Most of the patients were women with breast cancer,
and all the patients had already seen an oncologist in
a general or university hospital. When the physicians
at the second-opinion clinic reviewed pathological
and radiological charts, they recommended treatment plans different from the first opinion in more
than 100 cases—or about one in three. Half of those
were significant enough to trigger changes in the
patient’s recommended treatment, such as advising
radiation instead of surgery.
In a study led by Poch, researchers reviewed biopsy
tissue from nearly 1,200 patients with bladder cancer,
all of whom had been initially diagnosed at community hospitals. They reported in the July 2016 issue
of Urology that the second opinion would suggest the
need for treatment changes—altering a chemotherapy
regimen or recommending surgery—in 15 percent of
those patients. (The study did not follow up to see if
treatment changes were implemented.)
Poch says he hopes his study highlights the potential
benefits of second opinions, especially when a person
is first diagnosed at a small hospital that may not have
specialists who focus on certain types of cancer. The
right diagnosis has a big impact: For bladder cancer
patients, he says, it could mean the difference between
having the bladder surgically removed or not, or undergoing or skipping chemotherapy.
“There’s a lot at stake” when making diagnos-
tic and treatment decisions, agrees Mihir Parikh,
an interventional pulmonologist at Beth Israel
Deaconess Medical Center in Boston. “We like to
think we know everything and can do everything,
but a second opinion can bring an insight that I
haven’t thought about, and I welcome that.”
Parikh’s job includes offering second opinions on
the diagnosis and staging of lung cancer. Patients
with stage I or II lung cancer can undergo surgery
to have the tumor removed, but those with advanced
lung cancer are often ineligible for surgery. He says
confirming that a diagnosis is correct is important
before proceeding to surgery or other treatments.
Most of the time, he says, his evaluation backs
up what another physician has already found in
a patient. But this is not always the case. In 2014,
when Parikh worked at the University of California,
San Francisco Medical Center, a 56-year-old man
came to the clinic seeking a second opinion. He
When to Get a
• You want to be sure you have explored
• You think your doctor is underestimating
the seriousness of your cancer.
• Your doctor is not sure what is wrong
• You have a rare or unusual cancer.
• You think another treatment might be
• Your doctor is not a specialist in your type
• Your doctor tells you there is uncertainty
about the type or extent of cancer you have.
• Your doctor gives you a few different
• You’re having trouble understanding and
communicating with your doctor, or you want
your options explained by someone else.
• You just want peace of mind that you are
making the right choice.
SOURCE: American Cancer Society