Second Opinions – My Story
by Sandie Walters
In her book The Breast Book, Dr. Susan Love recommends to always ask for a second opinion, so I did. I was referred to another surgeon. When she said she thought she could treat my DCIS with a breast conserving lumpectomy that would only leave a small dent, I could have kissed her.
I also requested a second pathology opinion. My surgeon suggested Dr. Michael Lagios, a world-renowned DCIS expert and pathologist, with a consulting service anyone can use. He reviewed my pathology and concurred that I had DCIS.
Finally in December of 2007, I had a lumpectomy. The surgery went well, except the pathology report said some DCIS still remained. Once again I was told I would need a mastectomy. In my despair, I faxed Dr. Lagios’ office and asked if I had any other options.
I was very surprised when he called me himself and suggested I go to Arkansas for an Aurora RODEO MRI with Dr. Steven Harms. Since this is a more sensitive MRI, used only for breast imaging, he thought it might help locate exactly where any residual DCIS was, so my surgeon could do a tailored re-excision, rather than a mastectomy.
I traveled to Arkansas, where they did biopsies on two suspicious areas. Both were benign. As thrilling as this was, it also raised some obvious questions. If both suspicious areas were benign, why had my post surgical pathology report shown residual DCIS ?
Since Dr. Harms had reassured me the rate of false negatives for the RODEO MRI was 1 in 3000, I was confident that the RODEO MRI had not missed anything.
The only other possible explanation was that the local pathologists had mistakenly seen DCIS where there was none. Apparently, a pathologist’s opinion can be quite subjective with disagreement as much as 20 percent of the time. Again Dr. Lagios reviewed my pathology. This time he disagreed with my local pathologists. Not only did he give me clear margins, but he also reclassified my DCIS lesions as low grade. We deferred to his expert opinion, since not only was he a world-renowned DCIS expert, but his opinion had also been verified by Dr. Harms’ biopsies.
Not only did I no longer need a mastectomy, but using the Van Nuys Prognostic Index, Dr. Lagios calculated my risk of recurrence as only four percent without radiation. Because I had such a low risk and radiation can only be given once in the same area, I opted to save it for any invasive cancer that might appear later.
Dr. Lagios recommended I have a mammogram and MRI in one year as a follow up. Getting second opinions paid huge dividends for me. Because I asked, I was not only able to avoid a mastectomy, but also radiation.