F-15E Strike Eagles taxi into formation June 12, 2019, at Mountain Home Air Force Base, Idaho.

F-15E Strike Eagles taxi into formation June 12, 2019, at Mountain Home Air Force Base, Idaho. U.S. Air Force / Staff Sergeant Jeremy L. Mosier

Cancers Strike US Fighter Pilots, Crews at Higher Rates, Air Force Finds

Nearly 30% higher likelihood of testicular cancer and roughly 25% for skin and prostate cancer, according to the military’s most comprehensive study yet.

U.S. Air Force fighter pilots and crew members are far more likely to be diagnosed with certain types of cancers than their fellow airmen, according to the most comprehensive military study to date. 

The study is the first confirmation of a connection long suspected by fighter aviators who saw their peers contracting some cancers at concerning rates. Earlier, less comprehensive studies had proven inconclusive. 

The study also identified at least one airframe—the F-100 Super Sabre—whose crews faced higher rates of almost all types of cancer compared to both their non-flying fellow airmen and the general population. 

The 2021 study, “Cancer Incidence and mortality among fighter aviators,” was conducted by the Air Force Research Laboratory’s 711th Human Performance Wing. It tracked airmen who had recorded more than 100 flight hours in an Air Force fighter aircraft from 1970 to 2004. 

The study found a total of 34,976 “fighter aviators”: fighter pilots and weapons systems officers. Their cancer rates were compared to 316,262 Air Force officers who did not fly fighter aircraft and were on active duty for at least one day from 1970 to 2004. 

Compared to their non-fighter peers, the study found, fighter pilots and their crew were 29 percent more likely to be diagnosed with testicular cancer; 24 percent more likely to be diagnosed with melanoma; and 23 percent more likely to be diagnosed with prostate cancer. 

When compared to the general U.S. population, fighter aviators were 13 percent more likely to be diagnosed with non-Hodgkin lymphoma, 25 percent more likely to be diagnosed with melanoma, and 19 percent more likely to be diagnosed with prostate cancer. The study also found that the fighter aviators had similar rates of other types of cancer, such as brain cancer, compared to non-flying Air Force officers. And compared to the general U.S. population, they had lower rates in several categories, including renal, thyroid, and urinary cancer.  

“Current and former fighter aviators are encouraged to discuss this report with their flight surgeon or primary care provider, including such topics as ultraviolet radiation protection and its impact on vitamin D, lifestyle approaches to cancer prevention, and screening for melanoma skin and prostate cancers,” the study said. 

The study represents the deepest dive to date on a question that continues to surface among the military aviation community: Did their military flying careers cause the many cancers they now see among the men and women they flew with? 

“We’re about to graduate out of the era of ‘We think this deserves a study, and we think that cancer incidence rates and mortality are higher among military aviators, but no one’s paying attention.’ That was 2017, 2018, and 2019. Here in 2021, we have this study. And the Air Force is talking about it out loud,” said Vince “Aztec” Alcazar, a former F-15E Strike Eagle pilot who now leads the aviator medical issues committee for the Red River Valley Fighter Pilots Association, a private veterans support organization. 

The Air Force study also looked at a few specific fighter airframes to compare rates of incidence between those crews and non-flying personnel. However there were limitations. The study only singled out four Vietnam-era warplanes, the F-100, F-4, F-105, and RF-4, to look specifically at those crews’ cancer rates, even though the study covers all fighter jets flying through 2004, such as the F-16 and F-15. 

Earlier Air Force reports have found cancer clusters among F-15E Strike Eagle and C-130 aircrews but the new study did not single out those aircraft. 

Still, among those Vietnam-era planes, there were striking findings, particularly for the F-100 Super Sabre, the nation’s first supersonic warplane. 

“Male fighter aviators who flew the F-100 had greater odds of being diagnosed and dying from colon and rectum cancer, pancreas cancer, melanoma skin cancer, prostate cancer, and brain cancer. They also had greater odds of being diagnosed and dying from thyroid cancer and non-Hodgkin lymphoma, despite similar odds of diagnosis,” the study found. 

Crews who flew the F-105 and F-4 also showed higher rates of testicular, melanoma, and prostate cancer. 

A larger, Congressionally-directed cancer review is also underway. Run by the Defense Health Agency, or DHA, the study is looking at aviation community rates of cancer across all military branches, not just the Air Force. Initial results are expected by year’s end, said a spokesman for Sen. Dianne Feinstein, D-Calif.

The DHA study kicked off after Feinstein got language included in last year's defense bill that required the Pentagon to determine whether service members involved in any part of military aviation, whether a pilot, navigator, weapons officer, carrier deck crew or flight line crew have higher rates of cancer than the general U.S. population. 

If the DHA study does find higher rates of cancer for the aviation community, the legislation requires Defense Secretary Lloyd Austin to launch a deeper, and much-more-difficult-to-execute study. That study would look for causes, such as whether cockpit emissions may be linked, or contact with fuels, solvents, radars or other environmental factors. It would also calculate rates of cancer by type of aircraft flown and locations served. Finally, it would set recommendations for the age at which cancer screenings should begin for those service members. 

Feinstein and other lawmakers filed legislation to address aviator cancers after a number of former fighter pilots spoke out last year about the high rates of cancers and cancer deaths they were seeing among their ranks. 

One of the initial leaders of that outreach was Thomas “Boot” Hill, a former F-4 and F-14 Navy pilot who served as the commanding officer of Strike Fighter Squadron 143 and air boss aboard the aircraft carrier Washington. 

After several fellow aviators got sick with cancer, Hill started compiling an Excel database of every Tomcat pilot or commanding officer he could verify who had either been diagnosed with or died of cancer. He then expanded it to all Naval aviation airframes. 

Hill started with the year 1985 and got as far as 2001. He found that those naval aviators were three to five times more likely to be diagnosed with cancer than the general population. 

The Air Force study and the larger service-wide study expected later this year “means a lot,” said Hill’s daughter Lauren Farrelly, her voice breaking. “It means it wasn’t all in vain, it wasn’t just him sitting, you know, doing a spreadsheet. It gives us some comfort knowing this is something that will continue to be fought for.” 

Hill, 69, died nine days ago, after a decade-long battle with esophageal cancer. In his 23-year Naval aviation career he flew more than 3,600 hours and made 960 carrier landings. 

“My two boys want to be just like him,” Farrelly said.

Correction: An earlier version of this report misstated the numbers of fighter aviators studied and the total number of peer Air Force officers.