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In non preventive (therapeutic) oncology practice there are both
secondary screening and restaging. The difference may be crystal clear
but many of us order scans (or blood tests) on patients far into their
trajectory of remission hoping to be kind hearted (or perhaps clever) and
pick the disease up early on the naïve assumption that offering earlier
intervention might be truly beneficial – secondary screening.
When a patient has symptoms or signs during follow up we may make a
clinical diagnosis and order a scan – restaging – and act accordingly.
Restaging may be part of a research (clinical trials) protocol but should
it deserve to be part of an off-trial set of guidelines in the absence of
good evidence as discussed in this provocative editorial?
Is there good clear Type 1 evidence that it is globally beneficial in
any tumour group (except for germ cell tumours and potentially curable
tumours)? There appears not even clear data on its use in the “flavour of
the month” imaging for secondary screening in the quest for potentially
resectable colorectal metastases.
Yet we all do it and seem to be driven by two groups - the consumers,
to satisfy their double edged sword curiosities and, overenthusiastic
colleagues – but increasingly now, the health industry. Randomised
clinical trials of therapeutic interventions could quite easily
incorporate parallel studies of outcome benefits of secondary screening
with scheduled restaging scans (or blood tests etc) and this is where
these investigations should really be done.
Competing interests:
None declared
Competing interests:
No competing interests
14 May 2003
L-F Ng
Medical Oncologist
Beatson Oncology Centre, Western Infirmary, Glasgow G11 6AT
Secondary Screening and Restaging
In non preventive (therapeutic) oncology practice there are both
secondary screening and restaging. The difference may be crystal clear
but many of us order scans (or blood tests) on patients far into their
trajectory of remission hoping to be kind hearted (or perhaps clever) and
pick the disease up early on the naïve assumption that offering earlier
intervention might be truly beneficial – secondary screening.
When a patient has symptoms or signs during follow up we may make a
clinical diagnosis and order a scan – restaging – and act accordingly.
Restaging may be part of a research (clinical trials) protocol but should
it deserve to be part of an off-trial set of guidelines in the absence of
good evidence as discussed in this provocative editorial?
Is there good clear Type 1 evidence that it is globally beneficial in
any tumour group (except for germ cell tumours and potentially curable
tumours)? There appears not even clear data on its use in the “flavour of
the month” imaging for secondary screening in the quest for potentially
resectable colorectal metastases.
Yet we all do it and seem to be driven by two groups - the consumers,
to satisfy their double edged sword curiosities and, overenthusiastic
colleagues – but increasingly now, the health industry. Randomised
clinical trials of therapeutic interventions could quite easily
incorporate parallel studies of outcome benefits of secondary screening
with scheduled restaging scans (or blood tests etc) and this is where
these investigations should really be done.
Competing interests:
None declared
Competing interests: No competing interests