Anyone else not having any scans?
Just curious if anyone has never had a scan - CT, PET or MRI - during or after diagnosis. The only scan I've ever been offered has been the bone scan prior to chemo (and then another one shortly after completing chemo). I met with my MO yesterday; am 13 months PFC and not taking Tamoxifen. When I asked if there would ever be a scan in my future she said no - not unless I develop symptoms of mets. I complained about the pain in my shoulder enough yesterday to warrant an x-ray of the area, though. Just curious - so many here seem to be having CTs, PETs and/or MRIs as routine of care, and I worry that I'm being "left out" or need to advocate stronger. Thanks.
Comments
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It depends on your cancer centre or oncologist. There are many who believe that, if other diagnostic tests do not indicate metastasis, then a CT/MRI/PET scan isn't warranted. CT/MRI's can "light up" for reasons other than cancer and, because of this, some oncologists don't routinely use them. PET scans are expensive and not all insurance plans will cover them, plus not every cancer centre has access to a PET machine.
My diagnostic process included mammogram, ultrasound, core biopsy, bone scan, abdominal ultrasound, blood tests, CT scan (for radiation) and a chest xray. When the last five tests came back "negative", my oncologist decided (and I concurred), that an MRI wasn't warranted. Not every one would feel that way. And, I will not be, routinely, receiving scans in the future as a matter-of-course; only if I have troubling symptoms that need to be investigated. And I'm okay with this. If I develop metastasis, then an MRI/PET scan - no matter how early - is not going to stop the process; merely diagnose it. But that's just me.
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I tend to agree with your thoughts, Selena - a scan isn't going to prevent mets, just going to confirm it one way or the other. I just see so many posts from others who seem to have scans as a routine matter of course, and my docs don't seem to do that. Nothing is a guarantee, I know...
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Mine are not advising any future scans either and it just seems weird, I am wth you on that Nancy.
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Nancy...when I was first diagnosed my surgeon did MRI and PET scans since I had posiive nodes but my MO doesn't do scans either, she monitors with blood tests for tumor markers and chest xrays. She said if I developed any thickening around my scars or swollen nodes she would do ultrasounds or further diagnostics. After being watched so closely and monitored with exams and blood tests each week during chemo it was so hard to go to seeing my MO only every 6 months when chemo was over...makes me nervous...Maureen
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No scans or x-rays ever.
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I had an xray of my lungs before my second lx and SLN biopsy. Seemed standard procedure between my BS and MO. Now only one xray of foot and ankle for problems related to joints and AI med, not because anyone expected cancer there.
Though it was hard to not want extra scans, I never asked for them because I knew the risks and it wasn't indicated for my stage. The xray of my foot showed two asymptomatic bone spurs. Imagine what a whole body scan would show in my near 60 year old body. Probably a bunch of stuff unrelated to cancer.
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No post treatment scans of any kind except regular mamms (and one us due to seroma) unless I have symptoms. Not sure how I feel about that.
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Ditto here, no scans post treatment except for the mammo and MRI (I am a uni). My onc says she will scan if I have symptoms. She ordered a spine MRI once when I was having excrutiating bone pain...but we identified it as from the Tamoxifen.
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Only yearly mammograms (which I schedule myself so they are not even "diagnostic" mammograms)
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I get a CT and bone scan once a year. I did have 2 positive nodes though. Plus, my MO is very proactive and insurance apparently covers it all, so why not (just kidding, I know about the radiation risk). I get very anxious before the scans, but it is reassurring to hear NED. Anyway, I completely trust my MO, who is a distinguished professor at an NCI hospital.
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Yorkiemom, can't you get MRIs instead of CT scans. A doctor and several nurses have told me they give off a lot of radiation.
When I was a child we were all exposed to the x-rays in those machines they had in the 1940s where you got your feet x-rayed when buying shoes. We would go and play on the machines whenever we went shopping with my Mom. Thank Goodness they were outlawed a few years later.
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I asked my ONC that very question because I have never had a scan either. I am Stage 2, Grade 1 IDC. I had a lumpectomy followed by 33 RADS treatments and currently taking Tamoxifen. She pretty much confirmed what kay said. I did have a micromet in the SN but it was so tiny that the dr had to dissect and redissect and I had the Oncotype test as well. My score was 11 and my tumor was determined to be non-aggressive and smaller than first thought. I also wondered why when I have the blood tests my ONC never did the one for the tumor markers. Her nurse said she doesnt see the need to routinely do one so I wonder if she ever did because if she did one initially how would she know if they were up or down or the same if she doesnt run a test the next time I have blood drawn. Believe me not asking for any of this just wondering...diane
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I did have a breast MRI before surgery to investigate an area of concern (I had multifocal BC), but I didn't have any full-body scans. It does make me wonder if I could already have mets and not know it... but I'm coming to peace with the unknowns, I guess. I suppose if I do have mets, I'd rather live as long as possible without knowing about them.
I just finished chemo & started Tamoxifen... my follow-up will not involve any scans or tests, not even bloodwork! A bit disconcerting...
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My onc said she would not be doing tumor markers for the very reasons that kayb stated. I had no scans done pre op only yearly MRIs as part of high risk surveillance . I will now be having MRI to check the integrity of my implants and possibly any spread of disease to the chest wall , I believe every 2 years.
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The tumor markers is the one test that I do have. It is not very specific but they would be looking for big spikes in the numbers.
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Kayb and dogs, I think I would worry about radiation (more than catching an early metastasis) if I were younger. At 64 I don't think a few years of monitoring via yearly CT scans will do me any harm. The scaning won't go on forever btw. Dogs, I believe a full body MRI would be prohibitively expensive. I'm sure insurance would not cover it. I do completely trust my MO, who has been on the cutting edge of breast cancer research for 30 years.
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That's exactly my opinion, yorkiemom, I'm 64 and don't have that much time left to accumulate radiation. I might have had an x-ray or two during my earlier years, but all this new radiation, scans, rads, etc., have come since last fall.
But I can see a real benefit to lifetime exposure records for those who are younger, especially children.
Carol
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I am stage IV and had an unrelated PET scan that accidentally discovered my asymptomatic bone met. It was promptly treated with rads x15 and I got to skip chemo and am on Arimidex only . The met is now necrotic but the horse is out of the barn and the little SOBS are lurking, undetected, somewhere. I initially got PET scans every 3 months but after a year of NED, my mo wanted to minimize rads exposure so now it's every 6 months unless I develop symptoms. I will admit to feeling comfort that they found the met early but am not so naive as to believe I'm cured. I know it will come back and I sometimes wonder what the course of my disease would have been had it not been or the PET. Still, I think there are a great many early stage women who do not need scanning and should not be worried by the lack of them.
Caryn -
Dogsandjogs: Must be a California thing to get kids feet x-rayed when buying shoes. NEVER have heard of that. Sounds like most oncs here are of the same mindset. However, as in my case, my body did not tell me anything was wrong when dx'd, and even the most advanced technology of MRI & PET, did not light up even though 4 pos. nodes and a big tumor, which looked like a scar on the scans. I will probably always insist on doing whatever testing I can if I suspect anything, but then, how the hell would I know?? I do tumor markers but have heard the debate -- some say not a concern unless significant jump, like over 50 pts.
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Ive already had a ton of scans since chemo and surgery due to pain or swelling issues. I have to have another ct scan in a month to follow up lung nodules.
Kayb I just wante to tell you that most newer machines create dose reports and they are saved in the patients radiology file. Mostly scans and fluoro not regular xray.
Healing hugs -
I'm a believer in scans. I'd like to see all bc patients two years out, any stage at diagnosis, get either a PET or bone scan + CT. If all clear, a 5 year followup of either.
If mets are compromising your spine, you may never know it until your vertebra collapses from the cancer, and you're left temporarily, or even permenently, numb from the chest down. (happened to me) I also believe that if they catch the mets early, and you get on medication for it early, you might have a better quality of life during your illness, and it may even slow things down. X-rays don't necessarily show spine mets, btw.
Sometimes these "symptoms" they are waiting for never show up. Or they come but then go. Or they show up as something else, as they nerves from the spine can play tricks on the body, giving pain in a different place than the injury. Spine mets might give you back pain,but could also give referred pain to the shoulder as well as chest pain.
Cancer is s sneaky beast. The sooner you find it, push it back or stabilize it, the longer and more symptom free life we have.
Nancy, if you were diagnosed in 11/11, I would be pushing for a PET or CT/bone in November of this year, just to be safe. I know many (including doctors) would not agree.
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I get tumor markers checked regularly. After a year of one going up and up I had a CT scan. No mets -scarring in the pancreas responsible for the rise. My husband's tumor markers found his mets long before the tumor would have made itself known (he's NED for 25 ears). CT scans are powerful and should be used with discretion. The average person would likel only ever need one for an occasional illness or injury, so it's not as big of a deal. We have a much higher likelihood of needing add'l xrays in our future. Personally, I don't want to have anymore than necessary. The rads add up. I don't want to end up causing more of the problem I'm trying to cure.
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I agree about the CT scan. My internist would not ok one for a problem I had. He said they give off way too much radiation. He preferred an MRI.
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sandilee: Thank you so much for your suggestion. I think I might do just that. It'll be two years in November since dx, and I know the first couple of years are prime time for recurrence. Add to the fact that I quit Tamoxifen and refuse any other AIs - I know my MO is already not happy with my decision, but respects it.
Am I taking a chance? Sure, and I acknowledge and own that. Even by my MO's own words, people taking AI's still get recurrence, so there are no guarantees. And I'd rather know sooner, when treatment might be helpful, than later, like after a fracture, where treatment may be less helpful. I guess that's all I want to know. I have enough people around me telling me to "move on" and "stop playing the cancer victim" that I feel selfish for wanting scans. For some high-risk survivors (and I don't know what would constitute "high risk") it seems that scans would be beneficial for early treatment.
Thank goodness y'all are here...your input is so invaluable!
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Be sure to check with your insurance before you have any scans. Some may not be covered--Not trying to scare you, but I had a second mammogram refused a few years ago. My doc had to re-submit telling them my cancer history before they would pay.
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I wonder if the ACA mandates insurance companies to cover scans and treatments recommended by doctors.
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Thank you dogsandjogs - excellent advice! I've learned to check my insurance coverage myself before starting treatment. I was originally approved for rads early in my treatment when it was expected I would be doing 4xTC, so my rads pre-approval "expired" in May. Then my treatment plan changed to AC/T and I didn't start rads until June...and my insurance company didn't want to cover it. Of course, I didn't discover this until two weeks into rads when they presented me with a bill for several thousand dollars! I learned right then and there to (1) advocate for what I needed, and (2) never trust that what's prescribed is automatically approved!
yorkiemom - My insurance company has yet to deny anything my doctor has prescribed, but I've read several posts here from others who have been denied scans (in particularly MRIs) even with a BC diagnosis. I'd be interested in knowing more about the ACA and mandated coverage. Thanks for the suggestion!
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I have had to pay my share (20 percent) of my colonoscopy and all my mammograms. I don't know of any free tests or scans. I have United Health Care and before that Blue Cross (both tru my employer) maybe if you have an HMO you get some free stuff.
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