Diagnosis

How to Approach Second Opinions When Getting a Breast Cancer Diagnosis

Kevin Knopf, MD Health Guide June 29, 2007
  • I suppose an easy answer is – when you want one. 


    I think the two most common reasons patients get second opinions are (1) to gather information and see if the recommendation one doctor makes is similar to another, and (2) to find a doctor they feel comfortable with.  The second reason is equally important as the first – if you don’t feel comfortable with your oncologist and have a choice, you might see whether another doctor has a personality more to your liking.

     

    I’m writing this after a patient has had a second opinion with me (and a third opinion with another oncologist in my building) – in this case she decided to stay with me but it’s interesting that in the same city she had two similar recommendations and one different opinion.  In her case, two of us, including me, recommended a more modest chemotherapy program than the third doctor.


    Why was there a disagreement?  The published literature on breast cancer is written in black and white ink, but many areas are still grey and open to interpretation.  The features of her cancer were such that she was in a very grey area at this point in time.  Listening to a CD-ROM of medical oncologists from Harvard, MD Anderson, Sloan Kettering and several other prestigious institutions debating how to manage patients with different presentations of breast cancer, I was struck by the differences in opinions, even among academic physicians.  It just shows that often there may not be one right answer for a patient.

     

    Of course no doctor likes to “lose” a patient to another doctor.  But if a patient asks me about a second opinion, I recommend they have one, and I tend to offer the name of one or two medical oncologists whose opinions I would like to hear.

               

    You may actually be getting a second (or multiple) opinions that you weren’t aware of – for example I work right next to Dr. X, and across the hall from Drs. Y and Z (we’re a group of four).  Occasionally, we present cases to each other in very quick ways – like this two minute second opinion a few weeks ago:

     

    Dr. X: “I’m going to see a 44-year-old woman with a stage III locally advanced, ER- PR- Her2+…what do you think?”
    Me: “How about neoadjuvant TCH?  I’ve used that several times and each patient had a complete pathologic response – now there’s good data from San Antonio.”
    Dr. X: “Hmmm...that’s a good idea.  I think I’ll discuss that with her..”

     

    So often I will bounce a case off Dr. X and vice versa – it keeps us on our toes and is one of the things I like about being in a group.  Another format is our breast conference where we might present a case to get input in a “multidisciplinary format.”  Once in a while, I will email my mentor in Chicago, a brilliant oncologist, or several other colleagues across the country for their advice, as well.