Do You REALLY Need That Test?

PJ Hamel Health Guide
  • CAT scans, PET scans, bone scans, blood work – when you’re diagnosed with breast cancer, it’s tempting to have a wide range of tests to see if it’s spread. But in most cases, these tests do potentially more harm than good. 


    When you’ve been diagnosed with cancer – and gotten over the initial kick-to-the-gut shock –  one of your first questions is bound to be, “Has it spread?”


    You’re figuring, if it’s just in my breast, then surgery should take care of it. But what if some of those cells have gotten out of the tumor, and gone someplace else? I want this cancer out of my body completely. So I need to find out where else it might be.

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    First of all – slow down. Most breast cancers are very slow-growing. Researchers indicate it can take up to 8 years or more for a tumor to grow large enough to be seen on a mammogram, let alone felt during a breast self-exam. So getting a breast cancer diagnosis isn’t reason to panic; it’s serious, yes, but usually you have time to do some research and make some sensible decisions around treatment.


    In most women, the first actual treatment after biopsy has identified cancer is to have surgery, to remove the tumor. During this surgery, one or more of the lymph nodes under your arm or in your chest (depending on the location of your tumor) will be removed and examined; this is called sentinel node biopsy, and is the first and best way to see if there’s a chance the cancer has spread outside your breast. 


    If your sentinel nodes are clear – no sign of cancer – then it’s safe to say the cancer has been contained in your breast. Yes, there’s a tiny possibility that a few cells have escaped and traveled to a distant part of your body; but studies show the chances of that are slim. 


    So, what if your sentinel nodes DO show cancer? It’s left your breast and gone… where? “Let’s do whatever tests it takes, Doc, to figure out where this ugly beast might be…”


    Well, not so fast. First of all, it’s not that easy to identify cancer metastasis (cancer that’s spread out of your breast to another location), especially in its early stages. And second, even if you have the tests in an attempt to find a potential metastasis, the tests themselves are hurting you – almost certainly more than the very slight possibility they’ll show anything. 


    ASCO, the American Society of Clinical Oncologists, recommends further diagnostic screening only if your cancer is diagnosed stage III or higher; the majority of breast cancers are staged 0, I, or II. So if you’ve been diagnosed with early-stage breast cancer, unless it’s unusually aggressive your oncologist probably won’t recommend any further screening.  


    “I’m still very uneasy,” you’re thinking. “Can’t we just do the tests anyway, for my emotional well-being?”


    Not a good idea. First, the scans your doctor might order – CT/CAT, PET, and bone – are expensive, potentially costing thousands of dollars. 


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    But more important, further testing can easily lead to additional “suspicious” areas, which then need to be biopsied – despite the fact that these suspicious areas are seldom cancer. There’s an inherent risk (and lots of worry) involved in any kind of surgery, including biopsy; why take that risk, if the chance of it being worth it is so small?


    Finally, all of these tests expose you to radiation. Dr. Douglas Blayney, a member of the ASCO task force that developed the current diagnostic screening recommendations, notes, “Most of these tests expose patients to radiation, the effects of which are cumulative, over a lifetime. Excessive imaging actually increases your risk of cancer.” ("Cancer tests, treatments," 2012)


    Choose to raise your risk of cancer, because you’re afraid you might have cancer? I don’t think so. 


    Finally, what about those blood tests that look for “cancer markers?” If you’re in long-term maintenance mode after having been treated for early-stage breast cancer, and don’t have any new symptoms you’re worried about, ASCO advises against them. They’re not particularly accurate, coming up with many worry-inducing false positives; and the use of such tests in the aforementioned population hasn’t been shown to save lives.


    Bottom line: calm down. There’s a reason your doctor’s not recommending further screening – it’s not good for you. Use your energy to deal with the cancer you know about, rather than worrying about another one that almost certainly doesn’t exist.




    Cancer tests, treatments to question. (2012, October). Consumer Reports on Health, 24(10), 6.



Published On: October 09, 2013