If you have been treated for lymphoma, are in complete remission and have no symptoms, lymphoma experts say there is no reason to have routinely scheduled computed tomography (CT) scan or positron-emission tomography (PET) scans for check-ups.
The tests could expose patients to low-dose radiation from the medical imaging. Patients might be at risk for other types of cancer including lung or breast cancer and the unnecessary testing drives up health care costs.
But every year, excessive medical imaging such as CT and PET scans are ordered by physicians – often at the insistence of patients
In the March 11 issue of the New England Journal of Medicine, a University of Nebraska Medical Center oncologist, Julie Vose, M.D., and co-author Malik Juweid, M.D., published their recommendations in a letter to the editor. The letter related to a recent journal article that outlined the amount of radiation received with the scans.
Though Drs. Vose and Juweid wrote about scans in early-stage Hodgkin’s lymphoma, the standard of care advice also applies to non-Hodgkin’s lymphoma. Dr. Juweid is a professor of radiology at the University of Iowa.
“Recurrent Hodgkin lymphoma is detected in patients with localized disease with the use of scans in only about 2 percent of patients, with no proven long-term benefit,” said Dr. Vose, Neumann M. and Mildred E. Harris Professorial Chair and chief of the UNMC division of hematology/oncology. “Yet these patients, who are usually young, generally undergo five to 10 CT scans of the chest, abdomen, or pelvis, often in addition to several PET–CTs, within the initial three to five years of their treatment.
“Eliminating these scans will reduce unnecessary exposure to radiation and unnecessary health care costs,” she said.
More than 80 percent of the recurrences are first identified by the patient or the examining physician without the use of imaging.
Normally, lymphoma patients receive scans at diagnosis, during their treatment and at the end of their treatment. If the patient has no signs of lymphoma after therapy is completed, a standard of care is to carefully examine the patient and talk to them about symptoms.
In addition, routine blood tests and a yearly chest radiograph are done if indicated. Dr. Vose said if a patient asks, the policy is not to do a scan unless there are symptoms or an exam gives cause for concern. “In patients at low risk of recurrence, reducing the exposure to excessive radiation is an important goal,” she said.
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