Members Only - AOPA Pilot Information Center - Medical Certification: Breast Cancer

Cancer — Breast

Breast

Breast cancer is being reviewed more favorably, and the outlook is good if the disease is localized or limited to breast tissue and adjacent lymph nodes only. Evidence of tumor spread reduces the likelihood of certification.

Breast carcinoma is graded by staging on a scale of 0-4, with 0 being a non-invasive tumor and 4 indicating tumor that has spread (metastasized) beyond the breast tissue. Breast tumors may also be characterized by other designations: T, N, or M. 

"T" indicates tumor size and may be indicated by a range from Tx, tumor not present or can't be found, up to about T4, indicating a large tumor. "N" identifies the amount of lymph node involvement, where NX shows no lymph nodes involved and N1-3 indicates a higher number of identified positive nodes. Finally, the "M" grades the amount of metastasis from the primary tumor site.

Medical certification approval is based, among other things, on the likelihood of sudden or subtle incapacitation, as in the case of tumor spreading to the nervous system and brain, resulting in a seizure or other incapacitating neurological event. Any evidence of metastasis is a major consideration. Additionally, any adverse side effects from treatment are also important.

The extent of lymph node involvement will affect the outcome of review and the frequency of required follow-up intervals. If tumor is found in any lymph nodes, certification will require a brain MRI at the time of the initial application, and annually for continued recertification.   An MRI is usually not required if the cancer was confined to the breast tissue only. 

Breast cancer with distant metastasis may require a three year observation period before certification at any class can be considered.  

At the time of your next examination, you will need to provide your aviation medical examiner with the following information that will be forwarded to the FAA for certification approval:

  • Laboratory blood work, including tumor markers and CEA (carcinoembryonic antigen), if done.
  • Chest CT scan or X-ray; 
  • Treatment records (i.e., chemotherapy, radiation, radical surgery, hormone therapy, etc.). Include start and completion dates of treatments; 
  • Hospitalization records including;
    • admission history and physical;
    • laboratory studies;
    • diagnostic test results;
    • operative reports;
    • pathology reports;
    • discharge summary. 
  • A detailed, current status report from the treating physician to include commentary about the classification of malignancy, locations(s) of lesions, method of treatment, and extent of metastases, if any; 
  • Medications, dosage, and frequency of use. 
  • Intravenous (IV) chemotherapy and radiation therapy must be completed before the FAA will consider issuance of a medical certificate. Certification while on a low toxicity oral chemotherapy agent, such as progesterone or tamoxifen, may be favorably reviewed on a case-by-case basis.

AASI for Breast Cancer:


After initial certification by FAA staff doctors, subsequent renewals qualify for AME Assisted Special Issuance (AASI), a process that provides examiners the ability to issue an airman medical certificate to an applicant who has a medical condition that is disqualifying under 14 CFR Part 67.
The authorization letter received from FAA, granted in accordance with part 67 (14 CFR Part 67.401), is accompanied by attachments that specify what information the treating physician(s) must provide for the renewal issuance.
Examiners may issue renewal of an airman medical certificate if the applicant provides the following:
• An authorization granted by the FAA. 
• A current status report performed within 90 days that must include all the required follow-up items and studies as listed in the authorization letter and that confirms absence of recurrent disease. 
The examiner should defer to the AMCD or Region if:
• There has been any progression of the disease. 
• The CEA is elevated. 

Updated 6/13