A biopsy came back with inconclusive results, and Ms. Harwell wasted no time in seeking a second opinion at MD Anderson Cancer Center in Houston. "I went through every test in the book," says Ms. Harwell. Still, doctors couldn't be sure what she had. Finally, she underwent a surgical procedure to diagnose her case: It wasn't ovarian cancer after all, but a rare form of lymphoma. The 47-year-old horse trainer in Collinsville, Texas, underwent a rigorous regimen of chemotherapy that ended last spring. At her first six-month checkup in October, she received a clean bill of health.
Brandon Thibodeaux for The Wall Street JournalDawna Harwell, a horse trainer at Kyle Ranch in Whitesboro, TX
Dawna Harwell
Age: 47
Occupation: Horse trainer in Collinsville, Texas
July 2008: Diagnosed with tumors in abdomen, pelvis and spine. Ovarian cancer is suspected.
August 2008: Seeking a second opinion, Ms. Harwell meets with a gynecological oncologist at MD Anderson. Results of additional tests are inconclusive, and doctors say a surgical biopsy is needed for a definitive diagnosis.
September 2008: Results of an operation and surgical biopsy rule out ovarian cancer, but confirm Stage IV follicular lymphoma.
October 2008: Ms. Harwell begins chemotherapy, which continues through April 2011.
October 2011: Her first six-month checkup shows cancer is stable with no signs of tumors.
Evidence is mounting that second opinions—particularly on radiology images and pathology slides from biopsies—can lead to significant changes in a patient's diagnosis or in recommendations for treating a disease. Some malignancies, including lymphomas and rare cancers of the thyroid and salivary glands, are notoriously tricky to diagnose correctly; test results can be inconclusive or return false results. After a decade of annual mammograms, more than half of women will receive at least one false positive recall on a breast-cancer screening, a recent study found. And nearly half of malpractice claims at Harvard University's medical institutions that resulted in serious patient harm or death in the past five years were diagnostic errors, according to its liability company Crico/RMF.
Thomas Feeley, vice president of medical operations at MD Anderson, says as many as 25% of patients who arrive at the center with diagnoses for certain cancers such as lymphoma may receive a different diagnosis. Overall, 3% of MD Anderson patients ea
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