Annals of Occupational and Environmental Medicine

Case Report

Assessment of risks for breast cancer in a flight attendant exposed to night shift work and cosmic ionizing radiation: a case report: Dong Joon Park, Sungkyun Park, Seong Won Ma, Hoekyeong Seo, Sang Gil Lee, Kyung-Eun Lee; Ann Occup Environ Med 2022;34:e5. Published online March 22, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e5

Abstract Abstract in Korean PDF Supplementary Material PubReader ePub

Background

Some epidemiological studies have estimated exposure among flight attendants with and without breast cancer. However, it is difficult to find a quantitative evaluation of occupational exposure factors related to cancer development individually in the case of breast cancer in flight attendants. That is, most, if not all, epidemiological studies of breast cancer in flight attendants with quantitative exposure estimates have estimated exposure in the absence of individual flight history data.

Case presentation

A 41-year-old woman visited the hospital due to a left breast mass after a regular check-up. Breast cancer was suspected on ultrasonography. Following core biopsy, she underwent various imaging modalities. She was diagnosed invasive ductal carcinoma of no special type (estrogen receptor positive in 90%, progesterone receptor positive in 3%, human epidermal growth factor receptor 2/neu equivocal) with histologic grade 3 and nuclear grade 3 in the left breast. Neoadjuvant chemotherapy was administered to reduce the tumor size before surgery. However, due to serious chemotherapy side effects, the patient opted for alternative and integrative therapies. She joined the airline in January, 1996. Out of all flights, international flights and night flights accounted for 94.9% and 26.2, respectively. Night flights were conducted at least four times per month. Moreover, based on the virtual computer program CARI-6M, the estimated dose of cosmic radiation exposure was 78.81 mSv. There were no other personal triggers or family history of breast cancer.

Conclusions

This case report shows that the potentially causal relationship between occupational harmful factors and the incidence of breast cancer may become more pronounced when night shift workers who work continuously are exposed to cosmic ionizing radiation. Therefore, close attention and efforts are needed to adjust night shift work schedules and regulate cosmic ionizing radiation exposure.

국제항공 승무원에서 발생한 유방암 사례와 업무관련성 평가
배경
유방암은 여성에게 가장 흔하게 진단되는 암으로, 전리방사선과 야간교대근무와 같은 직업환경적 위험을 포함한 다양한 요인에 의해 영향을 받는다. 항공승무원은 우주 전리 방사사선과 야간교대근무 환경에 노출되는 대표적인 직업군으로 일반인구집단 대비 유방암의 발병 위험이 높다고 몇몇 역학연구에서는 보고되고 있다. 그러나 항공승무원의 유방암 사례에서 암 발병과 관련된 직업적 노출요인에 대하여 정량적으로 평가한 사례는 찾기 어렵다. 본 연구에서는 질환발병의 업무관련성을 인정받은 항공승무원 종사자의 유방암 사례에서 질환 발병과 관련된 직업적 요인들의 노출 수준을 정량적인 평가하였다.
증례
41세의 여성 환자는 항공승무원 재직 중 정기건강검진에서 우연히 발견된 좌측 유방종괴를 주소로 병원에 내원하였다. 초음파 검사 및 조직생검 등의 검사결과 유방의 침습암종(조직 및 핵분화도 3기), 을 진단 받았다. 환자는 유방 보존술을 위한 선행화학요법 시행 중에 부작용이 발생하여 수술적 치료를 시행하지 못하고 보존적 치료를 유지중이다. 환자는 1996년 1월 항공사에 입사하여, 20년 2개월간 항공승무원으로 종사하였다. 총 비행기 탑승 이력 중 94.9%는 국제선에 탑승하였고 총 비행시간의 26.2%는 야간 비행으로 한 달에 네 번 이상 야간 비행업무를 수행하였다. 컴퓨터 시뮬레이션 프로그램인 CARI-6M을 이용하여 추정한 근로자의 우주 방사선 누적노출 추정량은 78.81 mSv였다. 유방암에 대한 개인적 유발 요인 및 가족력은 없었다. 역학조사평가위원회는 이 여성 승무원에서 발생한 유방암은 20년 2개월 간의 야간교대근무와 78.81 mSv의 우주 방사선 노출을 근거로 업무관련성이 상당하다고 평가하였다.
고찰
이번 사례는 항공 승무원 집단에서의 높은 유방암 발병률은 야간교대근무와 함께 기체 탑승 중 우주 전리방사선의 복합적 노출에 의해 기인될 수 있음을 보여준다. 항공 승무원 집단에서의 야간교대근무와 우주 전리방사선 복합노출에 따른 건강영향을 최소화하기 위해서는 더많은 노출평가 사례 및 집단 역학조사를 통한 비행일정 관리기준의 근거마련이 필요하다.

Citations

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Influence of occupational factors on the development of gynecologic pathology in flight attendants in civil aviation
Nailya I. Nasyrova, Artem Y. Yurovskiy, Aleksei V. Overko, Lyudmila A. Ozolinya
V.F.Snegirev Archives of Obstetrics and Gynecology.2024; 11(2): 137. CrossRef

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Review

Radiation-related occupational cancer and its recognition criteria in South Korea: Songwon Seo, Dalnim Lee, Ki Moon Seong, Sunhoo Park, Soo-Geun Kim, Jong-Uk Won, Young Woo Jin; Ann Occup Environ Med 2018;30:9. Published online February 2, 2018; DOI: https://doi.org/10.1186/s40557-018-0219-y

Abstract PDF PubReader ePub

Ionizing radiation is a well-known carcinogen, and is listed as one carcinogenic agent of occupational cancer. Given the increase in the number of workers exposed to radiation, as well as the increase in concern regarding occupational cancer, the number of radiation-related occupational cancer claims is expected to increase. Unlike exposure assessment of other carcinogenic agents in the workplace, such as asbestos and benzene, radiation exposure is usually assessed on an individual basis with personal dosimeters, which makes it feasible to assess whether a worker’s cancer occurrence is associated with their individual exposure. However, given the absence of a threshold dose for cancer initiation, it remains difficult to identify radiation exposure as the root cause of occupational cancer. Moreover, the association between cancer and radiation exposure in the workplace has not been clearly established due to a lack of scientific evidence. Therefore, criteria for the recognition of radiation-related occupational cancer should be carefully reviewed and updated with new scientific evidence and social consensus. The current criteria in Korea are valid in terms of eligible radiogenic cancer sites, adequate latent period, assessment of radiation exposure, and probability of causation. However, reducing uncertainty with respect to the determination of causation between exposure and cancer and developing more specific criteria that considers mixed exposure to radiation and other carcinogenic agents remains an important open question.

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Original Article

Radiotechnologists and Radiation Exposure from PET and PET/CT Systems: Hoon Hee Park, Jeongbae Rhie, Pilkyun Jung, Jong Doo Lee, Jong Uk Won, Jaehoon Roh; Korean Journal of Occupational and Environmental Medicine 2012;24(1):86-95. Published online March 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.1.86

Abstract PDF

OBJECTIVES
In this study, radiotechnologists who work performing PET and PET/CT methodologies were analyzed in order to find the cause for the differences in radiation exposure as they applied to general characteristics, work characteristics, knowledge, and exposure recognition or conduct.
METHODS
From April 15th, 2010 to May 14th, 2010, we conducted a retrospective analysis on 80 radiotechnologists using data garnered from their individual general characteristics, work characteristics, knowledge, and exposure recognition or conduct. Their average annual radiation exposure dosages were measured using a thermoluminescence dosimeter. A multiple regression analysis was performed as a statistical tool.
RESULTS
Regarding the general PET and PET/CT characteristics, when the work experience was short, the exposure dose was higher. The factors of age, marriage, work experience in nuclear medicine, PET, PET/CT, and sex were found to have statistically significant effects. The knowledge, recognition, and conduct factors for the radiotechnologists were affected by unsecure radiation exposure at the moment of carrying, unsecure radiation exposure at the moment of injection, the application of protection at the moment of injection, and the use of auto distributor. It was found that, the use of an auto distributor, efforts in reducing the radiation exposure, unsecure exposure when with a patient, and the application of protective procedures at the moment of injection affected the overall factor of radiotechnologists radiation exposure dose.
CONCLUSIONS
We believe that if radiotechnologists would reduce their radiation exposure by using auto distributors, make efforts to reduce the chance of exposure, and be conscious of radiation, they would be able to reduce the radiation exposure dose even during unavoidable circumstances.

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A Comparative Study on the Radiation Awareness of University Students Gender in Chungbuk Area
Jae-Seon Jang, Seong-Hee Hwang
The Korean Journal of Food And Nutrition.2015; 28(3): 486. CrossRef

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