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Getting A Second Opinion

A second opinion is a great tool for those who are unsure about their diagnosis and uncomfortable with the treatment options that are being offered. There are several steps in the process of achieving a diagnosis that can lead to an error in diagnosis. These range from a mistake in interpretation of the mammogram to a mistake during interpretation of the biopsy tissue. Getting a second opinion concerning the diagnosis or any stage of treatment is always your right and cannot harm you in any way.

Second Opinion from the Pathologist

One of the most common types of breast cancer that requires a second opinion to confirm diagnosis is ductal carcinoma in situ (DCIS) due to its variable appearance. This type of cancer rarely presents with an obvious lump or mass, and is usually found as a result of seeing microcalcifications on mammogram or incidentally after biopsy for another suspicious area on mammogram. Another diagnosis that is often made incidentally after biopsy is lobular carcinoma in situ (LCIS), which is a marker for increased lifetime risk of breast cancer in either breast as opposed to breast cancer itself. Approximately 17% of women with LCIS will develop breast cancer within 15 years of the diagnosis, which may cause women to undergo treatment, such as a mastectomy, for something that they may or may not have.2 Thus, making the correct diagnosis is very important.

A pathologist will examine the breast tissue on a slide, as well as test it with different stains to determine whether or not cancer is present. Occasionally, the tissue does not stain well or has a questionable appearance which can lead to a wrong diagnosis or even the inability to make a diagnosis with the tissue that they have.1 Getting a second opinion from a pathologist should be standard if there is any question about the diagnosis. The second pathologist should be experienced in evaluating for breast cancer and they may require an additional biopsy if there was insufficient tissue or if the results were inconclusive. Pathologists may actually initiate the process of getting a second opinion if they are uncomfortable with the information they have.

Second Opinion from the Surgeon and Oncologist

Some women are initially in denial of a breast cancer diagnosis, particularly if there are no masses that they can feel. A second opinion can drastically improve their ability to accept the diagnosis, which will allow them to move on with the treatment process sooner.

Women tend to choose the option that is recommended to them by their first surgeon or oncologist. They may not realize that there are other treatment options that could be available to them. However, if a second opinion confirms what the first surgeon or oncologist says, it will increase their confidence in that doctor and help them to feel completely comfortable with the decision they choose.

Difficulties In Asking For A Second Opinion

Some people already have a good relationship with their primary care physician or surgeon, which is great and can increase your confidence in their decision making. Unfortunately, this can also act as a barrier for the patient to request a second opinion.  Some patients believe that when they ask for a second opinion from another medical professional, it devalues or is disrespectful to their current medical professional. Patients must understand that this is not true and all doctors should encourage their patients to receive a second opinion. After all, the doctor wants their patient to be just as confident in them as they are of their ability to treat each patient with the best care.

Another barrier to requesting a second opinion for many patients, particularly those in smaller communities, is the lack of alternatives. There may only be one treatment facility in the area and some patients may not be able to travel to obtain a second opinion. Also, some may not have insurance that will cover additional testing or out-of-network care. These are many of the factors that can prevent a patient from getting a second opinion concerning their breast cancer diagnosis.

References

1 Staradub, V. L., Messenger, K. A., Hao, N., & etal. (2002). Changes in breast cancer therapy because of pathology second opinions . Annals of Surgical Oncology , 982-987.

2 Page, D., Kidd Jr., T. E., & Dupont, W. (1991). Lobular neoplasia of the breast: Higher risk for subsequent invasive cancer predicted by more extensive disease. Human Pathology , 1232-1239.

3 Watson, M., Greer, S., Blake, S., & Shrapnell, K. (1984). Reaction to a diagnosis of breast cancer relationship between denial, delay and rates of psychological morbidity. Cancer , 2008-2012.

4 Stafford, D., Szczys, R., & Becker, R. (1999). How breast cancer treatment decisions are made by women in North Dakota . The American Journal of Surgery , 515-519.

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.