Uphill Fight for a Second Opinion

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By Marla Brin
Special to The Washington Post
Tuesday, March 27, 2007

I have a lump in my breast. I know this because I had a mammogram, and there it was . . . a white spot where it was not supposed to be. A white spot that did not appear on my mammogram two years earlier. The radiologist advised me to wait four to six months and have another mammogram.

No way was I going to do that. What I wanted was a second opinion, and fast.

I knew that was the right thing to do because, as a child of the middle class, I grew up with kids who became doctors and accountants, and I happen to have a friend who is an oncologist in another city who was willing to share some of her professional expertise. I mentioned to her that the radiologist had said my lump could be a "lymph node that migrated." My friend the oncologist told me that lymph nodes may get larger or smaller but they do not migrate and that a second opinion was in order. And that I should get an MRI of my breast as well, to make sure that the lump found by the mammogram was the only lump in my breast and that no smaller lumps were hiding. Then we would know what to do about a biopsy.

A study published in December in the journal Cancer confirms the importance of getting an impartial second opinion. Even better, according to the study, is getting a "multidisciplinary" second opinion. That is, a second opinion rendered by several specialists from different areas, such as radiology, oncology and pathology. In the University of Michigan study, researchers examined the effect of such a consult for a group of women with breast cancer diagnoses. The consult resulted in changed treatment recommendations for 52 percent of the women whose records were reviewed.

In spite of its importance, getting a second opinion turned out to be harder than I ever imagined. Though I am educated, I hadn't the slightest idea how to go about arranging it. For a broken bone, I would go to an orthopedic surgeon. But for a mammogram? Should I look under "breast" in the Yellow Pages?

My friend the oncologist explained that doctors who read mammograms are called breast radiologists and that I should arrange a consult with one.

Unfortunately, my new gynecologist, who took over when my old one retired recently, did not think I should get a second opinion. Or, rather, she felt that, although she is not a breast radiologist, she could read my mammogram and serve as my second opinion. And in her opinion, I should wait six months and see what happened. And not get the MRI. And not get a biopsy.

I have never been a willing participant in mammograms. Though I am 46, I have had only three in my life. I had figured that there was no need to radiate my breasts and perhaps risk giving them something they did not have.

I arranged this mammogram, the one that found the lump, only because I had had a dream -- a dream that I had breast cancer. In the dream there was a black seed in my left breast. It looked somewhat like a watermelon seed.

There was only one seed, but in the dream it could open up like a dandelion and then I would have little black flecks all through my breast. Call me superstitious, but I went in for the mammogram, just in case.

After we found the lump in my left breast, I told my gynecologist about the dream. I said that I probably would have wanted a second opinion anyway but that given the radiologist's "migrating lymph nodes" remark and my dream, I definitely wanted to pursue a second opinion, just to be sure.

She said that she once had a dream that her nanny poisoned her two children but that she did not fire her nanny, because she could tell the difference between a dream and reality.


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© 2007 The Washington Post Company

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