Second opinion yields treatment changes for half of patients

More than half of breast cancer patients who sought a second opinion from a multidisciplinary tumor board received a change in their recommended treatment plan, according to a new study from the University of Michigan Comprehensive Cancer Center.

A multidisciplinary tumor board includes a network of specialists from different disciplines devoted to treating breast cancer, including surgery, radiation oncology, medical oncology, radiology and pathology.

Researchers looked at the records of 149 consecutive patients referred to the U-M Cancer Center’s multidisciplinary breast tumor 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.

Results of the study appear in the Nov. 15 issue of the journal Cancer.

“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. Meanwhile, the patients come to only one setting, with no need to visit multiple specialists individually,” says study author Michael Sabel, M.D., assistant professor of surgery at the U-M Medical School and part of the U-M Cancer Centers multidisciplinary breast tumor board.

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. Thirty-two 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. Previous studies have documented variation in how radiologists interpret mammograms. Those who specialize in breast imaging tend to detect more abnormalities.

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 tumor 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 tumor.

U-M established one of the first multidisciplinary breast care centers in 1985 to provide comprehensive diagnosis and treatment for women with benign or malignant disease. U-M currently has multidisciplinary clinics in 11 tumor types.