Getting a Second Opinion After a Breast Cancer Diagnosis

When, where, how, and why to get a second opinion after a breast cancer diagnosis

Quick summary

Getting a second opinion after a diagnosis of breast cancer is almost always a good idea -- and not just from another oncologist. Consider enlisting the expertise of another pathologist to doublecheck the lab findings. This is important, since an accurate diagnosis is key to getting exactly the right type of treatment. Breast cancer surgery is another area where a second opinion is extremely important.

Should everyone who's diagnosed with breast cancer get a second opinion?

Generally, yes. In cases where breast cancer is in the very early stage and treatment seems straightforward, it may be safe to follow the oncologist's recommendation without getting another opinion. But when it comes to breast cancer, there are many different treatment options, and researchers are releasing new information all the time. Some doctors may be less current on the latest research than others. One way to think about it: In order to play it safe, it's almost always best to err on the side of more information and options, rather than less.

Why should I get a second opinion about a breast cancer diagnosis?

Two minds are better than one. The two doctors may agree with each other, confirming that the treatment plan is reasonable. However, if the oncologist has made a mistake -- and mistakes do happen -- a second opinion could make all the difference in outcome. Sometimes, for example, one doctor will say that the cancer is too advanced to operate, while another oncologist -- who might be more familiar with that particular type of cancer or with the surgical procedure that would be required to remove it -- will consider it operable. In other cases, bringing in a specialist leads to the discovery that it's a different kind of breast cancer altogether. The new oncologist may have more experience with a certain type of breast cancer or may interpret the test results differently or decide to run new tests, which could provide new insight. If you're trying to decide whether getting a second opinion is worth it, ask yourself whether you'd go the extra mile if a second examination discovered that the tumor is a more treatable type than the first doctor believes.

How can I avoid offending the doctor?

You may be concerned that the oncologist or surgeon will take your request for a second opinion as an expression of doubt or lack of confidence. Keep in mind that doctors receive this request very frequently. While some oncologists do resist when patients ask for a second opinion, most are supportive of the idea. No matter which way the oncologist reacts, all patients have the right to get a second opinion, and you may need to assume the role of advocate to make sure it happens. (For more information on this issue, see " What's the best way to ask for a second opinion on how to treat my mother's breast cancer? ")"Some doctors appreciate it when you want to bring in another expert because then the decision about treatment doesn't rest solely on their shoulders," says Bonnie Bajorek Daneker, author of The Compassionate Caregiver's Guide to Cari ng for Someone With Cancer . In cases where there's more than one treatment option to choose from, Daneker says, the doctor may welcome having another expert weigh in.

How do I find the right oncologist for a second opinion?

You can start by checking the credentials of other doctors at the same hospital or facility. But it's often a good idea to consult another facil ity altogether, such as a major cancer center. If the expert you choose is far away, your oncologist may be able to work with him or her via telephone or e-mail consultations. While this sounds awkward, it can deliver a big payoff. A specialist may know of a promising treatment that a local oncologist who hasn't seen many such cases doesn't know about. And if it's a treatment that's only available in a particular location, it may well be worth traveling for. Bringing in a specialist might also help you or the person in your care gain access to a clinical trial if that's a viable option.

Is it a good idea to get a second opinion on the pathology results?

Yes, a second opinion from a pathologist can be extremely valuable. A pathologist is a doctor who specializes in reading and interpreting lab results; the oncologist is the doctor who treats the diagnosed breast cancer . It's important to feel confident that the original diagnosis was made correctly, particularly if there's any question about the interpretation of the biopsy or lab results, or if there's more than one possible plan of action. Pathologists aren't infallible in interpreting lab results, and a second opinion is the most effective way for patients to uncover and correct errors that might result in an incorrect diagnosis. Because the treatment plan depends on the particular type of breast cancer and how far it has spread, the interpretation of the pathology can dramatically affect treatment and prognosis.

How do I get a second opinion from a pathologist?

Start by obtaining a copy of the pathology report and cell slides from your doctor, and then seek out pathologists who specialize in the type of cancer the doctor has diagnosed. There are a number of renowned cancer institutes that offer pathology services nationwide. One of the most respected is the Armed Forces Institute of Pathology , in Washington, D.C., which offers the most advanced diagnostic and imaging techniques. Other pathology services are available at major cancer centers such as Dana Farber , in Boston, and the M.D. Anderson Cancer Center , run by the University of Texas in Houston. You might even want to send the slides to more than one pathologist. Usually, the more information you have, the better off you are. If a pathologist doesn't agree with the original interpretation, she can perform additional studies to confirm or correct the original diagnosis.One caveat, however: If the oncologist tells you that the cancer is aggressive and there's no time to waste, it may be a mistake to delay while waiting to obtain a second opinion. There's nothing more disheartening than consulting a special ist who finds new cell growth that has occurred since the original tests were performed.

Should I get a second opinion from another surgeon?

If the oncologist has referred you to a particular surgeon, you'll want to check out that surgeon's credentials and, if possible, interview him or her. Whether you accept that surgeon depends on the type of breast cancer and how common the indicated surgical procedure is. If the cancer is in the early stage and the advised procedure is common, it may not be necessary to get a second opinion or to look for a specialist. However, if the cancer has spread to other organs, it's a good idea to look for a surgeon who has extensive experience performing that specific type of surgery.

How will I know if I have the right surgeon?

If you have a choice of surgeons, start by looking for someone who has treated this form of cancer. The questions you might ask when choosing a surgeon include:

  • How often do you perform this type of surgery?
  • How many of these procedures have you performed?
  • What's the overall success rate for this type of surgery?
  • What's the success rate for those surgeries that you've performed?

What else should I find out from the surgeon?

You'll want to talk to the surgeon about other issues, such as what to expect during and after the procedure. This kind of information can affect important treatment decisions.

If the person in your care is extremely frail, for example, and you discover that the surgery is very demanding, the recovery time long, and the percentage of patients with positive outcomes low, you might rethink your treatment options. To zero in on this information, ask the surgeon to list all the risks and complications, even rare on es, and to give you a realistic estimate on recovery time.