Multiple opinions on breast cancer diagnosis can clear up questions

By Nick Rees

Because of advances in mammography and other imaging technology over the past 30 years, pathologists are now able to provide opinions on breast lesions that are the size of a few grains of salt.

Despite these advances, however, the ability to tell a benign lesion from early stage breast cancer remains a challenge.

"Medicine, especially breast cancer diagnosis, is not always black and white," Dr. Heidi Memmel, MD, a top rated general surgeon in Chicago, says. "Physicians offer their best opinion on treatment with the information available.

"When looking at a biopsy of the breast, there are cells that can appear atypical, which we think are precursors to cancer, and those can be difficult to differentiate from a non-invasive cancer or from an invasive cancer."

According to the New  York Times, as many as 17 percent of ductal carcinoma in situ cases, which are the most common type of non-invasive breast cancer, that are identified by needle biopsy may be misdiagnosed.

"We know that there is quite a bit of variation in a pathologist's reading of DCIS," Dr. Memmel says. "As a physician, I have to make sure that the people providing me this info are people that I trust.

"When patients have a diagnosis that is borderline, what I generally recommend to make sure the diagnosis is the best possible, is that the patient seek a second opinion."

DCIS is diagnosed in more than 50,000 women a year in the United States. If left untreated, experts estimate, the abnormal cells have a 30 percent chance of turning into invasive cancer.

"We take into account not only the pathology, but also a patient's age, their health and their medical conditions, including the size and grade of the tumor, the size of the breast and what type of treatment it will tolerate when we deal with this," Dr. Memmel says. "We'll have patient say that they want both breasts removed if there is any small hint of cancer whereas another patient may prefer a more conservative approach with a smaller surgery, less treatment and closer observation.”

"What one patient wants is not necessarily what another patient wants. We treat the patient as an individual, not as a cut-and-dried case."

Dr. Memmel says that it is important that patients do not rush into treatment as breast cancer is not typically a medical emergency.

"If desired, a patient has time to see a second opinion," Dr. Memmel says. "Patients, if they aren't comfortable with the diagnosis or opinion, are absolutely entitled to seek another opinion."

Dr. Memmel takes a multi-disciplinary team approach for any questionable or difficult cases, which she says allows patients to be more comfortable because they hear from all of the experts.

"This allows patients to hear upfront what the experts have to say and gives them an idea of what their treatment process will entail," Dr. Memmel says. "It answers a lot of questions during a frightening and confusing time. The team approach eases their fears and answers a lot of their questions."

Dr. Heidi Memmel, MD, was selected in 2010 by TopTierMD as a Chicago Top Doctor - She was named a Best Chicago General Surgeon and specializes in breast surgery and the treatment of breast cancer.