Should I get a Pet Scan even though negative lymph node?

Hi!

Yes, you will be exposed to some radiation if you get a PET scan. But, is it enough to be worried about? As someone who has gotten three PET scans in the last two years, I would say, no. But, that doesn't meant that you should get a PET scan or that you need one.

You are right to be concerned about whether or not your oncologist is just looking to earn some more money. That, too, would make me suspicious. However, there might be some good reasons to get a PET scan.

Just because you are node negative doesn't mean that your cancer might not have migrated elsewhere. The chances of migration are smaller because you are node negative, but there is always that slight chance. Your Oncotype was high, and you are BRCA2 positive, so your oncologist could argue that your cancer was aggressive and might have spread. At the very least, a PET scan now could serve as a baseline scan that future scans could be compared to.

I got a PET scan because I was Stage IIIA with a large tumor (5 cm.+), Grade 3, and had one compromised node. The PET showed no mets. It was also used to see how well neoadjuvant chemo worked -- my second PET scan showed that chemo had wiped out all of the active cancer in my breast and in my node.

Since you're getting chemo post-surgery, your PET scan can't be used to determine the efficacy of chemo. At best, it can 1) check for mets, and 2) establish a baseline. If the risks of radiation outweigh these benefits of the PET scan for you, I would say "No" to the PET scan.

Good luck!

Hi LisbethS,

I was in a similar boat, but with HER2+ pathology (and a couple of other differences--I had multifocal disease, close DCIS margins, etc.). No PET here; my MO, RO, surgeon, and PCP all agree, both initially and after taking my case to tumor board, that additional scans aren't necessary. That was a hard pill for me to swallow at first, especially because I know other stage II women who had less aggressive BC who received scans, but I'm starting to see the wisdom in my MO's words: "don't worry unless you have a reason to worry. We all have aches and pains. If something lasts a month, we do a scan."

In essence--and my other three docs agree--we behave as if I'm NED unless I have symptoms that suggest I'm not NED. We do blood work quarterly (the CMP, in particular, can sometimes indicate further testing), and I get a clinical exam from at least one doctor every two months. But their assumption is that the surgery got it all, because the nodes were negative; chemo and radiation was just insurance. As is, I suppose, the combination of Zoladex and tamoxifen that I'm doing indefinitely.

All of that said, I second what ElaineTherese says above, especially because it's theoretically possible, if relatively uncommon, for BC to metastasize with negative nodes and no LVI: if you want a scan, just to establish a baseline or rule out mets with 100% certainty, you should have the scan. If peace of mind is worth the radiation and week of possible scanxiety, your MO can petition your insurance company on your behalf. I decided, ultimately, not to fight for a post-treatment PET, largely because I already had chest-wall rads, but also because, at the end of the day and purely subjectively, I'd rather forego more radiation and bask in being NED for as long as I'm NED (which I hope is forever). Having a scan doesn't change the present moment for me; it would give me more certainty about the future, but the future is always uncertain, regardless of what a scan says and even beyond cancer.

Forgive my existentialist leanings and possible rambling. I hope that helps! Good luck.