Second Opinions in Breast Cancer Surgery: What Have We Learned?

Abstract

Introduction: Second-opinion consultations (SOCs) provide many benefits. However, duplicate office visits and the logistics of transferring medical records may be concerning for delaying treatment. There is currently no clear understanding regarding the characteristics of patients with breast cancer who desire second surgical opinions or if this contributes to delays in care. Methods: A review of our institutional database from July 1, 2019, to December 31, 2019, identified breast cancer patients who were documented to be SOCs or primary consultations (PC). Neoadjuvant chemotherapy patients were excluded. Comparisons of patient characteristics, tumor characteristics, and surgery factors were performed using chi-square analysis. All analyses were two-tailed and statistical significance was assigned at p <0.05. This study was deemed IRB-exempt. Results: In our review, 158 breast cancer patients were identified, 21 (13.3%) SOCs and 137 (86.7%) PCs. Of the SOCs, 90% (19/21) underwent surgery at our institution. The study revealed an increased incidence of SOCs in those patients who ultimately underwent mastectomy (p=0.039) as well as those with lower pathologic T stage (p=0.021). There were no other differences in demographics, surgery, or tumor characteristics. No delay was seen in time for treatment. Conclusions: Patients who sought second opinions were more likely to undergo mastectomy and had lower pathologic tumor size. The time from biopsy to surgery appointment was longer in patients who sought second opinions but there were no differences in the time from biopsy or surgery appointment. It is encouraging that those who sought second opinions did not face any delay in care once established.