Cancer is scary. Really scary. If you have cancer that is localized and it is removed, probably you will live. If the cancer moves beyond its original home to somewhere else, then probably you will die. This is the unfortunate truth of cancer. Once you have had your initial surgery, doctors may do repeated body scanning to look for recurrent or residual disease. In some cases there is an improvement in outcome if disease is discovered unifocally and removed or irradiated prior to further spread.
Mostly though, if you are found to have recurrence or spread. Well, chemotherapy is an *option* but…it is most likely going to end poorly. So, you’d like to know if you have recurrence, right? I mean, it’s very important to know if you do or don’t? Traditionally, CT scans have been the mainstay of this surveillance, however a new finding on CT may be a benign one and as such a second CT down the road may be required to see if this small lesion is going to grow or not. Or maybe a biopsy.
Enter the PET/CT. This nifty technology utilizes a radiographic agent that is biochemically attached to, usually, a glucose molecule. Cancer cells are highly metabolic and so they eat up the glucose AND the radiotracer and, voila, hot spots appear where there may be cancer. In some cancers, this is practically the standard of care now.
So, why am I not impressed? Well, first off, what do you know now that you have a positive PET? Yeah, you know that you are indeed fucked. Not a little, but completely. Sure, a negative PET is a great thing and makes you feel hunky dory inside. Really nice and safe and happy in the new little Honda you bought. Wait, the what? That’s right, inside the car that you purchased for this scan that told you that you either will or will not die from cancer. Because a PET/CT costs about $15,000. Most of that money goes to the very expensive process of creating the custom agent that is infused into your body. It must be created at a cyclotron within about 24 hours of the procedure and as such, many such expensive facilities are needed in order to supply the many PET scanners with the product.
Is the one on the right really worth 15 times what the one on the left is? I don’t think so.
And now…you have to have one every 3 months for the rest of your life. Do you really think that your peace of mind is worth $60,000 a year? I mean, that’s not a Honda, that’s buying a fucking Yukon Denali every year just to feel warm and happy. Balding, fat, middle-aged doctors get to do that shit, not you. But, who cares, you’re not the one paying. I mean, a plain CT costs less than $1,000 now and can give you practically equivalent peace of mind, but…since the government or the evil insurance company is paying, fuck ’em, let them pay.
It’s thinking like this that has gotten us into the worst imaginable financial position in the field of medicine. So tell your fat, stupid doctor to shove his PET scan up his fat ass and just get a regular CT. Make him show you the data on why it’s such a great idea for YOU in this case to get a PET scan. Otherwise, fuck your doctor and the rolls of cash that he wants to put in his pocket.