Chest X-rays and Bone Scans

Chest X-rays may be performed in women who have or may have breast cancer to evaluate the slim possibility that the cancer may have spread to the lungs. This test is also used to assess the heart and lungs before a woman receives general anesthesia or chemotherapy. In women with metastatic disease that has spread to the lungs, a chest X-ray is used to check on how the disease is responding to treatment.

For women who develop a fever during chemotherapy, chest X-rays are used to check for the presence of pneumonia. If a woman experiences new shortness of breath in the first few months after radiation therapy, with or without a cough, her doctor may order a chest X-ray to see if the radiation caused any inflammation of the lungs.

Bone scans

Doctors order a bone scan (also called bone scintigraphy) to determine whether cancer has spread to any part of the bone system. Bone scans begin with an injection of radioactive material that is taken up by the body's bone-making cells. These bone-making cells are found mostly in areas damaged by disease—where they are busily trying to make new bone to patch the holes. Using a special camera, doctors are able to see these areas of extra bone activity (common in both cancer and arthritis) by detecting the gamma rays emitted by the injected material. These areas appear as dark patches on the film. Any part of the bone can be affected by cancer.

With arthritis, the radioactive material shows up on the bone surfaces of joints, not inside the bone. Sometimes it is hard to distinguish arthritis from cancer—especially in the spine. That's because the spine is made up of so many little bones and joints. For this reason, changes in the spine may require additional evaluation.

A bone scan is used to evaluate persistent or progressive bone pain in a woman with invasive breast cancer. Even without symptoms, bone scans may be done at initial diagnosis to see if the bones are OK, and to establish a baseline set of images to compare to future ones.

There is no need for yearly follow-up bone scans if you don't develop any symptoms. The exam is expensive and time-consuming, and studies have shown that it won't improve your quality of life or length of survival. Yet if you're experiencing persistent back or leg pain, a repeat bone scan that shows no change from the baseline study is usually reassuring. Back pain is a common problem, but if you've had breast cancer it can cause a great deal of anxiety.

Bone scans are not necessary for women with non-invasive breast cancer ("DCIS").

It's important to know that a bone scan to detect the presence of bone metastases is different from a bone density study (DEXA scan is the most popular type), which evaluates bone strength and your risk of osteoporosis.