Format

Send to

Choose Destination
Breast Cancer Res Treat. 2018 Jan;167(1):195-203. doi: 10.1007/s10549-017-4432-0. Epub 2017 Sep 6.

Second opinion strategies in breast pathology: a decision analysis addressing over-treatment, under-treatment, and care costs.

Author information

1
The Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, One Medical Center Drive Level 5 WTRB, Lebanon, NH, 03756, USA. anna.n.a.tosteson@dartmouth.edu.
2
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
3
Department of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health Sciences University, Portland, OR, USA.
4
Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
5
The Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, One Medical Center Drive Level 5 WTRB, Lebanon, NH, 03756, USA.
6
Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
7
Department of Family Medicine, University of Vermont, Burlington, VT, USA.
8
Department of Family Medicine, Oregon Health Sciences University, Portland, OR, USA.
9
Department of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
10
Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
11
Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
12
Department of Pathology, UVM Cancer Center, University of Vermont, Burlington, VT, USA.

Abstract

PURPOSE:

To estimate the potential near-term population impact of alternative second opinion breast biopsy pathology interpretation strategies.

METHODS:

Decision analysis examining 12-month outcomes of breast biopsy for nine breast pathology interpretation strategies in the U.S. health system. Diagnoses of 115 practicing pathologists in the Breast Pathology Study were compared to reference-standard-consensus diagnoses with and without second opinions. Interpretation strategies were defined by whether a second opinion was sought universally or selectively (e.g., 2nd opinion if invasive). Main outcomes were the expected proportion of concordant breast biopsy diagnoses, the proportion involving over- or under-interpretation, and cost of care in U.S. dollars within one-year of biopsy.

RESULTS:

Without a second opinion, 92.2% of biopsies received a concordant diagnosis. Concordance rates increased under all second opinion strategies, and the rate was highest (95.1%) and under-treatment lowest (2.6%) when all biopsies had second opinions. However, over-treatment was lowest when second opinions were sought selectively for initial diagnoses of invasive cancer, DCIS, or atypia (1.8 vs. 4.7% with no 2nd opinions). This strategy also had the lowest projected 12-month care costs ($5.907 billion vs. $6.049 billion with no 2nd opinions).

CONCLUSIONS:

Second opinion strategies could lower overall care costs while reducing both over- and under-treatment. The most accurate cost-saving strategy required second opinions for initial diagnoses of invasive cancer, DCIS, or atypia.

KEYWORDS:

Breast cancer diagnosis; Cost; Decision analysis; Overdiagnosis; Pathology; Second opinion

PMID:
28879558
DOI:
10.1007/s10549-017-4432-0
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center