Kimberly H. Allison, MD, is Director of Breast Pathology at the Stanford University School of Medicine in Stanford, CA. She’s the author of “Red Sunshine: A Story of Strength and Inspiration from a Doctor Who Survived Stage 3 Breast Cancer.” Follow her on Twitter: @DrKimAllison and @RedSunshineKim.
There’s a member of your health care team who plays a vital role in your diagnosis and cancer care who you may never meet face to face: the pathologist. A pathologist is a doctor who analyzes tissue samples removed during a biopsy or surgery in order to make a diagnosis.
I am a pathologist — and a cancer survivor. When I was diagnosed with cancer, I was terrified. There were so many unknowns and so much uncertainty to deal with. I was 33 years old and had just given birth to my second child. Suddenly, instead of wondering what to pack in my preschooler’s lunch before work, I was wondering how I’d survive to watch her graduate preschool the next year.
While I had no sense of security about my future, I considered myself incredibly lucky. Unlike many new cancer patients, I had the comfort of knowing a lot about my diagnosis and treatment plan. I’m a pathologist specializing in breast cancer diagnosis—and I’d been diagnosed with the very same disease. So the first thing I wanted to know was: “What exactly is the pathology?”
The key to personalized treatment
If you are diagnosed with cancer, understanding your pathology can help you understand your treatment options. Often, subtle differences in a cancer’s pathology can make big differences in what treatment options might be best.
The biology of my breast cancer was aggressive, so my treatment was more aggressive as well. One of the pathology tests performed on my biopsy sample found that it had increased levels of a protein called HER2. This meant that I was able to receive HER2-targeted therapy designed to treat my particular type of breast cancer. The entire 8-centimeter mass in my breast and in my lymph nodes melted away.
My cancer treatment worked because understanding the pathology of my cancer led my oncologist to choose the most effective treatments for my cancer.
Most patients will never meet the pathologists involved in their cancer care, yet these doctors play a critical role in determining how they will be treated. Although pathologists may not know a patient well, they do know their cancer well. And that knowledge becomes the centerpiece of a personalized cancer treatment plan.
3 ways to get to know your pathology
Get a copy of your pathology report. You can ask your oncologist or surgeon for this. Ask your doctor to go through the report with you and point out details that helped determine which treatments you’re being offered and your prognosis.
Sometimes, you may be able to look at the slides that the pathologist used to make the diagnosis. For me, it was therapeutic to look directly at my slides. I’ve also sat at the microscope with other people with breast cancer, explaining the different features of their cancer’s pathology. Often, these patients had specific topics that they wanted to review.
Ask how your treatment plan has been decided. It’s important to remember that cancer care is both an art and a science. Despite all the studies and clinical trials that have been performed, medicine is still full of gray areas, both in terms of which treatment options are the best as well as in some areas of how pathology is used to make a diagnosis.
So how do you know if your pathology is accurate? Ask your oncologist if there are any unusual features, borderline aspects, or specific details about the pathology that are making treatment decisions challenging. Ask your doctor if the pathologist making the diagnosis has a lot of experience with the type of cancer you have. A second opinion from a pathologist who specializes in your cancer type can help clarify the pathology and either confirm or recommend different treatment decisions.
A powerful tool in treatment decisions
Every cancer and every patient is different. What was the right treatment for 1 patient with cancer, even with the same type and stage as yours, may not be the right treatment for you. And people who undergo the same treatments for similar cancers can have very different outcomes.
While we can’t predict the outcomes 100% of the time, cancer treatment based on accurate pathology is helping more people live past their cancer than ever before. I owe my survival to these incredibly powerful tools. And it makes me all the more passionate about my job as a pathologist.