The power of a second opinion for cancer

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The importance of 'second opinions'

Rita Wilson's breast cancer diagnosis highlighting issue

Rita Wilson, 58-year-old actress, singer, and the wife of Tom Hanks, recently revealed she underwent a double mastectomy and reconstructive surgery after having been diagnosed with breast cancer. She credits to her decision to have a double mastectomy to getting a second opinion for her diagnosis. Now on her way to recovery, she expects to return to the Broadway show she was appearing in next month thanks to doctors who caught the breast cancer early.

"I am recovering and most importantly, expected to make a full recovery," Wilson shared in a statement to People Magazine. "Why? Because I caught this early, have excellent doctors and because I got a second opinion."

Wilson said she had been monitoring herself for breast cancer with mammograms and MRIs after discovering she had lobular carcinoma in situ (LCIS). LCIS is an area or areas of abnormal cell growth that increases a woman’s risk for developing invasive breast cancer later on. Then, a biopsy showed that the LCIS had turned into pleomorphic carcinoma in situ (PLCIS). However, initial tests showed that what she had was not cancerous.

There are two main types of in-situ carcinoma of the breast: ductal carcinoma in-situ (DCIS) and lobular carcinoma in situ (LCIS). DCIS is considered “pre-cancer,” while LCIS is not. This is because LCIS does not seem to turn into invasive cancer when left untreated. While women with LCIS have a higher risk of getting breast cancer, the risk is no higher than the chance cancer will occur in the other breast.

Normally, when LCIS is found with a biopsy, it does need further treatment. When LCIS is pleomorphic, as in Wilson’s case, it means that the cells look more atypical than usual. When LCIS is pleomorphic, it may be more aggressive, and is linked to an even higher risk of invasive breast cancer. So, LCIS that is pleomorphic is usually treated differently than LCIS that is not. This is what made Wilson’s case particularly different, and why her having a second opinion was crucial.

"A friend who had had breast cancer suggested I get a second opinion on my pathology and my gut told me that was the thing to do,” Wilson said in the statement. She ended up going to two other pathologists, who both confirmed that she had breast cancer.

Wilson could not have put it better when she said: "I share this to educate others that a second opinion is critical to your health. You have nothing to lose if both opinions match up for the good, and everything to gain if something that was missed is found, which does happen. Early diagnosis is key."

Another type of cancer where a second opinion can make a significant difference is prostate cancer. Men who have a prostate biopsy to detect prostate cancer can have a parallel diagnosis to the type of precancerous diagnosis Wilson had. In prostate cancer, this is known as high-grade prostatic intraepithelial neoplasia. This means that the prostate cells are atypical, but are not yet cancerous. So, if you have a prostate biopsy and it is negative, this does not necessarily mean you do not have cancer. This is why a follow-up biopsy is important because that initial biopsy may have missed the cancer, or the cancer was not significant enough to make a clear diagnosis.

Being diagnosed with cancer is often scary and confusing. It can be difficult for patients to know what the best decision is with regard to what type of treatment to have and when. Therefore, it is important to discuss the diagnosis and treatment options with a doctor or surgeon. Seeking advice from more than one doctor, also known as getting a second opinion, is encouraged to confirm the diagnosis and treatment plan.

Some of the benefits of a second opinion include:

• Confirmation of a diagnosis
• Different perspectives from various experts specializing in a particular type of cancer
• More information about the type of cancer and its stage
• Learning about all possible treatment options and which may best for you
• If treatment options are limited, there may be clinical trials that you are suitable for

The MRI-guided prostate biopsy is an innovative technique to detect prostate cancer. A patient will have an MRI of the prostate done in which a specialized urologist will fuse with the traditional biopsy in order to pinpoint suspicious lesions on the prostate from which tissue samples will be taken. The MRI-guided prostate biopsy can reduce how often men have to have repeat biopsies.

If you are diagnosed with prostate cancer, there are a number of treatment options available.

• Radical robotic prostatectomy (surgery)
• Radiation therapy
• Hormone therapy
• Active surveillance
• Chemotherapy
• Other emerging therapies include cryotherapy and high-intensity focused ultrasound