The Cancer Patient: Too Many Scans and X-rays?

GJC Rees

Hong Kong J Radiol 2004;7:44-8

The title of this article is the same as that of a paper by Brewin published in the Lancet more than 20 years ago. There have been substantial advances in diagnostic radiology and in oncological treatments during the past 20 years, but the question remains valid. Many radiological investigations requested for cancer patients stand little chance of being of overall benefit through altering clinical management or improving quality of life. There is considerable variation in the use of radiological investigations in cancer management. One area where this is seen in particular is in the ‘restaging’ of patients whose cancer has ‘returned’. The reasons given to patients for such investigations are often not convincing. Investigations are sometimes arranged to ‘rule out’ or ‘exclude’ malignant involvement of other organs and tissues, but the sensitivity of even the best forms of radiological assessment means that such ‘exclusion’ is, in fact, impossible. Some investigations reveal that the disease is more widespread than originally supposed. While for some patients this may very usefully influence management, for others this news may make no significant difference to treatment but can have a profound negative and unnecessary psychological impact. Many radiological investigations are expensive and many patients have to wait longer than they should for the scans they need. Resources are limited and requesting unnecessary tests for some patients can adversely affect the management of others.