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

Lung cancer is the leading cause of cancer-related deaths worldwide and among Singaporean males. While incidence in Singapore has declined due to reductions in smoking, patient outcomes have also improved because of advances in our understanding of cancer biology, lung cancer screening, and refinements in treatment. In the Republic of Singapore Air Force, its first diagnosed case of aircrew lung cancer was presented and deliberated at its Aeromedical Board in October 2024.

A narrative review was conducted to summarize aeromedically relevant updates on the current assessment and management of lung cancer, with a focus on return-to-flying considerations as well as future implications for military aircrew.

Developments in immune checkpoint inhibitors and targeted therapies has driven the requirement for molecular and immunohistochemical diagnosis in lung cancer management. Together with advances in radiation therapy and minimally invasive surgery techniques, lung cancer screening and smoking cessation have significantly improved disease mortality and morbidity. Despite this, a safe return to aviation duties may remain limited by treatment side effects and the possibility of late disease recurrence.

While there is an opportunity to update current waiver policies for resectable early-stage lung cancer, additional considerations are still required to individualize aeromedical decision-making based on underlying cancer histology, treatment response, side effects of newer therapies, and risk of cancer recurrence after remission. In preserving their fitness for duty, emerging evidence and the continuously evolving treatment landscape will continue to challenge flight surgeons to keep aircrew well-informed of their management options. Low JW. Current lung cancer management and return-to-duty considerations for military aircrew. Aerosp Med Hum Perform. 2026; 97(3):185-193.