The Big C: Medical certification of prostate or breast cancer

October 10, 2012

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Warren Silberman

Warren Silberman

  • Former Manager, FAA Aerospace Medical Certification 
  • Doctor of Osteopathic Medicine 
  • Expert in Aerospace/Preventive Medicine 
  • Pilot since 1986

The Big C we all know refers to cancer, and it is bad enough having to deal with that “C.” The last thing one needs after a cancer diagnosis is having to deal with another “C”—medical certification. This is an area where having AOPA’s Pilot Protection Services watching your back is hugely helpful.

First, take note that your aviation medical examiner cannot grant you a special issuance (equivalent to a “waiver”). You must obtain the proper medical records, evaluations, and tests and bring those to your AME. The doctor must obtain verbal or written permission from the FAA’s Aerospace Medical Certification department to grant the special issuance.

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This is not the place to list the pros and cons of various cancer treatments, but I do encourage you when facing serious illness to avail yourself of every piece of information you can so that you are enabled to consider alternatives with your physicians. However, I shall explain how the FAA views the particular treatments and what you can expect when you present medical records to the agency.

Men, even though you were unfortunate to develop prostate cancer, the FAA pretty much accepts all types of treatment—including no treatment at all, the rather fancy name for which is “watchful waiting” or “conservative management.” The airman must provide the records that explain to the FAA how the tumor was discovered including biopsy results. Although prostate specific antigen (PSA), a marker for prostate cancer detected in blood, is somewhat controversial as a reliable indicator of prostate health, the FAA wants to see PSA results prior to any treatment. This provides a "baseline" to compare future results. With the diagnosis of prostate cancer, the airman is considered grounded based on FAR 61.53. The FAA considers prostate cancer to be a disqualifying condition until the airman is granted a special issuance.

At least six weeks of post treatment stability needs to be reached before providing records to the FAA. This allows the PSA to stabilize, and in the case of surgery, adequate time for the patient to recover. At that time, the FAA will need to see the operative report if surgery was performed, or the radiation oncologist's report if radiation therapy was selected. If surgical treatment was obtained, the FAA will need the admission history and physical report, operative report, pathology report, and discharge summary.

If the treatment plan is to just observe, the records will need to include confirmation from the treating physician if the tumor has spread beyond the confines of the gland, especially if the PSA level was really high. The FAA usually does not grant medical certification if the airman's tumor has spread ( metastasized) to the bone or other organs.

A woman who has been diagnosed with breast cancer (although 1 percent of cases afflict men) must wait until all treatment has been completed. If surgery was carried out and no other treatment is needed, she can request a special issuance as soon as recovery is complete. FAA will require hospital admission and discharge summaries, operative report, and pathology reports. The applicant should also provide a status report informing the FAA how she has progressed since the surgery and include plans for future management. If the pilot is to have radiation or any chemotherapy post-operatively, she must wait until all treatments have been concluded. The pilot will also need a letter from the treating cancer specialist that explains the treatment she received and plans for future observation. If the breast cancer has spread to the lymph glands outside the breast then one will need a Computerized Axial Tomography (CAT) scan or Magnetic Resonance Imaging (MRI) of the head to demonstrate to the FAA that the tumor has not spread to the brain.

Again, lots of things to coordinate and poorly or inappropriately prepared paperwork can slow down the process. Pilot Protection Services can become part of your team to get you back in the air.

For more medical advice and professional assistance with protecting your pilot and medical certificates all year round, visit AOPA Pilot Protection Services.