What things should I be asking about in seeking a second opinion about my breast cancer?
Some important thoughts.
If you are seeking a second opinion for your breast cancer, there are several aspects to
that process.
As an example if you come to my institution and come to see me as an example, we would
have you bring with you all reports about your care so far that would include the reports
and films or CD of your mammograms, ultrasound examination, core biopsies, whatever it may
be related to the imaging part of having a diagnosis made.
Second, we would ask you to bring with you, your pathology slides.
These are the slides that were made of the needle biopsy done that made a diagnosis of
breast cancer.
My hospital as an example as part of the policy here at St. Joseph Hospital as a mandated
second opinion of looking at slides to make sure that the diagnosis is correct and giving
the subtleties of making diagnoses in breast cancer, that's an important second opinion
review.
Now, another aspect of second opinion review could be about the surgery that has been recommended
and as I tell patients all the time, we typically have multiple choices of surgery, breast conservation
with various types of radiation therapy versus mastectomy with or without reconstruction,
oncoplastic reconstruction, nipple sparing mastectomies, a variety of different surgical
options that higher end institutions can offer.
There may be a second opinion needed about whether you need chemotherapy as an example
and so one of the questions might be have you had a gene analysis done of the core biopsy
of your tumor, a good example this would be an Oncotype DX test.
There may be differences of opinion concerning needing or not needing chemotherapy or the
different kinds of chemotherapy programs or we call them regimens that you may be needing,
then finally there may be in fact great debate or need for second opinions when it comes
to radiation therapy.
Do I need radiation therapy at all as an example in women older than age 70, do I need whole
breast radiation therapy or can I have part of my breast to radiate, am I a candidate
for intraoperative radiation therapy, so it is typically all of those elements that go
into giving a second opinion.
At my institution cases were also presented in a multidisciplinary panel involving all
the specialists who in fact provide a second opinion on site for the cases diagnosed here
as well as cases from the outside, so if you seek a second opinion be sure that you have
all the materials needed.
All reports, all images, all pathology slides, and all relevant documents, so that the process
can be really thorough and complete for you to have an adequate second opinion.