Deciding Where to Go for a Second Opinion

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After talking to your doctor, your next step is to find a doctor (or doctors) who can review your case and give you a second opinion. Your best bet is to find a breast cancer specialist who works as part of a multidisciplinary team that includes surgeons, medical oncologists, radiation oncologists, pathologists, and radiologists. That specialist often will become the “point person” for getting second opinions from other experts, and his or her office staff can assist you with this. However, there may be cases in which you approach individual experts on your own — such as if you’re only seeking a second opinion from a pathologist, but no one else.

If you’re concerned about costs, you may want to limit your search to doctors who are part of your health plan (also called preferred providers) or who accept your health insurance. Also, be sure to investigate what your insurance covers. Some plans will pay for certain types of second opinions but not others. For example, some plans may cover a treatment second opinion but not a pathology second opinion. If cost is no object, then go to the best doctor you can find whose expertise seems best for your situation.

Pathology opinions

If you’re seeking a second opinion on treatment (see below), the specialist you choose often will be able to order a pathology second opinion for you, through his or her hospital’s pathology department. However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. Even if you live far away from a major cancer center, you can get a second opinion from a pathologist there. A pathologist would need your tissue samples and the initial pathology report.

Treatment opinions

To get a second opinion on your treatment plan, you might start by asking your physician if your case is likely to be reviewed by the hospital’s tumor board. A tumor board is a group of cancer specialists from different disciplines (such as surgery, medical oncology, radiation oncology, and pathology) who meet to review a patient’s case and make treatment recommendations. This kind of review may provide all the confirmation you need to proceed with treatment — or it may raise new questions you can discuss with your physician.

In most cases, though, you will need to find another breast cancer specialist for a second opinion. Generally, another physician — whether a surgeon, medical oncologist, or radiation oncologist — will require an in-person visit and physical exam before giving a second opinion about the details of your diagnosis and treatment plan. It’s best to look outside your current physician’s hospital or medical center, since doctors within the same institution may share the same ideas about treatment approaches. Try to find someone who works as part of a multidisciplinary team of specialists so that you can gather second opinions on treatments such as surgery, radiation, chemotherapy, and hormonal therapy all in one place.

Give some thought to how far you can travel and how much expense you’re willing to take on in order to get a second opinion. You might want to seek out a physician at a hospital or cancer center close to home. This is likely to be quicker and easier for you — and it can give you the option of switching to the second doctor if you decide this is in your best interest. On the other hand, you might not mind traveling to another city if you find a top specialist who has the expertise you’re seeking. Sometimes, family and friends in that location can provide some assistance and a place to stay. If you live in a remote area with limited options for medical care, or you have a rare form of breast cancer, getting a second opinion from a breast cancer specialist at a well-known cancer center can be especially worthwhile.

A few major medical centers — such as the Cleveland Clinic, Johns Hopkins, and Harvard-affiliated Partners HealthCare — now offer online second opinion services that don’t require an in-person visit. A specialist would review all of your test results and other information to compile a report of recommendations about your care, which is then sent to you and/or your current doctor. Because this type of service is so new, insurance companies don’t always cover the expense. Some state medical boards don’t allow remote second opinions, so you also would need to call the cancer center or check the website to find out whether residents of your state are eligible. If it’s impossible for you to travel but you really want a second opinion from a physician at a top-flight institution, this may be a good option for you.

If you live outside the United States, keep in mind that many major cancer centers offer programs specifically designed for international patients seeking second opinions. Just two of many examples are MD Anderson Cancer Center’s International Center in Houston, TX and Johns Hopkins Medicine International in Baltimore, MD. These and other cancer center websites can walk you through the process of seeking a second opinion. If traveling to the U.S. is not an obstacle for you, you might want to consider it!

Tips for finding a specialist for a second opinion

You may find the following tips helpful as you search for a specialist who can give you a second opinion:

  • Ask the doctor who diagnosed your breast cancer or is treating you now. You might phrase your request this way: “If you or your loved one were in my situation, whom would you consult about the diagnosis and treatment of the breast cancer? Which specialist(s) would you see?” Ask your doctor to recommend someone at another institution. You also could pose this question to a nurse, social worker, or your own primary care physician.
  • Search the websites of major cancer centers or medical centers in your area, or call the physician referral line. You should be able to find the names of physicians who specialize in breast cancer, along with information about their backgrounds and training. If traveling outside your area is an option, then you can do a broader internet search for breast cancer specialists.
  • Target your search within the National Cancer Institute (NCI)-designated cancer centers. The NCI, part of the federal government’s National Institutes of Health, has recognized 67 cancer centers nationwide for “scientific excellence and the capability to integrate a diversity of research approaches to focus on the problem of cancer.” Most of these centers treat people with cancer, although some focus only on research. Breast cancer experts at these centers are likely to be up-to-date on the latest diagnostic techniques and treatment options. In addition to searching online, you can call the NCI’s Cancer Information Service at 1-800-4-CANCER or consult with an information specialist through LiveHelp.
  • Use your network of family and friends. You probably know people who have been affected by breast cancer — either through their own diagnosis or the experience of a family member. Ask around and find out which doctor(s) they saw and whether they were happy with the care they received.
  • Post a request to an online forum or support group, such as the discussion boards right here at Breastcancer.org. People in your immediate area or region of the country may have recommendations based on their own experiences and research.
  • Look into online second opinion services such as those at the Cleveland Clinic, Johns Hopkins, and Harvard-affiliated Partners HealthCare.

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