Scanxiety and Cancer Surveillance: Rethinking the 'More Is Better' Mentality
By Sarah Friend, MD
The Idea Behind Scanning Sounds Logical—But the Reality is Different
When you finish cancer treatment, it’s natural to want reassurance. As an oncologist, I understand how powerful it feels to walk into a clinic, get a scan, and hear, “Everything looks good.” In the New England Journal of Medicine article “Routine Surveillance for Cancer Metastases—Does It Help or Harm Patients?” Drs Welch and Dossett discuss the data behind surveillance testing.(1) Their conclusion was surprising and counterintuitive.
It’s one of the most common things patient’s ask for: more scans, more bloodwork, more checks. And on the surface, it seems obvious—catching something early must be better, right?
But even though surveillance tests bring peace of mind in the short term, research shows they don’t necessarily help people live longer better. In fact, sometimes they can cause more harm than good.
Let’s walk through why
The thinking goes like this: If we catch recurrence early—before symptoms start—you’ll have a better chance at treatment success. And when researchers look at simple survival numbers (like 5-year survival rates), it looks like people who catch recurrences earlier live longer.
But there’s a big problem hidden in those numbers: it’s called a lead-time bias. If we find a recurrence early, it starts the clock sooner. That makes it seem like people live longer after the recurrence—but they might not live longer overall. They just knew earlier.
The only way to really know if early scanning saves lives is through randomized controlled trials—where people are randomly assigned to routine scanning or symptom-driven follow-up and compared fairly.
And when researchers have done these kinds of studies?
The answer has been surprisingly clear: Routine scans don’t save more lives.
Across 12 clinical trials looking at imaging after cancer treatment, none showed a real survival benefit from early scanning. It was essentially a coin toss—half the time the people who got routine scans did a little better, half the time they did a little worse. The same goes for blood tests, like CEA in colon cancer, PSA in prostate cancer, and even the newer blood-based DNA tests (ctDNA): no proven survival benefit—at least not yet.
So If Scanning Doesn’t Help You Live Longer, What’s the Harm?
You might wonder—even if it doesn’t help, what’s the harm in checking? Unfortunately, there are real downsides:
- “Scanxiety”: Worry before, during, and after scans—sometimes lasting days or weeks.
- False alarms: incidental findings leading to more tests, biopsies, or even surgeries for things that may never have mattered
- Financial Burden: copays, missed work, travel costs—it all adds up, often without insurance covering it fully.
- Earlier side effects: If a recurrence is found, treatments (like chemotherapy) start sooner—at a time when you might have been feeling perfectly fine.
Sometimes, finding a recurrence earlier doesn’t even change the treatment plan. In many cancers, especially if metastases are found, treatment is aimed at control—not cure. In those cases, knowing earlier doesn’t improve outcomes—it just makes patients live longer knowing the cancer is back.
But What About the Reassurance from Negative Scans?
It’s true—a clean scan can feel reassuring. But studies show that reassurance often fades quickly, when the anxiety cycle (waiting, worrying, wondering) keeps repeating every few months.
And crucially, there’s no evidence that getting routine “clean” scans improves your overall quality of life.
If people were fully informed—knowing scans don’t extend life, might cause more harm, and cost significant money—many might choose a different path.
Where Do We Go From Here?
I believe patients deserve honesty, compassion, and the full picture. That means:
- Focusing on symptoms: If you have a new symptom, please call us. Evaluating real symptoms saves lives.
- Being mindful about tests: Scans and blood tests should have a clear purpose—not just be “routine.”
- Reducing unnecessary anxiety and cost: Your peace of mind matters—but so does protecting your quality of life.
In breast cancer, for example, guidelines specifically recommend against routine imaging or lab tests for asymptomatic survivors. Instead, the emphasis is on open communication, physical exams, and addressing symptoms as they arise.
A Final Thought
We all wish there were a simple way to guarantee cancer would never return. But sometimes, medicine’s best path forward is counterintuitive: less is more.
Choosing not to scan routinely isn’t “doing nothing.” It’s a thoughtful, evidence-based decision to focus on your well-being—not just your worry.
Given this context, the decision about if and when to order scans should an individualized conversation between patients and their doctors. If patients are having symptoms (such as cough, abdominal pain, or bone pain) they should notify their doctors, who will likely act swiftly to get scans to look for recurrence. So routine scans are not recommended, but diagnostic are often done in the correct clinical setting.
(1) “Routine Surveillance for Cancer Metastases—Does It Help or Harm Patients” H. Gilbert Welsh and Lesly Dossett. NEJM 392; 17. May 1, 2025.
