AINsight: Navigating Screening Medical Testing for Pilots

Pilots are often faced with the decision of whether to embark on age-appropriate medical screenings. These tests are sometimes recommended by primary care physicians, or they are fresh in the pilot’s mind after a deluge of media advertising.

Let me begin by stating my support for medical screening tests, which have overall provided a good service and have reduced the morbidity and mortality rates of many illnesses, including cancers.

At the same time, I completely understand the trepidation that pilots feel about potentially opening the proverbial “can of worms” with the FAA. They worry that getting a screening test may turn into another “no good deed goes unpunished” situation. They do a recommended test, a goat rope ensues, and a period of grounding may result.

All that said, it's no different than with mechanical systems of an airplane: the sooner a problem is diagnosed, the sooner it can be taken care of. More importantly, the problem can be taken care of before it causes more serious and potentially life-threatening consequences. Pay me now or pay me later.

Common screening tests recommended at various ages include those for a multitude of the more common cancers: prostate, breast, cervix, and colon. We hear about screening for these conditions ad nauseam.

Pilots are sometimes reluctant to get screening for some of these cancers, for the reasons noted above. However, when cancers are found early, before they can metastasize (spread to other locations in the body), they are much easier to deal with.

When non-metastatic colon, breast, or prostate cancers are detected, the treatments are less severe and invasive. For the pilot, the period of grounding may not be excessive when a cancer is detected early.

In fact, many cancers can be followed under the Conditions the AME Can Issue (CACI) program. The AME gathers the appropriate data, issues the medical certificate, and simply keeps the data on file. The data does not have to be submitted to the FAA, which eliminates a waiting period for the FAA to review that data.

Once a cancer metastasizes, everything changes. First of all, the pilot is then literally in a battle—one that their life may very well depend on. Waging that battle is neither fun nor something typically resolved in a short period of time.

If a pilot has survived treatment for a metastatic cancer, FAA medical recertification may be possible. It is a much more complicated process than for a non-metastatic cancer, but if the pilot survives the illness, certification through the special issuance process may be attainable. But the period of grounding is often extensive.

A type of cancer that doesn’t get enough attention is oral cancer. This is one of the reasons why I hound pilots to continue with routine ongoing dental exams. During those visits, a thorough oral cancer screening is done.

This type of cancer can be very aggressive and also has the potential to metastasize. Therefore, while going to the dentist is important for your teeth, it serves other medical screening purposes, too.

Screening blood testing is very simple to do, is minimally invasive, and provides a wealth of information. Monitoring red and white blood cell counts may help diagnose or rule out cancer, and lipid testing is an important screen to assess cardiovascular risk, as examples. Thyroid screening, like oral cancer, often does not get enough press, but its importance cannot be overstated.

In my last blog, the screening electrocardiogram (ECG) was discussed. It is required for first-class medical certificates, initially at age 35 and then annually after 40. I discussed how it may help diagnose arrhythmias (irregular heartbeats) and discover various heart conduction anomalies (bundle branch blocks).

This test, while falling out of favor in primary care screening, can be a lifesaver. I had a situation not long ago wherein a pilot had a new bundle branch block on their screening ECG.

The requisite cardiology consultation incidentally discovered a very rare cardiac tumor. Fortunately, this tumor was excised before it could either spread or break loose from its small attachment stalk and cause a potentially fatal stroke. This is an unusual “save,” but it does point out that even a screening ECG may be of significant benefit. The pilot was back in the cockpit in a few months.

There are many other routine and readily available medical screening tests, but you get the idea. I am in full support of proven medically-recommended tests.

Buyer beware: there are many solicitations for medical screening tests that are, as of yet, of lesser-proven benefit. These are, to no surprise, typically expensive and not covered by insurance.

They range from esoteric blood testing to full body imaging, for example. The marketing is effective, as people are sometimes doing these tests while avoiding medically-proven screenings, which are usually covered by insurance.

Are these tests something to avoid? Do they cause harm? While they may not yet be evidence-based or tried-and-true technology, as long as the person obtaining such testing is aware of the risks and benefits of doing so, I have no complaints with the zeal to assess health. There are potential false-positive results associated with these and even the more well-established tests.

If a person can stomach the idea of a potentially time-consuming process to rule out a false positive, all while being concerned about the initial testing result, then all I can say is go for it. If that person winds up having a true-positive result that might not have been found with conventional testing modalities, they will feel grateful for the marketing that brought them to the technology that they purchased.

Once again, each person must evaluate their own risk tolerance and the potential risks and benefits of any medical modality that they are undertaking.

One condition that is important but not yet part of routine screening recommendations is obstructive sleep apnea. When clinically indicated, assessing and treating sleep apnea—if formally diagnosed—has vastly improved our understanding of its contributions to arrhythmias such as atrial fibrillation, diabetes, mental health, fatigue, and numerous other conditions that adversely affect health.

Screening medical testing may find the cancer before it spreads. Medical testing may uncover a cardiovascular problem before it causes a heart attack. Medical testing, for the most part, has reduced morbidity and mortality in the overall population.

Pilots sometimes tell me that they’ll get testing after they retire, when it will not affect their FAA medical status. That may be too late and is a suboptimal attitude when considering the ramifications to the pilot’s family of delaying the assessment and treatment of potentially preventable illnesses or death.

Remember, it is easier to keep flying if you are still alive.