Inquiring minds

Finding answers to your health questions is easy. The hard part is knowing what questions to ask.

Many health questions are obvious: What's the diagnosis? How is it treated? Will I get better?

But increasingly, the key questions we should be asking about some of the most common and serious health problems aren't so easy to figure out. With so many advances occurring almost daily in medicine, it's often impossible for patients to know what's real and what's hype. To help wade through the confusion, we asked doctors, patients and other health experts to focus on five key questions patients should ask if they are facing three of the most critical and complicated health problems: cancer, heart disease or surgery.

To be sure, asking questions of your doctor isn't always easy. Some of these questions are controversial and may be dismissed by your doctor because they are based on still-evolving science. Others may be difficult to ask because they challenge the expertise or authority of your physician or surgeon. And you may not always get the answers you were hoping for.

But asking these questions will, at the very least, arm you with new information — and may sometimes lead to dramatic changes in the course of your care.

Cancer

1. Are you sure?

Most patients don't think to question a cancer diagnosis, but they should. If a doctor tells you that you have cancer, you probably do. But cancer is complicated, and it can be mystifying under a microscope. In between a diagnosis of benign cells and a malignancy are a dizzying array of possibilities, and sometimes — more often than you'd expect — the pathology report is wrong.

Research at Johns Hopkins University in Baltimore has shown that about 1.4 percent of the time, a pathologist mistakenly diagnoses cancer, gets the type of cancer wrong or misses a cancer altogether. Errors that can significantly change the type of treatment are even more common. The risk of error depends on the body part and type of cancer. In the Johns Hopkins review, 5 percent of biopsies involving the female reproductive tract and 3 percent of skin-cancer pathology reports had errors. In prostate cancer, mistakes are made about 20 percent of the time in staging and grading, findings that can make the difference between conservative treatments or aggressive surgery. A Northwestern University study of 346 breast cancers resulted in pathology changes in 80 percent of cases, including major changes that altered lumpectomy or mastectomy plans for 8 percent of the women.