I had discussed the management of prostate and colon cancers in previous columns, but let me tell you a few facts about how the FAA manages the many different cancers. The FAA believes that the diagnosis of cancer is a self-grounding condition until the pilot is cleared either by an aviation medical examiner or by obtaining a special issuance from the FAA. The only exception is for basal cell cancer, which is a skin cancer commonly found on sun-exposed areas of the skin and cured if caught early and surgically removed.
Although in most cases, cancer is not likely to result in an incapacitation, the FAA is concerned about the pilot’s mental preoccupation brought on by the diagnosis of cancer, as well as the slight risk that the cancer has spread to other organs, including the brain, where there would be a risk for seizure. As we have mentioned numerous times in the past, this is the time when you need to listen to your physician and concentrate on getting well!
An airman will not be able to be considered for a cancer special issuance until all treatment has been completed, including surgery, chemotherapy, and radiation therapy, and the condition is considered to be in remission. The FAA cannot consider an airman for certification while the pilot is undergoing chemotherapy or radiation therapy.
I have written several articles on the conditions AMEs can issue (CACI). These are medical conditions that formerly required a special issuance, but may now be issued by your AME provided you bring the proper documentation to your FAA exam. Several cancers are included in this CACI group. They are colon, prostate, renal, and testicular cancer. These cancers, when caught early and treated, carry a high cure rate; however, the FAA will generally ask you for a follow up report from your doctor to present to your AME on subsequent exams, just to be sure there is no recurrence.
Here are some other common cancers and the time intervals required prior to consideration for special issuance. Note that each condition is reviewed on its own merits.
Melanoma, a skin cancer, depends on the depth of the tumor at time of diagnosis and whether there is spread beyond the local lymph nodes. If the tumor is localized only to the site of the cancer and what is known as a “sentinel node,” an airman can apply for certification once treatment is completed.
Lung cancers depend in part on the cell type and whether the pathology report indicates that the tumor has spread.
Lymphomas in general can be favorably considered after treatment has been completed.
Acute Leukemia is more volatile and stability more difficult to manage, so these cancers generally require two years of remission after treatment before certification can be considered.
Chronic myelogenous leukemia requires that the airman be in remission. This is one type of blood cancer where a specific chemotherapy agent is taken daily that helps the cancer remain in remission. In this situation it is acceptable to fly on the chemotherapy agent.
Bladder cancer, if limited to the wall of the bladder and does not penetrate into the muscular portion, is treated with regular observation and either instilling a medication or by “burning” the cancer off. This type of bladder cancer is one of the FAA's AME Assisted Authorization for Special Issuance (AASI) conditions. For AASI, the FAA grants your AME permission to issue your authorization in the office annually if you have the reports from your treating doctor.