How valuable is a second opinion for breast cancer diagnosis?
Surgical second-opinion programs have continued to expand since their development in the 1970s but a standard for assessing whether the first or second opinion is correct does not exist. Results of a recent study suggests that for women with breast cancer, a second opinion about their diagnosis from a National Cancer Institute (NCI)-designated cancer center may change recommendations for imaging and referrals.
Published in Annals of Surgical Oncology, the retrospective study reflected cases from August 2015 to March 2016 at the Medical University of South Carolina (MUSC). The researchers looked at data from patients who presented to MUSC for a second opinion after being diagnosed with breast cancer at an outside institution. Radiology, pathology and genetic testing reports from the other institutions were compared with the MUSC findings after review by a multidisciplinary tumor board (MTB) and subsequent testing. The authors then categorized the cases based on whether diagnostic variations were present or not.
Charts from 70 patients were included in the analysis. After the MTB review, 43 (61%) of the 70 second opinions resulted in identification of additional calcifications or lesions, more imaging, or recommendations for additional breast or axillary biopsies. Furthermore, in 16 of the 43 women, additional ipsilateral, contralateral, or axillary lymph node metastases were found. Thirty additional biopsies also were done on 25 patients. Of them, 16 (64%) resulted in discovery of an additional cancer, which accounted for about 23% of the 70 patients presenting for a second opinion.
Changes in pathology were not as dramatic and there were fewer as a result of the second opinions (14/70, 20%). The most frequent variation was a change in histology (10%). In regard to genetic testing, 11 of the 70 patients (15.7%) met National Comprehensive Cancer Network guidelines for testing but had not been offered it before their second opinions. Of those 11 women, two were found to have variants of unknown significance, but the finding did not change their disease management.
Given the significant number of new or changed diagnoses acquired through additional testing and imaging in this study, the authors believe it illustrates the value of a second opinion from a MTB or women with breast cancer. However, they noted a few limitations of their research.
They did not assess whether change in diagnosis resulted in change in management. The study also did not look at the clinical course of the individual tumors in relation to their pathologic diagnosis. As a result, it was not possible to determine whether the first or second diagnosis was more correct. The authors also pointed out that only six of the 70 patients seen had their first opinion at a medical research center.