Does that MDS diagnosis need a second opinion? An interview with Mikkael Sekeres
A recent study led by Mikkael Sekeres, Chief of Hematology (Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, CA, USA), has demonstrated that blood cancers known as myelodysplastic syndromes/neoplasms (MDS) are commonly misdiagnosed, putting patients at risk for treatment mistakes and other potentially harmful consequences. The findings were recently published in Blood Advances. In this interview we provide you with a breakdown of key points of the research.
In what ways can misdiagnoses of MDS lead to suboptimal treatment decisions?
MDS is a tricky cancer to diagnose, as the diagnosis depends on accurate analysis of cell morphology, immunophenotyping, and genetics. The wrong diagnosis can lead to patients being undertreated, for example if MDS is mistaken as a vitamin deficiency, or overtreatment, if the opposite occurs – if a benign condition is mistaken for MDS.
How do errors in population-based estimates of MDS incidence and mortality occur due to misdiagnosis and what implications do these errors have for both clinical practice and public health planning?
When misdiagnoses occur, population estimates in disease. – in registries such as SEER or cancer registries – can miss the mark, and either overestimate or underestimate population incidence rates and prevalence. This, in turn, affects allocation of appropriate resources to treat conditions such as MDS, and survival estimates. In the case of MDS, we believe these population registries underestimate both the incidence and prevalence of MDS, and the impact of the disease on healthcare resource use. For example, patients with MDS, who tend to have anemia or low platelet counts, use a disproportionate amount of blood products.
Given the effects associated with misdiagnosis of MDS, what strategies or improvements could be implemented to enhance the accuracy of initial MDS diagnoses. Also, how can healthcare professionals work together to minimize the occurrence of misdiagnoses and subsequent negative outcomes for patients?
We need to do a better job in education patients that, for rare bone marrow cancers such as MDS, a second opinion is a must – and that second opinion includes both a meeting with a clinical expert to help guide treatment recommendations, and a second opinion about the diagnosis, from a pathologist, to ensure that the diagnosis is accurate.
Interviewee profile:
Mikkael A. Sekeres joined the University of Miami Health System and Sylvester Comprehensive Cancer Center as Chief of the Division of Hematology. He earned his medical degree and a Master’s Degree in clinical epidemiology from the University of Pennsylvania School of Medicine (PN, USA). Sekeres completed his postgraduate training at Harvard University, finishing an internal medicine residency at Massachusetts General Hospital and a fellowship in hematology-oncology at the Dana Farber Cancer Institute (MA, USA). He chaired the Oncology Drugs Advisory Committee of the US FDA, has been on the editorial boards for several medical journals, and chairs scientific advisory boards for patient advocacy groups and research funding agencies.