Can cancer patients be evaluated annually with PET scanning?

Last Modified: January 19, 2003

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Question

Dear OncoLink "Ask The Experts,"
Why can't cancer patients be evaluated annually with PET scanning? If it is simply a matter of cost, can't a patient pay for one his/herself? It would be worth the cost for the peace of mind gained.  

Answer

Peeyush Bhargava, MD, Chief Fellow in the Department of Nuclear Medicine at the University of Pennsylvania, responds:

A PET scan is a diagnostic test (ordered to answer a specific question) as opposed to a screening test (ordered to try rule out a particular condition). PET scans are used in combination with other radiology procedures (MRI, CT, X-rays) to help make a diagnosis or follow a patient that has undergone treatment. They are not used as screening tests for cancer.

A good screening test needs to be safe, specific (positive only for the particular condition being screened), and make a difference in survival because it allows for early initiation of treatment. There are a number of reasons for a PET scan to have increased activity, not just cancer. If a PET scan was used to screen for cancer and increased activity was found, this may lead to undue anxiety and further unnecessary evaluations and procedures that could be harmful to the patient. Furthermore, PET scans are not helpful in all types of cancer. Thus it is not feasible to do a PET scan on everyone annually for cancer screening. Below are the indications for FDG-PET scans (both Medicare approved and non-Medicare approved). Typically a PET scan costs between US $ 1500 to 2500. We frequently encounter patients who pay from their own pockets to get a scan when their insurance company has denied. In future, the indications for PET scans are going to increase and the cost of getting a scan would decrease."

Medicare approved indications for FDG PET scan

PET Indications

Reason for Procedure

1.  Breast Cancer

*  Staging and restaging locoregional or metastatic recurrent disease
*  Monitoring tumor response to treatment for locally advanced and metastatic disease

2.  Lung Cancer (SPN)

*  To determine if the lung nodule if benign or malignant

3.  Lung Cancer (non-small cell)

*  Initial preoperative staging; lung cancer, non-small cell
*  Re-staging; lung cancer, non-small cell to determine recurrent and/ or distant disease after surgery, radiation therapy or chemotherapy

4.  Colorectal Cancer

*  Preoperative staging in high risk patients

*  Re-staging; colorectal cancer

*  Localize recurrent disease when CEA is elevated or rising

5.  Melanoma

*  Whole body staging in high risk patients

*  Restaging to evaluate recurrent and/ or distant sites of disease

6.  Lymphoma (Hodgkin's and non-Hodgkin's)

*  Diagnosis; lymphoma
*  Initial staging; lymphoma
*  Re-staging; lymphoma

7.  Head & Neck Cancer
(excluding CNS and thyroid)

*  Preoperative evaluation of regional nodal and distant metastasis

*  Assess presence of residual/ recurrent tumor

8.  Esophageal Cancer

*  Pre-surgical staging to evaluate regional nodal and distant metastasis

*  Restaging to evaluate recurrent and/ or distant disease

9.  Refractory Seizures

*  Metabolic brain imaging for pre-surgical evaluation of refractory seizures

10.  Myocardial Viability

*  Metabolic assessment for myocardial viability following inconclusive SPECT
*  Primary or initial diagnosis prior to revascularization

Non Medicare approved indications

  1. 1. Alzheimer's disease
    Evaluate early memory loss/ cognitive decline
    Differentiate Alzheimer's from other types of dementia
  2. 2. Ovarian Cancer
    Localize recurrent disease when tumor marker is elevated or rising
  3. 3. Thyroid Cancer
    Localize recurrent disease when thyroglobulin is rising and I - 131 scan is negative
  4. 4. Evaluation of Infection and inflammation
    Prosthesis infection, osteomyelitis
    Evaluation of FUO
  5. 5. Hepatocellular cancer
  6. 6. Brain cancer
  7. 7. Pancreatic cancer


News
Scan Can Find Small Cancers Undetected in Usual Evaluation

Jul 28, 2014 - Whole-body positron emission tomography-computed tomography can detect certain small cancers early in some patients in whom standard evaluation has failed to detect disease, making earlier treatment possible, according to a study published online Jan. 11 in the Archives of Neurology.



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