It's early morning and a team of more than 20 professionals cram around a long table in a dark room, peering at slide after slide of black-and-white mammogram images crossing the screen.
All the stories are different. The ages of the patients. The stages of the cancer. The prognosis. The diagnosis.
What remains the same throughout each case, though, is the intensity of the discussion and the wide breadth of comments based on the specialty of the medical professionals who are weighing in. There are radiation oncologists, surgical oncologists, medical oncologists, breast cancer nurse navigators, radiologists, geneticists and pathologists, all with their pagers on silent.
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Some of the questions on the table: Does this patient have the right diagnosis? What's the best treatment? What are other lifestyle considerations? Do they need cryopreservation - freezing of their eggs to preserve fertility? What are their wishes in how they get treated?
Occasionally, the professionals disagree. The discussion deepens, as the options are debated.
At the head of the table guiding the discussion is surgical oncologist Nancy DeMore, M.D., of the Hollings Cancer Center at the Medical University of South Carolina. She, more than most, knows the value of a multidisciplinary tumor board. It's one reason she and colleagues decided to conduct a study.
Published in the Annals of Surgical Oncology, the study looked at the value of a second opinion for breast cancer patients referred to a National Cancer Institute-Designated cancer center with a tumor board. Researchers concluded that a review by a multidisciplinary tumor board at an NCI-Designated cancer center changed the diagnosis for 43 percent of the patients who presented for a second opinion for breast cancer.
"Our results show our second opinion really does provide value in potentially changing the diagnosis, which in most cases will eventually change treatment," she said. "I would hope this study would empower patients to seek a second opinion at centers that specialize in oncology."
Researchers in this retrospective study analyzed breast cancer patients who had been diagnosed at an outside institution and who received a second opinion at MUSC Health from August 2015 to March 2016. Radiology, pathology and genetic testing reports from outside institutions were compared with reports generated after a review by a multidisciplinary tumor board and a subsequent workup at MUSC.
