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FAA CACI Breast Cancer Worksheet for AMEs

The FAA's CACI worksheet for breast cancer lets the AME issue for in situ disease only: stage 0 carcinoma in situ, DCIS, LCIS or Paget disease of the breast (Tis). The treating physician's note must show no evidence of disease, completed radiation if any, full recovery from surgery and no new treatment recommended. The worksheet was updated 04/27/2022.

Who completes it

The AME completes the worksheet from a current, detailed Clinical Progress Note written after a clinic visit with the treating physician or specialist, such as an oncologist or surgeon, no more than 90 days before the AME exam.

Submitting and payment

How to submit it
If all criteria are met, the AME issues, notes 'CACI qualified breast cancer' in Block 60 and keeps the documents on file without sending them to the FAA; otherwise the AME defers and submits them.
Who pays
The FAA does not set AME examination fees; the pilot pays the examiner, and the FAA recommends the usual and customary local fee for similar services.

Good to know

  • Any evidence of stage IA or higher disease, invasive or metastatic cancer, or chemotherapy for this condition at any time takes the pilot out of the CACI.
  • Approved medications are tamoxifen and the aromatase inhibitors anastrozole, letrozole or exemestane, if well tolerated with no side effects.
  • If 5 or more years have passed since surgery or radiation, with no metastatic disease or recurrence, CACI is not required; the AME notes this in Block 60.
  • After surgery the pilot must be off all pain medication, fully recovered, released by the surgeon and back to full, unrestricted activities.

Get the official form

Download the current version from the source each time; forms change without notice.

CACI – Breast Cancer Worksheet

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Which breast cancers qualify for the FAA CACI?

Only in situ disease on pathology: carcinoma in situ stage 0, ductal carcinoma in situ, lobular carcinoma in situ or Paget disease of the breast (Tis). Stage IA or higher, invasive or metastatic disease, or any chemotherapy for the condition means the AME must defer to the FAA.

Can a pilot taking tamoxifen get an FAA medical?

Under the breast cancer CACI, tamoxifen and the aromatase inhibitors anastrozole, letrozole and exemestane are approved if well tolerated with no side effects. The treating physician's current note should name the drug and confirm how it is tolerated so the AME can check that item.