Reacts to her not getting a PET scan – NRK Norway – Overview of news from different parts of the country
Elin Aase is 33 years old. In addition to having a four-year-old daughter, she is a bonus mum to an 11-year-old and a 17-year-old.
In March 2020, she got what is known in the technical language as «triple negative breast cancer», and a very aggressive type of cancer.
The young woman from Klepp på Jæren is in a high-risk group for spreading and has therefore asked to have a PET examination.
It is an imaging study where a radioactive tracer is injected into patients before the patients drive into a machine. There, the body is scanned from head to toe.
Because of the tracer, tumors will light up on the screen.
Aase says that every day she has to go to bed to rest.
All the chemotherapy treatments and operations at Stavanger University Hospital have led to the previously active woman now receiving disability benefits.
– It stings and burns in both feet and hands, then it becomes completely numb, she explains.
So far, Aase has been refused the request to have a PET scan. She says that she has a hereditary gene that makes her vulnerable to cancer, and that her left breast is distant.
– I have planned my own funeral, says the 33-year-old.
– Routinely
NRK has mapped the number of PET scanners in Norway and Denmark. The PET scan is considered one of the most advanced imaging studies available.
The mapping shows that Denmark, with approximately 5.8 million inhabitants, has 51 PET scanners. Norway, with 5.4 million, has 17.
The mapping also shows large differences when it comes to how widespread the use is.
In Norway, it is rare for women with breast cancer in stadium 3 – such as Aase has – to have a PET scan.
In Denmark it is different, says Trond Bogsrud, senior physician at the PET center at Aarhus University Hospital.
– PET is now routinely performed, among other things, on what we call stadium 3 patients. This means in patients who have demonstrated spread to local lymph nodes, but not distant spread, but who have a high risk of having it.
– PET is also done if relapse is suspected, says Bogsrud.
14 months longer life
Bogsrud talks to NRK while showing off one of the eight scanners they have at the PET center in Aarhus.
The Norwegian says they use the advanced imaging examination on an ever-increasing number of breast cancer patients. Bogsrud believes that Norwegian women should get the same offer as in Denmark.
Denmark is in the process of updating its guidelines for the use of PET in breast cancer, says Bogsrud.
He also refers to the new latest science-based recommendations for the use of PET scans in breast cancer in England.
– Of course this should host an offer for Norwegian breast cancer patients.
– Why?
– Because this is a method which is better than the one used in Norway as of today.
The Norwegian superior also mentions a study published in the journal «British Journal of Cancer».
This showed in the stadium three breast cancer patients who received a PET scan during the course of the disease had an average of 14 months longer life and patients who did not receive it.
Bogsrud also points out that more studies will be necessary to verify the cherished result.
Mentioned little
The Norwegian Breast Cancer Group (NBCG) is put together by a multidisciplinary committee of professionals as a major treatment program for breast cancer.
In the latest the action program PET scan is not mentioned more than three times, no one Bogsrud reacts to.
Only one of 784 literature references is partly about PET. In addition, it is from 2007 and obsolete, the superior believes.
– The Games relate to the action programme, and when PET is barely mentioned there, no, they do not use PET. Then they use SIR, CT and skeletal scintigraphysays Bogsrud.
Bogsrud is also superior at nuclear medicine department at the University Hospital in Tromsø.
He believes that whenever skeletal scintigraphy is requested, PET should be requested instead. In many cases, therefore, ordinary CT will also be external.
– Not a cookbook
Bjørn Naume is the head of the Norwegian breast cancer group, oncologist, professor and head of the cancer clinic at Radiumhospitalet.
He says the action program from the NBCG «is not a cookbook».
– The reason why PET is not used so much is because it is not necessary to use it and because it has no effect on the patient’s prognosis, he says.
Naume also believes that PET examinations can give more “false positive” findings.
These false positive findings can trigger new investigations. This could result in greater use of resources and strain on patients, because it may turn out not to be cancer.
– With all diagnoses, there is a certain risk of both false positive and negative results. There are no more false positive findings on PET than with other imaging diagnosticssays Bogsrud.
These are studies Naume is critical of.
– That completely different fields of study
Bogsrud in Århus thinks it is very nice that nuclear medicine is not included in the interdisciplinary group as the larger action program from the Norwegian Breast Cancer Group.
The head of the Norwegian Association for Nuclear Medicine, Eivor Hernes, says that they want to join the group that stores the action plan.
Hernes is a senior physician and works daily at the PET center at Ullevål hospital.
She says that, in her experience, it is very rare that they take a PET scan of breast cancer patients.
This despite the fact that she believes patients with “some spread” will benefit from it.
Hernes says that they work closely with radiologists, but that nuclear medicine does the imaging in a different way.
– We depict properties and get other information. We work closely with the radiologists and complement each other in the diagnostic area. But these are completely different fields of study, and it is important to get along, she points out.
Naume, for his part, says that there has been no request from nuclear medicine to join the Norwegian Breast Cancer Group.
He also points out that there are already radiologists in the group, and that it is not necessarily easy to expand the group further.
Professional question
So why is it that Denmark uses PET scans on breast cancer patients, while Norway hardly does?
Health and care minister Ingvild Kjerkol (Ap) does not want to answer that, and indicates that it is a “professional question”.
Both the Ministry of Health and Care and the Directorate of Health refer to the Norwegian Breast Cancer Group.
– It’s not like you need PET to get an overview in all contexts, but if you need PET to get that overview, then you use it, says manager Bjørn Naume, and adds:
– All breast cancer patients should be assessed for the right imaging examination, which also includes assessment of PET.
– I don’t understand why
Elin Aase from Klepp has put on a washing machine and hung it on a laundry during NRK’s visit. Now she must lie down to rest.
The 33-year-old does not understand why she did not get a PET scan when she asked for it. If she had lived in Denmark, she would have had it.
Chief physician Ingvil Mjaaland at Stavanger University Hospital replies to NRK in an email:
“On the basis of the patients’ information and clinical examination, treated doctors concluded that there was no suspicion of relapse (relapse, journal note). Therefore, no basis was found for requisitioning a PET scan.»
That explanation is not good enough for Aase.
– I don’t understand why Norway and Denmark have such big differences. In both countries the hospitals are public, and therefore I cannot understand why we in Norway do not use the latest and best imaging technology.