Pilots and flight attendants may face a higher risk of radiation-related cancer deaths than workers in many other occupations, according to a new study examining mortality data from more than 12.7 million people in the United States. Researchers analysed death certificate records from 2020 to 2024 covering 503 occupations and found that flight attendants had the highest proportion of deaths linked to cancers associated with radiation exposure, followed by pilots. The findings point to a potential occupational health concern for people who spend much of their careers at high altitudes.

The study found that flight attendants had about a 50 per cent higher rate of radiation-related cancer mortality compared with the other occupational groups examined, while pilots had a rate about 36 per cent higher. However, researchers did not find that aircrew had unusually high overall cancer mortality. For cancers not classified as radiation-related, results among pilots and flight attendants were closer to the middle of the occupations studied, suggesting that the primary concern identified in the analysis relates specifically to cancers potentially associated with radiation exposure.

Researchers pointed to cosmic radiation as one possible explanation. Earth's atmosphere shields people from high-energy particles originating in space, but that protection is reduced at commercial flight altitudes. Aircrew members are estimated to receive around 3 to 6 millisieverts of cosmic radiation annually, with exposure varying according to factors such as flight duration, route and latitude. By comparison, an air traveller taking about 10 cross-country return flights in a year is estimated to receive around 0.4 millisieverts of cosmic radiation.

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The study does not establish that cosmic radiation directly caused the cancer deaths recorded among pilots and flight attendants. Other occupational and lifestyle factors could also influence cancer risk. Researchers and outside experts have pointed to possible contributions from ultraviolet radiation entering aircraft windows, as well as disrupted sleep patterns and changes to body clocks associated with night flights and shift work. The findings therefore indicate an association rather than proof of a direct cause-and-effect relationship.

The researchers have raised questions about whether aircrew members should receive stronger workplace protections and monitoring for radiation exposure. They noted that the US Federal Aviation Administration recognises aircrew as occupationally exposed to ionising radiation, but US aircrew are not subject to the same federal dose limits or monitoring requirements that apply to some other radiation-exposed workers. The researchers argued that occupational protections should be considered in line with the exposure levels experienced by aircrew.

The findings add to ongoing discussion about the long-term health effects of working at high altitude. Pilots and flight attendants can spend thousands of hours in the air over the course of their careers, potentially resulting in substantially greater cumulative cosmic radiation exposure than occasional air travellers. The researchers said improved monitoring and health assessments could help determine the extent of the occupational risk and inform measures to better protect aircrew.

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