Impact of Second Opinions on Time to Treatment of Breast Cancer

The Commission on Cancer (CoC) advocates that upfront breast surgery is performed within 60 days of diagnosis of stage I-III breast cancer, but it is unknown whether patients seeking a second opinion at an outside institution experience increased delays in time to first treatment (TTT). This study compares TTT between externally diagnosed patients (EDP) and internally diagnosed patients (IDP) with breast cancer.

This retrospective cohort study included patients with stage 0-III breast cancer treated at a single institution between January and July 2024. Patient demographics, date of multidisciplinary consultations, number of additional imaging tests and biopsies performed, and treatment information were reviewed. Two different TTT were calculated: time from biopsy to treatment and time from first surgical oncology clinic appointment at our institution to treatment (TCT).

A total of 226 patients (113 IDP, 113 EDP) were included. Median TCT was 21 days (IQR 12, 29 days) with no difference between EDP and IDP (20 vs. 21 days, p = 0.6594). EDP required additional imaging and biopsies more frequently than IDP (88.5% vs. 65.5%, p < 0.001). Additional workup and breast surgery with concurrent reconstruction increased median TCT (11 vs. 22 days, p < 0.0001, and 20 vs. 26 days, p = 0.0007, respectively).

Obtaining a second opinion increased the overall time from diagnosis to treatment but remained within the CoC standard. There was no difference in TCT between EDP and IDP once initiating care at our institution. Patients should not be discouraged from obtaining a second opinion on the basis of concerns about time to treatment.