Pathology Second Opinion

Patients who receive a diagnosis of cancer have to make life-altering decisions at a time of overwhelming worry. That’s why it’s important to seek a second opinion before beginning treatment, to ensure that the diagnosis is correct and that treatment options are appropriate.

Getting it Right – Before Treatment Begins

“Of the second opinions we provide for cases from outside Roswell Park, about 10% involve a change of diagnosis,” says Cheney. That 10% may involve:

  • A reversal of diagnosis (someone received a diagnosis of cancer but does not actually have cancer, or someone has cancer but was told no cancer was present); or
  • Identification of a type of cancer that is different from the one that was diagnosed; this information can dramatically alter treatment options.

Cheney notes that the diagnosis error rate on outside cases varies from five to 40%, and is especially high for certain cancers, such as skin, breast and prostate. “A second opinion is particularly important if your cancer is hard to diagnose, a rare type, has many treatment options or if the patient wishes to be considered for a clinical research study.

Not all Cancers are Alike

Just because a tumor forms in the breast doesn’t mean it’s the same as every other breast tumor, or that it should be treated the same way.

Distinguishing between these sub-types of cancer, and making treatment choices accordingly, means a patient with a more aggressive disease should be offered more aggressive therapy, while the one with a lower risk of recurrence may want to avoid the expense and significant side effects of a treatment that is probably not needed.

Red flags for a second opinion

When should you seek a second opinion? It’s always a good idea, but Cheney says an independent review is especially important in these situations:

  • Your physician has not provided you with a full, clear explanation of your pathology report, in a language you understand.
  • Your physician tells you that you don’t need a second opinion. “A good doctor will suggest that you get another opinion if there are questions about your treatment or diagnosis,” says Cheney. “If your physician is offended, find a new doctor.”
  • Your physician wants you to start chemotherapy or surgery tomorrow. “Almost nothing in the world of cancer care requires that kind of immediacy, except patients with acute leukemia; cases in which a tumor is compressing a vital structure, such as the heart or large blood vessels; or certain other rare conditions,” notes Cheney. “If your physician is pressuring you to do something immediately because there’s no time to waste, that isn’t a good approach.”

Questions to Ask Yourself

If you’re not sure whether to ask for a second opinion, consider these questions:

  • Am I confident in the diagnosis or treatment options I’ve been given?
  • Am I comfortable with my treating physician?
  • Has my physician clearly explained all treatment options – not just the ones he or she prefers?
  • Are there clinical research studies offering new treatments for my cancer?
  • Was my cancer diagnosed at an office or community hospital setting or in a comprehensive cancer center?
  • Does my insurance plan require a second opinion? If not, what type of coverage does it provide for second opinions?

Arranging for a second opinion

Most physicians welcome second opinions, and in most cases, the secondary review confirms the initial diagnosis and your doctor’s plan. Telling your doctor you’d like a second opinion will make it easier for the consulting physician to discuss your condition with your doctor and to obtain any additional information that may be needed.

At Roswell Park, most patients who need a second opinion are seen within a week.

To contact the Roswell Park Cancer Institute referral service, call 1-800-ROSWELL (1-800-767-9355). You may also visit the Roswell Park website at www.roswellpark.org and choose Patient Care– Become a Patient. The National Cancer Institute also provides helpful tips for getting second opinions.