I just had surgery last week to have a cancer tumor removed from my breast and I just met with my doctor last week to decide on my cancer treatment plans. My doctor said that the cancer could have spread to other parts of my body so when I told her that I want to have a PET scan done of my body to determine whether or not it has, she got pretty upset with me and gave me an answer that didn't make any sense at all. I am a grown adult and I should be the one to have a say so or not whether I should have a PET done and not her. Am I able to have this test done even if the doctor doesn't want me to have it ? There are probably many reasons why a PET scan was not recommended. But what comes instantly to mind is that you would certainly not have a PET scan following surgery as the results could be inconclusive.
i.e. The area of your surgical operation would be inflamed and the PET scan would show all that area lit up like a Christmas tree! Potentially a false reading!
Other reasons that a PET scan may not be appropriate include;
- If you are pregnant or breast feeding, as the radioactive isotope injected into your bloodstream could be dangerous to the infant/baby.
- if there is a chemical imbalance in the body. eg. the scan may give false results if you have eaten within a few hours of the scan, or if you are diabetic.
- PET scan is only useful for detecting the cancerous cells within a given mass which is typically greater than 1cm in size. If there is no mass then it won't detect anything smaller.
- and lastly, depending on which country you live, PET scan are subsidised for only certain types of cancers and diagnostic staging procedures. As such, if your condition, type of cancer or staging does not qualify then it will not be covered by medicare, or whatever your government pharmaceutical fund is.
Your doctor probably has a very good reason as to why it may not be applicable and it may be that if you do not trust him/her with what they say, then it is time to seek another doctor. As treatment and on going follow-up of cancer is a life long deal and it is important that you have a good relationship with your oncologist.
In my case I trust and respect my oncologist completely, but will always scrutinise and inform myself as to the appropriateness of his proposed treatment and recommendations as it is a partnership and I have assigned him to be my case manager. Well, I guess a doctor would always be right because she knows what is good for you and what is bad for you. I think you should do whatever the doctor tells you to do. Everything else depends on you. docters do have the option of treating you they can simply refuse to treat you but you should go back to your doctor and ask her politly to explain why she doesnt recomend a pet scan not every tumor surgrey needs to be fallowed up with a scan
there are some reasons though
-you might have had a benign tumor (it wont spread)
-the doctor took a sample and determined after examining it that you didnt need a pet
doctors spen about 14-25 years after collage learning how to treat people there goal is to help you they usually know best
yes you can have the test done wihtout the doctors approval
try a second opinon by a different doctor in the same field of medicine to see if you need a costly exame first though Pinky is wrong, wrong, wrong. A doctor should never get upset with your questions. It is your life and your body and you have a right to make all decisions regarding it. Your request for a PET scan is reasonable and appropriate.
Technically, yes the doctor can prevent you from getting the scan as you cannot just walk into a hospital and request one. They need orders from a doctor to do it. Your insurance company will also want a request from a doctor to authorize it.
I would go to other doctors, you should go to oncologists and get their opinions. Take your medical records with you, especially your pathology reports and take a trusted friend or family member with you. The doctor should be respectful of you and your decisions and should explain things to your satisfaction. You should feel comfortable with him or her. Treatment for cancer can be exhausting and it should be a team effort to get you well.
I am a cancer registrar and the ex-wife of a physician. Everything below is based on the assumption that you have breast cancer and it was completely removed at surgery.
First of all, I agree the doctor should not get upset with you. Your request is a perfectly rationale one, though I must say your doctor's denial of it is perfectly rationale as well. The matter in which it was handled sounds unsatisfactory.
PET scans are only covered in certain situations, and routine staging after breast cancer surgery is not one of them. You can always pay for the exam (>$3000 easy), but I wouldn't recommend that. A PET scan is not simply a "cancer detection" scan. It can miss cancerous lumps the size of a small marble, and those lumps can still harbor literally millions of cells. Therefore, what a PET scan picks up is not necessarily being caught early. It is useful to tell us what lumps are in the body. A CT scan does a good job of telling us where something is, and what size it is, and occasionally what it is, but a PET scan can tell us if that "spot" is active or not, which could mean infection, inflammation, or cancer.
In your case, unless your tumor size or lymph node status strongly suggests you need further xrays, generally xrays are not done unless the patient has unexplained signs or symptoms or laboratory abnormalities. Having negative xrays of any sort does not guarantee you do not have cancer.
Most of the abnormalities we pick up on routine studies done without a good reason are actually benign; what do you think you will think though once your doc comes back with," Oh we found a spot on your lung/liver/adrenal/skull/etc." You will assume it is cancer, and now you will be forced to go through more xrays, anguish and likely biopsy to explain that spot (again, even though the odds are it is benign).
This is a tough thing to explain to patients. My advice is listen to your doctor. However, if your relationship with the doc is strained, you could either get a second opinion or get a new doc.
God bless and best wishes You do need a doctor's order to have the scan.
Your MD was most likely telling you that it is not the standard of care, yet, for breast cancer. She may also have been pointing out that your insurance company would most likely not pay for it. Most insurance companies follow the lead of the Medicare guidelines for testing. Also, a PET should not be done until any postoperative inflammation is gone or you could have a false positive.
From Cancer News: "Although positron imaging is very useful in identifying recurrent of metastatic disease, Medicare coverage for diagnosis of primary breast tumors is currently not approved by HCFA. Tumor size and cell type are factors that effect PET scan accuracy. Although accuracy in detecting tumors larger than 2cm is high, PET may miss approximately one third of invasive cancers smaller that 1 centimeter. PET is more likely to identify invasive ductal carcinoma, to miss invasive lobular carcinomas, and is not helpful for identification of non-invasive tumors." It's totally up to the doctor.
I just went through this.
My cousin's wife works for an oncologist group that gives every woman with breast cancer of stages1-4 a PET scan.
My oncology group only approves PET scans for stages 3 and 4 for breast cancer.
I wanted a PET scan with stage one and it won't be done. However, my onc explained it with compassion and in detail. |
