The Expanding Role of Pathologists in the Diagnosis and Management of Breast Cancer: Worldwide Excellence in Breast Pathology Program

Masood, Shahla

doi:10.1046/j.1524-4741.9.s2.11.x

Cited by 19 publications

(13 citation statements)

References 36 publications

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“…Diagnostic capacity is critical to the success of a comprehensive breast health care program in countries with limited resources. This central role of diagnosis highlights the importance of training health care providers in pathology and its subspecialties (e.g., cytopathology) (42). The availability of pathologists with expertise in breast pathology differs around the globe.…”

Section: Findings and Recommendationsmentioning

confidence: 99%

Breast Cancer in Limited-Resource Countries: Diagnosis and Pathology

Shyyan¹,

et al. 2006

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In 2002 the Breast Health Global Initiative (BHGI) convened a panel of breast cancer experts and patient advocates to develop consensus recommendations for diagnosing breast cancer in countries with limited resources. The panel agreed on the need for a pathologic diagnosis, based on microscopic evaluation of tissue specimens, before initiating breast cancer treatment. The panel discussed options for pathologic diagnosis (fine-needle aspiration biopsy, core needle biopsy, and surgical biopsy) and concluded that the choice among these methods should be based on available tools and expertise. Correlation of pathology, clinical, and imaging findings was emphasized. A 2005 BHGI panel reaffirmed these recommendations and additionally stratified diagnostic and pathology methods into four levels--basic, limited, enhanced, and maximal--from lowest to highest resources. The minimal requirements (basic level) include a history, clinical breast examination, tissue diagnosis, and medical record keeping. Fine-needle aspiration biopsy was recognized as the least expensive reliable method of tissue sampling, and the need for comparing its clinical usefulness with that of core needle biopsy in the limited-resource setting was emphasized. Increasing resources (limited level) may enable diagnostic breast imaging (ultrasound +/- mammography), use of tests to evaluate for metastases, limited image-guided sampling, and hormone receptor testing. With more resources (enhanced level), diagnostic mammography, bone scanning, and an onsite cytologist may be possible. Mass screening mammography is introduced at the maximal-resource level. At all levels, increasing breast cancer awareness, diagnosing breast cancer at an early stage, training individuals to perform and interpret breast biopsies, and collecting statistics about breast cancer, resources, and competing priorities may improve breast cancer outcomes in countries with limited resources. Expertise in pathology was reaffirmed to be a key requirement for ensuring reliable diagnostic findings. Several approaches were again proposed for improving breast pathology, including training pathologists, establishing pathology services in centralized facilities, and organizing international pathology services.

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Section: Findings and Recommendationsmentioning

confidence: 99%

Breast Cancer in Limited-Resource Countries: Diagnosis and Pathology

Shyyan¹,

et al. 2006

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“…The optimal management of breast cancer requires an interdisciplinary team composed of oncologists, radiologists, surgeons, and pathologists who determine a diagnosis and treatment plan by consensus (3). Correlation between the radiologist’s films and the pathologist’s review is crucial for an accurate diagnosis as well as for continuous quality improvement for each practitioner, particularly for the evaluation of nonpalpable lesions and microcalcifications (2,4,5).…”

Section: Introductionmentioning

confidence: 99%

Why Current Breast Pathology Practices Must Be Evaluated. A Susan G. Komen for the Cure White Paper: June 2006

Perkins¹,

Balma²,

Garcia³

2007

Breast Journal

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Ending breast cancer has long been the mission of Susan G. Komen for the Cure. To this end, the organization has a strong interest and proven track record in ensuring public investment in quality breast health and breast cancer care. Recently, Susan G. Komen for the Cure identified major issues in the practice of pathology that have a negative impact on the lives of thousands of breast cancer patients in the United States. These issues were identified through a comprehensive literature review and interviews conducted in 2005-2006 with experts in oncology, breast pathology, surgery, and radiology. The interviewees practiced in community, academic, and cooperative group settings. Komen for the Cure has identified four areas that have a direct impact on the quality of care breast cancer patients receive in the United States, the accuracy of breast pathology diagnostics, the effects of current health insurance, and reimbursement policies on patients who are evaluated for a possible breast cancer diagnosis, the substantial decrease in tissue banking participation, particularly during a time of rapid advances in biologically correlated clinical science and the role for the Susan G. Komen for the Cure, pathology professional societies and the Federal government in ensuring that breast pathology practices meet the highest possible standards in the United States Concerns surrounding the quality and practice of breast pathology are not limited to diagnostic accuracy. Other considerations include, training and proficiency of pathologists who are evaluating breast specimens, the lack of integration of pathologists in the clinical care team, inadequate compensation for the amount of work required to thoroughly analyze specimens, potential loss in translational research as a result of medical privacy regulations, and the lack of mandatory uniform pathology practice standards without any way to measure the degree of variation or to remedy it.

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“…14,[44][45][46] Building blocks for access to accurate diagnosis of breast lesions by a qualified pathologist require an international collaboration. 14,[44][45][46] Building blocks for access to accurate diagnosis of breast lesions by a qualified pathologist require an international collaboration.…”

Section: Discussionmentioning

confidence: 99%