Pilot Radiation Death
A pilot at the controls during a flight, where reduced atmospheric shielding at cruising altitude increases exposure to cosmic radiation Rafael Cosquiere/Pexels

Flight attendants and pilots have the highest and second-highest share of deaths from radiation-linked cancers among more than 500 US occupations, according to a study published in JAMA Internal Medicine.

The analysis, led by Dr Vishal Patel of Harvard Medical School and Brigham and Women's Hospital, drew on more than 12.7 million US death certificates recorded between 2020 and 2024.

Researchers linked each certificate to the deceased's usual occupation across 503 job categories, including roughly 14,190 pilots and 7,170 flight attendants.

After adjusting for age, sex, race, ethnicity, education and marital status, flight attendants showed the highest risk-adjusted percentage of deaths from radiation-related cancers, at 6.9 per cent, with pilots close behind at 6.7 per cent.

What The Numbers Show

Flight attendants had roughly 50 per cent higher odds of dying from a radiation-related cancer than the general working population, while pilots had about 36 per cent higher odds. For comparison, radiation-linked cancers accounted for about 5 per cent of deaths among the general working population.

Nuclear technologists, workers whose jobs involve handling radioactive materials directly, ranked twelfth on the list. Researchers looked specifically at cancers with established radiation links, including leukaemia, lymphoma, multiple myeloma, and cancers of the skin, breast, thyroid, prostate and central nervous system.

Flight attendants radiation death
Crew members who spend years working at cruising altitude face repeated exposure to cosmic radiation with each flight Vinh Lâm/Pexels

Which Cancers Are Driving The Pattern

Pilots and flight attendants showed elevated mortality from breast, prostate and central nervous system cancers, along with melanoma. Pilots also had higher leukemia deaths.

Crucially, deaths from cancers with no established radiation link were roughly ordinary among aircrew, a pattern that radiation experts Olsen and Karipidis, writing in an accompanying JAMA commentary, said supports occupational radiation exposure rather than lifestyle or socioeconomic factors as the underlying cause.

Ground-based aircraft mechanics and assemblers, who work near planes but not at altitude, did not show the same elevated pattern.

Why The Exposure Happens

At cruising altitude, there is significantly less atmosphere to shield aircrew from cosmic radiation, energetic particles arriving from the Sun and deeper space. The CDC notes that crews and passengers encounter cosmic ionising radiation on every flight, with exposure rising on high-altitude and high-latitude routes.

Occasional passengers absorb a negligible dose. Aircrew, by contrast, may accumulate an estimated 3 to 6 millisieverts annually depending on their routes, a cumulative exposure that builds across decades of flying rather than any single trip.

Other Possible Contributing Factors

The study cannot prove radiation caused any individual cancer, since the findings are observational rather than experimental. Researchers had no data on individual radiation doses, and occupation can be misrecorded on death certificates.

Other workplace exposures may play a role too. Pilots can encounter ultraviolet radiation through cockpit windows, and both pilots and cabin crew endure disrupted sleep from repeated shifts across time zones.

Speaking on the findings, Patel said occupational history is a field that clinicians often overlook when assessing patients with an aviation background.

The Federal Aviation Administration already classifies aircrew as occupationally exposed to ionising radiation and provides tools to calculate flight doses, yet the US has no federal requirement for routine radiation monitoring of crews. Europe takes a different approach.

Under the EU's basic radiation-safety standards, airlines operating within the bloc are required to assess and actively manage crew exposure to cosmic radiation, a regulatory step the US has yet to adopt.

The findings add mortality data to a question aviation researchers have examined for decades through smaller studies, which noted the unusually broad scale of the new dataset compared with prior aircrew cohort studies.

For the pilots and flight attendants captured in this analysis, and the wider workforce they represent, the results strengthen the case for treating a recognised occupational hazard with formal, ongoing measurement, closer to the standard already in place across the EU, rather than leaving exposure unmonitored.

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