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Background  To evaluate cancer incidence among licenced commercial pilots in association with cosmic radiation.    Methods  Cohort study where ionizing radiation dose of cosmic radiation was estimated from airline data and software program and cancer incidence was obtained by record linkage with nation-wide cancer registry. All licenced commercial male airline pilots were followed from 1955 to 2015, ever or never employed at airline with international routes. Standardized incidence ratios were calculated and relative risk by Poisson regression, to examine exposure-response relation.    Results  Eighty three cancers were registered compared with 92 expected; standardized incidence ratios were 0.90 (95% CI 0.71 to 1.11) for all cancers, 3.31 (95% CI 1.33 to 6.81) for malignant melanoma, and 2.49 (95% CI 1.69 to 3.54), for basal cell carcinoma of skin. The risk for all cancers, malignant melanoma, prostate cancer, basal cell carcinoma of skin, and basal cell carcinoma of trunk increased with an increase in number of employment years, cumulative air hours, total cumulative radiation dose, and cumulative radiation dose sustained up to age of 40 years. The relative risk for the highest exposure categories of cumulative radiation dose were 2.42 (95% CI 1.50 to 3.92) for all cancers, 2.57 (95% CI 1.18 to 5.56) for prostate cancer, 9.88 (95% CI 1.57 to 190.78) for malignant melanoma, 3.61 (95% CI 1.64 to 8.48) for all basal cell carcinoma, and 6.65 (95% CI 1.61 to 44.64) for basal cell carcinoma of trunk.    Conclusions  This study was underpowered to study brain cancer and leukaemia risk. Basal cell carcinoma of skin is radiation-related cancer, and may be attributed to cosmic radiation. Further studies are needed to clarify the risk of cancers in association with cosmic radiation, other workplace exposure, host factors, and leisure sun-exposure, as clothes, and glass in cockpit windows shield pilots from the most potent ultraviolet-radiation.

Incidence of cancer among licenced commercial pilots flying North Atlantic routes