Question on PET scans for Stage 1A people

Lisey

I've seen several ladies on here have ZERO node involvement and were 1a and suddenly within months were stage 4. My Oncologist says she doesn't do PET scans normally for people who have 0 nodes positive. I had 6 nodes tested, all negative in the SNB. She says my 1.7cm tumor has good margins and was a grade 2 overall. Hi ER+, low PR+, no HER2.

So is it standard not to do a PET scan on someone like me and just proceed with the surgeries and hormone therapies or chemo? She told me she requests PET scans if even just one lymph node is positive. She's willing to let me have a PET, but says usually it's pointless if I"m a IA.

Did any of you demand a PET, even when you had a clean MRI chest scan and full mastectomies and clean nodes?

I just wonder the percentage of ladies who seem to be 1A but it's in their liver without ever touching their lymphs nodes.

kcat2013

I didn't have a PET when diagnosed. I did have a full ct and a breast mri. These were ordered by my breast surgeon who felt the ct was prudent based on my age and her experience with younger women presenting with Mets at there initial diagnosis. Then when I had my first MO appointment I asked about a PET (because well meaning family and friends had been hounding me about getting one). MO said she didn't routinely do PETs on early stage patients if they had had other types of imaging already done. She felt the radiation exposure and the financial cost to the patient weren't worth it. That was fine with me. After seeing my MO for nearly 3 years now I've found her to be cautious with radiation involved imaging but will not hesitate to quickly order a scan if something concerns her. Last fall I went in for a check up, feeling good with no physical complaints, but my MO noted something that concerned her and I found myself having a PET the next day. Thankfully it was clear.

dtad

This is the 60 thousand dollar question. I'm being teated at a major NYC university based teaching hospital and they do not scan Stage 1. I understand that the first place the cancer cells will go is the sentinel nodes but it can metastasis through the bloodstream. IMO I would push for the scans if I was younger but at 63 I'm fine with not doing them unless I have symptoms. The theory is that early scans before symptoms does not improve survival rates. Good luck to all....

kbutler

My MO dosent routinely do scans. I did have a bone scan due to an abnormal X-ray of leg but thankfully all clear but no PET. She did order a colonoscopy right from the start. She said she does that for all her new patients just as a baseline.

SuC

Radiation exposure is an important fact to remember . Tests should only be done if they will benefit you. Evidence suggests that in 1A breast cancer, the risks of a PET would not outweigh the benefits

dtad

SuC....just wondering if there are any real studies on this subject. I know too many people who have progressed to Stage 4 within a year of diagnosis to believe this right now. I understand that this is the protocol presently but it just doesn't sit well with me. Good luck to all trying to navigate this disease.

Outfield

Regardless of whether or not it's the right medical decision, unless you are independently wealthy make sure your insurance covers a PET in this situation if you push to proceed. Mine did not cover the PET until I had pathology-proven node involvement.

Sjacobs146

I had a positive lymph node and did not have a PET scan. PET can only detect tumor's over a certain size (1 cm? Not sure). If your original tumor is small and there is no node involvement, i believe that the chances of having a detectable tumor are very low. Plus, when you do rads, you have a CT scan done and they do check that. I remember my RO saying that sometimes the CT scan showing tumors in lungs and liver, but mine was clear.

ChiSandy

Yup, the only scan I got was the pre-rads CT. I'm wary of cumulative radiation exposure--and even my DDS agreed to put me on a biennial X-ray schedule rather than annual now that I've been through rads. Wasn't happy about my ortho insisting on hand X-rays before doing my trigger thumb cortisone shot, but I guess he was trying to rule out fractures, OA or RA.

I guess with us Stage IA patients, it also depends on the grade, hormone-receptor and HER2 status. Makes more sense for those with aggressive cancers to get screening scans, while the benefits are outweighed by radiation exposure risk and high costs forthose of us with highly hormonal (especially progesterone) Luminal A tumors

dtad

Just the fact that the doc said the CAT scan could pick up tumors is so contradictory! What about those of us that had mastectomies and thus no radiation and CAT scans? Guess we are out of luck...

Sassa

If you look at everyone's diagnosis who posted on this thread, you are all ER/PR+, HER2- and either Grade 1 or 2. This is probably the basis that a PET scan is not being done as your cancers are not aggressive and your nodes are clear.

On the other hand, someone who is ER/PR-, HER2+, grade 3 and node negative will most likely have a PET scan as there is still a 25% chance that their very aggressive cancer metastasized through the blood and not through the lymphatic system.

I fit in the above category and I was scanned at diagnosis, every three months for the next 4 years, every six months for the next two years, and still have a yearly chest x ray .

dtad

Sassa...that was the first explanation that made any sense to me. Thank you!