Breast Cancer and Medical Certification

Breast cancer is common. Currently, the average risk for a woman in the United States to develop breast cancer sometime in her life is about 13%. That’s about a 1 in 8 chance. Fortunately, if it is detected early the outlook is good. That’s the reason screening mammograms are so important. When to start yearly mammograms is controversial. The Mayo Clinic recommends starting at age 40. The American Cancer society opts for age 45 and the U.S. Preventive Services Task Force, age 50. Obviously, if you have a family history of breast cancer, you’ll want to start at an earlier age. As always, it’s best to talk with your doctor about when. Also, men are not immune. About one in 883 will develop this disease at some time in their life.

So how does getting breast cancer impact your ability to fly? Like most things, it depends. Over the last 15 years, over 4,000 cases have developed among pilots. In consequence, the FAA has developed some pretty specific criteria that allow Aviation Medical Examiners to issue medical certificates to pilots with less severe forms of the disease.

Specifically, if the cancer was non-metastatic (did not spread out of the breast) and treatment was completed five or more years ago, the AME can issue then and there. It is OK with the FAA to continue hormone treatments such as tamoxifen. If non-metastatic treatment was completed less than five years ago, the case potentially becomes a CACI (Condition an AME Can Issue). To issue on the spot the following criteria must be met:

• You must be fully recovered;

• There must be no evidence of the cancer spreading out from the breast (metastatic);

• There must be no evidence of residual disease;

• Radiation therapy must be completed;

• You must be off all pain medications;

• You must be released by your surgeon.

As mentioned above you can continue to take certain preventive medications such as tamoxifen (Nolvadex), anastrozole (Arimidex) or letrozole (Femara).

However, if there is any evidence of spread of the malignancy to tissues outside of the breast your AME will have to defer to the FAA for further evaluation of your condition before a medical certificate can be granted. The same is true if you have had to receive chemotherapy for the breast cancer. If deferral is necessary, however stick with it. You will receive a letter from the FAA a few weeks after your AME submits your examination. It will specify what records and tests the FAA will need to evaluate your case. If you are doing well and not having to take any disqualifying drugs (mostly strong pain relievers) the odds are very good that you will receive a Special Issuance (SI). This will grant you your medical

certificate and specify when you will have to be re-evaluated by your treating physician. Usually this is every 12 months.

It will spell out what tests will have to be done and sent to the FAA for review. Usually what the FAA asks for in testing is no more than would be reasonable follow-up care even if you were not flying. Assuming you are doing well and do everything the FAA asks, you will get your medical certificate reissued.

Fly wisely. See you next month.

As always, comments, questions and suggestions are welcome: jdlakinmd@gmail.com.

Also, we’ve moved our office to Airlake Airport’s FBO (KLVN)! Call 952-469-4414 for a flight physical appointment.