You can get a second opinion at any point during the cancer care process. At the very least, though, it’s a good idea to seek one before starting treatment, because a second opinion can change the details of your diagnosis, suggest other treatment options, or even change the course of treatment entirely.
It can take up to a few weeks to get a second opinion. In most cases, this delay is not a problem and will not interfere with the effectiveness of your treatment. Just be sure to confirm with your doctor that waiting a bit to start treatment is OK.
The following are some common points at which people choose to get second opinions (and the first three often overlap because they all happen before treatment starts). Of course, each individual’s situation is different. You can work with your doctor and close family members or friends to decide what is best for you.
- When the pathology report is complete: Your doctor will order a series of tests on the cancer and nearby tissues to create a “profile” of how the breast cancer looks and behaves. Much of this work is done by a pathologist, a doctor trained to look at the tissue under a microscope to provide details about the diagnosis. Other results come from specialized lab tests done on the tissue. All of these results together make up your complete pathology report, which provides the information you and your doctor need to make the best treatment choices for your particular diagnosis. Even one mistake or misreading by a pathologist or testing lab potentially could alter your treatment plan in a way that does not make sense for you. If you’re thinking about a second pathology opinion, call your insurance company to make sure this service is covered. Sometimes, insurance companies only pay for a physician to give a second opinion about your original pathology results.
- Before having surgery: Imaging studies such as mammograms, ultrasound, and MRIs play a key role in determining the extent of the breast cancer. It can be helpful for a second radiologist to look over your images and give his or her opinion of the results. If you’re debating over what type of surgery to have — lumpectomy versus mastectomy, for example — it can be helpful to get a second opinion from another breast surgeon. If you’re planning breast reconstruction, talking with more than one plastic surgeon is a good idea, given that several reconstruction options are available. And if your doctor has recommended neoadjuvant treatment — chemotherapy or hormonal therapy to shrink the tumor before surgery — you may want to get a second opinion about this.
- When planning treatments after surgery: As you may know by now, treatment options after surgery can include radiation therapy, chemotherapy, hormonal therapy, and targeted therapies such as Herceptin (chemical name: trastuzumab). Within each category, there can be different forms of treatment and ways of giving them. The details of your diagnosis, along with your individual needs and preferences, will determine which treatments are appropriate for your situation. Once you and your doctors make a treatment plan, you may wish to get a second opinion from a medical oncologist, radiation oncologist, or both.
- During treatment, if there is any reason to believe a change in strategy might be in order: Maybe the prescribed treatment is not working as well as expected, or you have treatment-related problems or questions that you and your current doctor cannot resolve. Perhaps you’re just not comfortable with the way some aspect of your care is being managed. If you’re wondering whether a change in approach might be useful, it’s worth seeking a second opinion.
- After treatment, if you did not get a second opinion before: If you’ve already completed treatment for breast cancer and never thought about getting a second opinion, you’re certainly not alone. It’s not too late to get one. A second set of experts can review the details of your diagnosis and treatment plan and offer reassurance or additional advice.
On the other hand, you may be very comfortable with your original physician’s assessment and the treatment plan you’ve come up with together. You may not be interested in seeking a second opinion. “I think it’s fine to not seek a second opinion as long as your doctor has the expertise and judgment that you need,” says Dr. Marisa Weiss, president and founder of Breastcancer.org. “I would verify things by going online, researching your physician, and talking to your physician’s other patients. Just don’t be passive about it. When you’re feeling overwhelmed, anxious, and confused, it’s easy to be seduced by making the fastest decision to just get the whole thing behind you. Rushing can lead to poor decisions and mistakes. We’re not talking about buying a blender here!”
"My treatment was initially going to be limited to surgery. After the surgery, I went to another hospital for a second opinion. It was a good thing I went — it turned out that the original pathologist missed the positive margin of cancer cells against my chest wall. After that discovery, my doctor recommended chemo and radiation.” — Claire Nixon, senior editor, Breastcancer.org
Kutluk Oktay, M.D.