Scientific Studies Increasingly Clarify the Importance of a Second Opinion in Breast Cancer

Breast cancer has seen some of the most substantial recent advances. Changes in imaging, pathological assessment, molecular pathology and medical treatment, alongside radiotherapy and surgery, significantly benefit patients. To translate these innovations appropriately into care, skilled specialists must evaluate patients through a multidisciplinary approach.

Correct assessment of breast biopsy is essential for medical oncologists, radiation oncologists and surgeons to plan treatment. Today, biopsy reports evaluate many factors together.

The Main Factors Include;

• Tumor estrogen and progesterone receptor density, expressed as ER and PR positivity or negativity,
• Tests of suitability for targeted molecular treatments, expressed as cerbB2,
• Values such as "ki67" and "grade" determining tumor biology and aggressiveness.

These results directly affect treatment planning. As a medical oncologist, my first step when assessing breast cancer pathology is checking whether it comes from an experienced center. If the original center sees insufficient patient numbers or lacks attention to this issue, I always obtain a pathological second opinion from a trusted center.

The study discussed here confirms the need for care. Second opinions from an experienced center in more than 200 patients produced striking findings.

Reexamination of samples from 205 patients referred from elsewhere identified serious differences in 52 (%25.4). Major report changes led to reclassification of 33 (16%), while 19 (9.2%) had minor changes. More than one major change occurred in 6 reports. Principal differences involved histological classification (12 cases), presence or absence of ductal carcinoma spread (15 cases), hormone receptors (5 cases) and HER2 (7 cases).

More strikingly, two cases diagnosed as invasive ductal carcinoma, breast cancer, were actually benign tumors; four diagnosed as breast cancer were lung cancer metastases to the breast. Three cases diagnosed as breast cancer spread to axillary nodes were actually skin cancer. These are major changes.

In conclusion, a second breast pathology opinion can reveal important differences affecting treatment. An experienced center may uncover assessment errors approaching %30. This is substantial. In %16, namely among 205 patients in 33 cases, major changes potentially affecting planning and treatment were found. This deserves serious attention. Increasing cancer-specific centers have made expert teams easier to reach. If diagnosed at a center lacking competence or sufficient experience because it sees few patients, we recommend a second opinion from specialists.