Eliminating Barriers to Breast Cancer Care: The Life Saving Potential of Second Opinions through Telehealth

INTRODUCTION Cancer incidence continues to rise globally. In the United States alone, over 2 million new cancer cases and more than 600,000 cancer-related deaths are projected for 2025, reflecting a sustained increase from previous years.[1,2] Breast cancer remains a leading contributor to this burden. In 2025, approximately 316,950 new cases of invasive breast cancer and 59,080 cases of ductal carcinoma in situ (DCIS) are expected to be diagnosed among U.S. women, with an estimated 42,170 deaths.[3] Globally, breast cancer accounted for 2.3 million new cases and 670,000 deaths in 2022.[4] If current trends persist, incidence is expected to rise by 38% and mortality by 68% by the year 2050.[5] The disparity in outcomes between high and low Human Development Index (HDI) countries is stark. In very high HDI nations, 1 in 12 women will be diagnosed with breast cancer and 1 in 71 will die from it. In contrast, in low HDI countries, 1 in 27 women will be diagnosed, but 1 in 48 will die, highlighting critical gaps in early detection and treatment infrastructure.[6] DIAGNOSTIC DELAYS AND THE ROLE OF SECOND OPINIONS Delays in breast cancer diagnosis and treatment – especially among young women – remain a pressing concern. Many women under 40 report delays of 4 weeks or more from symptom onset to medical evaluation, often due to misinterpreted symptoms, lack of awareness, or provider dismissal.[7,8] These delays frequently result in more advanced disease at diagnosis, reducing treatment options and survival outcomes. Second opinions have the potential to help mitigate some of these risks. They often lead to significant changes in diagnosis or treatment planning, including the recommendation of more conservative surgical approaches or the identification of aggressive subtypes such as triple-negative (TN) breast cancer or inflammatory breast cancer (IBC).[9] However, access to timely second opinions remains inconsistent, particularly for younger women and those in rural or under-resourced communities. THE LIFE-SAVING POWER OF A SECOND OPINION – AN EXAMPLE At 28, Kommah, the author of this article, presented to her primary care provider with pain and swelling in her right breast. Over the course of 7 months, she returned multiple times as her symptoms worsened, progressing from sharp, radiating pain and nipple discharge to skin discoloration, changes in texture, prominent venous markings, and eventually a golf ball-sized axillary mass. Despite this progression and inconclusive results from mammograms and ultrasounds, she was told she was “too young for breast cancer” and diagnosed with a benign cyst. A needle aspiration yielded no fluid; yet both her primary care provider and a general surgeon resisted surgical intervention. Eventually, she insisted on surgery. During the procedure, the surgeon encountered tissue that he described as unlike anything he had seen before. Pathology revealed aggressive, TN DCIS. Initially, a lumpectomy, radiation, and potential chemotherapy were recommended. Ten days later, she sought a second opinion. This time, she received an accurate diagnosis: TN-IBC with lymph node involvement. The originally proposed treatment would have been inadequate and potentially fatal, given IBC’s rapid progression and its 95% mortality rate when misdiagnosed or undertreated. More than 20 years later, Kommah is a survivor and advocate for timely, expert second opinions as a critical step in young women’s cancer care. EXPANDING ACCESS TO CARE THROUGH TELEHEALTH As breast cancer care evolves and treatment options expand, patients today have more choices than ever before.[10] With the growing acceptance of telehealth, patients now enjoy unprecedented access to care but face the challenge of determining which service to trust. Telehealth companies such as Teladoc Health, Eagle Telemedicine, Access Telehealth, Included Health, and ClearDx are reshaping access to care during critical health events. These platforms streamline workflows, extend the reach of specialties, and alleviate staffing burdens at care facilities, allowing care teams to focus more effectively on in-person critical care patients. Benefits include reduced wait times for nonurgent cases and improved management of patient volume. These services are typically integrated into a hospital or clinic’s infrastructure and require prior authorization from insurance providers. KEY DIFFERENTIATORS Each platform approaches virtual cancer care in distinct ways, as illustrated in [Figures 1 and 2].[11-15] ClearDx is a specialized oncology second opinion provider that differentiates itself through on demand access to world class cancer experts across borders and a clear cash pricing structure (a notable industry innovation).[11] ClearDx’s direct to consumer model, which eliminates insurance hurdles and offers transparent pricing, as depicted in Figure 1,[11] may provide patients with greater control and clarity – something that is less common among larger telehealth providers. Teladoc Health stands out for its global scale and comprehensive services. It leverages a worldwide network spanning over 175 countries and is often integrated into insurance or employer plans, making cancer second opinions readily available (usually at low or no cost to the patient).[12] Included Health similarly targets insured populations through employers, providing a high touch concierge model where members receive expert cancer opinions free of charge at the point of use;[13] its focus is on matching patients with top tier specialists (mainly in the United States) for personalized guidance.Figure 1: ClearDx service process[ 11 ]Figure 2: Comparison chart – Teledoc Health, Eagle Telemedicine, Access Telehealth, Included Health, and ClearDx[ 11-15 ]Meanwhile, Eagle Telemedicine and Access TeleCare represent a different segment: they are B2B telemedicine providers for hospitals, not consumer-facing brands. Eagle and Access provide remote specialist coverage to medical facilities, thereby extending specialist access within hospital settings. For breast cancer, Eagle’s teleoncology service can connect inpatients to oncology consultations; however, these companies do not provide standalone second-opinion programs to the public. Their reach is primarily domestic (U.S.), and their financial model is based on hospital contracts and insurance reimbursement instead of upfront patient payments.[14] CONCLUSION In summary, Teladoc and Included Health offer comprehensive virtual-care ecosystems that incorporate second opinions for cancer as the part of their broader care offerings, often subsidized by employers or insurers. Clear Diagnostix focuses on cancer second opinions through a direct-pay, globally accessible platform, emphasizing specialist choice and cost transparency as key strengths. Eagle Telemedicine and Access TeleCare, on the other hand, serve institutional needs by ensuring that hospitals can offer specialist input (including for oncology in Eagle’s case) to their patients. However, they are not designed for direct consumer engagement or price transparency. It appears that the major differentiators lie in the service model (consumer vs. enterprise), the scope of the specialist network (general telehealth vs. oncology-specific), geographic reach, and pricing transparency. Each company has carved its niche: from Teladoc’s all-in-one global telehealth solution to ClearDx’s nimble second-opinion service, there are options depending on whether the priority is broad population health integration, employee health benefits, or specialized cancer care with on-demand global expertise. Breast cancer remains a major global health challenge, especially for young women who often face diagnostic delays and limited access to expert guidance. Early recognition of symptoms, prompt evaluation, and access to second opinions are essential to improving outcomes. Kommah’s story illustrates the transformative power of persistence and accurate diagnosis. In today’s evolving healthcare landscape, no woman should be told she is “too young for breast cancer.” Data availability statement Data supporting the results discussed in the manuscript are available from the corresponding author upon request.