By Irene S. Levine, PhD

When Sue Wood, 49, a speech pathologist and mother of two, went for her annual mammogram four years ago, it never occurred to her that the exam would be anything other than routine.

“I am a small-breasted woman and I had always thought, ‘That’s one benefit. I’ll never get breast cancer,’” says the resident of Williamsville, N.Y., Wood also felt confident knowing that just three months earlier she had a breast examination, as part of her regular gynecological exam.

But her sense of security unraveled the moment she received the mammography results. The radiologist told her that the films showed a small mass in her left breast. She asked to have a biopsy the same day and was shocked to learn that the suspicious tissue tested positive for cancer.

Wood initially thought she wanted a mastectomy but her surgical oncologist, Stephen Edge, M.D., chairman of the department of breast and soft tissue surgery at Roswell Park Cancer Institute in Buffalo, explained that in her case, there was no survival benefit to a mastectomy(1) as opposed to a lumpectomy(2).

One week later, Sue had a lumpectomy and sentinel node biopsy(3) followed by an axillary node dissection(4). At her next appointment, Wood learned that the cancer had spread to 12 of 14 lymph nodes. Her surgeon recommended chemotherapy and radiation and told her there was no need to rush. Even so, Sue felt compelled to move quickly. “I had this horrible feeling that I had this cancer inside me and I wanted it gone,” she says. “It felt like my life was suddenly spiraling out of control.”

Sue decided that she owed it to herself to get a second opinion. Fortunately, her older sister is married to a breast surgeon at the University of Michigan so she arranged to have her reports faxed to him.

The second opinion was totally consistent with the first, confirming the bad news that the cancer had spread. Yet, by having the diagnosis and the recommended course of treatment confirmed, Sue feels she has taken a first step in regaining control of her life. “There is no doubt in my mind that every woman should have a second opinion to help confirm that she has made the right choices,” she says.

“It’s very easy when you are sick to do things just because a doctor tells you to. This isn’t the thing to do when it comes to breast cancer.”

A breast cancer diagnosis leaves many women feeling vulnerable. These feelings may cause them to be reluctant to ask their doctor about a second opinion, fearful that he or she will become angry or resentful, experts say. “A lot of women don’t want to offend their physician,” says Cheryl Perkins, M.D., a breast cancer survivor who serves as senior clinical advisor for The Susan G. Komen Breast Cancer Foundation. “But if a woman receives advice that she isn’t comfortable with, it is always a good idea for her to consult someone else. Women need to be empowered to take charge of their own health.”

Dr. Edge agrees with the value of a getting a second opinion, despite the fact that it may slightly delay treatment. “In general, for most breast cancers, waiting a couple of weeks to be better informed does not jeopardize long-term outcomes,” he says.

“People should not feel pressured to start treatment tomorrow. In fact, it should be considered a red flag, if someone says, ‘We have to do your surgery tomorrow.’”

Another formidable barrier to obtaining a second opinion can be its expense, particularly for the uninsured. Fortunately, many private insurers will pay for second opinions but it is always prudent to find out about your coverage in advance by calling your health insurer. Medicare Part B pays 80 percent of the approved cost of a second opinion. And if the second opinion turns out to be inconsistent with the first, Medicare will provide similar coverage for a third opinion.

Once a patient decides to get a second opinion, he or she should look for a board-certified breast surgeon, experts say. Edge suggests that a patient ask a family doctor for a recommendation or even ask the doctor who provided the first opinon for some names. Other options include checking with a local hospital, finding an academic medical center, or obtaining recommendations from family or friends who have had a similar illness and were satisfied with their treatment.

In the case of a diagnosis of a rare or complex type of cancer, a woman may want to seek care at a multidisciplinary breast care center to benefit from the advice of a team, which may include specialists in breast surgery, pathology, medical oncology, and radiation oncology, says Edge. He advises women to bring copies of all pertinent information that will be needed for the consultation, including medical records, x-rays, ultrasound films, and pathology slides. Most of the time, the second opinion won’t require additional tests, but in some cases, a physician may suggest them.

Consider bringing a list of questions* with you, in writing, along with a tape recorder so you can listen to the answers at home when you’re less anxious. It may also be useful to bring a relative or close friend for emotional support and to help interpret things you don’t understand.

Wood decided to remain a patient of Dr. Edge, her comfort level bolstered by the second opinion. But she wanted to be more aggressive in her treatment and decided to undergo an experimental treatment. Six months after diagnosis and with the support of her treatment team, she chose to have an autologous blood and marrow transplantation(5).

Today, she’s back on her feet, balancing a family life with a rewarding, new career as study coordinator for a large breast cancer prevention trial. She is also a member of the “Hope Chest,” New York State’s first breast cancer survivor dragon boat racing team, working out all year with other survivors who use progressive weight training to stay fit during the long Lake Erie winters. “Everyone is in the same boat,” says Sue, referring to the normal anxieties that accompany a cancer diagnosis. “Most good physicians welcome patients who want second opinions; they know they have a patient who is thinking intelligently and taking responsibility for her own care.”

F O O T N O T E S :
1. A mastectomy is a surgical proceedure that removes the entire breast of a patient with breast cancer.
2. A lumpectomy is a surgical proceedure that removes only the cancer and a margin of healthy tissue around it.
3. A sentinel node biopsy, is a surgical proceedure that examines the first lymph nodes that contain cancer cells to determine if the disease has started to spread or mestastize.
4. An axillary node dissection, is a surgical proceedure during which all lymph nodes under the arm are removed on the side where the breast cancer is found.
5. An autologous blood and marrow transplantation replaces bone marrow that has been destroyed with high doses of anticancer drugs or radiation.

*Note - The Komen Foundation offers a free kit called, “Questions to Ask the Doctor about Breast Cancer,” to remind patients of the important questions to ask their physicians. This set of question cards is available for free by calling 1-800 462-9273.

Irene S. Levine, PhD., is a freelance medical journalist and professor of psychiatry at the New York University School of Medicine. She has written for many of the nation’s top dailies and magazines including Better Homes and Gardens, Health, Ladies Home Journal and Self Magazine.