The issue of second (or, sometimes, third or even fourth) opinions frequently comes up in my groups and individual conversations with women. There are several points in a breast cancer experience that especially stimulate this question, and it seems important to think carefully about the value of consulting with additional physicians.
First, two basic considerations if you find yourself thinking about finding another opinion. Will your insurance cover it and are there restrictions about whom you can see? Most insurance plans will pay for second opinions, but certainly it is important to confirm this--especially if you are having a third or fourth opinion and especially if you are hoping to meet with a doctor at a different institution. My basic advice about second opinions is this: If you find yourself wondering whether you should get one, the answer is probably "yes". You do not want to look back later and regret a missed opportunity.
When might it be smart to do this and where should you go?
This question sometimes arises shortly after a breast cancer diagnosis. If you are having trouble deciding about a mastectomy vs. a wide excision/lumpectomy/partial mastectomy (all those terms basically mean the same thing), talking with a second breast surgeon may help. It is really important, if you are planning a mastectomy, to at least meet with a plastic surgeon to hear about reconstruction options (and there will be later blogs about this). Even if you are pretty sure that you don't want reconstruction, go talk with a plastic surgeon about the choices. Again, the basic rule is that you don't want to look back later with regrets. If you think that you do want reconstruction, it is very important to consult with two plastic surgeons. This is actually the only breast cancer treatment choice when I think it is vital to speak with more than one doctor. The reason is that different plastic surgeons may very well have different opinions and suggestions. Each likely has her/his favored technique and will talk most about it. Your own body and any prior cancer treatments may limit these choices, but two plastic surgeons may well recommend two different reconstructions.
Another moment when a second opinion may seem sensible is if you find yourself in the gray area re needing chemotherapy. As cancer treatments are increasingly personalized and more is understood about tailoring treatments to specific cell and tumor types, there are still cases when the risk/benefit ratio of chemotherapy makes the decision tough. In Boston, there seem to be varying institutional philosophies about these unclear situations, and I suggest to women that they consult with a medical oncologist at more than one hospital.
Questions about second opinions also arise when women are being treated for Stage IV/metastatic breast cancer. While early breast cancers have fairly standard treatments, Stage IV cancers are managed in many different ways. This is a time when the "art of medicine" becomes as important as "the science of medicine", and women often benefit from talking with more than one doctor. It may be helpful to consider an additional consultation both at the the time of a diagnosis of metastatic disease as well as at various times when treatments must change.
How do you identify a good doctor for a second opinion? First, it is usually more helpful to meet with someone who practices in a different group or institution from your first or regular doctor. Second, it is important to meet with someone who is experienced in your particular situation. If a physician is especially busy and generally not taking new patients, it is still often possible to make an appointment for a second opinion because that is a one time appointment.
To repeat the rules: If you are wondering whether you should have a second opinion, you probably should. But, if it is people around you who are pushing you to see another or a different doctor, thank them for their concern, but make it clear that the decision is yours. You must do what feels right for you, not what pleases anyone else.