ASCO: PET Scans for Follicular Lymphoma

The ASCO conference was finished up last weekend, but I'm still getting around to looking at some of the research that was presented about Follicular Lymphoma.

Unfortunately, there wasn't really anything earth-shattering at ASCO about FL. In fact, I'm not really seeing any lymphoma news that's changing things in a huge way. And that's fine. Research is moving along at a really fast pace, but we can be patient and wait a little longer for some really great news.

That doesn't mean there wasn't some goof Follicular Lymphoma research that was presented at ASCO.

Another session that caught my eye was "Impact on Survival of Surveillance Imaging after First Remission in Follicular Lymphoma." In a way, this isn't presenting anything new. It was meant to confirm research that was done recently.

It caught my eye because I had a conversation with someone recently about this very topic -- the usefulness of PET scans after treatment.

The researchers in this study looked at an ASH presentation from a couple of years ago that found that PET scans do not help to detect a recurrence after treatment. That is, if you've had successful treatment, you're probably worried that the FL will come back. (Aren't we all?) Naturally, you think having frequent PET scans will help you keep an eye on this. A scan might pick up a small bit of cancer before it gets out of hand.

The problem, of course, with frequent PET scans is that they involve large amounts of radiation. Over time, that radiation can cause other problems, including new, different cancers.

And as that 2017 study found, the scans only pick up a very small number cancer recurrences that other things did find (a doctor's exam, or blood work, or even just the patient noticing symptoms). The ASH presentation that the research mention isn't online any more, but I did discuss it back then, if you want to take a look.

The ASCO research wanted to confirm what the 2017 study had found, and it did confirm it -- for most patients, frequent scans after successful treatment will not result in increased survival.

The research looked at 1121 Follicular Lymphoma patients who had been successfully treated and then had their cancer return. The patients' medical records were studied to see how the relapse was found -- either by clinical means (an exam by the doctor, or bloodwork, or patient noticing something strange), or by surveillance (a scan when no symptoms were present).

From that group, 117 patients had their cancer return. The median time for the relapse was 26 months. Of that group, 63 of them were detected by clinical means, and 50 by scans (4 were unknown). However, in that group, there was was difference in Survival between the two. Having the return of cancer found by PET scan did not mean the patient lived longer (but it did mean the patient had more radiation).

The researchers concluded that, for many patients, routine PET scans aren't necessary after successful treatment. If the cancer occurs, it is frequently found without the need for scans. They do acknowledge that there are some high-risk patients who might benefit from more frequent scans, and they would like to see more research that tries to identify those patients. But for most of us, frequent PETs probably aren't necessary.


Personally, I've moved toward believing that fewer PET scans for me are a good idea. I'm still young. I don't need the radiation unless it's necessary. I have an oncologist who feels the same way.

For you, the best thing to do is talk to your own oncologist. If you feel like the additionally radiation might be a problem, say so. Let your concerns be known. If you feel that your own mental health will benefit from getting a scan, say that too. Be open to being talked out of it, too -- maybe the doc can show you why your blood work and other exam information make it clear to her that a scan isn't necessary.

I plan to be around for a very long time. For me, understanding the long-term implications of everything I do really makes a difference.