Breast cancer
What the FAA's documents say about breast cancer, in plain words, with the FAA's own words one press away.
Short version
The FAA's table sorts it into three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row ANon metastatic, with treatment completed five or more years ago. The table's condition for ISSUE is no recurrence, current problems or ongoing treatment, and it says continued hormone treatment (tamoxifen, aromatase inhibitor) is allowed. | Examiner issues | Examiner can issue |
| Row BNon metastatic, with treatment completed less than five years ago. | Worksheet | CACI |
| Row CAll others. The row names chemotherapy used, lymph node spread, metastatic disease, and Stage IA or higher. | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Breast cancer
- Row A · Examiner can issue
Non metastatic, with treatment completed five or more years ago. The table's condition for ISSUE is no recurrence, current problems or ongoing treatment, and it says continued hormone treatment (tamoxifen, aromatase inhibitor) is allowed. The table says ISSUE, and has the examiner summarize this history in Block 60.
Non metastatic – treatment completed 5 or more years ago … If no recurrence, current problems, or ongoing treatment: Continued hormone treatment is allowed (tamoxifen, aromatase inhibitor) … ISSUE Summarize this history in Block 60.
- Row B · CACI
Non metastatic, with treatment completed less than five years ago. The table sends the examiner to the CACI worksheet for breast cancer, and has the examiner annotate Block 60.
Non metastatic – treatment completed Less than 5 years ago … See CACI worksheet Follow the CACI – Breast Cancer Worksheet. Annotate Block 60.
- Row C · Special Issuance
All others. The row names chemotherapy used, lymph node spread, metastatic disease, and Stage IA or higher. The examiner defers and submits the information to the FAA for a possible Special Issuance.
All others Chemotherapy used Lymph node spread Metastatic disease Stage IA or higher … DEFER Submit the information to the FAA for a possible Special Issuance.
- A note on the table, 1
The worksheet's note says that if it has been five or more years since the pilot had any treatment (surgery or radiation) for this condition, with no history of metastatic disease and no reoccurrence, CACI is not required, and the examiner notes this in Block 60.
Notes: If it has been 5 or more years since the airman has had any treatment (surgery or radiation) for this condition, has no history of metastatic disease, and no reoccurrence, CACI is not required. Note this in Block 60.
The FAA pathways for breast cancer
- How this pathway works: Examiner can issueNo special pathwayRow A
- How this pathway works: CACIConditions AMEs Can IssueRow B
- How this pathway works: Special IssuanceAuthorization for Special Issuance of a Medical CertificateRow C
- How this pathway works: AASIAME Assisted Special IssuanceAfter the FAA decides
Which exam
Your step-by-step plan
Step 1: The progress note from the treating doctor or specialist
The note the examiner reviews, and what it verifies.Within 90 days before the examOne question insideA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.
It verifies
- Stable, with no spread or reoccurrence and no evidence of disease (NED)
- Radiation therapy, if any, completed
- Back to full, unrestricted activities, with no new treatment recommended at this time
After surgery
- Off all pain medication
- A full recovery
- Released by the surgeon
Show the FAA's words: The progress note from the treating doctor or specialist
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.
FAA source: CACI – Breast Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
Condition is stable with no spread or reoccurrence and no evidence of disease (NED).
FAA source: CACI – Breast Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
Radiation therapy (if any) is completed
FAA source: CACI – Breast Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
The airman is back to full, unrestricted activities and no new treatment is recommended at this time.
FAA source: CACI – Breast Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
If surgery has been performed, the airman is off all pain medication(s), has made a full recovery, and has been released by the surgeon.
FAA source: CACI – Breast Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
Step 2: The worksheet's criteria
Your current medications, the pathology, and what the worksheet does not accept.No current medication, or an approved medication that is well tolerated with no side effects.
Approved medications include
- Tamoxifen (Nolvadex)
- Aromatase inhibitors: anastrozole (Arimidex), letrozole (Femara) or exemestane (Aromasin)
The pathology showed
- Carcinoma in situ (Tis), Stage 0
- Ductal carcinoma in situ (DCIS)
- Lobular carcinoma in situ (LCIS)
- Paget disease of the breast (Tis)
No evidence of
- Not: Stage IA or higher
- Not: Invasive or metastatic disease
- Not: Chemotherapy for this condition at any time
Show the FAA's words: The worksheet's criteria
Current medication(s):
Approved medications include: tamoxifen (Nolvadex); Aromatase inhibitors: anastrozole (Arimidex), letrozole (Femara), or exemestane (Aromasin)
[ ] None; or
[ ] An approved medication that is being well tolerated with no side effects
FAA source: CACI – Breast Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The pathology showed: Carcinoma in Situ (Tis), Stage 0; Ductal Carcinoma in Situ (DCIS); Lobular Carcinoma in Situ (LCIS); Paget disease of the breast (Tis) [ ] Yes
FAA source: CACI – Breast Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
Any evidence of:
Stage IA or higher
Invasive or metastatic disease
Use of chemotherapy for this condition at any time [ ] No
FAA source: CACI – Breast Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The table says ISSUE, and has the examiner summarize this history in Block 60.
Row BWorksheetCACI
The table sends the examiner to the CACI worksheet for breast cancer, and has the examiner annotate Block 60.
Row CDefers to the FAASpecial Issuance
The examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Non metastatic, with treatment completed five or more years ago. The table's condition for ISSUE is no recurrence, current problems or ongoing treatment, and it says continued hormone treatment (tamoxifen, aromatase inhibitor) is allowed. The table says ISSUE, and has the examiner summarize this history in Block 60.
Non metastatic – treatment completed 5 or more years ago … If no recurrence, current problems, or ongoing treatment: Continued hormone treatment is allowed (tamoxifen, aromatase inhibitor) … ISSUE Summarize this history in Block 60.
- Row B · CACI
Non metastatic, with treatment completed less than five years ago. The table sends the examiner to the CACI worksheet for breast cancer, and has the examiner annotate Block 60.
Non metastatic – treatment completed Less than 5 years ago … See CACI worksheet Follow the CACI – Breast Cancer Worksheet. Annotate Block 60.
- Row C · Special Issuance
All others. The row names chemotherapy used, lymph node spread, metastatic disease, and Stage IA or higher. The examiner defers and submits the information to the FAA for a possible Special Issuance.
All others Chemotherapy used Lymph node spread Metastatic disease Stage IA or higher … DEFER Submit the information to the FAA for a possible Special Issuance.
The CACI worksheet's criteria
Progress note
It verifies
- Stable, with no spread or reoccurrence and no evidence of disease (NED)
- Radiation therapy, if any, completed
- Back to full, unrestricted activities, with no new treatment recommended at this time
After surgery
- Off all pain medication
- A full recovery
- Released by the surgeon
Your current medications for breast cancer
Approved medications include
- Tamoxifen (Nolvadex)
- Aromatase inhibitors: anastrozole (Arimidex), letrozole (Femara) or exemestane (Aromasin)
The pathology showed
- Carcinoma in situ (Tis), Stage 0
- Ductal carcinoma in situ (DCIS)
- Lobular carcinoma in situ (LCIS)
- Paget disease of the breast (Tis)
No evidence of
- Not: Stage IA or higher
- Not: Invasive or metastatic disease
- Not: Chemotherapy for this condition at any time
Show the FAA's words: the CACI worksheet's criteria for Breast cancer
- The pathology the worksheet lists
FAA criterion: the worksheet asks whether the pathology showed carcinoma in situ (Tis), Stage 0; ductal carcinoma in situ (DCIS); lobular carcinoma in situ (LCIS); Paget disease of the breast (Tis). The acceptable answer on it is Yes.
The pathology showed: Carcinoma in Situ (Tis), Stage 0; Ductal Carcinoma in Situ (DCIS); Lobular Carcinoma in Situ (LCIS); Paget disease of the breast (Tis) [ ] Yes
- Stable, with no spread or reoccurrence and no evidence of disease
FAA criterion: the progress note verifies the condition is stable with no spread or reoccurrence and no evidence of disease (NED).
The treating physician’s current, detailed Clinical Progress Note verifies: … Condition is stable with no spread or reoccurrence and no evidence of disease (NED).
- Radiation therapy, if any, completed
FAA criterion: the progress note verifies that radiation therapy (if any) is completed.
The treating physician’s current, detailed Clinical Progress Note verifies: … Radiation therapy (if any) is completed
- If surgery has been performed, off all pain medication, a full recovery and released by the surgeon
FAA criterion, where surgery has been performed: the progress note verifies the pilot is off all pain medication, has made a full recovery, and has been released by the surgeon.
The treating physician’s current, detailed Clinical Progress Note verifies: … If surgery has been performed, the airman is off all pain medication(s), has made a full recovery, and has been released by the surgeon.
- Back to full, unrestricted activities, with no new treatment recommended
FAA criterion: the progress note verifies the pilot is back to full, unrestricted activities and no new treatment is recommended at this time.
The treating physician’s current, detailed Clinical Progress Note verifies: … The airman is back to full, unrestricted activities and no new treatment is recommended at this time.
- No evidence of Stage IA or higher, invasive or metastatic disease, or chemotherapy
FAA criterion: the worksheet asks whether there is any evidence of Stage IA or higher, invasive or metastatic disease, or use of chemotherapy for this condition at any time, and the acceptable answer on it is No.
Any evidence of: … Stage IA or higher … Invasive or metastatic disease … Use of chemotherapy for this condition at any time [ ] No
- Current medications
FAA criterion: under current medications the worksheet's boxes are None, or an approved medication that is being well tolerated with no side effects. The worksheet says approved medications include tamoxifen (Nolvadex) and the aromatase inhibitors anastrozole (Arimidex), letrozole (Femara) or exemestane (Aromasin).
Current medication(s): … Approved medications include: tamoxifen (Nolvadex); Aromatase inhibitors: anastrozole (Arimidex), letrozole (Femara), or exemestane (Aromasin) … [ ] None; or … [ ] An approved medication that is being well tolerated with no side effects
If the examiner defersSpecial Issuance
The table's last row is All others. It names chemotherapy used, lymph node spread, metastatic disease, and Stage IA or higher, and the table marks it DEFER.
What the FAA lists to send
- Item 1. A status report or treatment records from the treating oncologist that provide the initial staging, the disease course including any recurrences, the locations of metastatic disease (if any), the treatments used, how long the condition has been stable, and whether any upcoming treatment change is planned or expected, with the prognosis.
- Item 2. A medication list, with the dates started and stopped, and a description of side effects, if any.
- Item 3. Operative notes and the discharge summary, where there were any.
- Item 4. Copies of lab results, including pathology reports and tumor markers, where the treating physician has already done them.
- Item 5. Copies of imaging such as mammogram, MRI or CT, or PET scan reports that have already been performed. The table says in some cases the actual CDs will be required in DICOM format for FAA review.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's last row is All others. It names chemotherapy used, lymph node spread, metastatic disease, and Stage IA or higher, and the table marks it DEFER.
All others Chemotherapy used Lymph node spread Metastatic disease Stage IA or higher … DEFER Submit the information to the FAA for a possible Special Issuance.
What the FAA lists to send
- Item 1
A status report or treatment records from the treating oncologist that provide the initial staging, the disease course including any recurrences, the locations of metastatic disease (if any), the treatments used, how long the condition has been stable, and whether any upcoming treatment change is planned or expected, with the prognosis.
Submit the following to the FAA for review: … Status report or treatment records from treating oncologist that provides the following information: … Initial staging, … Disease course including recurrence(s), … Location(s) of metastatic disease (if any), … Treatments used, … How long the condition has been stable, … If any upcoming treatment change is planned or expected and prognosis;
- Item 2
A medication list, with the dates started and stopped, and a description of side effects, if any.
Medication list. Dates started and stopped. … Description of side effects, if any;
- Item 3
Operative notes and the discharge summary, where there were any.
Operative notes and discharge summary (if applicable);
- Item 4
Copies of lab results, including pathology reports and tumor markers, where the treating physician has already done them.
Copies of lab including pathology reports, tumor markers (if already performed by treating physician);
- Item 5
Copies of imaging such as mammogram, MRI or CT, or PET scan reports that have already been performed. The table says in some cases the actual CDs will be required in DICOM format for FAA review.
Copies of imaging such as mammogram, MRI/CT or PET scan reports that have already been performed. (In some cases, the actual CDs will be required in DICOM format for FAA review).
After the FAA decides
AASIThe AASI sheet for breast cancer says an FAA physician makes the first decision and grants the Authorization. After that, the sheet says the examiner may reissue under the Authorization when the pilot provides what it lists. The table says follow-up issuance will be per the pilot's authorization letter.
Show the FAA's words: after the FAA decides
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401 . … Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
DEFER Submit the information to the FAA for a possible Special Issuance. Follow up Issuance Will be per the airman’s authorization letter.
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.
Under an FAA Authorization, the AASI sheet lists what the pilot provides for the examiner to reissue. That is the Authorization itself, 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.
Show the FAA's words: at later exams
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.
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI sheet's list for a reissue begins with the Authorization the FAA granted.
Show the FAA's words: The Authorization granted by the FAA
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 from the last 90 days
The AASI sheet asks for 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.
Show the FAA's words: A current status report from the last 90 days
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.
What the Authorization letter comes with
The AASI sheet says the Authorization letter comes with attachments that specify the information the treating physicians must provide for the reissue determination.
Show the FAA's words: What the Authorization letter comes with
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.
When the examiner defers a reissue
The AASI sheet says the examiner must defer to the AMCD or Region if there has been any recurrence of the cancer, or any new treatment is initiated.
Show the FAA's words: When the examiner defers a reissue
The Examiner must defer to the AMCD or Region if: … There has been any recurrence of the cancer; or … Any new treatment is initiated.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Continued hormone treatment is allowed
In the row for non metastatic cancer with treatment completed five or more years ago, the table marks ISSUE if there is no recurrence, current problems or ongoing treatment. The same row allows continued hormone treatment (tamoxifen, aromatase inhibitor).
Show the FAA's words: good to know, 2
Non metastatic – treatment completed 5 or more years ago … If no recurrence, current problems, or ongoing treatment: Continued hormone treatment is allowed (tamoxifen, aromatase inhibitor) … ISSUE Summarize this history in Block 60.
Stage IA or chemotherapy at any time
The worksheet's criteria include no evidence of Stage IA or higher, invasive or metastatic disease, or chemotherapy for this condition at any time. The table's All others row, marked DEFER, names chemotherapy used, lymph node spread, metastatic disease, and Stage IA or higher.
Show the FAA's words: good to know, 3
Any evidence of: … Stage IA or higher … Invasive or metastatic disease … Use of chemotherapy for this condition at any time [ ] No
All others Chemotherapy used Lymph node spread Metastatic disease Stage IA or higher … DEFER Submit the information to the FAA for a possible Special Issuance.
The first AASI is deferred to the FAA
For a first-time AASI application for this condition, with all the medical information needed for a determination, the AASI sheet says the examiner must defer and submit all of it to the AMCD or RFS for the initial determination.
Show the FAA's words: good to know, 4
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Open to print: CACI – Breast Cancer Worksheet, a PDF at the FAA, in a new tab
- Breast Cancer Disposition TableOpen to print: Breast Cancer Disposition Table, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance
- Open to print: AASI – Breast Cancer, a page at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Medication guidance
Medications Crosscheck lists as taken for breast cancer, each with its own page on what published FAA guidance says about it.
- Approved medication on the FAA's breast cancer worksheet (aromatase inhibitor)
- Approved medication on the FAA's breast cancer worksheet (aromatase inhibitor)
- Approved medication on the FAA's breast cancer worksheet (aromatase inhibitor)
- Approved medication on the FAA's breast cancer worksheet
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.