Bladder Cancer and the FAA
March 1, 2018
A couple of years ago, one of our pilots strolled off the tarmac and ducked behind a tree to relieve himself. Much to his horror he produced a bright red urine stream. He had previously felt great. He had no pain. It was a bolt out of the blue. I promptly received a call from a very agitated airman and arranged for him to see the appropriate specialist pronto.
An expedited visit to the urologist revealed that he was one of some 68,000 adults in the United States who are diagnosed with bladder cancer every year.
Fortunately for him the tumor was found in its early stages. It was localized and easily removed by cystoscopy. He was then treated with chemotherapy by placing anti-tumor drugs directly into the bladder. This was done repeatedly over several months to make sure there was no recurrence of the malignancy. He has been free of tumor for several years now and is doing great.
Of course not everyone is as fortunate and sometimes the tumor can give little warning until it has spread outside the bladder. Sometimes the blood cells in the urine are so few that they are only seen on microscopic analysis. Although the tumor can sometimes be painless especially in the early stages, pain in the back or pelvis, frequent and/or painful urination can occur.
There are a number of factors that can increase your risk for bladder cancer. Some of them can be controlled. Some cannot. Older white males are at greater risk...can't do much about that. Smoking definitely increases you risk. Can do something about that!
Chemicals linked to bladder cancer risk include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products. So if you have had any of these exposures at work you might want to have your doc check a urine sample.
A family history of bladder cancer should also make you a bit wary. Ironically, treatments for other cancers with radiation or a cancer drug called cyclophosphamide can increase your risk of subsequent bladder cancer. Recurrent bladder infections also increase your risk.
How a cancer of the bladder will affect your flight status depends on several things. If you had non metastatic (not spread out of the bladder) disease and completed treatment five or more years ago with no recurrence, your AME can issue then and there. It would be a good idea to bring your medical records, however. If you have had non-metastatic disease treated less than five years ago, you may be eligible for a CACI1 issuance. In other words your AME can issue a medical if you condition is stable without symptoms, no tumor outside the bladder, treatment completed.
The FAA will allow a couple of what are considered maintenance treatments with the drugs BCG or mitomycin, to prevent recurrence.
If you don't fulfill all of these criteria you will have to go through the deferral process for a Special Issuance. Your treatment records will be reviewed by the FAA's Medical Division. This will take a few weeks but if you give them all the information they request and you are in any semblance of good shape, you'll probably get your medical certificate directly.
Bottom line, if you want to reduce your risk for bladder cancer don't smoke. Don't play with arsenic or lead and if you're an old white guy, get a urinalysis once a year!
Fly wisely. See you next month.