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Original Investigation |

The Risk of Melanoma in Airline Pilots and Cabin Crew:  A Meta-analysis ONLINE FIRST

Martina Sanlorenzo, MD1,2; Mackenzie R. Wehner, MPhil1,3; Eleni Linos, MD, DrPH1; John Kornak, PhD4; Wolfgang Kainz, PhD5; Christian Posch, MD1,6; Igor Vujic, MD1,6; Katia Johnston, BS1; Deborah Gho, BS1; Gabriela Monico, BS1; James T. McGrath, EE1; Simona Osella-Abate, PhD2; Pietro Quaglino, MD2; James E. Cleaver, PhD1; Susana Ortiz-Urda, MD, PhD1
[+] Author Affiliations
1Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco
2Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
3School of Medicine, Stanford University, Stanford, California
4Department of Epidemiology and Biostatistics, University of California, San Francisco
5Center for Devices and Radiological Health, Division of Physics, US Food and Drug Administration, Silver Spring, Maryland
6Department of Dermatology,The Rudolfstiftung Hospital, Vienna, Austria
JAMA Dermatol. Published online September 03, 2014. doi:10.1001/jamadermatol.2014.1077
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Importance  Airline pilots and cabin crew are occupationally exposed to higher levels of cosmic and UV radiation than the general population, but their risk of developing melanoma is not yet established.

Objective  To assess the risk of melanoma in pilots and airline crew.

Data Sources  PubMed (1966 to October 30, 2013), Web of Science (1898 to January 27, 2014), and Scopus (1823 to January 27, 2014).

Study Selection  All studies were included that reported a standardized incidence ratio (SIR), standardized mortality ratio (SMR), or data on expected and observed cases of melanoma or death caused by melanoma that could be used to calculate an SIR or SMR in any flight-based occupation.

Data Extraction and Synthesis  Primary random-effect meta-analyses were used to summarize SIR and SMR for melanoma in any flight-based occupation. Heterogeneity was assessed using the χ2 test and I2 statistic. To assess the potential bias of small studies, we used funnel plots, the Begg rank correlation test, and the Egger weighted linear regression test.

Main Outcomes and Measures  Summary SIR and SMR of melanoma in pilots and cabin crew.

Results  Of the 3527 citations retrieved, 19 studies were included, with more than 266 431 participants. The overall summary SIR of participants in any flight-based occupation was 2.21 (95% CI, 1.76-2.77; P < .001; 14 records). The summary SIR for pilots was 2.22 (95% CI, 1.67-2.93; P = .001; 12 records). The summary SIR for cabin crew was 2.09 (95% CI, 1.67-2.62; P = .45; 2 records). The overall summary SMR of participants in any flight-based occupation was 1.42 (95% CI, 0.89-2.26; P = .002; 6 records). The summary SMR for pilots was 1.83 (95% CI, 1.27-2.63, P = .33; 4 records). The summary SMR for cabin crew was 0.90 (95% CI, 0.80-1.01; P = .97; 2 records).

Conclusions and Relevance  Pilots and cabin crew have approximately twice the incidence of melanoma compared with the general population. Further research on mechanisms and optimal occupational protection is needed.

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Figures

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Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-analyses Flowchart of Article Search and Study Selection

Nineteen studies met inclusion criteria and were included in the meta-analysis.

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Figure 2.
Standardized Incidence Ratio and Standardized Mortality Ratio of Melanoma in the Studies Included in the Meta-analysis

The overall summary standardized incidence ratio (SIR) of participants in any flight-based occupations was 2.21 (95% CI, 1.76-2.77; P < .001; 14 records). The overall summary standardized mortality ratio (SMR) of participants in any flight-based occupation was 1.42 (95% CI, 0.89-2.26; P = .002; 6 records). ES indicates effect size. Weight, %, indicates the degree to which the study contributed to the final results.

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Figure 3.
Standardized Incidence Ratio and Standardized Mortality Ratio of Melanoma in the Studies Included in the Meta-analysis Stratified by Sex

For men, the overall summary standardized incidence ratio (SIR) was 2.38 (95% CI, 1.75-3.23; P = .001; 12 records) (A), and the overall summary standardized mortality ratio (SMR) was 1.87 (95% CI, 1.32-2.65; P = .39; 5 records) (B). For women, the overall summary SIR was 1.93 (95% CI, 1.50-2.48; P = .41; 2 records) (C), and the overall summary SMR was 0.61 (95% CI, 0.13-2.85; P = .51; 2 records) (D). Weight, %, indicates the degree to which the study contributed to the final results.

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Figure 4.
Funnel Plots With Pseudo–95% CIs for the Standardized Incidence Ratio (SIR) and Standardized Mortality Ratio (SMR) of Melanoma

Funnel plots to check the existence of publication bias. SE indicates standard error.

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