Colon cancer ranks as one of the most common malignant conditions worldwide. It is the fourth most common overall and its gender specific rating is number three for both men and women. It is also among the most deadly. For women, lung and breast cancer account for more deaths each year, while only lung cancer claims more lives in men [1].

Prevention is better than cure

One silver lining for pilots is that for unclear reasons, they tend to be diagnosed with colon cancer less frequently than their non-flying peers. Many experts speculate that pilots tend to have fewer medical conditions than the general population and their healthier lifestyles may provide some degree of protection. Maintaining a healthy body weight, regular exercise, and diets rich in fiber, fruits, and vegetables all reduce the risk of several cancers.

Some risk factors are beyond your control. Your family health history, genetic factors, and increased age all contribute to your risk of developing colon cancer. Others, like obesity, alcohol use, and smoking provide an opportunity to worsen the hand you have been dealt.

Early detection means better outcomes

Regardless of your baseline risk, diagnosing the condition before it produces symptoms or spreads to other parts of your body is a key element of successful treatment. The American Cancer Society and the United States Preventive Services Task Force both recommend that all adults begin screening for colon cancer at age 45 or earlier depending on personal health conditions and family history [2].

Getting back in the air

You are most likely not reading this article for advice about diagnosis or treatment of colon cancer. The first question most pilots ask after they determine if a condition will kill them or not is, “When can I start flying again?” The FAA has made answering that question relatively straightforward, though not free from its characteristic bureaucratic due process.   

Timing and Risk

The FAA decision matrix starts by considering when your colon cancer was diagnosed and whether or not you experienced certain high risk features [3].

Your AME can issue your certificate without further FAA review if your cancer was diagnosed five or more years before your AME appointment provided that you have not experienced any recurrence and have completed all related treatment. 

They can also issue your certificate regardless of timing if your cancer was limited to a completely removed adenocarcinoma polyp, no additional treatment is recommended by your doctors, and follow-up colonoscopies are scheduled no more than once per year. 

On the other extreme, AMEs are required to forward your medical certificate application to the FAA if you experienced ANY of the following high risk features:

• Your carcinoembryonic antigen (CEA) lab values have not declined since treatment
• Have you ever treated with chemotherapy
• You received radiation therapy
• You were diagnosed with Familial Adenomatous Polyposis (FAP) or Lynch syndrome
• Your pathology results were deemed “high risk” by your treating oncologist or showed something other than adenoma
• Your tumor(s) were not completely removed
• You have a history of metastatic disease (Refers to distant metastatic disease such as: lung, liver, lymph nodes, peritoneum, brain)
• You have experienced a recurrence of colon cancer
• You have had a sessile polyp with invasive cancer 

The middle ground

If you are not on either end of that spectrum, a good AME can still issue your certificate on the day of your exam under certain conditions. Colon cancer is one of a growing number of Conditions AMEs Can Issue (CACIs). The CACI program allows AMEs to issue medical certificates to pilots with disqualifying conditions if they meet predetermined criteria. 

If you were diagnosed with colon cancer in the previous five years, an AME can still issue any class of medical certificate if all of the following conditions are met:

• Your treating physician confirms the condition is stable and you are complete with treatment
• You have not experienced any of the high-risk features above
• Your Tumor, Node, Metastasis (TNM) stage at diagnosis was III or less
• Your CEA level at diagnosis was less than 5 ng/ml
• Your CEA level was measured within 90 days of your AME exam and did not increase from previous measurements
• Your complete blood count was measured within 90 days of your AME exam, showed no significant abnormalities,  and your hemoglobin (hgb) level was greater than 11 

Prepare for your exam – it’s PASS/FAIL

Properly diagnosed and treated, colon cancer will most likely not end your flying career. In most cases, when your treating physician determines you have completed treatment, the FAA will let you return to the air. That is not to say the process is without potential pitfalls.

Even if you would qualify for a certificate based on this article, you need to make sure that you show up to your appointment with everything your AME needs to make a decision. The right preparation can mean the differences between driving home with your certificate and months of administrative review by the FAA.

If you have other questions about how colon cancer or other medical conditions could impact your aviation career, visit our website to schedule a free consultation and find out how we can help keep you flying.

References 

[1] “Cancer today.” http://gco.iarc.fr/today/home (accessed Dec. 13, 2022).

[2] US Preventive Services Task Force et al., “Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement,” JAMA, vol. 325, no. 19, pp. 1965–1977, May 2021, doi: 10.1001/jama.2021.6238.

[3] “Guide for Aviation Medical Examiners | Federal Aviation Administration.” https://www.faa.gov/ame_guide/app_process/exam_tech/item38/amd/malignancies (accessed Dec. 13, 2022).

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