Pet CT in our country has become a house hold name when cancer is diagnosed or suspected. It is ironic that there is so much reservation about having a mammogram done since it involves some exposure to radiation, but when a cancer is diagnosed there is so much fear that no one questions about the radiation involved with Pet CT scans. Pet CT is overused in breast cancer in our country.
PET CT scan is a procedure in which a small amount of radioactive glucose (sugar) is injected into a vein. Then a scanner is used to make detailed and computerized pictures of areas inside the body where the glucose is taken up. The pictures can be used to find cancer cells in the body, because cancer cells often take up more glucose than normal cells.
It usually difficult to find lesions that a very small (ie less than 1 cms) on a Pet CT scan because of lack of spatial resolution.
Stage 1 and 2 breast cancers are considered as early breast cancer. The probability of spread is so low that a Pet CT scan to look for spread is not required.
Pet CT scan sometimes cause confusion. As the radioactive glucose accumulates in tissues where there is higher metabolism, there can be a false alarm if there is some inflammation or infection as this tissue also will pick up the tracer and can be mistaken for a cancer. This might lead to anxiety, more tests to clear the confusion, delay treatment unnecessarily and adds to cost as well.
The radiotracer gives very small levels of radiation, which go away very quickly. But for the rest of the day patients should be instructed not to have close contact with pregnant women, babies or young children.
It is particularly useful to plan treatment when the cancer is locally advanced. The probability of having metastatic disease is higher in locally advanced breast cancer. If there is evidence of cancer in other parts of the body (ie) liver, lung or brain, then the treatment is planned differently.
Pet Ct scans usually don’t help people who have completed cancer treatments and don’t have symptoms. For most breast cancer patients, these tests don’t help patients live longer or with a better quality of life. Pet Ct scans done without a good reason can lead to anxiety, false alarms, wrong diagnoses, unnecessary procedures, and more costs. Also frequent scans lead to high levels of radiation. The effects of radiation add up over one’s lifetime. It is more useful in clinical situations where metastatic disease is suspected. FDG PET has high accuracy for the diagnosis of recurrent or metastatic breast cancer. Pet Ct scan will be recommended for patients treated for advanced cancer to find out the response to the treatment.
Pet Ct scan costs close to 20,000 to 25,000 rupees. Our society assumes that any technology with a high price tag has value, but the latest technology is not necessarily the required technology for all patients. The NCCN Breast Cancer Panel also discourages the use of PET or PET/CT scanning in the work-up of staging early breast cancer.
http://snmmi.files.cms-plus.com/images/NCCN%20Narrative%20Summary%20Feb%202016.pdf
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What is a PET CT scan?
PET CT scan is a procedure in which a small amount of radioactive glucose (sugar) is injected into a vein. Then a scanner is used to make detailed and computerized pictures of areas inside the body where the glucose is taken up. The pictures can be used to find cancer cells in the body, because cancer cells often take up more glucose than normal cells.
It usually difficult to find lesions that a very small (ie less than 1 cms) on a Pet CT scan because of lack of spatial resolution.
Is it necessary in early breast cancer?
Stage 1 and 2 breast cancers are considered as early breast cancer. The probability of spread is so low that a Pet CT scan to look for spread is not required.
Pet CT scan sometimes cause confusion. As the radioactive glucose accumulates in tissues where there is higher metabolism, there can be a false alarm if there is some inflammation or infection as this tissue also will pick up the tracer and can be mistaken for a cancer. This might lead to anxiety, more tests to clear the confusion, delay treatment unnecessarily and adds to cost as well.
The radiotracer gives very small levels of radiation, which go away very quickly. But for the rest of the day patients should be instructed not to have close contact with pregnant women, babies or young children.
So when is Pet Ct useful?
It is particularly useful to plan treatment when the cancer is locally advanced. The probability of having metastatic disease is higher in locally advanced breast cancer. If there is evidence of cancer in other parts of the body (ie) liver, lung or brain, then the treatment is planned differently.
What is the role of Pet Ct scan after treatment?
Pet Ct scans usually don’t help people who have completed cancer treatments and don’t have symptoms. For most breast cancer patients, these tests don’t help patients live longer or with a better quality of life. Pet Ct scans done without a good reason can lead to anxiety, false alarms, wrong diagnoses, unnecessary procedures, and more costs. Also frequent scans lead to high levels of radiation. The effects of radiation add up over one’s lifetime. It is more useful in clinical situations where metastatic disease is suspected. FDG PET has high accuracy for the diagnosis of recurrent or metastatic breast cancer. Pet Ct scan will be recommended for patients treated for advanced cancer to find out the response to the treatment.
Conclusion
Pet Ct scan costs close to 20,000 to 25,000 rupees. Our society assumes that any technology with a high price tag has value, but the latest technology is not necessarily the required technology for all patients. The NCCN Breast Cancer Panel also discourages the use of PET or PET/CT scanning in the work-up of staging early breast cancer.
Reference
http://snmmi.files.cms-plus.com/images/NCCN%20Narrative%20Summary%20Feb%202016.pdf
Mail us: chennaibreastcenter@gmail.com
