US study looks at second opinions in breast cancer
WASHINGTON (Reuters) - Breast cancer patients were urged to change their treatment plans more than half the time when they received a second opinion from a team of specialists, U.S. researchers reported on Wednesday.
Overall, 52 percent of patients whose original diagnosis and treatment recommendations were taken to a multidisciplinary team were advised to make one or more changes in their treatment, the researchers at the University of Michigan Comprehensive Cancer Center found.
The changes were a result of breast imaging specialists reading a mammogram differently or breast pathologists interpreting biopsy results differently, the researchers reported in this week's issue of the journal Cancer.
The team, called a multidisciplinary tumor board, included surgeons, radiation oncologists, medical oncologists, radiologists and pathologists.
"A multidisciplinary tumor board that involves the collaborative effort of multiple medical specialties allows expert opinion and recommendations based on the most recent research findings," said Dr. Michael Sabel, a surgeon who worked on the study.
"Meanwhile, the patients come to only one setting, with no need to visit multiple specialists individually."
His team looked at the records of 149 breast cancer patients referred to the Cancer Center's multidisciplinary breast tumor board for a second opinion.
They found the original doctors often did not consider new surgery techniques, such as delivering chemotherapy before surgery to help save more of the breast, or sentinel lymph node biopsy, a new technique that helps find whether cancer has spread beyond the breast.
And radiologists reinterpreted imaging results in 45 percent of patients, in some cases identifying previously undiagnosed second cancers.
More than a quarter of patients were advised to have another biopsy.
Specialized breast pathologists made new interpretations of how aggressive a tumor, or what type of tumor it was, in 29 percent of patients, the researchers found.
More than 200,000 U.S. women will be diagnosed with breast cancer this year, according to the American Cancer Society, and 40,000 will die of it. Globally, 500,000 women die every year from breast cancer.
What breastcancer.org says about this article…
US study looks at second opinions in breast cancer
The study reviewed here found that a second opinion from a group of breast cancer experts was different in some way from the original treatment recommendations given to women with breast cancer more than half the time. Sometimes the diagnosis was different because of a different interpretation of a mammogram or biopsy. Sometimes the treatment plan was different because of a different opinion on when a particular treatment should be given.
These variations in diagnosis and treatment opinions may reflect true differences of medical interpretation. But bad medical judgment or a doctor's not knowing about new treatment options and research also can lead to recommendations that are not the best for you. Dealing with a breast cancer diagnosis is scary and overwhelming. Worrying about whether the diagnosis and treatment plan are right only adds to your anxiety.
There are a number of steps you can take to make sure that your diagnosis and decisions about treatment options are right for you:
- Don't be shy about asking for one or more second opinions. You might feel uncomfortable doing this, especially if you have great confidence in your doctor. But don't worry. Doctors are very familiar with second opinions. Insurance companies sometimes require them before certain treatments. Many doctors welcome a second opinion since it can reinforce their recommendations.
- Make sure that all of the doctors who are or will be caring for you are talking to each other. Surgeon, pathologist, medical oncologist, and radiation oncologist all can be members of your care team, and you should expect them to be working together to decide what's best for you. Don't be shy about this. Insist that your whole team agree about your diagnosis and treatment. If there are differences of opinion, tell your doctors you want to know about them. Don't hesitate to ask for opinions from other experts.
- Do your own homework about your diagnosis and treatment options. breastcancer.org exists to help you learn about breast cancer. The more you know, the more you can participate in your own care. Don't be afraid to ask questions and to bring up treatment options that your doctors may have not mentioned.
You are the most important member of your treatment team. Every woman is different and every breast cancer treatment plan will be different. By talking to your doctors and working together, you can all decide what is best for YOU.