Proven Higher Cancer Risk for Pilots and Ground Crew Sparks Search for Causes

Lawmakers pledged more study and action now that a Pentagon study has shown elevated cancer risks for military aviators and aviation ground personnel. Completed in January, the study is among the most comprehensive analyses of military aviator cancer yet.

The Defense Department examined health records for 156,050 aviators and 737,891 ground crew for the period 1992 to 2007, concluding that aviators were 24 percent more likely to be diagnosed with cancers of all kinds than members of the general population, when adjusting for age, sex, and race. Ground crew personnel were 3 percent more likely to be diagnosed with cancer.

Congress ordered the study in the 2021 National Defense Authorization Act in response to growing concern among retired pilots concerned about an apparent rising incidence of cancer. 

The new study found even higher rates with specific types of cancer. For example, aircrew were 87 percent more likely to suffer melanoma, 39 percent more likely to have thyroid cancer, and 16 percent more likely to contract prostate cancer. For ground crew, the most elevated rates were for brain and nervous system cancers (19 percent increased risk), thyroid cancer (15 percent higher risk), melanoma (9 percent higher risk), and kidney and renal pelvis cancers (also 9 percent higher risk). 

Actual rates are probably higher, researchers acknowledged, as “data from VA and civilian cancer registries were not included.” 

The Associated Press first reported the study’s findings earlier this month. A copy obtained by Air & Space Forces Magazine build upon a 2021 study from the Air Force’s School of Aerospace Medicine, part of the Air Force Research Laboratory, which studied the health histories of fighter pilots and backseat aircrew from 1970 to 2004. Among nearly 35,000 aviators studied, results also showed double-digit elevated risks for melanoma and prostate cancer. 

“We have two, arguably, bellwether studies,” said retired Air Force Col. Vince Alcazar, head of the Red River Valley Fighter Pilots Association’s aviator medical issues committee, in an interview with Air & Space Forces Magazine. “Their exact conclusions are not the same, but they align on the basic themes of elevated aviator cancer, which as a headline seems to continue to surprise people in government, both lawmakers and leaders inside the Pentagon.” 

At a House Appropriations Committee hearing on March 28, Rep. Betty McCollum (D-Minn.) challenged both Air Force Secretary Frank Kendall and Chief of Staff Gen. Charles Q. Brown Jr. to get to the bottom of these risks. 

“Let’s get our arms around this. Let’s work together,” McCollum said. “We have a big military health budget … and I know that members are concerned about this. So what can we do to help you? There might be specific things you need to have us look at and direct the money to go there.” 

Brown emphasized the need for more study to continue to better understand the issues. 

“We will learn more and more as we collect more and more data and start asking more and more questions about particularly those that are flying in fighter cockpits,” Brown said. It’s important to understand what factors drive the cancers in order to design protection into aircraft to guard against future exposure. “Because you’re exposed to the sun more,” he said, but “you also have a radar in the airplane. [We’ll] try to understand what the causes may be associated with those and then how we may take some mitigation.” 

Both studies focused on cancer rates, not causes. A range of possible factors, including galactic cosmic radiation, ultraviolet radiation, radar radiation, exposure to jet fuel and fumes, and non-ionizing radiation from radars and jamming equipment all pose potential risks. These hypotheses must be studied, however, to reach more advanced conclusions. Advocates say even more work can be done to capture all the necessary data.  

“Databases that track diagnosis of cancer and death from cancer, those databases aren’t as old as we would like them to be, nor probably as we need them to be in a more ultimate sense,” Alcazar said. 

Work on both fronts is set to unfold in the months ahead. Having found elevated cancer rates, the 2021 NDAA now requires the Pentagon to perform a Phase 2 study to identify what hazardous or carcinogenic materials, environments, or duties might be contributing to that elevated risk, and to examine time frames, dates and locations of service, and specific types of aircraft that might further indicate trends.  

In addition, the DOD is looking at a follow-up to the original study to include more data from other databases. 

On top of that, Alcazar said advocates are working with members of Congress to introduce legislation directing so-called “nexus” studies to determine if there is scientific evidence tying any particular exposure or carcinogen to a risk of cancer diagnosis or death. 

Alcazar and the Red River Valley Pilots worked with Rep. August Pfluger (R-Texas), a former Air Force F-15 and F-22 pilot, and others to introduce legislation in the last session of Congress; now they intend to reintroduce a bill, Alcazar said. 

“I’m optimistic in a guarded way that the aviator cancer study adds to not only the conversation but accelerates it in Congress,” said Alcazar, pointing to the successful passage of the PACT Act last year, which offered expanded benefits for veterans exposed to toxins during their service. 

“One of the things that [the PACT Act] did was it took the phrase ‘toxic exposure’ and injected it into conversation and stripped away the sort of skepticism and mythological elements, I think, that were present in a lot of people’s minds,” Alcazar said. “And I think this study kind of stands on that a little bit.” 

Determining toxic exposures matters for both the Pentagon and Air Force, that can then take action to mitigate those exposures for those currently serving, and for veterans’ advocates, who want to ensure those who become sick from their service get the care they need. 

“We may not know how big this problem is,” Alcazar said. “And the size of the problem matters because we have to deploy resources that are solutions to match it. So particularly on the veterans side, it’s important that we get to an a well-designed nexus study … and that multi-year study, we now transform that into law and policy, so that we can help the flyers that are sick today. We can’t bring back the ones that have succumbed. What we can do is create tracking and treatment that is more in-time oriented, so that we improve outcomes.”