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”, a very aggressive type of cancer. The young woman from Klepp på Jæren is in the high-risk group for spreading and has therefore asked to have a PET examination carried out. It is an imaging examination in which a radioactive tracer is injected into the patient, before the patient is driven 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. Elin Aase has had surgery to remove her left breast. She has asked for a PET scan, but was refused. Photo: Ole Andreas Bø 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 has been removed. – I have planned my own funeral, says the 33-year-old. – As a matter of routine, news has surveyed the number of PET scanners in Norway and Denmark. The PET scan is considered one of the most advanced imaging tests available. The mapping shows that Denmark, with approximately 5.8 million inhabitants, has 51 PET scanners. Norway, with 5.4 million, has 17. The survey also shows large differences when it comes to how widespread use is. In Norway, it is rare for women with stage 3 breast cancer – 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 stage 3 patients. This means 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 there is suspicion of relapse, says Bogsrud. 14 months longer lifespan Bogsrud talks to news as he shows off one of the eight scanners they have at the PET center in Aarhus. The Norwegian says they are using the advanced imaging examination on an ever-increasing number of breast cancer patients. Bogsrud believes that Norwegian women should receive 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 latest science-based recommendations for the use of PET scans in breast cancer in England. – Of course this should have been an offer for Norwegian breast cancer patients. – Why? – Because this is a method that is better than the one used in Norway as of today. The Norwegian chief medical officer also mentions a study published in the journal “British Journal of Cancer”. This showed that stage three breast cancer patients who received a PET scan during the course of the disease lived an average of 14 months longer than patients who did not. Bogsrud also points out that more studies will be necessary to verify the promising results. Not to be mentioned Norwegian Breast Cancer Group (NBCG) is made up of an interdisciplinary selection of professionals who create an action program for breast cancer. In the latest action programme, PET scan is not mentioned more than three times, which Bogsrud reacts to. Only one of 784 literature references is partly about PET. It is also from 2007 and out of date, the superintendent believes. – The doctors relate to the action programme, and when PET is barely mentioned there, no, they do not use PET. Then they use MRI, CT and bone scintigraphy, says Bogsrud. Bogsrud is also a senior physician at the 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, regular CT will therefore also be unnecessary. Bjørn Naume is head of the Norwegian breast cancer group and head of the cancer clinic at Radiumhospitalet. Photo: Ola S. Hana – Not a cookbook Bjørn Naume is head of the Norwegian Breast Cancer Group, oncologist, professor and head of the cancer clinic at Radium Hospital. He says the NBCG action program “is not a cookbook”. – The reason why PET is not used so much is because it is not necessarily necessary to use it, and because it is not important for the patients’ prognosis, he says. Naume also believes that PET examinations can produce more “false positive” findings. These false positive findings can trigger new investigations. This could result in greater use of resources and burden on the patients, because it may turn out not to be cancer. – With all diagnostics, there is a certain risk of both false positive and negative results. There are no more false positive findings on PET than with other diagnostic imaging, says Bogsrud. These are studies Naume is critical of. – Two completely different professional areas Bogsrud in Århus thinks it is very strange that nuclear medicine is not included in the interdisciplinary group that creates the 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 creates the action programme. 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 image properties and get other information. We work closely with the radiologists and supplement each other in the diagnostic area. But there are two completely different areas of expertise, and it is important to get that in mind, 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. Academic 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, pointing out that it is a “professional question”. Both the Ministry of Health and Care and the Norwegian Directorate of Health refer to the Norwegian Breast Cancer Group. – It is not the case that 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 the 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 up a load of laundry during news’s visit. Now she must go to bed 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 gotten it. Elin Aase does not understand why there is such a big difference in the use of PET scans for breast cancer patients in Denmark and Norway. Photo: Ole Andreas Bø / news Senior physician Ingvil Mjaaland at Stavanger University Hospital replies to news in an email: “Based on the patient’s information and clinical examination, the attending physician concluded that there was no suspicion of relapse (relapse, journal note). There was therefore no basis 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.
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Reacts to her not getting a PET scan – news Norway – Overview of news from various parts of the country
