South Africans may lose access to gold standard for cancer imaging

However, medical aid restrictions mean South African cancer patients have very limited access to PET-CT. These restrictions are so severe that unless they are changed, all six private PET-CT centres will close by mid-2009.

“We are at risk of losing the technology as it is not sustainable at current levels,” said Dr Ralph Posner. Dr Posner, who practises from Morningside Medi-Clinic in Johannesburg, is a member of the Radiological Society of South Africa (RSSA).

South Africa has the correct number of scanners to serve the insured population according to international norms. The current PET-CT centres invested millions in importing and setting up this very expensive equipment. However, after two years, these centres are not even close to covering their costs. They are still losing millions of Rands every year.

Closure of PET-CT centres would force patients who need a scan to travel overseas. Closing the centres will also affect government hospital patients. PET-CT is available at two government hospitals in Gauteng, but the state refers patients in other provinces to private centres.

Only cancer patients with top-end medical plans can currently get a PET-CT scan. Another restriction is that only an oncologist can request a PET-CT scan. The diagnosing specialist or physician cannot ask for PET-CT.

“PET-CT is 15 - 20% more accurate than other modalities in determining the stage and the extent of a cancer. Usually, a patient sees an oncologist after a specialist physician makes the initial diagnosis and surgery is performed. If the diagnosing specialist could access PET-CT, he and his patient would benefit enormously. He would be able to make decisions regarding appropriate treatment before surgery or other interventions,” said Dr Posner.

The RSSA has drawn up comprehensive and specific guidelines explaining when to use PET-CT. The cancers which PET-CT is used for are: Hodgkins, Non Hodgkins lymphoma, thyroid, head and neck, breast, stomach, testicular, oesophogael, ovarian, and melanoma.

Dr Jean de Villiers confirmed that good practice worldwide dictates that the diagnosing physician or operating surgeon can order a PET-CT scan.

“In South Africa, a cancer patient and his doctor have to submit the request for PET-CT to a peer review panel and then get medical aid authorisation. This may take up to two to three weeks to complete. This time period is critical if the cancer is malignant. The wait also adds unnecessarily to the patient's trauma,” he said.

The RSSA guidelines are so specific that any specialist can order a PET-CT scan and still meet medical aid requirements.

“We understand the concerns of medical scheme administrators that over-utilisation of PET-CT could unnecessarily raise costs. However, we only recommend PET-CT for cancer patients. Proper use of PET-CT actually lowers the overall cost of treating cancer by avoiding unnecessary surgery and modifying ineffective treatment. A single PET-CT scan provides the same information as a number of other examinations,” said Dr Clive Sperryn, president of the RSSA.

HOW PET-CT WORKS
PET CT is the only screening modality that uses size, shape, and biological activity to identify cancerous tumours. Other techniques diagnose cancer based on physical differences between normal organs and cancerous growths. This assumes the cancerous cells will be distorted. However, this is not always the case.

PET-CT works on physical AND metabolic differences in cells. A glucose-based isotope is injected into the patient. Tumours take up the isotope quicker than normal cells because they have faster biological activity. The isotope allows the tumour to show up on the scan even if the organ is not distorted.

BENEFITS OF PET-CT
PET-CT tells the specialist:
Whether the cancer it localise or spread. This information helps him decide if an operation will be successful.
Whether chemotherapy or radiation therapy is working; if not, he can adjust the dose or type of treatment at an early stage.
Whether the physical distortion of an organ after surgery is due to fibrosis, scarring, or swelling or the result of cancer cells that are still present
Medical schemes are denying their patients a world class diagnostic technique by restricting access to PET-CT. They will carry the responsibility for the loss of this technology to South Africa and their members.

A copy of the RSSA guidelines is available upon request.

Issued on behalf of the Radiological Society of South Africa (RSSA) by Health DiRxions.