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necessary before recertification.
Charts are based on published survival statistics following treatment for a particular type of tumour and
may need revision if new therapy is introduced or the results of new studies become available. States can
develop their own charts as guidance for the more common tumours based on the local prognostic factors
and treatments used. Studies used to calculate the certification assessment figures may use overall, eventfree
or disease-free survival, and may include subjects unrepresentative of a pilot population (in terms of
age, sex, country of residence, lifestyle and other variables) and may include cases where curative
treatment has not been attempted. Individual case assessment therefore remains paramount.
ICAO Preliminary Unedited Version — October 2008 III-15-9
Charts are useful for tumours that have a prognosis that improves with time. Some malignancies have a
long median survival time of ten years or more but the rate of progression remains relatively constant
with time. In such a situation it may be possible to maintain certification for several years provided the
licence holder remains asymptomatic, is not on active treatment, and is reviewed regularly.
Tumour Markers
The relapse or active progression of certain tumours may be effectively followed by measuring tumour
markers. The most common example in pilots and controllers is adenocarcinoma of the prostate where
levels of Prostate Specific Antigen (PSA) can be tracked over a period of time.
Analysis of the tumour marker is very useful in determining the risk of relapse for an individual. It is
inappropriate to use a certification assessment chart where this alternative type of specific risk assessment
is possible.
REFERENCES
Janvrin S. Aeromedical certification after treatment for malignant disease. Dissertation.
London: Royal College of Physicians, Faculty of Occupational Medicine, 1995.
Evans S. Malignant disease. In: Rainford DJ, Gradwell DP (eds). Ernsting’s Aviation
Medicine, 4th edn. London: Hodder Arnold, 2006; 665-681.
Renehan AG, Egger M, Saunders MP, O’Dwyer ST. Impact on survival of intensive follow-up after
curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials.
BMJ 2002; 324: 813-6.
McArdle CS, McMillan DC, Hole DJ. Male gender adversely affects survival following surgery for
colorectal cancer. British Journal of Surgery 2003; 90: 711-715.
Goldberg RM, Fleming TR, Tangen CM et al. Surgery for recurrent colon cancer: strategies for
identifying respectable recurrence and success rates after resection. Ann Intern Med. 1998; 129: 27-35.
Gunderson LL, Sargent DJ, Tepper JE et al. Impact of Tand N substage on survival and
disease relapse in adjuvant rectal cancer: a pooled analysis. Int J Radiation Oncology Biol
Phys 2002;54(2): 386-396.
ICAO Preliminary Unedited Version — October 2008
Part III
Chapter 16. ADDITIONAL CONSIDERATIONS RELATED
TO AIR TRAFFIC CONTROL OFFICERS
Page
Introduction............................................................................................... III-16-1
Selection and supervision ......................................................................... III-16-1
Job-related stress ...................................................................................... III-16-1
Coronary heart disease............................................................................. III-16-2
Psychiatric disorders ................................................................................ III-16-2
Pregnancy .................................................................................................. III-16-2
Visual problems......................................................................................... III-16-2
Refractive errors ...................................................................................III-16-3
Presbyopia ............................................................................................III-16-3
Flexibility ................................................................................................... III-16-3
ICAO Preliminary Unedited Version — October 2008 III-16-1
INTRODUCTION
Air Traffic Control (ATC) has developed rapidly since the 1950s. From simple beginnings, it is now a
sophisticated system in which the controller is in charge but in which the machine (i.e. the computer) plays
an important part. The controller processes some of the information but a proportion is processed by the
machine. Technical equipment such as the radar screen, closed-circuit television or visual display unit
(VDU) presents information in a convenient and usable form but it is the controller who has the final
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Manual of Civil Aviation Medicine 2(113)
