PART 3:
Richard Signarino’s Checkup—and the Bigger Picture for Veterans Who Worked Around Aircraft
What the research says about aircraft work and cancer
A large Department of Defense analysis of nearly 900,000 aircrew and aviation support personnel (1992–2017) found higher rates of several cancers compared with the general U.S. population. For men, the study reported a 16% higher rate of prostate cancer among aircrew; ground crews also showed elevated incidence for certain cancers. Mortality was lower overall—likely reflecting fitness and access to care—yet the incidence signal has prompted deeper investigation into aviation-related exposures and screening needs.¹
For those on the maintenance side, historical cohorts exposed to trichloroethylene (TCE)—a degreasing solvent widely used in aircraft repair—have been studied repeatedly. Extended follow-up of aircraft maintenance workers shows mixed results on all-cancer mortality, but TCE as a chemical has substantial epidemiologic literature linking it to several cancers; some studies and case evaluations include prostate cancer signals among broader cancer excesses.²⁻³,⁵
Another exposure class is jet fuels (JP-5/JP-8/Jet-A). The ATSDR toxicological profile and VA’s exposure pages summarize neurologic, respiratory, and dermal effects, with cancer associations still being clarified. A 2017 federal review concluded there is limited and inconsistent evidence for cancer risk specifically from jet fuels, underscoring the need for better exposure assessment and long-term follow-up.⁴
Concerns sometimes extend to radar and radiofrequency (RF) radiation. Meta-analyses and pooled evaluations generally do not show a significant increase in overall cancer risk from occupational radar exposure, though case series of young military patients have fueled calls for more granular exposure reconstruction.⁶
In recent years, PFAS (“forever chemicals”) contamination on military bases—often from AFFF firefighting foam—has raised new questions. The National Cancer Institute’s epidemiology group reports that elevated PFAS levels were not associated with increased aggressive prostate cancer in a large prospective analysis, though research continues and exposure scenarios for firefighters and base residents differ.⁷ VA notes potential PFAS exposures for military firefighters and some installations and provides guidance for concerned veterans.⁸
Finally, broader reviews have argued that military veterans should be specifically queried for exposure histories (solvents, fuels, shift work, burn pits, etc.) because several exposures are plausibly associated with prostate cancer risk—even when evidence is not yet definitive.²,³
What’s “publishable” now—without overstating the science
Aviation cohorts show a signal: DoD’s registry analysis reports elevated prostate cancer incidence among aircrew, with ongoing work to tease out the drivers (chemical, physical, circadian/shift-work, or combined).¹
Solvent exposure matters: TCE remains a credible mechanistic and epidemiologic concern from aircraft maintenance settings; it is reasonable to document and report solvent histories in occupational prostate health narratives.²⁻³,⁵
Jet fuel links are not settled: Health effects from JP-5/JP-8 are documented, but cancer associations are limited/inconsistent; any statement should be careful and evidence-proportional.⁴
Radar/RF evidence is mixed to null overall: You can note no clear overall increase in cancer from radar exposure in pooled analyses, while acknowledging data gaps in individual circumstances.⁶
PFAS is under study: No clear association with prostate cancer in a large NCI study, but exposure contexts vary, and federal/VA monitoring continues—appropriate to flag in occupational histories.⁷⁻⁸
Translating evidence into action for veterans
For veterans like Richard, the uncertainty can be frustrating. Dr. Bard’s approach is to pair exposure-aware history-taking with precision imaging:
Document the exposures. Years/roles on the flight line, tasks (degreasing, fuel handling), PPE use, known base contaminants (PFAS lists), and any radiation-risk activities (which have VA “presumptive” pathways for certain cancers).
Screen thoughtfully. PSA and DRE remain standard, but ultrasound adds immediate anatomy: hypoechoic nodules, capsular changes, and power Doppler can highlight suspicious vascular patterns; elastography quantifies focal stiffness. Imaging can triage who needs MRI or biopsy and help target any necessary sampling more precisely—reducing blind procedures and uncertainty.⁹
Monitor longitudinally. For veterans with notable exposure histories but equivocal labs, serial ultrasound mapping offers a low-burden way to watch for change—aligning with the DoD study’s implication that some aviation roles may merit closer surveillance, even when absolute risks remain modest.¹
Where aircraft maintainers fit
Aircraft maintainers face a different exposure mix than pilots: more direct contact with solvents (TCE and others), fuels and exhaust, lubricants, and sometimes shift work. The classic maintenance-facility cohorts anchor much of what we know; while not all outcomes rise to statistical significance, they justify exposure documentation and preventive care.²⁻³,⁵
Back to Richard
For Richard, the take-home is clarity and a plan. His checkup with Dr. Bard delivered a baseline prostate map, correlated with his exposure history from F-14 service. If future labs change—or if new symptoms arise—he has a reference point to guide targeted follow-up rather than guesswork. More broadly, his case illustrates how veteran-centric prostate care should work:
Ask detailed exposure questions from day one.
Use imaging to reduce uncertainty and personalize next steps.
Report exposures in clinical notes and, where appropriate, VA claims, leveraging evolving federal guidance.
The science is still maturing, and not every exposure leaves a measurable imprint. But veterans deserve a standard of care that recognizes their unique histories. For aircraft workers, that means acknowledging credible risks (solvents), openly labeling uncertainties (jet fuels, RF, PFAS for prostate cancer), and deploying the best tools we have—like ultrasound—to catch problems early and keep more veterans like Richard on a healthy, informed path.
Educational content only; not a substitute for medical advice. If you’re a veteran with relevant exposures, talk with your clinician about screening and document your service history.
References
Sigurdson AJ, Waters KM, Gaffney SG, et al. Incidence and mortality of cancer among military aircrew and aviation ground crew personnel. JAMA Netw Open. 2022;5(3):e220938. doi:10.1001/jamanetworkopen.2022.0938
National Research Council (US) Committee on Human Health Risks of Trichloroethylene. Assessing the Human Health Risks of Trichloroethylene: Key Scientific Issues. Washington, DC: National Academies Press; 2006.
Scott CS, Jinot J. Trichloroethylene and cancer: systematic and quantitative review of epidemiologic evidence for identifying hazards. Int J Environ Res Public Health. 2011;8(11):4238-4271. doi:10.3390/ijerph8114238
Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for Jet Fuels (JP-5, JP-8, Jet A). Atlanta, GA: US Department of Health and Human Services; 2017.
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Trichloroethylene, Tetrachloroethylene, and Some Other Chlorinated Agents. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 106. Lyon, France: International Agency for Research on Cancer; 2014.
Blettner M, Schlehofer B, Samkange-Zeeb F, Berg G. Medical exposure to radiofrequency and extremely low-frequency electromagnetic fields and risk of cancer: review of epidemiological studies. Radiat Environ Biophys. 2009;48(1):1-11. doi:10.1007/s00411-008-0206-8
Purdue MP, Lan Q, Baris D, et al. A prospective study of serum per- and polyfluoroalkyl substances and prostate cancer risk. Environ Health Perspect. 2023;131(2):27003. doi:10.1289/EHP11153
Veterans Affairs Office of Public Health. Military exposures: PFAS. US Department of Veterans Affairs website. Updated 2023. Accessed September 14, 2025. https://www.publichealth.va.gov/exposures/pfas/index.asp
Donovan JL, Hamdy FC, Lane JA, et al. Screening, detection, and treatment of prostate cancer: evidence from randomized trials. Lancet. 2016;387(10013):1227-1237. doi:10.1016/S0140-6736(15)01038-0
