Understanding Breast Cancer & The Importance of Second Opinions
- Aleseia Saunders was 32 years old when she received a stage 2B invasive ductal carcinoma diagnosis, after initially dismissing a lump in her right breast as a cyst. Now she’s sharing her story to help encourage others to get second opinions when it comes to a diagnosis and treatment.
- According to Moffitt Cancer Center, invasive ductal carcinoma “is the most common type of breast cancer, accounting for approximately 80% of the total number of cases” and it “occurs when cancerous cells form in a duct that carries milk from a lobule (a gland in the breast that produces milk) to the nipple, and then spreads to tissue outside the duct.”
- Getting a second opinion can help ensure that you get the best possible cancer care. You may want another opinion if you have a rare type of cancer, or you don’t like the treatment the first doctor recommended.
- Research finds that a second opinion can change the diagnosis or course of treatment for some people with cancer.
- Ask the doctor who diagnosed you for a referral, or search on the website of an organization like the American Society for Clinical Oncology.
Saunders, who is now a mom to three healthy children, recently recounted her cancer story to the American Federation of Government Employees (AFGE), revealing that her diagnosis came as a shock as she had no family history of the disease. It was a visit to her OBGYN to confirm her pregnancy that her doctor suggested she get a biopsy of a lump in her breast. Two weeks later she received her diagnosis.
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Saunders, who was diagnosed with breast cancer in 2013 and later declared to be in remission one year later, admitted, “I was very surprised because I don’t have any family history of breast cancer.”
After a doctor advised her she needed to terminate her pregnancy before undergoing chemotherapy, radiation, and hormonal therapy, she decided to seek additional insight from other doctors, in hopes of keeping her child and treating the cancer.
With the help of MammaPrint genomic testing, that offers more details on her breast cancer tumor and the risk of it returning or spreading, another doctor told her she had a low risk of the disease metastasizing [spreading] and that she’d be able to continue with her pregnancy.
She underwent a lumpectomy in her second trimester and then 39 rounds of radiation and a hormonal therapy called Tamoxifen [a selective estrogen receptor modulator] two months after giving birth.
What is Tamoxifen for Breast Cancer?
Saunders hopes her story will inspire others to do as she did and seek multiple opinions when facing a diagnosis.
She concluded, “I went from them not wanting me to have any children, now I have three kids.That’s my message every time I talk: seeking other opinions and being the biggest advocate for yourself and not allowing somebody to just tell you what needs to happen.
“You also need to do your research and due diligence to make sure you’re informed.”
Expert Breast Cancer Resources
- Getting to Know Your Breasts with Self-Exams
- Is a Preventative Mastectomy Right for Me?
- 23andMe Testing For Breast Cancer Gene May Be Highly Unreliable, Study Finds
- 3D Mammography Detects 34% More Breast Cancers Than Traditional Mammography
- 5 Things That Do Not Cause Breast Cancer, Because Facts Matter
- A Promising New Study Suggests Women with an Aggressive Form of Breast Cancer Could Benefit from Immunotherapy
Understand Breast Cancer Symptoms
It’s always a good idea to be familiar with your own breasts, so you can learn what’s normal for you, and how to spot any changes worth mentioning to your doctor, like Hilderbrand did. For this reason, SurvivorNet’s experts recommend that you do regular breast self-exams.
You don’t need to have an MD after your name to know whether a lump is new, or your breast is changing in appearance. Your goal in performing self-exams is to see whether anything about your breasts is different than usual.
Look for changes like:
- A new breast lump
- New swelling in one breast
- Changes in the nipple (such as puckering)
- Redness or flaking in the breast or nipple
- Discharge (including blood) from the nipple
- Pain in the breast
- Bring symptoms like these to your doctor’s attention.
Getting a Diagnosis
Your mammogram or self-exam results may lead your doctor to recommend further testing with a diagnostic mammogram, ultrasound, or magnetic resonance imaging (MRI). If these tests suggest changes that might be cancer, you’ll need a biopsy–a test in which your doctor removes a small sample of tissue and has it checked for cancer in a lab. Only a biopsy can confirm or rule out whether you have breast cancer.
Although it can be frightening to go through breast cancer testing, SurvivorNet’s doctors advise that you try not to get ahead of yourself. It’s very possible for a biopsy to find that a lump is benign (not cancer).
If you do receive a breast cancer diagnosis, you’ll get a lot more information along with it, such as the type and stage of the disease. The stage means how far in your body the cancer has spread.
Though most breast cancers are not linked to inherited genetic mutations, knowing whether you have a mutation could affect the type of treatment you get. Therefore, it’s recommended that all women who are diagnosed with breast cancer be given genetic testing.
Do you need genetic testing? The answer, according to Dr. Ophira Ginsburg, Director of the High-Risk Cancer Program at NYU Langone’s Perlmutter Cancer Center, depends on your family history of cancer.
Based on your test results, preferences, and personal circumstances (such as your age), you and your doctor will make decisions about how to proceed with treatment.
There are different types of breast cancer, and determining what type you have will help your doctor choose the best treatment option for you.
The links below will take you to simple guides SurvivorNet created to explain treatment options for different types of breast cancer.
- Living With ‘HER2-Low’ Breast Cancer
- Living With HER2-Positive Breast Cancer
- Living With Metastatic Breast Cancer
- Living With HER2-Positive Metastatic Breast Cancer
- Living With HR-Positive Metastatic Breast Cancer
Fertility and Cancer Treatment
Infertility can be a side effect of some cancer treatments, but there are options to consider. Fertility preservation, for example, is available to women of childbearing age. Options for women include:
- Egg and embryo freezing (the most common practice)
- Ovarian tissue freezing
- Ovarian suppression to prevent the eggs from maturing so that they cannot be damaged during treatment.
- Ovarian transposition, for women getting radiation to the pelvis, to move the ovaries out of the line of treatment.
Can I Have A Baby After Breast Cancer?
No matter what course of action you choose to take, it is important that all women feel comfortable discussing their options prior to cancer treatment.
In a previous conversation with SurvivorNet, Dr. Jaime Knopman said time was precious when dealing with fertility preservation for women with cancer. In other words, the sooner the better when it comes to having these important fertility conversations with your doctor.
“The sooner we start, the sooner that patient can then go on and do their treatment,” Dr. Knopman said. “A lot of the success comes down to how old you are at the time you froze and the quality of the lab in which your eggs or embryos are frozen in.”
RELATED: How Does Chemotherapy Affect Fertility?
When it comes to breast cancer patients specifically, there are some unique challenges for women with the disease. Dr. Elizabeth Comen outlined them for us in a previous interview:
- Young women who need chemotherapy could have their fertility significantly affected because many chemotherapy drugs can damage a woman’s eggs.
- If women are on a medication to stop the hormones which feed their specific kind of breast cancer, they may not be able to get pregnant for several years in some instances 10 years.
- Many stage four breast cancers need estrogen to grow. Pregnancy is a very, very high hormonal state, so it’s not recommended in these cases.
Getting Second Opinions
Once you’ve gone through all of the tests needed to diagnose your cancer and your doctor has recommended a course of action, you will likely, finally, feel a sense of resolution. But no matter how qualified and experienced the doctor who diagnosed you is, there may be a lingering feeling about getting a second opinion. It’s OK to consider your doctor’s treatment recommendations as just the first step in figuring out what to do next.
RELATED Second (& Third) Opinions Matter When Deciding Between Surgery or Radiation
“If I had any advice for you following a cancer diagnosis, it would be, first to seek out multiple opinions as to the best care,” National Cancer Institute chief of surgery, Dr. Steven Rosenberg, tells SurvivorNet.
“Finding a doctor who is up on the latest information is important, and it’s always important to get other opinions so that you can make the best decisions for yourself in consultation with your care providers.”
National Cancer Institute chief of surgery, Dr. Steven Rosenberg, offers advice on seeking a second opinion
A second opinion gives you the chance to explore other therapeutic options. Another doctor may offer a new perspective on your cancer, and possibly recommend treatments that are different than what the first doctor you saw suggested.
Getting another opinion may also help you avoid doctor biases. For example, some surgeons own radiation treatment centers. “So there may be a conflict of interest if you present to a surgeon that is recommending radiation because there is some ownership of that type of facility,” Dr. Jim Hu, director of robotic surgery at Weill Cornell Medical Center, tells SurvivorNet.
Other reasons to get a second opinion include:
- To see a doctor who has more experience treating your type of cancer
- You have a rare type of cancer
- There are several ways to treat your cancer
- You feel like your doctor isn’t listening to you, or isn’t giving you good advice
- You have trouble understanding your doctor
- You don’t like the treatment your doctor is recommending, or you’re worried about its possible side effects
- Your insurance company wants you to get another medical opinion
- Your cancer isn’t improving on your current treatment
Contributing: SurvivorNet Staff
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