Dr. Vose speaks against unnecessary CT, PET scans in NEJM letter

Those in complete remission from lymphoma who have no symptoms don’t need routinely scheduled computed tomography (CT) scans or positron-emission tomography (PET) scans for check-ups, say lymphoma experts including UNMC’s Julie Vose, M.D.

But every year — excessive CT and PET scans are ordered by physicians — often at the insistence of patients.









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Julie Vose, M.D.
In a letter published in today’s New England Journal of Medicine, Dr. Vose and University of Iowa radiologist Malik Juweid, M.D., note that the tests can expose patients to low-dose radiation, which possibly increases risk for other types of cancer. The unnecessary tests also drive up health care costs, the physicians wrote.

“Recurrent Hodgkin lymphoma is detected in patients with localized disease with the use of scans in only about 2 percent of patients, with no proven long-term benefit,” said Dr. Vose, the Neumann M. and Mildred E. Harris Professorial Chair and chief of section of hematology/oncology. “Yet these patients, who are usually young, generally undergo five to 10 CT scans of the chest, abdomen or pelvis, often in addition to several PET-CTs, within the initial three to five years of their treatment.”

More than 80 percent of lymphoma recurrences are first identified without the use of imaging.

The standard of care is not to do a scan unless there are symptoms or an exam gives cause for concern, Dr. Vose said.

Though Drs. Vose and Juweid wrote about scans in early-stage Hodgkin’s lymphoma, the standard of care advice also applies to non-Hodgkin’s lymphoma, Dr. Vose said.

“In patients at low risk of recurrence, reducing the exposure to excessive radiation is an important goal,” she said.