Radiation-associated tumor risk in aircrew in Germany - Implementation of a third follow-up (FLIPKO)


Airline crew is one of the occupational groups with the highest exposures to ionizing (cosmic) radiation. Since 1997, an ongoing cohort study examines occupation-related health risks of cockpit and cabin crew, in collaboration with national and international partners, with a focus on the identification of radiation-associated cancer risks. The third follow-up of the German cohort is currently being carried out in collaboration with the University of Bielefeld and the IMBEI at the Mainz University Medical Center.

Among the 26,846 cohort members, 1,592 deaths (518 cancer cases) and 752,434 person-years between 1960 and 2014 were recorded. A total of 503,021 dose reports are available for the entire cohort for the period 1960-2014, of which 257,305 (51.2%) of these dose values are based on the retrospective estimate for the cabin crew (1960-2003). The mean annual effective dose per person in 2014 was 1.99 mSv (Q1: 1.47: Q3: 2.61 Max: 4.69). For cockpit and cabin crew, the mean cumulative dose was 43.9mSv (Q1:29.9 Q3: 54.0, Max: 99.7) and 28.4mSv (Q1:11.2; Q3: 50.6; Max: 115.9), respectively.

All-cause mortality was significantly reduced in all subgroups (cockpit/cabin, gender) (SMR between 0.48 and 0.70). Mortality for all cancers and for radiation-associated cancers was also reduced, except for brain tumors in male cockpit crew (n=23, SMR=2.01 95% CI 1.15-3.28). Mortality for brain tumors was also increased but not significantly in female cabin crew (n=14, SMR=1.26 95% CI 0.60-2.36), as was mortality for malignant melanoma in male pilots (n=10, SMR=1.88 95% CI 0.78-3.85). The dose-response analyses showed heterogeneous mortality ratios without consistent dose-response relationships.
Overall, the results do not indicate an increased mortality risk for most cancers and other causes of death among German aircrew. The use of radiation registry data allowed an improved exposure assessment and may facilitate future follow-up studies by allowing a nearly complete exposure assessment and a more efficient vital status asssessment.

Funding period

Begin:   January 2014
End:   December 2017


  • German Social Accident Insurance Institution for Transport and Traffic


 Steffen Dreger