Incidence of cancer among Nordic airline pilots over five decades: occupational cohort study
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7364.567 (Published 14 September 2002) Cite this as: BMJ 2002;325:567All rapid responses
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This paper does not contain a null hypothesis, an omission that leads
to some doubt around the validity of its conclusions. If we assume the
hypothesis is that airline pilots are at greater risk of cancer (as
suggested by the conclusion) then this conclusion is incorrect. There was
not a significant difference between all cancers, observed and expected
(95%CI of the standardised incidence ratio 0.93-1.12)
The lack of a null hypothesis means that we are not able to determine
whether the sub group analysis was initially intended, or "post-hoc". The
dangers of relying on subgroup analysis in this instance has been
highlighted elsewhere.(1) If one analyses enough subgroups, by chance so
called significant findings may appear.
(1)Anon. Rules for detecting trials of poor quality. Bandolier. Oct
1996. pp 32-25 Available at http://www.jr2.ox.ac.uk/bandolier/band32/b32-
5.html
Competing interests: No competing interests
Sirs,
I read always with great pleasure data of researchers who suggest the
genetic factor of cancer. However, I am sorry to find out that
"Oncological Terrain", I described formerly, is completely overlooked by
authors all around the World ( See my site, HONCode, ID., N° 233736,
http://digilander.libero.it/semeioticabiofisica , Oncological Terrain, ans
Bibliography). As a matter of fact, in my 45-year long, well established
clinical experience, in the war against cancers, we have particularly to
discover something that allows “all” doctors to recognize promptly, at
the bed side, i.e. "clinically", even in apparently healthy individuals,
not only such as abnormality, like hyperinsulinemia-insulinresistance
and/or melatonin deficiency and/or excessive prolactin production and/or
endogenous opioids deficiency, a.s.o., which either bring about or
aggravate chromosomal aberrations as those observed in cancer cells.
Therefore, we can hopefully reach our goal if all doctors, in apparently
healthy persons, are able either to ascertain, or at least suspect, at the
bed-side chromosomal aberrations, before cancer on-set, and/or neuro-psycho-endocrine-immunological genetic abnormality, which, consequently,
cannot allow the body to eliminate the cells involved by such as
chromosomal aberration. I named such a genetic abnormality of the control
biological system Oncological Terrain (“Oncological Terrain”, accepted
for publication by Minerva Medica, Turin, Italy and
http://digilander.libero.it/semeioticabiofisica).
As a working hypothesis, I thought that all chromosomal alterations of
whatever location, nature and degree, causing oncogenesis, are
necessarily accompanied by similar microvascular modification, structural
and functional in nature, of the local microcirculatory bed. As a matter
of fact, both genetic and environmental factors induce contemporaneously
parenchymal and microvascular cells abnormalities, according to the well-known concept of Tiscedorf’s “Angiobiotopie”. For instance, a family of
molecules called cyclins was descovered. It is through changes in the
production of cyclins during the cell cycle that the activity of the genes
controlling it are themselves regulated. All these events (control,
regulation a.s.o.), however, can happen only by means of changes in local
microcirculation, which now fortunately, thanks to Biophysical Semeiotics,
can be evaluate clinically, in a precise manner (2-5).
My theory of “oncological terrain”, supported by a 45-year long "clinical"
experience, allows me to state that the decline in cancer rates all over
the world could be more intense than now, only if scientists would think
over and discuss, fortunately, the possibility that the "Oncological
Terrain" exists. As a matter of fact, e.g., not all smokers are affected
by pulmonary cancer. Similarly, not all people with chronic hepatitis will
die of hepatocarcinoma. On the other hand, in some families malignancies
occur more frequently than in others. Actually, as I described early in
the above-mentioned papers, there are other causes that account for the
reason of the existence of mother-dependent oncological “real” risk, i.e.
oncological terrain: it is nonsense, or at least useless, to ask a
patient if his or her father is or was affected by cancer.
At this point, the first question is the following: "What does
characterize oncological terrain from the "clinical" point of view"?. In
fact, in order to achieve efficacious cancer prevention on very large
scale it is unavoidable that the modifications occurring in the biological
control system could be easily, promptly, and “quantitatively”
ascertained and properly evaluated with the aid of a “clinical” method,
i.e. by the use of a sthetoscope, and certainly without application of
sophisticated semeiotics, that does not surely be applied in all
individuals, and, moreover, only a few doctors can utilize them.
If it is possible to answer such as first question, a second one
immediately follows: "The oncological terrain which is certainly
genetically provoked, is also in some way reversible?" It is urgent and
necessary to know if inherited oncological terrain can be reversed, i.e.
if it can totally or greatly disappear, with the aid of drugs or diet,
etymologically speaking, which exert a favourable influence on the
characteristic modifications of the psycho-neuro-endocrine- immunological
system, that really represent the “oncological terrain”. My answers to
these questions are readable in my above-cited site (5).
The war against cancer will be fortunately won if all doctors are going to
recognize, with the aid of a stethoscope, individual apparently healthy people positive for “oncological terrain”, particularly those with obvious results who have to
immediately eat a proper diet, etymologically speaking, and only in some cases take drugs.
Unfortunately, change in Medicine is an up-hill task! Moreover, in the
discussion between theories the power of the antagonists is more important
than that of the ideas. But, fortunately, “good” ideas go on and on, and
on...
Stagnaro Sergio MD., Member NYAS. Riva Trigoso (Genoa) Italy.
1) Watts G. Three cell cycle scientists win Nobel prize. BMJ 2001;
323:823 (13 October).
2) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica del torace, della
circolazione ematica e dell’anticorpopoiesi acuta e cronica. Acta Med.
Medit. 13, 25 1997
3) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: la manovra di
Ferrero-Marigo nella diagnosi clinica della iperinsulinemia-insulino
resistenza. Acta Med. Medit. 13, 125 1997
4) Stagnaro-Neri M., Stagnaro S., Cancro della mammella: prevenzione
primaria e diagnosi precoce con la percussione ascoltata. Gazz. Med. It. –
Arch. Sc. Med. 152, 447, 1993.
5) Stagnaro S., Diet and Risk of Type 2 Diabetes. N Engl J Med. 2002 Jan
24;346(4):297-298. letter [PubMed –indexed for MEDLINE].
Competing interests: No competing interests
Incidence of cancer among Nordic airline pilots over five decades: occupational cohort study
EDITOR- The only cancer shown to have an increase in incidence was
skin cancer. I would be interested to know if this was in long haul as
opposed to short haul pilots. As a commercial pilot’s spouse I am aware
that airline pilots who fly long haul tend to go to warm or tropical
destinations and have a few days stop over before flying home. Usually
the time is spent, at least in part, sunbathing, a risky occupation for
Nordic skins. A previous increased incidence of melanoma has been shown
in airline pilots.1, 2 I suspect their increased skin cancers incidence
may be more post- than in-flight.
1. Nicholas JS, Butler GC, Lackland DT, Tessier GS, Mohr LC Jr, Hoel
DG. Health among commercial pilots. Aviation Space and Environmental
Medicine 2001; 72: 821-826
2. Rafnsson V, Hrafnkelsson J, Tulinius H. Incidence of cancer among
commercial airline pilots. Occupational and Environmental Medicine 2000;
57: 175-179
Competing interests: No competing interests