A Descriptive Epidemiology of Skin Cancer in Military Aviators Randy Connolly, DO, MPH Resident, Aerospace and Occupational Medicine Naval Aerospace Medical Institute Pensacola, Florida 1
Disclaimer The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. 2
Daedalus and Icarus 3
Review of Literature Evolution of aviation Cancer association Skin cancer types Melanoma Non-melanoma Basal cell carcinoma Squamous cell carcinoma 4
Review of Literature 5
Review of Literature Originates from the sun Carcinogenic Types UV-A UV-B UV-C Exposure Time of year/day Weather conditions Altitude Latitude 6
Review of Literature Originates from supernovae Ionizing radiation Subatomic particles Beta, gamma, x-rays, protons, neutrons Unique biological effects Altitude and latitude dependent Exposure Shielding Altitude Latitude 7
Review of Literature Sleep/wake cycle Melatonin Hormone primarily secreted at night Regenerative effects Disruption Irregular hours Jet lag 8
Study Rationale Commercial Aviation Military Aviation 9
Study Rationale Long-range transport Homogenous fleet Large jetliner Regional jets High altitude High latitude Long duration Routine schedule Commercial Aviation Short-to-moderate range missions Heterogeneous fleet Fixed-wing Rotary-wing (Helo) Variable altitudes Lower latitudes Operational schedule Military Aviation 10
Study Rationale The purpose of this study is to investigate the incidence of skin cancer in US military aviators Skin cancer is one of only a few disorders that have an increased incidence in aviation personnel 11
Objectives Determine the incidence of melanoma and non-melanoma as a function of aviation status Provide new insight pertaining to the effect of altitude on skin cancer incidence by comparing fixed-wing pilots to rotary-wing (helo) pilots 12
Hypotheses The incidence of melanoma and nonmelanoma skin cancer in aviators does not equal that of non-aviators in the US military The incidence of melanoma and nonmelanoma skin cancer in fixed-wing aviators does not equal that of rotarywing aviators in the US military 13
Methods Data Source Defense Medical Epidemiology Database (DMED) melanoma and non-melanoma skin cancer military aviators, military non-aviators Armed Forces Health Surveillance Center in Silver Spring, Maryland Web-based interface Categorize ICD-9 based diagnosis data according to multiple demographic variables No personally-identifiable data or protected health information in any form 14
Methods Statistical Analysis Incidence density rate (IDR) IDR = (events / # of person-years)*1,000 Incidence rate ratio (IRR) IRR = IDRAviator / IDRNon-Aviator 95% confidence intervals and p-values for rate ratio comparisons were then calculated 15
Results: Melanoma Military Aviators N=222 PY=530,168 IDR: 0.42 events per 1000 person-years Non-Aviators N=2,489 PY=13,399,307 IDR: 0.19 events per 1000 person-years Analysis IRR: 2.25, 95% CI 1.97-2.59 p<0.001 Aviators are more likely to develop melanoma than nonaviators 16
Results: Melanoma Fixed-Wing Aviators N=110 PY=184,978 IDR: 0.59 events per 1000 person-years Rotary-Wing Aviators N=51 PY=142,840 IDR: 0.36 events per 1000 person-years Analysis IRR: 1.67, 95% CI 1.45-1.91 p<0.001 Fixed-wing military aviators are more likely to develop melanoma than rotary-wing military aviators 17
Results: Non-Melanoma Military Aviators N=1,318 PY=530,175 IDR: 2.49 events per 1000 person-years Non-Aviators N=10,754 PY=13,399,307 IDR: 0.80 events per 1000 person-years Analysis IRR: 3.10, 95% CI 2.93-3.28 p<0.001 Aviators are more likely to develop non-melanoma than non-aviators 18
Results: Non-Melanoma Fixed-Wing Aviators N=569 PY=184,978 IDR: 3.08 events per 1000 person-years Rotary-Wing Aviators N=373 PY=142,836 IDR: 2.61 events per 1000 person-years Analysis IRR: 1.18, 95% CI 1.11-1.25 p<0.01 Fixed-wing military aviators are more likely to develop non-melanoma than rotary-wing military aviators 19
Conclusions Military aviators have a statistically significant association with skin cancer Fixed-wing personnel have a higher incidence than rotary-wing pilots altitude and flight duration 20
Implications Given the occupational risk demonstrated, further study to investigate causality may be warranted Mitigation efforts may be indicated 21
Questions? 22