,” Cancer Investigation, 22 (5), Jan 2004, pp. 743-61.

8. Cancer Incidence and Mortality Among Flight Personnel An excellent review article and synopsis of all scientific studies of cancer in aircrew members to date [2000] (meta-analysis) concludes the following: Male pilots: • Slight increased incidence of cancers of the brain and melanoma • Increase mortality from prostate and brain cancer • Risk of other types of cancer was lower in pilots Female flight attendants: • Higher risk of melanoma and breast cancer Cause and Effect: “The cause for these findings is not clear since it is difficult to separate occupational exposures from routine exposures such as potential for more sun with increased access to travel and potentially increased leisure time.” Aviation, Space and Environmental Medicine, 2000; 71:216-24 "Cancer Incidence and Mortality Among Flight Personnel: A Meta-Analysis" Ballard et al.

9. Cancer Summary • Leading cause of death worldwide • Breast Cancer #1 in women (1/7) • Lung Cancer: leading cause cancer death men • Colon Cancer: leading cause cancer death in cancer that affects both men/women

10. Cancer Summary About 30% of cancer deaths are due to the five leading behavioral and dietary risks: • high body mass index, • low fruit and vegetable intake • lack of physical activity • tobacco use • alcohol use

11. Screening and Prevention • Lung Cancer—stop smoking/second hand • Breast Cancer—screening mammograms • Prostate Cancer—annual prostate exam • Cervical Cancer—annual PAP smear • Skin Cancer—sun screen/reduce exposure • Colon Cancer—screening colonoscopy

12. "The ultimate determinant in the struggle now going on for the world will not be bombs and rockets but a test of wills and ideas---a trial of spiritual resolve: the values we hold, the beliefs we cherish and the ideals to which we are dedicated."Ronald Wilson Reagan

13. QUESTIONS QUETIONS