Anyone who undergoes cancer treatment quickly learns that it is likely to include a number of radiologic procedures. These may be mammograms, X-rays, MRIs, CT scans, or PET scans. Different tests are used for different views and different situations, and some doctors prefer one over another. Some women worry about the exposure to radiation, and this certainly is a legitimate concern. The reality is that the exposure risks must be balanced against the value in making the right treatment decisions for someone with cancer. Unfortunately, we are not the normal population, and what might seem like unnecssary radiation exposure to a fully healthy person is likely not the case for us. If, however, this is a concern for you, you certainly should speak with your doctors about it.
A larger worry, for everyone, is the cost of all these tests and the need to be sure they are ordered for sound clinical reasons. Here is an interesting summary from MedPage about an article in JAMA:
Particularly PET, for Cancer Patients
By Kristina Fiore, Staff Writer, MedPage Today
April 28, 2010
Imaging costs also increased, outpacing the rate of increase in total costs among Medicare beneficiaries with cancer, they said. Use of imaging in cancer has been increasing because of emerging technologies, changes in diagnostic and treatment patterns, and changes in Medicare reimbursement.
To examine those changes and how they've affected the overall cost of cancer care, the researchers assessed a nationally representative 5% sample of claims from the Centers for Medicare and Medicaid Services (CMS) from 1999 through 2008.
All patients had some type of cancer, including breast, colorectal, lung, or prostate cancer or leukemia or non-Hodgkin lymphoma. There were 100,954 cancer cases in all. The researchers found significant annual mean increases in imaging use among all cancer types, particularly PET scans: Positron emission tomography (35.9% to 53.6%)Bone density scans (6.3% to 20%) Echocardiograms (5% to 7.8%) Magnetic resonance imaging (4.4% to 11.5%) Ultrasound (0.7% to 7.4%) The use of computed tomography (CT) also increased in all cancer subgroups except lymphoma (4.5% to 7.6%).
The use of conventional radiographs decreased or stayed the same in each cancer subgroup but remained the most heavily used modality for all diagnoses, at a mean of 4.3 to 12.2 procedures per patient, the researchers said.
Patients with lung cancer or lymphoma had the largest increase in PET use. "This rapid increase is largely due to the expanding number of indications for PET since the technology was approved in 1998 for the characterization of single pulmonary nodules and initial staging of nonsmall cell lung cancer," they wrote.
Those with lymphoma or lung cancer had the largest number of imaging procedures. By 2006, for example, the average patient with lung cancer had 11 conventional radiographs, six CT scans, a PET scan, a separate nuclear medicine test, an MRI, two echocardiograms, and an ultrasound -- all within two years of diagnosis.
Patients with these two conditions also incurred the largest overall imaging costs, exceeding a mean of $3,000 per beneficiary within two years of diagnosis. Overall, the researchers said, mean two-year imaging costs per patient increased at a rate greater than the increase in mean total costs per patient for all cancer types.
Still, as of 2006, imaging costs accounted for only a small fraction -- 6% -- of total Medicare cancer costs. Nevertheless, the researchers wrote, the federal government has been cautious about increases in imaging costs. For example, the new healthcare reform law aims to reduce imaging expenditures by lowering payment for imaging tests. (Note from Hester: the new law also prohibits physicians from referring patients for radiological studies to centers or machines that they own or have a financial interest in. That is, if the doctor owns the MRI machine, he can't refer his own patients to it.)
The authors noted that their study was limited by the accuracy of claims data.
Dinan MA, et al "Changes in the use and costs of diagnostic imaging among Medicare beneficiaries with cancer, 1999-2006" JAMA 2010; 303(16): 1625-31.
Medical imaging for cancer patients and resulting costs have increased over the last decade, particularly in positron emission tomography (PET), researchers have found. Annually, use of the diagnostic screen rose significantly between 1999 and 2006 -- ranging from 36% in lung cancer to 54% in breast cancer, Kevin A. Schulman, MD, of Duke University, and colleagues reported in the April 29 Journal of the American Medical Association.