What to know about breast cancer and medical certification

October is Breast Cancer Awareness Month

This month is Breast Cancer Awareness Month, which aims to increase awareness of the disease and to raise funds for research into its cause, prevention, diagnosis, treatment, and cure. I thought this would be a good time to highlight some important information on the subject. 

According to the December 2014 statistical manual published by the FAA Aerospace Medical Certification Division, there were 11,114 women who were issued first class medical certificates, 6,899 second class certificates, and 18,917 third class certificates as of Dec. 31, 2013. There were a total of 535,476 male airmen medical certificates issued that year. Although breast cancer is perceived as a woman’s issue, a small percentage of cases afflict men where the prognosis tends to be worse. 

From the Up to Date medical website, it is noted that the current average lifetime risk for breast cancer as less than 15 percent. The current recommendations for screening were the following: 

  • For women between the ages of 50 and 70, they recommend screening with mammography.
  • For women between the ages of 40 and 50, rather than routine screening, it is recommended they discuss the risks and benefits of mammography and the decision to perform the test be determined by the individual.
  • For women over the age of 70, they suggested screening if their life expectancy is at least another 10 years.  
  • For the average woman under age 40, they did not advise breast cancer screening. Interestingly, there have been no randomized trials (the most scientific way to investigate a health issue) done for breast cancer screening in women under the age of 40.   

In women who have a history of breast cancer in a first-degree relative, it was suggested that screening mammography be done at an earlier age, especially if that family member developed the cancer prior to going through menopause.   

The American Cancer Society recommends clinical breast cancer examination every three years from ages 20 to 39 and annually thereafter. The American College of Obstetricians and Gynecologists disagrees a bit and recommends clinical breast cancer examinations every one to three years from ages 20 to 30 and annually thereafter.   

Another interesting fact is that there is much less consensus among the experts about teaching women breast self-examination techniques. In 2003, the American Cancer Society changed a prior recommendation in favor of monthly breast self examinations to a recommendation that women be educated about the benefits and limitations of self examination. The American College of Obstetricians and Gynecologists recommends breast self-awareness, which “can include breast self-examination.” There are other public health organizations with differing recommendations, but I stuck to these two, because they are well known.  

The mammogram remains the test of choice to screen for breast cancer. There was also differing opinions as to the frequency of screening mammography. In general, the opinion is to have them done every two years based on the recommendations I listed above.   

Breast cancer without spread to distant areas and breast cancer with spread to regional lymph nodes are managed the same. All treatments have to have been completed. Pilots are not considered for special issuance while they are receiving chemotherapy or radiation until those treatments have been completed and any side effects are resolved. The aviator must then demonstrate that there are no metastases (spread) to the lung or bone. If there was spread to regional lymph nodes, the woman must have a current MRI of the brain as the cancer can spread there. That could result in a seizure as the first manifestation that there was spread.

If the woman had breast cancer with spread beyond the regional lymph nodes, then they are not considered for special issuance for three years from the date of diagnosis.

The use of regular suppressive therapy, such as the drug Tamoxifen, is acceptable to the FAA.  

Topics: Pilot Protection Services, AOPA Products and Services

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