Current Lung Cancer Management and Return-to-Duty Considerations for Military Aircrew

Area of Science:

• Aerospace Medicine
• Oncology
• Public Health

Background:

• Lung cancer is a leading cause of cancer mortality globally and in Singaporean males.
• Incidence is declining due to reduced smoking, but patient outcomes are improving with advances in diagnostics and treatment.
• The first diagnosed case of aircrew lung cancer in the Republic of Singapore Air Force was reviewed in October 2024.

Purpose of the Study:

• To review aeromedically relevant updates on lung cancer assessment and management.
• To focus on return-to-flying considerations for military aircrew.
• To discuss future implications of lung cancer management for aviation personnel.

Main Methods:

• A narrative review of current literature on lung cancer management.
• Focus on advancements in diagnostics, therapies, and surgical techniques.
• Consideration of aeromedical standards and return-to-duty protocols.

Main Results:

• New therapies like immune checkpoint inhibitors and targeted treatments necessitate molecular diagnostics.
• Advances in radiation therapy, minimally invasive surgery, screening, and smoking cessation improve survival.
• Treatment side effects and potential late recurrence may limit safe return to aviation duties.

Conclusions:

• Waiver policies for early-stage lung cancer may need updating.
• Individualized aeromedical decisions require assessment of histology, treatment response, side effects, and recurrence risk.
• Evolving treatments challenge flight surgeons to keep aircrew informed about management options and fitness for duty.