Breast Cancer - SI

[My Flight Surgeon]

This is another in the series of condition for which the FAA grants Special Issuance certificates.

As with all other conditions, the FAA will want to review the entire medical record. Your AME or http://www.faaspecialissuance.com can assist you in preparing your records for submission.

The following is information regarding breast cancer.

Breast cancer is the most common type of cancer among women in this country (other than skin cancer). Each year, more than 211,000 American women learn they have this disease. Each year, about 1,700 men in this country learn they have breast cancer.

Risk Factors
No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.
Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found the following risk factors for breast cancer:

• Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause.
• Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
• Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
• Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells increases the risk of breast cancer.
• Gene changes: Changes in certain genes increase the risk of breast cancer. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes.
• Reproductive and menstrual history:
  • The older a woman is when she has her first child, the greater her chance of breast cancer.
  • Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.
  • Women who went through menopause after age 55 are at an increased risk of breast cancer.
  • Women who never had children are at an increased risk of breast cancer.
  • Women who take menopausal hormone therapy after menopause also appear to have an increased risk of breast cancer.
  • Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer.
• Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.
• Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.
• Breast density: Breast tissue may be dense or fatty. Older women whose mammograms show more dense tissue are at increased risk of breast cancer.
• Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.
• Being overweight after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.
• Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.
• Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.

Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.
But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.
Screening
Screening for breast cancer before there are symptoms can be important. Screening can help doctors find and treat cancer early. Treatment is more likely to work well when cancer is found early.
Your doctor may suggest the following screening tests for breast cancer:

• Screening mammogram
• Clinical breast examination
• Breast self examination

Symptoms
Common symptoms of breast cancer include:

• A change in how the breast or nipple feels
  • A lump or thickening in or near the breast or in the underarm area
  • Nipple tenderness
• A change in how the breast or nipple looks
  • A change in the size or shape of the breast
  • A nipple turned inward into the breast
  • The skin of the breast, areola, or nipple may be scaly, red, or swollen. It may have ridges or pitting so that it looks like the skin of an orange.
• Nipple discharge(fluid)

Early breast cancer usually does not cause pain. Still, a woman should see her health care provider about breast pain or any other symptom that does not go away. Most often, these symptoms are not due to cancer. Other health problems may also cause them. Any woman with these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.
Diagnosis
If you have a symptom or screening test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history. You may have a physical exam. Your doctor also may order a mammogram. These tests make pictures of tissues inside the breast. After the tests, your doctor may decide no other exams are needed. Your doctor may suggest that you have a follow-up exam later on. Or you may need to have a biopsy to look for cancer cells.
FAA Special Issuance
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations
(14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14CFR67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or Regional Flight Surgeon for the initial determination.

Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

• An Authorization granted by the FAA; and
• A current status report performed within 90 days that must include all the required follow-up items and studies as listed in the Authorization letter and that confirms absence of recurrent disease.

The Examiner must defer to the AMCD or Region if:

• There has been any recurrence of the cancer; or
• Any new treatment is initiated.

[SkyCougar]

Dr Forred,

You may already be aware of this, but there are extensive studies being done here in the San Francisco Bay Area, particularly here in Marin County on breast cancer. Apparently Marin has one of the highest rates of breast cancer in the nation, if not the world. That being said, the demographics of Marin are mostly white, educated, and affluent.

There are several hypotheses regarding this. Marin County has the highest per capita income in the U.S., which means most have health insurance, thus more frequent mammograms, and early and more frequent detection. Also this means that many of the women have advanced secondary education, and are professional women, which often coincides with delayed childbirth. Given our proximity to the wine country of Northern California, we also consume more alcohol. (mostly wine it seems).

It's really rather scary. I know so many women, younger than I (I am 46) who have been diagnosed. Many, after early detection and lumpectomies, have gone on to live full and healthy lives. On another related note, we also have a very high rate of prostate cancer among men here.