I will always remember the first time I was confronted by the specter of cancer and the notion that my health, and that of my closest friends and family, did not come with a guarantee. I was in my late 20s – still flying fighter planes and emotionally confident in the assurance that my destiny would be determined by my own force of will. I had lost friends to accidents and mourned the loss of family members from older generations. Intellectually, I knew I was not invincible, but my sense of control was unshaken. 

Then my closest friend from college called with some unexpected news: he had been diagnosed with testicular cancer. Like most men in the same situation, he sought treatment in time for doctors to intervene and his cancer never went on to cause significant symptoms, much less shorten his life expectancy. Nonetheless, his experience changed my worldview. Cancer was no longer something that only my parents and their friends talked about. Perfect health could not be assured by clean living and exercise. If it could happen to him, it could happen to me. 

Many of my friends and colleagues have shared similar experiences and statistics bear that out. Considering all cancers as a group, age is the most significant risk factor for developing the disease with the rate of diagnosis rising dramatically as people advance into their 50s and 60s [1]. That trend holds true for all of the most common types of malignancy including those involving the breast, prostate, lung, and gastrointestinal system [2]. Testicular cancer is different. Even though it does not make the top 10 in overall statistics, it is the most commonly diagnosed malignancy in men younger than 35 and is among the most survivable forms of cancer [3].

What that means for men in young adulthood and early middle age is that they are more likely to experience or know a peer with testicular cancer than any other form. Because of high survival rates and short recovery from treatment, it is also likely for survivors in that age group to return to work soon after treatment and work for decades without experiencing relapse or complications. Easy for office workers. What about pilots?

If you have instinctively concluded that the FAA will want to exercise more scrutiny over your medical certificate application as a cancer survivor, you are correct. Even though it is not on their list of specifically disqualifying conditions, if you have experienced any cancer diagnosis, your AME will have to perform some extra due diligence. In the case of testicular cancer, the FAA has made that process very transparent by including it as one of their CACI conditions.

If you have fully recovered from treatment and your AME knows what they are doing, chances are you will still leave your examiner’s office with a valid FAA medical certificate. The FAA’s approach is relatively straightforward. 

If it has been more than five years since you were treated and you are still disease free, no additional documentation is required. Your AME can issue your certificate on the day of your exam. 

Conversely, if you are still undergoing treatment or your doctors have determined that your testicular cancer has spread to other areas of your body, the FAA will require a significant amount of additional paperwork, specialized studies, and careful consideration by the Aerospace Medical Certification Division (AMCD) at its headquarters in Oklahoma City.

In between those two extremes is where CACI Criteria come into play. If you have been treated for testicular cancer and recovered within the past five years, your AME can STILL issue your certificate under certain conditions. You will need to provide your examiner with a current detailed progress note from your treating physician that provides enough detail to determine the following: 

• Your condition must be stable
• Your testicular cancer must not have metastasized (spread to other areas of your body)
• You must be complete with any chemotherapy or radiation treatment 
• Your doctors must have determined that no additional treatment is anticipated in the future
• You must be fully recovered from any surgery and off any related pain medications

Provided you meet those conditions, your AME can still provide your medical certificate immediately after your examination without waiting for further review by the FAA. You should still read some AME reviews before scheduling your appointment and – better yet – discuss your condition with your examiner or consult us ahead of time to make sure it all goes smoothly. Understanding your AME’s role in the certification process will help to resolve the uncertainty that many pilots feel approaching their certification appointment. It can also make the whole process go faster by months or more. 

Testicular cancer might change the way you think about life, but once you have been treated, it does not need to change the way you think about flying. 

References:

[1] “Risk Factors: Age – NCI,” Apr. 29, 2015. https://www.cancer.gov/about-cancer/causes-prevention/risk/age (accessed Jul. 27, 2022).

[2] “Common Cancer Types – NCI,” Apr. 21, 2015. https://www.cancer.gov/types/common-cancers (accessed Jul. 27, 2022).

[3] R. L. Siegel, K. D. Miller, H. E. Fuchs, and A. Jemal, “Cancer statistics, 2022.,” CA. Cancer J. Clin., vol. 72, no. 1, pp. 7–33, Jan. 2022, doi: 10.3322/caac.21708.