Breast Cancer Pathology
Why the Roswell Park Doctor you Never Meet May Be the Most Important Person on Your Care Team
Breast cancer patients see many doctors during the course of their treatment, but rarely do they meet the specialist who plays a critical role in their outcome: the pathologist who diagnoses their cancer by analyzing samples of blood, tissue and body fluid. Precise diagnosis is what drives all subsequent decisions about treatment options and other patient choices.
Our pathologists are highly specialized and focus not just on cancer, but on breast cancer. They directly review all of the pathology slides from your biopsy (whether it was performed at Roswell Park or by an outside physician) and render an expert opinion on the key characteristics that will define your breast cancer treatment.
If you have breast cancer, pathologists will study the cancer cells from your biopsy to pinpoint the exact type and the grade of your cancer. This information tells our physicians how aggressive your cancer is; which treatments the cancer is likely to respond to; and the likelihood your cancer will recur.
These tests include:
- Estrogen and progesterone receptor test: Cancer cells that have an abnormal amount of estrogen or progesterone receptors (binding sites on the cells) mean that these hormones fuel the cancer cell growth.
- Human epidermal growth factor type 2 receptor (HER2/neu): This measures how many HER2/neu genes are in the cancer cell and how much HER2/neu protein is in the tissue sample.
- Multigene tests (such as the Oncotype DX): Looks at several genes in the tissue sample to determine whether you are at low, intermediate or high risk for having your cancer recur. If you’re at high risk, adding chemotherapy to your treatment plan may help lower that risk.
It takes years of training and a specific skill set to become an expert pathologist. After medical school, doctors complete a minimum of four years in a pathology training program and generally pursue additional training in a subspecialty.
Never before have pathologists been so critically important. Recent scientific developments have led to an explosion of information about markers and genomic analysis that helps to identify specific cancer types and pinpoint which one will be more aggressive or more likely to respond to a particular treatment than another type.
Second Look, World of Difference
Even if all you need is a second opinion from Roswell Park, we’re here for you! A second opinion is the best way to reassure you that your initial diagnosis of breast cancer is accurate and the recommended treatment strategy is right for you! Over a century, our specialists have successfully worked with community doctors, and are happy to discuss and share information, as needed. If you come to Roswell Park for a second opinion, you are under no obligation to receive care or treatment here.
Roswell Park pathologists reported that 10 percent of patients received a change in diagnosis after coming to RPCI from another care facility.
When Should You Seek a Second Opinion?
It’s always a good idea, but especially important if:
- Your physician or pathologist has not provided you with a full, clear explanation of your pathology report, in a language you understand.
- Your physician tells you that you don’t need a second opinion. A good doctor will suggest that you get another opinion if there are questions about your treatment or diagnosis. If your physician is offended, find a new doctor.
- Your physician wants you to have surgery tomorrow. Almost nothing in the world of cancer care requires that kind of immediacy, except patients with acute leukemia; cases in which a tumor is compressing a vital structure, such as the heart or large blood vessels; or certain other rare conditions.
If you’re still not sure whether to ask for a second opinion, ask yourself:
- Am I confident in the diagnosis or treatment options I’ve been given?
- Am I comfortable with my treating physician?
- Has my physician clearly explained all treatment options — not just the ones he or she prefers?
- Are there clinical research studies offering new treatments for my cancer?
- Was my cancer diagnosed at an office or community hospital setting or in a comprehensive cancer center?
- Does my insurance plan require a second opinion? If not, what type of coverage does it provide for second opinions?
Your Breast Cancer Pathology Report
You may have more than one pathology report. For example, one report will be prepared after your biopsy. Another may be prepared after testing tissue that was removed in surgical treatment. Key findings that may be detailed in your pathology report include:
- Breast cancer cell type: Refers to where the cancer cells began, such as ductal, lobular or nipple.
- Whether your cancer is invasive or noninvasive
- Whether your cancer tests positive or negative for:
- Estrogen receptors or progesterone receptors: Cancers that are positive for these receptors need these hormones to grow. Hormone therapy that blocks these hormones may help prevent your cancer from growing or recurring.
- HER2 protein: About 15 - 20 percent of breast cancers are HER2-positive which can mean the cancer cells have too many copies of the HER2 gene, the amount of HER2 protein is high or over-expressed, or the gene’s activity is high. These may cause the cancer cells to grow and divide quickly. If you cancer tests positive for this, treatments that target this protein (like trastuzumab and lapatinib) may stop your cancer from growing.
- Triple-negative: Cancers that are negative for estrogen receptors, progesterone receptors and HER2 are called triple negative.
- Node status: Refers to whether or not lymph nodes contain cancer.
- Cancer grade: A score of 1 to 3 refers to how different the cancer cells look from normal cells. A score of 1 is low grade and means the cells look most like normal cells to 3, high grade and cells appear very different from normal cells. In general, low-grade cancers are less aggressive, while moderate- to high-grade cancers suggest a need for genetic testing of the cancer cells.
Cancer treatments are becoming more and more targeted, so an accurate and comprehensive analysis by a pathologist is critical in determining the best approach. Learn more about how to read your pathology report.