Surgical Consultations Scheduled


We've scheduled a second consultation with Dr. David P. Winchester as well as a consultation with Dr. Monica Morrow for a second opinion.

Early on Monday (1/6/03) morning, Dr. Winchester will present Ann's case to the Evanston Northwestern Healthcare (ENH) Breast Cancer Conference, a weekly meeting of specialists including radiologists, pathologists, and surgeons. At 11:45 on the same day we have a consultation scheduled with Dr. Winchester to review his recommended treatment plan. Based on what he said in our prior consultation last month (12/23/02) as well as the results of Ann's second biopsy we expect Dr. Winchester to recommend a lumpectomy followed by radiation treatment for six weeks.

On the morning of Tuesday, 1/14/03, we will meet with Dr. Monica Morrow for a second opinion. She is a professor of surgical oncology at Northwestern University's medical school and is Director of the Lynn Sage Breast Cancer Program at Northwestern Memorial Hospital in Chicago. She has published extensively on breast conservation therapies (BCT) as well as the role of second opinions in the treatment of breast cancer. (See abstracts below). Additional information about Dr. Morrow is available online:

  http://www.surgery.northwestern.edu/content/ShowMemberPage.asp?typ=faculty&mbr_ik=68

She presented her views on BCT in an October, 2002 ABC news report.

  http://abcnews.go.com/sections/wnt/DailyNews/breastcancer_treatments021016.html
  http://abcnews.go.com/sections/community/DailyNews/chat_breastcancer021017.html

The Lynn Sage Cancer Program has a website.

  http://www.lynnsage.northwestern.edu/Site/template/lynn.html

The second opinion will include an independent review of Ann's biopsy slides and mammograms as well as a physical examination. A description of what we expect to occur as part of the second opinion process is online.

  http://www.nmh.org/services/outpatient_services/lynn_sage/breast_cancer_program.html

We don't expect Dr. Morrow's recommendations to be different from Dr. Winchester's. But everything that we read says that we should get a second opinion if only to reinforce our commitment to the recommended therapy.

Thank you for your continued support.

Love

- Ann and Nello









Ann Surg Oncol 2002 Dec;9(10):982-7

Changes in breast cancer therapy because of pathology second opinions.

Staradub VL, Messenger KA, Hao N, Wiley EL, Morrow M.

Lynn Sage Comprehensive Breast Program (KAM), Departments of Surgery (VLS, MM),
Pathology (ELW), and Preventive Medicine (NH), Northwestern University School of
Medicine, Chicago, Illinois.

BACKGROUND: Examination of pathology slides is a routine part of a breast cancer
second opinion. The purpose of this study was to determine how often the
pathologic second opinion (1) altered the diagnosis and (2) resulted in a change
in the surgical procedure. METHODS: Patients presenting between 1997 and 2001
for a second opinion after a biopsy diagnosis of breast cancer (invasive or
noninvasive) were included in this study. RESULTS: There were 340 patients
presenting for second opinions regarding 346 breast cancers. Sixty-eight
pathologic second opinions (20%) did not result in any change in pathology or
prognostic factors, whereas in the remaining 80%, some change occurred. Major
changes that altered surgical therapy occurred in 7.8% of cases, and pathology
review provided additional prognostic information in 40%. Changes were more
common in in situ carcinoma than invasive carcinoma (P =.004), but biopsy type
(core vs. excisional biopsy) was not a significant predictor of change in
pathologic information. CONCLUSIONS: This study confirms the benefit of a
pathology second opinion to improve preoperative estimates of prognosis and to
determine the appropriate surgical procedure. Missing information on grade and
histological subtype was responsible for a large number of cases, suggesting a
need for widespread application of standardization and quality improvement in
pathology reporting.

PMID: 12464590 [PubMed - in process]




Cancer 2002 Feb 15;94(4):889-94

Results of the Lynn Sage Second-Opinion Program for local therapy in patients
with breast carcinoma: changes in management and determinants of where care is
delivered.

Clauson J, Hsieh YC, Acharya S, Rademaker AW, Morrow M.

Lynn Sage Breast Program, Northwestern University, Chicago, Illinois, USA.

BACKGROUND: The treatment options of breast conservation therapy (BCT) and
immediate reconstruction for patients with carcinoma of the breast have not been
adopted widely. The objectives of this study were to determine how often a
second opinion on the local therapy of breast carcinoma changed patient
management and to identify factors predictive of remaining at the second-opinion
site for therapy. METHODS: Two hundred thirty-one patients with intraductal
carcinoma or Stage I and II breast carcinoma were reviewed retrospectively. At
the time of the second opinion, patients completed a questionnaire regarding
their initial surgical opinion and the reason for seeking consultation. RESULTS:
Only 46% of patients had a complete discussion of treatment options prior to the
second opinion. The second opinion changed management in 54 patients (20.3%).
The most common finding was eligibility for BCT in patients who were offered
only mastectomy. Definitive local therapy occurred at the second-opinion site in
65.8% of patients. The only predictors of remaining at the second-opinion site
were insurance type (P = 0.008) and the patient's perception that options were
not discussed at the initial opinion (P < 0.001). CONCLUSIONS: Second opinions
provide useful information to patients and may change the management of their
disease. They result in significant patient capture for an institution.
Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10318

PMID: 11920455 [PubMed - indexed for MEDLINE]






Posted: Sat - January 4, 2003 at 12:00 AM        

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