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When to get a 2nd pathology opinion

Posted by medconsumers on September 10, 2009

News Flash: American Cancer Society will warn of screening’s harms.

If I had my way, there would be a moratorium on mammography screening until doctors fully understand the natural history of what they’re looking for in the breasts of women without symptoms. The term natural history is medical jargon for knowing what would happen if breast abnormalities that look cancerous under the microscope were left untreated. At least one in every three breast cancers diagnosed via mammography screening would not progress; yet virtually all are treated aggressively as if they will. From the mammography screening clinical trials, we know that this includes not only ductal carcinoma in situ but also invasive breast cancers. Until about 40 years ago, it was thought that all cancers become lifethreatening if left untreated.

There are two breast pathologists in the U.S. who have spent their professional lives distinguishing the lethal from the nonlethal. Both have published widely on this topic. Both head second pathology opinion services that deal directly with women, who send in their tissue slides, mammograms…and their payments. In the usual situation, the pathologist and the patient do not interact. Dr. David L. Page, Vanderbilt University Medical Center, Nashville, TN, and Dr. Michael Lagios, St. Mary’s Hospital, San Francisco, CA, have, no doubt, spared many a woman the overtreatment that follows in the wake of any and all mammography screening activities. The overtreatment can involve unnecessary radiation therapy, unnecessary breast removal, and a lifetime of worrying about the recurrence of a cancer that would have been better off left undetected.

Every five or so years, I write about these two second opinion services. I decided to do it again when I heard recently from a long-time reader who was diagnosed with “ductal carcinoma in situ [DCIS] with scattered calcifications and atypical cells” at one of the top cancer centers in the U.S. She was told that a total mastectomy is necessary. Instead of following the advice, she paid for a second pathology opinion from each of the above experts who both assured her that she did not have DCIS and required only periodic follow-ups. When calling me about the revised diagnosis, she said, “My joy in learning that I didn’t need a mastectomy was overshadowed by the thought of so many women who are overtreated because of mammography screening.”

Each breast pathologist describes his service below:

David L. Page, MD Breast Consultants

“Our experienced professionals have reviewed over 50,000 consultative requests for pathologists, clinicians, and patients…. Our group has had a major interest in defining and diagnosing special breast conditions that are not truly malignant, but can recognize an increased risk of later breast cancer development, as well as minimally or low malignant lesions that may be successfully treated with local therapy alone.”

Michael D. Lagios, MD The Breast Cancer Consultation Service

“The Breast Consultation Service is designed to help self-referred women with newly diagnosed breast carcinoma or atypia with formal written review of their pathology slides, mammograms and other imaging studies. No physician referral or permission is needed to access this service.”

Disclosure: When writing this article I was surprised to see that Dr. Page has a 2004 article from our newsletter HealthFacts on his home page. It addressed the latest study about overdiagnosis and overtreatment, as well as the above second opinion services. I am flattered that Dr. Page thought enough of my article to post it. I am discouraged that it’s not out of date.

Maryann Napoli Center for Medical Consumers©

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One Response to “When to get a 2nd pathology opinion”

  1. As a medical writer and, more importantly, as a patient who has benefited from the services of the breast pathologists mentioned here, I strongly recommend second and even third opinions for anyone who receives an “early” cancer diagnosis of any kind.

    My local New Jersey hospital proudly advertises that their “nationally recognized” breast center finds more “stage 0” breast cancers (DCIS)than any other area hospital. Statements like this should serve as a red flag warning to women. Men should be alarmed by similar claims for “early” diagnoses of prostate cancer.

    Please heed the warnings in this Center for Medical Consumers report and in a recent (10/21/09) New York Times front page article that “Overdiagnosis [of early breast and prostate cancer] is pure, unadulterated harm.” (quote from Dr. Barnett Kramer, associate director for disease prevention at the National Institute of Health)

    Remember the American Cancer Society’s advertisements that mammograms are “one of the best things a woman can do to protect her health”? Dr, Otis Brawley, the Cancer Society’s chief medical officer, now admits that they were wrong!

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