Author(s): Raquel Velazquez-Kronen

Airline pilots and flight attendants might have concerns about long-term health risks related to their exposures in the workplace. Aircrew have the highest annual individual radiation dose of any occupation, work irregular hours, and can be at risk of exposure to infectious diseases when traveling. Here we answer some of the common health-related questions about people who fly for a living.

Do aircrew have higher rates of cancer than the general population?

Aircrew do not appear to be at higher risk for cancer than the general population. In the United States, 1 in 2 men and 1 in 3 women will develop some form of cancer in their lifetime. Many exposures can contribute to cancer risk, some of which could be related to a person’s occupation. Airline pilots and flight attendants are exposed occupationally to certain known cancer risk factors (e.g., cosmic radiation, ultraviolet radiation, and circadian rhythm disruption).

Several studies of aircrew have shown that overall and cause-specific cancer mortality is low compared with the general population despite these additional occupational exposures. As compared to people who do not fly for a living, pilots and flight attendants might be more likely to develop skin and female breast cancers, but reasons for this are unclear. CDC provides more information on cancer in aircrew, including steps that might reduce skin and breast cancer risk.

Are aircrew more likely to develop heart disease than the general population?

Aircrew might be at greater risk for developing some forms of heart disease compared with the general population. Heart disease is the leading cause of death in the United States. Although occurrence is rare, aviation medical examiners need to consider the likelihood of an in-flight incapacitation event due to common medical conditions (e.g., some forms of heart disease). Among pilots, heart disease and related conditions are the leading cause of grounding due to medical disqualification.

The prevalence of peripheral artery disease also has been shown to increase with the number of years flight attendants have worked. Combined with lifestyle and genetic factors, numerous occupational exposures in aviation might contribute to heart disease risk (e.g., circadian rhythm disruption, fatigue, shift work, chronic stress). CDC has information on heart disease prevention.

Are commercial aircrew at increased risk for contracting infectious diseases?

Aircrew, especially flight attendants, interact with many people daily and can be exposed to infectious diseases when in contact with sick crewmembers, passengers, or their bodily fluids; by inhaling airborne pathogens; or by touching contaminated surfaces. See information on standard safety protections for aircrew, identifying potentially infectious travelers, and infection-control guidance.

Aircrew can reduce their risk for becoming ill with infectious diseases by keeping up to date with routine vaccinations (e.g., diphtheria-tetanus-pertussis, influenza, measles-mumps-rubella) and by frequently washing hands with soap and water or using an alcohol-based hand sanitizer containing ≥60% alcohol when soap and water are not readily available. Aircrew should be trained to use appropriate personal protective equipment (e.g., disposable gloves, face masks) when assisting potentially infectious travelers (e.g., those with a fever or respiratory symptoms). For additional occupational health and safety information that might pertain to emerging infectious diseases or public health emergencies, aircrew also can review the Federal Aviation Administration (FAA)’s Safety Alerts for Operators.

Are workplace exposures linked to reproductive health effects in aircrew?

Some evidence suggests that cosmic radiation exposure, high physical job demands, and working during typical sleep hours might be associated with an increased risk for miscarriage among pregnant flight attendants. Flight attendants do not, however, appear to be at elevated risk for preterm birth, low infant birthweight, or female reproductive (e.g., ovarian, uterine) cancers. For breastfeeding aircrew members, exposure to external radiation while working will not expose a baby to radiation through the breastmilk.

The National Council on Radiation Protection and Measurements recommends a radiation dose limit of 0.5 mSv (millisievert) per month during pregnancy, and the National Oceanic and Atmospheric Administration provides information on current weather conditions and whether aircrew flying at higher altitudes could be exposed to higher radiation levels due to solar radiation activity.

Pregnant aircrew can take steps to reduce their exposure to other potential occupational hazards by limiting physically demanding job tasks (e.g., prolonged standing) and by following guidance on weight limits for lifting during pregnancy. More information on aircrew reproductive issues is available at the NIOSH webpages on Reproductive Health and Pregnancy.

Work-related Fatigue or Sleep Disorders

As compared to the general population, aircrew report fatigue and sleep disorders more frequently, which could be due to high job stress, irregular sleep schedules, jet lag, and long work hours. Chronic fatigue and sleep disorders (e.g., insomnia) can have negative long-term effects on overall physical and mental health and represent a potential risk for workplace injury.

In addition to recommending regular sleep, FAA provides guidance for aircrew to help reduce fatigue and improve sleep. Because even short naps can help increase alertness and improve performance throughout the day, aircrew should consider taking a nap either before starting work or when an opportunity arises to take a break during work. Other strategies include engaging in a few minutes of light physical activity (e.g., stretching, walking) during work to break up continuous tasks, and minimizing exposure to sunlight (which can make it more difficult to get enough sleep) after working a night shift. The FAA has a free online fatigue prevention training. CDC also offers a free fatigue prevention training for commercial pilots in Alaska.

. . . perspectives chapters supplement the clinical guidance in this book with additional content, context, and expert opinion. The views expressed do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).