Why Seek a Second Opinion?

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Simply getting a breast cancer diagnosis is good enough reason to seek a second opinion. Most people think nothing of shopping around before buying a car, renovating their home, or making some other major purchase. In the case of a cancer diagnosis, it can be helpful and even critically important to get another opinion before you make decisions about treatment.

“Because of my unique diagnosis and complex family history, there were a number of complex decisions to be made where there was no right answer,” says Marisa Weiss, M.D., president and founder of Breastcancer.org. “My medical oncologist encouraged me to seek a second opinion and was very open to getting input from other medical oncologists on the best solutions moving forward. While I didn’t seek an ‘official’ second opinion, I did reach out to several colleagues who had special expertise in the thorny areas of making decisions.”

A 2006 study of nearly 150 breast cancer patients in Michigan found that more than half were advised to change their treatment plans after getting a second opinion from a multidisciplinary tumor board made up of surgeons, medical oncologists, radiation oncologists, radiologists, and pathologists. (Most hospitals and cancer centers have a tumor board that reviews selected cancer cases — typically, cases that are more complex or challenging — and makes treatment recommendations.)

Even the most qualified, highly skilled doctors can make mistakes or differ in their opinions about what’s best for your situation and your type of breast cancer. For instance:

  • The pathologist who initially looks at the breast cancer tissue under a microscope could miss something or make a different judgment call than another pathologist would. This affects the content of the pathology report, which provides critical information about the type of breast cancer you have and becomes the basis for making treatment decisions.

    For example, research has shown that the results of testing for HER2 status are incorrect in 8% of cases, even when done by expert labs, and HER2 status can sometimes vary depending on the area of the tumor that’s tested. Inaccurate HER2 test results may cause women diagnosed with breast cancer to not get the best care possible. If all or part of a breast cancer is HER2-positive but test results classify it as HER2-negative, doctors aren't likely to recommend Herceptin (chemical name: trastuzumab) or Tykerb (chemical name: lapatinib) treatment — even though the woman could potentially benefit from those medicines. Likewise, if a breast cancer is HER2-negative but test results classify it as HER2-positive, doctors may recommend Herceptin or Tykerb treatment — even though the woman is unlikely to get any benefits and is exposed to the medicines' risks. Receiving a different interpretation than the original HER2 test results is just one example of a second pathology opinion changing a person’s treatment plan. Research shows that a second pathology opinion can change a person’s plan in other ways, such as type of surgery and other treatments.
  • Radiologists may interpret the results of breast imaging studies such as mammograms, MRI, and ultrasound differently — or make different recommendations about which additional imaging tests need to be done. Their readings can play an important role in not only diagnosing the cancer, but also planning treatments such as radiation therapy and surgery.
  • Two surgeons may differ in their opinions about the type or extent of surgery you need, as well as the best reconstructive options for you (if you choose reconstruction). Radiation and medical oncologists also may have different opinions about the treatment plan that will benefit you most after surgery, or in some cases before surgery (if treatment is needed to shrink the cancer first).

Other possible reasons for seeking a second opinion include:

  • Your doctor is not a breast cancer specialist. If your surgeon or oncologist treats many types of cancer — not just breast cancer — it may be wise to get a second opinion from a breast cancer specialist. The same holds true if the pathologist and/or radiologist involved in your diagnosis does not specialize in breast disease. A breast cancer specialist has the expertise that comes from seeing more cases and keeping up with the latest research.
  • Your doctor tells you there is uncertainty about the type or extent of the breast cancer you have. Imaging test results (mammography, MRI, ultrasound) and pathology test results (tests performed on the breast cancer tissue) are not always 100% conclusive. If your doctor expresses any uncertainty about the cancer based on your test results, it’s wise to get a second opinion.
  • Your doctor gives you a few different treatment options. Getting another perspective on those options may help with making decisions.
  • You’re having trouble understanding and communicating with your doctor, and/or you want your options explained by someone else. This can be a good time to find another specialist who takes the time to explain things in ways you can understand.
  • You have a less common or even rare type of breast cancer, such as inflammatory breast cancer or Paget’s disease of the nipple, that doctors don’t see very often. Although it may take some research and legwork, consider getting a second opinion from a doctor who studies and treats your form of breast cancer.
  • You’re doubting the accuracy of the first opinion, or you feel that all options have not been explored. Perhaps you’ve done your own research or sought advice from other women with breast cancer, and this has led you to wonder if there might be other options for you. Or maybe something just doesn’t feel right. If you’re having any doubts, it’s a good idea to get a second opinion.
  • Your health insurance plan requires a second opinion before having a particular treatment. If this is the case for your plan, then no other reason is necessary.
  • Your doctor recommends that you seek a second opinion. If your case is complex or uncertain, or more than one treatment option could benefit you, your doctor might even suggest that you get a second opinion. Many doctors welcome the input of a second expert on challenging cases.

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