Prostate Cancer Imaging Scans Often Unnecessary

Low-Risk Patients Are Getting Expensive, Unnecessary Tests to Determine if Cancer Has Spread, Research Shows

Feb. 18, 2011 (Orlando) — Thousands of men with low-risk prostate cancer are having unnecessary and expensive imaging tests, while thousands of men with high-risk disease who should get the tests are not.

When men are diagnosed with prostate cancer, they are classified as low-, intermediate-, or high-risk depending on their life expectancy, overall health status, and tumor characteristics. Current guidelines state that only high-risk men should undergo CT, MRI, and bone scans to determine if their cancer has spread beyond the prostate.

But in a study of more than 30,000 men diagnosed with prostate cancer in 2004 and 2005 in the U.S., 36% of low-risk men and 49% of intermediate-risk men got the scans.

“The chances of finding disease outside the prostate in these patients on one of these scans is less than 1%,” says study leader Sandip Prasad, MD, urologic oncology fellow at the University of Chicago.

Although those tests may expose men to unnecessary radiation and use resources unnecessarily, the bigger concern is that 39% of men with high-risk disease who should have undergone imaging did not, he tells WebMD.

The findings were presented at the Genitourinary Cancers Symposium.

Misuse of Tests May Lead to Wrong Treatment

“This is a double whammy,” says Mack Roach III, MD, head of radiation oncology at the University of California, San Francisco.

“This is a perfect example of how we are wasting money on inappropriate tests and then denying other people appropriate care,” he tells WebMD.

Misuse of the tests can lead to the wrong treatment, Roach says.

“If the scans show cancer has spread in high-risk patients, there is no sense in the patient having his prostate taken out. He’ll need chemotherapy and hormone therapy,” he says.

“In a low- or intermediate-risk patient, on the other hand, any sign of [cancer spread] is likely a false-positive test. But the patient may be denied [surgery] because of the results,” Roach says.

Prasad says he believes patients and doctors both contribute to the high rates of unnecessary tests.

“Men may ask for it. Physicians may do it because it gives them reassurance that they haven’t missed anything,” he says.

Prasad says the unnecessary tests cost taxpayers more than $35 million — “more than 10% of the annual budget of the National Cancer Institute for prostate cancer research.”

The study included 9,640 men with low-risk prostate cancer, 12,966 men with intermediate-risk prostate cancer, and 7,577 men with high-risk prostate cancer.

source: webMD

Racial/ethnic differences in job loss for women with breast cancer


We examined race/ethnic differences in treatment-related job loss and the financial impact of treatment-related job loss, in a population-based sample of women diagnosed with breast cancer.

Three thousand two hundred fifty two women with non-metastatic breast cancer diagnosed (August 2005–February 2007) within the Los Angeles County and Detroit Metropolitan Surveillance Epidemiology and End Results registries, were identified and asked to complete a survey (mean time from diagnosis = 8.9 months). Latina and African American women were over-sampled (n = 2268, eligible response rate 72.1%).

One thousand one hundred eleven women (69.6%) of working age (<65 years) were working for pay at time of diagnosis. Of these women, 10.4% (24.1% Latina, 10.1% African American, 6.9% White, p < 0.001) reported that they lost or quit their job since diagnosis due to breast cancer or its treatment (defined as job loss). Latina women were more likely to experience job loss compared to White women (OR = 2.0, p = 0.013)), independent of sociodemographic factors. There were no significant differences in job loss between African American and White women, independent of sociodemographic factors. Additional adjustments for clinical and treatment factors revealed a significant interaction between race/ethnicity and chemotherapy (p = 0.007). Among women who received chemotherapy, Latina women were more likely to lose their job compared to White women (OR = 3.2, p < 0.001), however, there were no significant differences between Latina and White women among those who did not receive chemotherapy. Women who lost their job were more likely to experience financial strain (e.g. difficulty paying bills 27% vs. 11%, p < 0.001).

Job loss is a serious consequence of treatment for women with breast cancer. Clinicians and staff need to be aware of aspects of treatment course that place women at higher risk for job loss, especially ethnic minorities receiving chemotherapy.

source:Journal of Cancer Survivorship
Research and Practice

Splenic Incidentalomas

Compared with other intraabdominal organs, there is a paucity of scientific investigation involving the spleen; in particular, little has been published in the radiology literature regarding the detection and characterization of splenic disease conditions. Splenic lesions are common in a busy radiology practice. Technical advancements in computed tomography (CT) allow unprecedented temporal and spatial resolution; unexpected splenic lesions are commonly detected on CT examinations of the abdomen and chest and often pose a diagnostic challenge to both the radiologist and clinician. This article discusses incidental splenic lesions detected on CT and explores potential management strategies.

source: science direct