Who is Eligible for PET Scans in Ontario?

When government insistence on cutting costs runs up against increasingly technologically advanced modern medicine, the resulting tangle of public health regulation can be just as complicated and unhelpful as the convoluted policies of any private health insurance company. An excellent example of this is the current situation for Ontario residents seeking PET scans. I'm providing this page as a guide for Ontario residents and an illustration of medical rationing gone mad.

PET scans, including combined PET/CT scans (the current standard of care), are an important tool in detecting, staging, and restaging many types of cancer, including lymphoma. PET scans may use a mildly radioactive tracer molecule, like FDG, which is absorbed in the body like sugar. Cancerous cells tend to demand more than their fair share of sugar, so they light up on the PET scan. Or they do in some provinces, anyways. According to the Canadian Agency for Drugs and Technologies in Health (CADTH), Quebec, with a population of about 8 million, conducts 21,000 PET scans a year. Ontario, with a population in excess of 13 million, funded just 2000 PET scans a year, although that number is probably now increasing substantially thanks to new funding provisions.

In the Ontario provincial healthcare system, there are several methods for qualifying for a PET scan from PET Scans Ontario. The bright side is, there's no waiting list. Unfortunately, that's because PET scans are strictly rationed. Only one of the criteria is directly relevant to lymphoma patients, and it includes only some lymphoma patients:


OHIP Criteria -- Since 2009, the Ontario Health Insurance Plan (OHIP) has provided public funding for PET scans for people with certain medical conditions. These are:

• assessments for certain candidates for heart surgery and heart transplants
• solitary pulmonary nodule where no needle biopsy is possible
• suspected recurrent colon cancer when other scans are negative
• non-small cell lung cancer which may be curable through surgery, or which is Stage III and may be treated through radiation and chemotherapy
• small-cell lung cancer which is early-stage and may be treated through radiation and chemotherapy
• post-chemotherapy Hodgkin's and non-Hodgkin's lymphoma, when potentially curative additional therapy is under consideration
• recurrent or persistent germ cell tumours when other scans are negative
• recurrent or persistent thyroid cancer

PET Registry -- The older PET Registry Program provides funding for PET scans for patients with several other conditions:

• assessment of response to treatment in testicular cancer, following an inconclusive biopsy
• staging of esophageal cancer
• staging of melanoma
• staging of pancreatic cancer

Clinical Trials -- Finally, patients may get PET scans for certain conditions by enrolling in a clinical trial. As of January 2011, the Ontario Clinical Oncology Group lists the following trials involving PET scans:

• during treatment for breast cancer (together with MRI)
• assessment for cervical cancer
• suspected relapse of lung cancer, breast cancer, head and neck cancer, ovarian cancer, esophageal cancer, or any form of lymphoma

PET Access Program -- Patients who do not fit any of the public funding criteria above can still have their doctors apply for a PET scan. Their application will be reviewed on a case-by-case basis by the PET Access Program. According to Cancer Care Ontario, the Access Program received 170 applications between 2006 and 2008, and granted just 68 of them (40%).


Private Scans -- People with ample financial resources may want to leave the public system and purchase a private PET scan. CARE Imaging, in Toronto, provides PET scans for about $2500, which incidentally is around twice the cost of a scan in the public system.