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Senior Citizen Health & Medicine
Breast Cancer Patients Seeking Second Opinion
Usually Receive Treatment Changes
Multidisciplinary tumor board leads to
different interpretations
 November 29, 2006- An estimated 212,920 women
predominately senior citizens - will be diagnosed with breast cancer
this year. Considering a second opinion from a multidisciplinary tumor
board may be a good idea, according to a study at the University of
Michigan Comprehensive Cancer Center, which found more than half of the
patients seeking the second opinion received a change in their
recommended treatment plan.
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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 Centers
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.
Editor's Notes:
For more information about breast cancer
treatment, call Cancer AnswerLine at 800-865-1125 or visit
www.mcancer.org.
In addition to Sabel, U-M study authors were
Erika Newman, M.D., surgery resident; Amy Guest, M.D., radiology; Mark
Helvie, M.D., professor of radiology; Marilyn Roubidoux, M.D., professor
of radiology; Alfred Chang, M.D., professor of surgery; Celina Kleer,
M.D., assistant professor of pathology; Kathleen Diehl, M.D., assistant
professor of surgery; Vincent Cimmino, M.D., clinical professor of
surgery; Lori Pierce, M.D., professor of radiation oncology; Daniel
Hayes, M.D., professor of internal medicine; and Lisa Newman, M.D.,
associate professor of surgery.
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