Although people think of medicine as a science—the facts reveal the diagnosis, the diagnosis dictates the treatment—most physicians acknowledge that medicine is as much an art as a science. It’s not like a simple math equation with one undeniably right answer. Even when the diagnosis is clear, there may still be multiple appropriate treatment paths that deliver similar outcomes. And there are many cases where the diagnosis is not definitive, especially in the case of complex diseases and many types of cancer.
That’s why a second opinion is an important tool for people who have received a cancer diagnosis. Not only can it help lower the risk of misdiagnosis or an inappropriate plan of treatment, but it’s also essential for decision making. A second opinion from a specialist who has extensive experience treating people with the type of cancer you’ve been diagnosed with can change or confirm your diagnosis.
In terms of treatment options, a second opinion is an opportunity to get a comprehensive understanding of all the appropriate possible treatments. This information can help you make a fully educated and informed decision. For example, some men diagnosed with prostate cancer can choose a path of active surveillance, delaying or avoiding surgery, which can cause significant side effects for some men. For some types of liver cancer, undergoing a biopsy to assess for genomic mutations can lead to more targeted therapy options.
A second opinion can help ensure you are receiving the most appropriate treatment from the start, which can have a tremendous impact on the outcome of your treatment. It’s difficult for any one physician to be absolutely up-to-date on new diagnostic and treatment options, clinical trials, and other information that can affect their clinical decisions. In addition, even highly regarded experts sometimes disagree on which treatment approach is most appropriate for a specific patient.
Some people who’ve been diagnosed with cancer don’t want to take the time needed to get a second opinion because they feel they must start treatment as soon as possible. For most types of cancer, however, there’s no need to rush to begin treatment immediately, and there are benefits to taking the time to seek a second opinion.
Studies support the benefits of seeking a second opinion after a cancer diagnosis
A number of studies have examined the effects of second opinions for people diagnosed with cancer and found that receiving a second opinion from an experienced specialist had a significant impact on diagnosis, treatment, or both. One study conducted at the Medical University of South Carolina (MUSC) found that the diagnosis was changed for 43% of women with breast cancer who were referred for a second opinion at a National Cancer Institute-designated cancer center with a tumor board.
In the study, the researchers compared the radiology, pathology, and genetic testing reports from the outside hospital with reports developed after the cases were reviewed by MUSC’s tumor board. Nearly 23% of the patients had additional cancers diagnosed in one of the breasts or a lymph node in the armpit. The pathology review changed in 20% of the cases. And 16% of the patients who met guidelines for genetic testing by the National Comprehensive Cancer Network had not been referred for testing that could affect which type of treatment they received or how well certain types of chemotherapy would work.
Other studies reaffirm the value of a second opinion from an experienced specialist. One study focused on PET/CT scans of people diagnosed with diffuse large B-cell lymphoma. In 36% of the cases studied, researchers found the second opinion lead to a change in staging, which can affect the choice of treatment.
Another study focused on the effects of a second opinion from a specialist at a comprehensive cancer center on biopsies for patients with bladder cancer. In that study, biopsies were performed and read at a community hospital. When a genitourinary pathologist at a comprehensive cancer center reviewed the same group of biopsies, the review resulted in a change in pathology reading for 24.7% of the biopsies. These changes affected the grade of tumor and stage of cancer, with 15.8% of these patients receiving a different treatment recommendation. Major changes in treatment recommendations occurred for 11.8% of these patients.
And in a study of patients with orthopedic cancers, a review of MRI studies by musculoskeletal radiologists found a 22.2% rate of clinically significant difference that had the potential to change the original diagnosis between the first interpretation and the second opinion.
All of these studies, and others not cited here, suggest that whenever possible, people diagnosed with cancer should consider seeking a second opinion from a specialist who has extensive experience in the diagnosis and treatment of the cancer they face. Seeking that second opinion has become easier in recent years, with the rise in the number of virtual second opinion programs at centers of excellence around the country. These programs provide access to top specialists without the need to travel to the center for the appointment.
Miles J. Varn is chief executive officer, PinnacleCare, and can be reached on LinkedIn.
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