By Jamie Talan
Getting a Second (or Third, or Fourth) Opinion
A patient learns that doctors don’t always agree on diagnosis or treatment
By Jamie Talan
I was lying on my back, my right arm lifted above my head, waiting for my daily dose of radiation. The radio was playing from speakers somewhere above me when a familiar voice wafted downward. The radio host was talking to the breast cancer surgeon who only a month ago had sent me home with great news: A benign tumor. “Go celebrate,” he said. My husband splurged on a wooden sculpture of a lady raising her hands to the sky.
So what was I doing in this ghastly hospital machine, sitting as still as the “Hallelujah Lady” now perched in my living room, soaking up radiation every weekday morning for seven weeks?
Welcome to my world of second and third and fourth opinions, a place where few people venture after hearing those delicious words: “It’s not cancer.” In short time, I learned a secret that few patients know: Pathology is as much an art as it is a science, and what one doctor calls a benign tumor another calls cancer.
I have logged more than 20 years as a science reporter at a daily newspaper in New York. So when I felt a large lump in my right breast in 2005, it was natural for me to call my local university hospital. Everyone at the hospital was attentive—from the chief of breast surgery, who took a biopsy and scheduled immediate surgery for a lumpectomy, to a hospital vice president who stopped by early on a Sunday morning just to make sure I was okay.
It happened so quickly that I barely had time to call a doctor I know who heads the breast oncology division of a major cancer center. When he urged me to come to his hospital, I demurred. I would be in and out in a day and it was probably nothing. “Well, then, send me your slides,” he said warmly.
And so, I would.
I could not have predicted the strange week of change-the-diagnosis that would follow my surgery. First, a fresh-frozen pathology sample taken during the surgery came back benign. The next day, my surgeon called to say further tests came back positive, but not to worry, it’s probably nothing. He would call in two days with the good news that led to my husband’s spending too much money on Hallelujah Lady.
A few days later, five samples of my breast tissue arrived at the major cancer center. There, a breast pathologist put the tissue slides under her microscope and typed off a short e-mail to her boss: There are cancer cells in some of the slides.
It wasn’t bad news, just not great news. The diagnosis was ductal carcinoma in situ (DCIS), an early stage and noninvasive cancer, sometimes referred to as a precancer. If it’s treated appropriately, the odds it will spread are very small. The breast oncologist at the cancer center recommended more surgery—and he advised a round of radiation.