Second Opinion often Yields Treatment Changes

Breast cancer - it´s a matter of
interpretation; © NCI Visuals Online

Researchers looked at the records of 149 consecutive patients referred to the University of Michigan Cancer Center´s multidisciplinary breast tumour board for a second opinion. The patients had already been diagnosed with breast cancer after having undergone initial evaluation, breast imaging and biopsy, and they already had a treatment recommendation from another hospital or care provider.

Overall, 52 percent of the patients evaluated had one or more changes in their recommendations for surgery. The changes were a result of breast imaging specialists reading a mammogram differently or breast pathologists interpreting biopsy results differently. In some cases, the initial recommendation was changed after the case was reviewed by medical oncologists and radiation oncologists prior to surgery.

The study authors found the initial treatment recommendations often did not consider new surgery techniques, such as delivering chemotherapy before surgery to make breast conservation possible or sentinel lymph node biopsy, a new technique to determine whether cancer has spread beyond the breast. 32 percent of patients had their surgery recommendations changed based on a multidisciplinary approach to surgical management

The researchers found radiologists re-interpreted imaging results in 45 percent of patients, in some cases identifying previously undiagnosed second cancers. More than a quarter of patients were recommended to undergo another biopsy.

In addition, a dedicated breast pathologist can make a difference in how the cancer is staged, which in turn can affect treatment recommendations. In this study, the tumour board pathologists interpreted test results differently in 29 percent of patients. For some patients, this meant a change in diagnosis, for other patients it affected the aggressiveness of their tumour.

A multidisciplinary tumour board includes a network of specialists from different disciplines devoted to treating breast cancer, including surgery, radiation oncology, medical oncology, radiology and pathology.; Source: University of Michigan Health System