High Error Rates
A 1999 study at Johns Hopkins University's School of Medicine found that 86 of 6,171 pathology reports, or 1.4%, contained errors serious enough to change the diagnosis. These errors included mistakes in staging, misidentification of the type of cancer, and misdiagnosis of a benign tumor as malignant (and vice versa). For example, prostate cancer staging/grading involved errors 20% of the time, skin cancer 2.9%, breast cancer 1.4%, lung cancer 0.6%, and female reproductive tract biopsies 5.1%.
A Dana Farber Cancer Institute study of 602 prostate cancer pathology reports found an error rate in the Gleason scores as high as 44%, with 10% of the pathology reports involving errors significant enough to affect treatment (mainly in the direction of combination therapy).
A study at Northwestern University of 340 breast cancer patients found that errors in breast cancer pathology reports would affect the decision to choose between a lumpectomy and mastectomy 7.8% of the time. Another Northwestern University study of 231 breast cancer patients found that second opinions resulted in changes in the management of 54 patients (23.3%).
A study of 97 bladder cancer patients at the Department of Urology at the University of Virginia Health Sciences Center found that second opinions resulted in significant discrepancies 18% of the time.
A study at Ohio State University of 295 gynecologic oncology patients found changes of major clinical significance in 14 cases (4.7%).
A study of 500 brain/spinal cord biopsy cases at the University of Texas M.D. Anderson Cancer Center found that a second opinion resulted in a serious disagreement in 44 cases (8.8%).
A study of 66 thyroid cancer patients at the Institute for Pathology at Leeds found that 18% had a different pathological diagnosis, with 7.5% resulting in a change in the management of the cancer.
When to Get a Second Opinion
Given the high error rates, it is sometimes important to solicit a second opinion. Signs that you may need a second opinion include:
- If there is a chance an error could affect the choice of treatment, get a second opinion to confirm your diagnosis and treatment plan.
- You have a rare cancer or your oncologist and pathologist do not have much experience with your type of cancer or the tissue sample is unusual in some way. In such a situation, you need to seek a second opinion from a recognized expert.
- When the pathology report is ambiguous or uncertain, a second opinion can help clarify the diagnosis.
- If your cancer is not responding to treatment or you are not satisfied with your progress, get a second opinion on the original diagnosis to make sure you're not treating the wrong type of cancer.
A second opinion may involve running additional diagnostic tests or repeating some of the old tests.
Oncologists rarely feel comfortable making a treatment recommendation based on just a pathology report unless the diagnosis is clear. They prefer to see confirmation of the diagnosis from additional tests, such as radiological exams and tumor marker blood tests.
If you don't like your doctor, a second opinion can be a first step toward switching doctors. You should get a second opinion if you are having trouble discussing your condition with your doctor, if you doctor doesn't share lab results with you, or if your doctor doesn't return your phone calls promptly.
Most insurance companies will pay for a second opinion if the patient or doctor requests it.
Only about 20% of patients seek a second opinion, and women are more likely to seek a second opinion than men.
Copyright © 2005-2018 by Mark Kantrowitz. All rights reserved.
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