In Reply We appreciate the interest and comments from Finger and colleagues. However, we respectfully disagree that our article overly emphasized the risks of aggressive metastatic surveillance. In our article, we presented numerous clinical regimens including single whole-body PET/CT scan, single CT scan of the chest/abdomen/pelvis, annual or biannual scans for 5- or 10-year periods, and calculated lifetime attributable risks for each of these protocols, in addition to the most aggressive surveillance protocol. While we did not specifically calculate the risk of a yearly abdominal CT in a 60-year-old patient with choroidal melanoma as Finger and colleagues suggested would constitute a more typical regimen, we did calculate and report the lifetime attributable risk of a yearly CT scan of the chest/abdomen/pelvis in a 50-year-old patient with choroidal melanoma as 0.9% for men and 1.3% for women over a 10-year period. We chose to estimate the lifetime attributable risk of cancer for 20-year-old men and women with an aggressive surveillance protocol to demonstrate the upper limits of cancer risks and also to emphasize to the clinician that younger patients carry higher risks. Our references to “significant” radiation risks were made with respect to these aggressive surveillance protocols and not to single or occasional imaging studies.
Wen JC, Sai V, Straatsma BR, McCannel TA. Radiation-Related Cancer Risk Associated With Radiographic Imaging—Reply. JAMA Ophthalmol. 2013;131(9):1249. doi:10.1001/jamaophthalmol.2013.4507