Study Shows Value of Second Opinions for Breast Cancer Diagnosis

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A study done in South Carolina suggests that getting a second opinion can be valuable for people diagnosed with breast cancer: more than 40% of the people in the study who asked for a second opinion had a change in diagnosis.

Still, the study was done only at one institution, so it’s not clear if the change in diagnosis was more correct.

The research was published in the October 2018 issue of the Annals of Surgical Oncology. Read the abstract of “The Value of a Second Opinion for Breast Cancer Patients Referred to a National Cancer Institute (NCI)-Designated Cancer Center with a Multidisciplinary Breast Tumor Board.”

Many people diagnosed with breast cancer feel a sense of urgency about jumping right in and starting treatment immediately. In most cases, though, there’s time to do some research to make sure your diagnosis is correct and your treatment plan makes sense — and this may include getting a second opinion.

Getting a second opinion means asking another breast cancer specialist, or a team of specialists, to review all of your medical reports and test results, give an opinion about your diagnosis, and suggest treatment options. A second opinion may confirm your original doctor’s diagnosis and treatment plan, provide more details about the type and stage of breast cancer, change your original doctor’s diagnosis and treatment plan, raise additional treatment options you hadn’t considered, or recommend a different course of action.

This small study, done by researchers at the Medical University of South Carolina (MUSC), included 70 people who were diagnosed with stage 0 to stage III breast cancer at a different institution and came to the MUSC multidisciplinary tumor board for a second opinion between August 2015 and March 2016.

Multidisciplinary tumor boards, as the name suggests, are boards made up of medical professionals from a variety of specialties within a specific cancer field (such as breast cancer), including radiation oncologists, surgical oncologists, medical oncologists, nurse navigators, geneticists, and pathologists. The experts review a person’s records and come to a consensus about a diagnosis and treatment plan. Multidisciplinary tumor boards are becoming the standard of care at many cancer centers.

In this study, the experts on the breast cancer multidisciplinary tumor board compared the people’s radiology, pathology, and genetic testing reports from the outside institutions with test results done at MUSC.

Overall, the tumor board recommended that 43 of the 70 people have additional imaging or biopsy, which found new cancers in 16 people. The tumor board also recommended that 11 people be referred for genetic testing; genetic testing had not been recommended at the outside institution. Based on the tumor board review and the board’s second opinion, 30 people (43%) had a change in diagnosis.

"Our results show our second opinion really does provide value in potentially changing the diagnosis, which in most cases will eventually change treatment," said surgical oncologist Nancy DeMore, M.D., of the Hollings Cancer Center at the MUSC. "I would hope this study would empower patients to seek a second opinion at centers that specialize in oncology.

"Those findings would drastically change care," she continued. "In addition, we found the pathology review changed in 20% of people. And 16% of people who met guidelines for genetic testing by the National Comprehensive Cancer Network guidelines for genetic testing had not been referred for testing."

While these results are interesting, it’s important to remember that the study was done only at one institution and only involved a small number of people. So, the results should be interpreted with caution. But that doesn’t diminish the value of a second opinion for many women.

The very idea of getting a second opinion can seem overwhelming at first, especially when you’ve just been diagnosed with breast cancer. It can take time and legwork to find a second doctor, arrange for the second opinion, and deal with any insurance issues that may arise. It also can be intimidating to tell your current doctor you want a second opinion. But many people with breast cancer decide to get second opinions, and doctors are used to hearing this request. In fact, your doctor may be able to help you find another specialist who can provide a second opinion. Some insurance companies even require a second opinion before treatment begins. In general, delaying the start of treatment for a short time usually does not pose a risk, although you and your doctor can discuss your unique situation and decide how much of a delay is okay.

For more information, including deciding where to get a second opinion and how to make sense of a second opinion, visit the Breastcancer.org Getting a Second Opinion pages.

If you've been recently diagnosed with breast cancer, and would like to discuss your diagnosis and how to go about getting a second opinion with others, visit the Breastcancer.org Discussion Board forum Just Diagnosed.


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