Second Opinion Yields Treatment Changes For Half Of Patients

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Second Opinion Yields Treatment Changes For Half Of Patients

http://www.sciencedaily.com/releases/2006/11/061129151415.htm

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 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 multidisciplinary tumor board consisted of surgeons, oncologists,

radiologists, pathologists, radiation oncologists, and nurses. The changes in

treatment recommendations were made after experts had reexamined the data on

each

patient, and in many cases, after ordering further diagnostic tests, including

additional imaging or histologic staining.

Many of the changes were made after breast-imaging experts on the board

reread the mammograms — they changed the previous interpretation in 45% of

cases

(67 of 149 patients). The most common change was the identification of

additional lesions, and 43

patients (29%) were recommended to undergo an additional biopsy or an

alternation in follow-up imaging. In all, 16 of 149 patients (11%) were

recommended a

change in surgical management based on a review of breast imagining — 8

patients on the basis

of the radiographic review alone, and 8 patients as a result of the

additional biopsies.

Dedicated breast pathologists reviewing the histology slides changed the

interpretation in 29% of cases (43 of 149 patients). For instance, 26 patients

(17%) had changes in tumor grade or subtype, and 6 patients (4%) originally

diagnosed with ductal carcinoma

in situ had their diagnoses changed to lobular carcinoma in situ and/or

atypical ductal hyperplasia. Solely as a result of pathological

reinterpretation, a

change in surgical management was recommended for 13 patients (9%).

Both of these findings tie in with those of other groups and " suggest that

expert radiology and pathology assessment is necessary in the routine treatment

of breast cancer, " the authors conclude.

In 48 patients (32%), changes were recommended not on radiologic or

pathologic findings, but on the opinion of surgeons, radiation oncologists, and

medical

oncologists, all following guidelines laid down by the National Comprehensive

Cancer Network. " In

some cases, this represented a difference in the management approach, " the

authors write. For instance, they note that 11 patients were initially

recommended to undergo a mastectomy. " However, after review at the tumor board,

our

recommendation was for

neoadjuvant chemotherapy with a possible attempt at breast conservation

therapy, " the authors write.

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. 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.

Cancer, Vol. 107, issue 10, pp. 2346-2351

From Breast Cancer Options- What You Need To Know

It’s always wise to get a second opinion on what type your cancer is, and how

it should be treated. After you get a pathology second opinion, you should

get second opinions about your treatment options. That will give you more

information and help you choose a course of care. A second opinion is

particularly

important if your cancer was discovered by a doctor without much experience in

dealing with your type of cancer.

New developments in cancer treatment are happening so fast that it’s

practically impossible for every doctor to be aware of all the most up-to-date

ways to

deal with the disease. The best doctor to see is one who has had many years

experience in treating

your type of cancer.

Studies have shown that one in five cancers are incorrectly diagnosed or

staged. And in one study, more than half of the women interviewed had not been

told all their surgical options at their first surgical consultation.

Get a second opinion outside the first doctor's medical practice or cancer

center. Often doctors who work together don't like to disagree with each other.

No reputable physician will question your right to a second opinion. Remember,

you are creating a healthcare team to help you. Your health is the primary

objective. You have a right to support and open communication from all your

healthcare providers.

When you go for a second opinion, take your current doctor's diagnosis and

treatment plan with you, along with your pathology report. Take all related test

results, tissue slides, x-rays and/or other imaging you have undergone so

they will not need to be redone. The doctor should review your medical records

and automatically reevaluate your diagnosis to make sure that its an accurate

second opinion.

There is an excellent chance that your second opinion will mirror your first

opinion with regard to diagnosis and treatment recommendations. If so, you can

move forward with treatment, confident that you are doing the right thing.

If the second opinion does not concur with the first, your are faced with the

dilemma of opting for a third opinion, or returning to your original doctor

and requesting that he or she engage in a constructive dialogue with the doctor

who rendered the conflicting

opinion. It's possible that after they share the reasons for their opposing

opinions, they will find common ground and agree on the best course of action

for you.

The important thing is that you must be able to trust and believe in the

persons charged with your care, so that you can focus your energies on getting

better and moving ahead with your life.

You can get second opinions from a:

breast surgeon

pathologist

radiation oncologist

medical oncologist

Here are some questions to consider:

1. How many women are treated for breast cancer at this hospital each year?

2. How many mammograms are performed each year at this facility?

3. How many stereotactic breast biopsies are performed each year?

4. How many surgical procedures to treat breast cancer are performed each

year?

5. How many women have radiation therapy or chemotherapy for breast cancer at

this

center?