Navigating a breast cancer diagnosis can be difficult, often creating a sense of urgency to begin treatment immediately.
But breast cancer is not a single disease – there are many types, and ensuring a correct diagnosis and accurate staging are both paramount to successful treatment planning.
A breast cancer second opinion from a subspecialist can help prevent the risk of misdiagnosis and provide an opportunity to confirm or optimize treatment. To dive deeper into some of the challenges radiologists encounter with diagnosing breast cancer, and to learn how a breast cancer second opinion can help avert such pitfalls, we spoke with UVM fellowship-trained women’s imaging subspecialist, Dr. Elise Hotaling.
DocPanel is committed to making sure every patient receives excellent care. If you would like an expert breast cancer second opinion from Dr. Hotaling or one of our other subspecialty radiologists, you can learn more here.
Ensuring an Accurate Diagnosis
[DocPanel] What are the different types of breast cancer?
[Dr. Hotaling]
There are multiple different types of breast cancer. About 70-80% of breast cancers are invasive ductal carcinoma. These cancers may be referred to as infiltrating ductal carcinoma or invasive carcinoma not otherwise specified.
The next most common type of breast cancer is invasive lobular carcinoma, comprising 10-15% of breast cancers. Other types of less common breast cancers include tubular cancers, mucinous (colloid) cancers, invasive papillary carcinoma, and carcinomas with medullary features.
Inflammatory breast cancer, metaplastic breast cancer, and Paget disease of the nipple are other rare forms of breast cancer.
[DocPanel] How do doctors determine the type of breast cancer? What are some of the challenges that can lead to a breast cancer misdiagnosis?
[Dr. Hotaling]
There are certain characteristics on breast exams, such as mammograms, breast MRI, and ultrasound, that help radiologists determine whether an abnormality is benign or potentially cancerous. If an abnormality is thought to be cancerous, a biopsy is then typically performed to confirm malignancy and determine the exact type of cancer.
But one radiologist may interpret the results of a breast imaging study differently than another. Their interpretation not only plays a major role in the inital classification of a tumor but also in guiding the area (or areas) that should be biopsied. A radiologist may also recommend additional imaging tests to help gather more information before proceeding with a biopsy. So there’s a lot of difficult calculating that takes specific expertise.
A study published in the Annals of Surgical Oncology found that more than 40% of the people in the study who asked for a breast cancer second opinion had a change in diagnosis.
A breast cancer second opinion may help with biopsy planning, especially if there are multiple areas of concern and it is unclear how many and which sites are recommended for biopsy. In such cases, a breast cancer second opinion decreases the likelihood of unnecessary procedures being performed. It may also help guide future treatment.
[DocPanel] What are some of the challenges in staging breast cancer?
[Dr. Hotaling]
Breast cancers are staged based on tumor size, whether it has spread outside the breast, tumor grade, and receptor status. These factors in combination determine prognosis and influence the type and benefit of treatment recommended. If a breast cancer is inaccurately staged, the wrong treatment may be recommended which would affect prognosis.
[DocPanel] What role can a breast cancer second opinion play in catching metastatic breast cancers that may have been initially missed?
Additional imaging evaluation may be recommended if there is a concern for metastasis, these may include a bone scan, CT of the chest, abdomen, and pelvis, and, occasionally, PET scans. A second opinion of these imaging studies may pick up major and ancillary findings that indicate the presence of metastatic disease that may have been missed at the initial interpretation.
Optimal Treatment Planning
[DocPanel] What role does a breast cancer second opinion play in treatment?
[Dr. Hotaling]
Each type of breast cancer responds uniquely to treatment methods. A breast cancer can also grow at different rates from person to person. So treatment must be tailored accordingly. Radiologists, surgeons, medical oncologists, radiation oncologists, and pathologists all play a vital role in determining the best treatment plan for a patient diagnosed with breast cancer. The more information doctors have, the better. A breast cancer second opinion may help provide more valuable information.
Medical imaging is also used to track treatment progress. But advanced exams, such as MRI and PET scans, are complex. A second opinion from a subspecialist can help ensure an accurate interpretation.
Getting a Breast Cancer Second Opinion
[DocPanel] How often do breast cancer second opinions result in a change of diagnosis?
[Dr. Hotaling]
Getting a second opinion has been proven to decrease the risk of medical errors. Having another set of eyes review an imaging study may lead to a major finding or reveal other breast abnormalities that would have otherwise been missed. Additionally, a re-review of an exam may also lead to a recommendation to cancel a biopsy or forgo additional imaging if the finding is felt to be benign. Having a second opinion, particularly by a subspecialist (a physician who has done additional training in an area of medicine) can also add great value in the care and management of a patient.
NEXT UP: Patient Story Feature – Mammogram and Breast Ultrasound Second Opinion Help Diagnose Tumor
[DocPanel] What questions should I ask my breast cancer second opinion radiologist?
[Dr. Hotaling]
The questions I recommend patients ask when getting a breast cancer second opinion are:
- Do you agree with the original interpretation?
- Do I need a biopsy?
- If already biopsied, has the area of concern been adequately sampled?
- Are there additional areas that need to be biopsied or followed up?
- Are the biopsy results consistent with the imaging findings?
- Should I ask for the pathologist to re -review the biopsy results?
- Would I benefit from a preoperative breast MRI?
One of the great things about getting a breast cancer second opinion is that, with companies like DocPanel, you can access highly specialized breast imaging radiologists that you may not have been able to in the town or city you live in. Being able to have a high-caliber expert review your scans can offer peace of mind or perhaps result in a life-changing recourse of action.
