Asked by Claire Myers, Rockledge, Florida
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Your question actually speaks directly to one of the controversies in medicine today regarding medical costs in the United States. Physicians tend to "over-image" with costly radiologic and nuclear medicine tests. It sounds like you have an orthodox oncologist who follows the rules and does not over-image.
If one is taking the medical oncology board exam, the answer is bone-only metastatic breast cancer that is being treated with hormones or that has been treated with chemotherapy and is now quiet should be followed with regular questioning of the patient about symptoms, physical examination and some blood tests to assess bone turnover, liver and renal function. A chest X-ray and X-ray of the area of metastasis (spread to bone) would also be useful. In a patient who is in good physical shape, I do this every three months with the advice to come in sooner if you have any worries.
In practice, many doctors do CT scans of the body and pelvis every few months; others do nuclear medicine tests such as PET scans or bone scans. Many patients also demand them. There is no evidence that these tests and early detection of tumor growth benefit the patients, but many doctors do them anyway. I know of a few patients who have had stable disease for more than 20 years. Seven or eight years is not unusual. Studies every three months can be quite expensive and expose the patient to a hefty dose of radiation.
I should also mention that unless contraindicated, we treat the patient with bone-only breast cancer with a bisphosphonate to harden the bones. I use pamidronate (trade name Aredia) or zoledronic acid (trade name Zometa). This may decrease risk of broken bones and may also fight the cancer by making it more difficult for the cancer to implant in bone and grow.
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