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Johns Hopkins Health - Second Opinions, Second Chances

Fall 2010
Issue No. 10

Second Opinions, Second Chances

Date: October 20, 2010

man with petri dishes

It’s in your best interest to ask for another look at a cancer diagnosis

If you’ve recently been diagnosed with cancer, it’s wise to ask for a second opinion on your pathology specimen.

Johns Hopkins researchers with the Urological Pathology Consult Division, led by Jonathan Epstein, M.D., first reported on biopsy errors a decade ago, when they found a margin of error in prostate cancer diagnoses large enough to give them pause. According to the study, one in every 600 diagnoses showed mistakes.

“This study only addressed major changes in diagnoses, such as a diagnosis of cancer being reversed to no cancer,” says Johns Hopkins pathologist George Netto, M.D. “It didn’t look at changes of grading of the cancer.”

The chances for some type of modification based on a second opinion are even greater than the study indicated.

“Asking for a second opinion could lead to a significant change in surgical or medical intervention,” Netto says.

Even if the diagnosis error isn’t catastrophic, such as advising a patient that he has cancer when he really doesn’t, an error in grading can be consequential. Netto points to prostate cancer as an example: If your diagnosis changes from a higher grade to a lower grade cancer, it could mean having the option to avoid radical treatment.

Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. Last year, Epstein’s lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions.

Netto says patients should be proactive in requesting that doctors take another look.

“A second opinion can reverse the diagnosis in up to 5 percent of cases for some types of cancers,” he says, “like those of the breast and pancreas.”

Diagnosis Errors by the Numbers

  • The margin of error is 1.4 percent, which is equivalent to 30,000 cancer diagnosis mistakes annually in the U.S.
  • Of 6,171 biopsy slides sent since late 2008 for a second review at Johns Hopkins, pathologists disagreed with the diagnosis on 86 of them.
  • 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system.

Learn More
For more information about pathology second opinions, visit or call 877-546-1872.

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