Optimal Breast Cancer Pathology – Organisation

Pathology is a medical specialty that underpins decision-making in many crucial steps of cancer care. Pathologists in many countries are medical doctors who are responsible for a wide – and rapidly growing – range of diagnostic reports on tissue that supports detection and characterization of disease, and informs the treatment and care carried out by surgeons, oncologists, radiotherapists and other health professionals in the cancer team. 

Pathologists play a vital role in managing all types of cancer but their work can be compromised by lack of resources, training and multidisciplinary teamwork in hospitals, and a lack of commitment to a patient-center, accountable service at national level. They are often the ‘invisible’ members of the oncology team and should be available to meet patients and explain reports.

This manifesto sets out optimal requirements for a pathology service for breast cancer, but the principles are applicable to oncology generally. It is a call for all involved – pathologists, oncologists, patients, advocates, healthcare administrators and policymakers – to check and improve where necessary this vital discipline.

Breast cancer is not one disease but many, and the approach to the diagnosis and treatment of breast cancer must reflect this reality. Breast pathology is a dynamic discipline; many consider it to be the most complicated and nuanced subset of surgical pathology. During interviews with breast cancer specialists, it became apparent that many have concerns that the quality of breast pathology done by general pathologists in community and commercial laboratories is suboptimal. A lack of accuracy can be gauged and defined in three ways: 1) an incorrect diagnosis refers to a major error, such as failure to distinguish benign and malignant disease or invasive and non-invasive disease, or failure to accurately identify ER or HER2 status, 2) an incomplete diagnosis refers to the omission of information crucial to the treatment plan, such as tumor size or HER2 status, and 3) an inconsistent diagnosis refers to the use of arbitrary, inconsistent, or obsolete terminology that could be misunderstood by a treating physician.

  • Individuals – Professional Expertise and Development Requirements
  • Departmental Requirements
  • Hospital Requirements
  • Health System Requirements
  • Breast Cancer Care Discussions

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