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Question: I had a breast lumpectomy at an Ontario hospital on March 7th. My follow-up appointment was on March 25th. At that appointment, the surgeon told me I have two breast tumours and one is invasive. I took the pathology report home and noticed that it was written on March 13th. If it only took six days to analyze the lump and write the report, diagnosing cancer, why did it take another 12 days after that for him to inform me?
I feel I have been robbed of the opportunity to get a second opinion. (Surgery is scheduled for April 9th to deal with the second tumour).
Furthermore, the last few weeks have been tremendously anxious ones for me. I was almost incapacitated by anxiety last weekend before the diagnosis; I have a five-year-old daughter and I really feel that I should have been allowed to meet my surgeon and hear the news of my cancer, much sooner after it was discovered.
I really hope to hear your unbiased opinion of how this went.
Answer: A diagnosis of breast cancer is always unnerving. Like many patients, you want to move forward with treatment as soon as possible. But you also want to be sure it’s the right therapy.
I think there are two components to your question:
1) How long do patients typically wait to learn the results of their cancer surgeries?
2) Have you been given adequate time to seek a second opinion?
For an answer to your question, I talked to Dr. Frances Wright, who is Head of Breast and Melanoma Surgery at the Louise Temerty Breast Cancer Centre of Sunnybrook Health Sciences Centre.
Dr. Wright says it can sometimes take between two and three weeks to have the full pathology report completed. The report contains a detailed description of the tumour and it’s based on a variety of tests and observations. Cells from the tumour, and some of the surrounding tissue removed in the surgery, are examined under a microscope. This work can help determine its size and the potential aggressiveness of the cancer. The tumour is also studied for a variety of hormone receptors. The growth of some tumours can be fuelled by hormones such as estrogen. Doctors will often prescribe certain drugs – for example, Tamoxifen – that can block these hormone receptors.
So the results of the pathology report are very important for determining what additional surgeries and therapies may aid in your cancer treatment.
Some of these findings take longer to complete than others. Dr. Wright says it’s usually best to book the patient for an appointment when there is a strong likelihood that all the results will be ready.
“It’s upsetting for the patients if we bring them back too early and the pathology report is not there because then they have to make a second trip and they are anxious again,” says Dr. Wright, who is also an Associate Professor of Surgery at the University of Toronto.
Based on the dates you provided, your follow-up appointment was 18 days after your surgery. So that would be within the normal range of time for meeting with your surgeon.
The fact that your pathology report was completed 12 days prior to your appointment means that certain results came back sooner than expected. And that’s not a bad thing.
Still, you’re obviously thinking those 12 days amount to a lost opportunity and that time could have been spent seeking a second opinion.
However, you likely have more time to consider your options than you think, says Dr. Wright. “In general, cancers spread in months – like six, seven, eight or nine months – not in days to weeks,” she explains. “It doesn’t move that quickly.”
You mention that your surgeon has already booked you for another operation to deal with the second tumour.
“It sounds like the surgeon saved operating time for the patient when he thought the patient would need a second operation and that, to me, is good patient care because the surgeon is moving things along,” says Dr. Wright.
But, she adds, an “OR [operating room] date is never cast in stone, especially if the patient is not comfortable with it or needs more information.”
Make sure you have a full discussion with your surgeon. He may be able to ease your concerns.
If you still feel you want a second opinion, then ask for one. Your surgeon may be able to refer you to one his colleagues. Or, your family physician can possibly set up an appointment with another cancer specialist.
“It doesn’t happen that often, but when patients ask us for a second opinion, usually we are more than happy to facilitate it because we want the patient to have the right information,” said Dr. Wright.
It will likely take several weeks to arrange for a second opinion. So you should be aware that getting a second opinion will cause a delay in your treatment. “But from a cancer outcome point-of-view, waiting a couple of extra weeks won’t make any difference,” says Dr. Wright. “And if it gives her more peace of mind, and she feels that it helps her make a decision, then she should do it.”
Postscript: This blog was shared with the patient before it was posted online. She’s also had additional conversations with her surgeon. She says her concerns have been addressed and she’s decided to proceed with this week’s operation, without first seeking a second opinion. “I was doubting the care I was receiving, but I’m now aware it’s in line with the norm,” she says.
Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. His blog Personal Health Navigator is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Email your questions to AskPaul@sunnybrook.ca and follow Paul on Twitter @epaultaylor