2nd Opinions

Getting a second opinion is done routinely whenever breast cancer is diagnosed. In fact, most insurance companies will pay for second opinions.

In seeking a second opinion, the type of doctor you choose depends on what you are asking. If you are trying to decide what type of surgery to have, you would get a second opinion from a surgeon. You can ask your primary care physician or any oncologist for referrals to a second surgeon. A second surgical opinion can be the difference between needing a mastectomy or a lumpectomy.

Because all treatment is based on what is seen in your pathology report and pathologists disagree up to 25 percent of the time, it is also usually wise to request a second pathology opinion. A study, published online May 7, 2012 in the Journal of Clinical Oncology concluded: “Rates of change are significant and warrant routine secondary pathology review among patients with node-negative breast cancer or ductal carcinoma in situ before final treatment is recommended.”

This should be done by a board certified expert pathologist, from a different hospital than the first pathologist. One such expert is Dr. Michael Lagios, a world  renowned DCIS expert and pathologist, with a consulting service that anyone can use. You will also want to request and keep a copy of each pathology report for yourself.

It may be especially important to do this with a diagnosis of DCIS, since “low-grade DCIS and ADH (Atypical Ductal Hyperplasia) can look very, very similar, and distinguishing between the two is the angst of most pathologists,” explains pathologist Dr. Joan Cangiarella in a NYU Langone Medical Center newsletter.

“In 2006, Susan G. Komen for the Cure, an influential breast cancer survivors’ organization, released a startling study. It estimated that in 90,000 cases, women who receive a diagnosis of D.C.I.S. or invasive breast cancer either did not have the disease or their pathologist made another error that resulted in incorrect treatment.” This is especially true of pathologists who read less than 250 pathology cases a year, as Monica Long found out when she was diagnosed with DCIS. She tells her story in this July 19, 2010 New York Times Article article.

Pathologists can also disagree about the size, the margin width or the grade of the DCIS. One way to resolve this dilemma is by going with the opinion of the pathologist who has the most expertise. Another way is to ask for a third opinion. Even though this can be traumatic and confusing, understanding your pathology report and having confidence that it is correct is important, since all treatment options will be based solely on it.

With all the hysteria surrounding a breast cancer diagnosis today, sometimes DCIS is over treated. Hopefully in the future we will see less one-size-fits all type of treatments. Until then it would seem wise to always request a second opinion from a DCIS expert. It could possibly save you from not only an unnecessary mastectomy, but also the side effects and harms of radiation and tamoxifen.

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