Intended for healthcare professionals

Rapid response to:

Paper

Doctors' knowledge of radiation exposure: questionnaire study

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7411.371 (Published 14 August 2003) Cite this as: BMJ 2003;327:371

Rapid Response:

Patient perspectives on CT risks

The following was posted to our support list in response to concerns
generated from the article. It may be of interest to your group because it
addresses patient perspectives -- in particular patients with indolent
cancers who have concerns about repeated use of CT for monitoring disease
and treatment response.

==
I've seen data showing higher incidence of secondary cancers in patients
with NHL - melanoma is but one.

So probably everyone can agree that something is contributing to the
increased risk. But what? It could be the NHL, the cytotoxic treatments,
treatment- disease- or genetic-based immune incompetence, and it could be
exposure to imaging radiation. How would any study tease out which
contributes most or least?

Maybe, it would be telling if we switched all lymphoma patients to
MRI monitoring. If the incidence decreases in twenty years we'd have a
fair estimate of how much CT contributes to the risk in this group.

I think Hodgkin's disease is where the best evidence of secondary
cancers is found because of the youngish age of the patients at diagnosis
and the excellent cure rate (~80%). But these patients are monitored
regularly by CT too. I find this practice particularly disturbing.

It's well established that radiation exposures increase risk of
getting cancer. If you have an alternative, such as MRI, which doesn't
increase the risk, it's prudent to use it. If you're young and have an
indolent cancer that requires frequent monitoring over many years, the
risks are greater.

I personally would not decline on participating in a trial because it
requires CT. But clinical trials do often increase the number of CT
exposures significantly, especially when the endpoint is time to
progression. Some studies require neck to pelvis CTs every 2 months. My
spouse has had ~20 such monitoring exposures. Something I now regret.

Karl Schwartz
President, Patients Against Lymphoma
www.lymphomation.org

Caregiver and Patient Advocate

Patient Consultant to the FDA/Oncologic Drug Advisory Committee

Participant in the NCI Progress Review Group for Blood Cancers

Competing interests:  
None declared

Competing interests: No competing interests

27 September 2003
Karl Schwartz
President
Patients Against Lymphoma