In the 1990s, nearly half of patients diagnosed with early-stage disease were treated with orchiectomy (testicle removal) alone. For those patients, the National Comprehensive Cancer Network Guidelines recommend a total of 15 CT scans in the first five years after surgery (every two to three months for the first year, then tapering off each consecutive year) to check for new signs of disease. After four years, CT scans are recommended just once annually.
Excessive CT scanning has been the subject of intense debate in recent years; as the technology has become better at detecting disease, it has been used with far more frequency, exposing more people to ionizing radiation, which can cause cancer at high doses.
"What has happened is that because CT images are so diagnostically useful, physicians request them for their patients in great numbers, so the concerns are really based upon the fact that 80 million CT scans are performed every year in the U.S.," said Boone. "That is a huge number."
Boone added that active surveillance protocols are one example where a large number of repeat CT scans are performed on a patient.
"It should be emphasized that this study involved patients who had 15 or more CT scans, not one or two," he said.
Chamie's research found that more patients who have been on active surveillance will be diagnosed with secondary malignancies after 15 years than will patients who received aggressive lymph node surgery or chemotherapy. Statistical analysis determined that of 10,000 patients put on active surveillance, 306 would get secondary malignancies, versus 233 if they had the surgery alone. That translates into 73 additional secondary malignancies. And while 73 may not seem like a big number, of the men who underwent surgery, only 50 died of testicular cancer.
"The side effect is worse than the disease," Chamie said. "More
|Contact: Dorsey Griffith|
University of California - Davis Health System