Would a PET scan detect breast anomaly? - 1246464

Tue, 08/07/2012 - 12:36

Hi Friends,

Odd question, I know. I had a PET scan and mammogram at the end of July. The PET was considered stable, i.e. nothing surprising (as regards my lung cancer, or anything else). However, I've now been called in to have an ultrasound and more pictures taken of my right breast due to something the radiologist saw on the mammogram.

If there was activity in my breast, wouldn't the PET scan have shown some uptake, or is that not an accurate test for breast anomalies?

And I was just starting to feel "normal" again!

Thank you,

Jazz

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JimC

Hi Jazz,

It certainly can, although not all breast cancer is imaged well by PET scan, especially small tumors. You may want to read this article from the Journal of Clinical Oncology: http://jco.ascopubs.org/content/23/8/1664.long

The conclusion is that "In short, the results of FDG-PET for the initial detection and diagnosis of primary breast cancer vary, largely due to heterogeneity of the disease and tumor size. Although some nuclear medicine physicians expected that FDG-PET would serve as a “metabolic biopsy” as a means of screening, this is not yet the case for breast cancer."

JimC
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double trouble

Hi Jazz! I just wanted to say that every time I have a mammogram they want additional images and ultrasound, and that my caregiver Daughter in Law just went through a biopsy, so I know the level of anticipation and anxiety can be high, especially with your history. I can also happily report that we are both clear... lumps and all, and I know that's small consolation but I am hoping that you will find that they're just being thorough and that you have nothing to worry about in that regard. I will be looking for your update.
Much love,
Debra

Dr West

I really agree with the comments in the link from wadvocator, specifically based on kimo's point there. I don't want to be morbid, but there isn't a lot of value in looking for problems that just aren't relevant from a time perspective if someone is managing advanced lung cancer. It's extraordinarily unlikely that a very small, PET-negative breast cancer would have any impact on the survival of someone who is dealing with a much tougher situation because of the lung cancer.

-Dr. West

catdander

Hi Jazz, I vote for forgetting about it. But the saying easier said than done may apply here. I remember when I first heard about not getting screenings after an advanced lung cancer dx. But now that suspicion has been raised incidentally (you skipped don't ask don't tell) I think you may be curious what Dr. Cianfrocca, our breast cancer specialist faculty has to say.

Janine

dr cianfrocca

While PET can pick up cancers in the breast, it's not 100%. If work-up of this area is indicated, mammogram and US would be the way to go. But as Dr West indicated, this issue needs to be taken in the context of your lung cancer and you and your oncologist would need to decide based on that whether further work-up is worthwhile for you.

Dr Cianfrocca

double trouble

I found this discussion very interesting, because I never even considered not having my yearly mammograms. I can see now why I probably could have skipped the last two... and now it makes more sense why my primary isn't pushing for PAP's and my GI mentions, but never schedules that colonoscopy that I'm over due for.

Duh!

Debra

Jazz

Thanks everyone - faculty and friends - for the enlightening discussion. Oddly, my Calif. oncologist feels I should follow up on the imaging and even get a biopsy if necessary. Dr. Camidge says the PET wouldn't pick up pre-cancer, and I think he probably agrees with the 'why bother' mode of thinking.

Now that 'inception' has occurred, I have to know. I've scheduled the follow-up for the end of the month (after mother-in-law visits). Will update with results!

I never even thought to skip pap smears!

Jazz

Jazz

After some discussion with one of the docs in Colorado (the Fellow I usually see before Dr. Camidge drops in), I'm postponing breast imaging indefinitely.

If a new malignancy is identified, it could disqualify me for the current the trial, and for any other trials I may be considering down the line. Most trials will accept DCIS, but any other malignancy must be 2 - 5 years in the past. So it's kind of a "Don't ask, don't tell" situation. A biopsy or lumpectomy could lead to delayed treatment for lung cancer, infection, complication... a host of possibilities I'm not ready to entertain today.

This is not to say the possible threat (of BC) doesn't bother me, as I'm now compulsively examining myself. But for the time being, I suppose I have bigger fish to fry...

Jazz

certain spring

Poor Jazz, what an extra strain on you. And it might be nothing.
I know it is not in your nature, but I confess to being of the "Don't ask, don't tell" fraternity. At a certain point I refused to have any more CT scans on precisely that principle. As in "If you find something, what are you going to do about it?" At the time it didn't seem morbid, but liberating. I was so fed up with being endlessly prodded and injected and supine.
Oh, and I was delighted to tell the GP I never wanted another cervical smear reminder letter ever again!