Cancer risk among air transportation industry workers in Korea: a national health registry-based study

Flight attendants face various risk factors in their working environments, particularly occupational exposure to cosmic radiation. This study aimed to assess cancer risk among air transportation industry workers, including flight attendants, in Korea by constructing a cohort using national health registry-based data and analyzing cancer incidence risk.

We used the Korea National Health Insurance Service database from 2002 to 2021 to construct a cohort of 37,011 workers in the air transportation industry. Cancer incidence was defined using the tenth version of the International Classification of Diseases. We calculated the age- and sex-specific standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) by applying the cancer incidence rate of the general population between 2002 and 2019.

Approximately 5% of the cohort developed cancer. Overall, the cancer incidence in the cohort was similar to or lower than that of the general population, with the SIRs for all cancers being lower. However, significantly higher SIRs were observed for nasopharyngeal cancer (SIR, 3.21; 95% CI, 1.71-5.48) and non-Hodgkin lymphoma (SIR, 1.57; 95% CI, 1.02-2.32) in male workers and breast and genital cancer (SIR, 1.51; 95% CI, 1.34-1.70) and thyroid cancer (SIR, 1.25; 95% CI, 1.05-1.47) in female workers.

The lower overall cancer incidence among air transportation industry workers observed in this study could indicate the "healthy worker effect"; however, the incidences of certain cancers were higher than those in the general population. Given that these workers are exposed to multiple occupational and lifestyle-related risk factors, including cosmic radiation, further studies are necessary to determine radiation-induced cancer risk while considering potential confounding factors.