Breast Cancer and Flight Deck Crews

October is Breast Cancer Awareness Month, which aims to promote screening and reduce the risk of the disease—the most common form of cancer afflicting women in Canada and the United States. Research indicates that female airline pilots may have an even higher risk level. These studies suggest that this increased probability is likely due to the greater amount of cosmic ionizing radiation pilots are exposed to while routinely traveling at higher altitudes, combined with the effects of irregular work hours and circadian rhythm disruptions, which can disturb hormonal balances.

The good news is that early detection can make a tremendous difference in effectively treating this condition, and women are encouraged to perform monthly self-exams, routinely see their physicians, and schedule regular mammograms. In addition, if pilots do develop breast cancer and go into remission, they can fly again following the necessary remission period.

The breast, also known as the mammary gland, consists of three primary parts: the lobules, the glands that produce milk; the ducts, or tubes that transport the milk to the nipple; and the fatty and connective tissue. Cancers occur when cells in this region begin to grow abnormally, forming a mass or tumor. Benign tumors are characteristically slow growers, whereas malignant tumors propagate more rapidly and can spread to other parts of the body.

The most common type of invasive breast cancer is invasive ductal carcinoma, which originates in the ducts and accounts for 80 percent of these cases. Alternatively, invasive lobular carcinoma starts in the lobules and represents nearly 10 percent of all invasive cases.

If you discover a lump in your breast, your doctor may use ultrasound, mammography, magnetic resonance imaging, bloodwork, and/or a biopsy to help make a diagnosis. A tumor is evaluated by the stage it’s reached, using a numerical system that compares it to previous cases applying the TNM (tumor, nodes, metastases) classification. If the growth is noninvasive or at Stage 1, it’s two centimeters or less in size and only appears in the breast.

Stage 2 indicates that the cancer is typically between two to five centimeters and has spread to the nearby lymph nodes. A Stage 3 tumor is considered locally advanced and the growth is now in the nearby lymph nodes or muscles and is likely larger than those sizes outlined in the previous stages. Stage 4, also known as metastatic breast cancer, occurs when tumor cells have spread to other vital parts of the body, such as the bones or lungs.

Treatment depends upon the stage as well as age and overall health, and options may include surgery (i.e., lumpectomy or mastectomy), chemotherapy, radiation therapy, and hormonal and/or biological therapies.

Aviation medical examiners may issue a standard medical certificate if nonmetastatic breast cancer has been in remission for five years. If nonmetastatic breast cancer is less than five years since diagnosis, it falls under the Conditions Aviation Medical Examiners Can Issue (or CACI category in the United States). Any metastatic breast cancer less than five years since the completion of treatment requires a special-issuance certificate with annual follow-up reporting requirements. Regulators stress that your eligibility to be medically certified is determined by whether you’re actually safe to fly.

While it’s not as common, breast cancer can also affect men. Less than one percent of these cancers diagnosed in North America are discovered in males and typically involve surgery to remove the tumor and surrounding tissue.

The coverage of this complex topic is cursory and, by no means, complete. If you’re confronting a breast cancer diagnosis, thoroughly research your condition and options, and have a detailed discussion with your physician about the best way to move forward.

More Resources for ALPA Pilots

Resources are available for ALPA members in the United States and Canada who have aeromedical questions related to women's health issues.

U.S. Members

Email your women's health questions to Womens.Health@alpa.org, which is monitored by ALPA’s Aeromedical Committee.
U.S. ALPA pilots with general health and medical certification questions are encouraged to contact the Aviation Medicine Advisory Service (AMAS), ALPA’s Aeromedical Office, Monday–Friday 8:30 a.m. to 4:00 p.m., mountain time.
Additional information is available on the AMAS website, including related materials in its medical article database.