As many as 4 in 10 women with breast cancer referred to a National Cancer Institute (NCI)-designated cancer center for a second opinion ultimately had a change in diagnosis, according to a recent study.1

This change in diagnosis was the result of review by a multidisciplinary tumor board at the cancer center.

“The treatment of breast cancer often involves not just surgery but chemotherapy, radiation, or hormonal therapy; it’s highly coordinated care,” Nancy Klauber-DeMore, MD, FACS, of Medical University of South Carolina (MUSC) in Charleston, told Cancer Therapy Advisor. “With a tumor board, everyone involved in each patient’s care can be sitting in 1 room discussing the case.”


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The multidisciplinary team can include a surgical oncologist, medical oncologist, radiation oncologist, radiologist, pathologist, genetic counselor, clinical trials nurse, nurse coordinator, and other specialist clinicians.

In this retrospective study, Dr Klauber-DeMore and colleagues reviewed data from 70 patients referred for a second opinion to MUSC between August 2015 and March 2016. Reports from the referring institutions were compared with MUSC reports.

Of the 70 cases, 25 had additional biopsies performed with new cancers found in 16 patients, or 22.8% of the total population. Additionally, 20% of patients had a change in pathology interpretation during the second opinion evaluation.

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After a complete workup, 42.8% of patients had a change in diagnosis as a result of the tumor board review.

These results really emphasize the importance of seeking a second opinion at an institution with a multidisciplinary tumor board, according to Dr Klauber-DeMore. All NCI-designated cancer centers, and probably most academic centers, have multidisciplinary tumor boards, she said. However, they are seen less commonly at community centers.

Dr Klauber-Demore pointed out that their study had a higher rate of change in diagnosis than some previous studies looking at this topic, but suggested this was because MUSC is the only NCI-designated cancer center in South Carolina. In prior research, second-opinions were examined in major cities where there are multiple academic or cancer centers, and patients were more likely to have obtained their initial diagnosis at a NCI-designated or academic center.

For example, a similar study published in 2017 looking specifically at the value of second opinion reviews of breast imaging at a cancer center found a change in diagnosis rate closer to 30%.2

In this study, Donna D’Alessio, MD, a radiologist at Memorial Sloan Kettering Cancer Center, and colleagues reviewed breast imaging studies of 200 patients who had undergone MRI and ultrasound at a community facility and then submitted those images for a second opinion at a cancer center. The second-opinion review resulted in a change in interpretation in 28% of the cases, including 13% that were recommended for a major change in management.

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“A follow-up study showed that even in patients who do not yet have a diagnosis of breast cancer, we can change their diagnosis based on the interpretation of subspecialists,” Dr D’Alessio said.

The follow-up study looked at patient-initiated second opinion in women without a diagnosis of breast cancer and showed that second opinion reviews disagreed with the original interpretation of imaging in almost one-half (47%) of lesions.3 Cancer center subspecialty expert review ultimately averted 25% of originally recommended biopsies and detected cancer in about one-third of additional biopsies recommended.

“In these situations you are not just getting 1 opinion, but seeking the opinions of multiple subspecialists,” Dr D’Alessio told Cancer Therapy Advisor. “Together these studies tell us that second opinions with a subspecialist are valuable and result in significant actional change.”

References

  1. Garcia D, Spruill LS, Irshad A, et al. 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. Ann Surg Oncol.2018;25:2953-2957.
  2. Coffey K, D’Alessio D, Keating DM, Morris EA. Second-opinion review of breast imaging at cancer center: Is it worthwhile? AJR Am J Roentgenol. 2017;208:1386-1391.
  3. Coffey K, Mango V, Keating DM, Morris EA, D’Alessio D. The impact of patient-initiated subspecialty review on patient care. J Am Coll Radoil. 2018;15:1109-1115.