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Next Steps After a Breast Cancer Diagnosis


Step 2: Decide If You Need a Second Opinion

We've all heard the mantra: Get a second opinion. Still, only about 20 percent of women seek one, according to a recent study of almost 2,000 breast cancer patients. Even more surprising, many experts think that's okay: "It's outdated to insist a second opinion is always essential. Today, if a woman is being treated at a top-notch cancer center and she feels good about the specialists she's seeing, a second opinion just may not be necessary," says Megan Baker Ruppel, M.D., medical director of the comprehensive breast care program at Hollings Cancer Center at the Medical University of South Carolina in Charleston.

Consider sticking with one opinion if...

Your surgeon is associated with a National Cancer Institute-designated comprehensive cancer center. These centers offer a broad range of up-to-date treatment options, psychological support services and complementary and alternative therapies. And, most important, they foster close cooperation and communication among all the members of your cancer care "team," which may include a surgical oncologist (your surgeon); medical oncologist (the doctor who oversees chemo, hormone therapy, and all other meds); radiation oncologist (administers radiation therapy); pathologist (prepares the lab reports on your tissue samples); and plastic surgeon (performs breast reconstruction). Search "NCI-Designated Cancer Centers" at cancer.gov or call 1-800-4-CANCER for a nationwide list. You can probably safely skip seeing more doctors if you feel confident you have all the information you need to choose a course of treatment.

But you may need a second opinion if...

You'll be treated at a local hospital that doesn't specialize in breast cancer. Many community-based hospitals do have excellent multidisciplinary teams, says Dr. Baker Ruppel. One of your doctors (usually your surgeon) helps connect you with the other physicians needed for your treatment. These specialists have weekly conferences to discuss breast cancer cases, so you're assured your treatment plan is being assessed by multiple experts. It's a good sign if the team practices at a hospital with a cancer program accredited by the American College of Surgeons (click "Find an Accredited Cancer Program Near You" at facs.org/cancer). But if your local doctors treat many other cancer types as well, consider traveling to a larger comprehensive center affiliated with the NCI or to an academic medical center for a consultation. Chances are it will help confirm the information you've heard. If the second opinion happens to differ, you may decide to switch doctors, go for a third opinion, or use the new advice to guide the care you receive at your local hospital.

A second opinion is strongly encouraged if...

The surgeon you've seen doesn't work with a team and doesn't practice at a hospital with an accredited cancer program. Several studies suggest that breast cancer patients have a higher likelihood of survival if they are treated by experienced surgeons at hospitals with a large volume of breast cancer patients.

You're confused about the approach being discussed. You should not feel pressured by your doctor to choose a particular course of action, be offered only one type of treatment, or have doubts about any aspect of the diagnosis or treatment plan you've been presented. "In these circumstances there is no question that it's in your best interest to get a second opinion," says Dr. Lee. "You need to be confident that you're receiving the best care possible." The American Cancer Society (cancer.org or 1-800-227-2345) can provide referrals to comprehensive cancer centers near you.