Breast cancer: no two ways about second opinion

Cancer is feared to be a life-threatening disease. People diagnosed with breast cancer feel a sense of urgency and panic and jump right in to start treatment, hoping for immediate recovery from the disease.

There are multiple treatment options for breast cancer depending on multiple factors such as the type and grade of cancer, the age and fitness of the patient, family history of the disease, the hormone receptor sensitivity profile and many other factors on the tissue pathology.

These factors also contribute to the ultimate outcome of the patient and her survival (called in medical terms as ‘prognosis’). In addition, socio-cultural implications and economic factors contribute to the decision-making process, compliance to treatment and regularity of follow-up.

To choose between treatment options can be overwhelming. Most Indian women opt for a second opinion and approach another specialist as the multiple treatment options offered to them by their primary doctor are confusing. For example, whether to opt for breast conservation surgery versus a modified radical mastectomy or to choose various chemotherapy options.

Nowadays, there is an easy accessibility to specialist doctors in the country, and a confusing wealth of information available on the internet. This encourages patients to approach another specialist for the assurance that they are making the right choice. Women approach medical experts and other specialists for the following reasons:

• To re-confirm the diagnosis and prognosis: once cancer is diagnosed, denial is a perfectly normal and common reaction. Patients go for a second opinion as they want to be absolutely certain and also know about the disease prognosis from the second doctor.

• To self-educate with professional advice on the disease and treatment: breast cancer patients usually want to educate themselves more about their disease to be able to find an apt solution and treatment. They approach medical experts to reconfirm their multiple treatment options suggested by their primary doctor.

• In searching for the right specialist/breast oncologist: in India, most of the breast cancer cases are still diagnosed by either general physicians or gynaecologist. It is more common and comfortable for women to approach their family doctor, or their gynaecologist at the outset, following which they are referred to oncologists and oncosurgeons. Women prefer approaching female surgeons owing to their cultural inhibitions and this translates to a preference for female oncosurgeons as well. Female surgeons also provide a natural empathy factor which increases the patient’s comfort level.

• To explore the latest treatment options, which their primary doctor may not be able to offer: Every year, there are new technologies and treatment methods adopted by different specialist doctors which give positive results. It is possible that a primary physician may not be fully updated on the latest research data and newest treatment options. This factor contributes to patients diagnosed with breast cancer reaching out to the specialist doctors who will have comprehensive knowledge and are updated on the most advanced solutions available.

• To know more about cheaper or charitable treatment or care options: treatments can be expensive. It is very common for patients, after diagnosis from one specialist, to opt for another hospital or doctor who is associated with the patient’s insurance plan. There are also certain hospitals that help avail the schemes provided by the government for patients who have financial crunches. If the patient does not hold any insurance cover, they reach out to the hospital that may offset their cost of cancer care.

• To get alternate treatment recommendations: It can be difficult and worrisome to accept the initial treatment options provided by one’s primary physician (for example, it is more difficult to accept the idea of a mastectomy).

It is not uncommon for some specialist doctors to be rigid on their treatment protocols. This may add to the patient’s discomfort and may motivate them to opt for a second opinion.

Taking a second opinion from another specialist may help the patient select an appropriate treatment plan. In general, patients prefer treatments that will be conducive to their socio-cultural-economic factors and treatments that are likely to provide quick recovery.

There can be many reasons for a patient to opt for a second opinion. But it is essential for patients to realise that there’s more
hope for breast cancer treatment today than ever before.

(The writer is surgical oncologist, BGS Gleneagles Global Hospitals)