Second Opinions Beneficial for Patients With Breast Cancer

A recent retrospective analysis examined the changes in diagnosis after a second opinion for patients with breast cancer from a multi-disciplinary tumor board (MTB) review at a National Cancer Institute (NCI)-designated cancer center.

The study analyzed patients receiving a breast cancer diagnosis at an outside institution who presented for a second opinion from August 2015 to March 2016 at the Medical University of South Carolina. Researchers compared radiology, pathology, and genetic testing reports from outside institutions with reports generated after an MTB review and subsequent workup at the hospital. The cases were categorized based on whether there were diagnostic variations.

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The review included 70 patients seeking second opinions, of which 33 (47.1%) had additional radiologic images. In total, 30 additional biopsies were performed for 25 patients, with new cancers identified in 16 patients. Thus, 16 (22.8%) of the 70 patients had additional cancers diagnosed.

Specifically, for 14 (20%) patients, a second opinion led to a change in pathology interpretation. Further, genetic testing was performed for 11 patients (15.7%) who met the National Comprehensive Cancer Network guidelines for genetic testing, though none of the results showed a significant mutation. After a complete workup, 30 (42.8%) of patients had a change in diagnosis. However, the authors do note that “one major flaw in second-opinion studies is that no ‘gold standard’ exists for pathology to assess whether the first or second opinion is correct.”

Though MTBs have been implemented across the nation and are becoming the standard of care in cancer centers, according to the authors, studies and reviews assessing the efficacy and utility of MTBs still need to be evaluated.

Overall, the researchers concluded that the findings of the review support the notion that a referral for a second opinion is beneficial and has a diagnostic impact for many patients.

Reference

Garcia D, Spruill L, Irshad A, Wood J, Kepecs D, Klauber-DeMore N. The value of a second opinion for breast cancer patients referred to a National Cancer Institute-designated cancer center with a multidisciplinary breast tumor board. Ann Surg Oncol. 2018; 25(10):2953-2957. link.springer.com/article/10.1245%2Fs10434-018-6599-y. Published July 3, 2018. Accessed October 5, 2018.