PHOTO: A CT scan shows the abdomen of a patient with lymphoma. Doctors are reviewing how often such scans should be used during diagnosis, treatment and follow-up of patients with cancer. Credit: University of Iowa.
Writing in the March 11 issue of the New England Journal of Medicine, University of Iowa Health Care radiologist Malik Juweid, M.D., said that cancer physicians and radiologists should do more to identify and eliminate medical imaging that is neither cost-effective nor beneficial to patients.
“We want to ensure that imaging used to diagnose and treat cancer is provided in a way that maximizes the benefit to the patient and minimizes both the cost and the potential risks posed by exposure to medical radiation,” said Juweid, who is a professor of radiology with the UI Roy J. and Lucille A. Carver College of Medicine.
To illustrate the point, Juweid and Julie Vose, M.D., a colleague at University of Nebraska, use their letter to the journal to highlight the case for eliminating post-treatment imaging for patients with nonbulky early-stage Hodgkin’s lymphoma.
This cancer, which often occurs in younger individuals, has a recurrence rate of less than 10 percent following the best standard of care. In addition, about 80 percent of recurrences of this form of cancer are discovered without the aid of imaging by the physician or the patients themselves.
This means that multiple use of post-therapy imaging provides “earlier” disease detection in only about 2 percent of treated patients, and there is no proven benefit from this early detection.
However, patients currently might receive as many as five to 10 CT scans and/or several PET/CT scans during the three to five years following treatment. This could amount to an accumulated radiation dose of over 50 millisieverts, which is the equivalent of 2,500 chest X-rays.
Juweid and Vose conclude that for this particular cancer, routine post-treatment imaging is not beneficial and should be reserved only for situations where it is needed to guide further treatment.
“This is one example of imaging being over-used without clear benefit to the patients,” Juweid said. “We believe that identifying and eliminating this type of unnecessary imaging will help us ensure patient safety and provide the most cost-effective, beneficial treatment.”
Juweid added that he is planning to work with professional organizations, such as the American Society of Clinical Oncology, and National Cancer Institute cooperative groups to find the best way to apply his findings.
STORY SOURCE: University of Iowa Health Care Media Relations, 200 Hawkins Drive, Room W319 GH, Iowa City, Iowa 52242-1009
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